Sedation of children in the emergency department for short painful procedures compared with theatre, how much does it save? Economic evaluation.

INTRODUCTION: Sedation of children for short painful procedures is increasingly performed in emergency departments as an alternative to hospital admission and theatre. In this study, the savings of this are sought to be quantified. METHODS: A matched-cohort economic evaluation was conducted. Detailed case note reviews were performed on children who were sedated in the emergency department and children who were admitted to theatre. The costs of these were compared. RESULTS: 17 children underwent sedation in our emergency department and were compared with 20 children admitted to theatre. Each emergency department sedation saved £614 (95% CI £441 to £787), and this result was statistically significant (p<0.0001). CONCLUSION: Emergency department sedation offers considerable savings, compared with theatre-based management for children who require short painful procedures.

A comparison of the effects of buspirone and diazepam on plasma corticosterone levels in rat.

The effect of the anxiolytic agents, buspirone and diazepam, on the hypothalamic-pituitary-adrenal axis (HPAA), indicated by changes in the concentration of corticosterone (CS) in plasma, were studied 1/2, 1, 2, 4, 6, 8 and 24 hr after administration of the drug (i.p.). Samples of plasma were collected in the mid-morning (0930-1130 hr) when activity in the hypothalamic-pituitary-adrenal axis in the rat and control levels of corticosterone were low and were repeated in the afternoon (1400-1600 hr) when activity in the hypothalamic-pituitary-arenal axis and levels of corticosterone were higher. At small doses (1 mg/kg) buspirone had a greater facilitating effect on the hypothalamic-pituitary-adrenal axis than did diazepam. In addition, buspirone had a greater maximum facilitatory effect (477%) on levels of corticosterone than diazepam (345%). However, buspirone (ED50 = 8.6 mumol/kg) and diazepam (ED50 = 8.7 mumol/kg) were equipotent. Administration of 1 mg/kg of buspirone in the morning increased the combined 1/2 and 1 hr circulating levels of corticosterone 75% above control levels. Diazepam, at 1 mg/kg, did not produce any significant changes in levels of corticosterone. Large doses (10 mg/kg) of buspirone increased morning levels of corticosterone by 328% and diazepam increased levels of corticosterone by 265%. During the afternoon small doses of buspirone or diazepam did not significantly alter levels of corticosterone.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of gepirone and 1-(2-pyrimidinyl)-piperazine on levels of corticosterone in rat plasma.

It was found that gepirone and 1-(2-pyrimidinyl)-piperazine (1-PP) increased levels of corticosterone in plasma in the intact rat. Gepirone was more potent and more efficacious than its metabolite, 1-PP. The ED50 was 6.4 mumol/kg for gepirone and 65.4 mumol/kg for 1-PP. Forty-five min after intraperitoneal administration, gepirone and 1-PP produced maximum increases in corticosterone of 283% and 211%, respectively, above control values. The amplitude and duration of the effects of the drugs were dependent on the ongoing activity in the hypothalamic-pituitary-adrenal axis. Consequently, the greatest absolute increases in corticosterone were produced during the afternoon when the activity in the hypothalamic-pituitary-adrenal axis was greatest. A single 10 mg/kg dose of gepirone significantly elevated levels of corticosterone in plasma (313% after 1 hr) above control values for 2 hr during afternoon trials and for 1 hr (244%) during morning trials. In addition, it was found that the effects of the administration of gepirone and of stress on the levels of corticosterone in plasma were additive. In the light of other work on the hypothalamic-pituitary-adrenal axis, these results suggest that the increased levels of corticosterone, elicited by gepirone, were mediated through a serotonergic action rather than through noradrenergic activity.

Constancy of subjective assessments and the stability of treatment preferences in team decision making.

Subjective probabilities and values were assessed with 34 subjects representing different medical specialties, in the context of a team decision-making problem as part of a single case study presentation. Treatment preferences were also assessed prior to and following the decision analysis, and as calculated by the expected values of the treatment options. The results indicated that subjective value assessments were relatively constant and uniformly held among participants, but that probability assessments varied widely. In this particular clinical application, rather than reconciling differences, the probability assessments of the specialists representing a particular modality are generally used, and the team decision analysis represents a composite of differently held assessments. The study also showed that participants were likely to change their treatment preferences after going through the formal decision analysis. This may reflect the use of speech tapes to communicate treatment outcomes or that the process itself had a bearing on the respondents' own treatment preferences.

Evaluation of speech after correction of rhinophonia with pushback palatoplasty combined with pharyngeal flap.

A comparison is made of the preoperative and postoperative speech evaluations of 15 selected subjects who had pharyngeal flap operations combined with palatal pushback. Postoperatively, 13 of the 15 patients (86 percent) showed no abnormal nasal emission and no evidence of significant hypernasality during word production. Gross substitution errors were also corrected by the surgical repair. While the number of patients is small, this study indicates equal effectiveness of the surgical technique described--regardless of the sex, the medical diagnosis, whether the procedure was primary or secondary, or the amount of postoperative time--providing there is good function of the muscles of the soft palate.

Effects of vascular surgery on the elderly vascular patient.

The majority of vascular patients are elderly and present a unique set of problems after an operation. Age plays a major role in their recovery, but the greatest challenge is their preexisting medical problems. The changes that occur with aging in the following body systems will be discussed: cardiac, pulmonary, renal, gastrointestinal, genitourinary, and central nervous system. Special concerns related to pain management, risk of delirium, and wound healing present continuing nursing challenges that require close observation after surgery.

The management of chronic venous disease.

Chronic venous disease represents a spectrum of problems ranging from the merely cosmetic to disabling venous ulcers. Chronic venous insufficiency can result in disfigurement, disability, and a financial burden on the patient and society. Delivery of optimal care of patients with venous disease requires a thorough understanding of this complex system and of current methods of diagnosis and treatment. Successful outcome of treatment depends on appropriate patient selection, meticulous surgery, outstanding nursing care, and patient education.

A randomized clinical trial to compare three methods of orthodontic space closure.

AIM: To compare the rates of orthodontic space closure for: Active ligatures, polyurethane powerchain (Rocky Mountain Orthodontics, RMO Europe, Parc d'Innovation, Rue Geiler de Kaysersberg, 67400 Illkirch-Graffenstaden, Strasbourg, France) and nickel titanium springs. SAMPLE: Patients entering the space closure phase of fixed orthodontic treatment attending six orthodontic providers. Twelve patients received active ligatures (48 quadrants), 10 patients received powerchain (40 quadrants) and 11 patients, nickel-titanium springs (44 quadrants). METHOD: Patients were randomly allocated for treatment with active ligatures, powerchain or nickel titanium springs. Upper and lower study models were collected at the start of space closure (T(o)) and 4 months later (T(1)). We recorded whether the patient wore Class II or Class III elastics. Space present in all four quadrants was measured, by a calibrated examiner, using Vernier callipers at T(o) and T(1.) The rate of space closure, in millimetres per month (4 weeks) and a 4-monthly rate, was then calculated. Examiner reliability was assessed at least 2 weeks later. RESULTS: Mean rates of space closure were 0.35 mm/month for active ligatures, 0.58 mm/month for powerchain, and 0.81 mm/month for NiTi springs. No statistically significant differences were found between any methods with the exception of NiTi springs showing more rapid space closure than active ligatures (P < 0.05). There was no effect of inter-arch elastics on rate of space closure. CONCLUSIONS: NiTi springs gave the most rapid rate of space closure and may be considered the treatment of choice. However, powerchain provides a cheaper treatment option that is as effective. The use of inter-arch elastics does not appear to influence rate of space closure.