The evidence for small-volume resuscitation with hyperoncotic albumin in critical illness

Small-volume resuscitation of critically ill patients with hyperoncotic albumin offers a number of theoretical advantages, such as increasing intravascular volume in excess of the volume of fluid administered and reducing interstitial edema. Whilst iso-oncotic albumin has been shown to be equi-effective to isotonic saline for the resuscitation of critically ill patients without associated traumatic brain injury, the efficacy of hyperoncotic albumin for resuscitation has not been evaluated in large-scale randomized-controlled trials. Overall, the evidence for resuscitation with hyper-oncotic albumin is limited by studies of poor methodological quality with heterogenous study populations and control regimens. There is marginal qualitative evidence of improvements in surrogate outcomes in disparate patient populations, but no evidence of any survival benefit associated with resuscitation with hyperoncotic albumin. Given the lack of evidence and clinical uncertainty about the efficacy of hyperoncotic albumin, a large-scale randomized-controlled trial is required to determine its role in the acute resuscitation of hypovolemic or hypoalbuminemic critically ill patients

Examining the Relationships between Aggression, Bullying, and Cyberbullying among University Students in Saskatchewan

While cyberbullying research has grown exponentially in the past decade, little attention has been paid to cyberbullying among postsecondary students and to informing research through the use of theory. In addition, definitional concerns abound, as scholars continue to disagree whether cyberbullying is a similar or discrete construct from traditional bullying. Attempts to demonstrate that the core components of traditional bullying—repetition, the intent to harm, and the presence of a power differential—are present in cyberbullying instances have produced mixed results. Additionally, cyberbullying presents with myriad unique features, including anonymity, the amplification of harm, and the particular medium (i.e., text or pictorial) through which the bullying act is conveyed. This study utilized survey methodology to assess the relationships between aggression, bullying, and cyberbullying among a sample of 398 university students, while also testing a novel theory of aggression (the I3 Model; Finkel, 2014) to explicate the findings. Results indicate that a high percentage of university students were cyberbullying victims (84.7%) and perpetrators (70.6%). In addition, the only definitional component to predict cyberbullying victimization was repetition. Finally, moderation analyses provided evidence that Internet addiction served as an instigating trigger while proactive aggression served as an impellor; however, none of the models were mediated by gender. While the current study was limited by its cross-sectional methodology, as well as certain concerns related to measurement and study design, the results indicate the utility of the I3 Model in conceptualizing cyberbullying incidents and the need to better conceptualize the measurement of the definitional components of aggression, bullying, and cyberbullying

Norepinephrine: more of a neurohormone than a vasopressor

Septic shock causes unpredictable cardiovascular responses through adrenoreceptor-mediated changes in cardiac function and vascular responsiveness. The use of norepinephrine should be regarded as neurohormonal augmentation therapy to defend decompensating haemodynamic function rather than as a rescue therapy to treat shock. Recent trials represent a perceptible change in clinical practice to preferentially use norepinephrine early in resuscitation to defend the mean arterial pressure and to use norepinephrine as a neurohormone rather than as a vasopressor

Primary scene responses by Helicopter Emergency Medical Services in New South Wales Australia 2008–2009

BACKGROUND: Despite numerous studies evaluating the benefits of Helicopter Emergency Medical Services (HEMS) in primary scene responses, little information exists on the scope of HEMS activities in Australia. We describe HEMS primary scene responses with respect to the time taken, the distances travelled relative to the closest designated trauma hospital and the receiving hospital; as well as the clinical characteristics of patients attended. METHODS: Clinical service data were retrospectively obtained from three HEMS in New South Wales between July 2008 and June 2009. All available primary scene response data were extracted and examined. Geographic Information System (GIS) based network analysis was used to estimate hypothetical ground transport distances from the locality of each primary scene response to firstly the closest designated trauma hospital and secondly the receiving hospital. Predictors of bypassing the closest designated trauma hospital were analysed using logistic regression. RESULTS: Analyses included 596 primary missions. Overall the HEMS had a median return trip time of 94min including a median of 9min for activation, 34min travelling to the scene, 30min on-scene and 25min transporting patients to the receiving hospital. 72% of missions were within 100km of the receiving hospital and 87% of missions were in areas classified as ‘major cities’ or ‘inner regional’. The majority of incidents attended by HEMS were trauma-related, with road trauma the predominant cause (44%). The majority of trauma patients (81%) had normal physiology at HEMS arrival (RTS = 7.84). We found 62% of missions bypassed the closest designated trauma hospital. Multivariate predictors of bypass included: age; presence of spinal or burns trauma; the level of the closest designated trauma hospital; the transporting HEMS. CONCLUSION: Our results document the large distances travelled by HEMS in NSW, especially in rural areas. The high proportion of HEMS missions that bypass the closest designated trauma hospital is a seldom mentioned benefit of HEMS transport. These results along with the characteristics of patients attended and the time HEMS take to complete primary scene responses are useful in understanding the benefit HEMS provides and the services it replaces

The hydrogen-ion concentration of the vaginal secretion of merino sheep during oestrus, dioestrus, and pregnancy, with some remarks on its influence on sex-determination, and the influence of the vaginal temperature at the time of mating on conception

(1) The pH of the vaginal secretion of mature merino ewes, measured during oestrus, gave a mean value of 6·648, with a range of 5·85 to 7·40. During mid-dioestrus the mean value was 6·694, with a range of 6·00 to 7·60. During pregnancy the mean value was 6·272, with a range of 6·00 to 7·00. There are indications that there is a tendency to slightly increased acidity during oestrus and pregnancy. (2) There are indications that there is a slight tendency for male offspring to be associated with a pH approaching neutral or alkaline measurements. (3) The percentage fertility was higher with pH measurements below 7 (82·51 per cent.) than with those above 7 (73·18 per cent.). There are indications that an alkaline medium may be detrimental to the vitality of the spermatozoa in the vagina when pregnancy is used as an indicator. (4) Forced exercise increased the vaginal temperature of ewes when they are compared with ewes, kept under similar environmental conditions, which were allowed voluntary exercise. (5) The temperature of the vagina (within a range of 100·2°F. to 106·2°F.), at the time of mating or artificial insemination did not influence the sex of the lamb. (6) The temperature of the vagina, within a range of 100·2°F. to 106·2°F., did not make a significant difference in the resulting pregnancies in three groups of sheep with mean temperatures, at 1st and 2nd matings or artificial inseminations, of: (1) 103·286, 103·264, (2) 103 ·244, 103·096, and (3) 104·017, 104·108 (temperatures are recorded in °F.). (7) The gestation period, for 79 normal pregnancies in merino sheep, showed a range of 146 to 156 days, with an average of 151·4 days.The articles have been scanned in colour with a HP Scanjet 5590; 300dpi. Adobe Acrobat XI Pro was used to OCR the text and also for the merging and conversion to the final presentation PDF-format

Impact of Coronavirus disease (COVID-19) crisis on migrants on the move in Southern Africa:Implications for policy and practice

Coronavirus disease 2019 (COVID-19) knows no borders and no single approach may produce a successful impact in controlling the pandemic in any country. In Southern Africa, where migration between countries is high mainly from countries within the Southern African Development Community (SADC) countries to South Africa, there is limited understanding of how the COVID-19 crisis is affecting the social and economic life of migrants and migrant communities. In this article, we share reflections on the impact of COVID-19 on people on the move within Southern Africa land border communities, examine policy, practice, and challenges affecting both the cross-border migrants and host communities. This calls for the need to assess whether the current response has been inclusive enough and does not perpetuate discriminatory responses. The lockdown and travel restrictions imposed during the various waves of the COVID-19 pandemic in SADC countries, more so in South Africa where the migrant population is high, denote that most migrants living with other comorbidities especially HIV/TB and who were enrolled in chronic care in their countries of origin were exposed to challenges of access to continued care. Further, migrants as vulnerable groups have low access to COVID-19 vaccines. This made them more vulnerable to deterioration of preexisting comorbidities and increased the risk of migrants becoming infected with COVID-19. It is unfortunate that certain disease outbreaks have been racialized, creating potential xenophobic environments and fear among migrant populations as well as gender inequalities in access to health care and livelihood. Therefore, a successful COVID-19 response and any future pandemics require a "whole system" approach as well as a regional coordinated humanitarian response approach if the devastating impacts on people on the move are to be lessened and effective control of the pandemic ensured

Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units

INTRODUCTION: Recent evidence suggests that choice of fluid used for resuscitation may influence mortality in critically ill patients. METHODS: We conducted a cross-sectional study in 391 intensive care units across 25 countries to describe the types of fluids administered during resuscitation episodes. We used generalized estimating equations to examine the association between patient, prescriber and geographic factors and the type of fluid administered (classified as crystalloid, colloid or blood products). RESULTS: During the 24-hour study period, 1,955 of 5,274 (37.1%) patients received resuscitation fluid during 4,488 resuscitation episodes. The main indications for administering crystalloid or colloid were impaired perfusion (1,526/3,419 (44.6%) of episodes), or to correct abnormal vital signs (1,189/3,419 (34.8%)). Overall, colloid was administered to more patients (1,234 (23.4%) versus 782 (14.8%)) and during more episodes (2,173 (48.4%) versus 1,468 (32.7%)) than crystalloid. After adjusting for patient and prescriber characteristics, practice varied significantly between countries with country being a strong independent determinant of the type of fluid prescribed. Compared to Canada where crystalloid, colloid and blood products were administered in 35.5%, 40.6% and 28.3% of resuscitation episodes respectively, odds ratios for the prescription of crystalloid in China, Great Britain and New Zealand were 0.46 (95% confidence interval (CI) 0.30 to 0.69), 0.18 (0.10 to 0.32) and 3.43 (1.71 to 6.84) respectively; odds ratios for the prescription of colloid in China, Great Britain and New Zealand were 1.72 (1.20 to 2.47), 4.72 (2.99 to 7.44) and 0.39 (0.21 to 0.74) respectively. In contrast, choice of fluid was not influenced by measures of illness severity (for example, Acute Physiology and Chronic Health Evaluation (APACHE) II score). CONCLUSIONS: Administration of resuscitation fluid is a common intervention in intensive care units and choice of fluid varies markedly between countries. Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were

Short-duration selective decontamination of the digestive tract infection control does not contribute to increased antimicrobial resistance burden in a pilot cluster randomised trial (the ARCTIC Study)

OBJECTIVE: Selective decontamination of the digestive tract (SDD) is a well-studied but hotly contested medical intervention of enhanced infection control. Here, we aim to characterise the changes to the microbiome and antimicrobial resistance (AMR) gene profiles in critically ill children treated with SDD-enhanced infection control compared with conventional infection control. DESIGN: We conducted shotgun metagenomic microbiome and resistome analysis on serial oropharyngeal and faecal samples collected from critically ill, mechanically ventilated patients in a pilot multicentre cluster randomised trial of SDD. The microbiome and AMR profiles were compared for longitudinal and intergroup changes. Of consented patients, faecal microbiome baseline samples were obtained in 89 critically ill children. Additionally, samples collected during and after critical illness were collected in 17 children treated with SDD-enhanced infection control and 19 children who received standard care. RESULTS: SDD affected the alpha and beta diversity of critically ill children to a greater degree than standard care. At cessation of treatment, the microbiome of SDD patients was dominated by Actinomycetota, specifically Bifidobacterium, at the end of mechanical ventilation. Altered gut microbiota was evident in a subset of SDD-treated children who returned late longitudinal samples compared with children receiving standard care. Clinically relevant AMR gene burden was unaffected by the administration of SDD-enhanced infection control compared with standard care. SDD did not affect the composition of the oral microbiome compared with standard treatment. CONCLUSION: Short interventions of SDD caused a shift in the microbiome but not of the AMR gene pool in critically ill children at the end mechanical ventilation, compared with standard antimicrobial therapy