Drug information centres and their provision of decision support: The Scandinavian experience.

WHAT IS KNOWN AND OBJECTIVE: Appraisal of drug information centres (DICs) is mainly by word of mouth communication and surveys of overall user satisfaction. Efforts to study the impact of this type of informatics and decision support systematically are generally lacking within the healthcare system. COMMENT: Scandinavian DICs question-answering databases are relevant sources for identifying recurring problems in pharmacotherapy, including drug safety questions, and for re-use of previous answers. Recent studies in this setting have shown that high-quality answers demand easily accessible literature sources, skills in literature search and critical assessment of the retrieved documentation. Furthermore, patient-specific advice in clinical cases presented within a requested time frame is appraised by clinicians. WHAT IS NEW AND CONCLUSIONS: Effective decision support by Scandinavian DICs depends on skills among staff and technological resources. Our experience could motivate further studies investigating methods and evaluating the impact of DICs in the healthcare system.

[Mouth-rinsing with chlorhexidine for prevention of pneumonia]. / Munnskylling med klorheksidin for å forebygge pneumoni.

Oral decontamination with chlorhexidine prevents accumulation of pathogens in the oral cavity, and can thereby reduce the risk of translocation to and colonization of the lungs. The antiseptic agent chlorhexidine has been widely used in dentistry, it has an excellent record of safety and efficacy and a broad antimicrobial spectrum. Mouth-rinsing with chlorhexidine may result in 90 % reduction of oral microbes. Cooperation between physicians and dentists is important in this area on the borderline between the two professions.

Gut luminal lactate measured by microdialysis mirrors permeability of the intestinal mucosa after ischemia.

The aim of the present study was to investigate the influence of a prolonged initial intestinal ischemic insult on transmucosal permeability after a subsequent ischemic event and whether microdialysis of biomarkers released to the gut lumen is able to reflect changes in intestinal permeability. The superior mesenteric artery was cross-clamped for 60 min followed by 4 h of reperfusion in 16 pigs. Nine pigs had a second cross-clamp of 60 min and 3 h of reperfusion, whereas seven pigs were observed for a further 4 h of reperfusion. Intestinal mucosal integrity was assessed by permeability of C-polyethylene glycol (PEG-4000) over the gut mucosa, luminal microdialysis of lactate, glucose and glycerol, and tonometry. During reperfusion, the PEG-4000 amount in venous blood was two times higher after the first than after the second ischemia (area under the curve, 44,780 [13,441-82,723] vs. 22,298 (12,213-49,698] counts min mL(-1), P=0.026 [mean {range}]). There was less lactate detected in the gut lumen after the second ischemia compared with the first (area under the curve, 797 [412-1,700] vs. 1,151 [880-1,969] mmol min L(-1), P=0.02) and a lower maximum concentration (4.8 [2.7-9.4] vs. 8.5 [5.0-14.9] mM, P=0.01). The same pattern was also seen for luminal glycerol and glucose. During the second ischemia, the intestinal mucosal/arterial CO2 gap was identical to the level during the first ischemic episode. A prolonged ischemic insult of the intestine confers protection, for reduced hyperpermeability against further ischemia. Microdialysis of biomarkers mirrors permeability changes associated with this type of protection. Lactate reflects permeability across the intestinal mucosa more precisely than glycerol.