Journal of the Royal College of Physicians of London
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J R Coll Physicians Lond · Nov 1997
Randomized Controlled Trial Clinical TrialLocal anaesthetic infiltration prior to arterial puncture for blood gas analysis: a survey of current practice and a randomised double blind placebo controlled trial.
Infiltration with local anaesthetic (LA) is recommended before arterial puncture (AP) for blood gas analysis. A telephone survey of 100 junior hospital doctors established that 84% never used LA; the reason for this cited by 47% of doctors was that they considered the injection to be as painful as AP itself. We therefore undertook a randomised double blind placebo controlled trial to establish whether the recommendation for LA is justified. ⋯ This study supports the recommendation that LA should be infiltrated before radial artery puncture is performed. The belief that the use of LA makes the procedure more difficult and is as painful as arterial puncture should be dispelled.
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J R Coll Physicians Lond · Nov 1997
Randomized Controlled Trial Clinical TrialHypoxaemia and supplemental oxygen therapy in the first 24 hours after myocardial infarction: the role of pulse oximetry.
To assess the incidence and degree of hypoxaemia in patients with acute myocardial infarction and evaluate the nation-wide perception and usage of oxygen therapy. ⋯ Hypoxaemia occurs frequently in patients in the first 24 hours after acute myocardial infarction. It is effectively and easily treated with supplemental oxygen which can be guided by pulse oximetry. This is rarely done. Measurements of oxygen saturation are therefore justified in all patients to guide oxygen therapy unless there is a decision to give all patients supplemental oxygen: this we believe to be unnecessary.
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To use the Appropriateness Evaluation Protocol (AEP) to assess the extent of inappropriate utilisation of hospital beds by acute medical patients. To determine whether clinicians viewed the AEP decisions as valid. ⋯ The AEP is a valid and useful instrument for assessing the utilisation of acute medical beds in a NHS hospital. In this study acute medical admissions were largely appropriate at the time of admission but a substantial proportion of subsequent days of care was considered inappropriate by AEP criteria. Most inappropriate utilisation was due to organisational issues within the hospital. As a result of this study, several service and policy developments were identified that should improve the efficiency of bed utilisation at the hospital.
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J R Coll Physicians Lond · Sep 1997
The use of personal health information in the coroner's inquiry.
A pathologist appointed by the coroner may feel that his or her role is to review the medical notes, perform a post-mortem, examination and then interpret the findings in the light of clinical information and any other information received from the coroner, and include in the clinico-pathological summary a cause of death. We believe that such an approach is not in accordance with the legal position relating to coroners' inquests. The coroner has no automatic right to see the medical notes (and neither does the coroner's pathologist); where there is, or may be, dispute as to the circumstances leading to death, the proper way for information in the medical record to be presented at the coroner's inquest is for the maker of any note to give oral evidence. Where the cause of death requires interpretation of the clinical history or knowledge of any circumstantial evidence, a pathologist should refrain from giving a cause of death; such a task is for the court, having heard all the evidence-medical or not-relating to the death.
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Medical research workers are making increasing use of logistic regression analysis for binary and ordinal data. The purpose of this paper is to give a non-technical introduction to logistic regression models for ordinal response variables. ⋯ For illustrative purposes we apply these methods to real data of a study investigating the association between glycosylated haemoglobin and retinopathy. We give some recommendations for the use and assessment of ordinal logistic regression models in medical research.