System ergonomic analysis of the morning ward round in an intensive care unit.

OBJECTIVE: Our objective was to find out what is discussed during a bedside morning ward round (MWR), whether there are any weak points, and if a standard work process structure can be recommended. METHODS: An intensive care unit (ICU) consultant recorded in a predefined form the topics that were discussed in 225 bedside discussions. RESULTS: The median length of discussions was 5 min. In more than 60% of the discussions, items were considered related to the respiratory, neurological, and cardiovascular systems, as well as to surgical and nursing problems. Specific variables relating to organ system conditions were seldom used (e.g., inspired O2 concentration, 35%; temperature, 28%; ventilation mode, 25%). We recorded two interruptions per MWR; only 17% of them were related to urgent decisions. Information that could not be found in the patient's file usually concerned microbiology findings (10%) or surgical procedures (6%). CONCLUSIONS: We recommend the following structure: (1) Addressing the patient by saying "hello"; (2) presentation of information related to case history, acute status (findings and strategy) (including the function of the main organ systems), infection status, and nursing problems; (3) patient-related discussion; and (4) discussion of general treatment rules, triggered by individual patient condition.

Analysis of the chest X-ray conference in an intensive care unit.

Bed chest X-rays carried out in an Intensive Care Unit (ICU) are an important means of patient monitoring. To get the starting points for standardization of the documentation of X-ray findings, we examined course and contents of the daily X-ray conference in an ICU. We video-taped the conferences and registered its vocabulary.Mean entire duration to comment on the X-rays of one patient was 150 s. On an average, discussion between radiologist and anaesthetist lasted 40 s, dictation of findings 50 s. Sorting and viewing the X-rays took 60 s. Main disruptions were related to non-availability of X-rays and clinical patient data. Clinical information reported during the discussion is rarely mentioned in the dictated findings.

Affinity of heavy metal ions to intracellular Ca2+-binding proteins.

Parvalbumin, troponin C and vitamin D dependent Ca2+-binding proteins (CaBP type I and II) share the property of calmodulin to interact with some heavy metal ions. In flow dialysis and in spot tests the affinities of Cd2+ and Pb2+ to these proteins were comparable to those of Ca2+. The relative affinities were for calmodulin: Pb2+ greater than Ca2+ greater than Cd2+, for troponin C: Ca2+ greater than Cd2+ greater than Pb2+, for CaBP I: Ca2+ approximately Pb2+, for CaBP II; Ca2+ greater than Pb2+ greater than Cd2+, and for parvalbumin: Cd2+ approximately Ca2+ greater than Pb2+. Upon gel filtration of the supernatant of a pig mucosal homogenate, binding for both Pb2+ and Ca2+ appeared in the MW range of 10,000, together with CaBP II. We conclude that the investigated proteins bind heavy metal ions, in particular Pb2+ and Cd2+, similar to calmodulin. Their role in transport, storage and toxicity remains to be assessed.

The interaction of aluminum and other metal ions with calcium-calmodulin-dependent phosphodiesterase.

In the search for the mode of action of aluminum ions in dialysis encephalopathy, their interaction with calmodulin has been assessed, and compared with those of Ca2+, Pb2+, Mn2+, Hg2+ and Cd2+. The basal and calmodulin-dependent activity of phosphodiesterase was measured in the presence of the ions, and their binding to calmodulin was assessed by competition with 45Ca2+ in flow dialysis. Al3+, Mn2+, Hg2+, and Cd2+ cannot be regarded as exclusive calmodulin antagonists or agonists, but rather interact with the phosphodiesterase itself. Pb2+ however, mimicks Ca2+ in every system tested, and is active in the same concentration range as Ca2+. Our results indicate that the assumed role of Al3+ ions in dialysis encephalopathy or other neurological disturbances is not linked with calmodulin.