Regular follow-up as part of an Asthma management plan : a study of hospitalised patients in Malta

Objective: To study the management of specific sub-groups of patients with asthma in Malta, using locally published guidelines for comparison. Method: A piloted, structured interview among patients between the ages of 14-59 years who were hospitalised with an admission diagnosis of acute asthma. In the case of repeated admissions, only the first interview was considered. All interviews were carried out by either of two clinical pharmacists and lasted about 30 minutes. The four-year prospective study started in February 1997 (one year before publication of the Malta guidelines) and finished in January 2001 (three years after publication). Main outcome measures: · Inhaled steroids on admission · Patient partnership: use of a written self-management plan and home peak flow monitoring · Patient compliance with inhaled steroids Results: 304 patients (68% females; mean population age 33.9 years SD 13.41) were interviewed over the four year period. Of the 304 patients, 32% were regularly followed up with the majority of patients (25.3%) being under specialist care; 54% of patients were not followed up as part of a long-term asthma management plan. It was not possible to obtain complete information in 14% of patients. The chi-square test was used to compare the two groups. With the exception of home peak flow monitoring, patients who were regularly followed up had statistically significant better management as recommended by the Malta asthma guidelines compared to those who were not regularly followed up. Conclusion: The findings of this study indicate that regular physician review results in better asthma management when assessed by comparison to published guidelines. However, despite regular follow up, certain aspects of patient care are inadequate in the light of the Malta asthma guidelines. It is suggested that the clinical pharmacist is well-placed to offer advice in order to promote adherence to guidelines.peer-reviewe

Potentially Low Cost Solution to Extend Use of Early Generation Computed Tomography

In preparing a case report on Brown-Séquard syndrome for publication, we made the incidental finding that the inexpensive, commercially available three-dimensional (3D) rendering software we were using could produce high quality 3D spinal cord reconstructions from any series of two-dimensional (2D) computed tomography (CT) images. This finding raises the possibility that spinal cord imaging capabilities can be expanded where bundled 2D multi-planar reformats and 3D reconstruction software for CT are not available and in situations where magnetic resonance imaging (MRI) is either not available or appropriate (e.g. metallic implants). Given the worldwide burden of trauma and considering the limited availability of MRI and advanced generation CT scanners, we propose an alternative, potentially useful approach to imaging spinal cord that might be useful in areas where technical capabilities and support are limited

Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO).

PURPOSE: To characterize the current scope and practices of centers performing extracorporeal cardiopulmonary resuscitation (eCPR) on the undifferentiated patient with cardiac arrest in the emergency department. METHODS: We contacted all US centers in January 2016 that had submitted adult eCPR cases to the Extracorporeal Life Support Organization (ELSO) registry and surveyed them, querying for programs that had performed eCPR in the Emergency Department (ED ECMO). Our objective was to characterize the following domains of ED ECMO practice: program characteristics, patient selection, devices and techniques, and personnel. RESULTS: Among 99 centers queried, 70 responded. Among these, 36 centers performed ED ECMO. Nearly 93% of programs are based at academic/teaching hospitals. 65% of programs are less than 5 years old, and 60% of programs perform ≤3 cases per year. Most programs (90%) had inpatient eCPR or salvage ECMO programs prior to starting ED ECMO programs. The majority of programs do not have formal inclusion and exclusion criteria. Most programs preferentially obtain vascular access via the percutaneous route (70%) and many (40%) use mechanical CPR during cannulation. The most commonly used console is the Maquet Rotaflow(®). Cannulation is most often performed by cardiothoracic (CT) surgery, and nearly all programs (\u3e85%) involve CT surgeons, perfusionists, and pharmacists. CONCLUSIONS: Over a third of centers that submitted adult eCPR cases to ELSO have performed ED ECMO. These programs are largely based at academic hospitals, new, and have low volumes. They do not have many formal inclusion or exclusion criteria, and devices and techniques are variable

Biodegradation behaviour of Fe-based alloys in Hanks’ Balanced Salt Solutions : part II. The evolution of local pH and dissolved oxygen concentration at metal interface

Commercially pure Fe, Fe35Mn, and (Fe35Mn)5Ag alloys were prepared by uniaxial pressing of the mixture of individual powders, followed by sintering. The influence of the alloying elements Mn and Ag on the corrosion behaviour of these Fe-based alloys was investigated in Hanks’ Balanced Salt Solution (HBSS). Furthermore, the role of the components in HBSS, particularly Ca2+ ions during alloys degradation was studied. Distribution of local pH and dissolved oxygen concentration was measured 50 μm above the interface of the degrading alloys. The results revealed that 5 wt% Ag addition to Fe35Mn alloy triggered micro-galvanic corrosion, while uniform corrosion dominated in pure Fe and Fe35Mn. Fast precipitation of Ca–P-containing products on the surface of these Fe-based alloys buffered local pH at the metal interface, and blocked oxygen diffusion at the initial stages of immersion. In the (Fe35Mn)5Ag, the detachment or structural changes of Ca–P-containing products gradually diminished their barrier property. These findings provided valuable insights into the degradation mechanism of promising biodegradable Fe-based alloys.peer-reviewe

Biodegradation behaviour of Fe-based alloys in Hanks’ Balanced Salt Solutions : part I. Material characterisation and corrosion testing

Research on Fe-based biodegradable alloys for implant applications has increased considerably over the past decade. However, there is limited information on the influence of testing electrolytes on corrosion product formation and general corrosion progress. In this work, the effect of Hanks’ Balanced Salt Solution (HBSS) with or without Ca2+ on the corrosion of Fe, Fe35Mn and (Fe35Mn)5Ag powder-processed coupons has been studied using potentiodynamic polarisation, Electrochemical Impedance Spectroscopy (EIS), and preliminary localised measurement of pH and dissolved oxygen concentration in close proximity to the metal surface. Both Fe35Mn and (Fe35Mn)5Ag alloys showed accelerated corrosion when compared to pure Fe based on potentiodynamic testing results, with FeMnAg exhibiting the highest corrosion rate in Ca2+-containing HBSS. The results indicate that in Ca2+-containing HBSS, the formation of a partially protective Ca/P layer decelerates the corrosion progress, whereas the Fe- and Mn-phosphates formed in Ca2+-free HBSS do not have the same effect. The Ca/P layer on (Fe35Mn)5Ag experienced a reduction in resistance following several hours of testing, indicating partial loss of its protective effect.peer-reviewe

FeMn and FeMnAg biodegradable alloys : an in vitro and in vivo investigation

Iron-based biodegradable metal bone graft substitutes are in their infancy but promise to fill bone defects that arise after incidents such as trauma and revision arthroplasty surgery. Before clinical use however, a better understanding of their in vivo biodegradability, potential cytotoxicity and biocompatibility is required. In addition, these implants must ideally be able to resist infection, a complication of any implant surgery. In this study there was significant in vitro cytotoxicity caused by pure Fe, FeMn, FeMn1Ag and FeMn5Ag on both human foetal osteoblast (hFOB) and mouse pre-osteoblast (MC3T3-E1) cell lines. In vivo experiments on the other hand showed no signs of ill-effect on GAERS rats with the implanted FeMn, FeMn1Ag and FeMn5Ag pins being removed largely uncorroded. All Fe-alloys showed anti-bacterial performance but most markedly so in the Ag-containing alloys, there is significant bacterial resistance in vitro.peer-reviewe