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PubMed2004

Risks of outpatient angiography and interventional procedures: a prospective study.

OBJECTIVE: The purpose of this study was to evaluate complications in diagnostic and interventional angiographic procedures performed on outpatients. MATERIALS AND METHODS: Data were collected prospectively for 2,683 procedures performed on an outpatient basis in 2,248 patients from the period March 1997 to March 2002. Patients were assessed by nursing or medical staff within 2-4 hr of the procedure and again via telephone 24-48 hr after the procedure. The collected data were summarized on the basis of procedure type into four main groupings: aortofemoral studies, cerebral studies, interventional procedures, and other studies. Complication frequency distribution was determined for each procedure type. An interim summary of complication rates was prepared for the period March 1997 to June 1999. Statistical analysis using a two-tailed z-test for the comparison of two proportions was performed to determine if a significant difference existed in the rates of complications from data collected before and after the June 1999 summary. RESULTS: Ninety-one percent of cases completed follow-up. In total, 561 complications were identified in 2,436 cases (23%). Most complications consisted of either local pain or puncture site hematoma and bruising. No deaths occurred. In the 1,128 diagnostic aortofemoral studies performed, 211 complications (19%) occurred. In the 359 cerebral studies, 87 complications (24%) occurred. The 441 interventional procedures resulted in 146 complications (33%). In the remaining 508 procedures, 117 complications (23%) occurred. Major complications in each group are presented. CONCLUSION: We observed a low incidence of complications requiring further treatment or resulting in a permanent deficit. The rates are comparable to published data from similar studies and practice standards guidelines. A statistically significant improvement was seen in the total complication rate between the periods March 1997-June 1999 and July 1999-March 2002 (p = 0.01).

Ambulatory Care↗
PubMed2004

Types of procedures performed by diagnostic radiology practices: past patterns and future directions.

OBJECTIVE: The purpose of our study was to determine the types of imaging procedures performed by diagnostic radiology practices and the patterns and differences related to practice characteristics. MATERIALS AND METHODS: The American College of Radiology (ACR) surveyed 970 practices by mail, using a 65-item questionnaire, in 1999. A response rate of 66% was achieved. Weighting was used to make responses representative of all radiology practices in the United States. Trends were explored by making comparisons with data from a 1991-1992 ACR study. RESULTS: Among the types of procedures studied, the highest percentage of multiradiologist diagnostic-radiology-only practices performed mammography (95%) and sonography (94%). (General conventional radiography and fluoroscopy were not studied.) The lowest percentage of these practices performed interventional procedures (69%) and MRI (77%). Solo practices showed less diversity in types of procedures performed than did multiradiologist practices and were a good deal less likely to perform each type of procedure except mammography and sonography. Generally, higher percentages of practices in nonmetropolitan cities or towns and rural practices performed various types of procedures than practices in metropolitan areas. Practice size, types of settings served (hospital or nonhospital), and practice type also influenced the number of types of procedures performed by a practice. The fraction of practices performing CT decreased from 91% to 83% between 1991-1992 and 1999. Percentages for other types of procedures were generally stable over time. CONCLUSION: Certain practice characteristics play a role in determining the types of imaging procedures a diagnostic radiology practice performs. The decline in the percentage of practices providing CT and the failure during the 1990s of percentages for MRI and interventional radiology to increase from a relatively low base is worrisome. Future analyses based on a subsequent ACR survey will provide further insights into trends.

Data Collection↗
PubMed2000

Performance of children with and without learning disabilities on Canter's Background Interference Procedure and Koppitz's scoring system for the Bender test.

Performance of 66 children, 30 with and 36 without learning disabilities, in four ways using the Bender Visual-motor Gestalt Test was compared. First, the test with the standard Koppitz scoring procedure, second with the Canter Background Interference Procedure sheet using the standard Koppitz scoring procedure; third, the Bender test on a standard sheet of paper using Canter scoring procedure; and fourth, the Canter Background Interference Procedure (BIP) sheet using the Canter scoring procedure. The effectiveness of the Canter procedure was examined when scored with an age-appropriate normative scoring system. This was accomplished by combining the Canter BIP interference sheet with the Koppitz scoring system. The children ranged in age from 6 to 10 years. Using discriminant analysis, all four methods correctly categorized statistically significant percentages of both types of students but there was a significant difference on the Canter BIP sheet using the Canter scoring procedure. This procedure classified students with the least absolute number and percentage of either false negatives or false positives when compared with the other three methods, suggesting that using this scoring method with the Bender Gestalt may be better for identifying younger children with learning disabilities.

Age Factors↗
PubMed1999

Technical note: development of a transcervical oocyte recovery procedure for sheep.

An oocyte recovery procedure was developed and evaluated to determine whether a transcervical embryo recovery procedure is feasible with our method, which includes estradiol-17beta (E2) and oxytocin (OT) treatments, for dilating the cervix in ewes. On d 6 of an estrous cycle, oocytes were recovered either transcervically or with a laparotomy procedure. In the laparotomy group, ovulation rate was determined during the procedure and was used to calculate the percentage ofoocytes recovered. The laparotomy procedure was a standard uterine flush, and 12 mL of PBS was used to flush each uterine horn. In the transcervical group, the ovaries in each ewe were evaluated ultrasonically to determine ovulation rate. For transcervical recovery, 100 microg of E2 were injected i.v. on d 5 to increase cervical OT receptors, and 100 USP units of OT were injected i.v. 10 to 12 h later to dilate the cervix. Approximately 25 min after OT, ewes were placed in dorsal recumbency in a Commodore cradle, and a modified Foley catheter was passed through the cervix and into the uterus for injection (80 to 210 mL) and aspiration of PBS. The PBS was aspirated with a vacuum pump. The percentage of PBS recovered was greater (P<.01) at laparotomy than with the transcervical procedure (85.8 vs. 36.2%). Despite that difference, oocyte recovery did not differ significantly between the two groups (67% for laparotomy vs. 50% for transcervical; [oocytes recovered/number of corpora lutea] x 100), and there was no evidence that the transcervical procedure damaged the oocytes; the zona pellucida remained intact around all of the oocytes. In conclusion, a procedure that includes E2-OT-induced cervical dilation, passage of a modified Foley catheter into the uterus, and incremental infusion and aspiration of media through the catheter can be used to recover oocytes transcervically from ewes. This procedure may make transcervical embryo recovery feasible for sheep.

Animals↗
PubMed2001

Anesthesia for fetal procedures and surgery.

Many of the anesthetic considerations for fetal procedures and surgery are identical to those for nonobstetric surgery during pregnancy, including concern for maternal safety, avoidance of both teratogenic drugs and fetal asphyxia, and the prevention of preterm labor and delivery. Anesthesia is required for the mother and quite often the fetus to perform many fetal procedures. Fetal procedures and surgery can be divided into subgroups according to their anesthetic requirements. For example: procedures that only require a needle insertion into the uterus but not into the fetus, such as intrauterine infusions; laser surgical photocoagulation of the communicating placental circulation for twin-twin transfusion syndrome (TTTS) and radio-frequency umbilical cord ablation for managing twin reversed arterial perfusion (TRAP), which are not really fetal procedures, rather they are placental or cord procedures; surgical procedures performed directly on the fetus; and the EX-utero Intrapartum Treatment (EXIT) procedure. Anesthetic considerations also depend on other factors, such as the location of the placenta. Unlike maternal surgery, for fetal procedures, the fetus is not an innocent bystander for whom the least anesthetic interference is used. Instead, the fetus can be the primary patient and may benefit from anesthesia, with close monitoring of the anesthetic effects to ensure well-being. Fetal asphyxia, hypoxia, or distress can be most effectively recognized, predicted, and avoided by fetal monitoring. Monitoring is also crucial for assessing the fetal response to corrective maneuvers.

Anesthesia↗
PubMed1990

Procedural skills of practicing nephrologists. A national survey of 700 members of the American College of Physicians.

OBJECTIVE: To determine which procedures nephrologists do in practice, where they learned the procedures, and how much training they recommend to achieve and maintain clinical competence in each. DESIGN: Mailed survey. PARTICIPANTS: A random sample of 700 members of the American College of Physicians who were identified as practicing nephrologists; 516 (74%) responded. RESULTS: Acute peritoneal dialysis, acute hemodialysis, continuous arteriovenous hemofiltration, and percutaneous renal biopsy were done by 95%, 97%, 87%, and 91% of the respondents, respectively. Except for hemofiltration, procedures were learned by most respondents during fellowship training. Compared with general internists, fewer nephrologists did most of the 19 general procedures included in the survey. The number of nephrology procedures done during the past year varied considerably among respondents, as did the minimum number of procedures they recommended for achieving and maintaining competence. Neither the variation in number of procedures done nor recommendations regarding certification were explained by differences in practice characteristics. Median recommendations remained relatively constant among subgroups. CONCLUSIONS: Nearly all nephrologists do the four nephrology procedures included in the survey. Their opinions about the training needed for competence help to better define requirements for training programs. More attention should be focused on training and certifying practicing nephrologists in procedures learned after formal fellowship training.

Biopsy, Needle↗
PubMed1999

Use of cardiovascular procedures among black persons and white persons: a 7-year nationwide study in patients with renal disease.

BACKGROUND: Black persons historically undergo fewer invasive cardiovascular procedures than white persons. OBJECTIVE: To determine whether acquisition of Medicare health insurance and comprehensive care for severe illness reduce ethnic disparity in use of cardiovascular procedures. DESIGN: 7-year longitudinal analyses in a cohort from the United States Renal Data System. SETTING: Health care institutions in the United States. PATIENTS: Nationwide random sample of 4987 adult black and white patients with incident end-stage renal disease (ESRD) from 303 dialysis facilities in 1986 to 1987. MEASUREMENTS: Medical history and service use records, physical examination, and laboratory data. Main outcome measures were receipt of a coronary catheterization or revascularization procedure before (baseline) and after (follow-up) development of ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables. RESULTS: At baseline, 9.9% of white patients and 2.8% of black patients had had a cardiac procedure; the odds were almost three times greater in white than in black patients (adjusted odds ratio, 2.92 [95% CI, 2.04 to 4.18]). During follow-up, white patients were only 1.4 times more likely than black patients to have a procedure (adjusted relative risk, 1.41 [CI, 1.13 to 1.77]); rates were 7.8% for white persons and 8.5% for black persons. In patients with Medicare coverage before development of ESRD, the initial three-fold difference in procedure use was eliminated over follow-up (odds ratio, 1.05 [CI, 0.56 to 1.60]). For procedures after hospital admission for myocardial infarction or coronary disease, no difference between ethnic groups was seen during follow-up (relative risk, 1.12 [CI, 0.68 to 1.85]). CONCLUSIONS: Differences between ethnic groups in use of cardiovascular procedures narrowed markedly once a serious illness (ESRD) developed and adequate insurance coverage was ensured; the disparity was eliminated in patients with previous Medicare insurance or a stronger indication for a procedure. These findings suggest that almost equal access to care is attainable by combining insurance with delivery of comprehensive, clinically appropriate care.

Adult↗
PubMedDate not supplied

Developing radiology procedure cost standards.

Containing costs is at the forefront of healthcare management, particularly as managed care replaces fee-for-service care. The first step in costs is to gain an understanding of the "building blocks" or components of procedure costs. The department of radiology at Duke University Medical Center and Health System, in conjunction with the department of management engineering, developed labor and supply standards to predict direct procedure costs throughout the radiology department, where 285,000 procedures are performed annually. This team concept resulted in a consistent approach to building procedure standards that predict direct costs across all sections. Step by step instructions are given for the following standards. Variable labor standards represent the average amount of staff time required for each procedure. Variable supply standards represent the average amount of consumable supply resources required per procedure. Fixed labor time standards predict the amount of fixed time resources necessary to operate the department of radiology at Duke University hospital. Cost per procedure uses the standards developed in the other sections. These basic steps will help readers determine their own direct costs per procedure for most radiology procedures (excluding capital and indirect costs). When these standards and costs are identified, the next step is to identify the areas to reduce such costs without affecting the quality of patient care.

Cost Allocation↗
PubMed1999

New refractive surgery procedures in ophthalmology and the influence on Pilot's fitness for flying.

During the last years more and more procedures came up to render people with refractive errors possible to see without contact lenses or glasses. The different procedures for hyperopia, myopia and astigmatism are performed in increasing numbers in hospitals, laser-centres and in private practise. Modern radial keratotomy was introduced in the late 70 by the Russian Fjodorov. Because of the many complications this procedure was replaced by other procedures. Photorefractive keratectomy (PRK) was introduced in 1985, using an excimer laser to vaporize corneal tissue. Because of the side effects as pain and glare and the limited indication area Laser in situ keratomileusis (LASIK) was developed. In this procedure a corneal lamella is cut in, flapped back and the excimer laser vaporize the corneal tissue. These two procedures are mostly applied nowadays. But there are also new techniques that are still in an experimental state. One of that is the implementation of an intrastromal corneal ring that can reduce myopia up to 4 diopters. During the laser thermo keratoplasty 8 to 16 laser applications are performed in the periphery of the cornea to reduce hyperopia up to + 5 diopters. Another refractive surgery procedure is the phakic intraocular lens implantation for high myopia and +3 to +10 diopters hyperopia and the clear lens extraction with intraocular lens implantation for high hyperopia. The Joint Aviation Authority Requirements allow a hyperopia and myopia for commercial pilots of 3 diopters. Some pilot candidates with higher refractive errors undergo refractive surgery. But there are also pilots who are customers of the refractive operating ophthalmologists to get rid of the crutch glasses. This paper gives an overview about the refractive procedures that are performed nowadays on pilots and pilot candidates and gives information about the relevant indications and complications of refractive procedures in the aviation environment.

Adult↗
PubMed1999

Benchmarking cardiac catheterization laboratories: the impact of patient age, gender and risk factors on variable costs, device costs, total time and procedural time in 53 catheterization laboratories.

Coronary catheterization laboratories (CCLs) are the cornerstones of the delivery system for many cardiovascular procedures performed in the United States. However, few comprehensive data exist benchmarking physician activities in CCLs. This study benchmarks cost and time data on 82,548 consecutive patient encounters in 53 CCLs for the 18-month period of January 1997 through June 1998. The data are compiled from the OEP program, a relational database developed by Boston Scientific/Scimed (Maple Grove, Minnesota) for use in CCLs. CCL productivity (total time and procedure time) and cost (variable costs and device costs) benchmarks are created for: 1) left heart catheterization; 2) right and left heart catheterization; 3) percutaneous transluminal coronary balloon angioplasty (PTCA); 4) atherectomy; and 5) coronary stents. Results show the variable costs (those costs that vary in direct proportion to changes in CCL activities) for the five procedures are: $308, left heart catheterization; $395, right and left heart catheterization; $841, PTCA; $2,768, atherectomy; and $3,186, coronary stent. These variable costs are lower than the typical average costs reported for these procedures because they do not include hospital, laboratory, and physician costs, only the procedure-specific activity-related costs most directly controlled and/or influenced by CCL physicians or administrators. The total time for the left heart catheterization averaged 64 minutes and 84 minutes for the right and left heart catheterization, respectively, and procedural times averaged 25 and 32 minutes, respectively. For the major interventional procedures N PTCA, atherectomy, and coronary stents, total times averages were 102, 135, and 117 minutes, respectively. Procedural times for these procedures averaged between 60 and 65 percent of the total time. The major implications of these findings are discussed and limitations noted.

Age Factors↗
PubMed1990

Comparative studies on the anti-punishment effects of chlordiazepoxide, buspirone and ritanserin in the pigeon, Geller-Seifter and Vogel conflict procedures.

The studies presented here compared the responsiveness to clinically effective anxiolytics of two major conflict procedures in rat (i.e. the Geller-Seifter and Vogel procedures) and of the newly introduced pigeon conflict procedure. The compounds studied were the prototypical benzodiazepine chlordiazepoxide and the non-benzodiazepine anxiolytics buspirone and ritanserin. Chlordiazepoxide produced reliable anti-punishment effects in all three procedures, but only the pigeon conflict procedure also revealed statistically significant effects on punished responding with buspirone and ritanserin. The data thus constitute the first confirmation of findings from another laboratory that these two non-benzodiazepine compounds exert robust disinhibitory effects on punished behavior in the pigeon. Further, the quantification of drug effects on punished and on unpunished responding in the pigeon. Further, the allowed the effects of the three compounds to be differentiated. The pigeon conflict procedure may be unique among available animal models of anxiety in combining the following two features. Firstly, the procedure allows the behavioral response to be highly defined and permits the experimenter to control rigidly the stimulus events which act in a conflicting manner to increase and decrease response frequency. Secondly, [??084] behavior in this procedure is responsive to benzodiazepines, but also to anxiolytic drugs the effects of which are not mediated by benzodiazepine receptors. It is proposed that the pigeon conflict procedure be used in extensive parametric studies, in an effort to examine the independent variables which may perhaps explain the widely varying and often paradoxical effects that drugs can produce in available animal models of anxiety.

Journal Article↗
PubMed2001

A national survey of procedural skill requirements in family practice residency programs.

BACKGROUND AND OBJECTIVES: Procedural skill training is a controversial but important component of family practice residency programs. This study examines the use and composition of required procedure lists in US family practice residency programs. METHODS: The study used a cross-sectional nine-item questionnaire. This survey was sent to 467 residency program directors listed in the 1999 American Academy of Family Physicians Directory of Family Practice Residency Programs. RESULTS: A total of 326 programs (70%) responded to the survey. Of these, 242 programs (74% of respondents) reported use of a required procedure list. Sixty-six programs provided a list. Of these, 63 lists were interpretable. The number of required procedures on the lists ranged from a minimum of 3 procedures to a maximum of 117, with an average of 42. A total of 265 distinct procedures were identified, with 25 procedures named on more than half of the lists. Thirteen programs (21%) mandated competency in required procedures, but only five programs (8%) gave clear definitions of what constituted competency. There were no significant differences in lists among training program type, university affiliation, number of hospitals used for rotation, size of affiliated hospital, or number of residents. CONCLUSIONS: The expectations of individual programs vary greatly in terms of required procedures. Few programs define how to evaluate the technical competency of their residents.

Clinical Competence↗
PubMed2001

Inpatient utilization of medical services associated with peripheral arterial disease-related inpatient procedures in the Department of Defense.

The objective of this study was to describe the inpatient procedural medical care utilization the first 10 years after initial inpatient confirmation of peripheral arterial disease (PAD). A retrospective review was carried out of the computer records of all the army beneficiaries of the Department of Defense healthcare system since 1971. Over 8000 subjects with an initial inpatient confirmation of PAD between January 1, 1980 and December 31, 1985 were reviewed for 10 years following the initial visit. The utilization of PAD-related invasive procedures gradually increased over the first 8 years, and rose sharply in the ninth and tenth years after initial diagnosis, while the utilization of examination procedures was highest in the first, fifth to seventh, ninth and tenth years. Procedures involving bypass and amputation had the highest utilization among invasive procedures, while procedures involving arteriography and ultrasonography accounted for 88% of all examination procedures. Bypass and repair of vessel procedures gradually rose throughout the 10 years after initial diagnosis, while amputations and skin grafts remained relatively constant. Procedures involving arteriography rose until year 5 and then tapered off, while utilization of ultrasonography rose in year 7 and tapered off. These results suggest that PAD-related studies should consider the progression of the disease past the fifth year after the initial inpatient visit for PAD when measuring a change in outcomes.

Adult↗
PubMed2001

[Perioperative complications after total hip revision surgery and their predictive factors. A series of 181 consecutive procedures].

PURPOSE OF THE STUDY: We conducted a retrospective study to assess morbidity and mortality in patients undergoing revision total hip arthroplasty (THA) procedures. MATERIAL AND METHODS: Perioperative complications were recorded in 181 revision procedures (162 patients) performed between January 1995 and March 1999 (117 bipolar revisions and 64 acetabular isolated revisions). RESULTS: There were 86 complications (68 patients) leading to 21 new revisions. About half (50/86) were related to the surgical procedure (dislocation, femoral fracture, infection.). Life-threatening complications (3.6%) ended in patient death in 1.6% of the cases. Complications were more frequent in patients with an ASA score=3 (p<0.01) or aged over 75 years (p<0.05). Age was also predictive of femoral misalignment and fracture (p<0.05). Dislocations (8.8%) were observed more frequently in patients who had undergone more than 2 procedures prior to the revision (p<0.05) (4.8% of the dislocations in patients undergoing a first revision procedure and 14.3% in the others). In addition, peroperative blood loss and duration of the procedure were significantly greater in case of bipolar replacement than for isolated acetabular replacement (sigma > 1.96). DISCUSSION: Our experience and data in the literature point to the important age factor in the development of complications. Preservation of a well-fixed femoral component does not appear to worsen prognosis and leads to fewer complications than bipolar changes. CONCLUSION: The decision to revise a THA must take into consideration the functional impairment but also the risks inherent in revision procedures, particularly in old patients who have undergone several procedures. Revising the acetabular component alone can be an interesting option if the femoral component remains well-fixed although our follow-up is insufficient to determine whether this attitude provides better long-term outcome than complete biopolar revision. Better patient selection and improved operative technique, in particular in femur preparation, should help reduce morbidity and mortality in this type of procedure.

Adolescent↗
PubMedDate not supplied

Rural-urban and gender differences in procedures performed by family practice residency graduates.

OBJECTIVE: We compared the types of procedures performed and obstetrical care provided by family practice residency graduates, by practice location and physician gender METHODS: We conducted a cross-sectional questionnaire survey of 702 graduates who completed family practice residency programs in Alberta, Canada, from 1985 to 1995, inclusive. Graduates were asked to indicate which of 28 procedures and 7 obstetrical care practices they performed. The data were analyzed by gender and current practice location. RESULTS: A total of 442 (63%) of the graduates responded to the survey. The top five procedures performed by family practice graduates were minor office surgery, foreign body removal (eye), joint aspiration, joint injection, and anterior nasal packing. There was a declining trend in the number of procedures performed by family practice graduates from rural, to regional, to metropolitan areas. Relatively more males performed procedures; however, more females did IUD insertion and obstetrical care practice. Except for a few exceptions, a similar proportion of male and female graduates in rural practice performed procedures. CONCLUSIONS: The procedural and obstetrical care pattern of practice differs between family practice graduates in rural and urban areas, as well as between male andfemale graduates. Family practice residency programs should consider additional training in procedural skills for those planning to practice in rural areas, as well as encourage females to become skilled at performing procedures relevant to family practice.

Adult↗
PubMed2002

Differences in length of stay between coronary bypass and valve procedures.

OBJECTIVE: Emphasis on cost reduction, national standardization of medical care, and quality improvement initiatives have led to reduced postoperative hospital stays after cardiac surgery. The present study was designed to verify the observation that valve patients have longer lengths of stay than bypass patients and to identify possible reasons. METHODS: The inpatient records of 26 consecutive patients who underwent valve procedures at our institution were reviewed and compared with the records of 25 consecutive coronary bypass patients. Patients whose postoperative stays were longer than 2 weeks were considered outliers and were excluded from further review. RESULTS: A total of 51 records were reviewed. There were no in-hospital deaths. Five patients in the valve group and two in the bypass group were excluded because of lengths of stay exceeding 14 days. The mean length of stay for the valve procedure group was 7.7 +/- 2.1 days, vs. 5.7 +/- 1.5 days for the coronary bypass group (p = 0.001). There were no reoperative procedures in either group, and the number of emergency procedures was higher in the bypass group. Both groups were similar with respect to age and sex. The frequencies of associated pulmonary disease and malnutrition were similar. Bypass patients had a higher incidence of vascular disease and/or renal disease. Sixty percent of valve procedures were complex operations. Valve patients had a higher incidence of cardiopulmonary bypass times exceeding 3 hours and more postoperative bleeding complications. Although not statistically significant, valve procedure patients were more likely to require prolonged mechanical ventilatory and circulatory support postoperatively. The frequencies of thrombotic complications, neurological complications, and nosocomial infections were similar for both groups. Postoperatively, more valve patients had atrial fibrillation, and all of them received anticoagulation. Multivariate analysis revealed only two factors to be significant with regard to length of stay: valvular surgery and the duration of postoperative ventilatory support. CONCLUSIONS: Cardiac valve procedures are associated with prolonged lengths of stay compared with isolated coronary bypass procedures. Despite recent trends toward earlier operation, valve patients tended to present with advanced disease. More than half of the valve patients required complex surgical procedures. This is reflected in longer bypass times, increased bleeding complications, and more postoperative support. The proportion of valvular surgery patients should be considered when analyzing lengths of stay for cardiac surgery cohorts.

Coronary Artery Bypass↗
PubMed2003

Ingestion of ethanol just prior to sleep onset impairs memory for procedural but not declarative tasks.

STUDY OBJECTIVES: The aim of Experiment 1 was to determine if moderate ethanol consumption at bedtime would result in memory loss for recently learned cognitive procedural and declarative tasks. The aim of Experiment 2 was to establish that the memory loss due to alcohol consumption at bedtime was due to the effect of alcohol on sleep states. DESIGN: In Experiment 1, participants were asked to learn a cognitive procedural task and a declarative task in the evening. Then, either the same evening or 2 nights later, they were asked to drink ethanol (0.7g/kg). Sleep was monitored for 3 days and re-testing of the tasks was done on the eighth day after training at the same time of day. In Experiment 2, subjects were asked to learn a cognitive procedural task (Tower of Hanoi) and a motor procedural task (Pursuit Rotor) in the late afternoon. Then one group was asked to drink ethanol (0.9 g/kg) right after task acquisition (5 hours before bed), while the other was asked to drink the same dose of ethanol just prior to bedtime. Re-testing was done 8 days later at the same time of day. PARTICIPANTS: Subjects in Experiment 1 were 15 college students between the ages of 19 and 24 that appeared to be in good health and were relatively naive in terms of drinking alcohol. Subjects in Experiment 2 were 13 college students in the same age range. These subjects were considered to be more experienced drinkers than subjects in Experiment 1 but were not judged to be heavy drinkers. MEASUREMENTS AND RESULTS: In Experiment 1, the alcohol ingestion resulted in memory loss for the cognitive procedural task but not the declarative task. Further, the effect was seen when alcohol ingestion occurred the same day or 2 days after the end of acquisition. In Experiment 2, alcohol ingestion at bedtime impaired memory for the cognitive procedural and motor procedural tasks. By contrast, alcohol ingestion in the afternoon, immediately after the acquisition of these two tasks, did not impair memory. There were clear changes in the nature of rapid eye movement (REM) sleep as a result of evening alcohol ingestion. In Experiment 1, the number of REMs and number of minutes of REM in the first half of the night were reduced. In Experiment 2, the reduction was in REM densities in the first half of the night. CONCLUSIONS: Moderate doses of ethanol can modify the REM sleep architecture by reducing the number of REMs and/or REM densities as well as minutes of REM sleep, particularly in the first half of the night. These modifications result in memory impairment for recently learned cognitive procedural material. Alcohol may also have a subtle effect on Stage 2 sleep as well, since memory for a Stage 2 sensitive motor procedural task was also impaired.

Administration, Oral↗
PubMed2004

Audit of diagnostic and interventional craniocervical catheter angiographic procedures at the Singapore General Hospital.

INTRODUCTION: Catheter angiography is an established imaging modality of evaluating cerebral and head and neck vascular diseases. It is, however, an invasive procedure with a small risk of complications. The aim of our study was to evaluate the prevalence of peri-procedural complications in a local hospital setting. MATERIALS AND METHODS: A total of 88 patients underwent diagnostic and interventional craniocervical procedures over 6 months in our department. The casenotes of 83 patients were retrospectively reviewed for complications arising from a total of 99 procedures carried out. RESULTS: A new focal neurological deficit developed in 3 different patients after a procedure, giving a prevalence of 3.0%. All these occurred in diagnostic procedures and were permanent deficits with correlative computed tomography (CT) or magnetic resonance (MR) imaging findings of acute cerebral infarction. All these occurred in high-risk patients who had severe underlying cerebrocarotid vascular compromise. There was 1 case of contrast medium-induced nephropathy (1.0%), occurring in a patient with pre-existing renal impairment. Local complications included 1 case of iatrogenic external iliac artery dissection (1.0%) and 5 cases (5.1%) of small and uncomplicated puncture site groin haematomas. CONCLUSION: The most significant complication associated with a craniocervical angiographic procedure was the development of post-procedural stroke in patients with significant preexisting cerebrocarotid vascular compromise. In the absence of this risk factor, craniocervical catheter angiography is a relatively safe procedure.

Adolescent↗