Descriptive assessment of adverse events associated with midazolam-etomidate versus saline-etomidate in healthy hydromorphone premedicated dogs.

OBJECTIVES: To determine the frequency, severity and duration of adverse events including myoclonus, pain on injection, hypersalivation, regurgitation and apnoea after administration of midazolam or saline followed by etomidate in hydromorphone premedicated dogs. MATERIALS AND METHODS: Dogs undergoing elective dental prophylaxis or soft tissue surgeries were enrolled in this randomised trial. Dogs were premedicated with hydromorphone 0.1 mg/kg IV. Sixty seconds later, midazolam 0.3 mg/kg or saline at an equivalent volume was administered IV. Sixty seconds after that, etomidate 1.5 mg/kg IV was administered over 60 seconds. Additional doses of 0.5 mg/kg etomidate were administered until endotracheal intubation was successful. Observers were blinded to the treatment. Frequency, duration and a severity score of 0 to 3 were recorded for myoclonus, pain on injection, hypersalivation and regurgitation. Duration of apnoea and frequency of any additional complications was recorded. RESULTS: Forty variable breed healthy dogs were enrolled in the study. Myoclonus, pain on injection, regurgitation, hypersalivation, gagging, tachypnoea and pigmenturia occurred, respectively, in 10%, 40%, 0%, 15%, 35%, 25% and 5% of dogs in the saline group and 0%, 65%, 0%, 10%, 45%, 15% and 5% of dogs in the midazolam group. Apnoea occurred for 115 seconds (range 0 to 660 seconds) and 160 seconds (range 0 to 600 seconds) in the saline and midazolam groups, respectively. Two dogs developed pigmenturia. The trial was stopped early due to the occurrence of pigmenturia. CLINICAL SIGNIFICANCE: Due to early stopping of the trial, the predefined sample size was not reached. Further investigation is needed to determine if midazolam reduced the incidence of adverse events or improved the induction quality when combined with hydromorphone and etomidate.

Hispanic ethnicity, race and blood donation in the United States.

The aim of this study was to assess the hypothesis that blood donation rates vary with Hispanic ethnicity (family origin in Spanish-speaking countries) in addition to race in the United States. Lower blood donation rates have been reported among African Americans (AAs) compared with non-Hispanic European Americans (EAs). Adequate published reports on donation rates are not available for Hispanic Americans (HAs). Using data from a 2002 national survey, which included 4923 men and 7600 women aged 15-44 years with complete data, we tested the hypothesis using weighted bivariate and multivariate statistics. Among men aged 25-44 years, the percentage [95% confidence limits (95% CL)] with a history of blood donation since 1985 was similar at ages 25-34 years (46%, 42-49) and 35-44 years (41%, 37-45). It was highest in non-Hispanic EA (49%, 45-52%), intermediate in AA (35%, 30-40%) and lowest in HA (30%, 25-36%) (P < 0.001). Other variables significantly (P < 0.01) associated with history of blood donation in bivariate analyses were nativity (United States/other), education (<12/>or=12 years), poverty (<200%/>or=200% poverty limit) and married (yes/no). Variables that are not significantly associated were age, metropolitan residence (yes/no), receipt of public assistance (yes/no), current labour-force participation (yes/no) and religion raised. Compared with non-Hispanic EA, the adjusted odds ratios were essentially the same for Hispanics 0.66 (95% CL 0.47-0.92) and AAs 0.64 (95% CL 0.49-0.84). Only 34% of women had donated blood, but the association with race/ethnicity was similar. Similar patterns were also seen at ages 15-24 years. HAs and AAs have similar low blood donation rates compared with non-Hispanic EAs. The difference is not explained by sociodemographic variables.

Gag rules.

When two parties enter into a business contract, they usually share an unspoken "gentlemen's agreement" that neither one will start bad-mouthing the other. But in the often shaky relationships between managed care plans and physicians, what was once assumed has increasingly become codified. Just a few years ago, little one- or two-sentence clauses began popping up in physicians' contracts with managed care plans around the country, which managed care plans call confidentiality clauses. The house of medicine calls them gag rules and says they are just another strong-armed tactic to stifle physicians' abilities to act as patient advocates.

Slam-dunked. New law forces insurance carriers to reduce rates.

No one saw it coming. Not consumer groups, not business or special interest groups, and especially not insurance carriers. The Texas Legislature did something this session no legislature had ever done, experts say. It ordered insurance carriers to cut premiums in practically all insurance lines, and for physicians, this will mean a 10% reduction in medical professional liability premiums effective January 1, 1996. Hospitals will see a 13% cut.

A rapid method for assessment of a macrophage chemotactant produced by SaD2 fibrosarcoma cells in vitro.

A new rapid method for assessing murine macrophage chemotaxis was developed using peritoneal exudate cells labeled with [5,6-3H]uridine in modified Boyden chambers with double polycarbonate filters. The method gave positive results with endotoxin-treated mouse serum and with serum-free culture supernatant of the DBA/2 SaD2 fibrosarcoma. These results correlated with results obtained with conventional microscopic assessment of chemotaxis. Using this method, the SaD2 supernatant was shown to be chemotactic rather than chemokinetic.