The "OBS" chart: an evidence based approach to re-design of the patient observation chart in a district general hospital setting.

OBJECTIVE: The primary role of the patient bedside observation chart is to make clinicians aware of the deteriorating patient. Despite this, its performance has not been scrutinised. Many versions exist with different styles of data entry but the optimal format remains elusive. This paper hypothesised that chart design measurably influences function and that redesign and standardisation would improve the detection of physiological decline by clinical staff. DESIGN: Objective evaluation of existing charts (n = 5), evidence based redesign, and re-evaluation of new chart. SETTING: 250 bed district general hospital. RESULTS: Design of existing observation charts had a significant effect on the ability of clinical staff to detect patient deterioration, with detection rates of parameters indicating physiological decline ranging from 0% to 100%. Graphical plots portrayed information better than written values for all parameters being measured except tachypnoea. No single existing chart was best for all variables. A new chart was designed, implemented with training in its use, and re-evaluated. The new chart also incorporated an early warning scoring system. There were significant improvements in the average detection rates of parameters poorly identified on existing charts: detection rates of tachypnoea and hypoxia increased by 41% (p<0.05) and 45% (p<0.05) respectively. There were also significant improvements in detection rates of tachycardia and fever by 29% (p<0.05) and 16% (p<0.05) respectively. CONCLUSION: Evidence based redesign of the patient bedside observation chart coupled with specific training in its use significantly improves the detection of patient physiological deterioration.

Subtle alterations in growth medium composition can dramatically alter the percentage of unsaturated fatty acids in the yeast Saccharomyces cerevisiae.

The essence of the scientific method is the production of reproducible results in repeated experiments. Cells of the yeast strain DBY747 normally contain 36% unsaturated fatty acids but suddenly, and initially inexplicably, lipid analysis revealed 72% unsaturated fatty acids in the same strain at the same growth temperature. A comparative lipid analysis of DBY747 grown in YEPD and in a number of different types and batches of Yeast Nitrogen Base media revealed two heretofore unreported phenomena. We provide mass spectroscopy and yeast bioassay evidence suggesting that the increase in lipid unsaturation can be attributed to the presence of the plasticizing agent dioctylphthalate in YNB and bactopeptone packaged in 'new' plastic containers first introduced by Difco some 3-4 years ago. We also demonstrate that L-methionine plays an important role in determining the percentage of unsaturated fatty acids in cells grown in laboratory-produced YNB. The results illustrate a novel aspect of methionine metabolism while at the same time highlighting the need for more stringent control to be exercised by the companies that formulate and package defined media.