The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial.

OBJECTIVES: To test the hypothesis that nurse led follow-up programmes are effective and cost effective in improving quality of life after discharge from intensive care. DESIGN: A pragmatic, non-blinded, multicentre, randomised controlled trial. SETTING: Three UK hospitals (two teaching hospitals and one district general hospital). PARTICIPANTS: 286 patients aged >or=18 years were recruited after discharge from intensive care between September 2006 and October 2007. INTERVENTION: Nurse led intensive care follow-up programmes versus standard care. Main outcome measure(s) Health related quality of life (measured with the SF-36 questionnaire) at 12 months after randomisation. A cost effectiveness analysis was also performed. RESULTS: 286 patients were recruited and 192 completed one year follow-up. At 12 months, there was no evidence of a difference in the SF-36 physical component score (mean 42.0 (SD 10.6) v 40.8 (SD 11.9), effect size 1.1 (95% CI -1.9 to 4.2), P=0.46) or the SF-36 mental component score (effect size 0.4 (-3.0 to 3.7), P=0.83). There were no statistically significant differences in secondary outcomes or subgroup analyses. Follow-up programmes were significantly more costly than standard care and are unlikely to be considered cost effective. CONCLUSIONS: A nurse led intensive care follow-up programme showed no evidence of being effective or cost effective in improving patients' quality of life in the year after discharge from intensive care. Further work should focus on the roles of early physical rehabilitation, delirium, cognitive dysfunction, and relatives in recovery from critical illness. Intensive care units should review their follow-up programmes in light of these results. TRIAL REGISTRATION: ISRCTN 24294750.

Predictors of emotional outcomes of intensive care.

Negative emotional outcomes (anxiety, depression and post-traumatic stress) have been identified in patients discharged from intensive care. The aims of this prospective, longitudinal study were to assess levels of and changes in emotional outcome after intensive care, and to explore how these relate to objective and subjective indicators of the intensive care experience. Emotional outcome was assessed using the Hospital Anxiety and Depression and Impact of Event Scales. Anxiety (p = 0.046) and depression (p = 0.001) were reduced subsequently, but not avoidance (p = 0.340) or intrusion (p = 0.419). Most objective (age, gender, length of ICU and hospital stay) and subjective indicators (as measured by the Intensive Care Experience Questionnaire) of the intensive care experience were related to negative emotional outcome. Subjective interpretation of the intensive care experience emerged as a consistent predictor of adverse emotional outcome, in both the short- and the long-term.

Assessment of individual quality of life in survivors of intensive care.

Quality of life is a dynamic, multi-dimensional concept, the essence of which is its individuality. In this study quality of life six to 12 months after intensive care was not significantly lower than quality of life prior to intensive care, assessed retrospectively. Family, leisure activities and people were seen as more important than health as a main determinant of quality of life after intensive care. Quality of life assessment after intensive care should combine generic measures of health status and individual measures.

Purification and Characterization of Two Endoxylanases from Clostridium acetobutylicum ATCC 824.

Two endoxylanases produced by C. acetobutylicum ATCC 824 were purified to homogeneity by column chromatography. Xylanase A, which has a molecular weight of 65,000, hydrolyzed larchwood xylan randomly, yielding xylohexaose, xylopentaose, xylotetraose, xylotriose, and xylobiose as end products. Xylanase B, which has a molecular weight of 29,000, also hydrolyzed xylan randomly, giving xylotriose and xylobiose as end products. Xylanase A hydrolyzed carboxymethyl cellulose with a higher specific activity than xylan. It also exhibited high activity on acid-swollen cellulose. Xylanase B showed practically no activity against either cellulose or carboxymethyl cellulose but was able to hydrolyze lichenan with a specific activity similar to that for xylan. Both xylanases had no aryl-beta-xylosidase activity. The smallest oligosaccharides degraded by xylanases A and B were xylohexaose and xylotetraose, respectively. The two xylanases demonstrated similar K(m) and V(max) values but had different pH optima and isoelectric points. Ouchterlony immunodiffusion tests showed that xylanases A and B lacked antigenic similarity.

Self-care motivation: a model for primary preventive oral health behavior change.

Attempts to promote compliance of children with preventive health practices are most successful when strategies for motivating self-care behavior change address the physical, cognitive, and affective components of individuals. This study evaluated the effectiveness of using a Self-Care Motivation Model and curriculum to promote oral health and hygiene behavior change among 92 third grade students randomly selected according to homeroom assignments in five Gloucester, Mass., public schools. Student gingival health and oral hygiene measures were obtained two weeks prior to, and two weeks, three months, and one year after educational sessions. Group one, comprised of mid-high socioeconomic status family students, served as an oral examination control. Groups two-five received educational sessions designed to teach students various aspects of oral health. Significant improvements (p less than .001) in gingival health and dental plaque scores were observed in all experimental groups for up to three months. During a period of three months to one year, mean group scores returned to baseline and worsened for all groups except group five, the lowest socioeconomic family status group and the only group receiving the full series of self-care motivation curriculum sessions. Experimental group teachers reported that most children responded favorably to the program, and specific attitude and behavior changes were observed in many children. Further research evaluating the efficacy of using this self-care motivation model in primary preventive health education programs is indicated.

Iron requirement of Rhizobium leguminosarum and secretion of anthranilic acid during growth on an iron-deficient medium.

Rhizobium leguminosarum GF160 required iron for growth under aerobic conditions in a chemically defined medium. Maximal growth of bacteria previously depleted in iron was obtained with approximately 50 microM unchelated ferric iron and with glucose as the only carbon source. Growth under iron deficiency did not result in the production of detectable levels of siderophores of either the catechol or hydroxamate types. Growing cells released a Fe3+-reducing agent that was identified as anthranilic acid by paper and thin-layer chromatography, ultraviolet and nuclear magnetic resonance spectroscopy, and mass spectrometry. The amount of anthranilic acid secreted per unit of cell growth was inversely related to the iron concentration in the culture medium and reached concentrations up to 1 mM. Ferric but not ferrous ions were solubilized in the growth medium by anthranilic acid.

Anthranilate-promoted iron uptake in Rhizobium leguminosarum.

Anthranilate promoted the uptake of ferric iron into iron-starved cells of Rhizobium leguminosarum GF160. The uptake system was a saturable function of the concentration of ferric anthranilate. It was characterized by an apparent Km of 6 microM and a Vmax of 1.6 nmol/min/mg cell protein. Uptake was temperature dependent and inhibited by the metabolic poisons arsenate and iodoacetate. The proton motive force may not be involved since no effect was demonstrated by the respiratory inhibitor sodium azide and by various uncouplers. The anthranilate-promoted iron uptake was lower for cells grown in increasing levels of available iron and the addition of anthranilic acid to low-iron cultures resulted in a stimulation of bacterial growth. During growth under iron deficiency, anthranilic acid was not assimilated by the cells.

Colorimetric determination of catechol siderophores in microbial cultures.

A highly sensitive spectrophotometric method for the selective detection of catechol compounds such as catechol siderophores (e.g., enterobactin) is described. The basis of the method involves the ability of the vicinal aromatic hydroxyl groups under acidic conditions to bring about a reduction of Fe3+ (from ferric ammonium citrate) to Fe2+. Detection of Fe2+ in the presence of Fe3+ is made with 1,10-phenanthroline under previously established conditions. The assay mixture is heated at 60 degrees C for 1 h to accelerate the development of color which is subsequently measured at 510 nm. The Beer-Lambert law is obeyed over the range of 0.16 to 60 microM 2,3-dihydroxybenzoic acid. Compared to the Arnow nitration method, the assay is more responsive, is approximately seven times more sensitive, and is effective with catechols substituted at positions 3 and 4. The method gives positive results with catechols such as DL-DOPA, L-dopamine, (+/-)-epinephrine, and DL-norepinephrine. Very rapid color development is obtained with ascorbic acid and p-diols, while m-diols are poorly detected. Low degrees of reactivity are shown by hydroxylamino and hydroxamate compounds. Phenolic, sulfydryl, indolyl, and quinonyl derivatives do not interfere with the reaction. The method has been adapted to determine catechol compounds in the culture medium of bacterial cells grown at different iron concentrations.

The quantitation of Trypanosoma congolense in calves. II. Biochemical changes.

Changes in serum electrolytes, osmolality, total proteins and protein fractions, lipid levels and organ function tests were determined in neonatal and 6-month-old calves infected with T. congolense TREU 112 and control calves. There were no consistent changes in electrolytes or osmolality for either age group of calves. There was a decrease in total serum protein in the infected 6-month-old calves, caused by decreases in the albumin and beta 2-globulin fractions. The total serum protein level remained constant in the infected neonatal calves, but there was a significant decrease in the albumin fraction which was compensated for by an increase in alpha-globulin and gamma-globulin fractions. Total serum lipids and cholesterol were decreased and triglyceride levels and erythrocyte phospholipid levels were significantly elevated in both age groups of infected calves. Tests of adrenal and hepatic function were not significantly different in infected calves compared to control calves of the same age group. Thyroid function tests showed that T3 was significantly elevated in infected 6-month-old calves, whereas T4 was significantly decreased in infected neonatal calves.

The lipid components of Candida boidinii and Hansenula polymorpha grown on methanol.

The lipid contents of Candida boidinii and Hansenula polymorpha grown on 2% glucose were low. Increased quantities were present in C. boidinii grown on 1 or 4% methanol and in H. polymorpha on 1% methanol. The lipid compositions of both yeasts were characterized by low levels of triacylglycerol and high contents of unsaturated fatty acid and phospholipid. Growth on methanol did not affect the quantity of total phospholipid in C. boidinii, but resulted in a decreased value for H. polymorpha grown on 4% methanol. Modification of the phospholipid composition of both yeasts involved a general increase in the phosphatidylserine-phosphatidylinositol levels at the expense of phosphatidylcholine. The possible relationship between the phospholipid component and the development of membranous systems accompanying growth on methanol has been considered.