Two Eyes Are Better Than One—Binocular Summation of Dark Vision in Healthy Individuals and Patients with Chronic Respiratory Disease

We compared monocular and binocular absolute thresholds of dark adaptation in two separate study populations. Eighteen healthy individuals (Group A) and 13 patients with chronic respiratory insufficiency (Group B) were examined three times each by computerised dark adaptometry with simultaneous but separate recordings from each eye and binocularly. The respiratory patients received oxygen supplement at visits 1 and 3. In Group A, at all three visits, binocular dark adaptation was significantly more sensitive (40.5%) than monocular dark adaptation with either eye. In Group B, at visits 1 and 3, binocular dark adaptation was also significantly more sensitive than monocular dark adaptation (40.5% higher than the right and 47% higher than the left eye). However, in Group B, at visit 2 without oxygen treatment, no significant differences were observed between monocular and binocular sensitivities. Binocular dark vision was superior to monocular dark vision in healthy individuals and in patients with respiratory insufficiency that were provided oxygen supplementation. Furthermore, deficit in oxygen seems to affect binocular summation, perhaps by impaired enhancement in the central nervous system.     

The frequency of and reasons for acute hospital transfers of older nursing home residents

The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR).     

手足口病患儿再次复诊住院危险因素分析及对策

目的探讨手足口病患儿再次复诊住院危险因素，并提出相应的护理措施。方法冲我院2011年5～8月经初诊后再次复诊入院的手足口病患儿195例进行研究，探讨其复诊住院的原因及相关危险因素。结果复诊与非复诊组的就诊时间、就诊体温、白细胞计数、并发症状比较差异有统计学意义。就诊时间〉3d、WBC〉10×10^9／L、就诊体温〉38．5℃、就诊时间、高危症状是手足口病患儿住院复诊的独立危险因素。结论不具备独立危险因素的患儿极少出现高危症状，可在家进行隔离治疗；如果患儿同时具有3项以上的独立危险因素，家长则应立即将患儿送入医院治疗，以保证患儿能够得到及时治疗和有效护理。     

Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injury

Objective: To determine if the presence of pneumonia and pressure ulcers are associated in individuals with an acute spinal cord injury during acute care and rehabilitation hospitalizations.

Design: Retrospective, secondary analyses of data obtained from the Spinal Cord Injury Model Systems enrolled from 1993 until 2006

Setting: Acute care hospitalization and inpatient rehabilitation facilities

Participants: A cohort of individuals hospitalized in acute care (n?=?3,098) and inpatient rehabilitation (n?=?1,768) was included in the analysis. Frequencies of pressure ulcer formation and episodes of pneumonia were noted in both settings.

Interventions: Not applicable.

Outcome Measures: Pressure ulcer formation and diagnosis of pneumonia

Results: The development of pressure ulcers, including stage I, was 20.3% acute care and 21.1% during in inpatient rehabilitation. Multivariate logistic regression analyses revealed a significant association of pneumonia with occurrence of pressure ulcers (P?≤?0.001, OR?=?2.3 and 2.2 respectively), the American Spinal Injury Association Impairment Scale grades (P?Conclusion: A higher presence of pressure ulcers was found in individuals with pneumonia, after adjusting for injury severity, age, sex, and utilization of mechanical ventilation. Impaired inflammatory response and decreased mobility in individuals with pneumonia may predispose these individuals to develop pressure ulcers. Surveillance and preventive measures for pressure ulcers should be rigorous in individuals with SCI and pneumonia.     

Facilitating comfort for hospitalized patients using non-pharmacological measures: Preliminary development of clinical practice guidelines

Nurses often use non-pharmacological measures to facilitate comfort for patients within the hospital setting. However, guidelines for use of these measures are commonly inadequate or absent. This paper presents 12 clinical practice guidelines that were developed from the findings of a literature review into non-pharmacological measures that are thought to facilitate patient comfort. The non-pharmacological measures addressed in these guidelines are: Aromotherapy, Distraction, Guided Imagery, Laughter, Massage, Music, Reiki, Heat or Cold, Meditation, Reflexology, Reposition and Transcutaneous Electrical Nerve Stimulation. These are preliminary guidelines for the use of non-pharmacological measures and further research and development of such guidelines is recommended.     

Bronchiectasis in indigenous and non‐indigenous residents of Australia and New Zealand

Background and objective

Bronchiectasis not associated with cystic fibrosis is an increasingly recognized chronic lung disease. In Oceania, indigenous populations experience a disproportionately high burden of disease. We aimed to describe the natural history of bronchiectasis and identify risk factors associated with premature mortality within a cohort of Aboriginal Australians, New Zealand Māori and Pacific Islanders, and non‐indigenous Australians and New Zealanders.

Methods

This was a retrospective cohort study of bronchiectasis patients aged >15 years at three hospitals: Alice Springs Hospital and Monash Medical Centre in Australia, and Middlemore Hospital in New Zealand. Data included demographics, ethnicity, sputum microbiology, radiology, spirometry, hospitalization and survival over 5 years of follow‐up.

Results

Aboriginal Australians were significantly younger and died at a significantly younger age than other groups. Age‐ and sex‐adjusted all‐cause mortality was higher for Aboriginal Australians (hazard ratio (HR): 3.9), and respiratory‐related mortality was higher for both Aboriginal Australians (HR: 4.3) and Māori and Pacific Islander people (HR: 1.7). Hospitalization was common: Aboriginal Australians had 2.9 admissions/person‐year and 16.9 days in hospital/person‐year. Despite Aboriginal Australians having poorer prognosis, calculation of the FACED score suggested milder disease in this group. Sputum microbiology varied with Aspergillus fumigatus more often isolated from non‐indigenous patients. Airflow obstruction was common (66.9%) but not invariable.

Conclusions

Bronchiectasis is not one disease. It has a significant impact on healthcare utilization and survival. Differences between populations are likely to relate to differing aetiologies and understanding the drivers of bronchiectasis in disadvantaged populations will be key.

     

One- and Two-Stage Arrhenius Models for Pharmaceutical Shelf Life Prediction

One of the most challenging aspects of the pharmaceutical development is the demonstration and estimation of chemical stability. It is imperative that pharmaceutical products be stable for two or more years. Long-term stability studies are required to support such shelf life claim at registration. However, during drug development to facilitate formulation and dosage form selection, an accelerated stability study with stressed storage condition is preferred to quickly obtain a good prediction of shelf life under ambient storage conditions. Such a prediction typically uses Arrhenius equation that describes relationship between degradation rate and temperature (and humidity). Existing methods usually rely on the assumption of normality of the errors. In addition, shelf life projection is usually based on confidence band of a regression line. However, the coverage probability of a method is often overlooked or under-reported. In this paper, we introduce two nonparametric bootstrap procedures for shelf life estimation based on accelerated stability testing, and compare them with a one-stage nonlinear Arrhenius prediction model. Our simulation results demonstrate that one-stage nonlinear Arrhenius method has significant lower coverage than nominal levels. Our bootstrap method gave better coverage and led to a shelf life prediction closer to that based on long-term stability data.