Our approach to changing the culture of caring for the acutely unwell patient at a large UK teaching hospital: A service improvement focus on Early Warning Scoring tools.

INTRODUCTION: Early Warning Scoring tools (EWS) play a major role in the detection of the deteriorating ward patient. EWS tools have been in place in Nottingham University Hospitals NHS Trust for over five years but compliance has been low. A service improvement project commenced across all admission wards in 2013, initiated through a financially driven CQUIN. Prior to the project, only one out of five clinical care targets set were achieved. STRATEGY: An established framework for service improvement was used to guide delivery. The approach has consisted of multi-faceted, inter-professional high impact interventions including ward delivered education, human factors training and clinician feedback, combined with regular performance audits. RESULTS: Since introduction of the service improvement team, consistent signs of improvement have been visible across the admission areas in four out of five of the clinical care targets. CONCLUSION: The first 12 months of the project has seen tangible benefits in patient care and staff experience. Personal feedback both to medical and nursing staff has been effective where a top-down approach may not have been.

A 12-month profile of community paediatric consultations in the Barwon region.

OBJECTIVE: To determine the profile of all consultations carried out in paediatricians offices in the Barwon region over a 12-month period. METHODOLOGY: The age, sex, category, diagnosis, and outcome of all non-hospital-based paediatric consultations carried out in the Barwon region were documented prospectively on a day by day basis. Relevant demographic data and information on Barwon children treated elsewhere were also collected. The frequency of different categories of illness, systems involved and groups of diagnoses was determined. RESULTS: A total of 14,711 consultations was carried out in the region with 10% of the childhood population having contact with the paediatricians during the year; 3135 new patients or problems were seen with 34.8% of all consultations involving behavioural problems and 76% of these relating to ADHD. The most frequent medical diagnostic group was CNS/disability being 16% of all consultations. At least 50% of the medical consultations involved chronic illness. CONCLUSIONS: Behavioural difficulty, chronic disability, and learning problems represent a significant part of the workload of community-based general paediatricians. Appropriate exposure during paediatric training should be given to these issues along with more sophisticated training in the medical, social and psychological complications of chronic illness and its effect on clients and families.

The evolving role of community-based general paediatricians: the Barwon experience.

OBJECTIVE: To detail the acute and chronic paediatric service and community-orientated activities and responsibilities of community-based general paediatricians. METHODOLOGY: Data were collected over the 12 months July 1996 to June 1997 relevant to (i) acute neonatology and paediatrics, (ii) the different community paediatric service organizations with which the paediatricians were involved, and (iii) the quantification of the amount of time spent in non-consulting paediatric work. RESULTS: Findings revealed decreasing hospital admissions, infrequent severe neonatal resuscitation requirements, extensive involvement in community organizations and a great deal of time spent in non-consulting paediatric work. CONCLUSIONS: Ongoing training and upgrading in acute paediatric diagnostic and procedural skills, rationalization of resuscitation expertise, training in management and administrative skills and models of care for the chronically ill should become part of the training of community-based general paediatricians.

A novel assay for the distribution of pyrithione biocides in bacterial cells.

Sodium pyrithione and zinc pyrithione (NaPT and ZnPT, respectively) are widely used as cosmetic preservatives and metal chelating agents. They are commonly assayed using thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). However, a simple quantitative colorimetric assay has not been previously reported for these compounds. This paper describes the development of a spectrophotometric assay for the quantification of the pyrithiones which is based on the chelation of copper (II) ions by the biocides. This assay was developed in order to facilitate the determination of the distribution of these biocides in the Gram-negative bacteria Escherichia coli NCIMB 10,000 and Pseudomonas aeruginosa NCIMB 10,548. Sodium pyrithione was exhibited only in the cytosol of E. coli and Ps. aeruginosa. Zinc pyrithione, however, was assayed in the cytosol of both bacteria and was found in the cell envelope of Ps. aeruginosa. These findings suggest that the pyrithione biocides are active within bacterial cells as well as at the cell membrane.

Pyrithione biocide interactions with bacterial phospholipid head groups.

Sodium pyrithione and zinc pyrithione (NaPT and ZnPT, respectively) are antimicrobial agents widely used in both the cosmetics and fuel industries. They are also utilized in the mining industry because of their metal chelating properties. They have been shown to depolarize membrane electropotential in fungi and are also known to inhibit fungal and bacterial substrate transport processes. Recent work has shown that both pyrithiones cause the leakage of intracellular material (potassium ions and O.D.260 nm absorbing material) from exposed bacterial cells. The work here reports studies on the interactions between the pyrithiones and the bacterial phospholipid head group structures, at both a practical and a theoretical level, utilizing tube dilution neutralizer studies, scanning spectrophotometry and molecular modelling. The tube dilution neutralizer studies exhibited a decrease in minimum inhibitory concentration (MIC) for both pyrithiones in the presence of extracellular phosphatidyl-ethanolamine and EDTA. Scanning spectrophotometry exhibited the chelation of the central zinc atom from the ZnPT chelate by the addition of EDTA. Molecular modelling studies exhibited the chelation of the phosphatidyl-ethanolamine head group by ZnPT. Zinc pyrithione also exhibited an interaction with the ammonium tail of the head group structures. Sodium pyrithione exhibited electrostatic interactions with the phospholipid head groups in the molecular modelling studies.

Pyrithione biocides as inhibitors of bacterial ATP synthesis.

Sodium pyrithione and zinc pyrithione (NaPT and ZnPT, respectively) are widely used as cosmetic preservatives and general antimicrobial agents. They have been shown to be active against fungal cell walls, associated membranes and bacterial transport processes. Investigations were undertaken into the effect of these antimicrobial agents on substrate catabolism and intracellular ATP levels using an oxygen electrode and luciferin-laciferase technology, respectively. Results indicate that, while both compounds are poor inhibitors of substrate catabolism, sub-inhibitory concentrations of biocide greatly reduces intracellular ATP levels in both Escherichia coli NCIMB 10000 and Pseudomonas aeruginosa NCIMB 10548. This is thought to be due to the action of NaPT and ZnPT on the Gram-negative bacterial membrane.