K J Rothman. Oxford University Press, 2002, $US29.95, £19.95, pp 223. ISBN 0-19-513554-7.
Making Sense of Data: A Self-Instruction Manual on the Interpretation of Epidemiological Data. 3rd Edition.
J H Abramson, Z H Abramson. Oxford University Press, 2001, $US39.95, £27.50, Pp 367. ISBN 0-19-508969-3.
The first edition of Ken Rothman’s Modern Epidemiology so indelibly stamped the future of epidemiology with his vision that the book’s initials—“ME”—spoke volumes.1 When Sander Greenland joined as co-editor for the second edition,2 the acronym “ME2” was immediately appropriate. Now comes “mini-ME”, an attempt to take the key messages of Modern Epidemiology and package them in readable format accessible to anyone who desires an introductory course in epidemiology.
The good news is that the repackaging is a success. Rothman has succeeded in preserving the intellectual content of his vision while making it much more accessible than in his two previous volumes. …
• This chapter provides a brief description of various techniques that can be employed to provide analgesia following abdominal surgery including epidurals, spinals, rectus sheath catheters, transversus abdominus plane block, ilioinguinal/iliohypogastric block and paravertebral block. • Epidural analgesia represents the main technique employed in the United Kingdom and produces a quality of analgesia against which all other techniques are judged. A recent national audit reinforced epidurals excellent safety profile but also noted the greatest proportion of complications arose in the colorectal group. • Recent attention to enhanced recovery programs has encouraged clinicians to adopt alternative techniques that enable rapid mobilization and whilst some results are encouraging, further work is required to assess these techniques before widespread adoption can be recommended. • Postoperative hypotension can be exacerbated by the choice of analgesia technique and may influence oxygen delivery to a surgical anastomosis.
Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken.A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses.A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac.This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.
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