Research priorities for the study of atrial fibrillation during acute and critical illness: recommendations from the Symposium on Atrial Fibrillation in Acute and Critical Care.

Atrial fibrillation (AF) is a common arrhythmia encountered in acute and critical illness and is associated with poor short and long-term outcomes. Given the consequences of developing AF, research into prevention, prediction and treatment of this arrhythmia in the critically ill are of great potential benefit, however, study of AF in critically ill patients faces unique challenges, leading to a sparse evidence base to guide management in this population. Major obstacles to the study of AF in acute and critical illness include absence of a common definition, challenges in designing studies that capture complex etiology and assess causality, lack of a clear outcome set, difficulites in recruitment in acute environments with respect to timing, consent, and workflow, and failure to embed studies into clinical care platforms and capitalize on emerging technologies.

Development of a national maternity early warning score: centile based score development and Delphi informed escalation pathways.

Objective: To derive a new maternity early warning score (MEWS) from prospectively collected data on maternity vital signs and to design clinical response pathways with a Delphi consensus exercise.

Design: Centile based score development and Delphi informed escalation pathways.

Setting: Pregnancy Physiology Pattern Prediction (4P) prospective UK cohort study, 1 August 2012 to 28 December 2016.

Intravitreal Injections: Improving Sustainability by Reducing Clinical Waste.

Background: Intravitreal injections are one of the most commonly performed ophthalmic procedures. It is estimated that over 1 million intravitreal injections are performed in Germany annually. The aim of this study was to quantify the waste and carbon footprint associated with single-use injection sets, and to establish a waste reduction strategy.

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We report an interesting case of a central nervous system vasculitis, presenting with a relapsing remitting nature and a previously unreported profile of cognitive deficits in this variant of the disease.The patient presented with bilateral headache, left eye upper temporal quarter visual field loss, dyschromatopsia and a transient loss of consciousness. He was previously evaluated for similar set of symptoms over the past eight years.

Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.

Objective: To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.

Design: This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean.

Unilateral leukonychia and hair depigmentation in multifocal motor neuropathy.

Neurophysiology studies in a 50-year-old man with slowly progressive weakness of the left upper limb revealed conduction block in the ulnar nerve above the elbow. His weakness remained stable with regular subcutaneous immunoglobulin, but he noted gradual hemibody hair depigmentation. Examination also revealed unilateral left hand leukonychia (figure).

Mimics and chameleons in motor neurone disease.

The progression of motor neurone disease (MND) is currently irreversible, and the grave implications of diagnosis naturally fuels concern among neurologists over missing a potential mimic disorder. There is no diagnostic test for MND but in reality there are few plausible mimics in routine clinical practice. In the presence of a progressive pure motor disorder, signs such as florid fasciculations, bilateral tongue wasting, the 'split hand', head drop, emotionality, and cognitive or behavioural impairment carry high positive predictive value.

A Non-Invasive Method for Estimating Cardiopulmonary Variables Using Breath-by-Breath Injection of Two Tracer Gases.

Conventional methods for estimating cardiopulmonary variables usually require complex gas analyzers and the active co-operation of the patient. Therefore, they are not compatible with the crowded environment of the intensive care unit (ICU) or operating theatre, where patient co-operation is typically impossible. However, it is these patients that would benefit the most from accurate estimation of cardiopulmonary variables, because of their critical condition.