BackgroundThe World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3–6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain.MethodsWe conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy.Main resultsOf the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies (n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema (n = 6) and dysnatraemia (n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures (N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates (N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85).ConclusionsDespite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1006-1) contains supplementary material, which is available to authorized users.
Methods Prospective data analysis of all babies born between 25th April and 31st July 2020 with confirmed or suspected EONS who were referred to the Hospital at Home service. Data collected included demographic information such as gestation and birth weight, C-reactive protein measurements, blood and cerebrospinal fluid culture results, timing of discharge and the total number of intravenous antibiotic doses given at home. A post-treatment questionnaire was undertaken to assess parental feedback. Results In total, 41 neonatal patients were referred to the Hospital at Home service over the study period. On average, babies received four doses of intravenous cefotaxime at home, resulting in a reduction of two inpatient treatment days per patient, and 85 inpatient treatment days across the study period. One patient required a trip to hospital for repeat cannulation. No patients required re-admission to hospital during the study period. A post-treatment questionnaire was universally positive with parents evaluating the service as 'efficient, professional and so much easier being comfortable at home.' There were no negative comments. Conclusions A neonatal Hospital at Home service is effective in reducing the length of inpatient stay for babies undergoing treatment of EONS. With an average reduction of two inpatient days per patient, the service not only provides an improved maternal and family experience, but also reduces the inpatient workload on postnatal wards and is a significant cost-saving initiative. More research is required to formalise the referral criteria and assess whether additional neonatal services such as phototherapy could also be provided in the home setting.
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On the other hand, antenatal care shown a protective gradient reducing the risk of SGA by 33% (OR 0.67, 95%CI, 0.64, 0.69), 25% (OR 0.75, 95%CI, 0.71, 0.78) and 23% (0.77, 95%CI, 0.73, 0.82) starting at the first, second and third trimester, respectively. Conclusions Data mining was useful to demonstrate how maternal education and other social determinants influence the proportion of SGA babies who start their lives under significant disadvantages. This digital profiling would be useful to gain visibility of nulliparous women with delayed education who are at the highest risk of having vulnerable newborn babies. Early contact with health care is the best opportunity to reduce SGA live births. Women's access to health care, schooling, and social security are modifiable factors that are feasible to target by political and financial policies.
Objective: To investigate the extent and qualitatively synthesize open science practices within research published in the top five sports medicine journals from 01 May 2022 and 01 October 2022. Design: Meta-research systematic review Data Sources: MEDLINE Eligibility Criteria: Studies were included if they were published in one of the identified top five sports medicine journals as ranked by Clarivate. Studies were excluded if they were systematic reviews, qualitative research, grey literature, or animal or cadaver models. Results: 243 studies were included. The median number of open science practices met per study was 2, out of a maximum of 12 (Range: 0-8; IQR: 2). 234 studies (96%, 95% CI: 94-99) provided an author conflict of interest statement and 163 (67%, 95% CI: 62-73) reported funding. 21 studies (9%, 95% CI: 5-12) provided open access data. 54 studies (22%, 95% CI: 17-27) included a data availability statement and 3 (1%, 95% CI: 0-3) made code available. 76 studies (32%, 95% CI: 25-37) had transparent materials and 30 (12%, 95% CI: 8-16) included a reporting guideline. 28 studies (12%, 95% CI: 8-16) were pre-registered. 6 studies (3%, 95% CI: 1-4) published a protocol. 4 studies (2%, 95% CI: 0-3) reported the availability of an analysis plan. 7 studies (3%, 95% CI: 1-5) reported patient and public involvement. Conclusion: Sports medicine open science practices are extremely limited. The least followed practices were sharing code, data, and analysis plans. Without implementing open practices, barriers concerning the ability to aggregate findings and create cumulative science will continue to exist.
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