Maternal rehospitalization after singleton term vaginal delivery

Objective: To determine risk factors for maternal rehospitalization after term vaginal delivery. Study design: The study group consisted of all women who were rehospitalized following singleton vaginal deliveries during 1996-1998 (n = 194). The control group consisted of 427 women who were not rehospitalized during the same period. Results: The incidence of rehospitalization was 0.75% (194/25 885). Maternal chronic diseases, preterm contractions and pre-eclampsia rates were significantly higher among the study group as compared to the controls (25.3% vs. 8.4%, p < 0.001; 6.7% vs. 2.8%, p = 0.022; 9.3% vs. 4.9%, p = 0.037, respectively). Duration of labor was significantly longer in the study group as opposed to the controls (379 ± 406 min vs. 259 ± 276 min, p < 0.001). The rates of postpartum hemorrhage, blood transfusion and antibiotic treatment during delivery hospitalization were significantly higher among the study group (1.5% vs. 0.2%, p = 0.021; 4.6% vs. 0.7%, p < 0.001; 26.8% vs. 14.1%, p < 0.001, respectively). Using a forward logistic regression analysis, prolonged labor and blood transfusion during labor were found as independent risk factors associated with rehospitalization (OR 1.001, 95% CI 1.001-1.002, p = 0.001; OR 4.751, 95% CI 1.698-13.292, p = 0.003). In contrast, vertex presentation had a protective effect against rehospitalization (p = 0.027, OR 0.084, 95% CI 0.009-0.758). Conclusions: Blood transfusion and prolonged labor are independent risk factors for rehospitalization after term vaginal delivery. Special attention should be given during the early postpartum period to patients receiving blood transfusions and those with prolonged deliveries, in order to reduce rehospitalization rates.     

Efficacy of a single dose of antenatal steroid in surfactant-treated babies under 31 weeks' gestation

Objectives: Antenatal steroids in labor improve the outcome in preterm babies. The objective in this retrospective study was to compare the efficacy of one dose of antenatal steroid against the standard course in surfactant-treated babies. Methods: A total of 226 babies treated with prophylactic surfactant and under 31 weeks' gestation were divided into three groups: group 1 (n = 89), no antenatal steroids; group 2 (n = 68), one dose of antenatal steroids 4-24 h before delivery; and group 3 (n = 69), two or more doses of antenatal steroids 24 h to 7 days before delivery. The three groups were compared for early clinical well-being and ultimate clinical outcome. Results: Apgar and Clinical risk index for babies (CRIB) scores in groups 2 and 3 were similar and both were significantly better than in group 1. Group 2 babies had a 23.5% reduction in serious intraventricular hemorrhage (IVH) (p < 0.0001, relative risk (RR) 0.2 (95% CI 0.07-0.54), numbers needed to treat (NNT) 4.6) and a 22.9% reduction in death (p < 0.001, RR 0.28 (95% CI 0.12-0.63), NNT 4.4) and group 3 babies had a 21.1% reduction in IVH (p < 0.001, RR 0.25 (95% CI 0.10-0.62), NNT 4.6) and a 24.2% reduction in death (p < 0.001, RR 0.23 (95% CI 0.10-0.57), NNT 4.2) compared to group 1. For these parameters, there was no significant difference between groups 2 and 3. Conclusions: One dose of antenatal steroids given 4-24 h before delivery was clinically comparable to the recommended schedule of the National Institutes of Health in surfactant-treated preterm infants. Should the findings of this study be confirmed in randomized controlled trials, the dosage regimen could be simplified, steroid administration reduced and the interval from delivery reduced in acute clinical conditions.     

Post total knee arthroplasty: age as a factor in early post-surgical outcome

Abstract

Total knee arthroplasty has been well documented in the literature as a successful means of alleviating pain and improving function in end-stage osteoarthritis. Improvement is greatest within a 3–6-month period with more gradual improvement up to 2 years. Analysis of improvement in the early post surgical stage (i.e. up to 6 weeks) is less well documented in the literature. As life expectancy increases in the industrialised world, the number of elderly people requiring total knee arthroplasty will continue to rise. Initial evaluation of the literature revealed a sparsity of studies which assessed if the benefits of total knee arthroplasty applied equally to the elderly population. This review examined the literature which evaluated the effect of age on early recovery after knee arthroplasty; 13 studies were assessed, 6 small clinical studies and 7 comparative studies. No evidence of a relationship between age, pre-operative status or early postoperative outcome was found and there was also limited evidence to support no relationship between the two variables. The effect of age on discharge destination and rehabilitation requirement is also inconclusive. However, methodical considerations such as the limited number of quality trials available for review impact on the overall conclusions of this review.     

A Structured Observational Method to Assess Dermal Exposure to Manufactured Nanoparticles: DREAM as an Initial Assessment Tool

Abstract

Preliminary results of inventories of exposure scenarios for nanomaterials have indicated possible dermal exposure. Within the NANOSH project focused on occupational safety and health aspects of nanotechnology a shortened version of the observational DeRmal Exposure AssessMent (DREAM) method was used as an initial method to assess dermal exposure. A total of 45 tasks (such as bagging, dumping, and cleaning) involving different manufactured nanoparticles (MNPs) such as carbon nanotubes, fumed silica, and cerium oxide, were observed in industrial and research facilities. In 39 tasks potential dermal exposure (that is, exposure of the skin and clothing) was likely to occur. Exposure resulted from different routes, including direct contact with MNPs as well as the deposition or transfer of MNPs. The survey showed it is both feasible and useful to assess the potential dermal exposure using shortened DREAM questionnaires.     

Hyponatremia and Fractures: Findings From the MrOS Study

Hyponatremia may be a risk factor for fracture. To determine the relationship between hyponatremia and fracture we conducted cross‐sectional and longitudinal analyses using data from the Osteoporotic Fractures in Men (MrOS) study. The MrOS study enrolled 5122 community dwelling men aged ≥65 years from six centers across the United States. We excluded men taking bisphosphonates, those with unknown medication history, those without serum sodium measures, or those with out of range assays for serum sodium. Serum sodium was measured at study entry. Subjects were followed for fractures (nonspine [including hip], hip, incident morphometric, and prevalent morphometric) for up to 9 years. We used Cox proportional hazards models to analyze the association between serum sodium levels (<135 mmol/L versus ≥135 mmol/L) and risk of nonspine and hip fractures, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs). We examined the association between morphometric vertebral fractures and serum sodium using logistic regression models, presented as odds ratios (ORs) and 95% CI. Hyponatremia was observed in 64 men (1.2% of the cohort). After adjusting for age, BMI, study center, and other covariates, we found that, compared to men with serum sodium ≥135 mmol/L, those with serum sodium <135 mmol/L, had an increased risk of hip fracture (HR = 3.04; 95% CI, 1.37 to 6.75), prevalent morphometric spine fracture (OR = 2.46; 95% CI, 1.22 to 4.95), and incident morphometric spine fracture (OR = 3.53; 95% CI, 1.35 to 9.19), but not nonspine fracture (OR = 1.44; 95% CI, 0.85 to 2.44). Adjusting for bone mineral density (BMD) did not change our findings. Our data show that hyponatremia is associated with up to a doubling in the risk of hip and morphometric spine fractures, independent of BMD. Further studies, to determine how hyponatremia causes fractures and if correction of hyponatremia decreases fractures, are needed. © 2014 American Society for Bone and Mineral Research.     

Association of Chronic Obstructive Pulmonary Disease and Smoking Status With Bone Density and Vertebral Fractures in Male Lung Cancer Screening Participants

We studied the vertebral fracture prevalence on low‐dose chest computed tomography (CT) in male lung cancer screening participants and the association of fractures and bone density with chronic obstructive pulmonary disease (COPD) and smoking. 1140 male current and former smokers with ≥16.5 packyears from the NELSON lung cancer screening trial were included. Age, body mass index, and smoking status were registered. CT scans and pulmonary function tests were obtained on the same day. On CT, vertebral fractures and bone density were measured. The cohort had a mean age of 62.5 years (standard deviation 5.2) old; 531 (46.6%) had quit smoking; and 437 (38.3%) had COPD. Of the group, 100 (8.8%) participants had a vertebral fracture. Fracture prevalence was higher in current compared to former smokers (11.3% versus 5.8%, p = 0.001), but similar in participants with COPD compared to those without (9.6% versus 8.3%, p = 0.430). The multivariable adjusted odds ratio for fracture presence was 1.79 (95% CI: 1.13–2.84) in current smokers and 1.08 (95% CI: 0.69–1.67) in COPD participants. Bone density was lower in current compared to former smokers (103.2HU versus 108.7HU, p = 0.006) and in participants with COPD compared to those without [100.7 Hounsfield Units (HU) versus 108.9HU, p < 0.001]. In multivariate analysis, smoking status and COPD status were independently associated with bone density, corrected for age and body mass index. In conclusion, our study shows that lung cancer screening participants have a substantial vertebral fracture burden. Fractures are more common in current smokers, who also have lower bone density. We could not confirm that COPD is independently associated with vertebral fractures. © 2014 American Society for Bone and Mineral Research.     

SGLT2 Inhibitors and Cardiovascular Outcomes: Do They Differ or There is a Class Effect? New Insights from the EMPA-REG OUTCOME trial and the CVD-REAL Study

A new group of hypoglycemic drugs has been used to treat diabetes type 2. This group is active sodium glucose co-transporter (SGLT2) or SGLT2 inhibitors. It has been shown that besides the treatment of diabetes, this drug class is responsible for the mildness of the cardiovascular events shown in patients with diabetes type 2. However, there is an intriguing question regarding the range of SGLT2 inhibitors and if there is a difference between them or if there is a class effect among their results. EMPA-REG OUTCOME trial and the CVD-study are used to answer this question. Additional information from the DECLARE-TIMI 58 and Dapa-HF trials is studied.     

Individual Differences in Perceived Information Processing Styles in Stress and Coping Situations: Development and Validation of the Perceived Modes of Processing Inventory

A new self-report instrument was constructed toassess a person's awareness and perception of his or herdominant mode of information processing in stress andcoping situations. The items were based on Epstein's (1990) cognitive-experientialself-theory, which distinguishes between rational andexperiential information processing. Exploratory andconfirmatory factor analyses found that this instrument is measuring three different perceivedprocessing styles: (1) rational processing, (2)emotional processing, and (3) automatic processing.Collectively, these measures were named the PerceivedModes of Processing Inventory (PMPI). Data supporting thereliability and criterion validity of the PMPI werepresented. In general, perceived rational processing wasmost strongly and consistently related to adaptiveproblem focused coping and positive psychologicalwell-being. Perceived emotional processing was relatedto adaptive emotion-focused coping (expressing emotions,seeking social support), but it was also related to more psychological distress and less positivewell-being.     

Five per cent of the time it works 100 per cent of the time: the erroneousness of the P value

Abstract

Background and Aim: Dizziness or vertigo is a frequent complication of whiplash injury and reported in 40% -80% of cases. The term dizziness covers a wide range of symptoms. Characteristics of the neuro-otological signs in patients with whiplash associated disorders (WAD) remains a subject of debate. It has been reported that whiplash injury is a cause of benign paroxysmal positional vertigo (BPPV). The aim of the present study was to document the incidence of BPPV in whiplash-patients referred for manual therapy. Methods: All patients with whiplash injuries referred by a physician (60%) or by a medical specialist (40%), were examined following a standard protocol (history-taking and neuro-otological assessment). A key diagnostic manoeuvre for BPPV is the Dix and Hallpike positional test. Subjects: In a five-year period, 368 patients were referred. Based on four inclusion criteria, 273 patients were included in the study. All gave their informed consent. Statistical Analysis: Non-parametric statistics are used, based on the measurement level of the tests (dichotomous and ordinal level). Results: BPPV was suspected as a result of history-taking in 96 (35%) of 273 patients. A positive Dix and Hallpike response was seen in 68 (25%) of 273 patients; 56 of these patients were assessed as typical (positional vertigo and rotatory nystagmus) and 12 patients as atypical (positional dizziness and no rotatory nystagmus). Conclusion: The incidence of suspected BPPV is anamnestically 35% and clinically 25%. There is a discrepancy between neuro-otological signs and symptoms. The prognosis of BPPV is considered good with peripheral and central adaptation within 6 to 12 weeks. No spontaneous recovery occurred in our patients. Discussion: The results of this study highlight the need for the manual therapist to differentiate between patients with whiplash with a clinical entity (for example, [suspected] BPPV) and patients with whiplash injury without a clinical entity. Therapeutic implications for both groups of whiplash patients are given.     

High Voltage Stimulation (HVS) for Enhanced Healing of Wounds

Abstract

High voltage stimulation (HVS) influences tissue repair at the level of the wound environment. This article discusses research findings and clinical use of HVS for enhancement of wound healing. A brief review of theories and current scientific rationale for use of HVS is provided. Included is a brief examination of research dealing with high voltage peak current, and wound healing processes. This article summarises recent developments and trends in the use of HVS for healing in order to facilitate clinicians' decision-making capabilities, and their understanding of treatment options.