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Control Day (control + day)
Selected AbstractsImpact of citrate therapy on the circadian rhythm of urinary magnesium ammonium phosphate saturation in normal individualsINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2000Yoshihide Ogawa Abstract Background: Alkaline citrate has been used widely in the prevention of stone formation. However, the risk of struvite stone during the alkalinizing therapy has not been adequately studied in terms of magnesium ammonium phosphate saturation. Methods: The circadian rhythm of the urinary saturation of magnesium ammonium phosphate was estimated by using the differential Gibbs' free energy values of magnesium ammonium phosphate before and during 5 days of treatment with sodium,potassium citrate (1 g t.i.d., 1 g q.i.d. or 3 g t.i.d.) in five healthy male volunteers. Results: The magnesium ammonium phosphate saturation varied during the day, peaking far below the solubility product between 08.00 and 10.30 h and between 13.00 and 18.00 h. The mean peak levels were increased by each treatment regimen in comparison with the control day. The mean increase on day 1 was significant between 10.30 and 23.00 h with the 3 g t.i.d. regimen, but the mean saturation still remained below the solubility product throughout the day. Conclusions: The urinary magnesium ammonium phosphate saturation appeared hard to exceed the solubility product with a high dose of alkaline citrate. [source] Effect of proton pump inhibition on the gastric volume: assessed by magnetic resonance imagingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009A. BABAEI Summary Background Proton pump inhibitor (PPI) therapy is known to suppress gastric acid secretion. Thus PPI therapy may decrease gastric volume and gastric contents available for gastro-oesophageal reflux by decreasing acid secretion. Aim To determine the effect of PPI therapy on the gastric volume after a standard meal. Methods A total of nine healthy subjects were studied using magnetic resonance imaging, before and after a standard liquid meal mixed with a paramagnetic contrast to help demarcate the gastric region. Images were acquired for a total of 90 min after the meal. Studies were conducted before and following esomeprazole twice daily for 7 days. Images were analysed to determine the gastric liquid volume. Results Gastric volume, 15 min after the meal peaked to 611 ± 37 mL on the control day and 539 ± 30 mL following the PPI administration (P < 0.001). Average gastric volume remained significantly lower (56 ± 9 mL, P < 0.05) on the PPI therapy from 5 to 75 min after the meal. Conclusions Proton pump inhibitor therapy causes a significant reduction in the gastric contents volume during first 75 min after the meal. In addition to increasing the gastric pH, PPI therapy may decrease the frequency of gastro-oesophageal reflux by decreasing the volume of gastric contents. [source] Sputum eosinophilia: an early marker of bronchial response to occupational agentsALLERGY, Issue 5 2009O. Vandenplas Background:, False-negative responses to specific inhalation challenge (SIC) with occupational agents may occur. We explored whether assessing changes in sputum cell counts would help improve the identification of bronchial reactivity to occupational agents during SICs. Methods:, The predictive value of the changes in sputum cell counts after a negative FEV1 response to a first challenge exposure to an occupational agent was determined using the changes in airway calibre observed during repeated challenges as the ,gold standard'. The study included 68 subjects investigated for work-related asthma in a tertiary centre. After a control day, the subjects were challenged with the suspected occupational agent(s) for up to 2 h. All subjects who did not show an asthmatic reaction were re-challenged on the following day. Additional challenges were proposed to those who demonstrated a , 2% increase in sputum eosinophils or an increase in nonspecific bronchial hyperresponsiveness to histamine after the second challenge day. Results:, Six of the 35 subjects without changes in FEV1 on the first challenge developed an asthmatic reaction on subsequent challenges. ROC analysis revealed that a >3% increase in sputum eosinophils at the end of the first challenge day was the most accurate parameter for predicting the development of an asthmatic response on subsequent challenges with a sensitivity of 67% and a specificity of 97%. Conclusions:, An increase in sputum eosinophils is an early marker of specific bronchial reactivity to occupational agents, which may help to identify subjects who will develop an asthmatic reaction only after repeated exposure. [source] Influence of endogenous angiotensin II on control of sympathetic nerve activity in human dehydrationTHE JOURNAL OF PHYSIOLOGY, Issue 22 2009J. A. Rabbitts Arterial blood pressure can often fall too low during dehydration, leading to an increased incidence of orthostatic hypotension and syncope. Systemic sympathoexcitation and increases in volume regulatory hormones such as angiotensin II (AngII) may help to maintain arterial pressure in the face of decreased plasma volume. Our goals in the present study were to quantify muscle sympathetic nerve activity (MSNA) during dehydration (DEH), and to test the hypothesis that endogenous increases in AngII in DEH have a mechanistic role in DEH-associated sympathoexcitation. We studied 17 subjects on two separate study days: DEH induced by 24 h fluid restriction and a euhydrated (EUH) control day. MSNA was measured by microneurography at the peroneal nerve, and arterial blood pressure, electrocardiogram, and central venous pressure were also recorded continuously. Sequential nitroprusside and phenylephrine (modified Oxford test) were used to evaluate baroreflex control of MSNA. Losartan (angiotensin type 1 receptor (AT1) antagonist) was then administered and measurements were repeated. MSNA was elevated during DEH (42 ± 5 vs. EUH: 32 ± 4 bursts per 100 heartbeats, P= 0.02). Blockade of AT1 receptors partially reversed this change in MSNA during DEH while having no effect in the control EUH condition. The sensitivity of baroreflex control of MSNA was unchanged during DEH compared to EUH. We conclude that endogenous increases in AngII during DEH contribute to DEH-associated sympathoexcitation. [source] Impact of Disaster Drills on Patient Flow in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 6 2008Nathan Timm MD Abstract Objectives:, Joint Commission on Accreditation of Healthcare Organizations (JCAHO)-accredited hospitals must conduct disaster drills twice a year, with one incorporating a mass casualty incident to the emergency department (ED). The authors found no studies describing the potential negative impact on the quality of care real patients in the ED receive during these drills. The objective was to determine the impact that mass casualty drills have on the timeliness of care for nondisaster patients in a pediatric ED. Methods:, Since 2001, nine disaster drills involving mass casualties to the ED were conducted at the authors' institution. The authors studied 5-, 10-, and 24-hour blocks of time surrounding these events and defined quality measures as the timeliness of care in terms of length of stay (LOS) in ED, time-to-triage, and time-to-physician. Drill dates were compared with control dates (the same weekday on the following week). Paired t-tests were used to compare outcomes of interest between drill and control days. Results:, Nine drill days and nine control days were studied. There was no statistically significant difference between drill dates and control dates in average time-to-triage and time-to-emergency physician and average ED LOS. Admitted patients spent less time in the ED during drill dates. Conclusions:, Disaster drills at this institution do not appear to significantly affect the timeliness of care to nondisaster drill ED patients. Attention should be paid to the quality of care "real" patients receive to ensure that their care is not jeopardized during an artificial stress to the system during a disaster drill. [source] Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled TrialACADEMIC EMERGENCY MEDICINE, Issue 8 2007Brian R. Holroyd MD BackgroundTriage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. ObjectivesTo evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. MethodsA six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 am to 8 pm) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. ResultsTLPs assessed a median of 14 patients per shift (interquartile range, 13,17), received 15 telephone calls per shift (interquartile range, 14,20), and spent 17,81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. ConclusionsA TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs. [source] | ||||||||||