General features of phospholipid phase transitions

The phase transitions that take place in hydrated phospholipid dispersions are reviewed in terms of the lyotropic and thermotropic mesomorphism. The thermodynamics of the phase transitions are discussed, including the various contributions to the shifts in phase transition temperatures. Particular attention is given to the phase transitions involving the lamellar or lipid bilayer phase, in view of the relevance to the lipid component of biological membranes. These transitions include especially the chain-melting transition and the transformation to non-lamellar phases.     

Molecular Comparison of Bacterial Communities on Peripheral Intravenous Catheters and Matched Skin Swabs

Skin bacteria at peripheral intravenous catheter (PIVC) insertion sites pose a serious risk of microbial migration and subsequent colonisation of PIVCs, and the development of catheter related bloodstream infections (CRBSIs). Common skin bacteria are often associated with CRBSIs, therefore the bacterial communities at PIVC skin sites are likely to have major implications for PIVC colonisation. This study aimed to determine the bacterial community structures on skin at PIVC insertion sites and to compare the diversity with associated PIVCs. A total of 10 PIVC skin site swabs and matching PIVC tips were collected by a research nurse from 10 hospitalised medical/surgical patients at catheter removal. All swabs and PIVCs underwent traditional culture and high-throughput sequencing. The bacterial communities on PIVC skin swabs and matching PIVCs were diverse and significantly associated (correlation coefficient = 0.7, p<0.001). Methylobacterium spp. was the dominant genus in all PIVC tip samples, but not so for skin swabs. Sixty-one percent of all reads from the PIVC tips and 36% of all reads from the skin swabs belonged to this genus. Staphylococcus spp., (26%), Pseudomonas spp., (10%) and Acinetobacter spp. (10%) were detected from skin swabs but not from PIVC tips. Most skin associated bacteria commonly associated with CRBSIs were observed on skin sites, but not on PIVCs. Diverse bacterial communities were observed at skin sites despite skin decolonization at PIVC insertion. The positive association of skin and PIVC tip communities provides further evidence that skin is a major source of PIVC colonisation via bacterial migration but microbes present may be different to those traditionally identified via culture methods. The results provide new insights into the colonisation of catheters and potential pathogenesis of bacteria associated with CRBSI, and may assist in developing new strategies designed to reduce the risk of CRBSI.     

Clinical risk management in obstetrics: eclampsia drills

Problem Infrequent presentation of patients with eclampsia, leading to staff inexperienced in the condition and untested emergency systems.Design “Fire drill” programme using on-site simulation of patients with eclampsia.Setting Tertiary referral obstetric unit.Key measures for improvement Successful implementation of measures to optimise management of eclampsia.Strategies for change Rapid activation of emergency team after one call, development and dissemination of evidence based protocol for eclampsia, strategically placed “eclampsia boxes,” individual staff feedback and education.Effects of change Efficient and appropriate management of subsequent simulated patients.Lessons learnt On-site simulation can identify and correct potential deficiencies in the care of patients with eclampsia.