Transferring patients to a pediatric trauma center: the transferring hospital's perspective

The rationale behind a regionalized trauma system is that patient outcomes are improved when trauma patients are rapidly transported to facilities with the level of expertise need to treat their injury. Functioning as an adult Level II trauma center, we wanted to know how the transfer process worked for pediatric patients whom we transfer to a Level I pediatric trauma center, which is part of the same multihospital system. Complete information on time of arrival, the time the transfer was accepted, and patient departure time were available for 116 patients (72% of pediatric patients transferred) for the period of January 1, 1997 through June 30, 1998. Patients were retrospectively stratified into two priority groups representing differing transport priority, based on use of a nasogastric tube, endotracheal tube or Foley catheter. Means for decision time and total time in transferring hospital were inspected. Decision time was 44 minutes (standard error 4.5 minutes) for priority patients and 92 minutes (11.5) for non-priority patients (t = 2.94, df = 114, P = 0.004). Total time for priority patients was 129 minutes (7.6) and 197 minutes (14.0) for non-priority patients (t = 3.37, df = 114, P = 0.001). Decision time was not influenced by extensive injury assessment or secondary studies. On average, pediatric patients spent nearly three hours in our facility. Our data indicate that a shorter decision time did not necessarily result in a reduction in wait time. Improving pediatric transfer times requires attention not only to injury assessment processes at the transferring facility and interhospital communications but also mobilization, hand-over, and any space or personnel constraints at the receiving pediatric facility.     

The importance of potency and durability in HIV patient antiretroviral therapy preferences: a telephone survey

Patients who were receiving or had received antiretroviral therapy (ART) participated in 45-minute telephone interviews to evaluate the importance of major treatment attributes. A Likert scale was used to quantify and rate the importance of 9 ART attributes. Trade-off exercises allowed participants to select a preferred hypothetical ART regimen from two options based on daily dosing and varied efficacy. Participants were asked to assume that all else about the medications was the same. A total of 387 patients were surveyed (72% male; 44% African American, 41% Hispanic; 28% with no high school diploma, 29% high school graduate, 25% college with no degree; 46% infected through men who have sex with men [MSM], 19% infected through injection drug use [IDU]). Efficacy attributes (lowering viral load, raising CD4, durability) were rated as "most important" or "very important" by significantly more patients than other attributes (resistance profile, appearance side effects, gastrointestinal side effects, dosing frequency, pill burden, cholesterol side effects). Similar results were seen for subgroups analyzed by gender, ethnicity, age, line of therapy, region, and route of infection. In the second set of questions, 92% of patients preferred more effective twice-daily regimens over less effective once-daily regimens, and 89% preferred more durable twice-daily regimens over less durable once-daily regimens. Results suggest that potency, immune improvement, and durability of ART regimens are more important to HIV patients than other attributes such as side effects, dosing frequency, or pill burden. These results, in conjunction with other studies, suggest that patients prioritize viral suppression, immune improvement, and regimen durability more highly than regimen convenience.     

Distal stent delivery with guideliner catheter: First in man experience

Failure to deliver stents is one of the commonest causes of procedural failure in contemporary PCI practice. We describe successful use of the Guideliner Catheter, the first purpose designed FDA and CE marked device delivery catheter in 13 complex cases in native coronary vessels and bypass grafts performed via the radial route to enable distal stent delivery following failure of conventional techniques. We discuss how the Guideliner catheter may be used to facilitate difficult radial cases. © 2010 Wiley‐Liss, Inc.     

CAN NITRIC OXIDE‐GENERATING COMPOUNDS IMPROVE THE OXIDATIVE STRESS RESPONSE IN EXPERIMENTALLY DIABETIC RATS?

1. The present study was designed to evaluate the protective effects of the nitric oxide (NO)-generating compounds L-arginine (L-Arg) and sodium nitroprusside (SNP) on oxidative stress markers in streptozotocin (STZ)-diabetic rats. 2. Diabetes was induced after a single intraperitoneal injection of STZ (60 mg/kg). Rats were divided into non-diabetic (control), diabetic and treated diabetic groups. The treated diabetic groups were supplemented with L-Arg (300 mg/kg), SNP (3 mg/kg per day) or glibenclamide (0.6 mg/kg per day) orally for 4 weeks. 3. At the end of the experiment, fasted rats were killed by cervical decapitation. Blood was collected for estimation of glucose, haemoglobin, glycosylated haemoglobin (HbA(1c)), total cholesterol, high-density lipoprotein-cholesterol and triglycerides. Thiobarbituric acid-reactive substances (TBARS; an index of lipid peroxidation), superoxide dismutase, glutathione peroxidase, catalase, nitrate/nitrite (NO(x)) and reduced glutathione (GSH) were estimated in liver and kidney homogenates. 4. A significant increase was observed in plasma glucose levels and HbA(1c), with a concomitant decrease in haemoglobin levels, in diabetic rats. These alterations reverted back to near normal after treatment with the NO-generating compounds. A loss of bodyweight, polydipsia, polyphagia and elevated levels of serum cholesterol and triglycerides were observed in diabetic rats. Hyperglycaemia was accompanied by a significant increase in tissue TBARS and a decrease in NO(x), GSH and anti-oxidant enzymes, whereas, supplementation with L-Arg and SNP significantly reduced TBARS levels and increased GSH and anti-oxidant enzyme activities. Linear regression analysis indicated that blood glucose and TBARS had a significant positive correlation with HbA(1c), whereas a negative correlation was observed between GSH and NO(x). 5. It is concluded that NO-generating compounds improve most of the biochemical abnormalities and anti-oxidant levels in diabetic rats. The beneficial effects of NO-generating compounds can be attributed to the generation of NO and/or enhanced anti-oxidant enzyme activities.     

Attenuation of oxidative stress in plasma and tissues of rats with experimentally induced hyperthyroidism by caffeic acid phenylethyl ester

Increased oxidative stress with high free radical generation has been described previously in animal models of hyperthyroidism. The present study was designed to investigate the protective effects of caffeic acid phenylethyl ester (CAPE) on oxidative damage in rats with experimentally induced hyperthyroidism. The study was conducted on 32 male Sprague-Dawley rats. The experimental animals were divided into four groups (control, CAPE alone, hyperthyroidism, and hyperthyroidism + CAPE). Hyperthyroidism was induced by intraperitoneal administration of 0.3 mg/kg/day L-thyroxine for 4 weeks. CAPE (10 micro g/kg) was administered intraperitoneally for 4 weeks. At the end of the experimental period, blood samples and various organs (liver, heart and brain) of rats were taken for the determination of thiobarbituric acid reactive substances (TBARS), reduced glutathione (GSH), oxidized glutathione, vitamin C and superoxide dismutase (SOD) levels and concentrations of triiodothyronine (T3), thyroxine (T4) and thyroxine-stimulating hormone (TSH). Our results indicate that TBARS, oxidized glutathione, SOD levels and concentrations of T3 and T4 were higher in plasma and tissues of the hyperthyroid group compared to controls. Vitamin C, GSH and TSH levels were decreased significantly in the hyperthyroid group when compared to the control group. CAPE treatment decreased the elevated TBARS, SOD, T3 and T4 levels and increased the lowered GSH, vitamin C and TSH levels to control levels in rats with hyperthyroidism. In conclusion, our results indicate that CAPE is beneficial as a protective agent against oxidative stress induced by hyperthyroidism in rats. The protection is probably due to multiple mechanisms involving free radical scavenger properties, attenuating lipid peroxidation and increasing the antioxidant status.