Training in the operating theatre: is it safe?

based patients may have even more variable glucose levels due to the intermittent nature of their caloric intake, in contrast to the continuous feeding that occurs commonly in critical care. The compounding effects of gluco-corticoid treatment, frequently used in patients with COPD, have already been highlighted. Insulin infusions carry a risk of inadvertent hypoglycaemia which increases as blood glucose targets become more stringent. Indeed, in a major study of insulin therapy which aimed for blood glucose levels between 4.4 and 6.0 mmol/l, a 4.2% increase in the incidence of blood glucose levels of ,2.2 mmol/l was identified, although these episodes apparently had no adverse sequelae. 4 Finally, the implications for nursing workload are considerable ; the development of computerised infusion control systems may help. If the benefits of tight glycaemic control on mortality in patients with acute exacerbations of COPD are proved, the potential impact on the health care of patients with such a common disease is enormous. It will be revealing if the outcome is significantly influenced by what many would consider to be routine medical care that should be undertaken in all patients. infarction. Prognostic value of white blood cell count and blood glucose level. Hyperglycaemia is associated with poor outcomes in people admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. Regulation of the somatotropic axis by intensive insulin therapy during protracted critical illness. Outcome benefit of intensive insulin therapy in the critically ill: insulin dose versus glycemic control. Contribution of circulating lipids to the improved outcome of critical illness by glycemic control with intensive insulin therapy. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. A lthough asthma has been recog-nised for millennia, 1 2 early writers made no attempt to estimate its prevalence. Salter 3 declared that asthma ''cannot, in this country, be said to be by any means rare, and I believe that all who direct their attention to it will find it to be much commoner than is imagined''. He did not, however, venture any estimate of its prevalence, and it was another …