A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

Plasma Catecholamines in Patients with Acute Myocardial Infarction and in Cardiac Arrest

Plasma catecholamine concentrations in cardiac arrest (ventricularfibrillation and asystole) are significantly higher than aftermyocardial infarction. The levels reached are well above thosenormally required to stimulate cardiac activity. Possible reasonsfor the failure of the myocardium to respond to the catecholaminesare discussed and the rationale for giving more catecholaminesis questioned.     

Plasma exchange in refractory cutaneous vasculitis

Eight patients with intractable cutaneous leucocytoclastic vasculitis were given a trial of plasma-exchange therapy. All but one improved, five substantially. Four have been successfully treated by intermittent plasma exchange for periods of 5-12 years. Apart from one episode of hepatitis B, possibly related to administration of fresh frozen plasma, no major adverse effects have occurred. Plasma exchange can be a valuable therapeutic option in patients with severe refractory cutaneous vasculitis.     

The Influence of Break Timing on the Sleep Quantity and Quality of Fly-in, Fly-out Shiftworkers

Although shift and break timing is known to affect the sleep of shiftworkers, this hasnot been demonstrated in Fly-in, Fly-out (FIFO) settings which, compared to residentialbased settings, may be favourable for sleep. This study investigated the sleep quantityand quality of shiftworkers working a FIFO operation comprising of shifts, and thereforebreaks, across the 24-h day. The sleep of 24 males (50.43 ± 8.57 yr) was measured usingactigraphy and sleep diaries. Morning breaks were associated with less sleep (09:00–12:00h; 4.4 ± 1.3 h) and a poorer sleep quality (06:00–09:00 h; 3.1 ± 1.0, “average”) comparedto breaks beginning between 00:00 h and 03:00 h (6.8 ± 1.7 h; 2.2 ± 0.9, “good”). Sleepefficiency remained constant regardless of break timing (85.9 ± 5.0% to 89.9 ± 3.5%).Results indicate that even in operations such as FIFO where sleeping conditions arenear-optimal and the break duration is held constant, the influence of the endogenouscircadian pacemaker on sleep duration is evident.