Evaluating the clinical and cost-effectiveness of a conservative approach to oxygen therapy for invasively ventilated adults in intensive care: Protocol for the UK-ROX trial.

Background: In the United Kingdom, around 184,000 adults are admitted to an intensive care unit (ICU) each year with over 30% receiving mechanical ventilation. Oxygen is the commonest therapeutic intervention provided to these patients but it is unclear how much oxygen should be administered for the best clinical outcomes.

Methods: The UK-ROX trial will evaluate the clinical and cost-effectiveness of conservative oxygen therapy (the minimum oxygen concentration required to maintain an oxygen saturation of 90% ± 2%) versus usual oxygen therapy in critically ill adults receiving supplemental oxygen when invasively mechanically ventilated in ICUs in England, Wales and Northern Ireland.

Randomised, placebo-controlled trial and meta-analysis show benefit of ondansetron for irritable bowel syndrome with diarrhoea: The TRITON trial.

Background: Ondansetron may be beneficial in irritable bowel syndrome with diarrhoea (IBS-D).

Aim: To conduct a 12-week parallel group, randomised, double-blind, placebo-controlled trial of ondansetron 4 mg o.d.

Treatment of irritable bowel syndrome with diarrhoea using titrated ondansetron (TRITON): study protocol for a randomised controlled trial.

Background: Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT receptor antagonist, has had an excellent safety record for over 20 years as an antiemetic, yet is not widely used in the treatment of IBS-D.

Oxygen Use in Critical Illness.

Oxygen is the most commonly used drug in critical care. However, because it is a gas, most clinicians and most patients do not regard it as a drug. For this reason, the use of medical oxygen over the past century has been driven by custom, practice, and "precautionary principles" rather than by scientific principles.

Relating oxygen partial pressure, saturation and content: the haemoglobin-oxygen dissociation curve.

The delivery of oxygen by arterial blood to the tissues of the body has a number of critical determinants including blood oxygen concentration (content), saturation (S O2 ) and partial pressure, haemoglobin concentration and cardiac output, including its distribution. The haemoglobin-oxygen dissociation curve, a graphical representation of the relationship between oxygen satur-ation and oxygen partial pressure helps us to understand some of the principles underpinning this process. Historically this curve was derived from very limited data based on blood samples from small numbers of healthy subjects which were manipulated in vitro and ultimately determined by equations such as those described by Severinghaus in 1979.

A crossover study of short burst oxygen therapy (SBOT) for the relief of exercise-induced breathlessness in severe COPD.

Background: Previous small studies suggested SBOT may be ineffective in relieving breathlessness after exercise in COPD.

Methods: 34 COPD patients with FEV1 <40% predicted and resting oxygen saturation ≥93% undertook an exercise step test 4 times. After exercise, patients were given 4 l/min of oxygen from a simple face mask, 4 l/min air from a face mask (single blind), air from a fan or no intervention.

Survey of major complications of intercostal chest drain insertion in the UK.

Background: Following reports from the National Patient Safety Agency of deaths and serious harm from intercostal chest drains (ICD) we conducted a national survey among chest physicians of their experience of harm associated with ICD.

Methods: A questionnaire was sent to 198 UK chest physicians at 148 acute hospital trusts, enquiring about current practice and any adverse incidents related to chest drains from 2003 to 2008.

Results: 101 of 148 trusts (68%) replied.

Comparison of skin prick tests with specific serum immunoglobulin E in the diagnosis of fungal sensitization in patients with severe asthma.

Background: It has been shown that patients with allergic bronchopulmonary aspergillosis (ABPA) and patients with severe asthma with fungal sensitization (SAFS) can benefit from antifungal therapy. It is not known whether allergy skin prick tests (SPT) or specific IgE tests are more sensitive in the identification of patients who are sensitized to fungi and who are therefore candidates for antifungal therapy.

Objectives: To compare SPT and specific serum IgE tests for fungal sensitization in patients with severe asthma.

Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder: a series of seven cases From one UK hospital.

Anthracofibrosis, which was recently defined as bronchial stenosis with overlying anthracotic mucosa, has been infrequently reported in Asia as a complication of tuberculosis (TB). It has not been reported in the United Kingdom or the United States, or, to our knowledge, in non-Asian patients. We have identified seven cases of patients presenting to a single teaching hospital in the northwest of England over a 13-year period.

The heart in renovascular disease--an association demanding further investigation.

A close relationship exists between cardiovascular and renal disease; they often occur concomitantly, and abnormalities in either system are pathophysiologically important in both causing disease and determining clinical outcome in the other. Whilst the main focus of the article relates to the adverse association between atherosclerotic renovascular disease (ARVD) and the cardiovascular system, it is important to briefly review relevant epidemiology.