A controlled trial of naltrexone in obese humans

Based on reports that opiate antagonists can curtail short-term eating in several species including humans, the efficacy of naltrexone in promoting weight loss by obese subjects was examined. Naltrexone, a long-acting oral opiate antagonist, was studied in a randomized parallel double-blind placebo controlled ten week trial in 27 females and 14 males who were 30-100 percent overweight. Subjects on naltrexone lost an average of 1.8 kg and placebo subjects lost 1.5 kg, with no significant difference between groups. Three subjects who took naltrexone had elevations of liver transaminases, two times higher than normal. In the present study naltrexone at a daily dosage of 200 mg did not appear to have efficacy in producing weight loss after eight weeks of treatment. Studies of the effects of naltrexone at higher dosage or for longer periods should monitor hepatic function.     

Point-of-care ultrasound use for vascular access assessment and cannulation in hemodialysis: A scoping review

Point-of-care ultrasound (POCUS) for access assessment and guided cannulation has become more common in hemodialysis units. The aims of this scoping review were to determine: circumstances in which renal nurses and technicians use POCUS; the barriers and facilitators; and evidence of the effects of POCUS in guiding assessment and cannulation. A search was conducted of CINAHL, Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and ProQuest, Trove and Google Scholar as grey literature sources. Of 1904 publications, 21 studies met inclusion criteria (11 full text and 10 abstracts). These included primary research publications (n = 5), clinical observational cohort studies (n = 5), case studies (n = 3), published guidelines (n = 2), and published position papers (n = 6). POCUS was used for: assessing arteriovenous fistula (AVF) maturation; identifying landmarks and abnormalities; assessing alternate cannulation sites; performing new AVF cannulation; performing difficult cannulation; increasing cannulation accuracy; performing cannulation through stents; and patient self-cannulation training. There were scant data on the barriers to, and facilitators of the use of POCUS, and a distinct lack of empirical evidence to support its use. These knowledge gaps highlight the need for further clinical studies, particularly randomized clinical trials, to test the effectiveness of POCUS in hemodialysis for assessment and guided cannulation.     

The role of collagen in the declining mechanical properties of aging human cortical bone.

The importance of the mechanical role of collagen in bone is becoming increasingly more clear as evidence mounts on the detrimental effects of altered collagen on the mechanical properties of bone. We previously examined a set of mechanical properties (material stiffness, strength, and toughness) of human femoral bone (ages 35-92) and found that a gradual deterioration in these properties occurs with age. The present study examines the collagen of the same specimens and relates the collagen properties to the mechanical ones. In the collagen we measured the concentration of stable mature crosslinks, the shrinkage temperature, and the rate of contraction during isometric heating. The changes in the concentration of mature (pyridinium and deoxypyridinium) crosslinks showed no clear relationship to age nor did they correlate with the mechanical properties. The shrinkage temperature declined with age and correlated with a bone's toughness. The maximum rate of contraction was strongly correlated with three different measures of tissue toughness, but much less to stiffness and strength. Our results reinforce speculation regarding the toughening role of collagen in bone mechanics and suggest that the fragility of aging bone may be related to collagen changes.     

Point prevalence of patients fulfilling MET criteria in ten MET equipped hospitals. The methodology of the RESCUE study

Objective

The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study.

Design and Setting

A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings.

Patients

All inpatients were eligible except intensive care and psychiatric patients.

Measurement and main results

On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment.

Conclusion

In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.