纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的网状 Meta分析

目的：银制剂用于烧伤创面外用药已有数十年历史,主要有磺胺嘧啶银、纳米银敷料、银离子敷料,目前并没有同时比较三者在Ⅱ度烧伤的效果研究,因此本研究拟采用网状 Meta分析的方法,纳入随机对照试验,分析纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的疗效,进而选择最佳的含银制剂。方法全面检索中英文数据库,纳入比较纳米银敷料、银离子敷料、磺胺嘧啶银治疗Ⅱ度烧伤的随机对照试验,两个作者独立筛选研究、提取资料和评价纳入研究质量,数据分析采取 Stata软件进行分析,二分类变量数据采用比值比（odds ratio ,OR）及其95％可信区间（95％ confidence interval ,95％ CI）为疗效分析统计量,连续性变量采用均数差（mean difference ,MD）及其95％ CI为疗效分析统计量。结果纳入14个研究（1211例患者）。纳米银敷料（M D ：－4．13,95％ C I：－5．74～－2．52）、银离子敷料（M D ：－3．25,95％ C I：－5．00～－1．49）较磺胺嘧啶银具有较快的伤口愈合时间,但是纳米银敷料和银离子敷料在伤口愈合时间上没有统计学差异（M D ：0．89,95％ C I：－1．49～3．27）。在伤口愈合时间上,纳米银敷料成为最佳治疗的可能性为77．2％,其次为银离子敷料（可能性为22．8％）,最后为磺胺嘧啶银（可能性为0％）。纳米银敷料的细菌感染发生率显著低于磺胺嘧啶银（OR：0．36,95％ C I：0．15～0．87）,银离子敷料的细菌感染发生率与磺胺嘧啶银（OR：0．52,95％ CI：0．18～1．51）、纳米银敷料（OR：1．43,95％ CI：0．36～5．66）无统计学差异。在细菌感染发生率上,纳米银敷料成为最佳治疗的可能性为70．3％,其次为银离子敷料（可能性为29．7％）,最后为磺胺嘧啶银（可能性为0％）。结论纳米银敷料可能是目前相对于银离子敷料和磺胺嘧啶银的最佳敷料,但是需要未来研究进行证实。     

Clinical Outcomes Related to Protein Delivery in a Critically Ill Population

Objective: Optimal intake of energy and protein is associated with improved outcomes, although outcomes relative to protein intake are very limited. Our purpose was to evaluate the impact of prescribed protein delivery on mortality and time to discharge alive (TDA) using data from the International Nutrition Survey 2013. We hypothesized that greater protein delivery would be associated with lower mortality and shorter TDA. Methods: The sample included patients in the intensive care unit (ICU) ≥4 days (n = 2828) and a subsample in the ICU ≥12 days (n = 1584). Models were adjusted for evaluable nutrition days, age, body mass index, sex, admission type, acuity scores, and geographic region. Percentages of prescribed protein and energy intake were compared with mortality outcomes using logistic regression and with Cox proportional hazards for TDA. Results: Mean intake for the 4‐day sample was protein 51 g (60.5% of prescribed) and 1100 kcal (64.1% of prescribed); for the 12‐day sample, mean intake was protein 57 g (66.7% of prescribed) and 1200 kcal (70.7% of prescribed). Achieving ≥80% of prescribed protein intake was associated with reduced mortality (4‐day sample: odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50–0.91; 12‐day sample: OR, 0.60; 95% CI, 0.39–0.93), but ≥80% of prescribed energy intake was not. TDA was shorter with ≥80% prescribed protein (hazard ratio [HR], 1.25; 95% CI, 1.04–1.49) in the 12‐day sample but longer with ≥80% prescribed energy in the 4‐day sample (HR, 0.82; 95% CI, 0.69–0.96). Conclusion: Achieving at least 80% of prescribed protein intake may be important to survival and shorter TDA in ICU patients. Efforts to achieve prescribed protein intake should be maximized.     

Nutrition Support Team Intervention Improves Activities of Daily Living in Older Patients Undergoing In-Patient Rehabilitation in Japan: A Retrospective Cohort Study

The effect of nutrition support on activities of daily living (ADL) in individuals aged ≥75 years requiring rehabilitation is unknown. This study aimed to investigate the effect of nutrition support on ADL improvement in older patients undergoing in-patient rehabilitation in Japan. This retrospective cohort study was performed in 175 patients aged ≥75 years. The nutrition support team (NST) intervened in 85 cases. ADL was evaluated by the functional independence measure (FIM). We analyzed the effects of NST intervention on FIM efficiency. Multiple linear regression analysis revealed that NST intervention (standard partial regression coefficient, β?=?0.164; 95% confidence interval [CI] 0.003–0.229; P?=?0.044), energy intake at admission (β?=?0.179; 95% CI, 0.000–0.016; P?=?0.043), body mass index (BMI) at admission (β?=?0.227; 95% CI, 0.005–0.046; P?=?0.014), and cerebrovascular disease (β?=??0.238; 95% CI, ?0.298 to ?0.063; P?=?0.003) were independently associated with FIM efficiency. NST intervention, energy intake, and BMI on admission may affect ADL improvement in older patients undergoing in-patient rehabilitation.     

Prioritization of intervention domains to prevent cardiovascular disease: a country-level case study using global burden of disease and local data

AMI and stroke are the leading causes of premature mortality and hospitalizations in China. Incidence data at the population level for the two diseases is limited and the reliability and completeness of the existing incidence registry have not been investigated. We aim to assess if the completeness of case ascertainment of AMI and stroke incidence has improved since the implementation of electronic reporting and to estimate the incidence of AMI and stroke in Tianjin, China. We applied the DisMod II program to model the incidence of AMI and stroke from other epidemiological indicators. Inputs include mortality rates from Tianjin’s mortality surveillance system, and the point prevalence, remission rates and relative risks taken from IHME’s Global Burden of Disease studies. The completeness of AMI and stroke incidence reporting was assessed by comparing the sex and age-specific incidence rates derived from the incidence surveillance system with the modeled incidence rates. The age and sex standardized modeled incidence per 100,000 person-year decreased (p?相似文献   

Clinical Outcomes in Critically Ill Patients Associated With the Use of Complex vs Weight‐Only Predictive Energy Equations

Background: The energy intake goal is important to achieving energy intake in critically ill patients, yet clinical outcomes associated with energy goals have not been reported. Methods: This secondary analysis used the Improving Nutrition Practices in the Critically III International Nutrition Surveys database from 2007–2009 to evaluate whether mortality or time to discharge alive is related to use of complex energy prediction equations vs weight only. The sample size was 5672 patients in the intensive care unit (ICU) ≥4 days and a subset of 3356 in the ICU ≥12 days. Mortality and time to discharge alive were compared between groups by regression, controlling for age, sex, admission type, Acute Physiology and Chronic Health Evaluation II score, ICU geographic region, actual energy intake, and obesity. Results: There was no difference in mortality between the use of complex and weight‐only equations (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.86–1.15), but obesity (OR, 0.83; 95% CI, 0.71–0.96) and higher energy intake (OR, 0.65; 95% CI, 0.56–0.76) had lower odds of mortality. Time to discharge alive was shorter in patients fed using weight‐only equations (hazard ratio [HR], 1.11; 95% CI, 1.01–1.23) in patients staying ≥4 days and with greater energy intake (HR, 1.19; 95% CI, 1.06–1.34) in patients in the ICU ≥12 days. Conclusion: These data suggest that higher energy intake is important to survival and time to discharge alive. However, the analysis was limited by actual energy intake <70% of goal. Delivery of full goal intake will be needed to determine the relationship between the method of determining energy goal and clinical outcomes.     

Association of COVID-19 mortality with COVID-19 vaccination rates in Rhineland-Palatinate (Germany) from calendar week 1 to 20 in the year 2021: a registry-based analysis

Vaccination is among the measures implemented by authorities to control the spread of the COVID-19 pandemic. However, real-world evidence of population-level effects of vaccination campaigns against COVID-19 are required to confirm that positive results from clinical trials translate into positive public health outcomes. Since the age group 80?+?years is most at risk for severe COVID-19 disease progression, this group was prioritized during vaccine rollout in Germany. Based on comprehensive vaccination data from the German federal state of Rhineland-Palatinate for calendar week 1–20 in the year 2021, we calculated sex- and age-specific vaccination coverage. Furthermore, we calculated the proportion of weekly COVID-19 fatalities and reported SARS-CoV-2 infections formed by each age group. Vaccination coverage in the age group 80?+?years increased to a level of 80% (men) and 75% (women). Increasing vaccination coverage coincided with a reduction in the age group’s proportion of COVID-19 fatalities. In multivariable logistic regression, vaccination coverage was associated both with a reduction in an age-group’s proportion of COVID-19 fatalities [odds ratio (OR) per 5 percentage points?=?0.89, 95% confidence interval (CI)?=?0.82–0.96, p?=?0.0013] and of reported SARS-CoV-2 infections (OR per 5 percentage points?=?0.82, 95% CI 0.76–0.88, p?<?0.0001). The results are consistent with a protective effect afforded by the vaccination campaign against severe COVID-19 disease in the oldest age group.

     

#26-S safety of thrombolytic agents in acute ischemic stroke: Analysis of randomized controlled trials

PURPOSE: To evaluate the safety of certain thrombolytic agents which can currently be a treatment option for acute ischemic stroke.METHODS: Studies were identified using MEDLINE (1966 to January 2002), the Cochrane Controlled Trial Register, and references of the papers selected. A number of biomedical and stroke related websites were also searched. Randomized-placebo-controlled trials of thrombolytic agents for the treatment of acute ischemic stroke patients were eligible. Streptokinase (SK) trials were excluded since all major SK trials were terminated early and a meta-analysis of individual patient data did not indicate a subgroup of patients for whom SK can be beneficial. Study quality was evaluated by using a previously validated scale. Data was extracted in duplicate by two independent investigators. Symptomatic intracranial hemorrhage (SIH) within the first ten days and mortality from all causes during follow-up were the outcomes. Odds ratio, absolute risk difference, and number needed to harm (NNH) which is the number of patients need to be treated to cause one additional adverse outcome were calculated to evaluate the safety of thrombolytic agents. According to homogeneity test results, a fixed effects model for SIH and a random-effects model for mortality were used to pool the individual effects of trials.RESULTS: 11 randomized controlled trials involving 3,643 patients were included in the analysis. Thrombolytic therapy was associated with a three-fold increase (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.4–4.75; p < 0.0001) in symptomatic intracranial hemorrhage (SIH) and an insignificant increase (OR, 1.07; 95% CI, 0.83–1.39; p = 0.291) in mortality. The treatment was associated with an absolute risk increase of 58 per 1000 persons (95% CI, 43–72; p < 0.0001) for SIH and 11 per 1000 persons (95% CI, (-24)-48; p = 0.261) for mortality. NNH was 17 (95% CI, 13–22) for SIH, and 84 (95% CI, including 0) for mortality. When including only trials using rt-PA, treatment was associated with a significant increase (OR, 3.6; 95% CI, 2.5–5.2; p < 0.0001) in symptomatic SIH and an insignificant increase (OR, 1.25; 95% CI, 0.87–1.78; p = 0.119) in mortality.CONCLUSION: These findings suggest that thrombolytic therapy increases the risk of symptomatic hemorrhage in 10 days when compared with placebo, however there is no significant difference in mortality during follow-up between the groups.     

Effects of a dietetic treatment in older, undernourished, community-dwelling individuals in primary care: a randomized controlled trial

Purpose

Undernutrition is a prevalent problem in older, community-dwelling individuals. Aim of this study was to determine the effects of a dietetic treatment in older, undernourished, community-dwelling individuals.

Methods

A parallel randomized controlled trial was performed in 146 non-institutionalized, undernourished individuals aged ≥65 years in primary care. Participants were randomly assigned to the intervention (referral to and treatment by a trained dietitian) or control group (no referral). Body weight, physical performance, handgrip strength, energy intake, protein intake and fat-free mass were assessed at baseline, after 3 months and after 6 months.

Results

All randomized participants (n = 146) were included in the intention-to-treat generalized estimating equations analysis (72 in intervention and 74 in control group). No treatment effect was found on the primary outcomes body weight (β = 0.49 kg, 95 % CI: ?0.15–1.12), physical performance (β = 0.15 points, 95 % CI: ?0.33–0.64) and handgrip strength (β = 0.49 kg, 95 % CI: ?0.62–1.60). Furthermore, no treatment effect was found for the secondary outcomes. Predefined subgroup analyses showed a treatment effect on body weight in physically active participants (β = 1.25 kg, 95 % CI: 0.70–2.11) and not in inactive participants (β = ?0.20 kg, 95 % CI: ?1.16–0.75).

Conclusions

After 6 months, a dietetic treatment by trained dietitians does not lead to increases in body weight and physical functioning in older, undernourished, community-dwelling individuals.     

Paternal occupational exposure to radiofrequency electromagnetic fields and risk of adverse pregnancy outcome

Background: During the last decades, public concern that radiofrequency radiation (RFR) may be related to adverse reproductive outcomes has been emerging. Our objective was to assess associations between paternal occupational exposure to RFR and adverse pregnancy outcomes including birth defects using population-based data from Norway. Methods: Data on reproductive outcomes derived from the Medical Birth Registry of Norway were linked with data on paternal occupation derived from the general population censuses. An expert panel categorized occupations according to exposure. Using logistic regression, we analyzed 24 categories of birth defects as well as other adverse outcomes. Results: In the offspring of fathers most likely to have been exposed, increased risk was observed for preterm birth (odds ratio (OR): 1.08, 95% confidence interval (CI): 1.03, 1.15). In this group we also observed a decreased risk of cleft lip (OR: 0.63, 95% CI: 0.41, 0.97). In the medium exposed group, we observed increased risk for a category of ‚other defects’ (OR: 2.40, 95% CI: 1.22, 4.70), and a decreased risk for a category of ‚other syndromes’ (OR: 0.75, 95% CI: 0.56, 0.99) and upper gastrointestinal defects (OR: 0.61, 95% CI: 0.40, 0.93). Conclusion: The study is partly reassuring for occupationally exposed fathers.These two authors share first authorship     

Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients

Background: To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients. Materials and Methods: International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60‐day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses. Results: Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66–1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72–1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87–1.55; P = .307) after adjusting for confounders. Conclusions: Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.     

Racial and Geographic Disparities in the Use of Parenteral Nutrition Among Inflammatory Bowel Disease Inpatients Diagnosed With Malnutrition in the United States

Background: Racial disparities have been described in the use of a diverse spectrum of surgical procedures. The objectives of this study are to determine whether disparities also exist for the use of parenteral nutrition (PN) in inflammatory bowel disease (IBD). Methods: The U.S. Nationwide Inpatient Sample between 1998 and 2003 is analyzed to determine PN use among IBD inpatients diagnosed with protein‐calorie malnutrition and assess whether use patterns differ by race and geographical region. Results: The proportion of African American IBD admissions with protein‐calorie malnutrition who receive PN is significantly lower than that in whites (19.9% vs 28.1%, P = .001), whereas there is no difference between Hispanics and non‐Hispanic whites. After adjustment for gender, comorbidity, health insurance status, geographic region, and median neighborhood income, African Americans remain less likely than whites to receive PN (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.50–0.89), whereas the difference between Hispanics and non‐Hispanic whites is marginally significant (OR 0.65; 95% CI, 0.41–1.04). PN use varies geographically, with highest rates in the Northeast (44.3%) and lowest in the Midwest (17.3%). Uninsured patients are less than half as likely to receive PN as those with insurance (OR 0.46; 95% CI, 0.31–0.69). Compared with whites, Hispanics experience a longer time interval between admission and initiation of PN (3.5 vs 4.8 days, P = .02) and have higher rates of catheter‐related complications (5.1% vs 12.2%, P = .04). Conclusions: Among IBD inpatients with clinically diagnosable malnutrition, PN use is lower among African Americans compared with whites. The underlying mechanisms of these racial variations merit further investigation.     

Infusion therapy team and dressing changes of central venous catheters.

OBJECTIVE: To determine whether central venous catheter (CVC) dressing changes could be performed by ward nurses rather than by the infusion therapy team (ITT) nurses without increasing the risk of catheter-related infection. DESIGN: Retrospective cohort study using prospectively collected data. The study extended from January 1995 to June 1996. SETTING: The University of Texas M.D. Anderson Cancer Center, a referral cancer center. PATIENTS: The study group was a random sample of 483 patients who received CVC dressing changes by ward nurses during the study period. A random sample of 483 patients who received CVC dressing changes by the ITT constituted the control group. RESULTS: The risks of catheter-related septicemia were 1.7% among cases and 1.4% among controls (risk ratio, 1.14; 95% confidence interval [CI95], 0.26-6.42; P=.70). There also were no significant differences between the two groups in the risks of catheter-related site infection (risk ratio, 0.50; CI95, 0.02-4.12; P=.25) or any catheter-related infection (risk ratio=1.00; CI95, 0.27-3.64; P=.59). CONCLUSIONS: Provided that aseptic techniques (including maximal barrier precautions during insertion) are maintained, the responsibility of CVC dressing changes could be delegated to the ward nurses without increasing the low risk of CVC-related infection, resulting in an estimated cost saving in excess of $90,000 per year.     

Increasing cancer mortality among opioid-dependent persons in Australia: a new public health challenge for a disadvantaged population

Objective: To examine cancer mortality in a population‐based cohort of opioid‐dependent persons. Methods: New South Wales opioid substitution therapy (OST) program registrants from 1985 to 2005 (n=43,789) were probabilistically linked to the National Death Index. Crude and standardised mortality rates and standardised mortality ratios (SMRs) were calculated. Results: The crude cancer mortality rate increased from 4 to 65 deaths per 100,000 person‐years (p trend <0.001). Overall, OST registrants were 1.7 times more likely to die of cancer than the general population (SMR 95% CI 1.4–1.9). Site‐specific SMRs were significantly elevated for lung cancer (3.6, 95% CI 2.8–4.6), liver cancer (6.9, 95% CI 4.3–10.5), and anogenital cancers (2.8, 95% CI 1.3–5.3), and significantly reduced for breast cancer (0.4, 95% CI 0.1–0.9). Conclusions: Cancer is an increasingly important cause of death among OST registrants as they live longer with their dependency. The site‐specific excess deaths suggest the role of tobacco, alcohol, and infection with hepatitis C and human papillomavirus. Implications: The OST setting may be a useful setting for the delivery of programs aimed at detection of precursor lesions, reducing exposure to established carcinogens, and treatment for those with HCV infection. Such targeted steps are likely to reduce the future cancer burden in this population.     

Effect of Improvement in Sarcopenia on Functional and Discharge Outcomes in Stroke Rehabilitation Patients

This cross-sectional study investigated the proportion of patients’ recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709–10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912–7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.     

Development and Validation of a New Cardio‐Specific Resting Energy Expenditure Equation for Adults

Background : This study tested the accuracy of resting energy expenditure (REE) equations among patients who underwent cardiopulmonary bypass and developed/validated a more accurate cardio‐specific equation (CSE). Materials and Methods : Prospective observational cohort of 240 adults (derivation data set, 170 patients; validation data set, 70 patients). REEs were calculated with 6 equations—Penn State 2003a, Penn State 2003b, Ireton‐Jones, Swinamer, Faisy, and American College of Chest Physicians—and results were compared with indirect calorimetry (IC). Multivariable linear regression analysis was used to develop the CSE. Agreement between measured and calculated REEs was assessed with Lin’s concordance correlation coefficient (LCCC), Bland‐Altman plot, and regression analysis. Results : LCCCs present poor agreement between measured and calculated REEs: 0.24 (95% CI, 0.19–0.29), for the Faisy equation; 0.15 (95% CI, 0.1–0.19), Ireton‐Jones; 0.31 (95% CI, 0.25–0.37), Swinamer; 0.17 (95% CI, 0.13–0.21), Penn State 2003a; 0.19 (95% CI, 0.14–0.23), Penn State 2003b; and 0.11 (95% CI, 0.07–0.15), American College of Chest Physicians. Based on the derivation data set, REEs are explained by the following equation: CSE = 616 ? 8 × age in years + 13 × weight in kilograms + 450 if on ventilator + 159 × MV in liters + 145 if on inotropes. Based on the validation study results, the LCCC between IC and the CSE was 0.82 (95% CI, 0.73–0.88). Conclusion : The CSE has adequate precision and could be used for REE estimation for patients undergoing cardiopulmonary bypass if IC is unavailable.     

Heavy cannabis users at elevated risk of stroke: evidence from a general population survey

Objective: Case reports and hospital‐based case–control studies suggest that cannabis use may increase the risk of stroke. We examined the risk of non‐fatal stroke or transient ischemic attack (TIA) among cannabis users in the general community. Method: A general population survey of Australians aged 20–24 years (n=2,383), 40–44 years (n=2,525) and 60–64 years (n=2,547) was used to determine the odds of lifetime stroke or TIA among participants who had smoked cannabis in the past year while adjusting for other stroke risk factors. Results: There were 153 stroke/TIA cases (2.1%). After adjusting for age cohort, past year cannabis users (n=1,043) had 3.3 times the rate of stroke/TIA (95% CI 1.8–6.3, p<0.001). The incidence rate ratio (IRR) reduced to 2.3 after adjustment for covariates related to stroke, including tobacco smoking (95% CI 1.1–4.5). Elevated stroke/TIA was specific to participants who used cannabis weekly or more often (IRR 4.7, 95% CI 2.1–10.7) with no elevation among participants who used cannabis less often. Conclusions: Heavy cannabis users in the general community have a higher rate of non‐fatal stroke or transient ischemic attack than non‐cannabis users.     

Malnutrition at Diagnosis Predicts Mortality in Patients With Systemic Immunoglobulin Light‐Chain Amyloidosis Independently of Cardiac Stage and Response to Treatment

Background: Nutrition status was shown to be a prognostic factor in patients with immunoglobulin light‐chain amyloidosis (AL). However, malnutrition was associated with cardiac involvement, thus suggesting potential interactions. This study aim was to clarify the association among nutrition status, cardiac stage, and mortality in AL. Methods: One hundred twenty‐eight consecutive newly diagnosed, treatment‐naïve patients with histologically confirmed AL were enrolled. Anthropometric, biochemical, and clinical variables were assessed. Results: At multivariable Cox proportional hazard analysis, body mass index (BMI) < 22 kg/m² (HR = 1.98, 95% CI = 1.09–3.56) and unintentional 6‐month weight loss (WL) ≥ 10% (HR = 1.94, 95% CI = 1.00–3.74) resulted in independent predictors of survival after controlling for hematologic response to treatment (HR = 0.27, 95% CI = 0.14–0.53) and cardiac stage (Mayo Clinic stage III, HR = 4.42, 95% CI = 2.61–7.51). There was no effect modification of malnutrition on mortality by cardiac stage (P for interaction = .27). Moderate and severe malnutrition (prevalence: 21.9% and 7.8%, respectively) similarly increased the risk of death (HR = 3.09, 95% CI = 1.75–5.46; 2.88, 95% CI = 1.23–6.72, respectively). Conclusions: In AL, malnutrition at diagnosis is a frequent comorbidity that affects the prognosis independently of hematologic response to treatment and cardiac stage. Nutrition status should be systematically considered in future intervention trials in AL. Nutrition support trials are warranted.     

Accuracy of national mortality codes in identifying adjudicated cardiovascular deaths

Objective: This study investigated the sensitivity and specificity of the national mortality codes in identifying cardiovascular disease (CVD) deaths and documents methods of verification. Methods: A 12‐year retrospective case ascertainment of all ICD‐coded CVD deaths was performed for deaths between 1990 and 2002 in the Melbourne Collaborative Cohort Study, comprising 41,528 subjects. Categories of non‐CVD codes were also examined. Stratified samples of 750 deaths were adjudicated from a total of 2,230 deaths. Expert panels of cardiologists and neurologists adjudicated deaths. Results: Of the 750 deaths adjudicated, 582 were verified as CVD [392 coronary heart disease (CHD) and 92 stroke] and 168 non‐CVD. Estimated sensitivity and specificity of national mortality codes for identifying specific causes of death were: CHD 74.2% (95% CI: 69.8–78.5%) and 97.6% (96.0–99.2%), respectively; myocardial infarction 59.9% (50.9–69.0%) and 94.2% (92.4–96.0%), respectively; haemorrhagic stroke 58.9% (46.0–71.7%) and 99.8% (99.4–100.0%), respectively and; ischaemic stroke 38.7% (20.5–56.9%) and 99.9% (99.6–100.0%), respectively. Misclassification was most common for deaths with primary ICD codes for endocrine‐metabolic and genito‐urinary diseases. Conclusions: National mortality coding under‐estimated the true proportion of CHD and stroke deaths in the cohort by 13.6% and 50.8%, respectively. Implications: Misclassification of cause of death may have implications for conclusions drawn from epidemiological research.     

Adequate Nutrition May Get You Home

Background: Macronutrient deficit in the surgical intensive care unit (ICU) is associated with worse in‐hospital outcomes. We hypothesized that increased caloric and protein deficit is also associated with a lower likelihood of discharge to home vs transfer to a rehabilitation or skilled nursing facility. Materials and Methods: Adult surgical ICU patients receiving >72 hours of enteral nutrition (EN) between March 2012 and May 2014 were included. Patients with absolute contraindications to EN, <72‐hour ICU stay, moribund state, EN prior to surgical ICU admission, or previous ICU admission within the same hospital stay were excluded. Subjects were dichotomized by cumulative caloric (<6000 vs ≥6000 kcal) and protein deficit (<300 vs ≥300 g). Baseline characteristics and outcomes were compared using Wilcoxon rank and χ² tests. To test the association of macronutrient deficit with discharge destination (home vs other), we performed a logistic regression analysis, controlling for plausible confounders. Results: In total, 213 individuals were included. Nineteen percent in the low‐caloric deficit group were discharged home compared with 6% in the high‐caloric deficit group (P = .02). Age, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II), and initiation of EN were not significantly different between groups. On logistic regression, adjusting for BMI and APACHE II score, the high‐caloric and protein‐deficit groups were less likely to be discharged home (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08–0.96; P = .04 and OR, 0.29; 95% CI, 0.0–0.89, P = .03, respectively). Conclusions: In surgical ICU patients, inadequate macronutrient delivery is associated with lower rates of discharge to home. Improved nutrition delivery may lead to better clinical outcomes after critical illness.     

Predictors of poor glycaemic control during the initial five years post-diagnosis in rural adults with type 2 diabetes

Objective: To identify factors predicting suboptimal glycaemic control in rural adults during the initial five years post‐type 2 diabetes diagnosis. Design: Retrospective medical record audit. Quantitative study. Setting: Rural community‐based primary health service, South Gippsland, Victoria, Australia. Participants: Two hundred and seventy‐two de‐identified medical records randomly selected from the type 2 diabetes outpatient database. Main outcome measures: Demographic, biochemical, anthropometric, pharmacological, co‐morbidity and lifestyle data during the first five years post‐diabetes diagnosis were retrospectively collected. Univariate analysis was performed to identify variables associated with poor diabetes control (HbA1c ≥ 7%). Results: Independent predictors of poor glycaemic control in this rural cohort were elevated fasting glucose at diagnosis (odds ratio (OR) 1.97, 95% confidence interval (CI) 1.31–2.97, P < 0.001), weight gain during the initial 2.5 years of diabetes (OR 1.33, 95% CI 1.11–1.59, P < 0.01), excessive body weight at diagnosis (OR 1.07, 95% CI 1.03–1.12, P < 0.001) and younger age at diagnosis (OR 0.94, 95% CI 0.88–1.00, P < 0.05). These variables combined explained 48% of the variation in HbA1c. Gender, body mass index, waist circumference and lifestyle factors at diagnosis were not significant predictors of diabetes control. Conclusions: Young–middle‐aged adults (≤58 years) with elevated fasting glucose (≥9.0 mmol L^?1) and excessive body weight (≥93.1 kg) at type 2 diabetes diagnosis and those unable to lose weight early in the course of the disease are more likely to experience a rapid deterioration in glucose control. Rural clinicians should target these individuals for aggressive diabetes management from the time of diagnosis.