Discussion This study showed that prompt endoscopy in patients consulting their primary care doctor for dyspepsia led to similar symptom resolution, improvement in quality of life and patient satisfaction as compared to the "test-and-treat" strategy. Over two thirds of the patients treated according to the "test-and-treat" strategy were not referred for endoscopy during a follow-up period of one year. Our study is the first study comparing the "test-and-treat" strategy to prompt endoscopy in a primary care setting. As most dyspeptic patients are entirely managed by their general practitioner GP ; , the "test-and-treat" approach should be evaluated in that setting. Lassen et al. recently compared the "test-and-treat" strategy to prompt endoscopy [15]. In that study, however, follow-up was performed completely in a secondary care setting, which may have biased the results. Reassurance and treatment by a gastroenterologist with a special interest in dyspepsia may be more effective than that by a GP, resulting in a decreased use of medical resources and a higher patient satisfaction. Our primary care study has several other positive features. After the initial investigation and treatment guidelines, GPs were allowed to treat and manage their patients according to their own insights. Therefore, it is to be assumed that the outcome of the "test-andtreat" strategy in our study will be very similar to the outcome if a similar approach would be followed in daily clinical practice, thus increasing the external validity of the results. Secondly, all questionnaires regarding symptoms, quality of life, and patient satisfaction were self administered, avoiding any interpretation bias by the GP. Finally, anti-H. pylori treatment was prescribed to all H. pylori infected patients. Although the benefit of anti-H. pylori treatment has only been demonstrated unequivocally in patients with PUD, we aimed to prevent any bias by a possible effect in patients with FD or GERD. Inevitably, our study had some drawbacks. Patients were recruited by their own GP which may have introduced a potential selection bias, limiting the comparability between the study patients and the normal dyspeptic population. Moreover, our study does not allow a comparison of the "test-and-treat" strategy to the currently most often chosen approach empiric treatment ; . We chose to include a control group prompt endoscopy ; rather than an empiric study group, in order to determine whether the "test-and-treat" strategy missed any important disease.The presence of abnormalities in the "test-and-treat" group at inclusion are assumingly similar to the endoscopic findings in the prompt endoscopy group. It should be noted that in the endoscoped "test-and-treat" patients H. pylori positive PUD was not diagnosed. This strongly indicates that the "test-and-treat" strategy correctly identified all patients and prinivil, for example, prevacid suspension. Chang-Tai Xu, Editorial Department, Journal of Fourth Military Medical University, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China Shu-Yong Meng, Department of Thoracic and Oncology Surgery, Shaanxi Provincial Textile Hospital, Xi'an 710038, Shaanxi Province, China Bo-Rong Pan, Department of Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China Supported by the Science Foundation of Health Bureau of Shaanxi province, No.04D26 Correspondence to: Chang-Tai Xu, Editorial Department, Journal of Fourth Military Medical University, Fourth Military Medical University, 17 Changle West Road, Xi'an 710032, Shaanxi Province, China. xuct2001 163 Telephone: + 86-29-83373804 Fax: + 86-29-83374499 Received: 2004-03-23 Accepted: 2004-04-29. NONINVASIVE MEASUREMENT OF PULMONARY DEAD SPACE CORRELATES WELL WITH STANDARD METHODOLOGY IN INTUBATED PATIENTS Scott E. Williams, MD * ; Virginia Eddy, MD; Steve Desjardins, RRT; Stephen Prato, MA. Maine Medical Center, Portland, ME PURPOSE: The standard for measuring dead space ventilation Vd Vt ; relies on the analysis of CO2 in mixed expired gas and simultaneous measurement of arterial CO2 tension. In modern ICUs this is achieved using bedside indirect calorimetry combined with arterial blood gas analysis. Recently, a method has been introduced which may permit noninvasive bedside measurement of Vd Vt, with simpler logistics than the standard technique. This method relies on analysis of the CO2 washout curves of single breaths obtained over one minute, using a CO2 sensor in line with the ventilator circuit. This technique has not been well validated in humans. The purpose of this study was to compare Vd Vt measurements obtained with calorimetry with those obtained using the single breath washout technique. METHODS: All intubated adult patients with an arterial catheter in the intensive care unit were considered for enrollment. Patients were excluded for lack of consent or inability to achieve steady state for exhaled gas measurement. Calorimetric Vd Vt was calculated by the Enghoff modification of the Bohr equation, using arterial and mixed exhaled CO2 measurements. Single breath CO2 washout NICO, Novametrix ; Vd Vt was compared to calorimetric Vd Vt using regression analysis and Bland Altman analysis. RESULTS: 40 patients met study criteria over a four month period. Vd Vt values ranged from 0.32 0.76 and procardia. Bend your knees and brace your abdominal muscles for turning. Your nurse places a pillow between your knees for turning and supports your back with pillows when you are on your side. The surgical site drain s ; is removed either the first or second day after surgery. Intravenous IV ; feeding continues until you are passing gas 24-72 hours after surgery ; . At that time, you are started on a liquid diet and as this is tolerated, the IV is then discontinued. You will then be started on oral pain medication. Your therapist will stand you at the bedside and walk with you a short distance on the first day after surgery if you are able; if not you most likely will get out of bed with help on the second day. This initial attempt to get up and move about can be tiring and frustrating, but remembering to brace with your abdominal muscles and applying good body mechanics will help. Wearing a body jacket or corset and using a walker are not substitutes for tightening your abdominal muscles and using good body mechanics. THREE TEN DAYS AFTER SURGERY "Surgery is just one step in your rehabilitation." Under the direction of your physician, the therapist increases your activity each day. When you are able to walk with assistance to the bathroom, your urinary catheter is removed. Let pain be your guide as you progress with walking. Ever day following surgery, you will find it easier to get in and out of bed and walk further on your own. You will receive instruction for getting dressed, and also will begin your exercise program. These exercises are the basis for the program which you will continue to follow at home. When permitted by your physician, you may shower and wash your hair with instruction and assistance from your occupational therapist or nurse. This will depend upon incisional healing and the length of time you can tolerate standing. Although the length of your hospital stay may vary, it is usually between one and seven days. Depending on the type of surgery you have, we expect you to be as independent and active as your pain will allow. Upon discharge we expect you to walk a block and be able to climb one or two flights of stairs. If you require medication at home it will be prescribed by your physician. The hospital nurses & therapists will provide you with postoperative discharge information. If you are going to require help getting to or being at home, the Discharge Planner is available to assist you in this transition. She he can arrange rental of assistive devices such as raised toilet seats and shower stools. It is important that your family or friends have a car available to take you home. A car with a reclining seat may be helpful. If your journey is more than an hour, it is helpful to stop every 45-60 minutes, get out of the car and walk to prevent stiffness and excessive discomfort.

Reglan can also be effectively added to regimens including prilosec or prevzcid and promethazine.

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