Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care.

Study Objective: We developed recommendations for antidote stocking at hospitals that provide emergency care.

Methods: An expert panel representing diverse perspectives (clinical pharmacology, clinical toxicology, critical care medicine, clinical pharmacy, emergency medicine, internal medicine, pediatrics, poison centers, pulmonary medicine, and hospital accreditation) was formed to create recommendations for antidote stocking. Using a standardized summary of the medical literature, the primary reviewer for each antidote proposed guidelines for antidote stocking to the full panel.

Identifying missed opportunities to curtail antimicrobial therapy for presumed ventilator-associated pneumonia using the clinical pulmonary infection score.

Background: Early discontinuation of antimicrobial therapy for ventilator-associated pneumonia can reduce the emergence of antimicrobial resistance, the occurrence of adverse drug events, and the cost of therapy. Evidence suggests that discontinuation of therapy by day 3 may be appropriate for patients with a clinical pulmonary infection score of 6 or less at baseline and on day 3.

Objectives: To determine the proportion of patients eligible for antimicrobial discontinuation on day 3 and day 7 of therapy and to determine the proportion of eligible patients for whom antimicrobials were discontinued within these timeframes.

Increased topoisomerase IIalpha expression in colorectal cancer is associated with advanced disease and chemotherapeutic resistance via inhibition of apoptosis.

Topoisomerase IIalpha is a nuclear enzyme that regulates the tertiary structure of DNA. The influence of topoisomerase IIalpha gene (TOP2A) or protein alterations on disease progression and treatment response in colorectal cancer (CRC) is unknown. The study investigated the clinical relevance of topoisomerase IIalpha in CRC using in vivo and in vitro models.

Staphylococcus epidermidis device-related infections: pathogenesis and clinical management.

Staphylococcus epidermidis, the most frequently isolated coagulase-negative staphylococcus, is the leading cause of infection related to implanted medical devices (IMDs). This is directly related to its capability to establish multilayered, highly structured biofilms on artificial surfaces. At present, conventional systemic therapies using standard antimicrobial agents represent the main strategy to treat and prevent medical device-associated infections.

Anti-infective photodynamic biomaterials for the prevention of intraocular lens-associated infectious endophthalmitis.

Bacterial attachment onto intraocular lenses (IOLs) during cataract extraction and IOL implantation is a prominent aetiological factor in the pathogenesis of infectious endophthalmitis. Photodynamic therapy (PDT) and photodynamic antimicrobial chemotherapy (PACT) have shown that photosensitizers are effective treatments for cancer, and in the photoinactivation of bacteria, viruses, fungi and parasites, in the presence of light. To date, no method of localizing the photocytotoxic effect of a photosensitizer at a biomaterial surface has been demonstrated.

Clinical characteristics and management of wound foreign bodies in the ED.

Objectives: Wound foreign body (FB) management is challenging. Little data exist describing ED management. We sought to describe case characteristics and ED management of wound FBs.

Key biological issues in contact lens development.

A contact lens is a medical device widely used as an alternative to spectacles in order to correct refractive vision problems. The evolution of polymeric biomaterials has heralded a continuous development in the materials used to produce contact lenses and maximize patient comfort and limit adverse events. Microbial keratitis (MK) is a relatively rare but potentially devastating condition associated with contact lens use, particularly with the extended wear of hydrogel lenses.

Aerodynamic changes as a result of vocal function exercises in elderly men.

Objectives/hypothesis: Voice therapy can improve the vocal quality of elderly patients with voice problems, but the changes in vocal aerodynamics associated with physiologic voice therapy are not well documented. The purpose of the present study was to determine the changes in vocal aerodynamics as a result of the management program known as Vocal Function Exercises (VFEs).

Study Design: Pre- and post-treatment differences in VFE maximum phonation times (MPT) and measures of vocal aerodynamics were analyzed.

Prior infection with murine cytomegalovirus (MCMV) limits the immunocontraceptive effects of an MCMV vector expressing the mouse zona-pellucida-3 protein.

We have developed a murine cytomegalovirus (MCMV)-vectored vaccine expressing the mouse zona-pellucida-3 gene (rMCMV-ZP3), which successfully induces infertility in experimentally inoculated laboratory or wild-derived mice. However, the future success of this vector as a fully disseminating vaccine in free-living mice may be compromised by pre-existing immunity since there is a high prevalence of naturally acquired MCMV infection in these mice. To evaluate the effect of prior immunity to MCMV on vaccine efficacy, we constructed two new biologically effective recombinant MCMV vectors expressing the mouse ZP3 protein from two MCMV strains (N1 and G4) derived from free-living mice.

A further example of a distinctive autosomal recessive syndrome comprising neonatal diabetes mellitus, intestinal atresias and gall bladder agenesis.

We report a patient born to consanguineous parents as a further example of a recently described phenotype comprising neonatal diabetes, intestinal atresias and gall bladder agenesis. Other reports have described cases with overlapping patterns including malrotation, biliary atresia and pancreatic hypoplasia (e.g.

Estimation of the requirement for implantable cardioverter defibrillators for the primary prevention of sudden cardiac death post-myocardial infarction based on UK national guidelines (2006).

Aims: To assess the impact of the new UK National Institute for Health and Clinical Excellence (NICE) guidelines on the incidence of implantable cardioverter defibrillator (ICD) indications for the primary prevention of sudden cardiac death following myocardial infarction (MI).

Methods And Results: We performed a retrospective single centre study in a District General Hospital. The transthoracic echocardiogram reports of all patients with a discharge diagnosis of MI during a 6-month period were studied.

Vestibular rehabilitation decreases fall risk and improves gaze stability for an older individual with unilateral vestibular hypofunction.

Background And Purpose: Partial or total unilateral vestibular loss is the third most common cause of peripheral vestibular dysfunction. Dysfunction of one or both of the vestibular mechanisms can manifest physically as abnormalities of posture, balance, and/or visual acuity. This case report describes physical therapy examination and individualized intervention with vestibular rehabilitation for a patient with unilateral vestibular hypofunction.

Characterization of the physicochemical, antimicrobial, and drug release properties of thermoresponsive hydrogel copolymers designed for medical device applications.

In this study, a series of hydrogels was synthesized by free radical polymerization, namely poly(2-(hydroxyethyl)methacrylate) (pHEMA), poly(4-(hydroxybutyl)methacrylate) (pHBMA), poly(6-(hydroxyhexyl)methacrylate) (pHHMA), and copolymers composed of N-isopropylacrylamide (NIPAA), methacrylic acid (MA), NIPAA, and the above monomers. The surface, mechanical, and swelling properties (at 20 and 37 degrees C, pH 6) of the polymers were determined using dynamic contact angle analysis, tensile analysis, and thermogravimetry, respectively. The T(g) and lower critical solution temperatures (LCST) were determined using modulated DSC and oscillatory rheometry, respectively.

Topically applied 1,25-dihydroxyvitamin D3 enhances the suppressive activity of CD4+CD25+ cells in the draining lymph nodes.

The immunomodulatory effects of vitamin D have been described following chronic oral administration to mice or supplementation of cell cultures with 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), the active form of vitamin D. In this study, topically applied 1,25(OH)(2)D(3), enhanced the suppressive capacity of CD4(+)CD25(+) cells from the draining lymph nodes. The effects of topical 1,25(OH)(2)D(3) were compared with those of UVB irradiation, which is the environmental factor required for 1,25(OH)(2)D(3) production in skin.

Suppression of the asthmatic phenotype by ultraviolet B-induced, antigen-specific regulatory cells.

Background: Over recent decades, there has been a significant global increase in the prevalence of asthma, an inflammatory disease of the respiratory system. While ultraviolet radiation (UV) has been used successfully in the treatment of inflammatory conditions such as psoriasis, studies of UV-induced regulation of allergic respiratory responses have been rare, and have not analysed in vivo measurements of airway hyperresponsiveness (AHR) or the antigen specificity of the UV-induced effects.

Objective: To investigate the regulatory properties of erythemal ultraviolet B (UVB) irradiation of the skin and the induction of allergen-induced airway immunity in a murine asthma model, and to examine the mechanisms involved.

Cancer-associated neutropenic fever: clinical outcome and economic costs of emergency department care.

Purpose. Febrile neutropenia (FN) is a common, costly, and potentially fatal complication in oncology. While FN in the inpatient setting has been extensively studied, only one study has evaluated emergency department (ED) care for FN cancer patients.

Antidote stocking in British Columbia hospitals.

Introduction: Previous studies have demonstrated that antidotes are insufficiently stocked in Canadian and US health care facilities. The purpose of this study was to determine the adequacy of antidote stocking in British Columbia hospitals based on the current guidelines.

Methods: A written survey was mailed to hospital pharmacy directors at all 93 acute care facilities in BC.

Corticosteroid treatment of severe community-acquired pneumonia.

Objective: To assess the evidence for adjunctive corticosteroids for severe community-acquired pneumonia (CAP).

Data Sources: MEDLINE (1966-February 2007) and EMBASE (1980-February 2007) were searched to identify English- and French-language publications that evaluated the use of corticosteroids for CAP in adults. Major search terms included community-acquired pneumonia, intensive care unit, steroids, glucocorticoids, and adrenal cortex hormones.

A model for teaching bedside detection of glass in wounds.

Background: Emergency physicians often manage wounds contaminated with glass. Even when glass is visible on x rays, removal may require real-time bedside imaging.

Aim: To assess whether novices can be easily trained to accurately detect tiny glass foreign bodies (GFBs) using low-power portable fluoroscopy.

Dalteparin versus enoxaparin for venous thromboembolism prophylaxis in acute spinal cord injury and major orthopedic trauma patients: 'DETECT' trial.

Background: To compare the impact of switching from enoxaparin 30 mg subcutaneously (SC) twice daily to dalteparin 5,000 units SC once daily for venous thromboembolism (VTE) prophylaxis in critically-ill major orthopedic trauma and/or acute spinal cord injury (SCI) patients.

Methods: DETECT was a retrospective, cohort study at a tertiary care referral teaching center-phase 1 from December 1, 2002 to November 30, 2003 (enoxaparin); and phase 2 from January 1, 2004 to December 31, 2004 (dalteparin). Major orthopedic trauma patients with pelvic, femoral shaft, or complex lower extremity fractures, and/or acute SCI patients admitted to the intensive care unit and who received a low-molecular-weight heparin (LMWH) for VTE prophylaxis were included.

Strategies for the development of the urinary catheter.

Indwelling urinary catheters are utilized in the management of a wide range of conditions both in an acute and a chronic setting. However, utilization of this type of device is associated with a number of issues, including an increased propensity to develop bacteriuria, symptomatic infection and also encrusted deposits on the device. The development of novel biomaterials, incorporation of therapeutic agents and other strategies to minimize the issues associated with these devices are discussed in this review.