A Comparative Study of Tracheal Diameter in Caucasian and Chinese Patients

Ethnicity may be considered a factor when considering what size endotracheal tube to insert. In particular it has been suggested that Chinese patients have a smaller tracheal diameter, justifying the selection of smaller endotracheal tubes. We systematically evaluated transverse tracheal diameters in Chinese and Caucasian patients, utilising archived computer tomography images. A convenience sample of 100 Caucasian patients from Australia was compared with 100 Chinese patients from Hong Kong. Patients over 18 years of age who had undergone a computerised tomography scan of the neck and thorax, and also had accurate body height and weight recorded, were studied. The mean transverse diameter of the trachea measured at three levels was similar between the Chinese and Caucasian patients. At the narrowest measurement point, the immediate subcricoid transverse diameter, the unadjusted mean difference between male Chinese and Caucasian patients was small (1 mm, standard deviation 0.83 mm, P=0.01), and similarly small between female Chinese and Caucasian patients (1.5 mm, standard deviation 0.8 mm, P <0.01). Multivariate analysis demonstrated only a small influence related to ethnicity (12% relative contribution to the overall variance [R2] of the model), but substantial influence of height (40%) and sex (41%). Our findings do not support the practice of routinely selecting a smaller endotracheal tube size for Chinese patients on the basis that there is a difference related to the Chinese ethnic phenotype. Considerations regarding choice of endotracheal tube size should rather focus on patient sex and height.

Abnormal frontostriatal connectivity in adolescent-onset schizophrenia and its relationship to cognitive functioning

BACKGROUND

Adolescent-onset schizophrenia (AOS) is associated with cognitive impairment and poor clinical outcome. Cognitive dysfunction is hypothesised, in part, to reflect functional dysconnectivity between the frontal cortex and the striatum, although structural abnormalities consistent with this hypothesis have not yet been demonstrated in adolescence.

OBJECTIVE

To characterise frontostriatal white matter (WM) tracts in relation to cognition in AOS.

DESIGN

A MRI volumetric and diffusion tensor imaging study.

PARTICIPANTS

Thirty-seven AOS subjects and 24 age and sex-matched healthy subjects.

OUTCOME MEASURES

Using probabilistic tractography, cortical regions with the highest connection probability for each striatal voxel were determined, and correlated with IQ and specific cognitive functions after co-varying for age and sex. Fractional anisotropy (FA) from individual tracts was a secondary measure.

RESULTS

Bayesian Structural Equation modeling of FA from 12 frontostriatal tracts showed processing speed to be an intermediary variable for cognition. AOS patients demonstrated generalised cognitive impairment with specific deficits in verbal learning and memory and in processing speed after correction for IQ. Dorsolateral prefrontal cortex connectivity with the striatum correlated positively with these measures and with IQ. DTI voxel-wise comparisons showed lower connectivity between striatum and the motor and lateral orbitofrontal cortices bilaterally, the left amygdalohippocampal complex, right anterior cingulate cortex, left medial orbitofrontal cortex and right dorsolateral prefrontal cortex.

CONCLUSIONS

Frontostriatal dysconnectivity in large WM tracts that can explain core cognitive deficits are evident during adolescence. Processing speed, which is affected by alterations in WM connectivity, appears an intermediary variable in the cognitive deficits seen in schizophrenia.

Bladder management and risk of bladder stone formation in spinal cord injured patients

PURPOSE

We determined by statistical analysis whether method of management is associated with risk of bladder stone formation in spinal cord injured patients.

MATERIALS AND METHODS

A retrospective cohort study was performed of 457 patients admitted to Stoke Mandeville Hospital Spinal Injuries Center between 1985 and 1990 with more than 6 months of followup. Analysis included Cox regression and Poisson regression.

RESULTS

Relative to those patients treated with intermittent self-catheterization, the hazard ratio was 10.5 (p <0.0005, 95% confidence interval 4.0-27.5) for patients with suprapubic catheters and it was 12.8 (p <0.0005, 95% confidence interval 5.1-31.9) for those with indwelling urethral catheters. The absolute annual risk of stone formation in patients with a catheter was 4% compared with 0.2% for those on intermittent self-catheterization. However, having formed a stone, the risk of forming a subsequent stone quadrupled to 16% per year. Bladder stones were no more likely to form in patients with suprapubic catheters compared to those with indwelling urethral catheters (hazard ratio 1.2, p = 0.6).

CONCLUSIONS

In spinal cord injured patients long-term catheterization is associated with a substantial increased risk of bladder stone formation. This increased risk occurs independently of age, sex and injury level. Degree of injury (complete or incomplete) was considered in the model. Catheter type (suprapubic or urethral) did not change this risk significantly if at all.

Information provision to cancer patients: a practical example of identifying the need for changes in practice from the Dorset Cancer Centre

The aim of this study was to produce a patient-centred information strategy based on the results of a local survey of cancer patients about the information they receive and their information needs. An anonymous patient survey was distributed at the Dorset Cancer Centre, Poole Hospital, the regional cancer centre for Dorset, in the South-west of England. All patients attending the Cancer Centre during 1 week in September 1999 were asked to complete a questionnaire on patient experience of the Cancer Centre, information sources, receipt and quality of Centre information, and perception of information requirements. Two hundred and eighty-two were returned. Most respondents had accessed information from a number of sources. Written Cancer Centre information had been given to most patients, and was generally perceived to be useful, understandable and timely. However, most patients had received information 'all at once', from a single professional group, and a notable proportion did not recall discussing it with staff. Furthermore, most patients indicated that information should also be provided to families and professionals. Seven items of information were selected as valuable by the majority of patients, with many others listed. There was a great deal of satisfaction with the current content of the patient information provided. However, the distribution system was shown to be in need of improvement. A new information strategy has been developed in the light of these findings.

An education programme for people with cancer

Evidence suggests that cancer patients want support, information and to be involved in treatment decisions. A course designed in the USA aims to help cancer patients learn more about the disease and become an informed part of the therapeutic team. The introduction of a similar course at one UK centre suggested that it is an effective way of informing and supporting people.

Colorectal cancer. Part 3: Patient care

Treatment for colorectal cancer will almost inevitably result in toxicity. Roy's model is ideal to enable nurses to monitor patients' physical and psychological condition. Patients need information about toxicity so that they report it promptly.

Colorectal cancer. Part 2: Treatment

Treatment choice for patients with colorectal cancer will depend on the stage of disease and the patient's prognosis at the time of presentation. The primary treatment for potentially curable cancer is surgical resection. Radiotherapy is often used in conjunction with surgery, while chemotherapy may be used in all stages of the disease.

Intravenous therapy: current practice and nursing concerns

The field of intravenous (i.v.) therapy has been subject to major change, with increasing numbers of nurses taking on the high profile, technical aspects of care. The transfer of previously medicalized tasks such as cannulation has been welcomed by nurses who are keen to develop practical skills in order to embrace the concept of holistic patient care. This literature review aims to clarify the role of the nurse in i.v. therapy, exploring cannulation as a specific issue. Legal and professional aspects are discussed in terms of extended/expanded practice and practical aspects in terms of i.v. access and maintenance. Discussion focuses on a team approach to the management of i.v. therapy. Finally, the nursing process is applied to an i.v. therapy scenario. Exploration of the nursing issues enables practitioners to justify the expansion of individual practice in order to deliver holistic care and improve standards of service. The review concludes that nurses cannot afford to lose sight of the caring component of their role as a result of immersion in the culture of technical skill acquisition.

Small-area population estimates: a review of methods used in Britain in the 1990s

"Population estimates are usually produced by local government administrations in Britain, for each small area within their authority. Increasing interest has been shown by commerce and by central government. Five main methods are identified: apportionment, ratio change, additive change, cohort survival, and local censuses. Estimation strategies also vary according to available data, the detail in which a population is estimated, and the precise combination of elements chosen from one or more of the main methods. The use of methods at the beginning of the 1990s is surveyed in this paper, and examples given. The accuracy of each main method is quantified from empirical data collated by the Estimating with Confidence project. Likely developments towards the end of the 1990s are reviewed."

Cognitive functioning in long-term survivors of high-grade glioma

In a pilot study, two groups of patients with malignant glioma underwent sequential neuropsychological evaluations after successful tumor treatment. Group 1 included nine patients treated from 1981 to 1985; all patients received irradiation and eight underwent chemotherapy. The baseline neuropsychological assessment was performed 1 to 63 months after tumor diagnosis, with follow-up evaluations at irregular intervals over the next 3 to 7 years. Six patients in Group 1 exhibited impairment on most measures at baseline; subsequently, two patients developed profound cognitive impairment. Initially, three patients functioned in the average range on most tasks; thereafter, two deteriorated on one measure each. Group 2 was ascertained prospectively and included 16 patients treated from 1985 to 1987, all of whom received irradiation and chemotherapy. The first evaluation was performed 18 months after diagnosis, then every 6 months for 2 years, and then yearly. Compared to a control group, those in Group 2 had significant cognitive impairment at baseline. Cognitive performance did not change over the next 12 months in 10 patients who remained free of tumor, but within 2 years of baseline testing, deterioration on specific tasks was evident in two of seven disease-free survivors. When last tested, five of six disease-free survivors had deteriorated on one or more measures. Unlike Group 1, severe global cognitive impairment was not seen, perhaps because Group 2 was followed for a shorter time. Verbal and nonverbal composite scores derived from intelligence quotient (IQ) tests showed less impairment at baseline than did other measures and were more likely to remain stable subsequently. Verbal memory and sustained attention were the most impaired at baseline, and verbal learning and flexibility in thinking showed the greatest tendency to decline over time. Cognitive functioning in survivors of high-grade glioma is best measured and monitored by tests that probe a broader spectrum of abilities than IQ. Neuropsychological measures used in this analysis lacked sensitivity at the lower end of the impaired range. Future studies should use tests better able to discern cognitive differences at low performance levels. Based on this experience, the authors conclude that most long-term survivors of high-grade glioma will have significant cognitive difficulties, usually evident by the first assessment; some patients will develop profound impairment years later, and few are capable of fully independent living.