No abstract

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care.

No abstract

To determine the mechanism of the amiodarone-phenytoin interaction, seven healthy male subjects were given intravenous phenytoin, 5 mg/kg, before (phase I) and after (phase II) 3 weeks of oral amiodarone, 200 mg/day. Serum AUC increased from 245 +/- 37.6 to 342 +/- 87.3 mg.hr/L (p = 0.007); area under the first moment curve increased from 5666 +/- 1003 to 11,632 +/- 4198 mg.hr2/L (p = 0.008); the time-averaged total body clearance decreased from 1.57 +/- 0.3 to 1.17 +/- 0.33 L/hr (p = 0.0004); and the apparent elimination half-life increased from 16.1 +/- 1.32 to 22.6 +/- 3.8 hours (p = 0.001) for phenytoin during phase II. The volume of distribution at steady state and the unbound fraction for phenytoin remained unchanged. However, the formation of p-hydroxyphenytoin as a function of serum phenytoin concentration decreased during phase II. These findings suggest that amiodarone inhibits phenytoin metabolism. These observations also suggest that phenytoin doses will need to be reduced when coadministered with amiodarone. The magnitude of this reduction is difficult to predict because of the saturable pharmacokinetics of phenytoin, and therapeutic monitoring is recommended if amiodarone is added to the phenytoin regimen.

Since the mid-1980's the Pacific Northwest National Laboratory (PNNL) has used a value of 0.85 as a correction factor for the self absorption of activity for particulate radioactive air samples collected from building exhaust for environmental monitoring. More recently, an effort was made to evaluate the current particulate radioactive air sample filters (Versapor 3000, 47-mm diameter) used at PNNL for self absorption effects. There were two methods used to characterize the samples. Sixty samples were selected from the archive for acid digestion to compare the radioactivity measured by direct gas-flow proportional counting of filters to the results obtained after acid digestion of the filter and counting again by gas-flow proportional detection. Thirty different sample filters were selected for visible light microscopy to evaluate filter loading and particulate characteristics. Mass-loading effects were also considered. Large error is associated with the sample filter analysis comparison and subsequently with the estimation of the absorption factor resulting in an inadequate method to estimate losses from self-absorption in the sample filter. The mass loading on the sample filter as determined after digestion and drying was approximately 0.08 mg cm; however, this value may not represent the total filter mass loading given that there may be undetermined losses associated with the digestion process. While it is difficult to determine how much material is imbedded in the filter, observations from the microscopy analysis indicate that the vast majority of the particles remain on the top of the filter. In comparing the results obtained, the continued use of 0.85 as a conservative correction factor is recommended.