Dale M. Needham

Socio-economic, gender and health services factors affecting diagnostic delay for tuberculosis patients in urban Zambia

In‐depth interviews regarding health seeking behaviour were conducted with 202 adults registered with pulmonary tuberculosis at the centralized Chest Clinic in Lusaka, Zambia. The median (mean) diagnostic delay was 8.6 (9) weeks, and was significantly associated with the following factors: female sex, lower education, more than six instances of health‐seeking encounters, outpatient diagnosis of tuberculosis, and visiting a private doctor or traditional healer. More effective tuberculosis control interventions require novel methods of accessing women and less educated people. Decentralization of public tuberculosis care and improved integration with private sector health providers may also reduce diagnostic delay.

Recent evidence for intravenous fluid choice in patients with severe infection

The choice of intravenous fluids for resuscitation of critically ill patients is again receiving increased attention. This is partially due to the publication of three systematic reviews, each with interesting, and slightly different, conclusions [1, 2, 3]. The use of systematic review in this area and the conclusions drawn from this research have been criticized [4). Despite this, evidence to date suggests that in certain patient populations colloids may not offer an advantage over crystalloids, and may be harmful [1, 2, 3, 5). Ultimately, larger methodologically sound randomized trials are needed in this field in order to detect differences, if any, between crystalloids and the various forms of colloids [6). Since the time of these systematic reviews further literature has been published in this field. Although it provides no definitive answers, the more recent literature has merit in advancing our understanding of the role of crystalloids, and both human and synthetic colloids. Three of these randomized trials are reviewed here.

Toronto Critical Care Medicine Symposium, 18–20 October 2001, Canada: Research breakthroughs are not enough

At the 2001 Toronto Critical Care Medicine Symposium, exciting new research results were presented, including a randomized trial of peri-operative pulmonary-artery catheter use and evidence-based guidelines for the prevention of ventilator-acquired pneumonia. Presenters reviewed other important recent critical care developments such as (1) activated protein C and low-dose steroids in sepsis, (2) prone positioning and long-term outcomes in patients with adult respiratory distress syndrome, and (3) medical errors in the critical care unit. Along with these new findings, another theme emerged during the symposium. This theme emphasized that research breakthroughs are not sufficient in themselves: outcome studies are needed to learn how new research is applied on a large-scale basis within actual clinical practice. Furthermore, additional study is needed for an understanding of how physicians implement new research findings. Successful methods of enhancing the widespread adoption of new research require further study.