Rats, Mice, and People: Rodent Biology and Management

Farm Management,

Should we use central venous saturation to guide management in high-risk surgical patients?

Measurements of central venous oxygen saturation (ScvO(2)) have been successfully used to guide haemodynamic therapy in critical care. The efficacy of this approach in the treatment of severe sepsis and septic shock has stimulated interest in the use of ScvO(2 )to guide management in patients undergoing major surgery. The physiological basis of ScvO(2 )measurement is complex. A number of outstanding issues will need to be resolved before incorporating ScvO(2 )measurement into routine practice. First, it is not yet clear which value of ScvO(2 )should be targeted. Second, there is some uncertainty as to which interventions are the most effective for achieving the desired value of ScvO(2 )or how long this value should be maintained. The study by The Collaborative Study Group on Perioperative ScvO(2) Monitoring published in this edition of Critical Care may help provide answers to some of these questions. Our understanding of ScvO(2 )measurement remains limited, however, and the routine use of peri-operative ScvO(2)-guided goal-directed therapy cannot be recommended until a large randomised trial has confirmed the value of this approach

Fundamental results from microgravity cell experiments with possible commericial applications

Some of the major milestones are presented for studies in cell biology that were conducted by the Soviet Union and the United States in the upper layers of the atmosphere and in outer space for more than thirty-five years. The goals have changed as new knowledge is acquired and the priorities for the use of microgravity have shifted toward basic research and commercial applications. Certain details concerning the impact of microgravity on cell systems is presented. However, it needs to be emphasized that in planning and conducting microgravity experiments, there are some important prerequisites not normally taken into account. Apart from the required background knowledge of previous microgravity and ground-based experiments, the investigator should have the understanding of the hardware as a physical unit, the complete knowledge of its operation, the range of its capabilities and the anticipation of problems that may occur. Moreover, if the production of commercial products in space is to be manifested, data obtained from previous microgravity experiments must be used to optimize the design of flight hardware

On the Importance of Intellectual Property Rights for E-science and the Integrated Health Record

An integrated health record (IHR) that enables clinical data to be shared at a national level has profound implications for medical research. Data that have been useful primarily within a single clinic will instead be free to move rapidly around a national network infrastructure. This raises challenges for technologists, clinical practice, and for the governance of these data. This article considers one specific issue that is currently poorly understood: how intellectual property (IP) relates to the sharing of medical data for research on large-scale electronic networks. Based on an understanding of current practices, this article presents recommendations for the governance of IP in an integrated health record

Comparison of three methods of extravascular lung water volume measurement in patients after cardiac surgery

This research was supported by an Intensive Care Society (UK) Young Investigator Award and unrestricted research grants from Barts and The London NHS Trust and LiDCO, Lt

Building A Culture of Scholarship with New Clinical Teachers By Writing About Social Justice Lawyering

This Article is a collection of essays about teaching social justice lawyering, as seen through the eyes of eight practitioners-in-residence in the clinical program at American University’s Washington College of Law (“WCL”). They include: Michelle Assad, Maria Dooner, Mariam Hinds, Jessica Millward, Citlalli Ochoa, Charles Ross, Anne Schaufele, and Caroline Wick. They teach in seven clinics, including the Civil Advocacy Clinic, the Criminal Justice Clinic, the Community Economic and Equity Development Clinic, the Disability Rights Law Clinic, the Immigrant Justice Clinic, the International Human Rights Law Clinic, and the Janet R. Spragens Federal Income Tax Clinic. We use the terms practitioner-in residence and practitioner interchangeably throughout this Article. These practitioners have full-time faculty status and represent a range of experience in our clinical program—from those who are in their first year of teaching in the program to those who have been teaching for several years and are near the end of their fellowships. Professors Assad, Millward, Schaufele, and Wick have now moved on to permanent teaching positions at other law schools, and Professor Dooner has returned to practice. They are all experienced lawyers who have brought their lawyering experiences in a variety of practice areas—criminal defense, criminal legal system reform, civil legal services, community and economic development, immigration, international human rights, employment, public benefits, health, tax law and policy, and special education—to their clinical teaching. They are diverse across a range of identities including race and ethnicity

Identification and characterisation of the high-risk surgical population in the United Kingdom

INTRODUCTION: Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to describe this population. The aim of the present study was to estimate the size of the high-risk general surgical population and to describe the outcome and intensive care unit (ICU) resource use. METHODS: Data on inpatient general surgical procedures and ICU admissions in 94 National Health Service hospitals between January 1999 and October 2004 were extracted from the Intensive Care National Audit & Research Centre database and the CHKS database. High-risk surgical procedures were defined prospectively as those for which the mortality rate was 5% or greater. RESULTS: There were 4,117,727 surgical procedures; 2,893,432 were elective (12,704 deaths; 0.44%) and 1,224,295 were emergencies (65,674 deaths; 5.4%). A high-risk population of 513,924 patients was identified (63,340 deaths; 12.3%), which accounted for 83.8% of deaths but for only 12.5% of procedures. This population had a prolonged hospital stay (median, 16 days; interquartile range, 9–29 days). There were 59,424 ICU admissions (11,398 deaths; 19%). Among admissions directly to the ICU following surgery, there were 31,633 elective admissions with 3,199 deaths (10.1%) and 24,764 emergency admissions with 7,084 deaths (28.6%). The ICU stays were short (median, 1.6 days; interquartile range, 0.8–3.7 days) but hospital admissions for those admitted to the ICU were prolonged (median, 16 days; interquartile range, 10–30 days). Among the ICU population, 40.8% of deaths occurred after the initial discharge from the ICU. The highest mortality rate (39%) occurred in the population admitted to the ICU following initial postoperative care on a standard ward. CONCLUSION: A large high-risk surgical population accounts for 12.5% of surgical procedures but for more than 80% of deaths. Despite high mortality rates, fewer than 15% of these patients are admitted to the ICU