BACKGROUND:Contemporary nursing leadership roles in critical care are a reflection of the changing environment in which critical care is provided.KEY ISSUES:In the UK, critical care nursing faces challenges in the form of: reduced number and seniority of medical staff cover for acute wards; mandated responsibility for management of patients outside of critical care units, without corresponding responsibility for managing staff; increased public and political awareness of deficits in critical care; increased use of Assistant Practitioners; and emphasis on longer-term outcomes from intensive care.EVALUATION:New leadership roles have met these challenges head on with two main foci: patient management across the acute/critical care interface and hospital wide policies and practice.CONCLUSIONS:The leadership roles examined in this paper highlight three underpinning goals: improved quality and safety of patient care; improved communication between professionals; and empowerment of junior nurses and doctors.IMPLICATIONS FOR NURSING MANAGEMENT:There has been considerable investment in strategic leadership roles for critical care nursing; evidence is developing of the return on this investment for patient and service outcomes. Consideration must now be given to the preparation, mentorship and development of leadership roles for the next generation of nurse leaders.

Fergusson, G. MRCPsych.; Cullen, L. RCN; Freeman, C. FRCPsych.; Hendry, J. MRCPsych. Scottish ECT Accreditation Network (SEAN)

We report a case of sudden cardiac arrest immediately after aortic cross clamping during surgery for infrarenal abdominal aortic aneurysm in a patient with coronary artery disease. The cause, treatment, and necessary monitoring for the case are discussed.

Eight patients with cystic fibrosis [CF] colonized with Pseudomonas aeruginosa (P. aeruginosa) had serial lung function, peripheral blood inflammatory markers, and serum IgG antibodies to Burkholderia cepacia (B. cepacia) lipopolysaccharide measured in the months preceding and following colonisation with B. cepacia.

INTRODUCTION This study was designed to determine the relationship between formation of serum antibodies to lipopolysaccharide (LPS) core antigen of Burkholderia cepacia and pulmonary colonization with B. cepacia and Pseudomonas aeruginosa in patients with cystic fibrosis (CF), and to define if an enhanced host humoral immune response to B. cepacia was related to a poor clinical outcome. METHODS Serum IgG to B. cepacia LPS core antigen was measured in adult cystic fibrosis patients colonized with B. cepacia and P. aeruginosa, and serial titres were measured in 13 B. cepacia and 41 P. aeruginosa colonized patients followed prospectively over 18 months. RESULTS The median B. cepacia antibody titre was significantly greater in the patients colonized with B. cepacia compared to those colonized with P. aeruginosa, a group which grew B. cepacia intermittently from their sputum. and nine healthy controls. The median antibody titre at recruitment into the study was significantly greater in patients who later went into exacerbations compared with those who remained clinically stable. but there was no difference between B. cepacia antibody titres in patients who died and those who survived the study duration. DISCUSSION The degree of overlap of serum IgG levels to B. cepacia LPS core antigen in cystic fibrosis patients colonized with B. cepacia and P. aeruginosa does not allow this antibody to be used in a clinical context to define infection status. The magnitude of the humoral response to B. cepacia may influence occurrence of pulmonary exacerbations, but a more exuberant humoral immune response to B. cepacia core LPS is not the mechanism by which pulmonary deterioration occurs.

Multicentre studies of airway responsiveness (AR) are increasingly important tools in asthma epidemiology. Because comparisons of AR are made between centres it is essential that measurement techniques are accurate and standard. This study investigated the Mefar dosimeter which is currently used in the 35 centre European Community Respiratory Health Survey (ECRHS) with the next phase currently being planned. Significant differences were found in driving pressures and aerosol outputs between the three Mefar dosimeters in the laboratory. A linear relationship was also found between driving pressure and aerosol output (R2=0.96). These differences are important as they may lead to variations between centres of < or =35% in the drug dose delivered in AR measurement, which could potentially diminish the power of individual study centres to accurately detect national differences in AR. Dosimeter driving pressure and nebulizer output should be standardized in future studies of airway responsiveness. With relatively simple quality control measures in place it is believed that the Mefar dosimeter can produce reliable between-centre longitudinal data with an increase in the accuracy of these important studies.

Pulmonary colonization by Burkholderia cepacia in cystic fibrosis (CF) may be associated with enhanced deterioration of pulmonary function. This may be due to a more florid host inflammatory response than in colonization by Pseudomonas aeruginosa, leading to greater lung injury. Circulating markers of inflammation were determined during infective exacerbations and periods of clinical stability in an 18 month prospective study in adults with CF colonized by P. aeruginosa (n=41). B. cepacia (n=13) and in adults who intermittently grew B. cepacia (n=6). There were no differences between the levels of the inflammation markers measured in the three groups (P. aeruginosa, B. cepacia, B. cepacia intermittent) at any of the assessment points. When clinically stable, levels of inflammatory markers in all groups were elevated compared to a matched non-CF population, indicating, continuous inflammation and the potential for lung damage between infective exacerbations. This study does not support the hypothesis that pulmonary colonization with Burkholderia cepacia is associated with a heightened inflammatory response compared with Pseudomonas aeruginosa colonization.

CancerVolume 16, Issue 2 p. 231-243 ArticleFree Access Primary solid tumors of the great omentum Arthur Purdy Stout M.D., Arthur Purdy Stout M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this authorJ. Hendry M.D., J. Hendry M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this authorF. J. Purdie M.D., F. J. Purdie M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this author Arthur Purdy Stout M.D., Arthur Purdy Stout M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this authorJ. Hendry M.D., J. Hendry M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this authorF. J. Purdie M.D., F. J. Purdie M.D. Laboratory of Surgical Pathology, Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York 32, N.Y.Search for more papers by this author First published: February 1963 https://doi.org/10.1002/1097-0142(196302)16:2<231::AID-CNCR2820160214>3.0.CO;2-XCitations: 53AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume16, Issue2February 1963Pages 231-243 ReferencesRelatedInformation