Healthcare Ltd Research Articles

The impact of a new emergency admission avoidance system for older people on length of stay and same-day discharges

unplanned hospital admissions of older patients continue to attract the attention of UK policymakers, advisors and media. Reducing the number and length of stay (LOS) of these admissions has the potential to save NHS substantial costs while reducing iatrogenic risks. Some NHS trusts have introduced geriatric admission-avoidance systems, but evidence of their effectiveness is lacking. In September 2010, The Royal Free Hospital and Haverstock Healthcare Ltd, a GP provider organisation, introduced an admission-avoidance system for patients aged 70 or over: the Triage and Rapid Elderly Assessment Team (TREAT). to measure the effect of TREAT on LOS and the rate of same-day discharges (an inverse measure of admission rate). TREAT was based in the Accident and Emergency (A&E) department of the Royal Free Hospital, London. a pre- and post-retrospective cohort study comparing the 5,416 emergency geriatric admissions in the 12 months preceding the introduction of TREAT with the 5,370 emergency geriatric admissions in the 12 months following. Emergency geriatric admissions were divided into TREAT-matching and residual (non-matching) cohorts from hospital provider spell records, using the Healthcare Resource Group (HRG), treatment function and patient classification of the TREAT admissions. LOS and same-day discharge rates were measured over the pre- and post-TREAT periods: for the TREAT-matching cohort; for the residual cohort of emergency geriatric admissions; and for all emergency geriatric admissions. TREAT is a system of care combining early Accident and Emergency (A&E)-based senior doctor review, Comprehensive Geriatric Assessment (CGA), therapist assessment and supported discharge; post-discharge supported recovery; and a rapid access geriatric 'hot-clinic'. TREAT was supported by a post-acute care enablement (PACE) team, providing short-term nursing support immediately following discharge. TREAT accepted 593 geriatric admissions over a 12-month period, of which 32.04% were discharged on the day of admission. The mean LOS was 4.41 days, and the median LOS was 1 day. After the introduction of TREAT, mean LOS reduced by 18.16% (1.78 days, P < 0.001) for TREAT-matching admissions; by 11.65% (1.13 days, P < 0.001) for all emergency geriatric admissions; and by 1.08% (0.11 days, P = 0.065) for the residual population. Over the same period, the percentage of admissions resulting in same-day discharges increased from 12.26 to 16.23% (OR: 1.386, 95% CI: 1.203-1.597, P < 0.001) for TREAT-matching admissions, but for the residual population fell from 15.01 to 9.77% (OR: 0.613, P < 0.001, 95% CI: 0.737-0.509). TREAT appears to have reduced avoidable emergency geriatric admissions, and to have shortened LOS for all emergency geriatric admissions. It aims to address the King's Fund's call for an 'overall system of care rather than lots of discrete processes' through 'better design and co-ordination of services following the needs of older people'. The ease of set-up lends itself to replication and testing in clinical and cost-effectiveness studies. Further studies are needed to measure the impact of TREAT on re-admission rates, patient outcomes and satisfaction.

A phase Ib, open-label study to assess the safety of continuous oral treatment with afatinib in combination with two chemotherapy regimens: cisplatin plus paclitaxel and cisplatin plus 5-fluorouracil, in patients with advanced solid tumors

BackgroundIn this phase Ib, dose-escalation study, the oral irreversible ErbB family blocker afatinib (BIBW 2992) was combined with cisplatin (Cadila Healthcare Ltd, Ahmedabad, India) 50 or 75 mg/m2/paclitaxel (Bristol-Myers Squibb Pharmaceuticals Ltd, New York, USA) (Taxol)175 mg/m2 (regimen A) or cisplatin 75–100 mg/m2/5-fluorouracil 750–1000 mg/m2 (regimen B) in patients with advanced solid tumors. Patients and methodsThe primary objective was to assess dose-limiting toxicities (DLTs) during cycle 1 for each regimen, from which the maximum tolerated dose (MTD) was determined. Patients received once daily oral afatinib 20, 30, 40 or 50 mg in 21-day cycles (3 + 3 design). ResultsThe MTD for afatinib in regimens A (n = 26) and B (n = 21) was determined as 20 mg and 30 mg following DLTs in five and four patients in cycle 1, respectively. Most frequent adverse events (AEs, any grade) were diarrhea and nausea. Disease control was observed in 54% and 29% of patients in regimens A and B, respectively. Plasma sampling suggested no relevant pharmacokinetic interaction between afatinib and the chemotherapeutic agents. ConclusionsThe MTD of afatinib was 20 mg with cisplatin–paclitaxel and 30 mg with cisplatin–5-fluorouracil. Pre-emptive management of side-effects is important to maintain adequate safety and tolerability. Both combinations showed antitumor activity across tumor types and lines of prior treatment.

Appropriate use and efficacy of telehealth comes under scrutiny

Independent NurseVol. 2013, No. 3 Professional InAppropriate use and efficacy of telehealth comes under scrutinyDavid WoodsDavid WoodsSearch for more papers by this authorDavid WoodsPublished Online:18 Feb 2014https://doi.org/10.12968/indn.2013.18.3.97545AboutSectionsView articleView Full TextView EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetailsCited byeHealth: is it the panacea?16 August 2013 | British Journal of Community Nursing, Vol. 18, No. 5 1 March 2013Volume 2013Issue 3ISSN (print): 1747-9800ISSN (online): 2052-2843 Metrics History Published online 18 February 2014 Published in print 1 March 2013 Information© MA Healthcare Ltd 2013

Effect of immune complexes and cytokines on expression and modulation of neutrophil complement regulatory proteins in SLE

Event Abstract Back to Event Effect of immune complexes and cytokines on expression and modulation of neutrophil complement regulatory proteins in SLE NIBHRITI DAS1*, Bintili Biswas2, Vaishali Arora3, Uma Kumar4 and Ashok Kumar5 1 All India Institute of Medical Sciences, India 2 All India Institute of Medical Sciences, Biochemistry, India 3 University of Pennsylvania, Rheumatology, United States 4 All India Institute of Medical Sciences, Rheumatology, India 5 Fortis Health Care Ltd, Rheumatology, India Modulation of neutrophil DAF, MCP, CD59 & CR1 transcripts in SLE and their close correlations with SLE disease activity had been documented. To gain further insight, we studied effects of serum opsonized heat aggregated immunoglobulins (sHIgG), IFN-, TNF-α, IL4 and, IL10 on the expression and, modulation of these proteins in SLE. Neutrophils isolated from the venous blood of patients and controls were treated in vitro with different effecters. The transcript levels of different complement regulatory proteins in treated and untreated cells were determined by real time PCR, data were compared between patients and controls. sHIgG down-regulated the levels of CR1 transcript but up-regulated the levels of MCP and DAF with no significant effects on CD59 expression both in controls and patients. CR1 correlated negatively with MCP, DAF, & CD59. Levels of all these proteins were upregulated by IFN-γ and were down regulated by TNF α. IL4 and IL10 significantly up regulated MCP and DAF, respectively. The upregulation by all the effecters ranged from 1.5 -4 fold and down regulation ranged from .25-.8 fold as compared to the untreated cells. Mostly, the modulation was more marked in patients compared to controls. Observations were statistically significant ((P<.05-0.001, Mann-Whitney test). Our study documents modulation of neutrophil complement regulatory proteins by cytokines and hence, suggests close interplay of cytokines with functional attributes of complement in health and diseases like SLE where complement proteins have disease modulating roles. Further studies are needed to confirm our findings and their translational implications. Keywords: modulation, cytokine, SLE, complement, Regulatory proteins Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Innate immunity Citation: DAS N, Biswas B, Arora V, Kumar U and Kumar A (2013). Effect of immune complexes and cytokines on expression and modulation of neutrophil complement regulatory proteins in SLE. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00208 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 14 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. NIBHRITI DAS, All India Institute of Medical Sciences, New Delhi, India, nibhriti@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers NIBHRITI DAS Bintili Biswas Vaishali Arora Uma Kumar Ashok Kumar Google NIBHRITI DAS Bintili Biswas Vaishali Arora Uma Kumar Ashok Kumar Google Scholar NIBHRITI DAS Bintili Biswas Vaishali Arora Uma Kumar Ashok Kumar PubMed NIBHRITI DAS Bintili Biswas Vaishali Arora Uma Kumar Ashok Kumar Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Primary Health Care Ltd v Giakalis

Primary Health Care Ltd v Giakalis

Articulating an ethical objection in practice

© MA Healthcare Ltd, 2012. All rights reserved. No part of the Journal of Renal Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 2041-1448 Printed by Pensord Press Ltd, Blackwood, NP12 2YA Editor Edda Hendry +44(0)20 7501 6749 edda.h@markallengroup.com Sales Executive Andrew Iafrati andrew.iafrati@markallengroup.com Publishing Director Anthony Kerr anthony.kerr@markallengroup.com Associate Publishers Tracy Cown and Chloe Moffat Team Senior Editor Julie Smith Production Manager Jon Redmayne Production Assistant Larry Oakes Chief Executive Officer Ben Allen Articulating an ethical objection in practice R enal nurses have a unique relationship with their patients and often develop a broad insight into our patients’ needs, more so than those allied to our profession. We often, but not exclusively, spend considerable time with our patients, both in clinical areas and on the phone, and have the privilege of assessing them in the context of their family and private lives. In short, we often have strong feelings about what is right for them. These feelings are often brought to bear in a multidisciplinary setting, when a course of action or decision proposed by a colleague may feel instinctively wrong to you. Examples of these decisions could include the withdrawal of dialysis, activation on to the transplant list or the progress of a questionable live donor to transplantation, among others. Your instincts and feelings about an issue are often correct and can be communicated effectively, but sometimes it can be difficult to do justice to what you feel in front of a tough crowd. Are your instincts enough, and is it adequate to simply state ‘I’m not happy!’? The difficulty lies in the fact that your colleagues also have the best interests of the patient as a primary focus, and often an argument based on diagnosis, prognosis and risk can seem more compelling than an argument based on a gut feeling. The following considerations may be useful to think about when expressing your concerns to colleagues or articulating an ethical objection in practice. First, we need to establish what your primary concern actually is. Does the decision or issue concern you because you consider the process by which the proposed outcome is achieved to be harmful, or do you have concerns about the outcome itself? To put it another way, are you more concerned with ‘how’ things are done or ‘where’ things going? It is important to test your thesis. An argument is only as good as the one that you refute, so think clearly about what the alternative is, should your concern be challenged. For example, if the proposal is

Prospective Randomized Controlled Trial

INTRODUCTION: Pain at split skin graft donor sites is common. Fibrin sealant has been demonstrated to reduce time to hemostasis at wound sites, and patients receiving this treatment were noted to report less pain, triggering this study, which aimed to evaluate pain and incapacity with and without fibrin sealant. METHODS: Fifty patients requiring split skin grafts were prospectively randomized to receive either Mefix only (Mölnlycke Health Care Ltd), or the fibrin sealant TISSEEL (Baxter Healthcare Ltd) plus Mefix, as primary donor site dressings. External secondary dressings were the same. Patients were blinded with regard to treatment group. Using visual analogue scales (scored 0-5), patients were asked to rate their donor site pain and incapacity for 14 days post-operatively. Secondary endpoints were length of hospital stay and duration of requirement for dressings. RESULTS: Fifty patients were recruited and 43 (86.0%) completed self-reported pain and incapacity scores. Twenty-two received TISSEEL plus Mefix and twenty-one received Mefix only (controls). Patients using TISSEEL plus Mefix reported significantly less pain (mean score 0.41 vs. 1.46, p<0.001), and significantly less incapacity (mean score 0.44 vs. 1.54, p<0.001). Patients allocated to the TISSEEL group recorded shorter lengths of stay and faster time to discontinuation of dressing, though statistical significance was not achieved. CONCLUSION: Patients whose split skin graft donor sites were dressed with TISSEEL plus Mefix experienced significantly less pain and incapacity than patients with Mefix dressings. This resulted in a shorter inpatient stay for patients treated with TISSEEL.Figure 1: Mean Daily Post Operative Pain Score, with 95% Confidence Intervals.Table 1: Table 1.

Treatment Of Chronic Kidney Disease Patients With A Supplemented Low Protein Diet And A Supplemented Very Low Protein Diet

The primary results of the Modification of Diet in Renal Disease were inconclusive and did confuse a lot of physicians about the dietary approach to CKD management. The study design was flawed and thus compromised the results and conclusions. Re-analysis of the MDRD study however clearly showed the benefits of dietary protein restriction and also more importantly an additional benefit by ketoanalogue supplementation in delaying progression of CKD. Despite the obvious benefits of protein restriction, concern has been raised recently especially patients on very low dietary protein (very-low-protein diets; VLPDs), which could lead to deterioration in the nutritional status of CKD patients. To address this particular issue of whether a sVLPD diet induces malnutrition the present study has been taken up 132 adult patients with Stage 3 to Stage 5 (Predialysis) were initiated on a protein restricted ketoanalogue supplemented diet after informed consent and the necessary Institutional Ethics Committee approvals. Based on their affordability, 92 patients randomly were assigned to the sLPD group whereby they received 0.6 G/Kg BW of dietary proteins supplemented by ketoanalogues at a dosage of one tablet per 10 Kg body weight. 40 patients received 0.3 G/Kg BW supplemented by ketoanalogues at a dose of one tablet per 5 Kg body weight. Renolog® tablets manufactured by La Renon Healthcare Ltd, Ahmebabad, India were prescribed as the ketoanalogue supplements. Renal, Metabolic, Nutritional parameters and Anthropometric analysis were done in both groups at the start of the study and at the end of 6 months of follow up. The mean blood urea in the SLPD group showed a decrease from 81.17+_ 00 mg/dl to 74.45+_30.75 mg/dl (p 0.05) at the end of six months indicating an improvement in renal function . The serum creatinine also showed a decrease from 3.52+_00 mg/dl to 3.30 +_1.63 mg/dl(p>0.05) in the SLPD group and a decrease from 3.74+_00 mg/dl to 3.55+_1.67 mg/dl(p>0.05) in the SVLPD group though not statistically significant. The eGFR showed improvement from 26.76+_00 ml/min to 30.75+_17.31 ml/min (p 0.05) in the SVLPD group. Serum albumin increased from 3.85+_00 gm/dl to 4.00+_0.56 gm/dl (p 0.05) . Blood hemoglobin increased from 11.18+_2.02 gm/dl to 11.48+_2.14 gm/dl in the SLPD group and an increase from 11.35+_0.96 gm/dl to 13.22+_1.03 gm/dl in the SVLPD group. Combined analysis of both the study groups together(SLPD +SVLPD) showed a statistically significant decrease in blood urea from 80.32+_0.0 mg/dl to 73.70+_31.81 mg/dl(p 0.05) and increase in eGFR from 25.82+_ 0.0 ml/min to 29.42+_ 15.67 ml/min(

Mini Focus: Interview With Dr James Birchall

James Birchall is a Reader in Pharmaceutics at the School of Pharmacy and Pharmaceutical Sciences, Cardiff University. Dr Birchall graduated from Bath University in 1993 and completed his PhD researching drug and DNA delivery systems in 1998 (Cardiff University). His current research is focussed on the use of microneedles for cutaneous drug, vaccine and gene delivery, and the exploitation of novel dry powder and metered dose inhaler formulations for pulmonary drug and gene delivery. Dr Birchall has acted as Associate Editor of Critical Reviews in Therapeutic Drug Carrier Systems, is a member of the Editorial Board of Expert Review of Medical Devices and is an Honorary Senior Lecturer and Research Pharmacist with the National Health Service. His research is funded by the NIH, Royal Society, British Skin Foundation and 3M Healthcare Ltd. Dr Birchall speaks to Laura Harvey (Commissioning Editor) on some of the challenges and future directions of transdermal delivery research into gene delivery and microneedle technology today.

Continence aids in the management of urinary incontinence – CORRIGENDUM

The legend to Figure 13 on page 11 of the above paper (Browning et al., 2012) was incomplete. The full legend is as follows:Figure 13. Examples of washable incontinence underwear and disposable products (reproduced with permission from P&amp;S Healthcare Ltd and SCA (TENA) Hygiene Products)

Non-invasive traction for proximal femoral fractures in amputees

Fracture reduction for fixation of proximal femoral fractures in amputees using a Steinmann pin carries the risk of infection and delayed mobilisation. The use of an arm trap used for shoulder arthroscopy provides non-invasive traction of the limb. Rotational control can be achieved using an assistant with a steady grip if required. Apply a thin layer of wool to the stump followed by the hand trap (Allen Medical Systems, Ashby de la Zouch, LE65 1JG). Wrap with a four-inch self-adhesive bandage (3M™ Coban™, 3M Health Care Ltd, Loughborough, LE11 1EP) and secure the cord to the traction table. Prepare and drape as routine. Figure 1 Use of the hand trap

An evaluation of the skin stripping of wound dressing adhesives

This study looks at six different modern wound dressings to investigate how likely they are to cause skin stripping and impairment of the skin's barrier function. Healthy volunteers had each dressing applied, removed and reapplied to the skin on their back over the study period of 15 days. Skin barrier function was investigated using the amount of transepidermal water loss (TEWL) and then related to the amount of skin stripping, investigated by measuring stained skin removal, the thickness of the stratum corneum after treatment, and the amount of skin attached to the removed dressings. General signs of trauma, such as skin dryness and erythema, were investigated by subjective and objective parameters. TEWL values measured on the untreated test area, as well as after application of Urgotul Trio, remained relatively unchanged and Mepilex Border decreased slightly (?1g/m2/h), while all other dressings displayed an increased in TEWL: Allevyn Adhesive (5g/m2/h), Versiva XC (14g/m2/h), Comfeel Plus (22g/m2/h) and Biatain (28g/m2/h). By the end of the study, only the untreated area (mean 43% dye remaining), Mepilex Border (76%) and Urgotul Trio (34%) areas had visible dye remaining. It is interesting to note that the untreated site had a colour change, suggesting loss of stratum corneum, due to the shedding of skin cells from the surface. The increase in total skin colour for Comfeel Plus and Biatain after day 8 might be assigned to an increased redness due to erythema. All the dressings showed evidence of stratum corneum attached to the adhesive, except Mepilex Border, which appeared to be free of any attached stratum corneum. Overall the best performance in terms of skin protection and failure to cause skin trauma was found to be for Mepilex Border. This project was funded by a grant from Mölnlycke Healthcare Ltd.

Being free to believe

MA Healthcare Ltd, St Jude’s Church, Dulwich Road, Herne Hill, London SE24 0PB (Tel: 020 7738 5454) © MA Healthcare 2010 All rights reserved. No part of the British Journal of Healthcare Assistants may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, withut prior permission of the Publisher Printed by Pensord Press Ltd, Blackwood, Gwent. NP12 2YA ISSN 1753 -1586 wwww.healthcare-assistants.co.uk UK Personal Quarterly Direct Debit £20 Annual Direct Debit £75 Cheque or credit card £82

Use of Extracorporeal Membrane Lung Assist Device (Novalung) in H1N1 Patients

We present three patients with severe respiratory failure secondary to H1N1 influenza type A pneumonitis, in whom hypercapnia and respiratory acidosis were not controlled by the conventional mechanical lung ventilation or high-frequency oscillatory ventilation. Use of a pumpless arteriovenous extracorporeal carbon dioxide removal device (Novalung™, Inspiration Healthcare Ltd, Leicester, UK) resulted in reduced carbon dioxide levels, improved pH, and a reduction in inspiratory pressures, allowing for a less-harmful ventilator strategy. These cases demonstrate that the Novalung is a safe and effective device to use in patients with H1N1 pneumonitis refractory to the conventional therapy and may be an alternative to extracorporeal membrane oxygenation (ECMO) in selected cases.

A typical man?

MA Healthcare Ltd, St Jude’s Church, Dulwich Road, Herne Hill, London SE24 0PB (Tel: 020 7738 5454) © MA Healthcare 2010 All rights reserved. No part of the British Journal of Healthcare Assistants may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, withut prior permission of the Publisher Printed by Pensord Press Ltd, Blackwood, Gwent. NP12 2YA ISSN 1753 -1586 wwww.healthcare-assistants.co.uk UK Personal Quarterly Direct Debit £20 Annual Direct Debit £75 Cheque or credit card £82

Peripheral vascular access devices: care and maintenance

Peripheral vascular access devices: care and maintenance

Time to pull together

MA Healthcare Ltd, St Jude’s Church, Dulwich Road, Herne Hill, London SE24 0PB (Tel: 020 7738 5454) © MA Healthcare 2011 All rights reserved. No part of the British Journal of Healthcare Assistants may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, withut prior permission of the Publisher Printed by Pensord Press Ltd, Blackwood, Gwent. NP12 2YA ISSN 1753 -1586 wwww.healthcare-assistants.co.uk UK Personal Quarterly Direct Debit £20 Annual Direct Debit £75 Cheque or credit card £82

Hand-held device for smoke extraction

Electrocautery produces smoke which potentially causes harm to theatre personnel as well as obscuring the surgical view. Few surgeons use smoke extraction units due to lack of availability, expense and the cumbersome nature of purpose-made, hand-held pieces.1 Our team passes the tip of the hand-held diathermy through a 53 cm 12-F suction catheter with a mully tip (Unomedical Pty Ltd, PO Box 405, NSW 2103 Australia; Fig. 1). This is secured with adhesive strips and connected to Flexi-Rib suction tubing (Pennine Healthcare Ltd, Derby, UK) to create an effective and ergonomically acceptable handheld smoke evacuator for less than one pound. The tubing is attached to a filtered smoke evacuator suction unit. Figure 1 Diathermy needle with smoke extractor.

The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting

A total environmental cleaning system based on microfiber technology was implemented within 2 intensive care units (ICUs). The efficacy of this modified cleaning program was assessed using adenosine triphosphate (ATP) bioluminescence. A team of trained hygiene technicians cleaned all near-patient furniture and equipment twice a day using ultramicrofiber cloths. Every week for 40 weeks, 10 surfaces within a randomly selected bed area were sampled using the 3M Clean-Trace Clinical Hygiene Monitoring System (3M Health Care Ltd, Loughborough, United Kingdom). The ability of the modified cleaning program to reduce surface contamination to "acceptable" levels was measured against previously proposed benchmark ATP values. In comparison with normal cleaning procedures routinely carried out by the nurses, the modified cleaning program significantly reduced (P < .001) the ATP readings obtained from surfaces within the near-patient environment. In both ICUs, 95% of surfaces sampled after modified cleaning had relative light unit values of <500 and were deemed "clean." Almost 90% of the surfaces could also be "passed" using the more stringent benchmark value of 250 relative light units. However, regardless of benchmark value used, the majority of surfaces sampled could also be considered adequately clean prior to them being cleaned by the hygiene technicians. The use of ATP bioluminescence has been proposed as a means to improve the management of hospital cleaning. Use of benchmark values can help continually monitor the efficacy of existing cleaning programs. However, when evaluating novel or new cleaning practices, baseline cleanliness (ie, the level of cleanliness routinely achieved using normal cleaning procedures) must also be taken into consideration, or the efficacy of modified cleaning will be overestimated.

Nasal high-flow therapy delivers low level positive airway pressure

BackgroundThe aim of this prospective study was to determine whether a level of positive airway pressure was generated in participants receiving nasal high flow (NHF) delivered by the Optiflow™ system (Fisher and Paykel Healthcare Ltd, Auckland, New Zealand) in a cardiothoracic and vascular intensive care unit (ICU).MethodsNasopharyngeal airway pressure was measured in 15 postoperative cardiac surgery adult patients who received both NHF and standard facemask therapy at a flow rate of 35 litre min−1. Measurements were repeated in the open mouth and closed mouth positions. Mean airway pressure was determined by averaging the pressures at the peak of inspiration of each breath within a 1 min period, allowing the entire pressure profile of each breath to be included within the calculation.ResultsLow level positive pressure was demonstrated with NHF at 35 litre min−1 with mouth closed when compared with a facemask. NHF generated a mean nasopharyngeal airway pressure of mean (sd) 2.7 (1.04) cm H2O with the mouth closed. Airway pressure was significantly higher when breathing with mouth closed compared with mouth open (P≤0.0001).ConclusionsThis study demonstrated that a low level of positive pressure was generated with NHF at 35 litre min−1 of gas flow. This is consistent with results obtained in healthy volunteers.Australian Clinical Trials Registry www.actr.org.au ACTRN012606000139572.