Hooray for Hypoxia?

The mortality of critically ill patients rises steadily as the partial pressure of arterial oxygen falls below about 11 kPa (80 mm Hg). A new animal study in the May 2005 issue of PLoS Biology showing a potential benefit for hypoxia is thus a challenge to current thinking

Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit

INTRODUCTION: The study aimed to compare the impact of computerised physician order entry (CPOE) without decision support with hand-written prescribing (HWP) on the frequency, type and outcome of medication errors (MEs) in the intensive care unit. METHODS: Details of MEs were collected before, and at several time points after, the change from HWP to CPOE. The study was conducted in a London teaching hospital's 22-bedded general ICU. The sampling periods were 28 weeks before and 2, 10, 25 and 37 weeks after introduction of CPOE. The unit pharmacist prospectively recorded details of MEs and the total number of drugs prescribed daily during the data collection periods, during the course of his normal chart review. RESULTS: The total proportion of MEs was significantly lower with CPOE (117 errors from 2429 prescriptions, 4.8%) than with HWP (69 errors from 1036 prescriptions, 6.7%) (p < 0.04). The proportion of errors reduced with time following the introduction of CPOE (p < 0.001). Two errors with CPOE led to patient harm requiring an increase in length of stay and, if administered, three prescriptions with CPOE could potentially have led to permanent harm or death. Differences in the types of error between systems were noted. There was a reduction in major/moderate patient outcomes with CPOE when non-intercepted and intercepted errors were combined (p = 0.01). The mean baseline APACHE II score did not differ significantly between the HWP and the CPOE periods (19.4 versus 20.0, respectively, p = 0.71). CONCLUSION: Introduction of CPOE was associated with a reduction in the proportion of MEs and an improvement in the overall patient outcome score (if intercepted errors were included). Moderate and major errors, however, remain a significant concern with CPOE

Establishing drug utilisation research in regional North Queensland.

[Extract] Quality Use of Medicines includes the safe and effective use of medicines, and is a core objective of the National Medicines Policy in Australia. Dispensing data are collected by a government agency (Medicare) for administrative purposes, for reimbursement of the pharmacy where the medicine was supplied. Prior to April 2012, dispensing data were limited to prescription medicines which exceeded the patient co-payment cost. A proof-of-concept was initiated by the primary author (Kairuz) to develop a comprehensive dataset of local dispensing records. Collaboration with Pudmenzky and Rossato led to the development of software to extract and de-identify dispensing data. A pilot study was conducted in collaboration with Fredericks in metropolitan South Queensland (Ethical approval UQ 2012000078)

Towards an architecture that facilitates research and education in a World Heritage Site : an environmental research facility for the iSimangaliso Wetland Park.

Thesis (M.Arch)-University of KwaZulu-Natal, Durban, 2008.The purpose of this research document was to determine a relevant, responsible and appropriate architecture for the design of an Environmental Research Facility for the iSimangaliso Wetland Park World Heritage Site in Northern KwaZulu Natal, South Africa. The nature of this architecture was generated through the investigation of current literature, case and precedent studies and personally conducted interviews with a number of informed professionals. The reason for these recommendations was ultimately the design of the facility for research and education, the goal was always the eventual application of the findings into a design. Ultimately, an appropriate architecture for an Environmental Research Facility for iSimangaliso Wetland Park, a UNESCO World Heritage Site, is one which is accountable and responsible regarding the social, economic and environmental aspects of its design. These three rubrics of sustainability were then unpacked and investigated in order to clarify how this would be most effectively be achieved in the eventual design

The diversity of aquatic insects in the Tsitsikamma region, with implications for aquatic ecosystem conservation

As a result of research carried out within the last decade to assess the diversity of macroinvertebrates of the Salt River in the Western Cape Province, South Africa, surveys of macroinvertebrates of 20 sites on 11 selected rivers from the same mountain range source were undertaken. This was done to make a preliminary assessment of the conservation status of the rivers of this region. Aquatic insects from the orders Ephemeroptera, Odonata, Plecoptera, Megaloptera, Trichoptera and the dipteran family Simuliidae were collected using techniques to maximize the number of taxa found. The insects collected were identified to species level where possible. Water physicochemical parameters were recorded at all sites for each sampling trip to characterize these rivers and to establish a set of baseline data for future comparisons. These parameters included measurements made on site and analysis of the concentrations of all the major ions in water samples in the laboratory. Multivariate analyses including Principle Components Analysis and Canonical Correspondence Analysis were used to reveal patterns within the water physicochemistry and species distributional data. Results include the identification of 123 species from 70 genera and 30 families. A total of 31 species were found to be undescribed, of which 17 were not previously collected and are thus completely new to science. In addition, four of these species could not be placed into any known genus. The analysis of water physicochemistry showed a clear distinction between rivers of Table Mountain sandstone and Bokkeveld shale origin. Downstream effects of anthropogenic influences were discernable too. Distinct macroinvertebrate assemblages were found based upon stream order and water chemistry composition. pH proved to be the most important driver of invertebrate assemblage composition. The high levels of endemism of the macroinvertebrates found within the upper reaches of these rivers and their degree of ecological specialization make these systems a priority for the conservation of aquatic biodiversity on a national and global scale