Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists.

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.

Allergic responses induced by goat milk αS1-casein in a murine model of gastrointestinal atopy.

Up to 3% of young children develop milk allergy and this may influence the development of immune-mediated diseases in later life. One protein that has been associated with allergic reactions to ruminant milk is α(S1)-casein (CN). Studies suggest that goat milk with low levels of α(S1)-CN may reduce allergenicity of milk, but the dose response to α(S1)-CN has not been confirmed. In this study, we examined the immune response to varying levels of goat α(S1)-CN in a mouse model of gastrointestinal allergy. BALB/c mice (aged 5 wk) were given intraperitoneal injections with α(S1)-CN and aluminum as adjuvant at 1 and 3 wk to sensitize mice to the antigen. In wk 5, groups of fasting mice (n=8/group) were challenged 4 times on alternate days by intragastric gavage with saline or 2, 10, or 20mg of α(S1)-CN. Serum levels of specific IgE, IgG(1), and IgG(2a) antibodies and mouse mast cell protease-I were determined. Interleukin-4, IL-10, and IFN-γ responses to 48-h activation with antigen were measured in cultured splenocytes. We determined that mice sensitized with α(S1)-CN had higher titers of specific IgG(1) and IgE antibodies compared with controls; however, groups challenged with differing doses of α(S1)-CN did not differ. The group challenged with the highest dose of α(S1)-CN had a 10-fold increase in mouse mast cell protease-I compared with the group challenged with saline. Both IL-4 and IL-10 were produced in a dose-dependent manner by cultured splenocytes incubated with α(S1)-CN. Overall, α(S1)-CN stimulated the production of cytokines associated with allergic disease in a dose-dependent manner. Thus, milk with lower levels of α(S1)-CN should contribute to a lesser antigenic burden.

A simulation-based evaluation of two proposed alternatives to Luer devices for use in neuraxial anaesthesia.

The National Patient Safety Agency has issued a Patient Safety Alert with the aim of eliminating Luer connectors from equipment for lumbar puncture and subarachnoid injections by 1 April 2011, and from all neuraxial and regional anaesthesia equipment in 2013. B-link (UK) Ltd and InterVene Ltd have produced non-Luer connectors for neuraxial devices: the Neurax and Spinalok respectively. Using an adult spinal simulator, 59 experienced clinicians performed neuraxial procedures using these devices and reported on specific performance characteristics and overall usability. Cross-connectivity between non-Luer and Luer connectors was also examined. The median (IQR [range]) overall assessment scores (0-10 scale) of usability for the standard, Neurax and Spinalok systems were 8 (8-9 [7-10]), 6 (5-7 [0-8]) and 7 (6-8 [1-9]) for spinal procedures and 8 (8-9 [6-10]), 7 (5-8 [1-9]) and 4 (3-6 [0-9]) for epidural procedures, respectively. Both study systems scored significantly lower than standard equipment for overall performance of spinal and epidural procedures, although the performance of non-Luer devices was mostly rated 'adequate' or better. Both non-Luer connectors could cross-connect with one or more Luer connectors. Following feedback to the manufacturers, both systems have been modified and cross-connectivity apparently has been eliminated. Our results indicate that clinicians may not find non-Luer devices immediately 'user-friendly'. More importantly, some cross-connectivity with Luer devices was possible. Our findings illustrate that introducing equipment that is fully compliant with the National Patient Safety Agency alert poses a significant challenge to manufacturers and clinicians. We conclude that before introducing any non-Luer device into widespread use, independent, formal evaluation should be carried out.

A comparison of the Glidescope and Karl Storz DCI videolaryngoscopes in a paediatric manikin.

A new paediatric Glidescope (Cobalt GVL Stat) has recently become available. This varies in design from the Karl Storz DCI videolaryngoscope, as it possesses a short curved disposable blade compared with the narrower straighter blade of the Storz. We compared the time taken for tracheal intubation under normal and difficult intubation conditions in a paediatric manikin. A total of 32 anaesthetists completed four intubations in a random order, with each participant blinded to the airway condition. We hypothesised there would be no difference between the devices. The results showed no difference in tracheal intubation time between the Glidescope and the Storz videolaryngoscope. The mean (SD) times under normal conditions were 18.8 (5.2) s vs 19.9 (6.1) s, (p = 0.16), respectively. Under difficult conditions the times were 22.6 (10.5) vs 27.0 (14.2) s, (p = 0.13), respectively. There were no differences in the visual analogue scores for field of view, ease of use, willingness to use in an emergency, and overall satisfaction.

Influence of knowledge and religiousness on attitudes toward organ donation.

There remains a great need for organ donation. Each year thousands of individuals wait for organs to be donated for transplantation. In this study, the Organ Donation Attitude Survey (ODAS) was developed. One hundred ninety undergraduate students (114 women with a mean age of 20.0 and 76 men with a mean age of 20.5 years) enrolled in general education classes at a small midwestern university participated. The present study determined that ODAS is a reliable and valid instrument to assess attitudes regarding organ donation. The data were analyzed by stepwise regression to determine which variables were related to attitudes regarding organ donation. The results indicated the impact of four variables: education regarding organ donation, knowledge of someone who had donated an organ after death, awareness of anyone who received a donated organ, and religious beliefs. These significant variables in the regression analysis explained 24.95% of the ODAS total score variability. The most important results of the present study indicated that the ODAS was psychometrically valid and it could be used to evaluate attitudes regarding organ donation.

Facilitation of internal locus of control in adolescent alcoholics through a brief biofeedback-assisted autogenic relaxation training procedure.

The purpose of the study was to determine if autogenic relaxation training facilitated through biofeedback promotes an increase in internal levels of locus of control. The participants were residents of two Southwest Missouri alcohol treatment centers and ranged in age from 18 to 21 years. Treatment and control groups were compared on their responses on the Drinking Related Locus of Control Scale (DRIE) and fingertip temperature pre- and posttraining. The training was effective in teaching autogenic relaxation as demonstrated by increased fingertip temperature for the treatment group posttraining, while no differences were observed for the control group. Most importantly, the treatment group was not only significantly more internal in their locus of control after training but were also significantly more internal than the control group posttraining. Given that alcoholics are significantly more external in their locus of control than nonalcoholics, and that an internal locus of control implies an individual's belief that he or she has control and is responsible for his or her behavior, autogenic relaxation facilitated through biofeedback may be a very important component in therapeutic intervention for adolescent alcoholics.

Early identification and remediation of phonological-processing deficits in first-grade children at risk for reading disabilities.

The present study assessed 486 first-quarter first graders on their reading and phonological-processing skills and intelligence. Based on this assessment, and using the classification data from Hurford et al.'s (1993) study, 99 children were identified as being at risk for reading difficulties: 53 children at risk for reading disabilities (RD) and 46 children at risk for becoming "garden-variety" poor readers (GV). Half of the RD and GV groups received the phonological-processing intervention. Posttraining assessment indicated that the training procedure not only was effective in increasing the phonological-processing skills of the trained participants, but also increased their reading ability. Both of the RD and GV trained groups benefited from the training. Analyses also indicated that the initial screening device was somewhat less accurate in the present study in identifying at-risk children than in our previous studies (85% vs. approximately 98%, respectively). The results of the present study indicate that it is possible to identify children at risk for reading difficulties and to significantly improve their phonological-processing and reading abilities.

Early identification of children at risk for reading disabilities.

The present study examined the development of phonological and reading skills in 171 students (98 males, 73 females) from the beginning of first grade (Time 1) to the end of second grade (Time 4). Based on their reading and intelligence scores at the end of second grade, these students were placed into nondisabled (ND), reading disabled (RD), or garden-variety poor reading (GV) groups. Although each group made gains in phonological processing, large differences were found between the ND and RD/GV groups. The RD and GV groups performed similarly on many of the tasks. Consistent with the literature, it was found that intelligence does not differentiate between good and poor readers. The most important finding of the present study was that reader-group membership at Time 4 could be very accurately determined from students' Time 1 scores. All of the children in the RD and GV groups were correctly identified, and only 3 of the 148 ND children were misclassified, indicating that children at risk for reading difficulties can be very accurately identified very early in their academic experiences.

An examination of phonemic processing abilities in children during their first-grade year.

The present study examined the development of reading and phonological processing abilities of 209 first graders (118 males, 91 females; mean age = 86.7 months) assessed during the first and last quarters of their first-grade year. The children were arranged into three different groups based on their Time 2 reading and intelligence data (children with and without reading disabilities, and "garden-variety" poor readers). Analyses indicated that the children with reading disabilities and the garden-variety poor readers did not differ significantly on many of the tasks, but both performed differently than the children without reading disabilities. Developmental analyses indicated that all three groups increased their reading and phonological skills; however, the gap between the performance of the children without reading disabilities and the other two groups widened from Time 1 to Time 2. The most important finding of the present study concerned the classification results of the discriminant analysis, which correctly identified the group membership of 207 of the 209 children (99.04% correct).

Training phonemic segmentation ability with a phonemic discrimination intervention in second- and third-grade children with reading disabilities.

The present study examined the possibility that phonemic discrimination training could improve the phonemic segmentation ability of children with reading disabilities. Half of the 32 children with reading disabilities (14 male and 4 female second graders and 10 male and 4 female third graders, with mean ages of 99.2 and 109.7 months, respectively) deficient in phonemic segmentation skills were assigned to the training group, while the other half acted as a nontrained control group. The trained children were successful at significantly improving their performance on the phonemic segmentation task. The control group made no improvement. Requiring children with reading disabilities to make discriminations concerning phonemic information may have helped them discover properties of the phoneme that they previously did not know.

The effect of varying alveolar carbon dioxide levels on free recall.

A recent study suggested that students who have increased minute ventilation receive poorer grades. The present study was interested in determining the role alveolar carbon dioxide (CO2) levels play with cognitive abilities. A free recall task was used to examine list learning under two conditions of alveolar CO2 level: normal and decreased. The results suggested that decreased alveolar CO2 level affect the participant's ability to rehearse and recall information. It was concluded that conditions that reduce alveolar CO2 levels, such as hyperventilation resulting from stress, nervousness, or inappropriate breathing habits, can lead to poorer learning. If these conditions produce a habitual breathing pattern, the academic performance of the individual may suffer.

Ice cream butterfat content by volume as a possible predictor of taste preference.

71 males and 75 females ranging in age from 18 to 61 yr. (M age 20 yr.) ranked three brands of vanilla ice cream for taste preference. The expectation that butterfat content by volume (rather than by weight) would predict taste preference was confirmed in this exploratory study.

Septicaemia in a granulocytopenic patient caused by Corynebacterium striatum.

A 64 year old woman with metastatic endometrial carcinoma was admitted to the hospital after three grand mal seizures. Blood cultures yielded Corynebacterium striatum. The patient responded to parenteral ampicillin therapy. This is believed to be the first case of sepsis caused by this organism.