Monocyte and Neutrophil Adhesion to Matrix Proteins is Selectively Enhanced in the Presence of Inflammatory Mediators

The authors investigated the time course of monocyte and neutrophil adhesion to fibronectin, vitronectin and albumin precoated culture wells, using mixed leucocyte populations from healthy blood donors. Moreover, the influence of chemotactic agonists on the adhesion properties as well as the quantitative expression of CD29, CD11b/CD18 and CD61 was analysed by flow cytometry. Different chemotactic agonists were used representing a classical chemotactic agonist (fMLP), and agonists with a preferential effect on monocytes (RANTES) and neutrophils (IL-8), respectively. The authors found a gradual increase in monocyte and neutrophil adhesion to all three surfaces, reaching a plateau at 15 min of incubation. Adhesion to fibronectin was significantly higher at all time points (5, 15 and 60 min, respectively) compared with vitronectin and albumin in both monocytes and neutrophils. Neutrophil adhesion to vitronectin was significantly lower at 60 min compared with 15 min. Monocyte adhesion to albumin was increased by fMLP and RANTES and to vitronectin also by IL-8. Neutrophil adhesion to albumin and vitronectin was increased by fMLP and IL-8, but not RANTES. The adhesion to fibronectin was not altered by any of the chemotactic agonists used. The quantitative levels of CD11b/CD18, but not CD29 and CD61, was increased by fMLP, but not RANTES nor IL-8. The authors conclude that the adhesion of human monocytes and neutrophils to vitronectin and albumin, but not fibronectin, is selectively enhanced by chemotactic agonists and may contribute to the selective accumulation of different leucocyte subsets at the inflammatory site.     

Adopt-a-Floor program: A hospital work strategy that works

It's no secret that the nursing staff has a significant impact on how a patient perceives his or her overall hospital experience. Today's nurses have a significant volume of daily responsibilities, both clinical and nonclinical. Sometimes those responsibilities include issues related to patient food service. For something that has little to do with clinical responsibilities, food service can be a high factor in health care environments for both nurse managers and their staff.     

Evaluation of Electrocardiographic Leads for Detection of Atrial Activity (P Wave) in Ambulatory EGG Monitoring: A Pilot Study

The usual lead systems for ambulatory ECG monitoring (AECG) used in the evaluation of arrhythmias is a modified bipolar V-1 and V-5. A comparison of various lead systems to enhance the detection of atrial activity (p waves) has not been reported. We evaluated various surface lead systems in 12 subjects comparing p waves recorded at 20 mm/mV and 50 mm/sec. We compared p wave area, amplitude, and duration from modified bipolar V1 and V5 as well as seven nonstandard leads recorded on a AECG monitor. Of the seven nonstandard leads, a vertical sternal lead, with the negative pole just below the suprasternal notch and the positive pole at the xiphoid process, had the largest area (1.46 +/- 0.65 mm2), and also had a greater area than the standard V1 (0.88 +/- 0.45 mm) and V5 (1.06 +/- 0.49 mm2) lead system (P less than 0.01). We conclude that the bipolar vertical sternal lead system provides a larger p wave area than seven nonstandard bipolar lead systems and the two standard lead systems currently used in AECG monitoring. Replacement of the modified bipolar V1 lead with a vertical sternal lead should improve the recognition of atrial activity and, therefore, enhance the diagnosis of cardiac arrhythmias.     

Care Coordination to Enhance Management of Long‐Term Enteral Tube Feeding

Background: A systematic review and meta‐analysis was completed to summarize care delivery models that used care coordination and/or team approach methods in the management of patients requiring long‐term enteral tube feeding. Our aim was to evaluate team composition, implementation strategies, and the effectiveness of these methods. Methods: We conducted a broad search of 7 databases from inception to May 2012, cross‐referenced clinical reviews and medical guidelines, and consulted clinical experts. Independent reviewers screened eligible studies, extracted data, and assessed study quality. Results: Fifteen studies enrolling 2145 patients were included in this review. The studies described multidisciplinary teams composed of primary care physicians, specialists, nurses, dietitians, and language or speech specialists. Patients and their families/caregivers were also an important part of the care team. The interventions were multifaceted and employed multiple simultaneous strategies that particularly included patient and family education, staff education, and continuous auditing and feedback methods. Meta‐analysis suggested no significant reductions in complications (incidence rate ratio [IRR], 0.53; 95% confidence interval [CI], 0.27–1.05), infections (IRR, 0.77; 95% CI, 0.48–1.24), and overall hospital admissions (IRR, 0.36; 95% CI, 0.13–1.00) most likely due to lack of statistical power. We found significant reduction of total hospital costs (estimates in US dollars: ?623.08; 95% CI, ?745.64 to ?500.53; P < .01) after the interventions. Conclusion: Studies suggested a positive association of care coordination by a multidisciplinary team approach and improved patient outcomes for long‐term enteral feeding patients. However, the available evidence does not allow estimating the effectiveness of a particular intervention or team composition.