Journal of the Royal Society of Medicine
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Details of 235 consecutive trauma patients brought to the Washington Hospital Trauma Center with intravenous infusions in situ were entered into the study. The volume of intravenous fluid administered prior to arrival at hospital and the time over which it was given (the infusion time) was recorded. The initial systolic blood pressure (SBP) on scene and the SBP on arrival at hospital were documented. ⋯ Of non-trapped patients 98% had infusion times of less than 30 min. Trapped or hypotensive patients were not given significantly more fluid than those who were not trapped or had SBPs of over 100 mm Hg. Because of the uncertain benefits and potential complications of this procedure, intravenous cannulation and fluid replacement may not be appropriate where expected prehospital time is likely to be less than 30 min.
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Many studies of acupuncture treatment are seriously flawed by methodological problems. Poor design, inadequate measures and statistical analysis, lack of follow-up data and sub-standard treatment are all too common. ⋯ While a number of different solutions have been proposed there is, as yet, no agreed way of assessing the adequacy of control conditions or of deciding which placebo to use in a particular trial. We propose that assessing the credibility of treatments and control conditions may provide a way forward to a more rigorous, consensus approach.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia following total hip replacement: a comparison of intrathecal morphine and diamorphine.
Sixty patients undergoing elective total hip replacement under spinal anaesthesia were randomly assigned to receive either intrathecal (IT) diamorphine 0.75 mg (n = 30) or IT morphine 1.0 mg (n = 30). Postoperative pain scores, analgesic requirements and side effects were assessed by a blinded observer. Postoperative pain scores were broadly similar and satisfactory for both groups but the amount of additional IV morphine required to achieve this was significantly reduced in the morphine compared with the diamorphine group (P < 0.05). ⋯ There were no differences between the groups in the incidence of side effects such as emesis and pruritus. No significant postoperative respiratory depression was noted. In the doses used intrathecal morphine provided superior postoperative analgesia to that of intrathecal diamorphine.
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As increasing numbers of recipients of renal allografts survive long term, complications of prolonged immunosuppression have become apparent. Of particular concern are the high rates of non-melanoma skin cancer (NMSC) and carcinoma of the cervix, vulva and perineum.