AudioAbstracts

Outcomes of Daytime Procedures Performed by Attending Surgeons after Night Work

Anand Govindarajan, M.D., David R. Urbach, M.D., Matthew Kumar, M.Sc., Qi Li, M.Sc., Brian J. Murray, M.D., David Juurlink, M.D., Ph.D., Erin Kennedy, M.D., Ph.D., Anna Gagliardi, Ph.D., Rinku Sutradhar, Ph.D., and Nancy N. Baxter, M.D., Ph.D.

N Engl J Med 2015; 373:845-853 DOI: 10.1056/NEJMsa1415994

August 27, 2015

Background: Sleep loss in attending physicians has an unclear effect on patient outcomes. In this study, researchers examined the effect of medical care provided by physicians after midnight on the outcomes of their scheduled elective procedures performed during the day.

Methods: The study authors conducted a population-based, retrospective, matched-cohort study in Ontario, Canada. Patients undergoing 1 of 12 elective daytime procedures performed by a physician who had treated patients from midnight to 7 a.m. were matched in a 1:1 ratio to patients undergoing the same procedure by the same physician on a day when the physician had not treated patients after midnight. Outcomes included death, readmission, complications, length of stay, and procedure duration. Generalized estimating equations were used to compare outcomes between patient groups.

Results: The authors included 38,978 patients, treated by 1448 …

Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised controlled trial

Andrew Appelboam, FRCEM, Adam Reuben, FRCEM, Clifford Mann, FRCEM, James Gagg, FRCEM, Prof Paul Ewings, PhD, Andrew Barton, MSc, Trudie Lobban, MRCP, Mark Dayer, FRCP, Jane Vickery, MSc, Prof Jonathan Benger, MD on behalf of the REVERT trial collaborators

The Lancet. 2015; DOI:10.1016/S0140-6736(15)61485-4

Published Online: 24 August 2015

Background: The Valsalva manoeuvre is an internationally recommended treatment for supraventricular tachycardia, but cardioversion is rare in practice (5–20%), necessitating the use of other treatments including adenosine, which patients often find unpleasant. Researchers assessed whether a postural modification to the Valsalva manoeuvre could improve its effectiveness.

Methods: The study authors did a randomised controlled, parallel-group trial at emergency departments in England. They randomly allocated adults presenting with supraventricular tachycardia (excluding atrial fi brillation and flutter) in a 1:1 ratio to undergo a modified Valsalva manoeuvre (done semi-recumbent with supine repositioning and passive leg raise immediately after the Valsalva strain), or a standard semi-recumbent Valsalva manoeuvre. A 40 mm Hg pressure, 15 s standardised strain was used in both groups. Randomisation, stratified by centre, was done centrally and independently, with allocation with serially numbered, …

Noninvasive Prenatal Testing and Incidental Detection of Occult Maternal Malignancies

Importance: Understanding the relationship between aneuploidy detection on noninvasive prenatal testing (NIPT) and occult maternal malignancies may explain results that are discordant with the fetal karyotype and improve maternal clinical care.

Objective: To evaluate massively parallel sequencing data for patterns of copy-number variations that might prospectively identify occult maternal malignancies.

Design, Setting, and Participants: Case series identified from 125 426 samples submitted between February 15, 2012, and September 30, 2014, from asymptomatic pregnant women who underwent plasma cell-free DNA sequencing for clinical prenatal aneuploidy screening. Analyses were conducted in a clinical laboratory that performs DNA sequencing. Among the clinical samples, abnormal results were detected in 3757 (3%); these were reported to the ordering physician with recommendations for further evaluation.

Exposures: NIPT for …