Student nurses can defibrillate within 90 seconds. An evaluation of a training programme for third year student nurses in the use of an automatic external defibrillator.

Automatic external defibrillators (AEDs) provide a means of reducing the response time in cardiac arrests but policies based on their use must take into account the costs of retraining. These depend on the level of retention of skills over time. This paper describes the retention of skills by student nurses following a training programme on the use of AEDs in cardiac resuscitation. Sixty-three student nurses were studied at intervals of 1 week, 1, 3 and 6 months following training. There was a slight deterioration in skills at 1 week and 1 month but the scores returned to the baseline level at 3 months and remained there. We conclude that there is now a case for a major study of the use of nurse-operated AEDs in the hospital setting.

Instructors--a weak link in resuscitation training.

One explanation for the well documented poor basic resuscitation skills of health-care professionals is that these skills are not acquired during initial training. The first aim of our study was to assess the basic life-support skills of trainers teaching basic resuscitation. The second aim was to examine the relationship between the trainers' confidence and actual skill. We found that practical basic life-support skills prior to the two-day training course were poor. They were still inadequate after training. Assessments before and after the course showed significant positive correlation between confidence at performing basic life-support and actual skill. There is an urgent need for formal instructor training in the UK. The training programme should be evaluated, as should the performance of both trainers and trainees, to ensure that all have acquired the requisite skills.

Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease.

In review of 871 lumbar fusion procedures performed during the last 8 years, the theoretical advantages of lumbar spinal instrumentation are not borne out in simple discogenic disease. Four groups of 30-35 patients without previous surgery who underwent fusion by different techniques were matched for age, sex, length of follow-up, surgeons, number of levels fused, duration of preoperative symptoms, diagnosis, and type of third party payer. At least for the diagnoses of herniated disc with segmental instability and the instrumentation systems used in this study, results were superior with no internal fixation. This is in keeping with the higher complication rates and frequent need for implant removal reported by many authors.

Calcium and bone metabolic homeostasis in active and denning black bears (Ursus americanus).

Decreased mechanical use of the skeleton results in osteoporosis in all species that have been studied, including humans. The unique metabolic adaptations of denning bears, however, suggest that these animals have evolved osteoregulatory mechanisms to protect against osteoporosis. The authors studied calcium and bone metabolism in black bears during three seasons: summer, winter, and spring. The serum calcium concentration did not change despite the fact that the bears remained metabolically active, recumbent, and anuric for four months. Furthermore, after four months of skeletal inactivity, bone mass and other parameters of osseous metabolism, including bone formation and mineral apposition rates were unchanged over summer values. A hypermetabolic state was observed after spring arousal in response to resumed skeletal loading. These findings suggest that bears may produce an osteoregulatory mechanism that prevents bone loss during prolonged periods of skeletal inactivity. Such a substance could have potential therapeutic applications for human beings.

An advanced resuscitation training course for preregistration house officers.

Preregistration house officers need to be able to manage the first 5-10 minutes of a cardiac arrest. A course has been designed based on the recommendations of the Resuscitation Council UK 1984 and the format of the American Heart Association advanced cardiac life support course. Fifty-nine newly qualified doctors from the same medical school class were studied in two consecutive groups: Group 1 (n = 31) were commencing their first post and Group 2 (n = 28), whose first preregistration post had been at other hospitals without practical resuscitation training, were commencing their second post. They were pretested and taught in three 2-hour sessions. Five months later they were tested to measure retention of knowledge and skills. Before training there was no difference in knowledge between the two groups but Group 1 were more skilled. The knowledge and skills of both groups immediately after training were significantly improved and at 5 months skills were subject to modest decay only. Experience of managing cardiac arrests was not a substitute for formal practical training.

Extraarticular reconstruction of the anterior cruciate ligament insufficient knee. A long-term analysis of the Ellison procedure.

This paper reports an analysis for treatment of anterolateral rotatory instability by the Ellison procedure, a technique involving rerouting a portion of the iliotibial band posterior to the fibular collateral ligament. A detailed description of the operative procedure is presented. One hundred four patients were evaluated for subjective improvement. The average length of followup was 51 months (range, 24 to 100 months). Eighty-one patients (80%) had a good or excellent result, 15 patients (14%) were rated fair, and 6 patients (6%) were rated poor. Sixty-three patients returned for a detailed clinical examination (average followup was 53 months; range, 24 to 100 months). An excellent or good objective rating was achieved in 49 patients (78%). Ten patients (16%) were rated as fair, and four patients (6%) were rated as failures. We recommend the Ellison procedure for the recreational athlete as a safe and effective mode of treatment for anterolateral rotatory instability.

Early results of spinal fusion using variable spine plating system.

Seventy-seven consecutive patients underwent application of variable spine plating (VSP) spinal plates between August 1984 and October 1985. Sixty-four percent had previous procedures at the same level or levels operated. Operative indications were spinal stenosis, segmental instability, unstable spondylolisthesis, herniated disc with instability, pseudoarthrosis, unstable fracture, and failed surgery syndrome with evidence of one of the preceding. Overall results showed 30% excellent, 30% good, 34% fair, 6% poor. There were four deep wound infections and 19 patients with one or more broken screws. Screw alignment and the angular relationship of each screw to the spinal plate are considered important technical factors in minimizing screw failure. Vigorous distraction of the vertebrae using interpedicular screws is rarely indicated. Twenty-four patients required reoperation. We feel the procedure is relatively indicated in cases of moderate to severe instability, such as some cases of spondylolisthesis, failed surgery with marked segmental instability, the obese, deconditioned patient, or cases of spinal stenosis rendered very unstable by surgical decompression, and most strongly indicated in unstable lumbar and thoracolumbar fractures.

Painful lumbar end-plate disruptions: a significant discographic finding.

Of the 692 discs injected during lumbar discograms, end-plate disruptions with leakage of contrast material into the vertebral bodies were noted in 14 discs. Although gentle pressure was applied during the injections, severe fully concordant pain was reproduced in four (28.3%) discs, moderately severe and fully concordant pain in nine (64.3%) discs, and mild discordant pain in one (7.4%) disc. This is compared to 11.2% of the remaining 678 discs without end-plate disruption that reproduced severe concordant pain, 31.1% with moderately severe concordant pain, 17.1% with mild pain, and 40.6% without any pain reproduction. The difference between pain frequency in discs with end-plate disruption and those without is statistically significant (P less than .001). This suggests that end-plate disruptions may be related to painful segments.

Knodt rod distraction lumbar fusion.

Ninety-nine cases of Knodt rod fusions have been followed for an average of 18 months postoperatively. These patients were all severely incapacitated with pain for an average of 5.3 years prior to surgery. They all had a thorough preoperative work-up including myelogram, EMG and extensive conservative care. The procedure performed was an extensive bilateral laminectomy of the L5 vertebra with foramenotomy and a posterior lateral intertransverse fusion with the use of Knodt rods between the L4-5 and S1 levels. There was an overall average improvement after surgery in 70.35% of the cases. When the consideration of psychological problems and industrial cases were eliminated, the overall improvement was 80.38%. There were no major complications except that in five patients the Knodt rods were removed from between one week and one year postoperatively. Knodt rod fusions have results reported in the literature of frequent complications and very poor success rates. They can be a very good adjunct to the spine surgeon's armamentarium. In patients with long-range back pain who plan to return to heavy labor, the Knodt rods can give a surprisingly high rate of success.

Epidural injections for the diagnosis and treatment of low-back pain.

Three hundred four consecutive patients with low-back pain were given epidural anesthetic and steroid injections. A prospective study demonstrated that selected patients had 87% short-term success and 34% relief of pain for as long as 6 months. No patient was cured by these injections. Needle placement during epidural injections was incorrect 25% of the time in experienced hands.

Avulsion of the posterior cruciate ligament from its femoral attachment: an isolated ligamentous injury.

A unique previously unreported injury is described, namely the avulsion of the posterior cruciate ligament from its femoral attachment, as an isolated injury. The mechanism of injury, i.e., hyperextension, is also unique although it is one that is commonly experienced by riders attempting to start their motorcycles.