Abstract 361: The Significance of Higher Mean Arterial Pressure After Inpatient Cardiac Arrests in Improving Neurological Outcome and Mortality

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Manishkumar Patel ◽  
Sourabh Sourabh ◽  
Victoria Gonzalez ◽  
Ankita Aggarwal ◽  
Fred Bittner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Sample Size ◽  
Small Sample Size ◽  
Small Sample ◽  
Inclusion Criteria ◽  
Anoxic Brain Injury ◽  
Significant Difference

Following cardiac arrest and the return of spontaneous circulation (ROSC), hemodynamic status can be critically unstable which may lead to the hypoperfusion of vital organs and poor clinical outcomes. In post-cardiac arrest survivors, studies have shown improved outcomes with a higher mean arterial pressure (MAP) compared with a lower MAP, however an ideal range of MAP post-ROSC is rarely explicitly defined in post-resuscitation care studies. The purpose of this study was to observe neurological and mortality outcomes in cardiac arrest patients with a lower range of post-ROSC MAP compared to a higher range of post-ROSC MAP.A retrospective single-center cohort study was used to design the project. Patients who met the inclusion criteria suffered a cardiac arrest while admitted to the hospital, achieved ROSC, and survived for at least 48 hours post-ROSC. Patients whose status was changed to DNR by 48 hours post-ROSC were excluded. The remaining patients were divided into two groups. The lower MAP group had an average MAP of 60 to 80 mmHg and the higher MAP group had an average MAP of 80 to 100 mmHg at 48 hours post-ROSC. The primary outcome analyzed was the presence of anoxic brain injury noted on EEG. Secondary outcomes were the length of intubation, ICU length of stay (LOS), and mortality rate. Of the total of 129 patients, 18 patients met our inclusion criteria. Of these, 10 patients met the lower MAP group and 8 patients met the higher MAP group. Anoxic brain injury was 20% in the lower MAP group compared to 12.5% in the higher MAP group (p>0.05). There was a 40% mortality in the lower MAP group, compared to 12.5% mortality in the higher MAP group (p>0.05) 48 hours post-ROSC. The mean length of intubation was 3.5 days in the higher MAP group compared to 4.9 days in the lower MAP group (p>0.05). There was no difference in the ICU LOS amongst the two groups. Our results showed a clinically significant difference between the two groups but could not reach statistical significance due to the small sample size. The optimal MAP for post-cardiac arrest patients has not been clearly defined by clinical trials. The simultaneous need to perfuse the post-ischemic brain adequately without putting unnecessary strain on the post-ischemic heart is unique to the post-cardiac arrest syndrome. The findings of this study show post-ROSC MAP maintained between 80 to 100 mmHg had a statistically insignificant tendency toward better neurological outcomes, decreased length of intubation and improved mortality compared to the group whose MAP was maintained between 60 to 80 mmHg at 48 hours. The small sample size is a limitation for this study, however, this preliminary study has shown promising results and it is predicted that a bigger population study with similar parameters will extrapolate similar results.

scholarly journals Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Fushui Liu ◽  
Jianyu You ◽  
Qi Li ◽  
Ting Fang ◽  
Mei Chen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sample Size ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Small Sample ◽  
Control Group ◽  
Large Sample Size ◽  
Cure Rate ◽  
Significant Difference

Objectives. Acupuncture has been widely used to relieve chronic pain-related insomnia (CPRI). However, the efficacy of acupuncture for CPRI is uncertain. The purpose of this study was to evaluate the efficacy of acupuncture for CPRI. Methods. Seven electronic databases were searched from inception to December 2018. Randomized controlled trials (RCTs) were included if acupuncture was compared to sham acupuncture or conventional drug therapies for treating CPRI. Two reviewers screened each study and extracted data independently. Statistical analyses were conducted by RevMan 5.3 software. Results. A total of nine studies involving 944 patients were enrolled. The pooled analysis indicated that acupuncture treatment was significantly better than control group in improving effective rate (OR = 8.09, 95%CI = [4.75, 13.79], P < 0.00001) and cure rate (OR = 3.17, 95%CI = [2.35, 4.29], P < 0.00001), but subgroup analysis showed that there was no statistically significant difference between acupuncture and sham acupuncture in improving cure rate (OR =10.36, 95% CI [0.53, 201.45], P=0.12) based on one included study. In addition, meta-analysis demonstrated that acupuncture group was superior to control group in debasing PSQI score (MD = -2.65, 95%CI = [-4.00, -1.30], P = 0.0001) and VAS score (MD = -1.44, 95%CI = [-1.58, -1.29], P < 0.00001). And there was no significant difference in adverse events (OR =1.73, 95%CI = [0.92, 3.25], P =0.09) between the two groups. Conclusions. Acupuncture therapy is an effective and safe treatment for CPRI, and this treatment can be recommended for the management of patients with CPRI. Due to the low quality and small sample size of the included studies, more rigorously designed RCTs with high quality and large sample size are recommended in future.

scholarly journals Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients—a meta-analysis and systematic review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiayi Li ◽  
Mingyang Li ◽  
Bo-qiang Peng ◽  
Rong Luo ◽  
Quan Chen ◽  
...  
Keyword(s):  
Renal Transplant ◽  
Sample Size ◽  
Total Joint Arthroplasty ◽  
Small Sample Size ◽  
Joint Arthroplasty ◽  
Small Sample ◽  
Dialysis Patients ◽  
Transplant Patients ◽  
Significant Difference ◽  
Renal Transplant Patients

Abstract Objectives End-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular skeletal function are threats to implants’ survival, while for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients. Methods A literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies comparing TJA outcomes between renal transplant and dialysis patients. Two reviewers independently conducted literature screening and quality assessments with the Newcastle-Ottawa Scale (NOS). After the data were extracted, statistical analyses were performed. Results Compared with the dialysis group, a lower risk of mortality (RR = 0.56, Cl = [0.42, 0.73], P < 0.01, I2 = 49%) and revision (RR = 0.42, CI = [0.30, 0.59], P < 0.01, I2 = 43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR = 0.19, CI = [0.13, 0.23], P < 0.01, I2 = 0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups. Conclusion Total joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a relatively small sample size to detect the difference between renal transplant patients and dialysis patients.

scholarly journals Validity of WebCAAFE questionnaire for assessment of schoolchildren’s dietary compliance with Brazilian Food Guidelines

2016 ◽  
Vol 19 (13) ◽  
pp. 2347-2356 ◽  
Author(s):  
Emil Kupek ◽  
Maria Alice Altenburg de Assis ◽  
France Bellisle ◽  
Adriana Soares Lobo
Keyword(s):  
Public Schools ◽  
Food Intake ◽  
Sample Size ◽  
Direct Observation ◽  
Small Sample Size ◽  
Small Sample ◽  
Reporting Bias ◽  
Food Groups ◽  
Significant Difference ◽  
Moderate Bias

AbstractObjectiveTo estimate reporting bias of WebCAAFE, a web-based questionnaire for the assessment of food intake (recall of frequency of intake of thirty-two food items the day before) and physical activity in schoolchildren.DesignCross-sectional study. Self-reported food intake on WebCAAFE was compared with direct observation of school meals in five public schools. Additional data included school grade, sex, BMI, socio-economic status and access to Internet at home. Poisson regression was used to calculate the reporting bias (WebCAAFE v. direct observation) and the sample size necessary to detect a statistically significant difference between WebCAAFE reports and at least 75 % compliance with the recommendations for a healthy diet.SettingIntentional sample of five elementary public schools in Florianopolis, Brazil.SubjectsSchoolchildren (n 629) from 2nd to 5th grades.ResultsModerate bias magnitude was found for most food groups of interest. Frequency of consumption was not related to the bias. Sample sizes necessary to detect the compliance with dietary recommendations varied between four and seventy-four individuals for the different groups investigated.ConclusionsAfter adjusting for moderate bias, WebCAAFE may be used as a food questionnaire for evaluation of schoolchildren’s food compliance on a group level, even with a relatively small sample size.

Abstract 221: Mean Arterial Pressure and Impact on Organ Function and Survival During Targeted Temperature Management After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Johannes Grand ◽  
Christian Hassager ◽  
Matilde Winther-Jensen ◽  
Sebastian Wiberg ◽  
Jakob H Thomsen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Arrest ◽  
Brain Injury ◽  
Renal Replacement Therapy ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Organ Injury ◽  
Post Hoc Analysis ◽  
Post Hoc ◽  
Hospital Cardiac Arrest

Introduction: Hemodynamic instability is common after resuscitated out-of-hospital cardiac arrest (OHCA). However, data on hemodynamic treatment-goals are sparse. This study investigates mean arterial pressure (MAP) in patients surviving 48 hours after OHCA in relation to organ injury and survival as a post hoc analysis of a large multicenter trial cohort. Hypothesis: We hypothesized that low MAP during TTM was associated with more organ injury. Methods: Post-hoc analysis of the prospective randomized TTM-trial including 851 comatose OHCA patients surviving more than 48 hours with available blood pressure data. Neuron-specific enolase (NSE) (brain injury) was the primary endpoint and estimated glomerular filtration rate (eGFR) (renal function) was the secondary endpoint. Measurements and Main Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and >80 mmHg (35%). NSE at 24, 48 and 72 hours was inversely related to mean MAP: 28 ng/ml [95% confidence interval (CI) 24-33], 26 [23-29], 21 [19-24] ng/mL; p group =0.002 for low, intermediate and high MAP groups. After adjusting for potential confounders, this association remained significant (p group_adjusted =0.006). A similar result was seen for eGFR (p group_adjusted =0.003). Mean MAP was not associated with mortality after 180 days, however higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.75 [95% CI, 0.63-0.88] per 5 mmHg increase; p < 0.001]) (figure 1). Conclusions: Lower mean MAP during TTM was independently associated with increased biomarkers of brain injury and initiation of renal replacement therapy in a large cohort of comatose OHCA patients. Increasing blood pressure above the guideline-recommended threshold of 65 mmHg during TTM could potentially mitigate organ injury and be renal-protective. This hypothesis should be investigated in prospective trials.

scholarly journals Arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest and association with brain injury and long-term cognitive function

2019 ◽  
Vol 9 (4_suppl) ◽  
pp. S122-S130 ◽  
Author(s):  
Johannes Grand ◽  
Gisela Lilja ◽  
Jesper Kjaergaard ◽  
John Bro-Jeppesen ◽  
Hans Friberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Cognitive Function ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Neuron Specific Enolase ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Impaired Cognitive Function ◽  
Hospital Cardiac Arrest

Objectives: During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. Methods: Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4–28 hours after admission; <70 mmHg, 70–80 mmHg, >80 mmHg). A biomarker of brain injury, neuron-specific enolase, was measured and impaired cognitive function was defined as a mini-mental state examination score below 27 in 6-month survivors. Results: Of the 657 patients included in the present analysis, 154 (23%) had mean arterial pressure less than 70 mmHg, 288 (44%) had mean arterial pressure between 70 and 80 mmHg and 215 (33%) had mean arterial pressure greater than 80 mmHg. There were no statistically significant differences in survival ( P=0.35) or neuron-specific enolase levels ( P=0.12) between the groups. The level of target temperature did not statistically significantly interact with mean arterial pressure regarding neuron-specific enolase ( Pinteraction_MAP*TTM=0.58). In the subgroup of survivors with impaired cognitive function ( n=132) (35%) mean arterial pressure during targeted temperature management was significantly higher ( Pgroup=0.03). Conclusions: In a large cohort of comatose out-of-hospital cardiac arrest patients, low mean arterial pressure during targeted temperature management was not associated with higher neuron-specific enolase regardless of the level of target temperature (33°C or 36°C for 24 hours). In survivors with impaired cognitive function, mean arterial pressure during targeted temperature management was significantly higher.

scholarly journals The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest*

2019 ◽  
Vol 47 (7) ◽  
pp. 960-969 ◽  
Author(s):  
Mypinder S. Sekhon ◽  
Peter Gooderham ◽  
David K. Menon ◽  
Penelope M. A. Brasher ◽  
Denise Foster ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Brain Hypoxia ◽  
Hypoxic Ischemic Brain Injury

scholarly journals Assessment of elementary students’ understanding of differences in viral and bacterial infections, and education of proper antibiotic use

2019 ◽  
Author(s):  
Lesley Hahn ◽  
Umron Alkotob ◽  
Melanie Biegler ◽  
Claire Cooper ◽  
Yasmeen Daher ◽  
...  
Keyword(s):  
Sample Size ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Small Sample Size ◽  
Antibiotic Use ◽  
Small Sample ◽  
P Value ◽  
Community Members ◽  
Significant Difference ◽  
Post Test

Intro This project aimed to teach third grade students the differences between viral and bacterial infections through active learning. Presentation effectiveness and students’ retention of information were assessed using a game and post-quiz. This project addresses the school’s concern about the misunderstanding of causes and treatments of illnesses. Methods Students took a pre-quiz in order to establish their base knowledge of bacterial and viral infections. A question and answer style presentation was utilized to teach differences between viral and bacterial illnesses, as well as the appropriate management of each. An interactive game of “doctor and patient” was then played, during which students were given a bacterial or viral infection scenario and choose associated symptoms and management utilizing pre-made answer cards. Finally, a post-quiz was administered to determine short-term change in knowledge. Students were given an informational magnet and flyer to share with parents or guardians to re-enforce the information. Results Of the 20 participants that took the pre-quiz, only a subset of 18 were available to take the post-quiz. The overall analysis of post-test questions portrayed an increased number of correct answers after the presentation and game. Individually, question two was trending towards significance, with a p value of .08.  Despite a lack of significance, students overall scored higher on the post-quiz and were better able to distinguish between types of infections and determine proper management. Conclusion Parents often seek the use of antibiotics for their children even when viral infections are present, which do not warrant antibiotic interventions. Understanding the signs, symptoms, and differences between viral and bacterial infections may help community members seek appropriate care and may reduce requests for antibiotics. It is more likely that community members will use antibiotics correctly if they have a better understanding of when they are warranted. In future studies, with larger parameters, a significant difference can be made in children and their families’ understanding of antibiotics, reducing misuse and misunderstanding within the community as a whole. Limitations Given the overall small sample size in our study, the data were limited statistically and may not be generalizable. Additionally, two students that took the pre-test quiz were not available to take the post- test, further limiting our sample size. We did not pair data between the pre-test and post-test due to a desire to preserve student anonymity. This pairing may have allowed for further analysis of specific results.

scholarly journals Do children with mental disorders have higher prevalence of hypovitaminosis D?

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 159 ◽  
Author(s):  
Mini Zhang ◽  
Keith Cheng ◽  
Robert Rope ◽  
Elizabeth Martin ◽  
Ajit Jetmalani
Keyword(s):  
Vitamin D ◽  
Mental Disorders ◽  
Sample Size ◽  
Psychiatric Disorders ◽  
Psychiatric Symptoms ◽  
Small Sample Size ◽  
Hypovitaminosis D ◽  
Small Sample ◽  
Diagnostic Categories ◽  
Significant Difference

Inadequate vitamin D level is associated with various adverse medical outcomes. There is a growing concern that insufficient vitamin D may play a role in the development of psychiatric symptoms. This study aims to answer the question: do children with mental disorders have a higher prevalence of hypovitaminosis D? A retrospective chart review examined 25 hydroxyvitamin D (25(OH)D) levels in youth ages 7 to 17 (n=67) at two Oregon psychiatric residential facilities. Vitamin D deficiency is defined as <20 ng/ml and insufficiency as <30 ng/ml. Diagnoses were organized into six categories. 25(OH)D levels were compared across genders and diagnostic groups using a two-sample t-test and ANOVA, respectively. Statistical differences in prevalence across diagnostic categories were calculated using a Pearson chi-square test. Using the data from Saintonge’s NHANES III study on healthy US children for comparison, 21% of our cohorts were found to be vitamin D deficient and 64% insufficient, in contrast to 14% and 48%, respectively. While our results are not statistically significant, mainly because of small sample size, the overall mean 25(OH)D level in our cohort was insufficient (27.59 ± 9.35 ng/ml), compared to a sufficient mean value of 32.1 ng/ml in the general population. No statistical significant difference was found in the prevalence across diagnostic categories. This study found that children with psychiatric disorders might have a higher prevalence of hypovitaminosis D than the general pediatric population. Although a causal relationship between hypovitaminosis D and psychiatric disorders cannot be derived based on the study design, our study provides initial descriptive data on the prevalence of hypovitaminosis D in children with psychiatric disorders, which has not been previously reported to our knowledge. Prospective studies with a larger sample size and controlled variables would allow more precise analysis of the relationship between hypovitaminosis D and childhood mental disorders.

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