Markers of Renal Function in Older Adults Completing a Higher Protein Obesity Intervention and One Year Later: Findings from the MEASUR-UP Trial

Increases in rates of obesity in the older population are hastening the development of chronic illnesses, including chronic kidney disease (CKD). However, obesity reduction in older adults is besought with concerns about the long-term benefit/risk, especially regarding loss of muscle mass and its impact on function. Higher protein intakes have been advocated to help offset the tendency for loss of muscle during weight reduction but this raises concerns about possible negative effects on older kidneys. We assessed markers of renal function in venous blood samples collected during a six-month randomized controlled weight loss trial of higher protein intake in obese (n?=?67; BMI?≥?30?kg/m²) older (≥60?years) adults with physical frailty and age-normal renal status (glomerular filtration rate [GFR]?≥?45); the Control diet (0.8?g protein/kg body weight/day; n?=?21) was compared to a protein-enhanced (1.2?g/g protein/kg body weight/day with 30?g protein/meal; n?=?41; Protein) diet. Results showed no group effect of the Protein treatment on markers of renal function (estimated GFR, blood urea nitrogen, and creatinine), either upon intervention completion or one year later. Our findings align with literature support for the benefits of higher protein in the diets of older individuals during obesity reduction and help to confirm the safety of moderate increases in protein intake during weight loss in this population.     

The use of Bi-level positive pressure ventilation in the treatment of acute respiratory failure within the emergency department

Acute respiratory failure (ARF) is one of the eight leading causes of death for over 65-year-olds in Australia. Bi-level positive pressure (BiPAP) ventilation is the preferred form of non-invasive ventilation in the treatment of acute respiratory failure in the emergency department (ED) because, when used appropriately, it reduces the need for intubation. The patient on whom BiPAP is applied is able to protect their own airway, remaining cooperative with a normal mental state. In this paper, I explain acute respiratory failure, the appropriateness of BiPAP in the treatment of ARF, patient selection and exclusion from BiPAP treatment, current practice and recommendations for future practice. While BiPAP is commonly used in Australian EDs as part of the treatment of acute respiratory failure, evidence supporting its use is limited and more high level research is recommended.     

Home-based behavioral treatments for chronic benign headache: a meta-analysis of controlled trials

Controlled clinical trials have consistently demonstrated that behavioral treatments for chronic benign headache produce clinically beneficial outcomes both post-treatment and at follow-up. Given these results there is interest in cost-reduction and redesign of these treatments to improve their accessibility. One promising approach in this regard is home-based headache treatment. These treatments seek to provide the same amount of treatment as clinic-based treatments; however, some of the material typically presented to the patient by a clinician is presented through home-study materials (e.g., manuals, audiotapes). To date, the published literature contains 20 controlled clinical trials which have examined the outcomes produced by home-based treatments. This article presents the first comprehensive meta-analysis of these clinical outcome studies. Results of the quantitative analyses suggest that home-based treatments produce comparable, or with certain outcome measures, superior results to clinic-based treatments. Moreover, cost-effectiveness scores of home-based treatments were found to be more than five times larger than those of clinic-based therapies. Methodological analyses are also presented along with suggestions for future research.     

Evaluation of the novel total artificial heart Realheart in a pilot human fitting study

Heart failure affects >26 million patients worldwide. Current cardiac devices save lives, but patients suffer complications. Hence, improved devices are needed. Realheart TAH is a novel total artificial heart which has shown promising results in acute pig studies. However, the device design needed to be evaluated in humans. Virtual implantations demonstrated the device fits in two of three patients, but that there was some interference with the left lung. Herein, we used an innovative 3D-printed model with swivelling device components to test the device in human cadavers. Our new method demonstrated how to optimize design to improve the surgical fit.     

Nosocomial pneumonia in the pediatric trauma patient: a single center's experience

OBJECTIVES: To evaluate a single center's experience with the frequency rate, patterns of occurrence, and impact on outcome of nosocomial pneumonia in the critically injured child. DESIGN: Retrospective review of prospectively collected data. SETTING: Level I university trauma center with a pediatric trauma intensive care unit. PATIENTS: A total of 523 consecutive critically injured children admitted to the pediatric intensive care unit during an 80-month interval. MEASUREMENTS AND RESULTS: Thirty-five episodes of nosocomial pneumonia were identified in 29 children (frequency rate of 5.5%). The mean age of the children was 9.2 yrs, and the mean Injury Severity Score was 27 +/- 9. In 91% of patients (26 children), nosocomial pneumonia was associated with mechanical ventilation. This represented a 13% frequency rate in injured children who were ventilated during the study period. The most common organisms recovered were Staphylococcus aureus (21%), Haemophilus influenzae (19%), Pseudomonas (11%), and Enterobacter (11%). Early pneumonia (diagnosed < or = 7 days after injury) was predominantly caused by Haemophilus species. In contrast, Enterobacter and/or Pseudomonas were isolated primarily in late pneumonia (diagnosed >7 days after injury). Staphylococcus was prominent throughout the hospitalization. Overall, children with nosocomial pneumonia were more severely injured (Injury Severity Score 27 vs. 17, p < .001) and had a longer hospital stay (26 vs. 7 days, p < .001). Despite this, mortality (6.9% vs. 7.9%, p = NS) was not significantly different from injured children without pneumonia. CONCLUSIONS: In this study of a single pediatric trauma center, nosocomial pneumonia occurred in a small but significant percentage of injured children. The frequency rate increased two- to three-fold with mechanical ventilation. Microbiology varied with day of onset. In contrast to the adult, mortality did not seem to be significantly altered by this complication. Analysis of additional pediatric trauma centers is encouraged to confirm these characteristics of nosocomial pneumonia in the injured child.