Postgraduate medical journal
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Randomized Controlled Trial Multicenter Study Clinical Trial
Investigation and management of iron deficiency anaemia in general practice: a cluster randomised controlled trial of a simple management prompt.
Iron deficiency anaemia (IDA) remains the most common cause of anaemia and is frequently secondary to occult gastrointestinal blood loss requiring further investigation. The study was designed to prospectively assess the adequacy of investigation of IDA and to establish whether a simple computerised prompt would increase the completeness of investigation of patients presenting to their general practitioners. ⋯ The investigation and management of IDA presenting in general practice remains inadequate and is not improved by a simple management prompt.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraoperative glove perforation--single versus double gloving in protection against skin contamination.
Surgeons have the highest risk of contact with patients' blood and body fluids, and breaches in gloving material may expose operating room staff to risk of infections. This prospective randomised study was done to assess the effectiveness of the practice of double gloving compared with single gloving in decreasing finger contamination during surgery. In 66 consecutive surgical procedures studied, preoperative skin abrasions were detected on the hands of 17.4% of the surgeons. ⋯ An overwhelming majority of glove perforations (83.3%) went unnoticed. Double gloving was accepted by the majority of surgeons, especially with repeated use. It is recommended that double gloves are used routinely in all surgical procedures in view of the significantly higher protection it provides.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intravenous and subcutaneous hydration in elderly acute stroke patients.
The aim of this study was to compare the effectiveness of subcutaneous and intravenous fluid therapy in hydrating, elderly acute stroke patients. Thirty-four such patients, needing parenteral fluids because of impaired consciousness or dysphagia, were randomly allocated to receive either subcutaneous or intravenous fluids (2 litres of dextrose-saline/24 hours). Serum osmolality was measured before starting fluid therapy (Day 1) and on Days 2 and 3. ⋯ The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route. Complication rates were similar for the two groups. The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route.
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Randomized Controlled Trial Clinical Trial
The effect of different nitrate preparations on plasma heparin concentrations and the activated partial thromboplastin time.
There is evidence that intravenous nitrates which are frequently used in acute coronary syndromes may interfere with the anticoagulant effect of heparin. We compared the effect of two different nitrate preparations on the activated partial thromboplastin time (APTT), anti-thrombin III activity (AT III) and plasma heparin levels in patients (n = 50) undergoing routine percutaneous transluminal coronary angioplasty (PTCA) for stable angina. Patients were randomized to either: (1) intravenous heparin and nitroglycerin (GTN); or (2) intravenous heparin and isosorbide dinitrate. ⋯ Within-group analysis showed significantly lower APTT ratio and heparin concentrations at 4 hours compared with the respective 2 hour values. These results would suggest that there is a potential impairment of anticoagulation with low-dose intravenous nitroglycerin and to a lesser extent with low-dose isosorbide dinitrate. Early and frequent monitoring may therefore be appropriate when intravenous nitrates and heparin are used in combination.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of methohexitone and propofol ('Diprivan') for induction of enflurane anaesthesia in outpatients.
In 73 unpremedicated patients scheduled for minor outpatient oral surgery or restorative dentistry, enflurane anaesthesia was induced either with an emulsion formulation of propofol (2.5 mg/kg) or with methohexitone (2 mg/kg). Sensations at the site of the injection were more common when the drugs were injected into a vein in the dorsum of the hand (58% for propofol and 28% for methohexitone) when compared to a vein in the forearm or antecubital area (7 to 8% with sensations). After induction of anaesthesia intravenous suxamethonium was given, and endotracheal intubation carried out. ⋯ The incidence of nausea or vomiting was similar (27 to 33%) in both groups. It is concluded that both propofol in emulsion form and methohexitone are satisfactory induction agents in outpatient dentistry. Propofol provided a smoother induction of anaesthesia and recovery was as rapid as after anaesthesia induced with methohexitone.