Safety of Lumason® (SonoVue®) in special populations and critically ill patients.

Evidence for the safe use of Lumason® (SonoVue®), an ultrasound enhancing agent (UEA), in special patient populations is critical to enable healthcare professionals to make informed decisions concerning its use in such patients. Herein, we provide insight on the safety and tolerability of Lumason® in special patient populations. Findings are presented from clinical pharmacology studies conducted in patients with compromised cardiopulmonary conditions, from a retrospective study performed in critically ill patients, and from post-marketing surveillance data from over 20 years of market use of Lumason® (SonoVue®). No detrimental effects of Lumason® on cardiac electrophysiology were observed in patients with coronary artery disease (CAD), and no significant effects on pulmonary hemodynamics were noted in patients with pulmonary hypertension or congestive heart failure. Similarly, no effects on several assessments of pulmonary function (e.g., FVC) were observed in patients with chronic obstructive pulmonary disease (COPD), and no clinically meaningful changes in O2 saturation or other safety parameters were observed after administration of Lumason® to patients with diffuse interstitial pulmonary fibrosis (DIPF). The retrospective study of critically ill patients revealed no significant difference for in-hospital mortality between patients administered Lumason® for echocardiography versus those who had undergone echocardiography without contrast agent. Post-marketing surveillance revealed very low reporting rates (RR) for non-serious and serious adverse events and that serious hypersensitivity reactions were rare. These findings confirm that Lumason® is a safe and well tolerated UEA for use in special populations and critically ill patients.

Primary care drug therapy training: the solution for PHC nurses?

The priority of the National Health System in South Africa is primary health care (PHC). The approach involves a health system led by PHC services and includes personal and curative services for acute minor ailments delivered by PHC nurses. The nurses are also responsible for the treatment of these ailments with essential drugs according to protocols as proposed in the Essential Drugs List. A before-after experimental research design was used to evaluate the effect of a competency-based primary care drug therapy (PCDT) training programme for PHC nurses in the treatment of acute minor ailments. An experimental group (n = 35) and control group (n = 31) consisting of registered nurses undergoing training in PHC at Gold Fields Nursing College were randomly selected. The results showed a significant increase in prescribing outcomes and medicine utilisation.

Air movement and heat loss from sheep. I. Boundary layer insulation of a model sheep, with and without fleece.

A model sheep, made from metal cylinders and hemispheres, was heated electrically. Heat loss by forced convection in a wind tunnel was analysed in terms of the dependence of the Nusselt number (Nu) on Reynolds number (Re). For a bare trunk Nu = 0.095 Re0.684, but with fleece covering the trunk to a depth of 3.5 cm, Nu = 0.0112 Re0.875 when the mean radiative temperature of the the coat was taken as the surface temperature. Heat transfer by convection from the whole body, including legs, was described by Nu = 0.029 Re0.80. However, a bulk Nesselt number should not be used to estimate heat loss from a live sheep in a hot environment if the windspeed is below about 4 m s-1 because the relation between mean surface temperature, Nusselt number and convective heat flux is not unique.

Air movement and heat loss from sheep. II. Thermal insulation of fleece in wind.

Penetration of an animal's coat by wind reduces its thermal insulation and increases heat loss to the environment. From studies of the sensible heat loss from a life-sized model sheep covered with fleece, the average fleece resistance -rf(s cm-1) was related to windspeed u (m s-1) by 1/-rf(u) = 1/-rf(0)+cu, where c is a dimensionless constant. As c is expected to be inversely proportional to coat depth l, the more general relation -k(u) = -k(0)+c'u was evaluated, where -k = l/-rf is the thermal diffusivity (cm2 s-1) of the fleece and c' = cl is another constant (cm). The orientation of the model to the wind had little effect on the bulk resistance of the fleece, but the resistance on the windward side was substantially lower than on the leeward side.