Is there a role for remote ischaemic postconditioning in cardiopulmonary resuscitation?

Cardiac arrest causes whole body ischaemic injury and cellular death. Successful cardiopulmonary resuscitation (CPR) can subsequently lead to a global reperfusion phenomenon with a paradoxically increased rate of cellular death. Interventions that decrease the ischaemia-reperfusion injury may be useful in the treatment of these patients. Remote ischaemic postconditioning with transient limb ischaemia is feasible in cardiac arrest patients. This article discusses the concept of ischaemic pre- and postconditioning and its potential use in patients during CPR and after return of a spontaneous circulation.     

New airways for resuscitation?

Over the last 15 years supraglottic airway devices (SADs), most notably the classic laryngeal mask airway (LMA) have revolutionised airway management in anaesthesia. In contrast for resuscitation, both in and outside hospital, facemask ventilation and tracheal intubation remain the mainstays of airway management. However there is evidence that both these techniques have complications and are often poorly performed by inexperienced personnel. Tracheal intubation also has the potential to cause serious harm or death through unrecognised oesophageal intubation. SADs may have a role in airway management for resuscitation as first responder devices, rescue devices or for use during patient extraction. In particular they may be beneficial as the level of skill required to use the device safely may be less than for the tracheal tube. Concerns have been expressed over the ability to ventilate the lungs successfully and also the risk of aspiration with SADs. The only SADs recommended by ILCOR in its current guidance are the classic LMA and combitube. Several SADs have recently been introduced with claims that ventilation and airway protection is improved. This pragmatic review examines recent developments in SAD technology and the relevance of this to the potential for using SADs during resuscitation. In addition to examining research directly related to resuscitation both on bench models and in patients the review also examines evidence from anaesthetic practice. SADS discussed include the classic, intubating and Proseal LMAs, the combitube, the laryngeal tube, laryngeal tube sonda mark I and II and single use laryngeal masks.     

The CDK inhibitors: potential targets for therapeutic stem cell manipulations?

Therapies involving adult stem cells are dependent upon sufficient expansion of these cells to repopulate or replace the diseased tissue and are consequently hindered by their relatively quiescent phenotype. Cellular proliferation is governed by the cyclin-dependent kinases, which in a complex with a corresponding cyclin, phosphorylate a number of downstream mediators to drive the cell through the cell cycle. In turn, biochemical activities of the cyclin-dependent kinases are regulated by two families of cyclin-dependent kinase inhibitors, which have been shown to be potent cell intrinsic blocks of adult stem cell proliferation in multiple tissue types. In contrast to normal stem cells, inappropriate regulation of the cell cycle in cancer stem cells may underlie tumorigenesis and failure of conventional chemotherapeutics to fully eradicate a tumor. Thus, definition of the roles of the cyclin-dependent kinase inhibitors in normal and cancer stem cells may permit the development of novel strategies for adult stem cell expansion and therapies specifically targeted to cancer stem cells.     

Patient narratives: The potential for “patient-centred” interprofessional learning?

The success of interprofessional education initiatives depends substantially on attitudes and readiness of health care students to this type of learning. To our knowledge, nothing is known about this subject in a non-western educational context. Using a self-administered extended 29 item version of the Readiness for Interprofessional Learning Scale (RIPLS), this study examined attitudes and readiness for interprofessional education of senior medical (n = 90) and nursing (n = 88) students' from the United Arab Emirates University and Institute of Nursing. The researchers also tested the validity of the RIPLS in this Middle Eastern context. Three main factors, comprising 20 statements emerged from statistical analysis of the data. Sub-scales were labelled “teamwork and collaboration”, “professional identity” and “patient-centredness” and each had a strong internal consistency (0.86, 0.80, 0.80 respectively). Both groups of students believed that there are potential academic and clinical benefits of interprofessional learning. Nevertheless, analysis of variance indicated significant differences between the two groups of students in respect of key statements on each factor. The extended RIPLS was validated for use in an undergraduate Middle Eastern community and thus provides programme developers and evaluators with a useful tool to assess medical and nursing students' readiness for interprofessional learning in this context.     

Lutrol gel: a potential role in wounds?

Excoriated skin from malignant wounds or from their effluent are uncommon but difficult situations. Many preparations are available that may relieve discomfort; however, difficulties arise because such wounds often occur in areas where dressings are difficult to apply and keep in place. Lutrol gel is a thermoreversible gel, first reported as a potentially useful base substance by MacGregor in 1994. We report three cases where lutrol gel appeared to reduce discomfort, improve functional ability, and quality of life for the patient. We also discuss other potentially useful agents for similar situations.