Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.     

Prolonged corrected QT interval in hospitalized patients with coronavirus disease 2019 in Dubai,United Arab Emirates: a single-center, retrospective study

ObjectiveTo evaluate the association of a prolonged corrected QT (QTc) interval in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its association with in-patient mortality.MethodsA cohort of 745 patients were recruited from a single center between 1 March 2020 and 31 May 2020. We analyzed the factors associated with a prolonged QTc and mortality.ResultsA prolonged QTc interval >450 ms was found in 27% of patients admitted with SARS-CoV-2 infection. These patients were predominantly older, on a ventilator, and had hypertension, diabetes mellitus, or ischemic heart disease. They also had high troponin and D-dimer concentrations. A prolonged QTc interval had a significant association with the requirement of ventilator support and was associated with an increased odds of mortality. Patients who died were older than 55 years, and had high troponin, D-dimer, creatinine, procalcitonin, and ferritin concentrations, a high white blood cell count, and abnormal potassium concentrations (hypo- or hyperkalemia).ConclusionsA prolonged QTc interval is common in patients with SARS-CoV-2 infection and it is associated with worse outcomes. Older individuals and those with comorbidities should have an electrocardiogram performed, which is noninvasive and easily available, on admission to hospital to identify high-risk patients.     

囊型包虫病综合性防治试点研究初报

目的在新疆北部囊型包虫病流行区,开展以包虫病防治新技术为主的综合性防治措施。考核和评价预防控制效果,探讨现阶段适宜于这一地区的包虫病预防控制模式。方法选择地理条件、生产类型和民族组成诸方面有代表性的乡为单位开展试点工作。在政府主导下实施健康教育、以有偿服务的方式对居民进行包虫病普查、对病人进行药物治疗、对家犬皮下埋植吡喹酮缓释药棒控制传染源作为主要预防控制措施。以预防包虫病基本知识的问卷调查结果、7岁儿童血清抗体水平调查结果、1岁龄绵羊包虫病患病率调查结果和家犬粪抗原检测结果等为监测指标,考核和评价预防控制包虫病的效果。结果在试点第3年末进行考核的结果为:居民对预防包虫病的四项基本知识和感染包虫病的风险行为的知晓率提高了30%-70%;7岁儿童血清抗体阳性率从试点前的28%-37.7%下降至8.0%-16.0%;绵羊包虫病患病率从50.6%下降为13.6%;家犬粪抗原阳性率从19.5%-43.2%下降至1.0% -1.98%。3个试点县中有2个县通过有偿服务的收入支付防治工作的开支后略有节余。结论试点研究的结果表明本次执行的在政府主导下,以健康教育为先导,采取有偿服务的方式,推行综合性防治措施的模式具有支撑技术先进、高效;指标明确,易于掌握和操作;适应性强;深受群众和干部的欢迎。可在较短的时间内取得显著的预防控制效果并实现防治工作的可持续发展。     

Prediction of no‐reflow and major adverse cardiovascular events with a new scoring system in STEMI patients

Background

No‐reflow is associated with a poor prognosis in STEMI patients. There are many factors and mechanisms that contribute to the development of no‐reflow, including age, reperfusion time, a high thrombus burden, Killip class, long stent use, ejection fraction ≤40, and a high Syntax score. In this study, we aimed to evaluate the parameters associated with no‐reflow prediction by creating a new scoring system.

Methods

The study included 515 consecutive STEMI patients who underwent PCI; 632 STEMI patients who had undergone PCI in another center were included in the external validation of the scoring system. The correlations between 1‐year major adverse cardiac events and low/high risk score were assessed.

Results

In this study, seven independent variables were used to build a risk score for predicting no‐reflow. The predictors of no‐reflow are age, EF ≤40, SS ≥22, stent length ≥20, thrombus grade ≥4, Killip class ≥3, and pain‐balloon time ≥4 h. In the derivation group, the optimal threshold score for predicting no‐reflow was >10, with a 75% sensitivity and 77.7% specificity (Area under the curve (AUC) = 0.809, 95%CI: 0.772‐0.842, P < 0.001). In the validation group, AUC was 0.793 (95%CI: 0.760‐0.824, P < 0.001).

Conclusion

This new score, which can be calculated in STEMI patients before PCI and used to predict no‐reflow in STEMI patients, may help physicians to estimate the development of no‐reflow in the pre‐PCI period.     

Role of environmental factors in autism spectrum disorders in Saudi children aged 3-10 years in the Northern and Eastern regions of Saudi Arabia

Objectives:To study the environmental factors which can contribute to the development of autism spectrum disorders in Saudi children aged 3-10 years in Northern region (Arar) and Eastern region (Dammam) in the Kingdom of Saudi Arabia.Methods:A case control study was conducted and the data was collected from September 2017 to December 2017 by interviewing the parents of 100 Saudi autistic children and 100 normal children aged 3-10 years from Arar and Dammam. A specially designed questionnaire was used to collect the data which includes socio-demographic characteristics of the parents and ante-natal history of the mother and developmental history, social history and dietary habits of the child. To find out the association between environmental factors and development of autism in children, logistic regression with odds ratio used.Results:There was a significant association between consanguineous marriages and autism. A significant association was also found between medications taken by the mother during pregnancy and autism. Significantly lowered ORs for Autism were observed for children in families of perceived adequate income and children consuming a Vitamin-D rich diet. Increased maternal age was observed in autistic children when compared to normal children.Conclusion:The environmental factors which could contribute to the development of autism are consanguineous marriage, inadequate family income, medications taken by the mother during pregnancy, vitamin D deficient diet of the child and maternal age during pregnancy.

Autism spectrum syndrome (ASD) consists of a group of developmental disorders that are difficult to detect without trained personnel. It is characterized by qualitative impairments in social interaction, qualitative impairments in communication, and restricted repetitive, stereotyped patterns of behavior, interests, and activities.1 The number of children diagnosed with autism spectrum disorder is rising.2,3 It is not clear whether it is due to better detection and reporting or a real increase in the number of cases.4,5 Many factors can contribute to increase in prevalence estimates including changes in diagnostic criteria and specialized diagnostic tools.The causes of autism remain unclear even though genetic and environmental factors may play a role in increasing the risk of autism. Researchers claim that toxic food contaminants like mercury can affect metabolism and alter neuronal plasticity and cause autism in children.6 Studies have shown that supplementation with Vitamin D and Tryptophan is an affordable solution to prevent autism.7 According to one study, high iron intake decreases autism.8 Other risk factors that increase the chance of having a child with autism are consanguinity, advanced parental age, and maternal lifestyle.9-11 Vaccinations are sometimes cited as a cause of autism, but there is no definite evidence to prove it.12According to World health organization (WHO) fact sheet published in April 2017, one in 160 children have autism spectrum disorder. Despite its increasing rate, currently autism remains untreatable.13 Most of the research in the field of autism has been conducted in Western countries. In the Arab world, the research conducted in the field of autism is relatively less. Autism was not the subject of interest in the region until the late 1990s. Lack of awareness and culture as well as lack of resources contribute to the unmet needs of autism patients in the region.14 The males diagnosed with autism are 4 times more when compared to females.Although various studies have been conducted in ASD’s etiology across the world, only few scientific researches have been conducted in Middle East especially in Kingdom of Saudi Arabia (KSA).15 Also, dietary habits should be looked into as they could help in identifying high risk foods that could affect their children.16 The present study was therefore undertaken to explore the various environmental factors including dietary factors which can contribute to the development of autism.     

Cutaneous silent period in myofascial pain syndrome

Introduction: An increased response to painful stimuli without spontaneous pain suggests a role of central hyperexcitability of pain pathways in the pathogenesis of myofascial pain syndrome (MPS). In this study we aimed to test the hypothesis that spinal pain pathways are affected in MPS. We used cutaneous silent period (CSP) parameters to demonstrate the hyperexcitability of spinal pain pathways in MPS. Methods: Twenty‐nine patients diagnosed with MPS and 30 healthy volunteers were included in the study. The CSP recordings were performed in the right upper and left lower extremities. Results: In both upper and lower extremities, patients had prolonged CSP latencies (P = 0.034 and P = 0.049 respectively) and shortened CSP durations (P = 0.009 and P = 0.008, respectively). Discussion: Delayed and shortened CSP in MPS patients implies dysfunction in the inhibitory mechanism of the spinal/supraspinal pain pathways, suggesting central sensitization in the pathogenesis of MPS and supporting our research hypothesis. Muscle Nerve 57 : E24–E28, 2018     

Evaluation of a professional development training programme for mental health clinicians specializing in early psychosis

The Early Psychosis Prevention and Intervention Centre Statewide Services (ESW) team provides training for multidisciplinary clinicians that specialise in early psychosis across the State of Victoria, Australia. The aim of this paper is to describe the 4‐phase approach utilised by ESW to prepare for and deliver workshops, to report on participants’ ratings of the ESW workshops, and to make recommendations for other trainers of early psychosis clinicians. Between March 2009 and September 2014, ESW provided 85 training workshops that had a strong focus on evidence‐based approaches and international guidelines, and utilized clinical examples of early psychosis interventions. At the conclusion of each workshop, participants were asked to complete a questionnaire that comprised qualitative and quantitative elements. These assessed perceived trainer knowledge, learning, interactivity and specific topic feedback. The focus of this paper will be on describing the quantitative data resulting from these questionnaires. A total of 1708 clinicians provided feedback on the 85 workshops. There was a high level of compliance, with 83.0% of workshop participants completing the questionnaires. Feedback was positive across all areas, with the 2 areas that were most highly endorsed being that presenters “appeared to know their subject matter well” (endorsed by 98.4% of participants) and that “topics were explained well” (endorsed by 96.8% of participants). Training for early psychosis clinicians that focusses on core clinical topics, is well planned, incorporates feedback from previous training, and is based on adult learning principles, is likely to be effective and well received by early psychosis clinicians.