British Medical Journal articles from November 2003

British Medical Journal archives from November 2003

Only a third of people with chronic fatigue have chronic fatigue syndrome.(POEM*)
November 29, 2003... Question How common is chronic fatigue syndrome among patients with chronic fatigue? Synopsis In this cross sectional British study, patients aged 16 to 75 years with fatigue lasting more than six months were evaluated with the Centers...

The NHS experiment.(National Health Service)
November 29, 2003... Ownership and integration--two attributes that typify Kaiser Permanente, a healthcare organisation that provides managed care to 8.2 million Americans. Last year's BMJ paper by Richard Feachem and colleagues compared the NHS unfavourably with...

What do we gain from the sixth coronary heart disease drug? Not much: guidelines must consider cost effectiveness.(Editorial)
November 29, 2003... From air travel to patient safety to coronary heart disease prevention, people strive to reduce risk to zero. We know that zero risk is unattainable, yet we pursue perfection. It may be useful to hold perfection as an ideal, but there can be...

Risk factor scoring for coronary heart disease: prediction algorithms need regular updating.( )(Editorial)
November 29, 2003... Global risk assessment has become an accepted component of clinical guidelines and recommendations in cardiovascular medicine. The aim is to provide a valid estimate of the probability of a defined cardiovascular event over a period of five...

Is the NHS getting better or worse? We need better data to answer the question.( )(Editorial)
November 29, 2003... The NHS is a shambles, and you are too much of a coward to say so. This was the gist of an email I received from an NHS consultant a few weeks ago. I answered--weakly in his eyes--that I couldn't be sure that the NHS was collapsing. I met...

Lessons for the NHS from Kaiser Permanente: ownership and integration are the key.( )
November 29, 2003... Kaiser Permanente is a healthcare organisation providing managed care to 8.2 million Americans. It is widely admired for doing this in a cost effective way that is valued by both its members and its clinicians and has been closely studied...

Should we be screening for and treating amblyopia? Evidence shows some benefit.( )(Editorial)
November 29, 2003... In 1981 the award of the Nobel prize for medicine for the discovery of the pathophysiology of amblyopia marked a turning point in the management of children with this condition. (1) Recognition that early visual experience is essential for...

Treatments for heavy menstrual bleeding: guidelines improve prescribing practice but may not affect hysterectomy rates.(Editorial)
November 29, 2003... Heavy menstrual bleeding is a common cause of iron deficiency anaemia and may affect a woman's quality of life. Thirty per cent of women consider their menstruation to be excessive. (w1) In more than half of women with menorrhagia no obvious...

Report predicts 20 million AIDS orphans in Africa by 2010.(News)
November 29, 2003... The number of children left as orphans because their parents have died from AIDS related diseases in sub-Saharan Africa is expected to almost double--to 20 million--over the next seven years and could account for as many as 12% of all the...

Nearly 50 000 adults in the United Kingdom now have HIV.(News)
November 29, 2003... The number of people infected with HIV in the United Kingdom increased by almost 20% between 2001 and 2002, from 41 700 to 49 500, says a report published by the Health Protection Agency to mark world AIDS day, 1 December. Also, the...

UK doctors urge ban on smoking in public.(Brief Article)
November 29, 2003... The leaders of 13 royal colleges of medicine wrote to the Times this week calling for a ban on smoking in public places, including restaurants, pubs, and all other workplaces.

Australia boosts medical workforce.(Brief Article)
November 29, 2003... Australia plans to have another 1500 doctors working within three years, with almost half to come from overseas, after the federal government announced the biggest changes to the Medicare universal health insurance scheme since it was...

Welsh consultants agree contract.(Brief Article)
November 29, 2003... In Wales, 1381 (94%) consultants have voted in favour of a new contract, with 85 voting against; the turnout was 65%. The deal, which included a 37.5 hour rather than a 40 hour week, is considered more favourable than the deal agreed in...

Deputy chief medical officer appointed.(Fiona Adshead)(Brief Article)
November 29, 2003... Fiona Adshead, currently director of public health at Camden Primary Care Trust, London, has been appointed England's deputy chief medical officer responsible for public health.

Ecstasy to be tested as treatment for stress disorder.(post-traumatic stress disorder)(Brief Article)
November 29, 2003... Ecstasy (also known as MDMA) is to be tested early next year as a treatment for people with post-traumatic stress disorder. An ethics committee at the University of South Carolina has approved the proposed trial, two years after the Food and...

CHAI appoints chief executive.(Commission for Healthcare Audit and Inspection appoints Anna Walker)(Brief Article)
November 29, 2003... Anna Walker, currently director general of land use and rural affairs at the Department for Environment Food and Rural Affairs, will become chief executive of the Commission for Healthcare Audit and Inspection (CHAI) early in 2004.

Global efforts to control AIDS are "entirely inadequate".(News)(Brief Article)
November 29, 2003... Efforts to stem the world's AIDS epidemic are "entirely inadequate," warned the United Nations this week as it released figures showing that the number of people who became infected with HIV and died from AIDS hit record levels this year. ...

South Africa introduces world's largest AIDS treatment plan.(News)
November 29, 2003... The South African government has reversed its previous refusals to use antiretroviral drugs to treat AIDS and will introduce what is likely to be the world's largest comprehensive AIDS treatment plan. While President Thabo Mbeki was out...

NICE recommends faster, easier access to care for MS patients.(News)(National Institute for Clinical Excellence; multiple sclerosis)
November 29, 2003... Every patient who is suspected of having multiple sclerosis should be seen by a neurologist within six weeks of referral, and investigations should be completed within another six weeks. These are recommendations in the new guidelines of the...

Scientists find gene linking inherited breast and ovarian cancer to non-inherited cases.(News)(EMSY gene)
November 29, 2003... A new gene for breast and ovarian cancer has been identified, which explains the link between hereditary and "sporadic" (non-inherited) forms of these cancers. It has been known for some time that mutations in the BRCA1 and BRCA2 genes...

GMC admits failings that left Shipman's patients unprotected.(news roundup)(General Medical Council; Harold Shipman)(Brief Article)
November 29, 2003... The General Medical Council admitted last week a range of past failings but insisted that improvements to its procedures, along with revalidation and local clinical governance, should help ensure that unfit doctors are detected infuture. ...

Drug companies succeed in keeping payments to doctors secret.(news roundup)(Brief Article)
November 29, 2003... Lobbying by Australia's drug industry association, Medicines Australia, has persuaded the Australian Competition and Consumer Commission (ACCC) to scrap a proposal to require public disclosure of drug companies' sponsorship of doctors' travel...

Charity says its staff are put at risk by US military's description of itself as "humanitarian".(news roundup)(Medecins Sans Frontieres/Doctors Without Borders concerned about risk of terrorist bombing)(Brief Article)
November 29, 2003... The German head of Medecins Sans Frontieres has warned that the lives of doctors and nurses working in Iraq are being put at risk by the US military's decision to brand many of its own activities as humanitarian help. Ulrike von Pilar...

Foundation hospitals will be introduced into NHS despite Opposition.(news roundup)(Brief Article)
November 29, 2003... Foundation hospitals became law last week as the Health and Social Care Bill narrowly scraped through a hostile House of Lords and survived the largest Commons rebellion since Labour came to power. Just hours remained in the parliamentary...

MEPs approve stem cell research using human embryos.(news roundup)(Members of the European parliament)(Brief Article)
November 29, 2003... Members of the European parliament have paved the way for the European Union to fund medical research involving embryonic stem cells derived from surplus human embryos. The parliament's support for ending the existing moratorium has...

Neonatal deaths hamper India's infant mortality targets.(news roundup)(Brief Article)
November 29, 2003... India will be unable to achieve any substantial further drop in its infant mortality without first intensifying efforts to protect babies during their first four weeks of life, neonatologists told a conference in New Delhi last week. An...

Drug company pushes for all children under 2 to be vaccinated against pneumonia.(news roundup)(Wyeth-Ayerst Laboratories Div. )(Brief Article)
November 29, 2003... The pharmaceutical company Wyeth has launched a campaign to persuade the UK governments to extend the use of its children's pneumococcal vaccine to all children under the age of 2. Currently, the Department of Health recommends its use only...

Nitric oxide helps neonates with respiratory disorder.(news roundup)(respiratory distress syndrome)(Brief Article)
November 29, 2003... The use of inhaled nitric oxide in premature infants with the respiratory distress syndrome decreases the incidence of chronic lung disease and death, a new study has shown (New Engl J Med 2003;349:2099-107). Inhaled nitric oxide...

Mentally ill patients in central Europe being kept in padlocked, caged beds.(News)
November 29, 2003... Mentally ill patients in four central European countries are being kept in padlocked, caged beds despite condemnation of the practice by the European parliament and the United Nations, a patients' organisation said this week. In some...

Nuffield Trust praises ambitious NHS plans but calls for better monitoring.(news roundup)(National Health Service)
November 29, 2003... The Nuffield Trust this week praised the government for its comprehensive effort to improve the quality of care in the NHS but also called for the setting up of a centre to provide regular independent reports of NHS performance. Based on...

Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening.(Papers)
November 29, 2003... Abstract Objectives To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity. Design Randomised controlled trial of full...

Randomised controlled trial of smoking cessation intervention after admission for coronary heart disease.(Papers)
November 29, 2003... Abstract Objective To determine whether a nurse led smoking cessation intervention affects smoking cessation rates in patients admitted for coronary heart disease. Design Randomised controlled trial. Setting Cardiac ward of a...

Hospital bed utilisation in the NHS, Kaiser Permanente, and the US Medicare programme: analysis of routine data.(Papers)
November 29, 2003... Abstract Objective To compare the utilisation of hospital beds in the NHS in England, Kaiser Permanente in California, and the Medicare programme in the United States and California. Design Analysis of routinely available data from...

Equity of access to renal transplant waiting list and renal transplantation in Scotland: cohort study.(Papers)
November 29, 2003... Abstract Objective To examine the access to the renal transplant waiting list and renal transplantation in Scotland. Design Cohort study. Setting Renal and transplant units in Scotland. Participants 4523 adults starting...

The requirements for a surgeon.(Endpiece)
November 29, 2003... The conditions necessary for a surgeon are four: first, he should be learned. Second, he should be expert. Third, he must be ingenious. Fourth, he should be able to adapt himself. Guy de Chauliac. The art of surgery. 1363. (The first...

Coronary heart disease prevention: insights from modelling incremental cost effectiveness.(Primary care)
November 29, 2003... Abstract Objective To determine which treatments for preventing coronary heart disease should be offered to which patients by assessing their incremental cost effectiveness. Design Modelling study Data sources Cost estimates...

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study.(Primary care)
November 29, 2003... Abstract Objective To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population. Design Prospective cohort study. Setting 24 towns in the United Kingdom. ...

Gallstones in custard.(Primary care)(medical humor)
November 29, 2003... Most recipes are not inventions. The Delia Smiths of this world don't invent new recipes in the scientific sense of the word. They take a known mix and add a bit more garnish here, a few herbs there, and, if successful, promulgate the new...

Lassa fever: epidemiology, clinical features, and social consequences.(Clinical review)
November 29, 2003... ********** Lassa fever is a viral haemorrhagic fever transmitted by rats. It has been known since the 1950s, but the virus was not identified until 1969, when two missionary nurses died from it in the town of Lassa in Nigeria. Found...

Colchicine in acute gout.(Lesson of the week)
November 29, 2003... We describe three histories of patients with gout who were treated with doses of colchicine as advised by the British National Formulary (BNF)--that is, 1 mg initially followed by 500 [micro]g every 2-3 hours until relief of pain is obtained...

Anecdotage.(When I use a word)
November 29, 2003... Anecdotal reports are classified at the bottom of the recognised hierarchy of evidence that should be used to mould clinical practice, a list that is topped by large randomised clinical trials and systematic reviews. Nevertheless, I have...

Resuscitation in pregnancy.(ABC of Resuscitation)
November 29, 2003... Cardiac arrest occurs only about once in every 30 000 late pregnancies, but survival from such an event is exceptional. Most deaths are from acute causes, with many mothers receiving some form of resuscitation. However, the number of indirect...

Ethical problems of evaluating a new treatment for melioidosis.(Education and debate)
November 29, 2003... When mortality from melioidosis fell sharply after multiple changes in management at an Australian hospital, doctors wanted to identify whether a new drug was responsible. But designing a trial that was ethically acceptable proved impossible....

Using socioeconomic evidence in clinical practice guidelines.(Education and debate)
November 29, 2003... The effects of socioeconomic position on health have been largely ignored in clinical guidelines. Australia's National Health and Medical Research Council has produced a framework to ensure that they are taken into account. The effects...

My holistic bakery.(Education and debate)(Brief Article)
November 29, 2003... In Exeter we are lucky in that some of our old-fashioned corner shops have survived the onslaught of the supermarkets. My bakery is such a remnant from the past. What is more, it is more holistic than an alternative health centre. The...

Paul Janssen: Belgian doctor who founded a drug company, now part of Johnson & Johnson.( )(Obituary)(Biography)
November 29, 2003... Exactly half a century ago, Paul Janssen set himself the challenge of creating a totally independent and self supporting medical research laboratory in his native Flanders, close to the Dutch border. By the time of his death earlier this...

George Harold Godwin Chase.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... Former general practitioner Stamford, Lincolnshire (b Chesterfield 1914; q Guy's Hospital, London, 1936), died from renal failure on 15 February 2003. After a brief spell in practice in Newark, in 1943 Harold moved to Stamford, where he...

Sylvia Ray Ingold.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... GP principal South Woodham Ferrers, near Cheltenham, 1967-92 (b London 1927; q University College London 1950; FRCOG), died from heart failure on 1 May 2003. Sylvia was a registrar in obstetrics and gynaecology in Nottingham and London...

Philip James Keep.(Brief Article)(Obituary)(Biography)
November 29, 2003... Consultant anaesthetist Norfolk and Norwich Hospital 1975-2002 (b 1942; q University College Hospital, London, 1966; FFARCS), died from renal cancer on 21 February 2003. Philip was the medical director of the intensive care unit at the...

Mark Lionel Levy.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... Former divisional medical officer Department of Health and Social Security north west region (b Middlesbrough 1921; q Liverpool 1944), died from lung cancer on 15 September 2003. After qualifying he served for three years in the army in...

Alasdair Cameron Macdonald.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... Former consultant physician and psychotherapist Glasgow (b Argyll 1916; q Glasgow 1939; VRD, FRCP Glas, FRCP), d 6 November 2003. In 1941 Alasdair Cameron Macdonald joined the Royal Marines and served on escort vessels in the north...

Theodore Robert Foster Raw.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... General practitioner Horley, Surrey, 1935-73 (b Rotorua, New Zealand 1910; q Guy's Hospital, London, 1934), d 15 September 2003. After hospital appointments he entered practice in Horley, where he remained until his retirement on health...

Leonard ("Johnnie") Walker.( )(Brief Article)(Obituary)(Biography)
November 29, 2003... Former consultant anaesthetist and mid-Cheshire (b 1914; q St Bartholomew 's Hospital, London, 1954), d 12 July 2003. Johnnie came late to medicine after years in the family business and six years' war service in the Royal Artillery. He...

Compassion's Way: A Doctor's Quest Into the Soul of Medicine.(Book Review)
November 29, 2003... Ralph Crawshaw Medi-Ed Press, $38.50, pp 648 www.Medi-Edpress.com/ ISBN 0 936741 15 5 Rating: **** What goes into the making of a good doctor? Most teachers and mentors stress intelligence and diligence. Yet they tend to ignore...

Younger People with Dementia: A Multidisciplinary Approach.(Book Review)
November 29, 2003... Eds Robert Baldwin, Michelle Murray Martin Dunitz, 39.95 [pounds sterling], pp 210 ISBN 1 84184 272 9 Rating: ** Early onset dementia destroys the mind, often at the peak of its powers. Families are devastated, and children feel...

Therapy Culture: Cultivating Vulnerability in an Uncertain Age.(Book Review)
November 29, 2003... Frank Furedi Routledge, 16.99 [pounds sterling], pp 243 ISBN 0 415 32159 X Rating: *** Frank Furedi is professor of sociology at the University of Kent, Canterbury. He is also, perhaps, the nation's best known sociologist,...

The UK based Drug Safety Research Unit is a charity concerned with detecting side effects associated with newly marketed drugs.(Netlines)(www.dsru.org/)(Brief Article)
November 29, 2003... * The UK based Drug Safety Research Unit is a charity concerned with detecting side effects associated with newly marketed drugs. It has a compact, informative, and user friendly website (www.dsru.org/), which, as well as explaining the role...

Medical humour has always been distinctive and there have been thousands of medical gags in circulation for years.(Netlines)(Brief Article)
November 29, 2003... * Medical humour has always been distinctive and there have been thousands of medical gags in circulation for years. Now the jokes are online, as well as medical satire and animated cartoons. http://galaxy.einet.net/galaxy/Medicine/Humor/ is...

Blogs or weblogs--online personal journals--are becoming increasingly popular.(Netlines)
November 29, 2003... * Blogs or weblogs--online personal journals--are becoming increasingly popular. http://blacktriangle.org/blog/ concerns drugs and adverse reactions. As well as regular and informative diary entries, this clearly designed site has a good...

The European Helicobacter Study Group has produced a useful online resource (www.helicobacter.org).(Netlines)(Brief Article)
November 29, 2003... * The European Helicobacter Study Group has produced a useful online resource (www.helicobacter.org). The home page contains a list of hypertext subject headings linking to various sections such as biographies of group members, expert advice...

Many doctors only vaguely remember their anatomy, but there is online help--after all, the web is an ideal medium for publishing an anatomy atlas.(Netlines)(CyberAnatomy Tutorials )(http://anatome.ncl.ac.uk/tutorials/index.html)(Brief Article)
November 29, 2003... * Many doctors only vaguely remember their anatomy, but there is online help--after all, the web is an ideal medium for publishing an anatomy atlas. CyberAnatomy Tutorials from the University of Newcastle upon Tyne is such an online resource...

ER blamed for nursing shortage.(TV)(negative portrayal of nurses on television show)
November 29, 2003... The top rated television show ER, now in its tenth season, is the target of a letter writing campaign by nurses who say that the show's depiction of them is demeaning. Such a negative portrayal, they say, is contributing to the critical...

Website of the week.(Coalition on Donation; www.shareyourlife.org/become_livingdonor.html)(US Living Organ Donor Network; www.lodn.org)(Living Donors Online!; www.livingdonorsonline.org/)
November 29, 2003... Living organ donation Two letters in this week's BMJ present conflicting views of living liver donation (p 1287). In arguing in favour of donation, Roger Williams says that there is an "unacceptable" wait for cadaver organs and that the UK...

Who'd be a reformer?(Personal View)
November 29, 2003... Ten years ago I was not prepared for the critical letter from the president of my surgical association, after the publication of a BMJ editorial I had jointly written (1994;309:620-1) on surgical removal of third molars--one of the commonest...

What does the patient want?(Soundings)(medical humor)
November 29, 2003... "What made you suspicious, Farrell?" Holmes was a trifle unimaginative, but he was a stout fellow and well worth his keep, as the big problem with a meritocracy is that good servants are hard to find; when everybody's somebody, then...

Minerva.(medical bits and piects)
November 29, 2003... Breast feeding mothers with postnatal depression are often advised not to take antidepressants. A study in Pediatrics (2003;112:e425), however, indicates that taking a selective serotonin reuptake inhibitor such as fluoxetine may be sale. All...

When DNA test for HPV is negative, patients are unlikely to have cervical cancer.(POEM *)(Brief Article)
November 22, 2003... Question Does HPV negative cervical cancer ever occur? Synopsis Although human papillomavirus (HPV) is well established as a causal agent in cervical cancer, most studies have shown a subgroup of up to 10% of cervical cancers that test...

Beyond doing.(Editor's choice)
November 22, 2003... We all love action. We want to do. Thinking, in contrast, can be so irritating--going round in circles, confusing each other, and wasting time in mental cul de sacs. "We're too busy around here to think" may be said with more pride than...

Controlling methicillin resistant Staphylococcus aureus: time to return to more stringent methods of control in the United Kingdom?
November 22, 2003... Methicillin resistant Staphylococcus aureus (MRSA) is a major cause of hospital acquired infection worldwide, posing a growing threat to public health. It belongs to a species of ubiquitous and versatile organisms that are continually...

Trauma life support in conflict: resources must be optimised for the many, rather than dispersed for the few.(Editorial)
November 22, 2003... War injures and kills combatants and civilians. Medical resources are usually scarce in combat zones, and doctors must plan to make the most of these resources to minimise death and suffering. Planners seek to apply the widely adopted...

Monitoring drug treatment: criteria used for screening tests should apply to monitoring.(Editorial)
November 22, 2003... We all want our treatments to work, and none of us wishes treatment to cause harm. Monitoring drug treatment is one way of seeing that a treatment works, while protecting the patient from adverse drug effects. For many patients and many...

Diastolic heart failure: the condition exists and needs to be recognised, prevented, and treated.(Editorial)
November 22, 2003... Diastolic heart failure refers to the clinical syndrome of heart failure with a preserved left ventricular ejection fraction (0.50 or more) in the absence of major valve disease. (1) About a third of patients with heart failure seen by...

Group calls for agency to boost UK bioscience industry.(News)
November 22, 2003... A government backed working group has this week called for the creation of a national body to coordinate "mutually advantageous" partnerships between the NHS and the bioscience industry, which would speed the development of new treatments and...

Fewer night emergency operations are performed by juniors.(News)(Brief Article)
November 22, 2003... The proportion of night time emergency operations that are performed by junior grade surgeons fell from 65% in 1995-6 to 20% in 2002, a new report on perioperative deaths in England and Wales shows. But nearly half of emergency operations...

Government consults on over the counter statins.(Brief Article)
November 22, 2003... Government consults on over the counter statins: A public consultation document published by the Medicines and Healthcare Products Regulatory Agency this week proposes that statins should be made available over the counter at pharmacies...

Europe launches a 12m [euro] project on obesity.(Brief Article)
November 22, 2003... Europe launches a 12m [euro] project on obesity: The European Commission has launched a five year, 11.7m [euro] (8.1m [pounds sterling]; $13.7m) programme to examine the treatment of obesity, one of the main causes of diabetes.

Kennedy to chair group on sudden infant death.(Helena Kennedy)(Brief Article)
November 22, 2003... Kennedy to chair group on sudden infant death: The Royal Colleges of Pathologists and of Paediatrics and Child Health have established a joint working group, chaired by Helena Kennedy QC, to consider the investigation of sudden death in...

SARS vaccine moves a step closer.(Brief Article)
November 22, 2003... SARS vaccine moves a step closer: Scientists at the University of Hong Kong expect to start testing a candidate SARS vaccine by the end of this year. Research at the university's Pasteur Research Centre is focusing on the development of a...

German smoker loses case.(Brief Article)
November 22, 2003... German smoker loses case: A German court has rejected an appeal by 56 year old chain smoker Wolfgang Heine for 213 000 [euro] (148 000 [pounds sterling]; $250 000) compensation from the tobacco firm Reemtsma. Heine, who has had two strokes,...

The student BMJ wins award.(British Medical Journal)(Brief Article)
November 22, 2003... The student BMJ wins award: For the second year running the student BMJ (www.sbmj.com) has been awarded the "student magazine of the year" award at the Guardian student media awards. According to the judges, it had the best ideas, great...

Face transplants should not be done without more research.(News)
November 22, 2003... Facial transplantation should not be performed until more research is done on the procedure and the risks that go with it, says an expert group of surgeons from England. The advice, from a working party from the Royal College of Surgeons...

London is more likely to detain people with mental problems.(News)
November 22, 2003... People with mental health problems in London are being admitted to hospital unnecessarily, because haphazard and uncoordinated community services are unable to cope, says an independent health service watchdog. The growth in community...

Children are often undertreated for pain.(News)
November 22, 2003... "Children in pain rarely seem to get the attention they need. There is a substantive gap between what we know and what we do," said Dr Richard Howard, from the anaesthesiology department at Great Ormond Street Children's Hospital, London,...

Painkillers before knee surgery improve outcomes.(News)(Brief Article)
November 22, 2003... Patients who had pre-emptive treatment of pain with a cyclo-oxygenase-2 (COX 2) inhibitor before knee replacement surgery had less pain and vomiting after the surgery, needed fewer opioids, slept better, had better knee flexion, and needed...