secondary outcome measure
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Author(s):  
Courtney Cox ◽  
Krishna Patel ◽  
Rebecca Cantu ◽  
Chary Akmyradov ◽  
Katherine Irby

OBJECTIVE: Status asthmaticus is commonly treated in pediatric patients by using continuous albuterol, which can cause hypokalemia. The primary aim of this study was to determine if serial potassium monitoring is necessary by examining treatment frequency of hypokalemia. METHODS: This retrospective analysis was performed in 185 pediatric patients admitted with status asthmaticus requiring continuous albuterol between 2017 and 2019. All patients were placed on intravenous fluids containing potassium. The primary outcome measure was the treatment of hypokalemia in relation to the number of laboratory draws for potassium levels. The secondary outcome measure was hypokalemia frequency and relation to the duration and initial dose of continuous albuterol. RESULTS: Included were 156 patients with 420 laboratory draws (average, 2.7 per patient) for potassium levels. The median lowest potassium level was 3.40 mmol/L (interquartile range, 3.2–3.7). No correlation was found between initial albuterol dose and lowest potassium level (P = .52). Patients with hypokalemia had a mean albuterol time of 12.32 (SD, 15.76) hours, whereas patients without hypokalemia had a mean albuterol time of 11.50 (SD, 12.53) hours (P = .29). Potassium levels were treated 13 separate times. CONCLUSIONS: The number of laboratory draws for potassium levels was high in our cohort, with few patients receiving treatment for hypokalemia beyond the potassium routinely added to maintenance fluids. Length of time on albuterol and dose of albuterol were not shown to increase the risk of hypokalemia. Serial laboratory measurements may be decreased to potentially reduce health care costs, pain, and anxiety surrounding needlesticks.


2022 ◽  
Vol 11 ◽  
pp. 3
Author(s):  
Hyginus Okechukwu Ekwunife ◽  
Emmanuel Ameh ◽  
Lukman Abdur-Rahman ◽  
Adesoji Ademuyiwa ◽  
Emem Akpanudo ◽  
...  

Background:  Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes.  Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9).  Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.


BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056471
Author(s):  
Ellen M Driever ◽  
Anne M Stiggelbout ◽  
Paul L P Brand

ObjectivesTo assess whether consultants do what they say they do in reaching decisions with their patients.DesignCross-sectional analysis of hospital outpatient encounters, comparing consultants’ self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters.SettingLarge secondary care teaching hospital in the Netherlands.Participants41 consultants from 18 disciplines and 781 patients.Primary and secondary outcome measureWith the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION)5 instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM).ResultsConsultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION5 scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION5 score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION5 scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001).ConclusionsThe limited patient involvement that we observed was not associated with the consultants’ self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.


2021 ◽  
pp. 175045892110640
Author(s):  
Benjamin Thomas Vincent Gowers ◽  
Michael Sean Greenhalgh ◽  
Kathryn Dyson ◽  
Karthikeyan P Iyengar ◽  
Vijay K Jain ◽  
...  

Background: Hip fractures are common presentations to orthopaedic departments, and their surgical management often results in blood transfusions. Compared with general anaesthesia, regional anaesthesia reduces the need for transfusions and mortality in the wider surgical population. Aims: In hip fracture patients, our primary outcome measure was to examine any relationship between anaesthetic modality and transfusion rates. The secondary outcome measure was to assess the relationship between anaesthetic modality and one-year mortality. Methods: A retrospective cohort study of 280 patients was carried out in 2017 and 2018. Data were collected from patient records, local transfusion laboratory and the national hip fracture database. Results: A total of 59.6% had regional and 40.4% general anaesthesia. Regional anaesthesia patients were younger with fewer comorbidities (p < .05). About 19.8% regional and 34.5% general anaesthesia patients received transfusions (odds ratio (OR) = 0.47, p < .05); 13.6% were taking anticoagulants and were less likely to receive a regional anaesthetic (31.6% versus 64%, OR = 0.26, p < .05). One-year mortality was 27% for regional and 37% for general anaesthetic patients (OR = 0.64, p = .09). Conclusion: Regional anaesthesia halved the risk of blood transfusion. Anticoagulated patients were 74% less likely to receive regional anaesthetics, but had no additional transfusion risk. With optimisation, a larger proportion of patients could have regional anaesthesia.


Author(s):  
Christine Studenmund ◽  
Jazzmin Williams ◽  
Antonio Hernandez ◽  
Elda Young ◽  
Ying Ying Hui ◽  
...  

BACKGROUND: Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS: With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS: From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering “Quit Kits” with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION: In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e047663
Author(s):  
Rui An ◽  
Feng Zhao ◽  
Liqian Wang ◽  
Jikang Shan ◽  
Xianjun Wang

ObjectiveTo evaluate the predictive effect of molecular and clinical characteristics for the efficacy of anti-programmed cell death 1 (PD-1)/programmed cell death ligand-1 (PD-L1) immunotherapy in patients with non-small cell lung cancer (NSCLC).DesignSystematic review and meta-analysis.SettingTwelve randomised controlled trials (RCTs) with 7442 patients were retrieved from all over the world.MethodsElectronic databases were searched for eligible RCTs. The HRs and 95% CIs for overall survival (OS) and progression‐free survival (PFS) for the whole and subgroup population were extracted for meta-analysis using Review Manager V.5.3 software.Primary and secondary outcome measureOS was the primary outcome and PFS was the secondary outcome.ResultsTwelve RCTs with 7442 patients were included. For the trial population, anti-PD-1/PD-L1 immunotherapy significantly improved OS (HR=0.78, 95% CI 0.70 to 0.86, p<0.00001) and objective response rate (ORR) (risk ratio=1.37, 95% CI 1.08 to 1.74, p=0.009). Subgroup analysis results showed an improved OS at PD-L1≥1%, ≥5% and ≥50% levels, and a longer PFS at PD-L1≥5% and ≥50% levels. Moreover, OS and PFS benefits were observed in the non-first line treatment, squamous cell carcinoma histology, male, smoking, non-central nervous system (CNS) metastasis, epidermal growth factor receptor (EGFR) wild-type and Kirsten rat sarcoma viral oncogene homolog (KRAS) mutant subgroups.ConclusionsAnti-PD-1/PD-L1 immunotherapy significantly improved OS and ORR and reduced the rate of Adverse Events (AEs) compared to chemotherapy. PD-L1 expression, line of therapy, histology, sex, smoking history, CNS metastases, EGFR and KRAS mutational status might be potential predictors for the therapeutic effect of anti-PD-1/PD-L1 immunotherapy in specific patients with NSCLC.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charles M. Medert ◽  
Catherine Q. Sun ◽  
Elizabeth Vanner ◽  
Richard K. Parrish ◽  
Sarah R. Wellik

Abstract Background The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD). Methods This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision. Results One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation. Conclusions In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.


BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0132
Author(s):  
Nasir Wabe ◽  
Judith Thomas ◽  
Gorkem Sezgin ◽  
Muhammad Kashif Sheikh ◽  
Emma Gault ◽  
...  

BackgroundThere has been a precipitous rise telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice.Design and SettingThis multisite, retrospective observational study used de-identified routinely collected electronic health data extracted from 806 general practices in Victoria and New South Wales (NSW), Australia between April-December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data are reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) Classification System level one groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13,608,216 consultations satisfied the inclusion criteria (61% face-to-face and 39% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication– a statistically significant difference (adjusted OR 1.38; 95% CI 1.379–1.381). The prescribing rate was greater for face-to-face vs telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared to telehealth consultations in the study population.


2021 ◽  
Vol 6 (9) ◽  
pp. 425-432
Author(s):  
Robert Allan McCulloch ◽  
Amirul Adlan ◽  
Scott Evans ◽  
Michael Parry ◽  
Jonathan Stevenson ◽  
...  

Abstract. Introduction: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. Patients and methods: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50–84) and were followed up for a mean of 50.4 months (range 2–128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was recurrent infection. Results: Flap survival was 100 % with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48 % (13 of 27 infected cases). Using limb salvage as the outcome, 77 % (23 of 30 patients) retained the limb. Infection recurrence occurred in 48 % (10 patients) in the type B3 cohort and 67 % (4 patients) in the type C3 cohort (p=0.65). Conclusions: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.


2021 ◽  
Author(s):  
RL Jessup ◽  
C Bramston ◽  
P Putrik ◽  
C Haywood ◽  
M Tacey ◽  
...  

Abstract BackgroundSuccessful public health responses to pandemics rely on individuals being able to access, clearly understand and easily interpret relevant information about symptoms, prevention, testing and containment strategies. Accessing and interpreting information during the pandemic has been difficult for many populations, particularly those experiencing social or economic disadvantage. The aim of this study was to understand how a population of frequent hospital users originating, from a disadvantaged population, have accessed and interpreted information during the COVID pandemic in Melbourne.MethodsCross sectional telephone survey of 200 frequent hospital users (115 with limited English proficiency) informed by the World Health Organisation’s “Rapid, simple, flexible behavioural insights on COVID-19”. Primary outcome measures included knowledge of symptoms, preventive strategies, government restrictions aimed at containment, and belief in misleading information. Secondary outcome measure was perceived trustworthiness of information which was measured using content analysis of open-ended questions. ResultsOverall, the survey participants had poor understanding of misleading information (69%). 41.2% were unable to accurately identify symptoms, while 35.8% were unable to identify preventative strategies. Just under 1/3 (30.2%) were unable to describe government restrictions. English-speaking participants were almost three times (OR 2.69, 95%CI 1.47;4.91) more likely tohave adequate knowledge about symptoms, were twice as likely to understand local restrictions (OR 2.10 95%CI 1.06; 4.19) and were 11 times more likely to recognise information that was misleading or incorrect (OR 11.52 95%CI 5.39; 24.60) than those with limited English. 50% of those surveyed stated that theytrusted all information that they read or heard, with on 20% stating that they were uncertain or untrusting of some information.ConclusionLimited English proficiency was strongly associated with inadequate knowledge of COVID-19 and much greater likelihood of believing widely circulating misinformation. In order to reduce transmission, morbidity and mortality associated with COVID-19, health authorities must tailor health messaging to disadvantaged populations to ensure they have adequate access, and understanding, of the information.


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