Effectiveness of student assistance programs in Nebraska schools.

BACKGROUND: This study investigated whether Nebraska schools with Student Assistance Programs (SAP) are associated with reduced adolescent alcohol use and a higher level of academic achievement than students from schools without a SAP. METHODS: In 1992, the Toward a Drug Free Nebraska (TDFN) survey was administered to 3,454 students in grades seven to twelve at eighty-three Nebraska schools. A second survey, the TDFN "team activity report" collected from each school's team, the presence of a SAP (n = 34 schools) or absence of a SAP (n = 49 schools). Student responses for alcohol use and academic achievements were linked with the presence of a SAP through use of a school identification number on both surveys. RESULTS: Students from schools with a SAP reported a lower use of alcohol in the last thirty days, compared with students from schools without a SAP program (p < 0.05), and they also reported a significant difference in academic achievement (p < 0.05). CONCLUSIONS: While this study used post hoc analysis of data, the results suggest lower alcohol use and higher academic achievement among students from SAP schools. Given SAPs' popularity, these trends suggest that further research should be conducted to demonstrate the effectiveness of student assistance programs.

Validation of computer systems: practical testing of a standard LIMS.

In recent years the introduction of computer systems for data handling in the pharmaceutical industry has increased. A standard LIMS (laboratory information management system) is software commercially available from different suppliers not only to facilitate data handling in laboratories but also to cover GMP-requirements. Computer systems introduced in GMP-areas of pharmaceutical companies have to be validated. For a standard LIMS, the general validation of the program is performed by the supplier. Nevertheless, the user is always required to cover all phases of a validation. The objective of this paper is to discuss suitable test procedures for the most critical functions of a standard LIMS needed during the verification step of the validation process.

The inverse Nehb J lead increases the sensitivity of Holter electrocardiographic monitoring for detecting myocardial ischemia.

A major reason for the relatively low sensitivity of Holter electrocardiography (ECG) for detecting ischemia is that the sensitivity of bipolar leads used for Holter ischemia monitoring has not been systematically evaluated, making lead selection difficult. Therefore, this study evaluated the sensitivity of 6 bipolar Holter leads for detecting ischemia during percutaneous transluminal coronary angioplasty. Seventy-five patients, each of whom had > 1 mm ST-segment elevation on an intracoronary electrocardiogram from the myocardium distal to the stenosis during balloon occlusion, were studied for the occurrence of > or = 1 mm ST-segment elevation or depression on the simultaneously recorded Holter leads II, III, aVF, CM5, CR4, and inverse Nehb J. The study found that the inverse lead Nehb J provided a significantly higher overall sensitivity for detecting myocardial ischemia than Holter leads II, III, aVF, CM5, and CR4. Also, the use of inverse lead Nehb J significantly increased the sensitivity of 2- and 3-lead Holter ischemia monitoring. These findings were based on a significantly higher sensitivity of inverse lead Nehb J for detecting ischemia induced by transient occlusion of the left anterior descending coronary artery and a slightly higher sensitivity for detecting ischemia induced by occlusion of the left circumflex coronary artery. None of the bipolar leads studied provided a very high sensitivity for detecting ischemia induced by occlusion of the right coronary artery. These findings show that adequate lead selection can increase the sensitivity of Holter ischemia monitoring. Furthermore, the lack of a highly sensitive lead for detection of inferior ischemia indicates that further evaluation of bipolar leads is warranted.

[Long-term electrocardiography. Detection of low-grade myocardial infarction: sensitivity of 9 bipolar leads]. / Langzeit-Elektrokardiographie. Erfassung von inferioren Myokardinfakten: Sensitivität bei 9 bipolaren Ableitungen.

UNLABELLED: The sensitivity of ambulatory electrocardiography (Holter ECG) for detecting ischaemia is relatively low. A case report of an inferior infarction missed by three-lead Holter monitoring that included a modified lead aVF especially places its sensitivity for detecting inferior ischaemia and infarction in question. Therefore, the present study evaluated the sensitivity of nine bipolar Holter leads for detecting isolated inferior Q-wave infarctions, and compared the sensitivity of the modified leads II, III, and aVF of the Holter ECG with the sensitivity of the "corresponding" leads of the standard ECG. METHODS: Sixteen patients, each of whom had a pathological Q-wave (> 0.04 s and > 0.1 mV) in at least two of the three standard ECG leads II, III, and aVF but in none of the other standard leads, were studied for the presence of a pathological Q-wave on the modified Holter leads II, III, aVF, CM2, CM5, CR4, Frank Z, Nehb D, and inverse Nehb J. RESULTS: Of the nine Holter leads, modified lead III provided the highest sensitivity for detecting inferior Q-wave infarctions, followed by lead Frank Z; leads CR 4 and inverse Nehb J were only slightly less sensitive. In contrast, modified leads II and aVF were significantly less sensitive than modified lead III. Modified bipolar lead aVF of the Holter ECG was significantly less sensitive than the "corresponding" lead aVF of the standard ECG, whereas modified leads II and III provided similar sensitivities for detecting inferior Q-wave infarctions as the "corresponding" leads of the standard ECG. CONCLUSIONS: The significantly lower sensitivity of modified lead aVF for detecting inferior Q-wave infarctions compared with standard lead aVF shows that the sensitivity of a Holter ECG lead cannot be deduced from that of the "corresponding" standard ECG lead. Moreover, the significantly higher sensitivity of modified lead III compared with modified leads II and aVF shows that lead selection is important for Holter monitoring.

[Effect of postoperative retransfusion of autologous blood products on hemostasis in heart surgery]. / Einfluss der postoperativen Retransfusion von autologen Blutprodukten auf die Hämostase in der Herzchirurgie.

In cardiac surgery a reduction of homologous blood products is mainly achieved by autologous blood salvage. Unprocessed retransfusion of autologous blood may induce changes in hemostasis. We assessed changes of activated clotting times (ACT) after retransfusion of unprocessed (1) oxygenator blood and (2) shed mediastinal blood. In 41 patients undergoing cardiac surgery (37 revascularization and 4 valve procedures) with a mean cardiopulmonary bypass time of 116.3 min, ACT was measured at the following time points: pre- and postoperatively, and before and after retransfusion of oxygenator blood and shed mediastinal blood. A significant prolongation of ACT values was only seen between pre- to postoperative blood (p < 0.003). Retransfusion of oxygenator blood changed ACT from 120 +/- 25 vs 116 +/- 17 sec and retransfusion of shed mediastinal blood showed a mean ACT of 118 +/- 14 vs 115 +/- 20 sec from before to after transfusion. There was a significant correlation between the ACT value in the unprocessed oxygenator blood and the ACT value measured in the patient after retransfusion (r = 0.41, p < 0.02). 6 patients receiving over 1 litre of unprocessed autologous blood (either from the oxygenator or the mediastinum) in less than 60 minutes showed a significant increase of ACT value after transfusion (p < 0.05). Hence, under normal conditions, retransfusion of unprocessed autologous blood will not significantly alter hemostasis measured by the ACT test in patients undergoing cardiac surgery.

[Massive intraoperative pulmonary embolism. Diagnosis and control following embolectomy with transesophageal echocardiography]. / Massive intraoperative Lungenembolie. Diagnose und Erfolgskontrolle nach Embolektomie durch transösophageale Echokardiographie.

Massive intraoperative embolism is a life-threatening condition that may lead to immediate death. Important for the survival of the patient are rapid diagnosis and prompt surgical embolectomy. Case report. Nineteen days after a traffic accident, a 67-year-old patient who had complex ligamentous injuries was operated upon on both knees during general anaesthesia. The operation progressed uneventfully for the first 30 min when the patient's systolic blood pressure became slightly unstable and decreased to 85 mm Hg despite administration of ephedrine and infusion of hetastarch. This was followed 30 min later by an immediate drop to values that were undetectable on an oscilloscope. The pulse oximeter no longer detected a signal at the finger-tip and the end-tidal CO2 decreased to 1 kPa (7.5 mm Hg). To confirm the diagnosis of an acute pulmonary embolism, we performed transoesophageal echocardiography (TEE) and found a large amount of free-floating material in the right atrium, a dilated and hypokinetic right ventricle, and a collapsed left ventricle (Fig. 1 a). Embolectomy was immediately started using the inflow-occlusion technique supported by cardiopulmonary bypass (CPB). All emboli were removed from the right atrium and pulmonary artery (Fig. 1 b). During closure of the sternotomy, heart function was monitored by TEE and we again noted large emboli in the right atrium (Fig. 1 c). To remove these, we reinstated CPB and then placed an inferior vena cava filter. The final TEE control showed free heart chambers with good contractility (Fig. 1 d).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute traumatic rupture of the thoracic aorta: immediate or delayed surgical repair?

The appropriate management of traumatic aortic rupture is often difficult to determine, particularly if the rupture is associated with severe additional lesions. Between 1986 and 1991, ten consecutive patients with acute traumatic rupture of the thoracic aorta (ATRTA) and concomitant injuries were initially treated medically and submitted to delayed aortic repair. Within the same period no other patient had emergency reconstruction of the thoracic aorta. Diagnosis of ATRTA was established immediately after admission in eight patients. Five patients underwent emergency surgery for severe concomitant injuries. With regard to the aortic lesion, all patients were managed medically and submitted to pharmacological treatment in an attempt to reduce cardiac shear forces. None of the patients developed clinical signs of imminent free rupture while waiting for aortic surgery. In the absence of a significant hemothorax and when no coarctation syndrome is evident, the risk of free aortic rupture is considered to be rather low if the patient reaches the hospital in a stable circulatory condition. Postponement of aortic reconstruction is particularly indicated when severe concomitant lesions preclude safe immediate repair of the aortic tear. Following the patient's recovery from associated major injury, aortic surgery can be performed as a low risk procedure using cardiopulmonary bypass which is recognised as the most effective technique to prevent spinal cord ischemia and to reduce the risk of paraplegia.

[Non-respiratory therapy of adult respiratory distress syndrome]. / Die nicht-respiratorische Therapie des Atemnotsyndroms des Erwachsenen.

Several approaches to non-respiratory management of adult respiratory distress syndrome (ARDS) are discussed. (1) Diagnosis and therapy of the underlying disease is a primary goal in order to avoid the ongoing process of lung injury. (2) Specific pharmacologic therapy for primary lung injury is not available even after 25 years of immunologic research, because no specific mediator has yet been identified as a primary pathogenic factor in ARDS, which is a heterogenous clinical syndrome. (3) Supportive therapy (i.e. improving right ventricular dysfunction and treating pulmonary arterial hypertension) should be emphasized. (4) The most important approach is to optimize prophylactic management to avoid nosocomial infection by eliminating unnecessary invasive techniques, changing the patients' positioning and conserving organ function. So far the latter approach seems to be the only way to improve survival in respiratory failure.