Regionalisation of trauma care in England

Aims We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England. Patients and Methods An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital. Results and Conclusion A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of “good recovery”. In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system

Nutritional therapy and infectious diseases: a two-edged sword

The benefits and risks of nutritional therapies in the prevention and management of infectious diseases in the developed world are reviewed. There is strong evidence that early enteral feeding of patients prevents infections in a variety of traumatic and surgical illnesses. There is, however, little support for similar early feeding in medical illnesses. Parenteral nutrition increases the risk of infection when compared to enteral feeding or delayed nutrition. The use of gastric feedings appears to be as safe and effective as small bowel feedings. Dietary supplementation with glutamine appears to lower the risk of post-surgical infections and the ingestion of cranberry products has value in preventing urinary tract infections in women

Seasonal variation of temperature response of respiration in invasive Berberis thunbergii (Japanese barberry) and two co-occurring native understory shrubs in a northeastern US deciduous forest

In the understory of a closed forest, plant growth is limited by light availability, and early leafing is proposed to be an important mechanism of plant invasion by providing a spring C ‘‘subsidy’’ when high light is available. However, studies on respiration, another important process determining plant net C gain, are rare in understory invasive plants. In this study, leaf properties and the temperature response of leaf respiration were compared between invasive Berberis thunbergii, an early leafing understory shrub, and two native shrubs, Kalmia latifolia, a broadleaf evergreen and Vaccinium corymbosum, a late leafing deciduous species, in an oak-dominated deciduous forest. The seasonal trend of the basal respiration rates (R0) and the temperature response coefficient (E0), were different among the three shrubs and species-specific negative correlations were observed between R0 and E0. All three shrubs showed significant correlation between respiration rate on an area basis (20_C) and leaf N on an area basis. The relationship was attributed to the variation of both leaf N on a mass basis and leaf mass per area (LMA) in B. thunbergii, but to LMA only in K. latifolia and V. corymbosum. After modeling leaf respiration throughout 2004, B. thunbergii displayed much higher annual leaf respiration (mass based) than the two native shrubs, indicating a higher cost per unit of biomass investment. Thus, respiratory properties alone were not likely to lead to C balance advantage of B. thunbergii. Future studies on whole plant C budgets and leaf construction cost are needed to address the C balance advantage in early leafing understory shrubs like B. thunbergii