Intravenous paracetamol — waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex—Bloemfontein

Background: Paracetamol can be given both orally and intravenously (IV) with similar clinical efficacy, but the IV formulation is 360 times more expensive. IV paracetamol is therefore only recommended when the oral route is not available. This study investigated whether IV paracetamol was being used appropriately and whether there had been a change in prescribing patterns between 2008 and 2015 after the introduction and update of a prescribing protocol at an academic hospital complex in Bloemfontein, South Africa.Methods: A retrospective comparative audit of patient files was undertaken. The prescribing and administration habits of IV paracetamol were compared for two consecutive months, seven years apart, including 88 and 83 patients, respectively, who had received IV paracetamol.Results: IV paracetamol was administered appropriately in 37.5% of patients in 2008 and in 43.4% of patients in 2015 (p = 0.43). There was an improvement in the duration that IV paracetamol was prescribed for, which decreased from a median two days in 2008 to one day (p < 0.01) in 2015. In total, 55 (32.4%) patients had a concomitant oral and IV paracetamol prescription, of which 37 (21.6%) patients also received concomitant paracetamol administration. Twenty patients exceeded the 24-hour maximum dose. Seventeen patients weighed less than 40 kg; six of these patients (three paediatric and three adult) did not receive the correct weight adjusted dose of paracetamol, 15 mg/kg, resulting in excessive doses of paracetamol being administered (21– 32.3 mg/kg).Conclusions: Patients are receiving IV paracetamol when the oral route is available; this is an unnecessary waste of money. Excessive doses of paracetamol were administered due to concomitant oral and IV paracetamol prescription and administration, and a failure to calculate dose of paracetamol according to body weight in low body weight patients. Further remedial interventions are therefore required.Keywords: acetaminophen, analgesia, appropriate, audit, intravenous, pain, paracetamol, pyrexi

Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome

It is the position of the Academy of Nutrition and Dietetics that women of childbearing age should adopt a lifestyle optimizing health and reducing risk of birth defects, suboptimal fetal development, and chronic health problems in both mother and child. Components leading to healthy pregnancy outcome include healthy prepregnancy weight, appropriate weight gain and physical activity during pregnancy, consumption of a wide variety of foods, appropriate vitamin and mineral supplementation, avoidance of alcohol and other harmful substances, and safe food handling. Pregnancy is a critical period during which maternal nutrition and lifestyle choices are major influences on mother and child health. Inadequate levels of key nutrients during crucial periods of fetal development may lead to reprogramming within fetal tissues, predisposing the infant to chronic conditions in later life. Improving the well‐being of mothers, infants, and children is key to the health of the next generation. This position paper and the accompanying practice paper on the same topic provide registered dietitian nutritionists and dietetic technicians, registered; other professional associations; government agencies; industry; and the public with the Academy’s stance on factors determined to influence healthy pregnancy, as well as an overview of best practices in nutrition and healthy lifestyles during pregnancy

Mineral Potential of Arctic Canada

Canada is on the threshold of a major new phase in the development of its Arctic resources. The Prudhoe Bay discovery triggered a boom in northern petroleum exploration that is just getting into high gear this year. Mining activity also has greatly expanded in the last few years with some 73 active exploration programs underway and several large new mines just coming into production. The size of these ventures is indicated by ore reserves of two lead-zinc mines to the value of 900 million dollars at Pine Point in southern Northwest Territories, and 1.2 billion dollars at the Anvil property in the southern Yukon Territory. Other properties with very large reserves are currently under development. Approximately 465,000 sq. miles of the 1.5 million square miles of Canada north of the 60th parallel are underlain by sedimentary rocks. A volumetric estimate of petroleum potential on the basis of rather scanty evidence is made at 54 billion barrels. With the current activity in the area it should be possible to improve this estimate considerably in the next 2 or 3 years. The two most promising areas are the Arctic Coastal Plains containing large volumes of young sedimentary rock and large structures, and the Mesozoic Sverdrup Basin also with many potential hydrocarbon traps. The Interior Plains of the mainland and the Arctic lowlands, as well as the fold belts of the Franklinian miogeosyncline indicate lesser potential

Occurrence of and attempts to eradicate grape phylloxera (Homoptera: Phylloxeridae) in British Columbia

oai:jesbc.journals.sfu.ca:article/1817The chronological occurrence, survey methods, and eradication programs of the grape phylloxera, Phyiloxera vitifoliae (Fitch), in British Columbia are described. The insect was first found in the Okanagan Valley in 1961. Though an eradication program at that time was apparently successful, the insect reappeared in 1971. It is now well established in the area. The pest was accidentally introduced on imported vines

Platelet reactivity is independent of left atrial wall deformation in patients with atrial fibrillation

It has been documented recently that left atrial (LA) deformation in AF patients (while in AF) is predictive of subsequent stroke risk. Additionally, diminished LA deformation during AF correlates with the presence of LA blood stasis. Given that endothelial function is dependent on laminar blood flow, the present study sought to investigate the effect of diminished LA deformation (during AF) on platelet reactivity and inflammation in AF patients. Patients (n = 17) hospitalised with AF underwent echocardiography (while in AF) for determination of peak positive LA strain (LASp). Whole blood impedance aggregometry was used to measure extent of ADP-induced aggregation and subsequent inhibitory response to the nitric oxide (NO) donor, sodium nitroprusside. Platelet thioredoxin-interacting protein (Txnip) content was determined by immunohistochemistry. LASp tended (p = 0.078) to vary inversely with CHA2DS2VASc scores. However, mediators of inflammation (C-reactive protein, Txnip) did not correlate significantly with LASp nor did extent of ADP-induced platelet aggregation or platelet NO response. These results suggest that the thrombogenic risk associated with LA stasis is independent of secondary effects on platelet aggregability or inflammation.Nathan Procter, Vincent Goh, Gnanadevan Mahadevan, Simon Stewart, and John Horowit

Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the MOBILIZE Boston cohort study

Background: Despite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature. We examined the circumstances, consequences and resulting injuries of indoor and outdoor falls according to sex in a population study of older adults. Methods: Men and women 65 years and older (N = 743) were followed for fall events from the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston prospective cohort study. Baseline measurements were collected by comprehensive clinical assessments, home visits and questionnaires. During the follow-up (median = 2.9 years), participants recorded daily fall occurrences on a monthly calendar, and fall circumstances were determined by a telephone interview. Falls were categorized by activity and place of falling. Circumstance-specific annualized fall rates were calculated and compared between men and women using negative binomial regression models. Results: Women had lower rates of outdoor falls overall (Crude Rate Ratio (RR): 0.72, 95% Confidence Interval (CI): 0.56-0.92), in locations of recreation (RR: 0.34, 95% CI: 0.17-0.70), during vigorous activity (RR: 0.38, 95% CI: 0.18-0.81) and on snowy or icy surfaces (RR: 0.55, 95% CI: 0.36-0.86) compared to men. Women and men did not differ significantly in their rates of falls outdoors on sidewalks, streets, and curbs, and during walking. Compared to men, women had greater fall rates in the kitchen (RR: 1.88, 95% CI: 1.04-3.40) and while performing household activities (RR: 3.68, 95% CI: 1.50-8.98). The injurious outdoor fall rates were equivalent in both sexes. Women’s overall rate of injurious indoor falls was nearly twice that of men’s (RR: 1.98, 95% CI: 1.44-2.72), especially in the kitchen (RR: 6.83, 95% CI: 2.05-22.79), their own home (RR: 1.84, 95% CI: 1.30-2.59) and another residential home (RR: 4.65, 95% CI: 1.05-20.66) or other buildings (RR: 2.29, 95% CI: 1.18-4.44). Conclusions: Significant sex differences exist in the circumstances and injury potential when older adults fall indoors and outdoors, highlighting a need for focused prevention strategies for men and women

Synthesis of Phospho-Amino Acid Analogues as Tissue Adhesive Cement Additives

In this paper we report the synthesis of a library of phospho-amino acid analogues, via a novel single-step allyl-phosphoester protection/Pd-mediated deprotection strategy. These phosphoserine and phosphotyrosine analogues were then applied as additives to create adhesive calcium phosphate cements, allowing us to probe the chemical origins of the increased surface binding strength. We demonstrate the importance of multiple calcium binding motifs in mediating adhesion, as well as highlighting the crucial role played by substrate hydrophobicity and orientation in controlling binding strength