Do emergency department attendances by homeless people increase in cold weather?

BACKGROUND: Little is known about how and when homeless people use the emergency department. It might be anticipated that attendances would increase in cold weather as homeless people seek possible shelter. The authors aimed to describe emergency department attendances by homeless people and determine whether ambient temperatures affect attendance rates. METHODS: The authors undertook a retrospective study of routine data from the Northern General Hospital Emergency Department and Weston Park Weather Station from 2003 to 2008. RESULTS: There were 528 573 emergency department attendances between 2003 and 2008, including 2930 by homeless people (5.5 per 1000 attendances). Total attendances increased steadily over the study period, while attendances by homeless people peaked in 2005 and 2006. Attendances by homeless people were more frequent in the evening and at night, and a relatively high proportion (17.4%) left without being seen. There was a small positive correlation between daily attendances by homeless people and minimum (r=0.061, p=0.004) or maximum (r=0.049, p=0.022) daily temperature. CONCLUSION: We found no evidence to suggest that homeless people are more likely to attend the emergency department in cold weather. If anything, there was a small positive correlation between rate of attendances and daily temperature.

The impact of the 4 h target on patient care and outcomes in the Emergency Department: an analysis of hospital incidence data.

BACKGROUND: Recent government initiatives in the NHS have seen patient care becoming increasingly target-driven. However, the impact of targets, particularly those based on a timeframe, have not been extensively studied, and concerns remain about unintended consequences for patients. The aim of this study was to evaluate the effect of a 4 h target in the Emergency Department (ED) on patient care and outcomes. METHODS: The study comprised an interrupted time-series regression analysis of anonymised patient-level data from 580,000 new patient episodes in the ED between April 2000 and Feb 2006. Outcomes were time in ED, time to clinician, mortality, admission and reattendance rates, and number of investigations. RESULTS: 90% target was associated with reductions in time in department and fewer patients admitted for less than 24 and 48 h, and a slight increase in the number reattending within 7 days. 98% target was associated with levelling-off of time in department and reductions in numbers admitted and reattending within 7 days. Neither target was associated with change in time to clinician. The introduction of a minor injuries unit (MIU) was associated with reductions in time to clinician and percentage not waiting, and increases in number of investigations, percentages admitted, admitted for 24 h and reattendances within 7 days. Mortality was unaffected by either target or MIU. CONCLUSION: Although time target introduction is associated with changes in patient care, the introduction of a co-located MIU had greater impact.

The future: a primary care-led NHS.

The NHS is becoming increasingly primary care and community focused and the role of the community nurse is becoming more significant, not just in managing long-term conditions and end of life but in providing vital help and education. Helping people become more knowledgeable about maintaining both their own health and that of their families at home or within the community is vital - the desired end being less need for expensive hospital care. As the demand to implement more complex services grows, so the need for nurses to contribute to the planning and delivery of services becomes more important. Nurses in the community have the experience and practical knowledge and must use it to influence commissioning and engage proactively, and positively, with current policy agendas and with the people whose responsibility it is to implement them. Change in primary care is constant and increasingly it is the frontline deliverers of services that drive that change and help set the agenda. As more care and treatment is devolved from the secondary to primary care setting, there must be greater integration between general practice and the community nursing team, with each helping and informing the other to deliver a world class primary care service.

A Prospective Randomized Controlled Two-Arm Clinical Study Evaluating the Efficacy of a Bioelectric Dressing System for Blister Management in US Army Ranger Recruits.

This study focused on a clinically relevant healthcare problem in the military: acute soft tissue wounds, or blisters. The trial was a prospective, controlled, randomized two-arm study evaluating the efficacy of a bioelectric dressing, Procellera®, applied topically two to three times per week for 2 weeks to blisters developed in Ranger trainees during training at Fort Benning, Georgia. A total of 80 US Army Ranger recruits with blister wounds below the knee were randomly assigned to one of two treatment groups (n = 40/group). The primary goal was to assess the clinical efficacy (rate of healing) of administered Procellera in conjunction with the standard-of-care (SOC) treatment, moleskin and Tegaderm ®, on the healing rate of blisters compared with the SOC treatment alone. The secondary end points for efficacy were the quantities of wound fluid biomarkers and bacterial bioburden. The tertiary end point was assessment of pain in the treatment group compared with that of the control group during the 2-week study. The results showed no statistical difference between the SOC and SOC+Procellera groups in wound healing and pain. Wound fluid was reported for 24 participants (64.9%) in the SOC group and 21 participants (56.8%) in SOC+Procellera group at the baseline measurement (ρ = .475); however, the wounds were devoid of fluid on follow-up visits. The mild nature of the wounds in this study was apparent by the low pain scores at the beginning of the study, which disappeared by the follow-up visits. The average wound sizes were 2.2cm2 and 1.5cm2 for the SOC and SOC+Procellera groups, respectively. This trial protocol should be conducted on open softtissue wounds in severe heat. To our knowledge, this is the first clinical study conducted within the US Army Rangers training doctrine.

An Overview of the Efficacy of a Next Generation Electroceutical Wound Care Device.

Novel approaches including nonpharmacological methodologies for prevention and control of microbial pathogens and emerging antibiotic resistance are urgently needed. Procellera is a wound care device consisting of a matrix of alternating silver (Ag) and zinc (Zn) dots held in position on a polyester substrate with a biocompatible binder. This electroceutical medical device is capable of generating a direct current voltage (0.5-0.9 Volts). Wound dressings containing metals such as Ag and/or Zn as active ingredients are being used for control of colonized and infected wounds. Reports on the presence of electric potential field across epithelium and wound current on wounding have shown that wound healing is enhanced in the presence of an external electrical field. However, majority of the electrical devices require an external power source for delivering pulsed or continuous electric power at the wound site. A microelectric potential-generating system without an external power source is an ideal treatment modality for application in both clinical and field settings. The research presented herein describes efficacy evaluation of a wireless bioelectric dressing against both planktonic and biofilm forms of wound pathogens including multidrug resistant organisms.

Modulation of CSF-1-regulated post-natal development with anti-CSF-1 antibody.

Colony-stimulating factor-1 (CSF-1) regulates the survival, proliferation and differentiation of macrophages. CSF-1-deficient mice are osteopetrotic due to a lack of osteoclasts, while their tissue macrophage deficiencies and an absence of CSF-1 regulation of CSF-1 receptor-expressing cells in the female reproductive tract contribute to their pleiotropic phenotype. To further understand CSF-1 regulation of macrophages in vivo, we developed a neutralizing anti-mouse CSF-1 antibody which was expressed as a recombinant Fab' fragment and coupled to 40 kDa polyethylene glycol. As developmental regulation by CSF-1 is highest during the early post-natal period, the ability of this anti-CSF-1 reagent to inhibit development was tested by regular subcutaneous injection of mice from post-natal days 0.5-57.5. Antibody treatment decreased growth rate, decreased osteoclast number, induced osteopetrosis, decreased macrophage density in bone marrow, liver, dermis, synovium and kidney and decreased adipocyte size in adipose tissue, thereby inducing phenotypes shared by CSF-1- and CSF-1 receptor-deficient mice. While the antibody blocked macrophage development in some tissues, macrophage densities in other tissues were initially high and were reduced by treatment, proving that the antibody also blocked macrophage maintenance. Since cell surface CSF-1 is sufficient for the maintenance of normal synovial macrophage densities, these studies suggest that anti-CSF-1 Fab'-PEG efficiently neutralizes all three CSF-1 isoforms in vivo, namely the secreted proteoglycan, secreted glycoprotein and cell surface glycoprotein. Since CSF-1 has been shown to enhance chronic disease development in a number of mouse model systems, these studies demonstrate the feasibility of neutralizing CSF-1 effects in these models with an anti-CSF-1 antibody.

Managing exacerbations of chronic obstructive pulmonary disease.

The worldwide incidence of chronic obstructive pulmonary disease (COPD) is increasing and, in parallel, so is the social and economic burden. Mortality data underestimate COPD as a cause of death because the disease is more likely to be cited as a contributory rather than as an underlying cause of death, or may not be cited at all. By 2020, COPD is expected to be the third most common cause of death worldwide yet it receives less funding, publicity and fewer resources than is deemed necessary. The major burden of COPD falls on the patient and carer, and it is difficult to quantify. The quality of life of patients is evident and depends on the severity of their disease and their ability to adapt physically, socially and emotionally to the resulting disability. COPD leads to 30000 deaths per year in the UK. It is a considerable load to the NHS, particularly in the winter months when exacerbations occur most commonly; it results in 13% of all acute medical admissions.

The role of nurse-led care in allergy management.

Allergic diseases can cause increasingly complex problems and are increasing in prevalence. This article outlines recent policy for management of allergies and highlights the role that nurses can take in allergy management clinics.

Clinical management. Getting up to scratch.

Allergic disease accounts for 6 per cent of GP consultations and 0.6 per cent of hospital admissions. A highly critical report by the Commons health select committee called for the development of a national allergy service, but the government has failed to act. Primary care trusts can help to improve local allergy services by commissioning practice-based allergy clinics or integrated allergy/asthma services.

Halitunal, an unusual diterpene aldehyde from the marine alga Halimeda tuna.

Halituna(1), a novel diterpene aldehyde possessing a unique cyclopentadieno[c]pyran ring system, has been isolated from the marine alga Halimeda tuna. The structure of 1 was elucidated by spectroscopic techniques. Halitunal shows antiviral activity against murine coronavirus A59 in-vitro.

The self-care approach requires us to be skilled and confident.

Lynn Young's article on self-care (reflections July 18) was interesting and I agree that this is a subject nurses need to embrace.

Nurse of the year highlights the value of prison nurses.

The work of nurses with prisoners is often overlooked, so it is inspiring to read about nurse of the year Johanne Tomlinson's engagement with inmates at HMP Stafford (features October 10), a category C prison that houses up to 740 male offenders.

Work-related allergies can be controlled and prevented.

Occupational allergies and irritants often fail to be recognised because many people do not want to admit that they have a problem that is being exacerbated by something they are working with. I am sure that nurses are no different to anyone else in this regard.

Hamigerols A and B, unprecedented polysulfate sterol dimers from the Mediterranean sponge Hamigera hamigera.

Two novel polysulfate sterol dimers, hamigerols A (1) and B (2), have been isolated from the Mediterranean sponge Hamigera hamigera. Their structures and stereochemistry have been assigned from the analysis of spectroscopic data.

A nondisposable microplate for use with organic solvents.

A nondisposable, or "hard", multiwell microplate is described for use with small volumes of biological solutions containing organic solvents. The design of this teflon-coated, aluminum device resembles the 96-well layout of the disposable variety of tissue culture microplates. The reusable, hard microplate has been specifically developed to hold and evaporate volatile organic solvents from aliquots of crude sample extractions or partitions intended for testing in various in vitro biological screening assays. This device is a valuable adjunct for converting numerous small volumes of nonpolar or nonaqueous dissolved compounds into reconstituted solutions containing acceptable assay solvents.