Aim: To study the influence of prednisone dose during the first month after systemic lupus erythematosus (SLE) diagnosis (prednisone-1) on glucocorticoid burden during the subsequent 11 months (prednisone-2-12). Methods: 223 patients from the Registro Español deLupus Eritematoso Sistémico inception cohort were studied. The cumulative dose of prednisone-1 and prednisone-2-12 were calculated and recoded into a four-level categorical variable: no prednisone, low dose (up to 7.5 mg/day), medium dose (up to 30 mg/day) and high dose (over 30 mg/day). The association between the cumulative prednisone-1 and prednisone-2-12 doses was tested. We analysed whether the fourlevel prednisone-1 categorical variable was an independent predictor of an average dose >7.5 mg/day of prednisone-2-12. Adjusting variables included age, immunosuppressives, antimalarials, methyl-prednisolone pulses, lupus nephritis and baseline SLE Disease Activity Index (SLEDAI).Results: Within the first month, 113 patients (51%) did not receive any prednisone, 24 patients (11%) received average low doses, 46 patients (21%) received medium doses and 40 patients (18%) received high doses. There was a strong association between prednisone-1 and prednisone-2-12 dose categories (p<0.001). The cumulative prednisone-1 dose was directly associated with the cumulative prednisone-2-12 dose (p<0.001). Compared with patients on no prednisone, patients taking medium (adjusted OR 5.27, 95% CI 2.18 to 12.73) or high-dose prednisone-1 (adjusted OR 10.5, 95% CI 3.8 to 29.17) were more likely to receive prednisone-2-12 doses of >7.5 mg/day, while patients receiving lowdose prednisone-1 were not (adjusted OR 1.4, 95% CI 0. 0.38 to 5.2). If the analysis was restricted to the 158 patients with a baseline SLEDAI of ≥6, the model did not change.
Introduction: An effective and standardized communication anticipates and limits the appearance of possible adverse events. Objective: To evaluate the effect of the implementation of a handoff program in reducing the frequency of adverse events (AE) in Paediatric Intensive Care Units (PICUs). Methods: Facility-based, cluster randomised stepped wedge trial in six Argentine PICUs, with more than 20 admissions per month. The intervention comprised a Spanish version on the I-PASS Handoff Bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises and observation and standardized feedback of handoffs. Results: We recruited 6 cluster PICUs in 5 hospitals. We reviewed 1465 medical records (MR). We did not observed differences in the rates of preventable AE per 1000 days of hospitalization (control 60.4 [37.5 - 97.4] vs. intervention 60.4 [33.2 - 109.9], p=0.3568, RR:1.21 [CI95%:0.80 - 1.83]), and no changes in the categories or types of AE. We evaluated 847 handoffs. Compliance with all items in verbal and written handoff was significantly higher in the intervention group. We observed a longer time per patient to complete the handoff in the intervention group (7.29 minutes [5.77 - 8.81] vs. 5.96 [4.69 - 7.23]; p <0.0002, RR:1.33 [CI95%:0.64 - 2.02]), without changes in the whole time used for handoff (control: 35.7 [29.6 - 41.8] vs. intervention: 34.7 [26.5 - 42.1]; p = 0.4900, RR:1.43 [CI95%:-2.63 - 5.49]). Perception of improved communication from provider did not show changes. Conclusions: After the implementation of the I-PASS bundle, improvement in the quality of handoffs was observed. Nevertheless, no differences were observed in the frequency of AE, nor in the perception of improved communication.
BackgroundThere are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes’ effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).MethodsFacility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.ResultsWe reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5–97.4) vs intervention 60.4 (33.2–109.9), p=0.99, risk ratio: 1.0 (0.74–1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6–41.8) vs intervention 34.7 min (26.5–42.1); difference 1.43 min (95% CI −2.63 to 5.49, p=0.49)). The providers’ perception of improved communication did not change.ConclusionsAfter the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs’ frequency or the perception of enhanced communication.Trial registration numberNCT03924570
Introducción: La adherencia a prácticas basadas en la evidencia (PBE) permite una mejor gestión del proceso salud-enfermedad en pacientes críticos, existiendo una estrecha relación entre su cumplimiento y la calidad alcanzada. Nos propusimos mejorar la adherencia a PBE en pacientes internados en una Unidad de Cuidados Intensivos Pediátrico (UCIP) y mejorar los indicadores de calidad de la atención. Métodos: Estudio controlado, tipo antes-después de una implementación, desarrollado en la UCIP del Hospital General de Niños Pedro de Elizalde (HGNPE), que involucró a todos los pacientes internados en el período 01/12/2019 al 31/08/2020. La implementación consistió en una lista de verificación (LV) que incluía 27 PBE, segmentadas en 10 áreas de mejoras. Se consideró adherencia a la LV si cumplía el 80% de las PBE. Resultados: Durante el período de estudio ingresaron a la UCIP del HGNPE 153 pacientes. Los grupos pre-intervención y post-intervención, fueron similares en requerimientos de asistencia respiratoria mecánica (ARM) y mortalidad preestablecida. En la última etapa, la adherencia a la lista aumento un 23% (p<0,001). La tasa de uso de ARM experimentó el mayor descenso (18%, p=0,033). En relación a los indicadores de calidad, se evidenció una disminución de los episodios de neumonía asociada a ARM (p=0,002) e infección asociada a sonda vesical (p=0,001). No hubo diferencias en la estadía ni en la mortalidad en UCIP. Conclusión: La implementación de una LV permitió aumentar el cumplimiento de las distintas PBE estudiadas, una menor tasa de uso de ARM y reducción en la tasa de infecciones asociadas a dispositivos.
Chronic hypoxia in high altitude constitutes an associated factor for fetal growth restriction, even when there is genetic adaptation, as observed in studies performed in populations living at high altitudes (Tibet, Andes, Europe and North America). Socioeconomic and nutritional deprivation is frequently observed in those populations, being also associated to fetal growth. Objective: To analyze anthropometric measures at birth in relation with altitude, and to assess the effect of maternal nutrition status, socioeconomic conditions and altitude on those measures. Population and methods: The study was based on the information registered in the Perinatal Information System (SIP -Clap-OPS) by the provincial team from the province of Jujuy and forwarded to national level, between 1996 -1998. Variables included pre-gestational BMI, maternal weight gain, maternal education, birth weight (BW), length at birth (LB), and head circumference (HC). Cases were grouped in three categories according to the altitude of the institution where the childbirth was attended: 84.1% R1, 5.8% R2 and 10.1% R3, being the latter the area at higher altitude (Puna). Confounding variables were controlled by exclusion and analytical tools. Results: From 25,811 registries, 24,651 with complete information were selected. Mean BW was 3259 Ϯ 538 g in R1; 3162 Ϯ 420 in R2, and 3080 Ϯ 483 in R3, with a difference of 179 grams between R1 and R3, (F 110.7; p Ͻ 0.001) and 209 g between R1 and R3 (F 199; p Ͻ 0.001) in term deliveries. In this group, LB difference was 0.3 cm (Fϭ274,9, pϽ0.001), and HC difference was 0.6 cm (F102.7; p Ͻ 0.001) between low and highlands (R1 and R3, respectively). Multivariate analysis, by linear regression, showed a final model to predict BW ϭ -1557.4 183.2 * birth at high altitude ϩ 28.9 * parity ϩ 13.3 * 8.7 BMI ϩ 8.7 * maternal weight gain ϩ 113.3 * gestational age at birth ϩ ⌺. Conclusion: Altitude influences BW significantly. Nevertheless, nutritional and social factors have a direct and sinergic relationship with BW. Background. Reduced iron is one of the most commonly used iron fortificants, because of its low cost and lack of chemical reactivity. The bioavailability of this fortificant has not been reliably measured in humans because of technical difficulties. Objective. To assess iron bioavailability of wheat flour fortified with reduced iron. Methods. Homemade bread fortified with two reduced iron compounds was produced. We used an in vitro digestion and the Caco-2 cells model to measure the bioavailability of two types of reduced Fe (8 and Ͼ20 m particle size), using ferritin formation by Caco-2 cells and intracellular Fe concentration as indicators of Fe incorporated to the enterocyte. Results. In vitro digestion experiments showed higher values of solubility and dialyzability of reduced-8 m Fe compared to reduced Ͼ20 m Fe. Intracellular iron and ferritin concentrations in Caco-2 cells exposed to digest from bread fortified with reduced-8 m Fe were higher than in bread fortified with reduced Ͼ20 m Fe. When brea...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.