Key actors in behavioral health services availability and accessibility research: a scoping review bibliometric analysis.

This bibliometric review aims to identify key actors in the behavioral health services availability/accessibility literature. Coalescing information about these actors could support subsequent research efforts to improve the availability and accessibility of behavioral health services. The authors used a scoping review method and a bibliometric approach. The articles came from Medline, Embase, Web of Science, CINAHL, and PsycINFO. Articles were included if they assessed behavioral health service availability or accessibility quantitatively and were written in English. The final sample included 265 articles. Bibliometric data were extracted, coded, and verified. The authors analyzed the data using univariate and social network analyses. Publishing in this area has become more consistent and has grown since 2002. Psychiatric Services and Graduate Theses were the most frequently used publication venues. The National Institute on Drug Abuse, National Institute of Mental Health, and the Veterans Administration funded the most research. The most frequently used keyword was "health services accessibility." The findings suggest that this literature is growing. There are a few clusters of researchers in this area. Government organizations primarily fund this research. The paper and supplementary materials list the top researchers, publication venues, funding sources, and key terms to promote further behavioral health availability/accessibility research.

Regional anaesthesia for repeat Caesarean section in a patient with phantom limb pain.

The triggering of phantom limb pain by subarachnoid or epidural anaesthesia has been well described leading to the suggestion that neuraxial regional anaesthesia is relatively contraindicated in lower limb amputees. We report our experience of the provision of anaesthesia for repeat Caesarean section on two occasions in such a patient. Intrathecal fentanyl and morphine supplementation of bupivacaine successfully abolished peri-operative phantom limb pain, whereas epidural anaesthesia was associated with recurrence of phantom limb pain upon regression of the block.

Withdrawal forces during removal of lumbar extradural catheters.

After performing successful continuous lumbar extradural conduction block, we investigated the effects of the extradural insertion technique (midline (M) or paramedian (P)) and patient position during extradural catheter removal (flexed lateral (L) or sitting (S)) on the force required to remove extradural catheters. One hundred parturients were allocated randomly to four groups: ML, MS, PL, PS. The results indicated that neither the midline nor paramedian approach affected withdrawal forces. However, more than 2.5 times as much force was required to remove the catheters when patients were in the flexed sitting compared with the lateral position (P < 0.005). For ease of removal of catheters from the lumbar extradural space we therefore strongly recommend the flexed lateral position.

Comparison of the force required for dural puncture with different spinal needles and subsequent leakage of cerebrospinal fluid.

An in vitro model was used to determine the force required to pierce bovine dura with a range of new spinal needles and to measure the subsequent leakage rate of cerebrospinal fluid (CSF). A significantly greater force was required to pierce the dura with pencil-point style needles compared to Quincke needles of the same size. Quincke needles caused a greater loss of CSF than their pencil-point equivalents. The results suggest that there is not likely to be a significant reduction in postdural puncture headache (PDPH) using a 27-gauge pencil-point needle compared to a 25-gauge needle that may be easier to use. Different makes of the same design and gauge of needle showed significant differences in the amount of CSF leakage, which may influence the clinician's choice of needle.

Study of the anatomy of the extradural region using magnetic resonance imaging.

We have studied magnetic resonance images of the lumbar spine of 39 subjects to examine the anatomy of the lumbar extradural region. The segmental nature of the posterior extradural region at each lumbar level may explain reports of easier cranial passage of extradural catheters introduced by the paramedian approach. This approach may thus provide a more reliable route for rapid introduction of an extradural catheter during the needle-through-needle, combined spinal-extradural technique.

An evaluation of a combined spinal/epidural needle set utilising a 26-gauge, pencil point spinal needle for caesarean section.

We have conducted a prospective study into the ease of use and incidence of postdural puncture headache with the 'Portex' combined spinal/epidural set. The pack contains a 16-gauge Tuohy needle of standard 8 cm shaft length with a matching 26-gauge pencil point spinal needle. The study included 150 consecutive combined spinal/epidural anaesthetics for lower segment Caesarean section. Eighty-eight percent of the cases fulfilled the criteria as technically perfect, i.e. cerebrospinal fluid obtained at the first attempt after identifying the epidural space. There were two cases of significant postdural puncture headache requiring blood patch due to puncture by the 26-gauge spinal needle giving an incidence of 1.3%. This compares favourably with previously reported rates in obstetric patients.

Epidural insertion: how far should the epidural needle be inserted before testing for loss of resistance?

The aim of this study was to determine the depth to which an epidural needle can safely be inserted before testing for loss of resistance. This ensures that the epidural needle is advanced far enough to encounter ligament thus avoiding the confusion that can occur when testing for loss of resistance whilst still in subcutaneous tissues. A survey of the distance between the skin and the epidural space in 400 obstetric patients was performed. Three hundred and ten midline epidurals showed a highly significant correlation (P<0.001) between the patient's pregnant weight and the distance to the epidural space. Using these data confidence limits were calculated in order to quantify the distance that the epidural needle could safely be inserted before testing for loss of resistance. Dividing the patient's pregnant weight by 25 will give this distance in centimetres. Seventy six paramedian approaches were performed and a less good correlation was found between the depth of the space and the woman's weight. There was no correlation with height or foot size.