Critical care transfers and COVID-19: Managing capacity challenges through critical care networks.

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients. Within a short 50-day period 223 patients were transferred within the network to distribute pressures. This unprecedented number of critical care transfers, combined with the creation of extra capacity and new pathways, allowed the region to continue to offer timely and unrationed access to critical care for all patients who would benefit from admission. This extraordinary response is a testament to the power and benefits of a regionally networked approach to critical care, and the lessons learned may benefit other healthcare providers, managers and policy makers, especially in regions currently facing new outbreaks of COVID-19.

Learning from critical care: Improving intra- and inter-hospital transfer processes in enhanced care and the ward.

The Intensive Care Society (ICS) has recently published guidance on the transfer of critically ill adults. Since 2007, the North West London Critical Care Network has documented and audited patient transfers undertaken across 13 hospitals, and trained staff in transferring critically ill or injured patients. In 2015/16 the network introduced intra-hospital transfer documentation and applied the same transfer training and audit methodology for critically ill patients being moved within hospitals. While increasing data capture and with a targeted training strategy adapted from transfer experience, the network has seen a reduction in number and severity of incidents in the region. In contrast to this experience, no formalised processes exists to support the inter-hospital or intra-hospital transfer of patients from enhanced care areas or wards not embedded within critical care. Often very little data is collected from these areas, but we suspect transfer risks are higher in these cases as a consequence of the deficit of structured transfers. In collaboration with members of the critical care network, we have developed a basic training module along with the use of a transfer form which has been well received and had a positive impact in terms of incidents reported.

Interactive effects of neonicotinoids and natural ultraviolet radiation on yellow perch (Perca flavescens) larvae.

Neonicotinoids (NEOCs) are insecticides that are widely used worldwide in the culture of maize and soya. Whereas they specifically target terrestrial insects by acting as agonists of the neurotransmitter acetylcholine in their nervous system, their effects on the cholinergic system of vertebrates is still unclear. Moreover, there is an increasing concern about their effects on aquatic biota because of their high leaching potential. In the agricultural watershed of Lake St. Pierre (LSP) (St. Lawrence River System, Québec, Canada), for example, NEOC concentrations considered toxic for aquatic biota (>8.3 ng L-1) have frequently been detected. These conditions may affect the yellow perch (Perca flavescens) population in LSP, which collapsed in the mid 1990s and is now experiencing poor recruitment. Moreover, because their larvae are found in shallow waters (<80 cm) near agricultural land, they are also exposed to ultraviolet radiation (UVR), with unknown potential interactions with NEOCs. The objective of this study was to test the synergistic effects of two commonly used NEOCs (imidacloprid and thiamethoxam) with natural UVR on yellow perch larvae using survival analysis and biomarkers to better quantify lethal and sublethal effects. Three common garden experiments were conducted with thiamethoxam and/or imidacloprid and natural UVR following a factorial design. Our results showed an interaction between UVR and thiamethoxam in terms of larval mortality. At the sublethal level, imidacloprid was associated with increased protein content and, in the presence of UVR, with increased acetylcholinesterase activity, thus indicating a cholinergic perturbation like that found in insects. Finally, we also found unexpected reduced lipid peroxidation associated with imidacloprid. A reduction in the overall lipid accumulation is suspected to be behind this puzzling result. These results will open new research avenues related to the effects of NEOCs on proteins and lipid accumulation.

An Analysis of Quality Improvement Education at US Colleges of Pharmacy.

Objective. Analyze quality improvement (QI) education across US pharmacy programs. Methods. This was a two stage cross-sectional study that inspected each accredited school website for published QI curriculum or related content, and e-mailed a questionnaire to each school asking about QI curriculum or content. T-test and chi square were used for analysis with an alpha a priori set at .05. Results. Sixty responses (47% response rate) revealed the least-covered QI topics: quality dashboards /sentinel systems (30%); six-sigma or other QI methodologies (45%); safety and quality measures (57%); Medicare Star measures and payment incentives (58%); and how to implement changes to improve quality (60%). More private institutions covered Adverse Drug Events than public institutions and required a dedicated QI class; however, required QI projects were more often reported by public institutions. Conclusion. Despite the need for pharmacists to understand QI, it is not covered well in school curricula.

The bariatric patient: an overview of perioperative care.

Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care.

Modeling, synthesis and biological evaluation of potential retinoid X receptor-selective agonists: novel halogenated analogues of 4-[1-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphthyl)ethynyl]benzoic acid (bexarotene).

The synthesis of halogenated analogues of 4-[1-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydro-2-naphthyl)ethynyl]benzoic acid (1), known commonly as bexarotene, and their evaluation for retinoid X receptor (RXR)-specific agonist performance is described. Compound 1 is FDA approved to treat cutaneous T-cell lymphoma (CTCL); however, bexarotene treatment can induce hypothyroidism and elevated triglyceride levels, presumably by disrupting RXR heterodimer pathways for other nuclear receptors. The novel halogenated analogues in this study were modeled and assessed for their ability to bind to RXR and stimulate RXR homodimerization in an RXRE-mediated transcriptional assay as well as an RXR mammalian-2-hybrid assay. In an array of eight novel compounds, four analogues were discovered to promote RXR-mediated transcription with EC(50) values similar to that of 1 and are selective RXR agonists. Our approach also uncovered a periodic trend of increased binding and homodimerization of RXR when substituting a halogen atom for a proton ortho to the carboxylic acid on 1.