Legionnaires' disease after a campervan holiday: a case report.

This case report describes a case of Legionnaires' disease for whom the source of infection was the campervan in which the patient had travelled for 3 months. This case shows that Legionnaires' disease can be acquired by exposure to a relatively new (not previously reported) source that is commonly used as (holiday)transportation vehicle.

High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial.

Importance: Enteral administration of immune-modulating nutrients (eg, glutamine, omega-3 fatty acids, selenium, and antioxidants) has been suggested to reduce infections and improve recovery from critical illness. However, controversy exists on the use of immune-modulating enteral nutrition, reflected by lack of consensus in guidelines.

Objective: To determine whether high-protein enteral nutrition enriched with immune-modulating nutrients (IMHP) reduces the incidence of infections compared with standard high-protein enteral nutrition (HP) in mechanically ventilated critically ill patients.

Informal interprofessional learning: visualizing the clinical workplace.

Daily collaboration of senior doctors, residents and nurses involves a major potential for sharing knowledge between professionals. Therefore, more attention needs to be paid to informal learning to create strategies and appropriate conditions for enhancing and effectuating informal learning in the workplace. The aim of this study is to visualize and describe patterns of informal interprofessional learning relations among staff in complex care.

Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial.

Background: Delirium is frequently diagnosed in critically ill patients and is associated with adverse outcome. Impaired cholinergic neurotransmission seems to have an important role in the development of delirium. We aimed to establish the effect of the cholinesterase inhibitor rivastigmine on the duration of delirium in critically ill patients.

Can mild-to-moderate hyperhomocysteinaemia impair endothelial function in the absence of other risk factors for cardiovascular disease?

The majority of clinical studies demonstrate that patients with hyperhomocysteinaemia have an increased risk of atherothrombotic events. However, there is a striking and poorly understood heterogeneity in the severity of clinical features in individuals with hyperhomocysteinaemia. This observation suggests that other factors must exist that modulate the relationship between hyperhomocysteinaemia and clinical disease.

Intensive lipid lowering by statin therapy does not improve vasoreactivity in patients with type 2 diabetes.

Cardiovascular disease is the most important cause of morbidity and mortality in patients with type 2 diabetes. Endothelial dysfunction predicts cardiovascular outcome. Type 2 diabetes is characterized by endothelial dysfunction, which may be caused by dyslipidemia.

Selective ET(A) receptor antagonism with ABT-627 attenuates all renal effects of endothelin in humans.

++Endothelin (ET-1) acts as a potent vasoconstrictor in the human kidney, and this vasoconstriction could contribute to the ischemia seen in acute renal failure. In animal studies, the vasoactive properties of ET-1 are known to be ET(A) receptor-and/or ET(B) receptor-mediated; however, the receptor subtype involved in the human kidney remains to be defined. In a phase I, single-center, double-blind, randomized, three-period, crossover design, the effects of orally administered ABT-627, a selective ET(A) receptor antagonist, on renal hemodynamics during ET-1 infusion were evaluated.