Crisis management during anaesthesia: bronchospasm

© 2005 BMJ Publishing Group Ltd.BACKGROUND: Bronchospasm in association with anaesthesia may appear as an entity in its own right or be a component of another problem such as anaphylaxis. It may present with expiratory wheeze, prolonged exhalation or, in severe cases, complete silence on auscultation. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for bronchospasm, in the diagnosis and management of bronchospasm occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by anaesthetists involved. RESULTS: There were 103 relevant incidents among the first 4000 AIMS reports, 22 of which were associated with allergy or anaphylaxis. Common presenting signs, in addition to wheeze, were decreased pulmonary compliance and falling oxygen saturation. Of the non-allergy/anaphylaxis related incidents, 80% occurred during induction or maintenance of anaesthesia. Of these, the principal causes of bronchospasm were airway irritation (35%), problems with the endotracheal tube (23%), and aspiration of gastric contents (14%). It was considered that, properly used, the structured approach recommended would have led to earlier recognition and/or better management of the problem in 10% of cases, and would not have harmed any patient had it been applied in all of them. CONCLUSION: Bronchospasm may present in a variety of ways and may be associated with other life threatening conditions. Although most cases are handled appropriately by the attending anaesthetist, the use of a structured approach to its diagnosis and management would lead to earlier recognition and/or better management in 10% of cases.R N Westhorpe, G L Ludbrook, S C Help

CLIL: The potential of multilingual education

CLIL (Content and Language Integrated Learning) is an educational approach to language learning promoted by the EU Commission to develop multilingual European citizens. The approach has rapidly spread in different forms throughout Europe, mainly as a teacher-led phenomenon. The CLIL approach is also being introduced into Higher Education to meet the needs of rapid internationalisation in European universities. This article provides a brief overview of how CLIL is being implemented, and discusses some of the issues that are currently the subject of debate, focussing mainly on the questions surrounding the CLIL teacher. It concludes with a description of a project for CLIL teacher qualification being developed at the University of Venice

English for Welfare Services

English for Welfare Services is intended for Italian students of social services who are required to use English in their tertiary studies but whose knowledge of the language is limited to what they have learnt in a general school course. The manual aims at providing specific and relevant language work in the field of social welfare, together with some up-to-date information regarding British institutions and services. As the book is primarily designed to improve students’ skills in comprehension and written English, some restrictions have necessarily been imposed. There is no specific comprehension work connected with the reading passages to permit students and teachers the freedom to select and use the texts in the way that most closely meets their specific needs. The grammar section is limited to the main difficulties likely to be encountered in texts of this kind with practice at a pre-intermediate/intermediate level. As a result, some aspects of grammar have been omitted or have not been dealt with in an extensive manner. Priority has been given throughout to the structures and aspects most commonly found in formal written English

English for International Social Work

English for International Social Work si propone come nuovo strumento per l'insegnamento dell'inglese a fini speciali ed è rivolto soprattutto agli studenti universitari italiani a livello B1/B2 (CEFR) che desiderano migliorare le loro competenze linguistiche attraverso lo studio di una varietà di testi autentici. I testi selezionati coprono campi specifici quali povertà, migrazione, sviluppo internazionale e uguaglianza sociale. Il libro mira a sviluppare principalmente le abilità di lettura e comprensione con l'aiuto di glossari e attraverso esercizi sul lessico e sui registri linguistici

Language testing for students with SpLDs: Considerations of validity and fairness

Recent legislation in Italy has established national guidelines to learning and assessment for students who are medically certified with specific learning disabilities (SpLDs) to guarantee their access to education. The guidelines set out recommended compensatory measures and alternative assessment, as well as exemptions from examinations. As a result of the greater awareness of the needs of students with SpLDs, increasing numbers of dyslexic students are continuing their studies at secondary school and university level. Italian universities now require mandatory certification of general English skills at the CEFR level B1 on enrollment, and many postgraduate courses require certification of a B2 level of English proficiency. The growing numbers of dyslexic students applying for university entrance raise the issue of providing fair and valid tests of English language, while applying the guidelines imposed by law. This article sets out to examine some of the issues of validity that arise when considering the assessment of the English language of university students who are certified with dyslexia and related SpLDs. I begin with a review of the legislative background in Italy to identify the provisions made for students with SpLDs. I then give a brief definition of these SpLDs and the implications they have for the learning of English. I conclude with an outline of concepts of validity in language testing, and a discussion of how a judicious application of the Italian guidelines is needed to reduce the threat to test validity and fairness

English for History and Philosophy

English for History and Philosophy has been written for university students whose knowledge of English is limited to what they have learned in a general language course, but whose needs are increasingly directed towards specific language skills. It aims at providing students with the linguistic proficiency necessary to deal confidently with the kind of English text they may find themselves required to read during their undergraduate studies or when involved in post-graduate research. Every attempt has been made to create a flexible study tool, combining authentic reading material, a practical review of relevant grammar points, and some contrastive analysis to provide greater clarity for Italian students

Certifying teachers' foreign language proficiency: developing a performance test for Italian CLIL teachers

The article illlustrates a project based at the University of Venice to design a performance test to certify the conpetences of CLIL teachers. As CLIL is not easily understood as a construct, there are many directions for research within this context. The article discusses how investigation of the target language use through the qualitative analysis of data from CLIL classroom observations can help to address some of the main issues that challenge performance test design

A Selective Approach to Bleeding Esophageal Varices

It is possible that the best results of treatment for bleeding esophageal varices will come when a selective approach is used. In patients bleeding acutely and in patients with poor liver function shunt operations should be avoided, and a direct attack on the varices with either sclerosant therapy, percutaneous obliteration, or staple gun gastro-esophageal transsection should be carried out. In patients who have stopped bleeding, or those in whom elective treatment is being undertaken, the best operation at present appears to be selective distal splenorenal shunt