Intra- and inter-rater reliability of jumping mechanography muscle function assessments.

Muscle function can be assessed through jumping mechanography, where portable ground reaction force plates collect dynamic information as a subject jumps. The aim of this study was to assess both intra- and inter- rater reliability of jumping mechanography. Ten healthy adults underwent 3 sets of testing (collected by 3 different raters) at two separate sessions, one week apart. They performed a number of tests in each session: multiple one-legged hopping (M1LH; on right and left legs) and single two-legged jumps (S2LJ; with or without arm swing). The S2LJ assessed variables of power per body mass, jump height, velocity and efficiency; whereas, M1LH assessed maximum force per body mass and stiffness. Inter-rater coefficients of variation (CV) were less than 0.6% and 2.6% for the S2LJ and M1LH, respectively, for the primary outcome variables of power/body mass and force/body mass. Analyzing intra-rater results also produced CVs less than 5.3% for all variables. The present study reports that the Leonardo ground reaction force plate system yields reproducible results between sessions, without significant contribution of variability from the test operator. Jumping mechanography is an easy, safe and reliable method for the assessment of lower limb musculoskeletal function.

Vasoconstrictors in the management of bleeding from oesophageal varices. A clinico-economic appraisal in the UK.

BACKGROUND: Bleeding from oesophageal varices is an uncommon but potentially fatal condition that often leads to expensive hospitalizations in intensive care or high-dependency units. METHODS: To assess the clinical and economic impact of this condition, we have devised a management plan illustrating current clinical practice in the UK. RESULTS: Approximately 6.1 million pounds of NHS resources are devoted to the treatment of 3000 acute hospital admissions for variceal bleeding every year. Vasoconstrictors like vasopressin may save approximately 36 lives per annum for an additional 145 thousand pounds. However, current clinical practice requires vasopressin to be concurrently administered with intravenous glyceryl trinitrate, increasing overall costs by 582 thousand pounds to a total of 6.7 million pounds. The additional cost for each extra life saved is estimated at 16,180 pounds. CONCLUSION: The efficacy of current vasoconstrictors requires further confirmation. In particular, new agents like octreotide (Sandostatin) should be carefully assessed to determine their potential clinical and economic benefits.

Cefuroxime pharmacokinetics in continuous and intermittent peritoneal dialysis.

Pharmacokinetics of cefuroxime was studied in patients on continuous ambulatory or intermittent peritoneal dialysis. A single intravenous bolus (15 mg/kg) of cefuroxime provided a mean serum concentration of 86 mg/litre 5 min, 40 mg/litre 1 h, 163 mg/litre 24 h after the injection. The peritoneal clearance of cefuroxime varied widely among different individuals, ranging from 1.45 to 6.17 ml/min with a mean of 3.59 ml/min during 4-hour exchanges, and from 0,52 to 11.3 ml/min during 2-hour exchanges. A single injection (15 mg/kg) of the antibiotic could not provide satisfactory antibiotic concentrations in peritoneal effluent during peritoneal lavage. When cefuroxime had been added to peritoneal dialysis solution before the solution was instilled into the peritoneal cavity, a significant decrease in cefuroxime concentration occurred in the peritoneal effluent even after a short equilibration time. Furthermore, cefuroxime concentrations measured in residual dialysis solutions in the plastic bags ranged from 44.3 to 1,351% of the concentration of cefuroxime calculated from the added doses, indicating that despite great care, mixing of the antibiotic with dialysis solutions in plastic bags was far from uniform.