Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial.

Objective: The objective of this study was to evaluate the efficacy of the automatic oxygen control (A-Fio) in reducing the percentage of time spent in severe hypoxaemia (Spo <80%) in preterm infants for the time period on invasive ventilation and/or nasal continuous positive airway pressure (NCPAP) delivered by AVEA ventilator.

Design: A parallel arm randomised controlled trial.

Setting: A level-III neonatal intensive care unit.

Research priorities for the management of complex fractures: a UK priority setting partnership with the James Lind Alliance.

Objective: To determine research priorities for the management of complex fractures, which represent the shared priorities of patients, their families, carers and healthcare professionals.

Design/setting: A national (UK) research priority setting partnership.

Participants: People who have experienced a complex fracture, their carers and relatives, and relevant healthcare professionals and clinical academics involved in treating patients with complex fractures.

Physiological dead space and alveolar ventilation in ventilated infants.

Background: Dead space is the volume not taking part in gas exchange and, if increased, could affect alveolar ventilation if there is too low a delivered volume. We determined if there were differences in dead space and alveolar ventilation in ventilated infants with pulmonary disease or no respiratory morbidity.

Methods: A prospective study of mechanically ventilated infants was undertaken.

Volumetric capnography slopes in ventilated term and preterm infants.

Objective: To assess whether the slopes of volumetric capnography differ in preterm compared to term-born ventilated newborn infants and whether they are related to gestational age and the duration of ventilation.

Approach: The slopes of phase II (S) and III (S) of volumetric capnographs were measured in ventilated term and preterm infants at King's College Hospital NHS Foundation Trust. The correlations of the slopes with gestational age (GA), duration of invasive ventilation and fraction of inspired oxygen (FO) were assessed.

Guideline developers in the United States were inconsistent in applying criteria for appropriate Grading of Recommendations, Assessment, Development and Evaluation use.

Objectives: We assessed whether guidelines published by organizations based in the United States comply with published criteria for the use of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Study Design And Setting: We performed a cross-sectional study of all clinical practice guidelines that indicated the use of the GRADE approach, were published between 2011 and 2018, and listed in the National Guidelines Clearinghouse.

Results: We included 67 guideline documents from 44 of 135 (32.

Age and the distribution of major injury across a national trauma system.

Background: Trauma places a significant burden on healthcare services, and its management impacts greatly on the injured patient. The demographic of major trauma is changing as the population ages, increasingly unveiling gaps in processes of managing older patients. Key to improving patient care is the ability to characterise current patient distribution.

Ventilation Efficiency and Respiratory Muscle Function at Different Levels of CPAP in Intubated Prematurely Born Infants.

Background: CPAP improves respiratory function in prematurely born infants by establishing and maintaining functional residual capacity, but the level of CPAP that optimizes respiratory function has not been adequately described. We compared ventilation efficiency and respiratory muscle function at different levels of CPAP.

Methods: We studied spontaneously breathing, intubated convalescent premature infants at King's College Hospital NHS Foundation Trust and calculated the ventilation efficiency index and the respiratory muscle time constant of relaxation (τ) at the end of 3 consecutive 5-min periods at 4, 6, and 8 cm HO of CPAP delivered in random order.

Effect of maturity and infection on the rate of relaxation of the respiratory muscles in ventilated, newborn infants.

Aim: To assess the respiratory muscle time constant of relaxation (τ), an index of respiratory muscle function in ventilated newborns.

Methods: Sixty-two infants (42 born prematurely) with a median gestational age of 29 [interquartile range (IQR) 26-37] weeks were prospectively studied. Measurement of τ was taken during spontaneous breathing on endotracheal continuous positive airway pressure prior to extubation, and τ was calculated from the reciprocal of the slope of the airway pressure decline versus time.

Physiological and anatomical dead space in mechanically ventilated newborn infants.

Objectives: To compare the anatomical (V ) and alveolar dead space (V ) in term and prematurely born infants and identify the clinical determinants of those indices.

Working Hypothesis: V and V will be higher in prematurely born compared to term born infants.

Study Design: Retrospective analysis of data collected at King's College Hospital NHS Foundation Trust, London, UK.

Refining metformin prescribing in New Zealand.

Metformin is the mainstay of treatment of type 2 diabetes. However, there has been significant concern on prescribing metformin in patients with renal impairment as a result of metformin-associated lactic acidosis (MALA). Recent studies have cast doubt on the existence of MALA purely related to metformin use.

Pre-operative echocardiogram in hip fracture patients with cardiac murmur--an audit.

Background: All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients.

Methods: All hip fracture patients (N = 349) between 01/06/08 and 01/06/09 were included in the study.

Spontaneous bilateral distal ulna fracture: an unusual complication in a rheumatoid patient.

Bilateral ulna stress fractures are extremely rare. Patients with rheumatoid arthritis have osteopenic bone secondary to a variety of causes. We report a case of bilateral stress fractures of the ulna in an elderly patient with rheumatoid arthritis, and literature on this condition is reviewed.

Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption.

The needs component of the current formulae for allocating resources for hospital services and prescribing in England is based on a utilisation approach. This assumes that expenditure on NHS activity in different geographical areas reflects relative needs and supply conditions, and that these can be disentangled by regression models to yield an estimate of relative need. These assumptions have been challenged on the grounds that the needs of some groups may be systematically 'unmet'.

GREIT: a unified approach to 2D linear EIT reconstruction of lung images.

Electrical impedance tomography (EIT) is an attractive method for clinically monitoring patients during mechanical ventilation, because it can provide a non-invasive continuous image of pulmonary impedance which indicates the distribution of ventilation. However, most clinical and physiological research in lung EIT is done using older and proprietary algorithms; this is an obstacle to interpretation of EIT images because the reconstructed images are not well characterized. To address this issue, we develop a consensus linear reconstruction algorithm for lung EIT, called GREIT (Graz consensus Reconstruction algorithm for EIT).

The use of an articulating spacer in the management of infected total knee arthroplasties.

Eleven infected total knee arthroplasties underwent revision using an articulating spacer comprising a total condylar component and meniscal polyethylene insert cemented in place using antibiotic-loaded cement. Only 1 case required subsequent rerevision for infection, 2 were revised for pain, 6 remain in situ, and 2 patients have died with their spacers in situ. Average Knee Society clinical rating for the spacers left implanted is 167 at an average of 65 months.

First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders.

Background: Diabetes is an important cause of morbidity and mortality amongst young people. Despite improvements in technology, maintenance of good glycaemic control is hard to achieve.

Methods: In July 2003, 12 paediatric and adult hospital-based diabetes services across New Zealand were invited to take part in an audit of the process and outcomes of care.

The PLISSIT Model: care and management of patients' psychosexual needs following radical surgery.

Patients who have undergone invasive medical procedures requiring radical body changes often experience feelings of worthlessness and particularly negative feelings about their sexuality. Their initial contact with the healthcare team is frequently a nurse who may be poorly equipped, too busy, or too embarrassed to help address the patients' sexual issues; therefore, vital information may be lost to the healthcare team. The PLISSIT Model offers nurses or case managers a concise framework for intervention to address patients' concerns at the earliest stages of their distress, and helps assure informed feedback to the healthcare team regarding the patients' sexual issues.

Ganglion cysts of the anterior cruciate ligament: a series of 15 cases.

Purpose: To increase awareness of the presence of ganglion cysts of the anterior cruciate ligament and to consider this diagnosis in any knee that has lost range of motion (ROM) in the absence of osteoarthritis.

Type Of Study: Case series.

Methods: We present a series of 15 cases recorded over a period of 5 years illustrating the clinical presentation and additional pathology seen at arthroscopy.

Reaction times to words vs symbols for both hands.

Reaction times were used to infer an interaction between different stimuli (verbal and symbolic) and the hand used to respond to such stimuli for 26 college students. Significant differences in reaction times were found dependent upon whether the stimulus was a word or a symbol and which hand was used in response to the different stimuli. There was more rapid mediation with significantly shorter latency for symbolic stimuli than for verbal stimuli for both the right and left hands.

Knee extensor torque, work, and EMG during subjectively graded dynamic contractions.

We examined knee extensor peak torque, work, and electromyogram (EMG) during dynamic contractions to perceived exertion levels in men and women. Thirty subjects performed three maximal effort isokinetic knee extensions (60 deg x s(-1)), followed by three contractions to each of nine separate levels of perceived exertion. Surface EMG of the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF), and knee extensor peak torque and work were normalized to a percent of each respective value obtained during the maximal effort contractions.