Ice cream, a new alternative to oral nutritional supplements

Background: Cancer patients have been identified as being at risk of nutritional problems due to the treatments of cytotoxic chemotherapy and local radiotherapy which can cause side effects such as general loss of appetite, sore, dry mouth, mucositis and oral thrush (Bella Talwar, 2007). Traditionally, oral nutritional supplement drinks are prescribed to provide nutritional support. Ice cream presents a new popular approach to treat malnutrition and has been proved successful in at least one previous unpublished trial. Ice cream is a cool, soft nutritious food which is very palatable and easy to swallow. Therefore, soft whip ice cream (Malibu Ice cream) machines were installed on the oncology wards. The aims of this study were to assess overall patient satisfaction of the ice cream compared with the standard hospital ice cream, how easy patients thought the new ice cream is to eat and the preference of ice cream over taking oral nutritional supplements. Methods: A total of 123 patients on two oncology wards admitted from in 2007 over a 4 week period were asked to complete an internally developed patient satisfaction survey on the intervention, the new ice cream. Patients were asked to rate the new ice cream on taste, texture and preference over the standard ice cream. The new ice cream was given at meal times and available in between meals. The nutritional content of the ice cream (Malibu), 1269.7 kJ (300 kcal), 6 g protein per 6.6 oz portion [679 kJ (162 kcal), 4.1 g protein per 100 g] compares favourably with oral nutritional supplement drinks. The ice cream was given at meal times and available between meals on demand. Results: There was a 41% (n = 59) response rate from the patient satisfaction survey. Of the responses received 74% rated the new ice cream as either excellent or good for taste. The majority (79%) of patients who responded thought that the ice cream was easy to eat. When asked about preference of the new ice cream compared to the standard hospital ice cream 77% of patients would prefer to eat the Malibu ice cream. Most (88%) patients would rather eat the ice cream than conventional nutritional supplements. Discussion: The patients’ response to the introduction of this variety of ice cream was very positive. The ice cream showed potential benefits due to the compliance in this patient group. Conclusion: The use of ice cream illustrates a positive way forward for the dietetic treatment of malnutrition in cancer patients and further work is planned for the future. The use of branded ice creams provides an acceptable alternative to oral nutritional supplements in cancer patients with chemotherapy and radiotherapy associated mouth problems. Reference Talwar, B. (2007) Tackling nutritional problems related to cancer and its treatment. Complete Nutr. 7, 61–63.     

The injury experience observed in two emergency departments in Kingston, Ontario during 'ice storm 98'.

OBJECTIVES: 1) To describe patterns of unintentional injury presenting for emergency medical care in Kingston, Ontario following the ice storm in January 1998; and 2) to provide recommendations for prevention during such situations. METHODS: Unintentional injuries related to the ice storm that presented at the two emergency departments in Kingston, Ontario were identified and described. RESULTS: A total of 254 injuries were identified. Injuries peaked the day following the onset of the ice storm and again 4-6 days following the storm. Common sources of injury included slips and falls on the ice (56%), activities related to clearing brush or trees (15%), and unintentional carbon monoxide poisonings (9%). CONCLUSIONS: While the number of injuries that presented during the storm and its aftermath was not unusual, the distribution of injuries by type did reflect the irregular nature of environmental conditions. This analysis provides useful information for public officials to use reviewing disaster plans and to generate recommendations for managing future occurrences.     

胡萝卜冰块对放射性口腔黏膜炎的防治疗效观察

目的 探讨胡萝卜冰块对口腔黏膜放射损伤（RTOM）的防治作用。方法 2016年8月-2017年11月将40例初治鼻咽癌放疗病人随机分为实验组与对照组，每组各20例。实验组放射治疗前半小时、放射治疗后半小时、睡前1小时口含胡萝卜冰块。对照组按常规护理。观察两组患者口腔黏膜放射损伤出现时间及具体情况。结果 实验组与对照组I、Ⅱ、Ⅲ、Ⅳ级放射性口腔黏膜炎分别为14、6、0、0例和8、8、3、1例，实验组口腔黏膜损伤情况明显轻于对照组，差异有显著意义（P < 0.05）。结论 胡萝卜冰块对放射性口腔黏膜放射损伤具有一定的预防和治疗作用。     

Double J stents in the treatment of gynaecological injury to the ureter.

Ureteric injury is a recognized complication of hysterectomy and may present with obstruction or fistula. Between 1987 and 1989 in Oxford nine patients with 10 injured ureters underwent attempted retrograde placement of double J stents. Three patients had successful outcomes and one patient with bilateral ureteric obstruction required reimplantation of the right ureter after successful stenting of the left ureter. One patient required removal of a stent due to irritation but her fistula eventually closed. In three patients placement was unsuccessful and in one patient injury to the bladder base prevented the ureteric orifices from being seen and hence stenting was not possible. Thus five of these 10 injured ureters were managed successfully with double J stents. We advocate the initial use of double J stents in gynaecological ureteric injury. This approach is simple and may cure the fistula. If it is unsuccessful, subsequent reimplantation is not hindered.     

可塑形柔性冰囊的研制及临床应用

目的：解决高热患者物理降温过程中冰袋接触面小、难以固定等弊端，寻找一种降温效能可靠，适用于各种特殊部位降温的新型冰囊。方法：选用乙二醇溶液、薄铝片、高密度海绵、韧性塑料等材料，根据人体特点，制作12种不同型号的可塑形冰囊。结果：2002年研制的“用于医疗护理佩戴式冰囊”获得国家实用新型专利，2007年研制的可塑形液态柔性冰囊已申报国家发明专利。结论：可塑形液态柔性冰囊不凝固、佩戴方便，适用于各种不同部位，降温效果良好。     

Irradiated or aseptically prepared frozen dairy desserts: acceptability to bone marrow transplant recipients.

Sterile ice cream and frozen yogurt were offered to immunosuppressed patients recovering from bone marrow transplantation. To obtain sterile products, two of the dairy desserts (prepackaged ice cream and frozen yogurt bars) were exposed to 40 kGy of cobalt 60 irradiation. Four different flavors of ice cream were aseptically prepared under a laminar airflow hood using commercially sterilized ingredients. A commercially sterile, frozen milk-based drink on the low-microbial menu served as the control. Ratings of the seven products by 17 patients indicated that a frozen vanilla milk-based drink and aseptically prepared chocolate ice cream were highly acceptable to recovery immunosuppressed patients who have difficulty eating most foods. However, the seven desserts received higher ratings from a sensory panel of healthy individuals than from the patient panel, confirming that new foods for the low-microbial diet should be "market-tested" by the targeted patient population before inclusion in the menu.     

Case report: mixed cholestatic/hepatocellular liver injury induced by the herbicide quizalofop-p-ethyl

CONTEXT: Quizalofop-p-ethyl is an often applied, slightly toxic herbicide for which no severe toxicity has been reported in humans. CASE PRESENTATION: We present the case of a farmer exposed to quizalofop-p-ethyl who presented with obstructive cholestasis. A complete workup disclosed no other cause of liver pathology, but liver biopsy established drug-induced hepatotoxicity. The patient was treated with ursodeoxycholic acid and prednisolone, and was recovered fully 70 days after his exposure to the herbicide. The patient was followed for the next 9 months. CONCLUSION: Quizalofop-p-ethyl can induce a mixed cholestatic/hepatocellular liver injury. We discuss possible mechanisms implicated in liver injury after exposure to quizalofop-p-ethyl. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: In patients presenting with mixed cholestatic/ hepatocellular liver injury, occupational exposure to quizalofop-p-ethyl in the course of agricultural use should be investigated.     

Incidence and costs of injuries in The Netherlands

BACKGROUND: Injuries are a major and persistent public health problem, but a comprehensive and detailed overview of the economic burden is missing. We therefore estimated the number of emergency department (ED) attendances and health care costs as a result of injury. METHODS: We estimated lifetime health care costs of injuries occurring in The Netherlands in the year 1999. Patient groups were defined that are homogeneous in terms of health service use. Health service use and costs per patient group was estimated with data from national databases and a prospective study among 5755 injury patients. RESULTS: Total health care costs due to injury in 1999 were euro 1.15 billion, or 3.7% of the total health care budget. Major cost peaks were observed among males between ages 15 and 44 due to a high incidence, and among females from age 65 onwards due to a high incidence and high costs per patient. For the age groups 0-14, 15-44, 45-64, and 65+ ED attendances per 1000 person years were 85, 85, 43, and 49, respectively, and costs per capita were euro 38, euro 59, euro 43, and euro 210, respectively. Costs per patient rise about linearly up to age 60 and about exponentially thereafter. From age 25 onwards, females have higher costs per patient than males. Hip fracture (20%), superficial injury (13%), open wounds (7%), and skull-brain injury (6%) had the highest total costs. Most costs were attributable to falls (44%) and traffic injuries (19%). CONCLUSION: Young adult males, elderly females, falls, hip fractures, and minor injuries without medical need for hospitalization account for a substantial share of health care costs.     

Metabolic response to injury and role of anabolic hormones

PURPOSE OF REVIEW: To provide a short review of the literature describing the hypermetabolic response to injury and potential treatments. Associated findings include changes in inflammatory mediators and secreted hormones. RECENT FINDINGS: Treatments should be aimed at decreasing the response and potentially the use of anabolic agents. Of note, recent interest in the hyperglycemic response to injury and insulin treatment will be highlighted. SUMMARY: The current metabolic care of the burned patient including nutrition is now being unfolded. It is relatively clear that anabolic treatment should be considered in all those with severe injury. Timing of the treatment, however, is still a topic of discussion.     

可调节式冰袋的研制

目的研制可调节式冰袋,提高患者冷敷舒适度。方法QC小组活动。结果患者冷敷舒适度由45.7%提高到89%,冷敷面积适宜度由34.3%提高到91%,冰袋使用适用性由49.1%提高到94%,达到了活动目标,提高了患者满意度,增强了护理团队解决问题的能力。     

院前气管插管联合简易呼吸机对院前颅脑外伤影响的护理研究

目的探讨使用院前气管插管联合简易呼吸机对院前颅脑外伤的影响。方法对我院2009年2月至2010年12月收治的51例颅脑外伤的患者，在院前急救中采用气管插管和简易呼吸机联合使用，观察患者使用后的情况。结果51例患者经过气管插管和简易呼吸机使用，患者均抢救成功，抢救成功率达100%。患者呼吸恢复平稳，血氧饱和度增加。结论院前气管插管联合简易呼吸机使用方便，在院前急救颅脑损伤，可提高患者治愈率，减少并发症，效果明显。     

院前气管插管联合简易呼吸机对院前颅脑外伤影响的护理研究

目的探讨使用院前气管插管联合简易呼吸机对院前颅脑外伤的影响。方法对我院2009年2月至2010年12月收治的51例颅脑外伤的患者,在院前急救中采用气管插管和简易呼吸机联合使用,观察患者使用后的情况。结果 51例患者经过气管插管和简易呼吸机使用,患者均抢救成功,抢救成功率达100%。患者呼吸恢复平稳,血氧饱和度增加。结论院前气管插管联合简易呼吸机使用方便,在院前急救颅脑损伤,可提高患者治愈率,减少并发症,效果明显。     

Reduction in injury rates in nursing personnel through introduction of mechanical lifts in the workplace

BACKGROUND: Health care workers incur frequent injuries resulting from patient transfer and handling tasks. Few studies have evaluated the effectiveness of mechanical lifts in preventing injuries and time loss due to these injuries. METHODS: We examined injury and lost workday rates before and after the introduction of mechanical lifts in acute care hospitals and long-term care (LTC) facilities, and surveyed workers regarding lift use. RESULTS: The post-intervention period showed decreased rates of musculoskeletal injuries (RR = 0.82, 95% CI: 0.68-1.00), lost workday injuries (RR = 0.56, 95% CI: 0.41-0.78), and total lost days due to injury (RR = 0.42). Larger reductions were seen in LTC facilities than in hospitals. Self-reported frequency of lift use by registered nurses and by nursing aides were higher in the LTC facilities than in acute care hospitals. Observed reductions in injury and lost day injury rates were greater on nursing units that reported greater use of the lifts. CONCLUSIONS: Implementation of patient lifts can be effective in reducing occupational musculoskeletal injuries to nursing personnel in both LTC and acute care settings. Strategies to facilitate greater use of mechanical lifting devices should be explored, as further reductions in injuries may be possible with increased use.     

76例老年重型颅脑损伤临床治疗分析

目的：探讨重型颅脑损伤患者的治疗方法及不同患者预后及并发症情况。方法：选择本院2010年1月-2012年5月收治的重型颅脑损伤患者,按治疗方法不同分为研究组与对照组,两组又根据治疗方法不同分为老年组与非老年组,对照组患者给予常规治疗,研究组在对照组的基础上给予标准大骨瓣减压＋冰毯冰帽降温治疗,评价治疗效果及并发症发生情况。结果：研究组总病死率明显低于对照组,差异有统计学意义（P〈0．05）;两组内老年患者并发症发生率及病死率明显低于对照组,差异有统计学意义（P〈0．05）。结论：老年重型颅脑损伤患者病死率及并发症发生率较高,在常规治疗的基础上给予标准大骨瓣减压＋降温治疗,效果较好,值得应用。     

Proven methods to achieve high payment for performance

Clinical performance measures and cost per episode of care are key ingredients of healthcare "value" and are increasingly being viewed as belonging in the public domain. "Pay for performance" (P4P) programs reward high performance of clinical "processes" and "outcome" measures, in particular for those related to chronic disease, patient satisfaction, patient safety, use of information technology, and other measures. At the core of the Advocate Health Partners clinical integration approach are specific practice interventions linked with clinical performance targets and supported by an incentive P4P program. Techniques of improvement include the use of registries of patients with specific conditions; clinicalprotocols; patient outreach with education tools and reminders; office staff training programs; physician continuing medical education; ongoing performance feedback; and an incentive program that rewards individual performance as well as collaboration among hospitals, physician hospital organizations, and peers.     

Considerations in fluids and electrolytes after traumatic brain injury.

Appropriate fluid management of patients with traumatic brain injury (TBI) presents a challenge for many clinicians. Many of these patients may receive osmotic diuretics for the treatment of increased intracranial pressure or develop sodium disturbances, which act to alter fluid balance. However, establishment of fluid balance is extremely important for improving patient outcomes after neurologic injury. The use of hyperosmolar fluids, such as hypertonic saline, has gained significant interest because they are devoid of dehydrating properties and may have other beneficial properties for patients with TBI. Electrolyte derangements are also common after neurologic injury, with many having neurologic manifestations. In addition, the role of electrolyte abnormalities in the secondary neurologic injury cascade is being delineated and may offer a potential future therapeutic intervention.     

Bicycle helmet counseling by pediatricians: a random national survey.

A random sample of 1201 pediatricians who are members of the American Academy of Pediatrics completed questionnaires regarding bicycle injury prevention counseling. Of the 871 pediatricians in the sample who provide health supervision, 80% reported that they discuss bicycle helmet use with their patients at least once before the patient reaches the age of 12 years. Provision of bicycle helmet counseling did not vary significantly by pediatricians' age, gender, or practice location. The most important predictor of provision of bicycle helmet counseling was professional experience with injured children, including having had a patient who experienced a serious injury or death due to a bicycle accident in the last year.     

Ice machines--an audit of their use in clinical practice

Ice is used in clinical settings for a variety of reasons and ice making machines have been implicated in outbreaks of nosocomial infection. An audit was undertaken to investigate the routine local and strategic management and maintenance of ice machines in clinical settings. The results highlighted the need to implement local policies for the purchase, use and maintenance of such machines.     

A new method of repair for quadriceps tendon ruptures. A case report

Rupture of the quadriceps tendon is an uncommon injury observed predominantly in subjects over 40 years old. Multiple surgical techniques have been employed to repair fresh and neglected ruptures; methods that make use of allograft and augmentation with tissues harvested from around the knee have been reported. We describe a case of surgical repair of a tendon-bone junction rupture in a 64-year-old patient by use of suture anchors to attach the tendon to bone and improve fixation of the soft tissue elements. Clinical diagnosis of rupture was confirmed radiographically and echographically. Surgical repair was performed within 24 hours of injury. Active movement of the knee started after 3 weeks and the patient was permitted to walk without weight-bearing with a knee cage. Three weeks later, he was permitted to walk with full weight-bearing unassisted by crutches; the knee cage was removed 6 weeks after surgery. At his most recent follow-up 24 months postoperative, quadriceps strength was equal to that of the controlateral knee and the patient has returned to sports and daily activities. The surgical method presented here provides a suture of the tendon ends without putting excess stress on the suture line during the period of early knee mobilization. Advantages over other techniques include reduced operative time, easy access to the implantation site, and better resistance of the suture material: the patient is thus able to initiate physical therapy earlier and more aggressively.     

"Ice" use and eating disorders: a report of three cases

OBJECTIVE: To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss. METHOD: We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit. RESULTS: Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment. DISCUSSION: "Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.