Prehospital Blood Transfusion: A Cross-Sectional Study of Prehospital and Retrieval Medicine Services across Australia & Aotearoa-New Zealand.

BACKGROUND: The frequency and type of prehospital blood product delivery across Australia and Aotearoa-New Zealand is unknown. This study aims to describe transfusion practice across different services in the two nations, as well as identifying potential barriers to the carriage of blood products. METHODOLOGY: Prehospital and retrieval medicine services operating teams of doctors, specialist paramedics, and/or flight nurses out of specialty bases across Australia and Aotearoa-New Zealand were sent a standardized questionnaire regarding their base characteristics and their current blood transfusion practice. Bases that only performed inter-hospital transfers or search & rescue operations were excluded. Bases were queried on personnel, equipment, transport times, type and volume of blood products carried, frequency of use, and barriers to implementation for those without prehospital blood transfusion programs. RESULTS: 64 bases were identified and contacted, of which 5 were excluded and 45 of the remaining 59 (76.3%) responded. 62% (28/45) of respondents routinely carry prehospital blood products. 78.6% (22/28) carried packed red blood cells (PRBC) only, 14.3% (4/28) carried both PRBC and plasma, and 1 service (3.6%) carried whole blood. The mean number of units of blood product carried was 3.3 (SD 0.82). 2 bases (7.1%) carried fibrinogen concentrate. All services carried tranexamic acid and calcium. 734 patients received a blood transfusion in 2021, with trauma being the most common indication (552, 75.2%). Base characteristics varied significantly in staffing, vehicle platform and transfer times. The median transfer time from scene to hospital was 65 min (IQR of 40-92). Services without access to prehospital blood products identified multiple barriers to implementation, including training and supply chain. CONCLUSION: Approximately two-thirds of prehospital services operating advanced teams across Australia and Aotearoa-New Zealand carried blood products and there was wide variation both in the type and number of blood products carried by each base. Multiple barriers to the carriage of blood by all bases were reported, which have implications for service equity. Transfer times are generally long in Australia and Aotearoa-New Zealand, which may impact the generalizability of overseas research performed in prehospital systems with significantly shorter transfer times to services operating in Australia and Aotearoa-New Zealand.

The Five W's Meet the Three R's: The Who, What, When, Where, and Why of Telepractice Service Delivery for School-Based Speech-Language Therapy Services.

School-based speech-language pathologists (SLPs) are implementing telecommunication technologies for service provision. Telepractice is one among an array of service delivery models that can be successfully implemented in the public-school setting. While many school-based SLPs have been plunged into telepractice with the recent pandemic, this temporary shift to emergency instruction is not the same as fully implementing a telepractice service delivery model. SLPs who recognize the potential application of telecommunications would profit from additional training and experience to take advantage of the benefits of this service delivery model. The purpose of this article is to explore the concept of telepractice as a service delivery model, and to answer the who, what, when, where, and why questions of school-based telepractice. Telepractice is one of several service delivery models that school-based SLPs can confidently utilize to provide effective speech and language therapy services to school-age students.

Is there an association between back pain and stress incontinence in adults with cystic fibrosis? A retrospective cross-sectional study.

BACKGROUND: Back pain and stress urinary incontinence (SUI) are common in adults with cystic fibrosis (CF). This study aimed to establish whether there is an association between back pain, lung function and stress urinary incontinence and its relative risk. METHOD: This was a cross-sectional, retrospective analysis of the Manchester Musculoskeletal Screening Tool (MMST) data. It includes pain, (Short Form McGill Pain Questionnaire (SF-MPQ and VAS)) and International Consultation on Incontinence Short Form (ICIQ-UI-SF) measures. Associations were tested using Spearman's rank correlation coefficient. Relative risk of developing symptoms was calculated the sig level was p=0.05. RESULTS: ICIQ-UI-SF was associated with back pain (SF-MPQ) (Rho=0.32, p<0.001) and pain (VAS) (Rho=0.23, p<0.01). RR of developing SUI with back pain was 2; RR of developing back pain with SUI was 1.3. CONCLUSIONS: An association is indicated between back pain (SF-MPQ and VAS), and SUI in adults with CF. This information is important when developing management strategies in the CF population.

Launching biosimilar rituximab: an industry opinion on biosimilar uptake in Europe.

Richard Trollope and Sue Johnson talk with Henry Ireland, Senior Editor about the recent approval of biosimilar rituximab (Truxima®) & the current state of biosimilar uptake across Europe Richard Trollope, Head of Biosimilars, Mundipharma International Limited, qualified as a biochemist before joining Wyeth's commercial operations, prior to its acquisition by Pfizer. Richard later joined Yamanouchi Pharmaceuticals (now Astellas Pharma). His fascination with oncology led him to join Mundipharma in Europe and after joining the company's UK arm (Napp Pharmaceuticals Limited), Richard began his journey in biosimilars. He now heads up the biosimilar franchise at Mundipharma International as it launches biosimilar rituximab (Truxima®) - the first biosimilar monoclonal antibody for the treatment of cancer, which will be distributed by Napp Pharmaceuticals in the UK. Sue Johnson, PhD, Medical Insights at Mundipharma International Limited, is a scientist by background and completed her postdoc fellowship at Harvard Medical School. On returning to the UK, she began her career in the pharmaceutical industry, working in UK Medical Affairs before transitioning to a European role with Mundipharma 2 years ago, where she leads on Medical Insights for the biosimilars franchise.

Going green: using a bio-cellulose membrane for patients with chronic non-healing wounds.

A 20-patient evaluation was undertaken on the most chronic non-healing wounds that had been present in excess of 6 months. Patients were treated with a biotechnology dressing that is provided in a mesh and gel combination. Eighteen of out 20 patients went on to heal. Cost effectiveness examined the cost associated with maintaining non-healing wounds where all alternative therapies had failed. Nursing time both in outpatients and home visits were included. A wide variety of secondary dressings were applied according to clinical preference as the new dressings are designed as a direct wound contact mesh. This is a very new concept to wound care, with initial unit cost being high, but the possibilities of natural plant extracts that can mimic collagen synthesis is exciting. Both the staff and patients have seen a marked improvement, with up to date no recurrence. Further studies need to be undertaken to establish if these early findings are repeatable.

Evaluation of a foam dressing for acute and chronic wound exudate management.

This article discusses the use of a foam dressing for exudate management in both chronic and acute wounds, such as surgical wounds, pressure ulcers, diabetic ulcers, trauma wounds, and leg ulcers. The primary objective of the study was to observe patients' wound progression in terms of wound size and the condition of the wound bed, when using this foam dressing as either a primary or secondary dressing. The outcome of the evaluation demonstrated that ActivHeal Foam Contact dressing effectively managed exudate. It was also observed that the dressing can assist in autolysis and support improvements in peri-wound status. Choosing an appropriate dressing to manage a wound is essential. Clinicians working in the NHS are under pressure to deliver good-quality clinical outcomes, and the ActivHeal Foam Contact dressing supports this outcome.

Impact of the introduction of emergency ultrasound to one large UK emergency department: the REBUS study.

AIM: Firstly, to detail the experiences of one UK training region in establishing an emergency ultrasound (EU) training programme and secondly, to report the initial 30 months of EU scanning experience. METHODS: Prospective study of all documented emergency department (ED) ultrasound scans. Results were extracted from written paper reports and/or electronically saved images. Details of scan date, time, type of scan, grade of operator, supervision status (whether supervised by a level 1 competent scanner) and whether the scan was clinical (performed or supervised by a level 1 operator) or training, were recorded. EU scans were reviewed for quality (internal quality assurance) and for diagnostic accuracy (external quality assurance). RESULTS: Between 14 January 2009 and 4 July 2011, 626 scans were performed by 41 operators. 263 (42%) scans were completed outside of normal working hours (09:00 to 17:00). There were 251 abdominal aorta and inferior vena cava scans (40% of all scans) and 198 focused assessment with sonography in trauma scans (32%). The number of scans performed by each operator varied widely. 87 scans (14%) were supervised but the majority (459; 73%) were not. 484 (77%) scans were for training purposes, 124 (20%) were clinical scans and the majority (401; 63%) were performed by either speciality registrars (ST4-6) or specialist registrars (SpR). When the three commonest types of scans performed were analysed, eight false positives and 11 false negatives were identified. Only seven of these were deemed of poor quality and none led to poor patient outcome. CONCLUSIONS: Since the acquisition of our ED ultrasound machine and the development of a quality assured training programme, on average 20 scans per month have been performed in the ED, with no known adverse patient outcomes.

RESNA's position on wheelchairs used as seats in motor vehicles.

This position paper is based on the premise that those who ride seated in wheelchairs are entitled to equivalent occupant safety when they are traveling in motor vehicles. The document summarizes research and best practice for safety and selection of crashworthy wheelchairs with the requisite features required by the WC19 safety standard when it is necessary for individuals to use a wheelchair as a seat in a motor vehicle. Recommendations are based on data from accident and injury databases, prior research and a synopsis of the design, testing, performance and labeling requirements of ANSI and ISO voluntary industry standards for wheelchair transportation safety. This paper is intended for an audience of consumers, rehabilitation and health care professionals, manufacturers of wheelchairs and wheelchair transportation equipment and those who make reimbursement and public policy decisions.

Nursing research or research nursing? Two separate terms, two separate careers.

The terms 'nursing research' and 'research nursing' are often confused, although the skill sets associated with each occupation are different. Clinical research nurses do not require academic research qualifications, although they develop considerable skills in the practice of research and their potential input into research planning should not be neglected. This paper considers the skills required in research nursing and how they develop, and highlights the importance of the research nurse to the conduct of a clinical trial.

The effect of Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality.

BACKGROUND: With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of Haemophilus influenzae type b (Hib) and pneumococcal (PC) conjugate vaccines on incidence, severe morbidity and mortality from childhood pneumonia. METHODS: We summarized cluster randomized controlled trials (cRCTs) and case-control studies of Hib conjugate vaccines and RCTs of 9- and 11-valent PC conjugate vaccines conducted in developing countries across outcome measures using standard meta-analysis methods. We used a set of standardized rules developed for the purpose of populating the LiST tool with required parameters to promote comparability across reviews of interventions against the major causes of childhood mortality. The estimates could be adjusted further to account for factors such as PC vaccine serotype content, PC serotype distribution and human immunodeficiency virus prevalence but this was not included as part of the LiST model approach. RESULTS: The available evidence from published data points to a summary effect of the Hib conjugate vaccine on clinical pneumonia of 4%, on clinical severe pneumonia of 6% and on radiologically confirmed pneumonia of 18%. Respective effectiveness estimates for PC vaccines (all valent) on clinical pneumonia is 7%, clinical severe pneumonia is 7% and radiologically confirmed pneumonia is 26%. CONCLUSIONS: The findings indicated that radiologically confirmed pneumonia, as a severe morbidity proxy for mortality, provided better estimates for the LiST model of effect of interventions on mortality reduction than did other outcomes evaluated. The LiST model will use this to estimate the pneumonia mortality reduction which might be observed when scaling up Hib and PC conjugate vaccination in the context of an overall package of child health interventions.

A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy.

We compared the progress made by school children in speech language therapy provided through videoconferencing and conventional face-to-face speech language therapy. The children were treated in two groups. In the first group, 17 children received telemedicine treatment for 4 months, and then subsequently conventional therapy for 4 months. In the second group, 17 children received conventional treatment for 4 months and then subsequently telemedicine treatment for 4 months. The outcome measures were student progress, participant satisfaction and any interruptions to service delivery. Student progress reports indicated that the children made similar progress during the study whichever treatment method was used. There was no significant difference in GFTA-2 scores (Goldman-Fristoe Test of Articulation) between students in the two treatment groups. Satisfaction surveys indicated that the students and parents overwhelmingly supported the telemedicine service delivery model. During the study, a total of 148 of the 704 possible therapy sessions was not completed (21%); the pattern of cancellations was similar to cancellations in US public schools generally. Videoconferencing appears to be a promising method of delivering speech language therapy services to school children.

Preventing DVT: a perioperative perspective.

In the absence of thromboprophylaxis, deep vein thrombosis (DVT) is a significant risk for surgical patients especially those undergoing orthopaedic surgery and lengthy procedures (ICS 2002, SIGN 2002, Geerts et al 2004, ICS 2006, NICE 2007). Venous thromboembolism (VTE) is preventable; however it kills 25,000 patients each year in the UK. This article reviews relevant literature regarding thromboprophylaxis, and focuses particularly on the use of intermittent pneumatic devices (IPC) within the perioperative environment.

Arabidopsis thaliana inositol 1,3,4-trisphosphate 5/6-kinase 4 (AtITPK4) is an outlier to a family of ATP-grasp fold proteins from Arabidopsis.

The Arabidopsis genome encodes a family of inositol 1,3,4-trisphosphate 5/6-kinases which form a subgroup of a larger group of ATP-grasp fold proteins. An analysis of the inositol 1,3,4-trisphosphate 5/6-kinase family might, ultimately, be best rewarded by detailed comparison of related enzymes in a single genome. The enzyme encoded by At2G43980, AtITPK4; is an outlier to its family. At2G43980 is expressed in male and female organs of young and mature flowers. AtITPK4 differs from other family members in that it does not display inositol 3,4,5,6-tetrakisphosphate 1-kinase activity; rather, it displays inositol 1,4,5,6-tetrakisphosphate and inositol 1,3,4,5-tetrakisphosphate isomerase activity.

A lysine accumulation phenotype of ScIpk2Delta mutant yeast is rescued by Solanum tuberosum inositol phosphate multikinase.

Inositol phosphates and the enzymes that interconvert them are key regulators of diverse cellular processes including the transcriptional machinery of arginine synthesis [York (2006) Biochim. Biophys. Acta 1761, 552-559]. Despite considerable interest and debate surrounding the role of Saccharomyces cerevisiae inositol polyphosphate kinase (ScIPK2, ARG82, ARGRIII) and its inositol polyphosphate products in these processes, there is an absence of data describing how the transcripts of the arginine synthetic pathway, and the amino acid content of ScIpk2Delta, are altered under different nutrient regimes. We have cloned an IPMK (inositol phosphate multikinase) from Solanum tuberosum, StIPMK (GenBank(R) accession number EF362785), that despite considerable sequence divergence from ScIPK2, restores the arginine biosynthesis pathway transcripts ARG8, acetylornithine aminotransferase, and ARG3, ornithine carbamoyltransferase of ScIpk2Delta yeast to wild-type profiles. StIPMK also restores the amino acid profiles of mutant yeast to wild-type, and does so with ornithine or arginine as the sole nitrogen sources. Our data reveal a lysine accumulation phenotype in ScIpk2Delta yeast that is restored to a wild-type profile by expression of StIPMK, including restoration of the transcript profiles of lysine biosynthetic genes. The StIPMK protein shows only 18.6% identity with ScIPK2p which probably indicates that the rescue of transcript and diverse amino acid phenotypes is not mediated through a direct interaction of StIPMK with the ArgR-Mcm1 transcription factor complex that is a molecular partner of ScIPK2p.

Characterization of an Arabidopsis inositol 1,3,4,5,6-pentakisphosphate 2-kinase (AtIPK1).

The metabolic pathway(s) by which plants synthesize InsP6 (inositol 1,2,3,4,5,6-hexakisphosphate) remains largely undefined [Shears (1998) Biochim. Biophys. Acta 1436, 49-67], while the identities of the genes that encode enzymes catalysing individual steps in these pathways are, with the notable exception of myo-inositol phosphate synthase and ZmIpk [Shi, Wang, Wu, Hazebroek, Meeley and Ertl (2003) Plant Physiol. 131, 507-515], unidentified. A yeast enzyme, ScIPK1, catalyses the synthesis of InsP6 by 2-phosphorylation of Ins(1,3,4,5,6)P5 (inositol 1,3,4,5,6-pentakisphosphate). A human orthologue, HsIPK1, is able to substitute for yeast ScIPK1, restoring InsP6 production in a Saccharomyces cerevisiae mutant strain lacking the ScIPK1 open reading frame (ScIpk1Delta). We have identified an Arabidopsis genomic sequence, AtIPK1, encoding an Ins(1,3,4,5,6)P5 2-kinase. Inclusion of the AtIPK1 protein in alignments of amino acid sequences reveals that human and Arabidopis kinases are more similar to each other than to the S. cerevisiae enzyme, and further identifies an additional motif. Recombinant AtIPK1 protein expressed in Escherichia coli catalysed the synthesis of InsP6 from Ins(1,3,4,5,6)P5. The enzyme obeyed Michaelis-Menten kinetics with an apparent V(max) of 35 nmol x min(-1) x (mg of protein)(-1) and a K(m) for Ins(1,3,4,5,6)P5 of 22 microM at 0.4 mM ATP. RT (reverse transcriptase)-PCR analysis of AtIPK1 transcripts revealed that AtIPK1 is expressed in siliques, leaves and cauline leaves. In situ hybridization experiments further revealed strong expression of AtIPK1 in male and female organs of flower buds. Expression of AtIPK1 protein in an ScIpk1Delta mutant strain restored InsP6 production and rescued the temperature-sensitive growth phenotype of the yeast.