Can an interprofessional tracheostomy team improve weaning to decannulation times? A quality improvement evaluation

There are several indications for percutaneous tracheostomy and, although it is a common bedside procedure performed by a surgeon in intensive care units, gaps exist in follow-up after transfer to the ward. Given that deficiencies in specialized tracheostomy management may lead to serious complications -- some of which may be life threatening -- it is important to address these knowledge gaps in particular management strategies. Prompted, in part, by the lack of formalized processes at the author's institution and the scarcity of high-quality literature evidence supporting the value of interprofessional tracheostomy teams, this article describes the implementation of such a team and its impact on several metrics

When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto

INTRODUCTION: There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection. METHODS: Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated. RESULTS: In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza. CONCLUSIONS: The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile or admitted during weeks of peak influenza activity

Mineral vein dynamics modelling (FRACS)

Die FRACS-Gruppe setzte sich aus fünf Forschungseinrichtungen an den Universitäten Aachen, Tübingen, Karlsruhe, Mainz und Glasgow (ehemals ebenfalls Mainz) zusammen. Das Ziel der Gruppe war die Entwicklung eines erweiterten Verständnisses der Interaktion von Bruchentstehung, Fluidfluss und Bruchheilung mit Fokus auf den Vergleich zwischen Geländebeobachtungen und numerischen Modellen. Geländegebiete waren in den Oman-Bergen, in einer siliklastischen Serie von Sedimentgesteinen der Internen Ligurischen Einheiten in der Nähe von Sestri Levante (Italien) sowie in der Zechsteinkarbonatfazies eines Gasvorkommens in Norddeutschland lokalisiert. Mit den numerischen Modellen wurde kleinskalige Bruchheilung mit Kristallwachstum und Fluidfluss simuliert, der Einfluss mittelskaliger Bruchheilung auf die Machanik und Bruchbildung untersucht, sowie schließlich die Interaktion zwischen Fluidüberdruck und Bruchbildung/-heilung auf der Reservoirskala modelliert. Die numerischen Modellergebnisse wurden mit den Ergebnissen der Geländeuntersuchungen verglichen. Dabei wurden Proxies identifiziert, die zur Erkennung mechanischer Ader/Nebengestein-Verhältnisse sowie Unterschiede zwischen Fluidüberdruck und tektonischen Spannungen geeignet erscheinen. Weiterhin wurden vom Konsortium eine neue Klassifikation von Styloliten basierend auf den numerischen Modellen und Erkenntnissen aus den Zechsteinkernen erarbeitet. Ebenfalls erarbeitet wurde die Möglichkeit, aus einer weiterentwickelten Spannungsinversionsmethode die Bildungstiefe der Stylolite zu errechnen

Hepatic insulin sensitizing substance: a novel ‘sensocrine' mechanism to increase insulin sensitivity in anaesthetized rats

1. We recently described the sensory nitrergic nature of the hepatic insulin sensitizing substance (HISS) mechanism linked to postprandial activation of anterior hepatic plexus fibres in rabbits. This study is designed to assess the involvement of the sensory pathways in this mechanism. 2. Selective sensory denervation of the anterior hepatic plexus (AHP) was achieved by a 3-day perineurial treatment with 2% capsaicin solution in Wistar rats (230–250 g). After 1 week, hyperinsulinaemic (100 μU kg(−1)) euglycaemic (5.5 mmol kg(−1)) glucose clamp studies were performed to estimate insulin sensitivity. 3. The rats with regional AHP sensory denervation exhibited a significantly decreased insulin sensitivity, that is, 9.1±1.0 mg kg(−1) min(−1) glucose reinstalled euglycaemia vs 13.3±1.9 mg kg(−1) min(−1) glucose (P<0.01) in control rats. 4. Acute partial hepatic denervation by AHP cut was without effect on insulin sensitivity, whereas chronic hepatic denervation induced insulin resistance was similar to that achieved by regional AHP capsaicin treatment. 5. Intraportal administration of L-NAME (10 mg kg(−1)) decreased, whereas capsaicin (0.3 mg kg(−1) min(−1)) increased insulin sensitivity. Neither atropine (1 mg kg(−1)) nor acetylcholine (1–10 μg mg min(−1)) produced any significant effect. In animals with preceding regional capsaicin desensitization, none of the pharmacological manoeuvres modified the resulting insulin-resistant state. 6. Cysteamine (200 mg kg(−1) s.c.) is known to cause functional somatostatin depletion-induced insulin resistance similar to that produced by either chronic partial hepatic denervation or perineurial AHP capsaicin desensitization. Intraportal capsaicin (0.3 mg kg(−1) min(−1)) was unable to modify insulin resistance achieved by cysteamine. 7. We conclude that capsaicin-sensitive sensory fibres play a crucial role in neurogenic insulin sensitization known as the HISS mechanism without involvement of anatomical reflex-mediated circuits. The results also suggest that HISS is identical to somatostatin of AHP sensory neural origin