The development of highly active acyclic chiral hydrazides for asymmetric iminium ion organocatalysis.

Double asymmetric induction has been employed as a tool to optimise pyrazolidinone-derived organocatalysts for the asymmetric iminium ion catalysed Diels-Alder reaction. Mechanistic studies revealed a superior hydrazide catalyst deriving from methanolysis of the chiral pyrazolidinone precursor. This catalyst displays unusually high endo diastereoselectivity and good enantioselectivity with a range of ß-arylenals and cyclic dienes at catalyst loadings as low as 1 mol%.

Managing a chest tube and drainage system.

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes.

Promoting safe transfusion practice: right blood, right patient, right time.

Despite an array of initiatives designed to support the delivery of safe and appropriate transfusion practice, incidences of patients receiving the wrong blood continue to be reported. Nurses play a key role in delivering safe and appropriate transfusion care and have a responsibility to support national initiatives, such as the NHS Better Blood Transfusion programme of action and the National Patient Safety Agency Safer Practice Notice 14, Right Patient, Right Blood. This article examines factors, which impact on the successful implementation of a programme aimed at promoting best transfusion practice, such as organizational support, leadership, education and competency assessment, and the role of audit and feedback. By championing the systematic assessment of transfusion procedures, the implementation of education and guidelines and the use of innovative approaches, such as care bundles, we can ensure that nurses have the appropriate knowledge, skills and understanding to provide the highest standards of transfusion care to our patients.

Estrogen administration does not reduce the rate of recurrence of affective psychosis after childbirth.

BACKGROUND: High rates of postpartum relapse occur in women with histories of bipolar or schizoaffective disorder. These relapses may be triggered by the postdelivery fall in circulating estrogen through alteration of central neurotransmitter (especially dopaminergic) systems. This study tested the hypothesis that estrogen administration after childbirth would prevent postpartum relapse and would alter dopamine receptor sensitivity. METHOD: Twenty-nine pregnant women with a Research Diagnostic Criteria diagnosis of hypomania (bipolar II), mania (bipolar I), or schizoaffective disorder participated in an open clinical trial. Three transdermal dose regimens of estrogen (17beta-estradiol) were tested. Starting doses were 200 (N = 13), 400 (N = 3), and 800 (N = 13) micro g/day, beginning within 48 hours after delivery and reduced by one half every 4 days for a total of 12 days. On the fourth day after starting estradiol therapy (before relapse occurred), subjects participated in a neuroendocrine challenge test that measured the sensitivity of the central nervous system (tubero-infundibular) dopaminergic system (plasma prolactin and growth hormone responses to apomorphine). RESULTS: Estradiol at all dose regimens did not reduce the rate of relapse. However, of the 12 women who relapsed, those who had taken the highest dose of estradiol (800 micro g/day) needed less subsequent psychotropic medication (fewer chlorpromazine equivalents) and were discharged sooner than those who had taken either of the 2 lower doses. No differences in neuroendocrine responses to apomorphine were detected between women receiving the high-dose and the lower-dose regimens. CONCLUSION: The results do not support the hypothesis that a fall in circulating concentrations of estrogens precipitates relapse in subjects at risk of postpartum affective psychosis. The use of prophylactic estrogen in such circumstances is therefore highly questionable.

Occupational lung disease in the South African mining industry: research and policy implementation.

South African miners face an epidemic of occupational lung diseases. Despite a plethora of research on the mining industry, and the gold mining industry in particular, research impact (including disease surveillance) on policy implementation and occupational health systems performance lags. We describe the gold mining environment, and research on silicosis, tuberculosis, HIV and AIDS, and compensation for occupational disease including initiatives to influence policy and thus reduce dust levels and disease. As these have been largely unsuccessful, we identify possible impediments, some common to other low- and middle-income countries, to the translation of research findings and policy initiatives into effective interventions.

Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review.

Malrotation of the midgut is generally regarded as paediatric pathology with the majority of patients presenting in childhood. The diagnosis is rare in adults, which sometimes leads to delay in diagnosis and treatment. A high index of suspicion is therefore required when dealing with patients of any age group with abdominal symptoms. We present a case of a 55-year old man who presented with an acute abdomen with preoperative computed tomography scan and operative findings confirming midgut rotation. The duodenum, small bowel, caecum and appendix were abnormally located, with the presence of classical Ladd's bands. There was no evidence of intestinal volvulus. The patient underwent an emergency laparotomy with an uneventful postoperative recovery.A review of the literature is presented to highlight the rarity of intestinal malrotation and the controversies surrounding its management in the adult population.

A rare case of a mid sigmoid tumour presenting as an intussuscepting low rectal tumour causing clinical dilemma in a 22-year-old: a case report.

A 22-year-old man presented to clinic with a 1 year history of bloody diarrhoea and weight loss. Flexible sigmoidoscopy showed the presence of a low polypoidal rectal carcinoma. Whilst awaiting neoadjuvant chemo-radiotherapy, the patient presented to accident and emergency with an anal protrusion of the tumour. An emergency laparotomy unexpectedly revealed a mid sigmoid tumour which had intussuscepted through the anus and therefore required an anterior resection as opposed to an abdomino-perineal resection. Colorectal carcinoma presents in a specifically unique pattern in patients less than 30 years. We present this rare case with a brief review of the literature.

'Indirect VAC': a novel technique of applying vacuum-assisted closure dressing.

Vacuum-assisted closure (VAC) wound dressing is increasingly used to assist closure in various wounds ranging from simple finger pulp defect to complex wounds such as laparostomy or infected sternotomy. The traditional application of direct vacuum therapy can cause discomfort and put the patient at risk of injuring the affected area while mobilising. We describe a novel technique of applying VAC therapy indirectly which is much more comfortable and convenient for the patient while mobilising.