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Byline: S. Suri, K. Hillman Acute colonic pseudo-obstruction is managed with bolus neostigmine as shown in a recent prospective, double blind, placebo-controlled study. Parasympathetic stimulation with neostigmine leads to abdominal [...]

Background: Vital signs monitoring is an old hospital practice for patient safety but evaluation of its effectiveness is not widespread. We aimed to identify strategies to improve intermittent or continuous vital signs monitoring in general wards; and their effectiveness in preventing adverse events on general hospital wards.Methods: Publications searched between 1980 and June 2014 in five databases. Main outcome measures were in-hospital death, cardiac arrest, intensive care unit (ICU) transfers, length of stay, identification of physiological deterioration and activation of rapid response systems.Results: Twenty-two studies assessing the effect of continuous (9) or intermittent monitoring (13) and reporting outcomes on 203,407 patients in-hospital wards across 13 countries were included in this review. Both monitoring practices led to early identification of patient deterioration, increased rapid response activations and improvements in timeliness or completeness of vital signs documentation. Innovative intermittent monitoring approaches are associated with modest reduction in in-hospital mortality over intermittent vital signs monitoring in 'usual care'. However, there was no evidence of significant reduction in ICU transfers or other adverse events with either intermittent or continuous monitoring.Conclusions: This review of heterogeneous monitoring approaches found no conclusive confirmation of improvements in prevention of cardiac arrest, reduction in length of hospital stay, or prevention of other neurological or cardiovascular adverse events. The evidence found to date is insufficient to recommend continuous vital signs monitoring in general wards as routine practice. Future evaluations of effectiveness need to be undertaken with more rigorous methods and homogeneous outcome measurements. [ABSTRACT FROM AUTHOR]

Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

To identify the reasons and determinants of discharge delay in acute care patients, information associated with delayed discharge was extracted from the medical record of 1958 patients in a tertiary referral hospital in New South Wales. A logistic regression model was used to examine the association between demographic factors and reasons for discharge delay. Delayed discharge was most commonly associated with the patient's medical conditions, delayed health care or medical consultation, delayed diagnostic services and delayed allied health services. Elderly patients, those living alone and patients from a non-English-speaking background were more likely to have these reasons for delayed discharge. [ABSTRACT FROM AUTHOR]

1. The effect of the dietary inclusion of 5 culinary herbs or their essential oils on the growth, digestibility and intestinal microflora status in female broiler chicks was assessed. From 7 to 28 d of age, either a basal control diet without supplement was given or one of 10 others, consisting of the basal diet with either 10 g/kg herb (thyme, oregano, marjoram, rosemary or yarrow) or 1 g/kg of essential oil. 2. Body mass (BM) and feed consumption (AFC) were measured on a weekly basis and used to calculate chick performance. Total viable counts of lactic acid bacteria, coliforms, anaerobes and Clostridium perfringens were determined at 25 d. Apparent nutrient digestibilities were calculated from the measured values for gross energy, nitrogen (N), dry matter (DM) and organic matter, and sialic acid concentration was also measured. 3. Generally, dietary thyme oil or yarrow herb inclusion had the most positive effects on chick performance, while oregano herb and yarrow oil were the poorest supplements. Only thyme and yarrow in these diets had a different effect when used as a herb or oil on weight gain and BM. 4. Dietary treatment had no effect on the intestinal microflora populations, apparent metabolisable energy (AME) or the calculated coefficients of digestibility. Sialic acid concentration was greatest in the birds given dietary thyme oil, compared with all other treatments except those birds receiving marjoram oil, rosemary herb and the controls. However, less sialic acid was excreted in those birds given diets with oregano or rosemary oils, or oregano herb, than in the controls. 5. Plant extracts in diets may therefore affect chick performance, gut health and endogenous secretions, although the chemical composition of the extract appears to be important in obtaining the optimal effects. [ABSTRACT FROM AUTHOR]

Cruciferous vegetables have been studied extensively for their chemoprotective effects. Although they contain many bioactive compounds, the anti-carcinogenic actions of cruciferous vegetables are commonly attributed to their content of glucosinolates. Glucosinolates are relatively biologically inert but can be hydrolysed to a range of bioactive compounds such as isothiocyanates (ITC) and indoles by the plant-based enzyme myrosinase, or less efficiently by the colonic microflora. A number of mechanisms whereby ITC and indoles may protect against colo-rectal cancer have been identified. In experimental animals cruciferous vegetables have been shown to inhibit chemically-induced colon cancer. However, the results of recent epidemiological cohort studies have been inconsistent and this disparity may reflect a lack of sensitivity of such studies. Possible explanations for the failure of epidemiological studies to detect an effect include: assessment of cruciferous vegetable intake by methods that are subject to large measurement errors; the interaction between diet and genotype has not been considered: the effect that post-harvest treatments may have on biological effects of cruciferous vegetables has not been taken into account. [ABSTRACT FROM AUTHOR]

P2X7 is an intriguing membrane receptor for the extracellular nucleotide ATP, which functions as a ligand-gated ion channel; it can activate cell membrane permeabilization and also has a wide range of downstream signaling pathways, including mediation of inflammatory responses and modulation of cell turnover. Despite recent identification of P2X7 receptor protein in the renal tract, the biological and potential pathological functions of this receptor and its signaling cascades in the kidney are not yet fully understood. P2X7 receptor protein is expressed in normal kidney development, predominantly in the condensing mesenchyme, and later in the maturing and adult derivatives of the ureteric bud. Glomerular expression of the molecule is scarce in normal kidney, but is upregulated in chronic and inflammatory conditions, suggesting a role in the inflammatory response or in repair and remodeling in these settings. P2X7 receptor expression in the adult collecting ducts of murine kidney, as well as the collecting duct cysts in autosomal recessive polycystic kidney disease, has been described and agonists of the receptor can modulate the development of renal cysts in an in vitro model of cyst formation derived from the cpk/cpk mouse. Further investigation of the function of the P2X7 receptor in normal and abnormal kidneys might lead to novel therapeutic targets in a wide range of renal diseases. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract Hospital systems are failing the critically ill. This has been welldocumented in many countries around the world, with detailed reportsof suboptimal care prior to intensive care and high rates of seriousadverse events, including death. These events are potentially preventable,but insufficient attention has been directed towards developing solutionsto these important problems to date. The medical emergency team (MET) is a system approach that promotesearly and appropriate inter­vention in the care of criticallyill hospital patients. The benefits of the MET in terms of absolutein-patient ­mortality and cardiac arrest rates are notyet well-defined, although preliminary studies are promising. The MET does provide a potentially beneficial impact on manyother aspects of patient care. These benefits include: (i) facilitatingan integrated and coordinated approach to patient care across thehospital, (ii) increasing awareness of at-risk patients,(iii) encouraging early referral of seriously ill patientsto clinicians with expertise in critical care and (iv) providinga foundation for quality initiatives for hospital-wide care of theseriously ill. The MET also empowers nursing staff and junior medical staffto call for immediate assistance in cases where they are seriouslyconcerned about a patient, but may not have the experience, knowledge,confidence or skills necessary to manage them appropriately. (Intern MedJ 2003; 33: 511−514) [ABSTRACT FROM AUTHOR]

The modification of an existing in vitro model of the porcine ileum is described, together with its initial validation in terms of specific bacterial content, resistance to transient pathogen colonisation and test antimicrobial exposure. With the primary aim of producing a standardised test system requiring a low animal cost, a single-stage continuous culture fermenter inoculated with porcine faecal material was shown to be capable of establishing and maintaining a microflora comparable to that of the porcine ileum. Such comparison was based upon total aerobic and anaerobic bacterial population magnitude, total Bacteroides, Bifidobacterium and Enterococcus spp., Escherichia coli and lactic acid bacteria numbers and E. coli strain complexity. The robustness of the model was demonstrated through resistance to transient pathogen (Salmonella poona) exposure. Test glycopeptide exposure (vancomycin) served both to verify the simulated microflora response as comparable with that reported elsewhere in vivo and to demonstrate the model’s value in the assessment of dietary antimicrobial activity.The trends observed under antibiotic exposure illustrate the influence of vancomycin treatment on the enteric commensal microflora, inhibiting potentially probiotic bacteria that may be vital to the competitive exclusion of the gut and favouring the selection of opportunistic pathogens. Despite the limitations of such a model system, the in vitro porcine ileum produced highly repeatable data at a low cost, with complete control and containment. Given a comparable seeding inoculum the model proved capable of yielding data reproducible over time, describing the test antibiotics influence on the ileal microflora in a form suitable for comparison elsewhere. [Copyright &y& Elsevier]

Objective: This study assessed the accuracy of an intragastric method of measuring intra-abdominal pressure (IAP).Design: Prospective sequential study with simultaneous paired measurement of gastric and urinary bladder pressures.Setting: Operating theatre, University Teaching Hospital.Patients: 9 patients undergoing laparoscopic cholecystectomy were studied.Interventions: Intraperitoneal pressures were monitored during peritoneal insufflation at laparoscopy up to a pressure of 20 mmHg.Measurements and Results: Intra-abdominal pressure measurements were recorded simultaneously using a gastric balloon and urinary catheter. Gastric pressure may be up to 4 mmHg higher or 3 mmHg lower than urinary bladder pressure.Conclusions: Intra-abdominal pressure can be measured easily in this new fashion, allowing a continuous pressure trend to be obtained without interfering with urinary output estimation. [ABSTRACT FROM AUTHOR]

The first objective in diabetic ketoacidosis is to restore the circulating volume and improve tissue perfusion. In any form of hypovolaemic shock the most efficient way of restoring circulating volume is to be use colloid solutions rather than crystalloids. At least three times the amount of crystalloid must be used to achieve the same effect. The historical reason for using isotonic saline in diabetic ketoacidosis is related not to its similarity to the fluid lost, but to its supposed efficiency in correcting the circulating volume. Excess crystalloid expands the interstitial space which results in pulmonary oedema, peripheral oedema and possibly cerebral oedema. Although currently difficult to define precisely in their more subtle forms, they all produce adverse pathophysiological effects. The fluid loss in diabetic ketoacidosis is equivalent to "half-normal" saline, a relatively hypotonic solution. As well as causing extensive oedema, resuscitation with isotonic saline can increase serum sodium and osmolarity while not providing free water to replace the intracellular losses. [ABSTRACT FROM AUTHOR]