What happens when the tasks dry up? Exploring the impact of medical technology on workforce planning.

Increasing evidence suggests that new technologies tend to substitute for low skilled labour and complement highly skilled labour. This paper considers the manner in which new technology impacts on two distinct groups of highly skilled health care labour, cardiologists and cardiac surgeons. We consider the diffusion impact of PCI as it replaces CABG in the treatment of cardiovascular disease in the English NHS, and explicitly estimate the degree to which the cardiac surgical workforce reacts to this newer technology. Using administrative data we trace the complementarity between CABG and PCI during the mature phase of technology adoption, mapped against an increasing employment of cardiologists as they replace cardiothoracic surgeons. Our findings show evidence of growing employment of cardiologists, as PCI is increasingly expanded to older and sicker patients. While in cardiothoracic surgery, surgeons compensate falling CABG rates in a manner consistent with undertaking replacement activity and redeployment. While for cardiologists this reflects the general findings in the literature, that new technology enhances rather than substitutes for skilled labour, for the surgeons the new technology leads to redeployment rather than a downsizing of their labour.

Perioperative anaphylactic reactions: Review and procedure protocol in paediatrics.

Perioperative anaphylactic reactions are immediate, hypersensitive reactions that are potentially life-threatening resulting from a sudden release of mediators from mast cells and basophiles, due to either immune (IgE or non-IgE mediated) or non-immune mechanisms. The most frequent causing agents are neuromuscular blocking agents (NMBAs), latex and antibiotics, with latex being the first cause in paediatrics. With regard to perioperative anaphylactic reactions, the usual early signs and symptoms of an anaphylactic reaction could be overlooked or erroneously interpreted and non-severe anaphylaxis could go undetected, with a risk of more severe reactions in the future. Using the data registered on the anaesthesia sheet, it is essential to establish a chronological relationship between drugs and/or substances administered and the reaction observed. An elevated level of tryptase confirms an anaphylactic reaction, but this does not usually increase in the absence of compromised circulation. An allergy study should be carried out preferably between 4 and 6 weeks after the reaction, using a combination of specific IgE, skin and controlled exposure tests (if indicated). Test sensitivity is good for NMBAs, latex, antibiotics, chlorhexidine, gelatine and povidone, and poor for barbiturates, opiates (these can give false positives since they are histamine releasers) and benzodiazepines. Special preventive measures should be taken, especially in the case of latex. We present the maximum concentrations recommended for skin tests, the recommended dosage to treat anaphylactic reactions in paediatrics and a procedure algorithm for the allergological study of these reactions.

Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Macrolide antibiotics in the treatment of asthma. An update.

It seems clear that certain macrolide antibiotics exert anti-inflammatory and immune modulating effects beyond their purely antibacterial action, as has been demonstrated in a number of bronchial inflammatory disorders such as diffuse panbronchiolitis. Randomised, controlled clinical trials involving larger patient samples are needed to confirm whether these actions are of clinical relevance in application to asthma. On the other hand, the macrolide antibiotics have a long half-life, with a prolonged elimination interval, which appears to favour the development of resistances that persist over the long term, as in the case of azithromycin. Would the risk/benefit ratio of sustained low-dose macrolide use be justified, considering the risk of selecting resistant strains? A number of questions must be answered before these drugs can be recommended in application to asthmatic patients: In which patients should they be used? Which drug or drugs would be most appropriate? What would the recommended dose be, and for how long should treatment be administered? What adverse effects can be expected?

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail.

AIM: Our objective was to compare the results of PCCP (Percutaneous Compression Plate) device and Gamma 3 nail for the treatment of stable trochanteric hip fractures and to demonstrate that PCCP device is a minimally invasive system. METHOD: Prospective, randomized trial. Eighty patients aged 60 and over with stable trochanteric fracture were selected and then randomized using a table of randomized numbers. Length of time of operative procedure, hemoglobin levels at 6 and 48 h after surgery, packed cells units administered, and hospital stay were recorded. In addition, the postoperative complications in the first year after the surgery was collected. RESULTS: No differences were found in hospital stay, surgical time, blood loss, functional outcome at 1-year follow-up, neck-shaft angle, fracture collapse, and mortality. CONCLUSIONS: PCCP and Gamma 3 have not presented significant differences in any measured parameter for treatment of stable trochanteric fractures. Therefore, the PCCP system is shown to be as minimally invasive as the Gamma 3.

Effects of gabapentin on the motor response to levodopa: a double-blind, placebo-controlled, crossover study in patients with complicated Parkinson disease.

BACKGROUND: Motor fluctuations and dyskinesias affect many parkinsonian patients chronically treated with levodopa. Imbalance between gabaergic direct and indirect striatopallidal pathways may originate them. Manipulating GABA neurotransmission may be effective in the treatment of these patients. Gabapentin is an antiepileptic drug that increases the synthesis and release of GABA. Previous studies suggest that gabapentin may be useful in Parkinson disease (PD). OBJECTIVE: To know the effects of gabapentin on the motor response to levodopa in PD patients with motor complications. DESIGN: A randomized double-blind, placebo-controlled, cross-over trial with four weeks of treatment. SETTING: A tertiary referral center. PARTICIPANTS: Twenty subjects with PD and motor fluctuations and dyskinesias on stable antiparkinsonian treatment, took gabapentin up to a maximum dose of 2.400 mg/d in three doses and placebo. METHODS: Three levodopa challenges were performed: at the beginning of the study and at the end of each period of treatment (4 weeks). Basal (off) and best (on) motor status were assessed by the UPDRS III. Latency to peak effect, magnitude of motor response (difference between "on" and "off" scores in the UPDRS III), duration of motor response and severity and duration of dyskinesias after each levodopa challenge were assessed. Patients' diaries were administered. RESULTS: : Fifteen patients completed the study. A significant improvement in the basal UPDRS III resulting in a significant reduction in the magnitude of the motor response after gabapentin was obtained (P < 0.001). No other changes were observed, either on pharmacological parameters or in levodopa-induced dyskinesias. Number of daily hours spent in "on," "on with dyskinesias" and "off" also remained unchanged. Tolerance was good, dizziness being the most common side effect. CONCLUSION: Gabapentin improved parkinsonian symptoms (basal UPDRS III and magnitude of the motor response) following levodopa. This improvement was not reflected in the daily motor situation of patients. Dyskinesias remained unchanged. Gabapentin was well tolerated. Further studies are needed to know the impact of these results in the long-term.

[Peak expiratory flow rate in 4- to 15-year-old children. Comparison of 3 measuring models]. / Pico de flujo espiratorio en escolares de 4 a 15 años de edad. Comparación de tres modelos de medidor.

OBJECTIVE: a) To establish the possible differences between three different models of PEF-meter, including PF-Control for the first time; b) to build a normogram for each of the three models, as a function of different variables (age, height, and inspiratory and espiratory thoracic circumference); c) to search for differences between both sexes, and d) to study the mathematical correlation between the results yielded by the different models. METHODS: PEF was measured in a sample of 476 school-children, in the range of 4 and 15 years (233 boys, 243 girls), with a mean age of 9,3 years and a height range between 96,8 cm and 178,8 cm (mean 137,9). PEF value was recorded as the best of three attempts when the difference them was less than 10%. Three devices of each model were used (Vitalograph, Mini-Wright, PF-Control). The utilisation was always done in a rotatory fashion at school time (15-17 hours) in the children's school. RESULTS: We found significant differences between the three models (p < 0,0004). The best predictive variable for PEF is height, with an r = 0,90-0,92 (depending on the model) when the exponential model is considered. Independently of the device, there were significant differences between sexes. CONCLUSIONS: a) The variable that expresses PEF the better is height; b) PEF values are different between girls and boys; c) there were significant differences between the various models; d) Monitoring of a given child must be done with the same model of PEF-meter, and e) The best correlation is obtained with the exponential model, although differences with the lineal model were not statistically significant.

Breast cancer screening of the high risk population with clinical examination and thermography. A combination of telethermography and plate thermography.

On a total of 2523 patients, including the High Risk group, a breast screening was made by clinical exploration and Thermography used as a selective method for the cases due for a Mammography. Although the electronic thermographic examination was done according to the criteria established by the School of Marseilles, we excluded from these criteria the vascular asymmetry test. Such a controversial parameter was substituted by the data given by the angiographic analysis of contact thermography. The results obtained were compared to those referenced in a previous study. The analysis of the compiled data indicated that even if we weren 't the sensitivity of the technique, we did get improvements diagnosing less false positive results with the new procedure (91.43%) than with the previous study (87.65%) (p less than 0.001). The predictive Value (+) was 0.4133 in the present group against the previous 0.10, which meant that 41.33% of the cancers diagnosed were true cancers, against 10% in the previous group. Summing up the analysis showed a higher rate of positive global detections (p less than 0,0005) with our present analytic criteria for Thermography.

Crecimiento de los huesos largos y de los nucleos de osificacion del feto. / Development of the large bones and of the ossification nucleus of fetus

En 268 embarazos de entre 11 y 32 semanas, usando ultrasonidos, se estudio la longitud del femur, humero y los complejos cubito-radio y tibia y perone, como asi tambien los nucleos de osificacion distales del femur y proximales de la tibia. Las curvas de regresion obtenidas mostraron una clara correlacion estadistica con la edad gestacion. Se comparan nuestros resultados con casos de abortos tardios y partos prematuros. Como el nuevo material muestra la aparicion de nucleos de osificacion distal del femur a las 33 semanas y proximal de la tibia a las 37 semanas, se muestran las curvas de crecimiento