Comparison of heparin administration using the Rapidpoint Coag and Hepcon HMS

A retrospective chart review was conducted of patients who underwent cardiopulmonary bypass (CPB) to compare the quantities of heparin administered, postoperative blood loss, and homologous blood products transfused during their procedure and subsequent stay in the intensive care unit. The primary purpose of this review was to determine if any difference in heparin administration resulted when two different devices were used for dosing and monitoring heparin. Postoperative blood loss and amount of blood products transfused were also quantified, as any differences would potentially be a result of a difference in administration of heparin. The first group (n = 341) underwent CPB using the Hepcon HMS, Medtronic Inc., Minneapolis, MN, for heparin dosing and monitoring. The Rapid Point Coag, Bayer Healthcare LLC, Tarrytown, NY was used for the second group (n = 345). The two populations were compared for similarity on: age, body surface area (BSA), CPB time (minutes), aortic-cross clamp time (minutes), baseline activated clotting time, and baseline hematocrit. No significant difference was found between the two groups. The second group, using the Rapidpoint Coag, received less heparin during CPB than the group using the Hepcon HMS. In addition, there were decreases in amounts of some blood products transfused as well as mediastinal drainage from the Hepcon HMS to the Rapidpoint Coag group. A summary of the findings can be found in Table 1. A secondary purpose of this study was to determine the influence of hemodilution on the Heparin Management Test (HMT). Citrated whole blood was diluted to varying degrees at various concentrations to determine whether hemodilution with crystalloid would alter the HMT measurements. At all heparin levels and degrees of dilution, the HMT remained stable, with coefficients of variation (CV) of less than 5% at all heparin levels even while incorporating excessive crystalloid dilution (up to 75%).     

Musculoskeletal response to exercise is greatest in women with low initial values

INTRODUCTION: The "initial values" principle of exercise training states those with the lowest initial values of a physiologic system have the greatest capacity for improvement in response to training. We sought to determine whether initial values predicted the musculoskeletal response to training in premenopausal women (N = 31) who participated in a 1-yr program of resistance and jump training designed to improve physical indices of fracture risk. Significant improvements in trochanteric bone mineral density (BMD), hip abductor strength, power, and postural stability occurred in response to training. METHODS: To determine the predictive power of initial values, we performed separate stepwise regression analyses for each variable including the following dependent variables: age, initial value, highest weight lifted during training, and total number of exercise sessions attended. RESULTS: In each case, the initial value was the most significant predictor of percent change in response to training. Initial values explained 15-29% of the variance in the magnitude of the training response. For each unit lower BMD of the greater trochanter (0.01 g.cm-2), the training response was 12% greater. For each unit decrease in initial strength (1 N.m), power (1 W), and stability (1 SI unit), the training response was 1.0%, 0.2%, and 8.0% greater, respectively. When categorized by quartile of initial values, women in the lowest quartile had two- to fivefold greater improvements in musculoskeletal measures than those in the upper quartile. CONCLUSION: Women who began training with the lowest initial values had the greatest improvements in hip BMD, hip abductor strength, leg power, and postural stability. These results support the training principle of initial values and suggest that this training program may be most successful in premenopausal women with lower values of musculoskeletal indices of fracture risk.     

Food for trans-Atlantic rowers: a menu planning model and case study

Every 4 years, rowers from around the world compete in a 50- to 60-day trans-Atlantic rowing challenge. These ultra-distance rowers require a diet that provides adequate calories, protein, vitamins, minerals, and fluids so they can perform well day after day, minimize fatigue, and stay healthy. Yet, the rowers are confronted with menu planning challenges. The food needs to be lightweight, compact, sturdy, non-spoiling in tropical temperatures, calorie dense, easy to prepare, quick to cook, and good tasting. Financial concerns commonly add another menu planning challenge. The purpose of this case study is to summarize the rowers' food experiences and to provide guidance for sports nutrition professionals who work with ultra-endurance athletes embarking on a physical challenge with similar food requirements. The article provides food and nutrition recommendations as well as practical considerations for ultra-distance athletes. We describe an 8,000 calorie per day menu planning model that uses food exchanges based on familiar, tasty, and reasonably priced supermarket foods that provide the required nutrients and help contain financial costs.     

Pretreatment predictors of time to cancer specific death after prostate specific antigen failure

PURPOSE: Whether pretreatment factors that predict for time to prostate specific antigen (PSA) failure also predict for time to prostate cancer specific death after PSA failure for patients with competing causes of mortality treated during the PSA era was the subject of this study. MATERIALS AND METHODS: Of 415 men with a median age of 73 years who underwent external beam radiation therapy between 1988 and 2001 for clinically localized prostate cancer 160 (39%) experienced PSA failure and 96 (23%) died. In 46 men (48%) the cause of death was prostate cancer. Cox regression multivariable analyses (multivariable analysis) were performed to evaluate the ability of the pretreatment PSA and centrally reviewed biopsy Gleason score to predict time to prostate cancer specific death after PSA failure. RESULTS: When analyzed as categorical variables using multivariable analysis, biopsy Gleason score 4 + 3 (p = 0.02), 8 to 10 (p = 0.02) disease and a pretreatment PSA greater than 20 ng./ml. (p = 0.03) were significant predictors of time to prostate cancer specific death after PSA failure. Estimates of prostate cancer specific death 5 years after PSA failure were 24%, 40% and 59% (p = 0.01) for patients with a biopsy Gleason score < or = 6, 3 + 4, 4 + 3 or higher and 22%, 40% and 60% (p = 0.04) for patients with a pretreatment PSA of 10 or less, greater than 10 and 20 or less, or greater than 20 ng./ml., respectively. CONCLUSIONS: Patients at high risk for PSA failure after radiation therapy based on pretreatment PSA greater than 20 ng./ml. or biopsy Gleason score 4 + 3 or greater are also at high risk for death from prostate cancer after PSA failure despite competing causes of mortality.     

Dietary Sodium in Chronic Kidney Disease: A Comprehensive Approach

Despite existing guidelines, dietary sodium intake among people worldwide often exceeds recommended limits. Research evidence is growing in both animal and human studies showing indirect and direct adverse consequences of high dietary sodium on the kidney. In patients with kidney disease, dietary sodium may have important effects on proteinuria, efficacy of antiproteinuric pharmacologic therapy, hypertension control, maintaining an optimal volume status, and immunosuppressant therapy. Dietary sodium intake is an important consideration in patients with all stages of chronic kidney disease, including those receiving dialysis therapy or those who have received a kidney transplant. We review in detail the dietary sodium recommendations suggested by various organizations for patients with kidney disease. Potential barriers to successfully translating current sodium intake guidelines into practice include poor knowledge about the sodium content of food among both patients and providers, complex labeling information, patient preferences related to taste, and limited support for modifications in public policy. Finally, we offer existing and potential solutions that may assist providers in educating and empowering patients to effectively manage their dietary sodium intake.     

Lower risk of urinary tract infection with low‐dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid‐withdrawal immunosuppression regimen

Giullian JA, Cavanaugh K, Schaefer H. Lower risk of urinary tract infection with low‐dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid‐withdrawal immunosuppression regimen.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01129.x
© 2009 John Wiley & Sons A/S. Abstract: Background: Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low‐dose TMP/SMZ also reduces the risk of PCP, although its ability to reduce the risk of UTI is uncertain. Design: Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression. Results: Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early because of an adverse reaction. Urinary infection occurred in 16% without a significant difference in the risk of UTI between those treated with dapsone vs. those treated with TMP/SMZ (HR [95%CI]: 1.7 [0.75, 3.9], p = 0.2). In the subset of patients who were older than age 47 yr (mean age for this cohort, SD ± 6.2 yr), those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR [95%CI]: 4.3 [1.2, 15.5], p = 0.024). Conclusions: For renal transplant recipients over the age of 47 yr, treated without long‐term glucocorticoids, our retrospective data suggest that low‐dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.     

Queensland Alcohol-related violence and Night-time Economy Monitoring (QUANTEM): Rationale and overview

This commentary introduces the special section on the outcomes of the Queensland Alcohol-related violence and Night-time Economy Monitoring project and outlines the political and policy context of the interventions put in place under the Queensland government's Tackling Alcohol-Fuelled Violence strategy. The development of the strategy was informed by alcohol policy initiatives trialled in other major Australian cities over the past two decades. The articles in this special section examine the impact of the Tackling Alcohol-Fuelled Violence policy stages on alcohol-related harms and local economies across selected entertainment precincts (Safe Night Precincts). A rich array of data were utilised, including administrative health and justice data, data reflective of nightlife trading (i.e. foot traffic data, ID scanner data and live music performances) and street surveys. Findings have implications for research, policy and practice and demonstrate the need for comprehensive evaluations that can accommodate the complexities of modern alcohol policy in Australia.     

Effects of Maternal Nutritional Supplements and Dietary Interventions on Placental Complications: An Umbrella Review,Meta-Analysis and Evidence Map

The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-eclampsia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).