This study attempted to determine the underlying factors that may influence the development of peanut sensitization in young children in South Africa. One of our objectives was to ascertain whether the consumption of peanuts or peanut-containing foods during pregnancy and lactation by mothers from atopic families impacted upon the development of an allergic response to peanuts in the child. Forty-three children between the ages of 0 and 3 yr participated in this study. There were 25 peanut-sensitized subjects and 18 control subjects (children sensitized to milk and/or egg, but not to peanuts). A significant association was found between peanut sensitization and sensitivity to soya (p=0.0002), wheat (p=0.03), and cod fish. We found that mothers who consumed peanuts more than once a week during pregnancy were more likely to have a peanut-allergic child than mothers who consumed peanuts less than once a week (odds ratio=3.97, 98% confidence interval 0.73-24). Peanuts or peanut butter was introduced into the child's diet from a significantly younger age in the peanut-allergic subjects (p<0.03). There was a positive correlation in the peanut-allergic subjects between age of introduction of peanuts and age at the onset of symptoms (r=0.63). Exclusive breast feeding did not protect against the development of peanut sensitization. Peanut allergy is associated with an increased risk of sensitization to other foods. It is more likely to occur if mothers eat peanuts more frequently during pregnancy and introduce it early to the infant's diet. These features highlight potentially avoidable factors that might prevent sensitization.
Background
An “unscheduled absence” refers to an occurrence when an employee does not appear for work and the absence was without advance approval by an authorized supervisor. Recently we estimated the prevalence of unscheduled absences in a cohort of certified registered nurse anesthetists at the University of Miami. We performed a historical cohort study for all types of anesthesia practitioners at the University of Iowa.
Methods
Two-years of person-assignment days were studied. The total population was 62,951 regular operating room days among 293 people. There were 56,437 days among 203 practitioners with multiple workdays over multiple quarters.
Results
In the total population, the 91 nurse anesthetists had 1.48% person-days with an unscheduled absence, comparable to the 1.74% from University of Miami. Most unscheduled absences (99% lower confidence limit 80.1%) resulted in the person being absent from an operating room clinical assignment for just 1 day. Compared with nurse anesthetists, residents and fellows had proportionately fewer unscheduled absences (odds ratio 0.24 [0.13-0.45],
P
<.0001), as did anesthesiologists (0.49 [0.30-0.79],
P
=.0002). Among all practitioners, Mondays, Fridays, and days adjacent to holidays had significantly more unscheduled absences than Tuesdays, Wednesdays, and Thursdays (1.45 [1.19-1.76],
P
<.0001).
Conclusions
To have an adequate daily workforce, anesthesia clinical directors need to estimate the daily expected percentage of assigned anesthesia practitioners who will be absent. Potential inter-group differences should be considered. We provide a worked example showing how to use the results to decide numbers of practitioners to plan daily.
Ultrasound-guided block of the saphenous nerve at the adductor canal is not only noninferior but also superior to block at the distal transsartorial level in terms of success rate, with additional advantages of faster block onset time and better nerve visibility under ultrasound.
BackgroundThe American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the preoperative assessment. In early 2013, the Department of Anesthesia was notified that the distribution of ASA PS scores for sampled patients at the University of Iowa had recently begun to deviate from national comparison data. This change appeared to coincide with the transition from paper records to a new electronic Anesthesia Information Management System (AIMS). We hypothesized that the design of the AIMS was unintentionally influencing how providers assigned ASA PS values.MethodsPrimary analyses were based on 12-month blocks of data from paper records and AIMS. For the purpose of analysis, ASA PS was dichotomized to ASA PS 1 and 2 vs. ASA PS >2. To ensure that changes in ASA PS were not due to “real” changes in our patient mix, we examined other relevant covariates (e.g. age, weight, case distribution across surgical services, emergency vs. elective surgeries etc.).ResultsThere was a 6.1 % (95 % CI: 5.1–7.1 %) absolute increase in the fraction of ASA PS 1&2 classifications after the transition from paper (54.9 %) to AIMS (61.0 %); p < 0.001. The AIMS was then modified to make ASA PS entry clearer (e.g. clearly highlighting ASA PS on the main anesthesia record). Following the modifications, the AS PS 1&2 fraction decreased by 7.7 % (95 % CI: 6.78–8.76 %) compared to the initial AIMS records (from 61.0 to 53.3 %); p < 0.001. There were no significant or meaningful differences in basic patient characteristics and case distribution during this time.ConclusionThe transition from paper to electronic AIMS resulted in an unintended but significant shift in recorded ASA PS scores. Subsequent design changes within the AIMS resulted in resetting of the ASA PS distributions to previous values. These observations highlight the importance of how user interface and cognitive demands introduced by a computational system can impact the recording of important clinical data in the medical record.
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