Oxygen use for chest pain in coronary care units across the UK.

AIM: To quantify the adherence to national guidance for the use of oxygen in patients presenting with chest pain to coronary care units (CCUs) across the UK. DESIGN: Prospective survey. METHODS: A total of 307 hospitals were contacted by telephone between August 2010 and October 2010. Of these, 48 had no CCUs, 10 units refused to take part and 18 hospitals were contacted on 2 occasions but were unable to provide the information due to paucity of time owing to heavy clinical workload. Overall 231 hospitals participated in the audit questionnaire. RESULTS: A total of 30% of the units used oxygen titrated to saturations in accordance with national guidelines. There was no difference between units that had on-site availability of percutaneous coronary intervention and those that did not. Those hospitals where there was a policy for routine oxygen prescription were as unlikely to comply with the guidelines on oxygen use as hospitals where oxygen was not routinely prescribed. CONCLUSION: Only one-third of CCUs in the UK reported adherence to guidelines with regards to oxygen delivery in patients presenting with chest pain. Despite this figure seeming rather low, this is consistent with practice through a range of specialties and guidelines. The evidence base for the oxygen guidance remains insecure. Additional research is required but in the meantime we recommend oxygen is prescribed according to current guidelines.

A landscape analysis of cougar distribution and abundance in Montana, USA.

Recent growth in the distribution and abundance of cougars (Puma concolor) throughout western North America has created opportunities, challenges, and problems for wildlife managers and raises questions about what factors affect cougar populations. We present an analysis of factors thought to affect cougar distribution and abundance across the broad geographical scales on which most population management decisions are made. Our objectives were to: (1) identify and evaluate landscape parameters that can be used to predict the capability of habitats to support cougars, and (2) evaluate factors that may account for the recent expansion in cougar numbers. Habitat values based on terrain ruggedness and forested cover explained 73% of the variation in a cougar abundance index. Indices of cougar abundance also were spatially and temporally correlated with ungulate abundance. An increase in the number and total biomass of ungulate prey species is hypothesized to account for recent increases in cougars. Cougar populations in Montana are coping with land development by humans when other components of habitat and prey populations are sufficient. Our analysis provides a better understanding of what may have influenced recent growth in cougar distribution and abundance in Montana and, when combined with insights about stakeholder acceptance capacity, offers a basis for cougar management at broad scales. Long-term conservation of cougars necessitates a better understanding of ecosystem functions that affect prey distribution and abundance, more accurate estimates of cougar populations, and management abilities to integrate these components with human values.

The economics of a pharmacy-based central intravenous additive service for paediatric patients.

This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.

Effects of 6-hydroxydopamine lesions of the nucleus accumbens septi and olfactory tubercle on feeding, locomotor activity, and amphetamine anorexia in the rat.

Bilateral 6-hydroxydopamine lesions of the nucleus accumbens septi (NAS) and olfactory tubercle (OT) caused enhanced intake of wet mash in 23-hr-food-deprived rats tested in photocell activity cages during restricted 30-min sessions. This mild hyperphagia was accompanied by a significant hypoactivity in the group with NAS/OT lesions. No hyperphagia was observed during a prolonged 120-min test session or in free-feeding tests conducted in the home cage. Anorexia induced by d-amphetamine (.5 and 1.5 mg/kg) was unaltered by the lesion, although the locomotor stimulant action of the drug was attenuated. A second experiment showed that the NAS/OT lesion also enhanced food intake in the photocell cages during 30-min sessions with dry food pellets but that food-associated drinking was concomitantly reduced. The results are consistent with the hypothesis that the behavioral changes caused by mesolimbic neuron destruction result in part from an inability to switch from one behavioral activity to another.