The effectiveness of faecal collection devices in preventing incontinence-associated dermatitis in critically ill patients with faecal incontinence: A systematic review and meta-analysis

ObjectiveThe objective of this study was to investigate the effects of different types of faecal collection devices on incontinence-associated dermatitis (IAD) in critically ill patients with faecal incontinence.Review method usedThis was a systematic review and meta-analysis.Data sourcesA comprehensive electronic literature search was performed in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and WeiPu. All the databases were searched from their inception to July 31, 2019, and the data were updated on November 2, 2019.Review methodsRandomised controlled trials (RCTs) and quasi-experimental studies were included. Participants were critically ill patients with faecal incontinence, and the interventions involved care with faecal collection devices. Comparisons were usual care, and the outcome was the incidence of IAD. Odds ratios (ORs) were used to calculate the pooled effect sizes. Heterogeneity was tested using the inconsistency index (I²) method.ResultsNineteen studies were included in this systematic review including 16 RCTs and three quasi-experimental studies. Twelve RCTs were included in the meta-analysis, which showed that the use of faecal collection devices significantly reduced the incidence of IAD. Subgroup analyses based on device type showed significant effects for anal pouch collection devices (OR, 0.14; 95% confidence interval [CI], 0.07–0.26; P < 0.00001), anal pouch connected to negative-pressure suction devices (OR, 0.18; 95% CI, 0.08–0.42; P < 0.00001), anal catheter/tube collection devices (OR, 0.24; 95% CI, 0.13–0.44; P < 0.00001), and anal catheter/tube connected to negative-pressure suction devices (OR, 0.20; 95% CI, 0.07–0.59, P < 0.00001).ConclusionsFaecal collection devices can reduce the incidence of IAD in critically ill patients with faecal incontinence. It is suggested that when using a device to care for critically ill patients with faecal incontinence, an anal pouch connected to continuous low-negative-pressure suction device should be preferred. Further high-quality research is still needed regarding anal catheter/tube collection devices and anal catheter/tube connected to continuous low-negative-pressure suction devices.     

Risk for corneal injury in intensive care unit patients: A cohort study

AimTo identify the incidence and risk factors for corneal injury amongst critically ill patients.MethodA prospective cohort study with adult patients from one intensive care unit in Northern Brazil. Logistic regression was performed to predict the risk factors associated with corneal injury.ResultsData from 149 patients revealed 18.8% (28/149) corneal injuries. Factors independently associated with corneal injury were patients with eyeball exposure (OR: 27.31; 95% CI: 3.50–212.78); lagophthalmos (OR: 17.15; 95% CI: 5.78–50.85); chemosis (OR: 7.39; 95% CI: 2.28–23.97), periorbital oedema (OR: 7.99; 95% CI: 2.19–29.13) and hospitalisation >7-days (OR: 11.96; 95% CI: 3.27–43.66) had a significantly higher risk of developing corneal injury in this ICU.ConclusionCorneal injury was a common complication amongst critically ill patients and was associated with altered physiological function of the eyes such as exposure, lagophthalmos, chemosis and periorbital oedema. This study suggests introduction of a corneal injury prevention protocol for nursing and adding lagophthalmos and chemosis to the NANDA-I Taxonomy, thus contributing to the assessment and monitoring for the risk for corneal injury in critically ill patients.     

危重患者失禁相关性皮炎皮肤保护的研究进展

危重患者常因胃肠营养不当、神经功能紊乱或由于长期大量应用广谱抗生素致胃肠道内菌群失调而引起大便失禁,发生皮肤损伤,导致失禁相关性皮炎( IAD )的发生。加重患者的痛苦,增加护理工作量。本文就危重症患者IAD产生的相关因素及目前关于IAD的预防及皮肤保护措施综述如下。     

Efficacy of a comprehensive strategy to reduce moisture-associated skin damage in an intensive care unit: A quasi-experimental study

ObjectivesAssess the impact of a bundle of interventions to reduce the incidence of moisture-associated skin damage in an intensive care unit.MethodsQuasi-experimental study with pre-post comparison carried out in a general intensive care unit. The intervention consisted of an online training on skin lesions and implementation of a skin care program. In the pre-post intervention period, the skin of the pelvic area was assessed daily until the appearance of a moisture-related lesion or intensive care unit discharge. Demographic and clinical variables, type of moisture lesion and severity were collected. To assess the impact of the intervention the odds ratio (OR) adjusted for the confounding variables was used.ResultsTrained nurses accounted for 87.7%. In each phase 145 patients were studied. The incidence of moisture-associated skin damage in the pre-phase was of 29% and 14.5% in the post phase. The OR adjusted for the confounding variables (ICU length of stay, obesity, faecal incontinence and non-communicative patients) was 0.44 (95%CI:0.23–0.82). The reduction of incontinence-associated dermatitis presented an OR of 0.81 (95%CI:0.30–2.16) and intertriginous dermatitis of 0.39 (95%CI:0.17–0.85).ConclusionsOnline training for nurses and the introduction of structured skin care reduced by half the moisture-associated skin damage, especially intertriginous dermatitis.     

Can increasing the prevalence of vegetable-based diets lower the risk of osteoporosis in postmenopausal subjects? A systematic review with meta-analysis of the literature

ObjectivesSeveral epidemiological investigations have assessed the association between vegetable-based diet intake (VDI) and risk of osteoporosis in postmenopausal subjects (OPS), but the outcomes have been inconsistent. We performed a review of the updated literature to evaluate this correlation.MethodsWe searched for relevant studies published in September 2018 or earlier. Two researchers conducted eligibility assessment and data extraction. Discrepancies were resolved through consultation with a third expert. Pooled odds ratios (ORs) were calculated with 95% confidence intervals (CIs).ResultsTen studies, which included 14,247 subjects, were identified. On comparing the highest category of VDI consumption with the lowest category of VDI consumption, the pooled OR for OPS was 0.73 (95% CI = 0.57–0.95), i.e., participants with a higher intake of vegetables had a 27% (95% CI = 5–43%) lower risk of OPS. Significant benefits were found on subgroup analyses of case-control studies (OR, 0.61 [95% CI, 0.48–0.78]), but not on subgroup analyses of cross-sectional studies (OR, 0.82 [95% CI, 0.57–1.16]). The synthesized effect estimates were in the direction of decreased risk of OPS on subgroup analyses of the femoral region (OR, 0.57, 95% CI = 0.41–0.80) and the lumbar spine (OR = 0.55, 95% CI = 0.38–0.81), but not on subgroup analyses of the calcaneus (OR = 0.85, 95% CI = 0.33–2.16) and the lumbar and/or femoral region (OR = 1.04, 95%CI = 0.79–1.38). Positive results were observed on pooled analyses of the Dual energy X-ray absorptiometry (DEXA) measurement method (OR, 0.72 [95% CI, 0.54–0.95]), but not on pooled analyses of the Standardized Quantitative Ultrasound (QUS) measurement method (OR, 0.85 [95% CI, 0.33–2.16]). This might have resulted from a type II error due to wide confidence intervals and less number of included studies.ConclusionThis meta-analysis seemingly confirms that higher consumption of VDI was associated with a lower risk of OPS. Taken together, these results highlight the need for future high-quality design-based trials on quantified vegetable intake and OPS.     

Risk Factors for Injuries From Physical Violence in African Women in the Gambia

BackgroundPhysical violence against women is a major public health problem in African countries; however, no studies have focused on factors associated with violent injuries to women in Africa.ObjectivesA matched case-control study was conducted to investigate risk factors for injuries from physical violence against African women in The Gambia.MethodsOver a 12-month study period, study participants were recruited from emergency departments of eight government-managed health care facilities. Cases were female patients aged ≥ 15 years who had been violently injured. Matched by the health facility, date of injury, sex, and age, a control patient for each case was selected from those injured due to nonviolent mechanisms.ResultsIn total, 194 case-control pairs were recruited. Results of a conditional logistic regression showed that being a Fula (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.06–5.66), living in an extended family compound (OR 3.07; 95% CI 1.22–7.72), having six or more female siblings (OR 3.10; 95% CI 1.38–6.97), having been raised by grandparents (OR 3.34; 95% CI 1.06–10.51), and having been verbally (OR 3.04; 95% CI 1.56–5.96) or physically abused (OR 3.36; 95% CI 1.34–8.39) in the past 12 months were significantly associated with injury from physical violence.ConclusionMost risk factors identified for violent injury among African women are unique to the studied geography. Violence prevention programs, if designed based on these identified risk factors, may be more effective for this population.     

Risks and Outcomes of Perioperative Pulmonary Embolism in Major Surgeries: A Population-Based Study

PurposePerioperative pulmonary embolism (PE) is a significant cardiovascular complication in many surgeries. This study aimed to investigate the risks and outcomes of perioperative PE in major surgery.MethodsDischarge records of the Nationwide Readmission Database from 2010 to 2015 were extracted and analyzed. Length of stay, charges, death, and 30-day hospital readmission rate were compared for patients with and without perioperative PE. In addition, surgery-specific risk factors and therapies associated with PE were explored in a multivariable model.FindingsA total of 12,376,153 hospitalizations for major surgeries were involved, and perioperative PE occurred in 22,676 hospitalizations (0.18%). The length of stay, charges, rate of death, and 30-day hospital readmission were higher in patients with perioperative PE than in those without perioperative PE. Respiratory (odds ratios [OR], 2.09; 95% CI, 1.89–2.3), cardiovascular (OR, 1.62; 95% CI, 1.51–1.73), and musculoskeletal (OR, 1.22; 95% CI, 1.1–1.29) surgeries were risk factors for the occurrence of perioperative PE. In patients with perioperative PE, respiratory surgery was a risk factor for death (OR, 1.48; 95% CI, 1.10–2.00), whereas gynecologic/obstetric surgery was a protective factor for 30-day readmission (OR, 0.30; 95% CI, 0.10–0.88). Regarding therapy for perioperative PE, thrombolytic therapy (OR, 1.74; 95% CI, 1.26–2.42) and embolectomy (OR, 3.60; 95% CI, 2.35–5.51) were risk factors for death.ImplicationsRespiratory, cardiovascular, and musculoskeletal surgeries were risk factors for the occurrence of perioperative PE and death. Future research on precise models to predict PE in major surgeries is needed for appropriate interventions to improve outcomes of perioperative PE.     

An approach to develop clinical prediction rule for candidemia in critically ill patients: A retrospective observational study

PurposeEarly detection of candidemia in critically ill patients is important for preemptive antifungal treatment. Our study aimed to identify the independent risk factors for the development of a new candidemia prediction score.MethodsThis single-centre retrospective observational study evaluated 2479 intensive care unit (ICU) cases from January 2016 to December 2018. A total of 76 identified candidemia cases and 76 matched control cases were analyzed. The patients' demographic characteristics and illness severity were analyzed, and possible risk factors for candidemia were investigated.ResultsMultivariate logistic regression analysis identified renal replacement therapy (RRT) (odds ratio [OR]: 52.83; 95% confidence interval [CI]: 7.82–356.92; P < 0.0001), multifocal Candida colonization (OR: 23.55; 95% CI: 4.23–131.05; P < 0.0001), parenteral nutrition (PN) (OR: 63.67; 95% CI: 4.56–889.77; P = 0.002), and acute kidney injury (AKI) (OR: 7.67; 95% CI: 1.24–47.30; P = 0.028) as independent risk factors. A new prediction score with a cut-off value of 5.0 (80.3% sensitivity and 77.3% specificity) was formulated from the logit model equation.ConclusionsRenal replacement therapy, AKI, PN, and multifocal Candida colonization were the independent risk factors for the new candidemia prediction score with high discriminatory performance and predictive accuracy.     

Factors affecting the occurrence of pressure injuries among patients receiving targeted temperature management after cardiac arrest

BackgroundPressure injuries (PIs) are a well-known complication of critically ill patients admitted to the intensive care unit with targeted temperature management (TTM) after cardiac arrest (CA). However, little is known about the factors that impact the occurrence of PIs among these patients.ObjectivesThis study aimed to examine factors related to the occurrence of PIs among patients after CA treated with TTM.MethodsThis retrospective observational study collected data from 126 patients after CA aged 18 years or older from a single tertiary hospital admitted between January 2017 and December 2019. Demographic, clinical, and medical device–related characteristics were collected by patient chart review. Multivariable logistic regression analysis was performed to identify factors related to the occurrence of PIs.ResultsThe study showed that the incidence of PIs was 31.8%. Patients who were male (odds ratio [OR], 4.80; 95% confidence interval [CI], 1.21–19.08), developed diarrhoea (OR, 4.90, 95% CI, 1.31–18.41), or were subjected to physical restraint (OR, 6.03; 95% CI, 1.52–23.96) were at a higher risk of developing PIs. A lower risk of developing PIs was associated with the Glasgow Coma Scale score greater than 13 on the third day of admission (OR, 0.08; 95% CI, 0.01–0.52), higher haemoglobin level (OR, 0.65; 95% CI, 0.49–0.86), or low nutritional risk index (≤100) (OR, 0.10; 95% CI, 0.02–0.57).ConclusionsNurses should be aware that patients treated with TTM after CA are at a high risk of developing PIs from the moment of admission and should be closely monitored.     

Risk of major bleeding associated with aspirin use in non-surgical critically ill patients receiving therapeutic anticoagulation

BackgroundWe aimed to evaluate the risk of major bleeding in non-surgical critically ill patients who received aspirin in conjunction with therapeutic anticoagulation (concomitant therapy) compared to those who received therapeutic anticoagulation alone.MethodsThis is a retrospective cohort study of critically ill patients initiated on therapeutic anticoagulation at a large academic medical center from 2007 to 2016. The exposure of interest was aspirin therapy during anticoagulation. The primary outcome was the incidence of major bleeding during hospitalization. Secondary outcomes included in-hospital mortality, hospital free days, and new myocardial infarction or stroke.Results5507 (73.2%) patients received anticoagulation alone and 2014 (26.8%) received concomitant therapy; major bleeding occurred in 19.0% and 22.2%, respectively. There was no increased risk of major bleeding [OR 1.10 (95% CI: 0.93–1.30); p = .27] or mortality [OR 0.93 (95% CI: 0.77–1.11); p = .43] with concomitant therapy. Patients receiving concomitant therapy had fewer hospital-free days (mean decrease of 0.73 [1.36, 0.09]; p = .03) and were more likely to experience new myocardial infarction or stroke [OR 2.61 (95% CI: 1.72–3.98); p < .001].ConclusionsIn non-surgical critically ill patients receiving therapeutic anticoagulation, concomitant use of aspirin was not associated with an increased risk of bleeding or in-hospital mortality.     

Prognostic factors in nursing and healthcare-associated pneumonia

Background and objectiveNursing and healthcare-associated pneumonia (NHCAP) is a category of healthcare-associated pneumonia modified for the healthcare system in Japan. To date, only a few studies have examined the prognostic factors of NHCAP in a prospective cohort. This study aimed to investigate the prognostic factors related to 30-day mortality in patients with NHCAP by analyzing prospective data.MethodsWe analyzed patients hospitalized for NHCAP who were enrolled between October 2010 and February 2017. Age, sex, comorbidities, vital signs and laboratory findings were used as prognostic variables. The primary outcome was 30-day mortality.ResultsOf 817 NHCAP patients identified, the mean age was 78.0 ± 11.1 years, 580 (71.0%) were men and 30-day mortality was 13.1% (107/817). On multivariate analysis, male sex (odds ratio [OR]: 2.07, 95% confidence interval [CI]: 1.18–3.63), malignancy (OR: 2.35, 95%CI: 1.38–4.01), performance status (PS) (OR: 1.55, 95%CI: 1.23–1.96), body temperature (OR: 0.77, 95%CI: 0.61–0.97), heart rate (OR: 1.02, 95%CI: 1.01–1.03), respiratory rate (OR: 1.04, 95%CI: 1.01–1.08), serum albumin (Alb) (OR: 0.45, 95%CI: 0.30–0.66) and blood urea nitrogen (BUN) (OR: 1.02, 95%CI: 1.01–1.03) were significantly related to 30-day mortality. On the other hand, the risk factors for involvement by drug-resistant pathogens predicted a better prognosis (OR: 0.39, 95%CI: 0.19–0.82).ConclusionsMale sex, malignancy, poor PS, hypothermia, tachycardia, tachypnea, low serum Alb and high BUN are worse prognostic factors. Thus, the risk of drug-resistant pathogens is not necessarily related to poor prognosis.     

Fecal incontinence in hospitalized patients who are acutely ill

BACKGROUND: Information about fecal incontinence experienced by patients in acute-care settings is lacking. The relationship of fecal incontinence to several well-known nosocomial or iatrogenic causes of diarrhea has not been determined. OBJECTIVES: To determine the cumulative incidence of fecal incontinence in hospitalized patients who are acutely ill, and to ascertain the relationship between fecal incontinence and stool consistency, and between diarrhea and two well-known nosocomial or iatrogenic etiologies of diarrhea: Clostridium difficile and tube feeding. The relationship of fecal incontinence and risk factors for diarrhea associated with C. difficile and tube feeding in hospitalized patients was examined. METHODS: Fecal incontinence, stool frequency and consistency, administration of tube feeding and medications, severity of illness, and nutritional data were prospectively recorded in 152 patients on acute or critical care units of a university-affiliated Veterans' Affairs Medical Center. Rectal swabs and stool specimens from patients were obtained weekly for C. difficile culture. C. difficile culture and cytotoxin assay were performed on diarrheal stools. HindIII restriction endonuclease analysis (REA) was used for typing of C. difficile isolates. RESULTS: In this study, 33% (50/152) of the patients had fecal incontinence. The proportion of total surveillance days with fecal incontinence in these patients was 0.50 +/- 0.06. A greater percentage of patients with diarrhea had fecal incontinence than patients without diarrhea (23/53 [43%] vs. 27/99 [27%]; p = 0.04). Incontinence was more frequent in patients with loose/liquid stool consistency than in patients with hard/soft stool consistency (48/50 [96%] vs. 71/100 [71%]; p < 0.001). The proportion of surveillance days with fecal incontinence was related to the proportion of surveillance days with diarrhea (r = 0.69; p < 0.001) and the proportion of surveillance days with loose/liquid stools (r = 0.64; p < 0.001). Multivariate risk factors for fecal incontinence were unformed/loose or liquid consistency of stool (RR = 11.1; 95% confidence interval [CI] = 2.2, 56.7), severity of illness (RR = 5.7; CI = 2.6, 12.3), and age (RR = 1.1; CI = 1, 1.1). CONCLUSIONS: Fecal incontinence is common in hospitalized patients who are acutely ill, but the condition was not associated with any specific cause of diarrhea. Because loose or liquid stool consistency is a risk factor for fecal incontinence, use of treatments that result in a more formed stool may be beneficial in managing fecal incontinence. However, treatments that slow intestinal transit should be avoided in patients with C. difficile-associated diarrhea.     

Risk factors for methicillin-resistant Staphylococcus aureus colonization and infection in patients with human immunodeficiency virus infection: A systematic review and meta-analysis

ObjectiveTo investigate the potential factors affecting methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in patients with human immunodeficiency virus (HIV) infection.MethodsA systematic search of publications listed in electronic from inception up to August 2020 was conducted. A random-effects model was used to calculate odds ratio (OR) with 95% confidence interval (CI).ResultsA total of 31 studies reporting 1410 MRSA events in 17 427 patients with HIV infection were included. Previous hospitalization (OR 1.80; 95% CI 1.37, 2.36), previous antibiotic therapy (OR 2.69; 95% CI 2.09, 3.45), CD4+ count (OR 1.79; 95% CI 1.41, 2.28), Centers for Disease Control and Prevention classification of stage C (OR 2.66; 95% CI 1.80, 3.93), skin lesions (OR 2.02; 95% CI 1.15, 3.55), intravenous device use (OR 2.61; 95% CI 1.59, 4.29) and an MRSA colonization history (OR 6.30; 95% CI 2.50, 15.90) were significantly associated with an increased risk of MRSA colonization and infection. Antiretroviral therapy (OR 0.71; 95% CI 0.50, 0.99) and current antibiotic use (OR 0.13; 95% CI 0.05, 0.32) were significantly associated with a reduced risk of MRSA colonization and infection.ConclusionMRSA colonization and infection in HIV-infected patients is associated with a number of risk factors.     

Mobbing among care workers in nursing homes: A cross-sectional secondary analysis of the Swiss Nursing Homes Human Resources Project

BackgroundAs a category of bullying, mobbing is a form of violence in the workplace that damages the employing organization as well as the targeted employee. In Europe, the overall prevalence of mobbing in healthcare is estimated at 4%. However, few studies have explored mobbing among long-term care workers.ObjectivesThis study aims to examine the frequency of mobbing in Swiss nursing homes and its relationships with care workers’ (i.e. registered nurse, licensed practical nurse, assistant nurse, nurse aide) health status, job satisfaction, and intention to leave, and to explore the work environment as a contributing factor to mobbing.DesignA cross-sectional, multi-center sub-study of the Swiss Nursing Homes Human Resource Project (SHURP).SettingNursing homes in Switzerland’s three language regions.ParticipantsA total of 162 randomly selected nursing homes with 20 or more beds, including 5311 care workers with various educational levels.MethodControlling for facility and care worker characteristics, generalized estimation equations were used to assess the relationships between mobbing and care workers’ health status, job satisfaction, and intention to leave as well as the association of work environment factors with mobbing.ResultsIn Swiss nursing homes, 4.6% of surveyed care workers (n = 242) reported mobbing experiences in the last 6 months. Compared to untargeted persons, those directly affected by mobbing had higher odds of health complaints (Odds Ratios (OR): 7.81, 95% CI 5.56–10.96) and intention to leave (OR: 5.12, 95% CI 3.81–6.88), and lower odds of high job satisfaction (OR: 0.19, 95% CI 0.14–0.26). Odds of mobbing occurrences increased with declining teamwork and safety climate (OR: 0.41, 95% CI 0.30–0.58), less supportive leadership (OR: 0.42, 95% CI 0.30–0.58), and higher perceived inadequacy of staffing resources (OR: 0.66, 95% CI 0.48–0.92).ConclusionsMobbing experiences in Swiss nursing homes are relatively rare. Alongside teamwork and safety climate, risk factors are strongly associated with superiors’ leadership skills. Targeted training is necessary to sensitize managers to mobbing’s indicators, effects and potential influencing factors.     

Exploring medical device-related pressure injuries in a single intensive care setting: A longitudinal point prevalence study

ObjectivesTo report longitudinal prevalence rates of device-related pressure injuries in critically ill adult patients in the intensive care unit and to explore the patient characteristics associated with the development of device related pressure injuries.Research designA prospective observational design where observations of patients’ skin integrity were conducted on one day each week for 52 weeks.SettingThe study was conducted in the 36-bed intensive care unit of a major metropolitan tertiary referral hospital in Queensland, Australia. The sample included all patients aged 18 years or older admitted to the intensive care unit before midnight on the day preceding the observation, with a medical device in situ.Main outcome measuresThe primary outcome measure was device related pressure injuries identified at the weekly observations and defined as a pressure injury found on the skin or mucous membrane with a history of medical device in use at the location of the injury. Patient demographic and clinical characteristics were recorded.ResultsOver the study period, 11.3% (71/631) of patients developed at least one hospital-acquired DRPI.The most common devices associated with injury were nasogastric/nasojejunal tubes (41%) and endotracheal tubes (27%). Significant predictors of device related pressure injuries were the total number of devices (OR 1.230, 95% CI 1.09–1.38, p < 0.001), the length of time in the ICU (OR 1.05, 95% CI 1.02–1.09, p = 0.003), male sex, (OR 2.099, 95% CI 1.18–3.7, p = 0.012), and increased severity of illness score on admission (OR 1.044, 95% CI 1.01–1.09, p = 0.013).ConclusionDevice related pressure injuries are an all-too-common iatrogenic problem for this vulnerable patient cohort.     

Uncarboxylated matrix Gla-protein: A biomarker of vitamin K status and cardiovascular risk

BackgroundDephosphorylated uncarboxylated matrix Gla-protein (dp-ucMGP) is a biomarker of functional vitamin K status. High plasma dp-ucMGP concentrations reflect a low vitamin K status and have been related to vascular calcification. Our aims were to assess plasma levels of dp-ucMGP and their association with cardiovascular risk in a general population.MethodsPlasma dp-ucMGP measurements were performed using the IDS-iSYS InaKtif MGP assay in 491 consecutive participants in a Danish general population study (229 males and 262 females, aged 19–71 years). Multivariable linear and logistic regressions were used to assess the association between dp-ucMGP levels and cardiovascular risk factors.ResultsMean ± standard deviation (SD) for dp-ucMGP was 465 ± 181 pmol/L, and upper 95th percentile was 690 pmol/L. In logistic regression analyses, an increase in dp-ucMGP category (<300, 300–399, 400–499, ≥500 pmol/L) was positively associated with obesity, odds ratio (OR) 2.27 (95% confidence interval (CI) 1.54–3.33), history of cardiovascular disease, OR 1.77 (CI 1.02–3.05), and above-median estimated pulse wave velocity (ePWV), OR 1.54 (CI 1.21–1.96), when adjusted for age, sex, and lifestyle factors. 1 SD increase in diastolic and systolic blood pressure (BP) corresponded to a 5.5% (CI 2.9–8.0%) and 4.7% (CI 2.1–7.4%) increase in dp-ucMGP, respectively, when adjusted for age and sex.ConclusionPlasma dp-ucMGP levels were positively associated with obesity, BP, ePWV, and history of cardiovascular disease. These findings support that dp-ucMGP is a biomarker of cardiovascular risk, and that vitamin K status could play a role in vascular calcification. The strong association with obesity deserves further attention.     

Epidemiology of Pediatric Transports andNon-Transports in an Urban Emergency Medical Services System

Objective. This study was done to describe an urban, Emergency Medical Service (EMS) system's experiences with pediatric patients andthe rate andcharacteristics of non-transports in this setting. Methods. A retrospective analysis of all pediatric patients responded to by the Detroit Fire Department Division of EMS between January 1, 2002 andAugust 30, 2002 was done. Results. There were 5,976 pediatric EMS cases. Children 10 years of age or older accounted for 49.4% of transports, 53.8% of all patients had medical illness, and38.8% of the patients belonged to the non-urgent category. A large percentage of patients were not transported (27.2%), most commonly secondary to parent/caregiver/patient refusals. The median number of minutes on-scene for refusals was longer than for transports (23.5 vs. 17.3, respectively)[difference = 6.2 minutes (95% CI: 5.6–6.9)]. The odds ratios (OR) for refusal was highest for assaults (2.09; 95% CI: 1.66–2.63), difficulty in breathing (1.38; 95% CI: 1.14–1.68), andmotor vehicle accidents (1.19; 95% CI: 1.04–1.37). Conclusions. In this system, the majority of pediatric patients are not severely ill, anda large number are not transported. Non-transports are more likely to be young adolescents, have been involved in assaults, andhave a longer on-scene time.     

Herpesviridae in critically ill hematology patients: HHV-6 is associated with worse clinical outcome

PurposeAlthough viral infections are frequent among patients with hematological malignancies (HM), data about herpesviridae in critically ill hematology patients are scarce. We aimed at determining the impact of herpesviridae reactivation/infection in this population.Material and methodsWe performed a single center retrospective study including all consecutive adult hematology patients admitted to our comprehensive cancer center ICU on a 6-year period. Clinical characteristics, microbiological findings, especially virus detection and outcome were recorded.ResultsAmong the 364 included patients, HHV-6 was the predominant retrieved herpesviridae (66 patients, 17.9%), followed by HSV1/2 (41 patients, 11.3%), CMV (38 patients, 10.4%), EBV (24 patients, 6.6%) and VZV (3 patients). By multivariable analysis, HHV-6 reactivation was independently associated with hospital mortality (OR, 2.35; 95% CI, 1.03–5.34; P = 0.042), whereas antiviral prophylaxis during ICU stay had a protective effect (OR, 0.41; 95% CI, 0.18–0.95; P = 0.037). HHV-6 pneumonitis was independently associated with 1-year mortality (OR, 6.87; 95% CI, 1.09–43.3; P = 0.04).ConclusionsAmong critically ill hematology patients, HHV-6 reactivation and pneumonitis are independent risk factors for hospital and 1-year mortality, respectively. Impact of prevention and treatment using agents active against HHV-6 should be assessed to define a consensual diagnostic and therapeutic strategy.