The relationship between obstructive sleep apnoea and postoperative delirium and pain: an observational study of a surgical cohort.

Patients with obstructive sleep apnoea are at increased risk of adverse postoperative outcomes, such as cardiac and respiratory complications. It has been hypothesised that obstructive sleep apnoea also increases the risk for postoperative delirium and acute postoperative pain. We conducted a retrospective, observational study investigating the relationship of obstructive sleep apnoea with postoperative delirium and acute postoperative pain severity. Patients were classified as being at high risk for obstructive sleep apnoea if they had been diagnosed with this condition, or if they were positive for more than four factors using the 'STOP-BANG' screening tool. Adjusted logistic regression was used to investigate the association between obstructive sleep apnoea and postoperative delirium, and multivariable linear regression to study the relationship between obstructive sleep apnoea and postoperative pain severity. The incidence of postoperative delirium was 307 in 1441 patients (21.3%; 95%CI 19.2-23.5%). In unadjusted analysis, high risk for obstructive sleep apnoea was associated with delirium, with an odds ratio (95%CI) of 1.77 (1.22-2.57; p = 0.003). After adjustment for pre-specified variables, the association was not statistically significant with odds ratio 1.34 (0.80-2.23; p = 0.27). The mean (SD) maximum pain (resting or provoked) reported for the entire cohort was 63.8 (27.9) mm on a 0-100 mm visual analogue scale. High risk for obstructive sleep apnoea was not associated with postoperative pain severity (ß-coefficient 2.82; 95%CI, -2.34-7.97; p = 0.28). These findings suggest that obstructive sleep apnoea is unlikely to be a strong risk factor for postoperative delirium or acute postoperative pain severity.

[Enthesopathy in inflammatory spondyloarthropathy. Incidence, clinical, radiological and anatomical descriptions. Current status of the question. Apropos of 37 cases]. / Les enthésopathies des spondyloarthropathies inflammatoires. Fréquence, description clinique, radiologique et anatomique. Etat actuel de la question. A propos de 37 observations.

Based on a series of 37 personal patients and data from the literature, a number of characteristics of enthesopathies can be observed in the course of inflammatory spondyloarthropathies. Our series is based on 20 cases of ankylosing spondylitis (ASP), 8 cases of Fiessinger-Leroy-Reiter syndrome, 8 cases of psoriatic rheumatism (Pso Rh) and one combined form (psoriasis + Reiter + ASP). As well as the frequent involvement of the calcaneus (29 patients), we found more unusual extra-calcaneal localisations in 23 patients. The clinical symptomatology consisted of pain on activity and on weight-bearing at the sites of insertion of the tendons, which were sometimes swollen. The disease was occasionally very incapacitating. The radiological signs consist of lesions of erosion (initially) and reconstruction (subsequently). The histological signs consist of zones of osseous reorganisation and osteo-tendinous inflammatory infiltration. The mechanism of these enthesopathic lesions is still unclear. Our observations are similar to those reported in the literature, which are essentially paediatric studies. Enthesopathy appears to be a diagnostic and lesional element in common with inflammatory spondyloarthropathies (which include ASP, Reiter's Pso Rh, enteropathic rheumatisms and Behçet's disease) and, at least partially, with juvenile rheumatisms. In the latter case, the precocity of the tendinoperiosteal signs seems to be a very important element in the orientation of the diagnosis at the pre-spondylitic stage.

Delegation of functions by dietitians to dietetic technicians.

Questionnaires were sent to 197 randomly selected hospitals in the continental United States. Replies were used as a basis for determinign the degree to which dietitians are willing to delegate tasks to dietetic technicians. No significant difference was found between the percentage of task functions clinical dietitians were willing to delegate to clinical dietetic techncians and the number that administrative dietitians were willing to delegate to administrative dietetic technicians. Dietitians who serve in both capacities are willing to delegate a significantly higher percentage of ther clinical task functions than their administrative functions. Comparing dietitians who graduated before 1968 with those graduating in 1968 or later, no significant difference was found between the two groups of administrative dietitians; however, the clinical dietitians who graduated in 1968 or later were willing to delegate significantly more duties. No significant difference was found in the average number of task functions dietitians working in different size hospitals were willing to delegate. For task functions which 33 per cent or more of dietitians were unwilling to delegate, it appears that those who do not feel this would be ideal also feel it is impractical. Dietitians who have performed a given function do not appear more or less willing to delegate it than those who have not performed that task. Thus, while a substantial number of dietitians were willing to delegate to the dietetic technician, there was also reservation as to the type of task functions, some of which the dietitians apparently feel should remain a function of the dietitian's role. This is especially true of the administrative dietitian.