The impact of performance status on tuberculosis-related death among elderly patients with lung tuberculosis: A competing risk regression analysis

While advanced age is a main prognostic factor in patients with tuberculosis, the factors that specifically affect tuberculosis-related death are unclear because elderly people are at a risk for other age-related lethal diseases. We aimed to assess the impact of performance status on tuberculosis-related death among elderly patients with lung tuberculosis. Elderly patients (≥65 years of age) admitted to our hospital for bacteriologically-diagnosed lung tuberculosis were included, and analyzed the influence of performance status on tuberculosis-related in-hospital death, with non-tuberculosis-related death as a competing risk. Forty and 19 of the 275 patients died from tuberculosis-related causes and non-tuberculosis-related causes, respectively. The tuberculosis-related death group had a greater number of patients with a poor performance status (defined as category 3 and 4 [HR 21.022; 95%CI 2.881–153.414; p = 0.003]), a lower serum albumin level (HR 0.179; 95%CI 0.090–0.359; p < 0.001) and a higher C-reactive protein level (HR1.076; 95%CI 1.026–1.127; p = 0.002). A multivariate competing risk regression analysis showed that a poor performance status (HR 7.311; 95%CI 1.005–53.181; p = 0.049) and low albumin level (HR 0.228; 95%CI 0.099–0.524); p = 0.001) significantly predicted tuberculosis-related death. Performance status can be a useful scale for predicting tuberculosis-related death among elderly patients with pulmonary tuberculosis.     

Investigation of the incidence of immunisation stress-related response following COVID-19 vaccination in healthcare workers

IntroductionSafe vaccination worldwide is critical to end the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate adverse reactions to vaccination using a web-based questionnaire and examine the risk factors for the occurrence of immunisation stress-related response (ISRR).MethodsWe conducted a questionnaire survey using Google Form® among the employees of St. Marianna University Hospital who had received the COVID-19 vaccine between April 2021 and May 2021, 1 week after the first and second vaccinations. We developed and used a questionnaire to identify individuals with ISRR according to the World Health Organization diagnostic criteria. A generalised linear mixed model was constructed with ISRR onset as the dependent variable, subjects as the random factor, and each parameter as a fixed factor. A multivariate model was constructed using the forced imputation method with factors that were significant in the univariate analysis.ResultsWe enrolled 2,073 and 1,856 respondents in the first and second questionnaire surveys, respectively. Fifty-five and 33 ISRR cases were identified in the first and second vaccinations, respectively. In the univariate analysis, strong pre-vaccination anxiety (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.30–4.12, p = 0·004) and history of allergy (OR, 1.6; 95% CI, 1.14–2.24, p = 0·007) were significant risk factors. Multivariate analysis also showed that strong pre-vaccination anxiety (OR, 2.1; 95% CI, 1.15–3.80, p = 0.016) and history of allergy (OR, 1.5; 95% CI, 1.09–2.15, p = 0.014) were significant risk factors.ConclusionsConfirmation of allergy prior to vaccination and subsequent action are essential for addressing ISRR.     

Effect of renal clearance on vancomycin area under the concentration–time curve deviations in critically ill patients

IntroductionAugmented renal clearance (ARC) increases vancomycin (VCM) clearance. Therefore, higher VCM doses are recommended in patients with ARC; however, impacts of ARC on the area under the concentration–time curve (AUC) discrepancies between initial dosing design and therapeutic drug monitoring (TDM) period remains unclear.MethodsWe retrospectively collected data from critically ill patients treated with VCM. The primary endpoint was the association between ARC and AUC_24–48h deviations. ARC and AUC deviation were defined as a serum creatinine clearance (CCr) ≥130 mL/min/1.73 m² and an AUC at TDM 30% or more higher than the AUC at the initial dosing design, respectively. The pharmacokinetic profiles of VCM were analyzed with the trough levels or peak/trough levels using the Bayesian estimation software Practical AUC-guided TDM (PAT).ResultsAmong 141 patients (median [IQR]; 66 [58–74] years old; 30% women), 35 (25%) had ARC. AUC deviations were significantly more frequent in the ARC group than in the non-ARC group (20/35 [57.1%] and 17/106 [16.0%] patients, respectively, p < 0.001). Age- and sex-adjusted multivariate analyses revealed that the number of VCM doses before TDM ≥5 (odds ratio, 2.56; 95% confidence interval [CI]: 1.01–6.44, p = 0.047) and CCr ≥130 mL/min/1.73 m² were significantly associated with AUC deviations (odds ratio, 7.86; 95%CI: 2.91–21.19, p < 0.001).ConclusionOur study clarifies that the AUC of VCM in patients with ARC is higher at the time of TDM than at the time of dosage design.     

Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

PurposeNebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP.Materials and methodsWe performed a search in Web of Science, PubMed, Embase, and the Cochrane Library to retrieve randomized controlled trials (RCTs) and observational studies published at any time until February 6, 2023. The primary outcome was clinical response. Secondary outcomes included microbiological eradication, overall mortality, length of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), nephrotoxicity, neurotoxicity, and bronchospasm.ResultsSeven observational studies and three RCTs were included. Despite exhibiting a higher microbiological eradication rate (OR,2.21; 95%CI, 1.25–3.92) and the same nephrotoxicity risk (OR,0.86; 95%CI, 0.60–1.23), NC was not significantly different in clinical response (OR,1.39; 95%CI, 0.87–2.20), overall mortality (OR,0.74; 95%CI, 0.50–1.12), MV length (mean difference (MD),-2.5; 95%CI, −5.20–0.19), and the ICU-LOS (MD,-1.91; 95%CI, −6.66–2.84) than by the intravenous antibiotic. Besides, the risk of bronchospasm raised significantly (OR, 5.19; 95%CI, 1.05–25.52) among NC.ConclusionNC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.     

Automatic acoustic gunshot sensor technology’s impact on trauma care

IntroductionAs cities nation-wide combat gun violence, with less than 20% of shots fired reported to police, use of acoustic gunshot sensor (AGS) technology is increasingly common. However, there are no studies to date investigating whether these technologies affect outcomes for victims of gunshot wounds (GSW). We hypothesized that the AGS technology would be associated with decreased prehospital transport time.MethodsAll GSW patients from 2014 to 2016 were collected from our institutional registry and cross-referenced with local police department data regarding times and locations of AGS alerts. Each GSW incident was categorized as related or unrelated to an AGS alert. Admission data, trauma outcomes, and prehospital time were then compared.ResultsWe analyzed 731 patients. Of these, 192 were AGS-related (26%) and 539 were not (74%). AGS-related patients were more likely to be female (p < 0.01), have a higher injury severity score (ISS) (p < 0.01), and require an operation (p = 0.03). Ventilator days (p < 0.05) and hospital length of stay (p < 0.01) was greater in the AGS cohort. Mortality, however, did not differ between groups (p = 0.5). On multivariable analysis, both total prehospital time and on-scene time were lower in the AGS group (p < 0.01).ConclusionOur study suggests reduced transport times, decreased prehospital and emergency medical service on-scene times with AGS technology. Additionally, despite higher ISS and use of more hospital resources, mortality was similar to non-AGS counterparts. The potential of AGS technology to further decrease prehospital times in the urban setting may provide an opportunity to improve outcomes in trauma patients with penetrating injuries.     

Noninvasive Ventilation in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource-Limited Setting

ObjectiveTo study the role of noninvasive ventilation (NIV) in Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) related acute respiratory failure (C-ARF).Patients and MethodsPatients with C-ARF managed on NIV were categorized as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as odds ratio (OR) with 95% CI.ResultsBetween April 1, 2020, and September 15, 2020, a total of 286 patients with a mean ± SD age of 53.1±11.6 years and Acute Physiology and Chronic Health Evaluation II score of 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe acute respiratory distress syndrome. When compared with NIV success, NIV failure was associated with lower admission PaO₂ to fraction of inspired oxygen ratio (P<.001) and higher respiratory rate (P<.001). On penalized logistic regression analysis, NIV failure was associated with higher Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.01 to 1.24), severe acute respiratory distress syndrome (OR, 3.99; 95% CI, 1.24 to 12.9), D-dimer level of 1000 ng/mL DDU (to convert to mg/L, divide by 1000) or greater (OR, 2.60; 95% CI, 1.16 to 5.87), need for inotropes or dialysis (OR, 12.7; 95% CI, 4.3 to 37.7), and nosocomial infections (OR, 13.6; 95% CI, 4.06 to 45.9). Overall mortality was 30.1% (86/286). In patients requiring intubation, time to intubation was longer in nonsurvivors than survivors (median, 5; interquartile range, 3-8 vs 3; interquartile range, 2-3 days; P<.001).ConclusionNoninvasive ventilation can be used successfully in C-ARF. Illness severity and need for non–respiratory organ support predict NIV failure.     

Weight-based versus non-weight-based diltiazem dosing in the setting of atrial fibrillation with rapid ventricular response

PurposeThere is conflicting evidence to support the superiority of weight-based (WB) dosing of intravenous (IV) diltiazem over non-weight-based (NWB) dosing strategies in the management of atrial fibrillation (AFib) with rapid ventricular response (RVR).MethodsA retrospective review evaluated patients presenting to the emergency department (ED) in AFib with RVR and receiving IV diltiazem from 2015 to 2018. Those receiving a NWB dose were compared with those receiving a WB dose based on actual body weight (ABW). Secondary analyses evaluated safety profiles of the regimens and compared response in groups defined by ABW or ideal body weight (IBW).ResultsA total of 371 patients were included in the analysis. No significant difference was observed in achieving a therapeutic response (66.5% vs. 73.1%, p = 0.18) or adverse events between the groups. Patients receiving a WB dose were significantly more likely to have a HR < 100 bpm than those receiving a NWB dose (40.9% vs. 53.5%, p = 0.01). When groups were defined by IBW, WB dosing was associated with a significantly higher incidence of achieving a therapeutic response (62.7% vs. 74.3%, p = 0.02).ConclusionIn patients presenting with AF with RVR, there was no significant difference in achieving a therapeutic response between the two strategies. A WB dosing approach did result in a greater proportion of patients with a HR < 100 bpm. The utilization of IBW for WB dosing may result in an increased achievement of a therapeutic response.     

Effective treatment for clarithromycin-resistant Mycobacterium avium complex lung disease

Clinical management of macrolide-resistant Mycobacterium avium complex (MR-MAC) lung disease is difficult. To date, there only exist a limited number of reports on the treatment of clarithromycin-resistant MAC (CR-MAC) lung disease. This study aimed to evaluate prognostic factors and identify effective treatments in CR-MAC lung disease. We retrospectively collected clinical data of patients newly diagnosed with CR-MAC lung disease at the Kinki-Chuo Chest Medical Center between August 2010 and June 2018. Altogether, 37 patients with CR-MAC lung disease were enrolled. The median age was 69 years; 30, 22, and 21 patients received clarithromycin, ethambutol, and rifampicin, respectively, on their own or in drug combination. The observed sputum culture conversion rate was 29.7% (11/37 patients). In univariate analysis, ethambutol significantly increased the rate of sputum culture conversion (p = 0.027, odds ratio (OR) 10; 95% confidence interval (CI) 1.11–89.77). Multivariate analysis confirmed that ethambutol increased sputum culture conversion rate (p = 0.026; OR 21.8; 95% CI 1.45–329) while the existence of lung cavities decreased it (p = 0.04; OR 0.088; 95% CI 0.009–0.887). The combined use of ethambutol with other drugs may improve sputum culture conversion rate in CR-MAC lung disease.     

Effectiveness and safety of droperidol in a United States emergency department

BackgroundDroperidol is a dopamine receptor antagonist that functions as an analgesic, sedative, and antiemetic. In 2001, the U.S. Food and Drug Administration required a black box warning in response to case reports of QT prolongation and potential fatal arrhythmias. The aim of this study was to evaluate the effectiveness and safety of droperidol in patients presenting to a United States Emergency Department (ED).MethodsObservational cohort study of all droperidol administrations from 1/1/2012 through 4/19/2018 at an academic ED. The primary endpoint was mortality within 24 h of droperidol administration. Secondary endpoint included use of rescue analgesics.ResultsA total of 6,881 visits by 5,784 patients received droperidol of whom 6,353 visits authorized use of their records for research, including 5.4% administrations in children and 8.2% in older adults (≥65). Droperidol was used as an analgesic for pain (N = 1,387, 21.8%) and headache (N = 3,622, 57.0%), as a sedative (N = 550, 8.7%), and as an antiemetic (N = 794, 12.5%). No deaths secondary to droperidol administration were recorded within 24 h. Need for rescue analgesia occurred in 5.2% of patients with headache (N = 188) and 7.4% of patients with pain (N = 102); 1.1% of patients with headache received rescue opioids (N = 38) after droperidol, as did 5.4% of patients with pain other than headache (N = 75). No patients had fatal arrhythmias. Akathisia occurred in 2.9%.ConclusionNo fatalities were seen among this large cohort of patients who received droperidol in the ED. Our findings suggest droperidol's effectiveness and safety when used as an analgesic, antiemetic and/or sedative.     

Contributing factors to diaper dermatitis and NICU length of stay

ObjectiveDiaper dermatitis (DD) among NICU infants is preventable and under-recognized. The role of clinical characteristics (CC) on DD is also poorly described. This study examined the: 1) prevalence of DD in NICU; 2) relationship of factors including CC and DD; and 3) contribution of DD and CC factors on NICU Length of stay (LOS).MethodRetrospective chart review data was collected on all infants admitted to the NICU. Analyses included bivariate and multivariable logistic regression for DD outcome and negative binomial regression model for predicting infants’ NICU LOS.ResultsDD prevalence in the NICU sample was 34% (n = 180), 70% White, 56% male, 72% infants born at higher gestational age, and 62.2% born vaginally. Logistic regression results showed that Black infants have lower AOR of DD, whereas, NICU LOS (OR 1.02; 95% CI 1.01, 1.03), number of skin injuries (OR 1.22; 95% CI 1.01–1.47), and older gestational age (OR 3.73; 95%CI 0.83–0.95) increased the odds of DD. Significant interaction of gestational age group and days to full feed was identified.ConclusionDD is common among NICU infants and several CC play an integral role as risk and moderating factors for DD. Routine collection of infant skin integrity data is currently lacking in large collaborative databases, which limits better understanding of DD in NICU. Improvements in preventative measures could benefit from continued study of the impact nutrition and LOS have on DD development. Better systems of collecting and analyzing DD data and its impact on NICU LOS are needed.     

Superiority of high sensitivity cardiac troponin T vs. I for long-term prognostic value in patients with chest pain; data from the Akershus cardiac Examination (ACE) 3 study

BackgroundCardiac troponins (cTn) are essential in the diagnostic assessment of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS). Elevated concentrations of cTnT and cTnI predict cardiovascular events in non-acute settings, but the individual troponin isotype association with long-term mortality in patients with suspected unstable angina pectoris (UAP) is less clear.MethodsPatients hospitalized with chest pain between June 2009 and December 2010 were included in the Akershus Cardiac Examination 3 Study and followed for median 6.6 (IQR 6.2-7.1) years. The index diagnosis was adjudicated by an independent committee as NSTE-myocardial infarction (NSTEMI), UAP or non-ACS. Blood samples were collected within 24 h of admission and analyzed with high sensitivity assays for cTnT (hs-cTnT, Roche) and cTnI (hs-cTnI, Singulex).ResultsOf 402 patients included, 74 (18%) were classified as NSTEMI, 88 (22%) UAP and 240 (60%) non-ACS. hs-cTnI concentrations were detectable in all patients (median 3 [IQR 1–11] ng/L), while hs-cTnT concentrations were above the level of blank in 205 (51%) (median 3 [IQR 3–16] ng/L). In patients with UAP, both log₂-transformed hs-cTnT and hs-cTnI were associated with all-cause mortality in analyses that adjusted for other risk factors: HR 2.40 [95% CI 1.75–3.30], p < 0.001 and HR 1.44 [1.14–1.81], p = 0.002. There were no significant sex-dependent differences in the association between hs-cTnT or hs-cTnI and outcome. Time dependent receiver-operating characteristics area under the curve was 0.85 (95% CI 0.79–0.92) for hs-cTnT and 0.74 (0.64–0.84) for hs-cTnI, p = 0.008 for difference between values.ConclusionsHigher concentrations of hs-cTnT and hs-cTnI were both associated with all-cause mortality in patients with UAP, but the association with outcome was stronger for hs-cTnT than for hs-cTnI.     

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being

ObjectiveTo evaluate how variation in the way patient satisfaction feedback is delivered relates to physician well-being and perceptions of its impact on patient care, job satisfaction, and clinical decision making.Participants and MethodsA cross-sectional electronic survey was sent to faculty physicians from a large academic medical center in March 29, 2019. Physicians reported their exposure to feedback (timing, performance relative to peers, or channel) and related perceptions. The Professional Fulfillment Index captured burnout and professional fulfillment. Associations between feedback characteristics and well-being or perceived impact were tested using analysis of variance or logistic regression adjusted for covariates.ResultsOf 1016 survey respondents, 569 (56.0%) reported receiving patient satisfaction feedback. Among those receiving feedback, 303 (53.2%) did not believe that this feedback improved patient care. Compared with physicians who never received feedback, those who received any type of feedback had higher professional fulfillment scores (mean, 6.6±2.1 vs 6.3±2.0; P=.03) but also reported an unfavorable impact on clinical decision making (odds ratio [OR], 2.9; 95% CI, 1.8 to 4.7; P<.001). Physicians who received feedback that included one-on-one discussions (as opposed to feedback without this channel) held more positive perceptions of the feedback’s impact on patient care (OR, 2.0; 95% CI, 1.3 to 3.0; P=.003), whereas perceptions were less positive in physicians whose feedback included comparisons to named colleagues (OR, 0.5; 95% CI, 0.3 to 0.8; P=.003).ConclusionProviding patient satisfaction feedback to physicians was associated with mixed results, and physician perceptions of the impact of feedback depended on the characteristics of feedback delivery. Our findings suggest that feedback is viewed most constructively by physicians when delivered through one-on-one discussions and without comparison to peers.     

Diagnostic utility of fecal calprotectin in patients presenting to the emergency department with suspected acute appendicitis

BackgroundAcute appendicitis (AA) is one of the most common diseases faced by the surgeon in the emergency department. In clinical practice, how to diagnose patients with AA accurately is still challenging.MethodsWe conducted a prospective study of 84 patients who presented in the emergency department with suspected AA and measured fecal calprotectin (FC) value. The final diagnosis of AA was independently determined without reference to the test results of FC. Then, we retrospectively analyzed the FC value for identifying AA.ResultsFC value in patients with AA were significantly higher than that in patients without AA (240.5 vs. 68.5 ug/g, P < 0.001). Receiver-operating characteristic analyses demonstrated FC value to be highly sensitive and specific for the diagnosis of AA, as indicated by an overall area under the curve (AUC) of 0.928 (500 times of boot strap estimated 95% CI, 0.855–0.972), with an optimal cut off point of 106 ug/g. FC levels in 26 patients with simple AA were significantly lower than it in the 14 patients with suppurative AA (206 vs. 304ug/g, P = 0.001).ConclusionsFC test provides a sensitive, convenient and economical method to help facilitate the diagnosis of AA in emergency department. Especially for hospitals without computed tomography equipment or patients who are not suitable to exposed to radiation, FC test is of great significance for improving the diagnostic accuracy of AA.     

Kidney Microstructural Features at the Time of Donation Predict Long-term Risk of Chronic Kidney Disease in Living Kidney Donors

ObjectiveTo determine whether microstructural features on a kidney biopsy specimen obtained during kidney transplant surgery predict long-term risk of chronic kidney disease in the donor.Patients and MethodsWe studied kidney donors from May 1, 1999, through December 31, 2018, with a follow-up survey for the results of recent blood pressure and kidney function tests (estimated glomerular filtration rate [eGFR] and proteinuria). If not recently available, blood pressure and eGFRs were requested from a local clinic. Microstructural features on kidney biopsy at the time of donation were assessed as predictors of hypertension and kidney function after adjusting for years of follow-up, baseline age, sex, and clinical predictors.ResultsThere were 807 donors surveyed a mean 10.5 years after donation. An eGFR less than 45 mL/min/1.73 m² in 6.4% (43/673) of donors was predicted by larger glomerular volume per standard deviation (odds ratio [OR], 1.48; 95% CI, 1.08 to 2.04) and nephron number below the age-specific 5th percentile (OR, 3.38; 95% CI, 1.31 to 8.72). An eGFR less than 60 mL/min/1.73 m² in 42.5% (286/673) of donors was not predicted by any microstructural feature. Residual eGFR (postdonation/predonation eGFR) was predicted by nephron number below the age-specific 5th percentile (difference, ?6.07%; 95% CI, ?10.24% to ?1.89%). Self-reported proteinuria in 5.1% (40/786) of donors was predicted by larger glomerular volume (OR, 1.42; 95% CI, 1.08 to 1.86). Incident hypertension in 18.8% (119/633) of donors was not predicted by any microstructural features.ConclusionLow nephron number for age and larger glomeruli are important microstructural predictors for long-term risk of chronic kidney disease after living kidney donation.     

Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals

IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.     

Regional Adipose Compartments Confer Different Cardiometabolic Risk in Children and Adolescents:: The China Child and Adolescent Cardiovascular Health Study

ObjectiveTo investigate the associations of fat mass in specific regions with cardiometabolic risk factors in Chinese children and adolescents.Patients and MethodsThis cross-sectional study consisted of 8460 children and adolescents aged 6 to 18 years from Chinese urban areas who underwent dual-energy x-ray absorptiometry for regional fat masses and had cardiometabolic risk factors measured between January 1, 2013, and December 31, 2015.ResultsIn the multivariate model containing arm fat mass, leg fat mass, and trunk fat mass, after adjustment for region, family income, age, puberty development, physical activity, and smoking, higher trunk fat mass was independently associated with greater odds of clustered cardiometabolic risk (odds ratio [OR], 2.21; 95% CI, 1.80-2.72), higher leg fat mass was associated with lower odds of clustered risk (OR, 0.72; 95% CI, 0.59-0.87), and arm fat mass was not significantly associated with clustered risk (OR, 1.22; 95% CI, 0.97-1.55). In the multivariate model including android fat mass, gynoid fat mass, and other covariates, higher android fat mass was positively associated with clustered risk (OR, 2.23; 95% CI, 1.88-2.64), but gynoid fat mass was not associated with clustered risk (OR, 0.86; 95% CI, 0.72-1.03). Analyses for individual risk factors demonstrated similar results.ConclusionFat stored in different regions has differential influences on cardiometabolic risk in youth. Prospective studies are warranted to evaluate the long-term impacts of regional fat masses in childhood on cardiovascular risk in adulthood.     

Physiological vital sign differences between well newborns greater than 34 weeks gestation: A pilot study

BackgroundNewborns have their vital signs measured as part of routine care. However, there is inconsistency in accepted physiological ranges for well newborns beyond the post-delivery stabilisation period which has implications for the identification of illness.ObjectiveTo explore differences in physiological vital signs between three gestational age groups: late preterm (34⁺⁰ - 36⁺⁶), early term (37⁺⁰–38⁺⁶) and term (≥39⁺⁰) weeks gestation.DesignA single site prospective observational study.SettingA postnatal ward and special care baby unit in a major tertiary hospital in Australia.ParticipantsNewborns from 34 weeks gestation admitted to either the postnatal ward or special care baby unit.MethodsHeart rate, respiratory rate and oxygen saturation were continuously monitored for up to 6 h. Newborn temperature and blood pressure were measured twice during the monitoring period.ResultsContinuous monitoring resulted in 284,542 heart rate, 275,826 respiratory rate, 287,572 SpO₂ values, and 60 temperature and 60 blood pressure data points. Heart rate was significantly different between gestational age groups with late preterm heart rates 13.4 bpm (95% CI 6.5–20.4) higher than term newborns. Early term heart rates were 2.3 bpm (95% CI -4.6 – 9.3) higher than term newborns, although not statistically significantly different. Heart rate was significantly different based on sex with females on average 7.7 beats per minute (bpm) (95% CI 1.9–13.5) higher than males.Respiratory rate was not significantly different between gestational age groups however, on average, was −2.0 respiration rate per minute (rpm) (95% CI -6.8 – 2.7) lower for late preterm babies and −1.3 rpm (95% CI -6.0 – 3.4) lower for early term babies compared to term newborns. SpO₂ was not significantly different between gestational age groups, however, on average was −1.17 log units (95% CI -2.32 to −0.01) lower for late preterm newborns and −1.00 log units (95% CI -2.16 – 0.15) lower for early term newborns compared to term newborns. Respiratory rate and SpO₂ were neither clinically nor statistically significantly different by sex.There were no significant differences between gestational age groups for temperature (p = 0.38) or blood pressure (systolic p = 0.93, diastolic p = 0.54). No significant mean differences were observed based on sex for temperature (p = 0.57) or blood pressure (systolic p = 0.98, diastolic p = 0.40).ConclusionsThis study demonstrated a clinically significant higher heart rate in those born late preterm. This may have implications for current “one-size fits all” newborn early warning tools, as well as care of well late preterm infants in maternity units.     

Student nurses,increasing placement capacity and patient safety. A retrospective cohort study

One solution to the global nursing shortage is to increase the numbers of student nurses: clinical placements need to increase their capacity to host them. Capacity increases have previously been viewed as problematic if they increase the supervisory burden on registered nurses, and unsafe if they dilute students’ supervision. The aim of this study was to assess the impact on specific patient safety measures (pressure ulcers, falls and medications errors) of having students in placement being educated in Collaborative Learning in Practice (which increases capacity) compared to when they were not. Audit data were collected from four NHS trusts in the South West of England in a retrospective cohort study. We received data on 5532 adverse events from 15 clinical areas in four NHS trusts, with 996 students on placement between January 2018 and August 2019. The risk ratio and mean differences for adverse patient events were favourable (RR = 0.9842; 95%CI 0.9604–1.008; mean difference 279, 95%CI 213–346, p = 0.01). There was no statistically significant correlation between increased student numbers and increased adverse patient events. Our data must be interpreted with caution, but we conclude that increasing capacity for student nurses in placements appears to have a positive impact on patient safety.