Low volume ECMO results study.

Objectives: To report extracorporeal membrane oxygenation (ECMO) experience at Princess Alexandra and Gold Coast University hospitals and compare mortality with benchmarks. Design: Case series of patients treated with ECMO. Setting: Two adult tertiary Australian intensive care units with low ECMO case volumes. Participants: Patients treated with ECMO, aged > 18 years. Main outcome measures: Patients were categorised into respiratory, cardiac, and extracorporeal cardiopulmonary resuscitation (eCPR) groups. Observed mortality was compared with mortality predicted using individual risk of death predictions from the Survival after Veno-arterial ECMO (SAVE) and Respiratory ECMO Survival Prediction (RESP) scores; mortality predicted when mortality predictions of the SAVE score were modified to be consistent with the validation cohort in the SAVE study (Alfred Hospital); and with mortality predicted when eCPR patients were all assigned a risk of death equal to Extracorporeal Life Support Organization (ELSO) Registry eCPR mortality. Results: Over 10 years, 86 patients were treated with ECMO. Eight deaths were observed in 49 patients with respiratory failure, below the 95% CI (13-24) for the deaths predicted by the RESP score (P < 0.001). Nine deaths were observed in 27 patients with cardiac failure, below the 95% CI (14-23) for the deaths predicted by the SAVE score (P < 0.001), but within the 95% CI (9-17) for the deaths predicted by the SAVE score modified to be consistent with the Alfred Hospital cohort (P > 0.05). Seven deaths were observed in the ten eCPR patients, within the 95% CI (4-10) predicted using the risk of death derived from the ELSO Registry. Conclusions: Mortality in two low volume ECMO centres was not inferior to benchmarks.

A survey of self-reported management of hypernatraemia acquired in Australasian intensive care units.

OBJECTIVE: To examine self-reported treatment preferences among Australasian consultant intensivists for intensive care-acquired hypernatraemia (IAH). DESIGN AND SETTING: We used a web-based survey with 10 questions about the management of IAH. MAIN OUTCOME MEASURES: We measured number of respondents and response rate, IAH treatment methods, thresholds and the reasons for these. RESULTS: There were 156 survey respondents, of whom 137 were consultant intensivists, representing a response rate of 31%. Ninety-three percent of responding clinicians (95% CI, 87%-96%) used intravenous fluid (49%; 95% CI, 40%-57%) or enteral nutrition changes (44%; 95% CI, 36%-53%) as their first choice of treatment. As alternative therapies, respondents reported using thiazides (22%; 95% CI, 16%-30%), aldosterone antagonists (20%; 95% CI, 14%-28%) and renal replacement therapy (14%; 95% CI, 9%-21%) less commonly. CONCLUSIONS: There is a wide variety of treatments in use for IAH. Most clinicians initiate treatment at a level greater than the level that is independently associated with increased mortality in the literature.1 Initial treatment is equally divided between changes in intravenous fluid and changes in enteral nutrition.

Policy-contribution assessment and field-building analysis of the Robert Wood Johnson Foundation's Active Living Research Program.

BACKGROUND: The Robert Wood Johnson Foundation requested this utilization-focused evaluation of its Active Living Research (ALR) program. This evaluation reports on the trajectory of influence of past and future ALR outcomes on field-building and policy contributions as well as on possible users of completed and disseminated ALR products. METHODS: In 2006 and 2007, key-informant interviews were conducted with 136 representatives of first-line potential users of ALR research products, including state physical activity and nutrition program coordinators, policymakers, scientists, and funders. Literature reviews, bibliometric analyses, and document reviews served to describe the context for ALR's work and the ways it could enhance its utility for field building and policymaking. RESULTS: The contributions of ALR to the emerging transdisciplinary field included leadership in the development of measurement tools, epidemiologic studies, implementation research, the translation of research to practice, and the communication of learned lessons to diverse audiences. ALR's contributions to policy discussions were found across a spectrum of policy-development phases that included describing the problem, raising awareness of alternative strategies for increasing physical activity, convening nontraditional partners, and evaluating policy implementation. CONCLUSIONS: Policy-relevant research can make contributions to policymakers' thinking but almost never causes a change by itself. Five years after the original authorization of ALR, there is ample evidence of its recognition as a resource by key players, its field-building influence, and its contributions to policy discussions. All these bear promise for a broader contribution to obesity prevention. Recommendations for increasing ALR's impact on policy and practice are offered.

The ideal nasal profile: rhinoplasty patients vs the general public.

OBJECTIVES: To evaluate whether patients seeking reduction rhinoplasty hold a different concept of the ideal nose than does the general public, and to determine what features characterize the ideal nasal profile. METHODS: Twenty-seven patients seeking reduction rhinoplasty and 15 randomly selected members of the public evaluated a series of computer-manipulated photographic profiles using a pictorial visual analogue scale to rate their preferences for several variables. Center-scale images were created from mesh-warped ("morphed") computer averaging of 12 white women. Differences between the rhinoplasty group and the public group were then compared, as was each group's deviation from the center of the scale. RESULTS: Both groups preferred narrowly distributed differences from the "average" profile to a high degree of significance. No statistically significant difference was found between the ideal nasal profiles selected by the rhinoplasty group and the public group. CONCLUSIONS: Reduction rhinoplasty patients do not appear to have a different concept of the ideal nose than does the public at large. The ideal nose, as it pertains to the ideal white female profile, has characteristics that differ from a mathematically averaged nasal profile.