Is enteral feeding tolerated during therapeutic hypothermia?

Objective To determine whether patients undergoing therapeutic hypothermia following cardiac arrest tolerate early enteral nutrition. Methods We undertook a single-centre longitudinal cohort analysis of the tolerance of enteral feeding by 55 patients treated with therapeutic hypothermia following resuscitation from cardiac arrest. The observation period was divided into three phases: (1) 24 h at target temperature (32–34 °C); (2) 24 h rewarming to 36.5 °C; and (3) 24 h maintained at a core temperature below 37.5 °C. Results During period 1, patients tolerated a median of 72% (interquartile range (IQR) 68.7%; range 31.3–100%) of administered feed. During period 2 (rewarming phase), a median of 95% (IQR 66.2%; range 33.77–100%) of administered feed was tolerated. During period 3 (normothermia) a median of 100% (IQR 4.75%; range 95.25–100%) of administered feed was tolerated. The highest incidence of vomiting or regurgitation of feed (19% of patients) occurred between 24 and 48 h of therapy. Conclusions Patients undergoing therapeutic hypothermia following cardiac arrest may be able to tolerate a substantial proportion of their daily nutritional requirements. It is possible that routine use of prokinetic drugs during this period may increase the success of feed delivery enterally and this could usefully be explored

Travelling With Desmond Hogan: Writing Beyond Ireland

The uneven and at times tentative development of Desmond Hogan’s fiction, based in Ireland for over some twenty years, was transformed in 1995 by his novel ‘A Farewell to Prague’ when Hogan discovered that while he could still assemble fragments from Irish life and history, now he had at his command a new means of incorporating insights from his restless travelling in many countries and a way of moulding diverse experiences into personal encounters with inner landscapes, the imagined worlds of others and visions in art. The most exhilarating effect of such travel writing is the perspective where one’s own indigenous culture may appear insignificant by itself, yet when viewed in certain ways may become a linking and a bonding with the peoples of other cultures. Hogan’s ‘miracle’ occurs when the human tragedies of history do not divide but actually help to unite individuals from whatever culture when they are moved to join in the crosscurrents of mutual understanding and guarded hope.The uneven and at times tentative development of Desmond Hogan’s fiction, based in Ireland for over some twenty years, was transformed in 1995 by his novel ‘A Farewell to Prague’ when Hogan discovered that while he could still assemble fragments from Irish life and history, now he had at his command a new means of incorporating insights from his restless travelling in many countries and a way of moulding diverse experiences into personal encounters with inner landscapes, the imagined worlds of others and visions in art. The most exhilarating effect of such travel writing is the perspective where one’s own indigenous culture may appear insignificant by itself, yet when viewed in certain ways may become a linking and a bonding with the peoples of other cultures. Hogan’s ‘miracle’ occurs when the human tragedies of history do not divide but actually help to unite individuals from whatever culture when they are moved to join in the crosscurrents of mutual understanding and guarded hope

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest : a feasibility study. PROXY: post ROSC OXYgenation study

Background Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. Methods A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention. Results One hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90 days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients. Conclusions It may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research

The Hindu Celticism of James Cousins (1873-1956)

The very existence of James Cousins as a significant Irish Cultural Revival voice is barely acknowledged in the field of Irish Studies. Alan Denson’s pioneering and admittedly congested bio-bibliographical survey published in 1967 has made very little difference in the many commentaries on the Irish Revival in which Cousins was imaginatively formed and from which he emerged as a great teacher in India. Very recently, the young American scholar Joseph Lennon has devoted a very welcome long chapter on Cousins in his book Irish Orientalism wherein Cousins is seriously discussed in the light of issues arising out of the implications of Edward Said’s seminal post-colonial work Orientalism. The essay which follows will attempt to track the passage of Cousins from Ireland to India where finally the veteran Celticist was admitted to Hindu worship on January 14 1935 in the temple of Travancore in South India. The cross-cultural significance of the spiritual formation of Cousins as Hindu Celt will be discussed in the light of certain key texts which he wrote along the way – plays, poems, theosophical writings, autobiographical musings and educational philosophising. This considerable legacy of writings, which Tagore felt deserved the Nobel Prize for Literature in 1934, awaits discovery by a new generation of Irish cultural commentators.The very existence of James Cousins as a significant Irish Cultural Revival voice is barely acknowledged in the field of Irish Studies. Alan Denson’s pioneering and admittedly congested bio-bibliographical survey published in 1967 has made very little difference in the many commentaries on the Irish Revival in which Cousins was imaginatively formed and from which he emerged as a great teacher in India. Very recently, the young American scholar Joseph Lennon has devoted a very welcome long chapter on Cousins in his book Irish Orientalism wherein Cousins is seriously discussed in the light of issues arising out of the implications of Edward Said’s seminal post-colonial work Orientalism. The essay which follows will attempt to track the passage of Cousins from Ireland to India where finally the veteran Celticist was admitted to Hindu worship on January 14 1935 in the temple of Travancore in South India. The cross-cultural significance of the spiritual formation of Cousins as Hindu Celt will be discussed in the light of certain key texts which he wrote along the way – plays, poems, theosophical writings, autobiographical musings and educational philosophising. This considerable legacy of writings, which Tagore felt deserved the Nobel Prize for Literature in 1934, awaits discovery by a new generation of Irish cultural commentators

The Vanishing Ideas of Sean O’Faolain

Marie Arndt. A Critical Study of Sean O’Faolain’s Life and Work. (New York: The Edwin Mellen Press, 2001).Marie Arndt. A Critical Study of Sean O’Faolain’s Life and Work. (New York: The Edwin Mellen Press, 2001)

Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit

Objective To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. Methods A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge. Results The overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2–2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. Conclusions These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest

Nun of Kenmare Embattled Religious Reformer

The Nun of Kenmare was a widely known controversial Victorian writer and figure in Ireland and America. After her death in 1899, her veryexistence became a little known fact. Early in the 1960s the Poor Clare nuns in Kenmare, County Kerry in Ireland were amazed to discover her books and papers as belonging to one of their founders about the time when they were marking the centenary of the convent’s foundation. Later in the 1960s, a Dublin journalist began reading the Nun’s writings. The Poor Clares of Kenmare strove to distance themselves from the Nun of Kenmare when the Dublin journalist published books about her as pioneering feminist. During the 1970s, the Congregation of St.Joseph of Peace in America at last discovered the identity of their true founder, the Nun of Kenmare, a historical fact which surprised and continues to inspire them to lead the way in researching her life and proclaiming her radical views of church reform. Recently Irish historians have been looking into the Nun. Initial approval of “Sister Suffragette” has givenway to questioning the Nun’s eccentricity as a reformer, the Nun’s attitudes towards the hierarchical workings of the Catholic Church, the Nun’s excessive hagiographical tendencies, the Nun’s emotional entrapment in Victorianism. In response to these questions, here is presented a version of the life and works of the Nun as embattled religious reformer, still relevant to the problems within the Catholic Church in the twenty-first century.Keywords: The Nun of Kenmare; Congregation of St.Joseph of Peace;“Sister Suffragette”

Effectiveness of antiarrhythmic drugs for shockable cardiac arrest : a systematic review

Purpose The purpose of this systematic review is to provide up-to-date evidence on effectiveness of antiarrhythmic drugs for shockable cardiac arrest to help inform the 2018 International Liaison Committee on Resuscitation Consensus on Science with Treatment Recommendations. Methods A search was conducted in electronic databases Medline, Embase, and Cochrane Library from inception to August 15, 2017. Results Of the 9371 citations reviewed, a total of 14 RCTs and 17 observational studies met our inclusion criteria for adult population and only 1 observational study for pediatric population. Based on RCT level evidence for adult population, none of the anti-arrhythmic drugs showed any difference in effect compared with placebo, or with other anti-arrhythmic drugs for the critical outcomes of survival to hospital discharge and discharge with good neurological function. For the outcome of return of spontaneous circulation, the results showed a significant increase for lidocaine compared with placebo (RR = 1.16; 95% CI, 1.03–1.29, p = 0.01). Conclusion The high level evidence supporting the use of antiarrhythmic drugs during CPR for shockable cardiac arrest is limited and showed no benefit for critical outcomes of survival at hospital discharge, survival with favorable neurological function and long-term survival. Future high quality research is needed to confirm these findings and also to evaluate the role of administering antiarrhythmic drugs in children with shockable cardiac arrest, and in adults immediately after ROSC