Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery

Guidelines are presented for the organisational and clinical management of anaesthesia for day-case surgery in adults and children. The advice presented is based on previously published recommendations, clinical studies and expert opinion.

A demographic and health profile of gay and bisexual men in a large Canadian urban setting

The purpose of this study was to provide both a population estimate and a socio-economic and health profile of gay and bisexual men living with HIV/AIDS in a large Canadian urban centre. A random telephone survey was used to determine the number of men in the study area over the age of 20 identifying as gay or bisexual and to characterize their health and socio-economic status. Out of a total of 1,176 completed interviews, 300 males described themselves as gay or bisexual. Projecting this figure on recent census data we estimated the number of men identifying as gay or bisexual in this region of downtown Vancouver, BC, at 5,100. Among these men we found an HIV prevalence rate of 16%, with those who reported a positive serostatus being less likely to be employed full time and more likely to earn less than $20,000 per year. In terms of clinical characteristics, HIV-positive men had a median CD4 cell count of 397 cells/mm(3) and a median viral load of less than 500 copies/ml. Eighty-three per cent of the HIV-positive respondents were on antiretroviral therapy and the median number of drugs taken by these men was three. In summary, random surveys of populations affected by this epidemic are important for policy makers, clinicians and persons caring for those with HIV/AIDS as they paint a clearer picture of who is being affected and help to identify areas where increased services are needed.

Genetic transformation of Trametes versicolor to phleomycin resistance with the dominant selectable marker shble

We have developed a stable, DNA-mediated transformation system for the white-rot basidiomycete Trametes versicolor based on the dominant selectable marker shble (phleomycin resistance). We employed a vector containing the selectable marker under control of expression sequences from the basidiomycete Schizophyllum commune and a polyethylene glycol/ CaCl2 protoplast-fusion technique to introduce the transforming DNA. This transformation system generated stable phleomycin-resistant transformants at a frequency of four to seven transformants/microg of transforming DNA.

Modern antiretroviral therapy improves life expectancy of gay and bisexual males in Vancouver's West End

This study was undertaken to evaluate the life expectancy of gay and bisexual men in the West End of Vancouver, British Columbia during two time periods. Mortality data for males were obtained for the periods 1990 to 1992 and 1995 to 1997 and population estimates were obtained from the 1991 and 1996 Census. The proportion of the male population over 20 years of age estimated to be gay and bisexual was derived from a random telephone survey. Mortality patterns were assessed by comparing changes in life expectancy at age 20 years between the periods, and by examining the life expectancy lost attributed to HIV/AIDS. Between the periods there was 3.8 +/- 3.4 years increase in life expectancy among gay and bisexual men. At exact age 20 years, life expectancy increased from 37.0 +/- 3.5 years during the period 1990 to 1992 to 40.8 +/- 2.4 years during the period 1995 to 1997. The loss of life expectancy attributed to HIV/AIDS at this age was 13.8 +/- 3.9 during the first period and 9.8 +/- 3.6 years during the second period. This gain is most likely the result of the improved efficacy of antiretroviral therapies.

Adult attachment processes: individual and couple perspectives

This paper overviews a new approach to understanding the range of difficulties experienced in close attachment relationships in adulthood. Drawing on the work of Bowlby, four prototypic adult attachment patterns are defined in terms of the intersection of two underlying dimensions, the positivity of the person's self-image and the positivity of the person's image of others (Bartholomew, 1990; Bartholomew & Horowitz, 1991). The distinct interpersonal difficulties associated with each attachment pattern are described. Findings are presented indicating that individual differences in attachment have implications for the quality of adults' romantic relationships, and that attachment theory may be helpful in understanding violent spousal relationships. Five current issues in the study of adult attachment are addressed: the stability of attachment patterns, the associations between attachment and general personality factors, the relative merits of categorical and prototype assessments of attachment, the identification of multiple attachments in adulthood, and the specificity of adult attachment patterns. It is suggested that the four-category model of adult attachment is especially sensitive to the range and complexity of attachment-related difficulties experienced in adulthood.

Social-emotional adjustment and patterns of alcohol use among young adults

Individual differences in social-emotional adjustment, jointly defined by levels of distress and self-restraint, were used to evaluate (a) patterns of alcohol use, (b) reasons for use, and (c) associated problems in two college samples of young adults (N = 287 and N = 215). As hypothesized, low self-restraint was associated with high levels of alcohol use, drinking to increase positive affect, and high levels of alcohol-related problems. Subjective distress was not related to levels of use; however, it was associated with drinking to escape negative moods and social discomfort and with excessive alcohol-related problems. Both high distress and low self-restraint predicted problem drinking beyond what could be accounted for by quantity or frequency of alcohol use or by peers' use. Within Weinberger and Schwartz's (1990) six-group typology, reactive individuals (high distress-low restraint) were especially likely to be problem drinkers, even when compared to groups with equivalent alcohol use. In a separate study, knowledgeable peers' reports validated the differences between reactive and repressive individuals, the two groups most likely to have inaccurate self-reports.

Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy

The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.

Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy

The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.

Attachment styles among young adults: a test of a four-category model

A new 4-group model of attachment styles in adulthood is proposed. Four prototypic attachment patterns are defined using combinations of a person's self-image (positive or negative) and image of others (positive or negative). In Study 1, an interview was developed to yield continuous and categorical ratings of the 4 attachment styles. Intercorrelations of the attachment ratings were consistent with the proposed model. Attachment ratings were validated by self-report measures of self-concept and interpersonal functioning. Each style was associated with a distinct profile of interpersonal problems, according to both self- and friend-reports. In Study 2, attachment styles within the family of origin and with peers were assessed independently. Results of Study 1 were replicated. The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.

Attachment styles among young adults: A test of a four-category model

A new 4-group model of attachment styles in adulthood is proposed. Four prototypic attachment patterns are defined using combinations of a person's self-image (positive or negative) and image of others (positive or negative). In Study 1, an interview was developed to yield continuous and categorical ratings of the 4 attachment styles. Intercorrelations of the attachment ratings were consistent with the proposed model. Attachment ratings were validated by self-report measures of self-concept and interpersonal functioning. Each style was associated with a distinct profile of interpersonal problems, according to both self- and friend-reports. In Study 2, attachment styles within the family of origin and with peers were assessed independently. Results of Study 1 were replicated. The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.

Prilocaine for Bier's block: how safe is safe?

Prilocaine has become the agent of choice for Bier's block (or intravenous regional anaesthesia--IVRA), since 1983 when the product licence of bupivacaine was withdrawn for this purpose owing to fatal or serious complications. No serious complications have been documented in the literature relating to prilocaine in IVRA and we have conducted a survey within the U.K. which indicates that about 45,000 Bier's blocks have been carried out with prilocaine without convulsion, arrhythmia or fatality. This includes cases of accidental cuff deflation or even failure to inflate the cuff, resulting in bolus doses to the circulation. Prilocaine has now been in use since 1964 and the Committee for Safety of Medicines has no deaths on record over a 25-year period. (This includes other types of regional anaesthesia). We suggest that intravenous regional anaesthesia using prilocaine is a safe technique. It is highly unlikely that fatalities will occur, provided present guidelines are adhered to. We can find no reason to limit its use to trained anaesthetists only, but would recommend that a strict protocol is adhered to.

An educational booklet diminishes anxiety in parents whose children receive total parenteral nutrition

A major cause of anxiety in parents of hospitalized children is insufficient information about hospital procedures. In an effort to determine the extent to which parental anxiety could be diminished and knowledge and satisfaction enhanced in regard to total parenteral nutrition (TPN), we developed a booklet that describes the mechanics of TPN administration and related procedures. When informal discussions were held between parents and members of the nutritional support team during four alternating periods (every five to six months), parents of first-time recipients of TPN either did not receive the booklet (period 1, n = 20; period 3, n = 30) or received it (period 2, n = 23; period 4, n = 27). Within one week of TPN initiation, parents in both groups completed the Spielberger State-Trait anxiety scale, an attitude questionnaire, and a quiz on TPN. No differences between groups were found in ethnic background, socioeconomic status, severity of illness, age of children, or route of TPN administration. Predisposition to anxiety was also similar between the groups. In contrast, acute situational anxiety was significantly greater in the group with no booklet than in the booklet group. Parents in the no-booklet group demonstrated less comfort in the care of their children and less knowledge about TPN than did the booklet group. Written information provided to parents decreased their anxiety and increased satisfaction with patient care more successfully than did verbal communication. Such a booklet may reduce parentally induced anxiety in the child and facilitate parent-hospital staff interactions.