An update of the effects of vitamins D and C in critical illness

Many critically ill patients are vitamin D and vitamin C deficient and the current international guidelines state that hypovitaminoses should be compensated. However, uncertainty about optimal dosage, timing and indication exists in clinical routine, mainly due to the conflicting evidence. This narrative review discusses both micronutrients with regards to pathophysiology, clinical evidence of benefits, potential risks, and guideline recommendations. Evidence generated from the most recent clinical trials are summarized and discussed. In addition, pragmatic tips for the application of these vitamins in the clinical routine are given. The supplementations of vitamin D and C represent cost-effective and simple interventions with excellent safety profiles. Regarding vitamin D, critically ill individuals require a loading dose to improve 25(OH)D levels within a few days, followed by a daily or weekly maintenance dose, usually higher doses than healthy individuals are needed. For vitamin C, dosages of 100–200 mg/d are recommended for patients receiving parenteral nutrition, but needs may be as high as 2–3 g/d in acutely ill patients

Reviewing the strategic influence of governance professionals in UK colleges: Acting as the translator of the conduct of conduct

This article considers the contribution of the governance professional to the governing of further education colleges in the United Kingdom and arises from a wider study of the ways in which college boards develop and implement college strategy. This is the first observational study to focus on what the governance professional does within the college governance space. From observation and other forms of evidence, the governance professional performs a significant, challenging and expert role in the processes and practices of governing colleges. The governance professional is instrumental as a governance sense-maker and, at a higher level, as translator of governing deliberations and decision making. The governance professional role in practice can vary depending upon a range of personal, local institutional and national factors. However, in essence the governance professional exists to legitimise college governance through the structures, processes and reporting of governing interactions. The article considers the extent to which the governance professional is pivotal to the governing of colleges and analyses the implications for college governing. Our research identifies some barriers to gaining greater impact from the college governance professional.Output Status: Forthcoming/Available Onlin

The outcomes of secure care in Scotland

This paper describes the findings of a three year study of the use and effectiveness of secure accommodation in Scotland. Data were collected on 53 young people shortly after their admission to secure accommodation. Most young people were admitted because they were a danger to themselves and/or they were likely to abscond; a third were considered a danger to others. Secure accommodation was considered to have benefits in relation to keeping young people safe and addressing health issues. On other dimensions, such as behaviour or family relationships, signs of benefit were more ambiguous. Thirty-three young people were considered to have clearly benefited from placement. At follow-up, after two years, outcomes were assessed as: 'good' - 14 (26%); 'medium'- 24 (45 %); and 'poor' - 15 (28%). The research highlighted the importance of effectively managing the transition from secure care. Social workers attributed a good outcome more to an appropriate placement and education being offered when the young person left secure rather than simply the placement itself. A gradual 'step-down' approach from the structure and supervision of the secure setting was also linked to better outcomes. Young people respond well when offered continuity and the opportunity to develop relationships with one or more reliable adults who can help with problems as they arise

Secure Accommodation in Scotland: Its Role and Relationship with ‘Alternative’ Services - Summary

This research was carried out between November 2002 - 2005 to increase understanding of the use and effectiveness of secure accommodation in relation to young people placed on the authority of a children's hearing. It also examined the circumstances in which open residential or community-based services might provide an ‘alternative' to secure placement

Proenkephalin A and bioactive adrenomedullin are useful for risk prognostication in cardiac surgery

IntroductionVarious clinical scores have been developed to predict organ dysfunction and mortality in patients undergoing cardiac surgery, but outcome prediction may be inaccurate for some patient groups. Proenkephalin A (penKid) and bioactive adrenomedullin (bio-ADM) have emerged as promising biomarkers correlating with shock and organ dysfunction. This imposes the question of whether they can be used as prognostic biomarkers for risk stratification in the perioperative setting of cardiac surgery.MethodsPatients undergoing cardiac surgery were prospectively enrolled in this observational study. PenKid and bio-ADM plasma levels, as well as markers evaluating inflammation and organ dysfunction, were measured at five perioperative time points from before the induction of anesthesia to up to 48 h postoperatively. Clinical data regarding organ dysfunction and patient outcomes were recorded during the intensive care unit (ICU)-stay with a special focus on acute kidney injury (AKI).ResultsIn 136 patients undergoing cardiac surgery, the bio-ADM levels increased and the penKid levels decreased significantly over time. PenKid was associated with chronic kidney disease (CKD), the incidence of AKI, and renal replacement therapy (RRT). Bio-ADM was associated with lactate and the need for vasopressors. PenKid was useful to predict an ICU-length of stay (LOS)>1 day and added prognostic value to the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE) II when measured after the end of cardiopulmonary bypass and 24 h after cardiac surgery. For bio-ADM, the same was true when measured 24 h after surgery. PenKid also added prognostic value to the EuroSCORE II for the combined outcome “ICU length of stay >1 day and in-hospital mortality.”ConclusionThe combination of preoperative EuroSCORE II and intraoperative measurement of penKid may be more useful to predict a prolonged ICU LOS and increased mortality than EuroSCORE II alone. Bio-ADM correlates with markers of shock. More research is encouraged for early risk stratification and validation of penKid and bio-ADM as a tool involved in clinical decisions, which may enable the early initiation of organ protective strategies

Distress in long-term head and neck cancer carers: a qualitative studyof carers’ perspectives

Aims and objectives: To identify and describe the triggers of emotional distress among long‐term caregivers (more than 1 year postdiagnosis) of people with head and neck cancer. Background: Limited research has been conducted on the factors that cause head and neck cancer caregivers to become distressed. Design: Qualitative cross‐sectional. Methods: In‐depth semi‐structured interviews. Interviews were conducted via telephone. The study setting was the Republic of Ireland. Results: Interviews were conducted with 31 long‐term caregivers (mean time since diagnosis 5·7 years, SD 2·9 years). Head and neck cancer caregivers experienced significant distress. Six key triggers of emotional distress were identified: understandings and fears of illness, lifestyle restrictions and competing demands, facial disfigurement, financial problems, comorbid health problems and witnessing suffering. Cutting across all of these individual causes of distress was a strong feeling of loss caused by head and neck cancer. Conclusions: Some head and neck cancer caregivers became considerably distressed by their caring role. Although distress appears to decline with time for many caregivers, some continue to be distressed for years following the patient's diagnosis. It would be useful for future research to explicitly investigate caregivers' experiences of lo

Self-management strategies used by head and neck cancer survivors following completion of primary treatment:a directed content analysis

Objective: Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self‐management strategies that HNC survivors use to overcome these posttreatment challenges. Methods: Twenty‐seven individuals from 4 designated cancer centres in Ireland were interviewed about self‐management strategies that helped them overcome challenges following HNC treatment. Interviews were audio‐recorded, transcribed, and analysed using directed content analysis. Results: Twenty self‐management strategy types (encompassing 77 specific strategies) were identified. The most frequently used self‐management strategy types were self‐sustaining (used by 26 survivors), self‐motivating (n = 25), and proactive problem solving (n = 25). The most frequently used specific strategies were adaptive approaches to ongoing physical consequences of HNC and its treatment (n = 24), customising dietary practices (n = 24), and maintaining a positive outlook (n = 22). Conclusions: The study identified strategies that helped HNC survivors to self‐manage posttreatment challenges. This information could inform the design/development of self‐management interventions tailored towards HNC survivors