Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital

Context

Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.

Reasons for drinking less and their relationship to sustained remission from problem drinking

AIMS: To compare representative general population and treated samples on their reasons for drinking less and whether particular reasons were related to sustained remission from problem drinking for either group. PARTICIPANTS AND DESIGN: A total of 659 problem drinking adults in a Northern California county identified through a probability survey in the general population (n = 239) and a survey of consecutive admissions to public and private alcohol and drug programs (n = 420), who reported drinking less at the one-year follow-up and provided reasons for reducing their drinking, were assessed 1-, 3-, and 5-years post-baseline regarding their problem drinking status. MEASUREMENTS: Logistic regression models were used to predict sustained remission from problem drinking. RESULTS: While the treated sample endorsed a majority of reasons in significantly higher proportions than the general population sample, the same three reasons were significant for both groups in predicting sustained remission from problem drinking: hitting rock bottom, experiencing a traumatic event and undergoing a spiritual awakening. Interventions by medical personnel and family members were either non-significant predictors or significantly negatively related to sustained improvement for both general population and treated problem drinkers. CONCLUSIONS: General population and treatment samples have similar reasons for cutting down as they relate to sustained remission from problem drinking.     

Development of a parent-proxy quality-of-life chronic cough-specific questionnaire: clinical impact vs psychometric evaluations

BACKGROUND: Chronic cough affects at least 7% of children, and the impact of this on families is significant. Although adult cough-specific quality-of-life (QOL) instruments have been shown to be a useful cough outcome measure, no suitable cough-specific QOL for parents of children with chronic cough exists. This article compares two methods of item reduction (clinical impact and psychometric) and reports on the statistical properties of both QOL instruments. METHOD: One hundred seventy children (97 boys and 73 girls; median age, 4 years; interquartile range, 3 to 7.25 years) and one of their parents participated. A preliminary 50-item parent cough-specific QOL (PC-QOL) questionnaire was developed from conversations with parents of children with chronic cough (ie, cough for > 3 weeks). Parents also completed generic QOL questionnaires (eg, Pediatric Quality of Life Inventory, version 4.0 [PedsQL4.0] and the 12-item Short Form Health Survey, version 2 [SF-12v2]). RESULTS: The clinical impact and psychometric method of item reduction resulted in 27-item and 26-item PC-QOL questionnaires, respectively, with approximately 50% of items overlapping. Internal consistency among the final items from both methods was excellent. Some evidence for concurrent and criterion validity of both methods was established as significant correlations were found between subscales of the PC-QOL questionnaire and the scales of the SF-12v2 and PedsQL4.0 scores. The PC-QOL questionnaire derived from both methods was sensitive to change following an intervention. CONCLUSION: Chronic cough significantly impacts on the QOL of both parents and children. Although the PC-QOL questionnaires derived from a clinical impact method and from a psychometric method contained different items, both versions were shown to be internally consistent and valid. Further testing is required to compare both final versions to objective and subjective cough measures.     

生活行为综合干预妊娠期糖尿病的效果评价

目的：探讨生活行为综合干预对妊娠糖尿病（GDM）患者临床预后的影响,为完善干预策略提供理论依据。方法：238例GDM患者随机分为对照组和干预组。对照组给予常规健康教育,实验组实施基于健康教育、膳食干预、运动干预、心理干预等生活行为综合干预。SPSS统计学软件分析评价两种干预方法的干预效果。结果：干预前,实验组与对照组基线资料中年龄、怀孕前体重、怀孕前BMI、文化程度、家族史、家庭年收入等均无差异（P>0.05）。干预后,实验组患者BMI、餐后血糖、甘油三酯、总胆固醇较干预前的降低量大于对照组,且均有统计学差异（P<0.05）,但两组患者高密度脂蛋白及低密度脂蛋白的变化无统计学差异（P>0.05）;干预后,对照组出现早产（29.0%）、巨大儿（20.2%）的概率高于实验组（χ2=5.11, P=0.024; χ2=4.20, P=0.040）,对照组患者并发妊娠高血压（6.5%）的概率高于实验组（3.5%）（P<0.05）。结论：综合干预在患者一般临床结局及改善妊娠相关并发症结局方面均优于对照组,值得进一步在大人群中推广应用。     

Carga de la mortalidad por diabetes mellitus en América Latina 2000-2011: los casos de Argentina,Chile, Colombia y México

ObjectiveTo analyze trends in mortality in Argentina, Chile, Colombia and Mexico, between 2000 and 2011, by sex and 5-year age groups (between 20 and 79 years of age).Material and methodsMortality vital statistics and census data or projected population estimates were used for each country. Age-specific mortality rates and the years of life lost were calculated.ResultsAmong the countries analyzed, Mexico had the highest mortality rate and lost the most years of life due to diabetes. Between 2000 and 2011, Mexicans lost an average of 1.13 years of life, while Colombia (0.24), Argentina (0.21) and Chile (0.18) lost considerably fewer life years. In general, deaths from diabetes were higher in men than in women except in Colombia. Nearly 80% of years of life lost due to diabetes occurred between 50 and 74 years of age in the four countries.DiscussionDiabetes is a huge challenge for Latin America, especially in Mexico where mortality due to diabetes is accelerating. Even though the proportion of deaths due to diabetes in Argentina, Chile and Colombia is smaller, this disease figures among the main causes of death in these countries.     

Environmental exposures,breast development and cancer risk: Through the looking glass of breast cancer prevention

This review summarizes the report entitled: Breast Cancer and the Environment: Prioritizing Prevention, highlights research gaps and the importance of focusing on early life exposures for breast development and breast cancer risk.     

Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic Type 1 (insulin-dependent) diabetic patients

The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1(insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) than in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts). Evaluation of quality of life in patients receiving a kidney and pancreas transplantation showed an improvement in psychological well-being, when compared to patients receiving a kidney transplantation alone. Physical well-being was similar in patients transplanted with kidney and pancreas or with kidney alone.     

Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal

Introduction and Aims

Shorter patient delays are associated with a better prognosis for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). This study aimed to identify predictors of patient delay in the Portuguese population.

Health-Related Quality-of-Life after Percutaneous Coronary Intervention in Patients with UA/NSTEMI and STEMI: the Korean Multicenter Registry

Compared with ST elevation myocardial infarction (STEMI), long-term outcomes are known to be worse in patients with unstable angina/non-STEMI (UA/NSTEMI), which might be related to the worse health status of patients with UA/STEMI. In patients with UA/NSTEMI and STEMI underwent percutaneous coronary intervention (PCI), angina-specific and general health-related quality-of-life (HRQOL) was investigated at baseline and at 30 days after PCI. Patients with UA/NSTEMI were older and had higher frequencies in female, diabetes and hypertension. After PCI, both angina-specific and general HRQOL scores were improved, but improvement was much more frequent in angina-related HRQOL of patients with UA/NSTEMI than those with STEMI (44.2% vs 36.8%, P < 0.001). Improvement was less common in general HRQOL. At 30-days after PCI, angina-specific HRQOL of the patients with UA/NSTEMI was comparable to those with STEMI (56.1 ± 18.6 vs 56.6 ± 18.7, P = 0.521), but general HRQOL was significantly lower (0.86 ± 0.21 vs 0.89 ± 0.17, P = 0.001) after adjusting baseline characteristics (P < 0.001). In conclusion, the general health status of those with UA/NSTEMI was not good even after optimal PCI. In addition to angina-specific therapy, comprehensive supportive care would be needed to improve the general health status of acute coronary syndrome survivors.