Neonatal extravasation injury: prevention and management in Australia and New Zealand-a survey of current practice.

BACKGROUND: Extravasation injury remains an important cause of iatrogenic injury in neonatal intensive care. This study aims to describe the current approach to extravasation injury (EI) prevention and management in Neonatal Intensive Care Units (NICUs) in Australia and New Zealand. METHODS: A literature review regarding extravasation injury in the newborn was carried out to inform questionnaire design. An internet-based survey was then conducted with the clinical directors of the 27 tertiary NICUs in Australia and New Zealand. RESULTS: The survey received a 96% response rate. Approximately two thirds of Australian and New Zealand NICUs have written protocols for prevention and management of extravasation injury. Considerable practice variation was seen for both prevention and treatment of EI. 92% of units had experienced cases of significant EI. CONCLUSIONS: Australian and New Zealand tertiary neonatal units clearly recognise EI as an important cause of iatrogenic morbidity and mortality. Significant variation still exists among units with regards to guidelines for both prevention and management of EI. We recommend that neonatal staff should remain vigilant, ensuring that guidelines for the prevention and treatment of EI are available, and rigorously followed.

Differences in nutritional care in pressure ulcer patients whether or not using nutritional guidelines.

OBJECTIVE: Malnutrition, characterized by a loss of lean body mass, enhances the risk of pressure ulcers (PUs). Because the intrinsic risk factor nutritional status in PU development can be influenced by practitioners' interventions, the use of clinical guidelines might be a satisfactory management approach. This study investigated the influence of using nutritional guidelines in daily practice on the actual nutritional care that PU (prone) patients receive, and barriers with regard to providing nutritional support were also explored. METHODS: A cross-sectional study was carried out in 1087 hospitals, nursing homes, and home care organizations in the Netherlands, Germany, and the United Kingdom. Because this study focused on comparing nutritional care in daily practice in PU (prone) patients using and not using nutritional guidelines, for the analyses two groups (health care organizations with and without guidelines) were identified. Differences between groups were tested using chi-square test and by analysis of variance. RESULTS: Respondents from 363 organizations participated in the study, of which 66.1% used nutritional guidelines for PU care in practice. Significant differences between organizations with nutritional guidelines versus organizations without guidelines were mostly on nutritional screening (P = 0.001) and the extent of nutritional assessments that included significantly more weight history recalls, weight measurements, and body mass index measurements (all P < 0.05). The most important barrier to providing nutritional support for PU (prone) patients in both groups was knowledge and skills. CONCLUSION: Using a nutritional guideline in PU care contributes to the amount of nutritional screening conducted in daily practice and to the content and extent of the assessment.

Disruption of CCTbeta2 expression leads to gonadal dysfunction.

There are two mammalian genes that encode isoforms of CTP:phosphocholine cytidylyltransferase (CCT), a key rate-controlling step in membrane phospholipid biogenesis. Quantitative determination of the CCT transcripts reveals that CCTalpha is ubiquitously expressed and is found at the highest levels in the testis and lung, with lower levels in the liver and ovary. CCTbeta2 is a very minor isoform in most tissues but is significantly expressed in the brain, lung, and gonads. CCTbeta3 is the third isoform recently discovered in mice and is expressed in the same tissues as CCTbeta2, with its highest level in testes. We investigated the role(s) of CCTbeta2 by generating knockout mice. The brains and lungs of mice lacking CCTbeta2 expression did not exhibit any overt defects. On the other hand, a large percentage of the CCTbeta2(-/-) females were sterile and their ovaries exhibited defective ovarian follicle development. The proportion of female CCTbeta2(-/-) mice with defective ovaries increased as the animals aged. The rare litters born from CCTbeta2(-/-) x CCTbeta2(-/0) matings had the normal number of pups. The abnormal ovarian histopathology was characterized by disorganization of the tissue in young adult mice and absence of follicles and ova in older mice, along with interstitial stromal cell hyperplasia which culminated in the emergence of tubulostromal ovarian tumors by 16 months of age. Grossly defective CCTbeta2(-/-) ovaries were associated with high follicle-stimulating (FSH) and luteinizing (LH) hormone levels. Male CCTbeta2(-/0) mice exhibited progressive multifocal testicular degeneration and reduced fertility but had normal FSH and LH levels. Thus, the most notable phenotype of CCTbeta2 knockout mice was gonad degeneration and reproductive deficiency. The results indicate that although CCTbeta2 is expressed at very low levels compared to the alpha-isoform, loss of CCTbeta2 expression causes a breakdown in the gonadal response to hormonal stimulation.

Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand.

OBJECTIVE: To compare the dispensed volumes and prescribed doses for inhaled corticosteroids (ICS) for children in New Zealand. DESIGN: Longitudinal analysis of prescribing trends using the Royal New Zealand College of General Practitioners Research Unit database and the Pharm Warehouse database of the New Zealand Health Information System. SETTING: New Zealand from 1993 to 2001. SUBJECTS: Children aged 0-5 years and 6-17 years. MAIN OUTCOME MEASURES: The ratio of potency-adjusted mean daily dose of fluticasone propionate (FP) to beclomethasone (BDP) and dispensed volumes of FP, BDP and budesonide. RESULTS: The ratio of potency-adjusted mean daily dose of FP to BDP prescribed to children aged 0-17 years ranged from 1.22 to 1.91. With the introduction of FP, the total amount of ICS dispensed to children aged 0-5 years in New Zealand nearly doubled, when adjusted for potency. CONCLUSIONS: The introduction of FP into New Zealand corresponds with an increase in the total amount of ICS dispensed and an increase in the adjusted daily dose prescribed.

Gene structure, expression and identification of a new CTP:phosphocholine cytidylyltransferase beta isoform.

CTP:phosphocholine cytidylyltransferase (CCT) is a key regulatory enzyme in phosphatidylcholine (PtdCho) biosynthesis, and in mammals, there are two distinct genes that encode enzymes that catalyze this reaction. This work defines the structures of both the murine CCT genes (Pcyt1a and Pcyt1b) and identifies a new CCT protein, CCTbeta3, with a unique amino terminus that arises from an alternate initiation exon. CCTalpha is expressed in all tissues, and is most abundant in liver, kidney and heart. A second CCTalpha transcript is described that initiates from a separate untranslated exon that is most highly expressed in testis. The CCTbeta isoforms are most highly expressed in brain and reproductive tissues. CCTbeta3 is not expressed in embryonic brain tissues, but is a significant transcript in the adult. These data suggest unique roles for the CCT protein isoforms in the differential regulation of PtdCho biosynthesis in specific tissues.

Focus group interviews as a methodology.

Focus groups are a form of group interview used widely in social science research. It is a methodology that has also been applied in a number of areas of healthcare study, particularly in health promotion and consumer satisfaction. First described by Bogardus in 1926 ( 1 ). focus groups fuse the principles of qualitative research and group process theory. Morgan ( 2 ) suggested that: 'The explicit use of group interaction is to produce data and insights that would be less accessible without the interaction found in a group.'