Patients’ preferences for enrolment into critical-care trials

Background  

Most critically ill patients are incapable of providing informed consent for research.     

Evaluation of the Food And Nutrient Database for Dietary Studies for use with a mobile telephone food record

The development of a mobile telephone food record (mpFR) in which image analysis and volume estimation data can be indexed with the Food and Nutrient Database for Dietary Studies (FNDDS) has the potential to improve the accuracy of dietary assessment. To validate the mpFR for use with adolescents, a convenience sample of adolescents, aged 11–18 years, was recruited to eat all meals and snacks in a controlled feeding environment over a 24-h period. Each food item matched a food code in the FNDDS 3.0. The objective of this analysis was to compare the measured energy and protein content of foods to the published values in the FNDDS. Duplicate plates of all meals and snacks were prepared, and samples of 20 foods were individually weighed, homogenized, freeze dried, and analyzed for energy with a bomb calorimeter and for protein with a Dumas nitrogen analyzer. Eleven of the twenty food items had energy values in the FNDDS within ±10% of the measured energy value. The measured energy and protein values from all foods correlated significantly with the energy (r = 0.981, P < 0.01) and protein (r = 0.911, P < 0.01) values in the FNDDS. These results support the use of the FNDDS with the mpFR.     

A Review of the Clinical Presentation of Dientamoebiasis

Among 750 symptomatic and asymptomatic patients, Dientamoeba fragilis was detected at a prevalence of 5.2% and more common than Giardia intestinalis. Most infected patients presented with diarrhea and abdominal pain with symptoms greater than 2 weeks duration being common. Bacterial and viral causes of infection were excluded by routine microbiological techniques. Treatment of D. fragilis infection with either iodoquinol, paromomycin, or combination therapy resulted in the eradication of the parasite and complete resolution of symptoms. Treatment failure/relapses were associated only with the use of metronidazole. Nineteen patients were examined for pin worm, no Enterobius vermicularis, a proposed vector of transmission, were detected. Intermittent shedding of D. fragilis was found to be highly variable. These studies confirm the pathogenic nature of D. fragilis and we recommend laboratories routinely test for the organism.     

Early Pleural Effusions Related to the Myocardial Injury after Open-heart Surgery for Congenital Heart Disease

Objectives. The degree of effusion immediately after cardiopulmonary bypass (CPB) can vary and may reflect several factors including the degree of myocardial injury. We compared the degree of pleural effusions after CPB to the overall myocardial injury as determined by serum cardiac troponin I (cTnI) levels after elective repair of a variety of congenital heart defects, including univentricular surgeries via cavopulmonary shunts. Methods. Serum was collected pre-CPB, post-CPB, and daily after that and cTnI level measured. The postoperative pleural effusion was measured each day until the chest tube was removed. Results. The 21 study patients were of average age of 5.5 years (±5.6). The duration of chest-tube drainage after open-heart surgery was 4.3 days (±3.5) and the amount was 2.4 mL/kg/hour (±2.9). For the biventricular repairs, cTnI levels on the postoperative day (POD) 1 best correlated with amount of effusion (n = 16, r = 0.5, P = 0.02) and the average (POD 0–3) cTnI levels with the total duration (n = 16, r = 0.4, P = 0.01) and also the amount (n = 16, r = 0.5, P = 0.02) of effusions. For the cavopulmonary shunts, the post-CBP cTnI level best correlated with the duration (n = 5, r = 0.8, P = 0.02) and amount (n = 5, r = 0.9, P = 0.02) of effusions. A cTnI level on the first postoperative day ≥15 µg/L was associated with effusions >2 days (sensitivity of 81% and specificity of 80%). Conclusion. We found that higher the cTnI released, especially ≥15 µg/L, longer the duration and greater the amount of early pleural effusions for a variety of congenital heart surgeries including cavopulmonary shunts. A number of factors may lead to excessive pleural effusions and the degree of myocardial injury may be one of them.     

Alloantibodies against low-frequency human platelet antigens do not account for a significant proportion of cases of fetomaternal alloimmune thrombocytopenia: evidence from 1054 cases

BACKGROUND: Maternal alloantibodies against the five common human platelet antigen (HPA) systems (HPA-1 to -3, -5, and -15) are found in only 20% of cases referred for fetal and neonatal thrombocytopenia (FMAIT) investigations. The question asked was whether mismatches for the remaining 11 low-frequency HPAs (HPA-4 and -6bw to -17bw) might in part explain the remaining 80% of cases.
STUDY DESIGN AND METHODS: A total of 1054 paternal DNA samples from referred FMAIT cases (among which 223 cases where antibodies against a common HPA were found) were genotyped for 11 low-frequency HPAs as well as a recently discovered polymorphism ( ITGA2B -C2320T). The initial genotyping was carried out by TaqMan and potential heterozygotes were confirmed by DNA sequencing. Clinical and serologic data were collected for each case with a heterozygote father.
RESULTS: In total, eight heterozygous fathers were identified: four for HPA-6w, one each for HPA-10w and -11w, and two for HPA-12w. Maternal antibodies against the corresponding antigen were identified in four of the eight cases. In two of these cases, antibodies against HPA-1a and HPA-1b were also found.
CONCLUSION: It was concluded that the minor alleles of HPA-4 and -6bw to -17bw are exceptionally rare in the Caucasian population and therefore do not explain the large number of FMAIT referrals which test negative for the common HPA antibodies.     

British Association of Critical Care Nurses position statement on prescribing in critical care

Background: Nurses in the UK are now one group of non-medical staff who can prescribe. This practice is evolving for critical care nursing staff who care for critically ill patients during their stay in hospital through ward and outpatient follow-up after admission to critical care.
Aim: The purposes of this paper were to present existing information regarding prescribing to support nurses in critical care currently prescribing and to inform those who are intending to prescribe.
Methods: To develop the position statement, a search of the literature was conducted using key databases. To ascertain the current level and type of prescribing in critical care, a short questionnaire was sent by email to British Association of Critical Care Nursing members, and the results of this are presented in Appendix A.
Outcomes/Results: Evidence was found in relation to the history, context in critical care, educational requirements and issues of consent related to non-medical prescribing.
Conclusions: The position statement is based upon evidence from the literature, National Health Service policy and the Nursing and Midwifery Council regulations. It takes account of the critical care patient pathway before, during and after an admission to critical care.