Microalbuminuria: is it a valid predictor of cardiovascular risk?

Microalbuminuria strongly predicts cardiovascular morbidity and mortality, clinical nephropathy, and progression of renal disease in high-risk populations. We recommend screening patients with type 2 diabetes, older patients with type 1 diabetes, and older patients with stage 2 hypertension or higher (ie, > or = 160/100 mm Hg).     

CPR: is it cruel or is it kind?

When people have a cardiac arrest, whether in hospital or the community, there is a presumption is that cardiopulmonary resuscitation should be attempted in all but exceptional circumstances. This is based on ethical, legal, political and cultural principles. However, few patients leave hospital with their faculties intact following CPR, which often simply postpones death for a short time. The authors argue that this represents a poor use of public resources and condemns many patients to severe debilitation. They suggest that the focus should move towards preventing cardiac arrest, so that scarce resources can be redirected to interventions with proven benefits.     

Second-hand smoke: how damaging is it to health?

In the 20th century, over half the English population smoked, but this figure has now dropped to a quarter (Office for National Statistics, 2003). A combination of scientific evidence, health education campaigns and larger warnings on cigarette packets has contributed to achieving this change. Public opinion has also shifted dramatically, and most people now accept that being a smoker is damaging to health. In 1992, the World Health Organization International Agency for Research and Cancer classified second-hand smoke as being 'carcinogenic' to humans (WHO International Agency for Research on Cancer, 2002). Following this report, New York became one of the first cities in the world to introduce a comprehensive ban on smoking in public places to protect employees. In the UK, however, many employees, including nurses, are still routinely exposed to tobacco smoke in the workplace.     

Aprotinin: is it prothrombotic?

Controversy continues as to whether aprotinin (Trasylol) is prothrombotic. The recent discovery of the thrombin receptor family, known as the protease-activated receptor family (PAR) has been essential in aiding our understanding of the mechanism of action of aprotinin. Our results show that aprotinin has no effect on platelet aggregation induced by adrenaline, adenosine diphosphate, phorbol-12-myristate-13-acetate, collagen or PAR 1 agonist peptide. However, aprotinin inhibits thrombin-induced platelet activation as assessed by macroaggregation, microaggregation and platelet membrane calcium flux. Aprotinin inhibits proteolytic activation of platelets, but platelets can still be activated by non-proteolytic mechanisms.     

IMRT: is it Nirvana?

Abstract

Intensity modulated radiotherapy (IMRT) is a complex form of external beam radiation therapy, which is not called on commonly for palliative therapy. However, its use in day-to-day therapy is becoming more wide-spread with the increasing incorporation of new imaging and planning technologies into radiotherapy departments, together with the increasing availability of multileaf collimators and electronic portal imaging devices. In the clinical setting, IMRT is being used in a number of tumour settings where dose escalation is desirable or where there are dose-limiting organs in close proximity to the tumour. The clinical evidence and basis for treatment is discussed.     

Rash: is it shingles?

CASE PRESENTATION: Mrs. Smith, a 56-year-old Caucasian woman, was seen in the office for complaints of a rash at her waist. She completed three cycles of dose-dense cyclophosphamide and doxorubicin chemotherapy for stage III breast cancer. The third cycle was 10 days prior. Grade III neutropenia was the only complete blood count abnormality.     

The concept of branding: is it relevant to nursing?

This concept exploration examines branding and its relevance to nursing. Branding is used to differentiate products through use of symbols. The symbols are the brands that are designed to communicate the value of products. Nursing has had many identifying symbols, such as the nurse's cap and the white uniform, but these symbols have failed to clearly communicate the essence of nursing. Lack of a distinct nursing brand has led to confusion about the discipline. The Roy adaptation model provides a view of branding as a process for clearly defining the profession, improving its image, and differentiating its role within the healthcare milieu.     

Fever in sepsis: is it cool to be hot?

Changes in body temperature are a characteristic feature of sepsis. The study by Kushimoto and colleagues in a recent issue of Critical Care demonstrates that hypothermia is a very important manifestation of infection associated with very high mortality. Combined with recent data suggesting that febrile patients with infections have the lowest mortality risk, the study raises the question of whether inducing therapeutic hyperthermia might be beneficial in this patient group. Body temperature is easily measured and manipulated in the ICU, and interventional trials defining the most appropriate temperature targets in ICU patients with infections are urgently needed. One such study is in progress.