Practice Aids in Transplants

Practice makes perfect for hospitals, and this appears to be especially true for those that perform liver transplants.

A study looked at all liver transplants performed in the United States and found that those hospitals that do the operations infrequently have higher death rates. The researchers recommended that such data be made widely available to the public.

Erick B. Edwards and others from the United Network for Organ Sharing in Richmond reviewed all 9,623 liver transplants in the United States from 1987 to 1994. The results were published in today's New England Journal of Medicine.

They found that 52 unnamed hospitals did more than 20 liver transplants a year, while 47 did fewer. The yearly death rate was 20 percent in the high-volume centers and 26 percent in the ones with low volume. Thirteen centers, all of which had low volume, had annual death rates above 40 percent. At one hospital, the death rate was 100 percent.

Unneeded-Treatment Ethics

Is it ethical for doctors in training to practice unneeded procedures on the nearly dead? A survey of Yale medical residents found that about one-third believe that in one instance, at least, this is a reasonable thing to do.

The survey asked residents whether it is appropriate to practice inserting an unnecessary catheter into a vein of someone who has undergone 20 minutes of unsuccessful CPR. Typically, such resuscitation efforts stop after a half-hour because the patient is presumed dead.

One-third said such practice is sometimes appropriate. One-quarter said they have seen it done, and 16 percent said they have done it themselves.

However, those who conducted the survey disagreed.

In a report on the survey in today's New England Journal of Medicine, Lauris C. Kaldjian and others from Yale wrote that such unnecessary treatment "is inconsistent with current standards of medical ethics that are based on principles of beneficence, nonmaleficence and respect for patients' autonomy."

Chewing (Away) the Fat

Could the chewing gum diet be next? There's evidence it really works.

A team of researchers calculated that chewing gum burns up about 11 calories an hour. That may not sound like much, but the researchers figured that someone who chews gum every waking hour for a year and does nothing else differently will lose about 11 pounds.

The calculations, made by James Levine of the Mayo Clinic and others, were published in today's New England Journal of Medicine.

The researchers wanted to make sure all seven volunteers, wearing face masks, chewed for 12 minutes with equal vigor. They used a metronome to set the pace.