To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm.Design: A before-and-after interventional trial (12 months preintervention and 12 months postintervention).Setting: A tertiary care, academic children's hospital.Participants: Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards.Intervention: Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas.Outcome Measures: Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory ar-rests on the wards and agreement between independent reviewers on categorization of CPAs.

In the present study, we examined a German sample to determine whether anxiety symptoms during pregnancy had an impact on the duration and method of childbirth. Data of N = 88 women recruited at the Heidelberg University Hospital were used in the analyses. Prepartum anxiety symptoms were assessed with the State-Trait Anxiety Inventory (STAI, general anxiety) and the Pregnancy Related Anxiety Questionnaire (PRAQ-R, pregnancy-specific anxiety). Obstetric outcome was taken from birth records and operationalized by two parameters: the total duration of birth (dilation and fetal expulsion) and the incidence of pregnancy or birth-related interventions (ventouse, planned, and unplanned Cesarean section). The data show that childbirth-specific anxiety assessed by the PRAQ-R is an important predictor of total birth duration. In contrast, general anxiety measured by the STAI had no effect. The incidence of birth intervention was explained by parity. Anxiety, however, had no predictive value. In addition to medical factors, childbirth-specific anxiety during pregnancy plays an important role in the process of childbirth. The findings of the present study point to the need of implementing psychological interventions to reduce childbirth-specific anxiety and thereby positively influencing birth outcome.

Nearly half of pediatric emergency visits are for nonurgent care. Racial disparities in use of the ED for nonurgent care may be related to patient's proximity to the hospital. Patterns of use are stable across the 3 years. Further study is needed to identify mutable factors in emergency care use.

Purpose: To compare the efficacy of ropivacaine 7.5 mgml -~ with bupivacaine 5.0 mg'ml -~ for subclavian perivascular brachial plexus block. Methods: After informed consent, 104 ASA I-III adults participated in a randomized, double-blind, multi-center trial to receive 30 ml of either ropivacaine 7.5 mg'ml -~ or bupivacaine 5.0 mg.ml -I for subclavian perivascular brachial plexus block prior to upper limb surgery. Onset and duration of sensory and motor block in the distribution of the axillary, median, musculo-cutaneous, radial and ulnar nerves were assessed. Results: Onset times and duration of sensory and motor block were similar between groups. Mean duration of analgesia for the five nerves was between I 1.3 and 14.3 hr with ropivacaine and between 10.3 and 17. I hr with bupivacaine. Quality of muscle relaxation judged as excellent by the investigators was not significantly different (ropivacaine -35/49, bupivacaine -30/49). The median time to first request for analgesia was comparable between the two groups (I I-12 hr). One patient developed a grand mal seizure shortly after receiving bupivacaine and recovered consciousness within 30 min. There were no serious adverse events in the ropivacaine group. Conclusions: Thirty ml ropivacaine 7.5 mg.ml -~ (225 mg) produced effective and well tolerated brachial plexus block of long duration by the subclavian perivascular route. In this study, the results were similar to those of 30 ml bupivacaine 5.0 mg-ml -I.Objec'df: Comparer I'efficacit6 de 7,5 mg-ml -~ de ropivaca~fne avec 5,0 mg'ml-~de bupivacai'ne dans le cas d'un blocage p&ivasculaire sous-clavier du plexus brachial. M&hode : Ayant ~t6 bien inform&, 104 adultes ASA 1411 ont consenti/~ participer ~ un essai multicentrique, randomis6 et en double aveugle et ont regu 30 ml de ropivaca'ine 7,5 mg'ml -~ ou de bupivacai'ne 5,0 mg'ml -I pour un blocage p&ivasculaire sous-clavier du plexus brachial, pr&6dant une intervention au membre sup&ieur. On a not~ le d6but et la dur~e du blocage sensitif et moteur selon la distribution des nerfs axillaire, m6dian, muscuIo-cutan6, radial et cubital. REsultats : Le d6but et la dur6e du blocage sensitif et moteur ont 6t6 similaires dans les deux groupes. La dur& moyenne de I'analg&ie pour les cinq nerfs se situait entre I 1,3 et 14,3 h avec la ropivaca'ine et entre 10,3 et 17, I h avec la bupivacai"ne. La qualit~ du rel~chement musculaire, jugEe excellente par les chercheurs, n'a pas pr&en-t6 de diff&ence intergroupe significative (ropivaca'ine -35/49, bupivacai"ne -30/49). Le temps moyen &oul6 jusqu'~ la premi&e demande d'analg&ique a &6 comparable 6galement (I I -12 h). Un patient a subi une crise d'6pilepsie peu apr& avoir regu la bupivaca'ine et est redevenu conscient en moins de 30 min. II n'y a pas eu d'incident d~favorable important dons le groupe ropivaca~ine. Conclusion : Trente millilitres de ropivaca'ine 7,5 mg-ml -t (225 mg) ont produit un blocage du plexus brachial effcace, de Iongue dur& et bien to16r6, par voie p&ivasculaire sous-clavi&e. Les r6sultats ont 6t6 simil...