Plos One
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Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery associated with increased morbidity and mortality. Although sustained hyperglycemia is a known risk factor of AF and poor ICU outcomes, emerging in-vitro studies reveal acute glycemic fluctuations to be an additional independent predictor of AF. The effect of acute glycemic fluctuations on the incidence of POAF in the clinical setting remains unclear. We aim to investigate the effect of the magnitude of acute perioperative glycemic fluctuations on the incidence of POAF in a multi-ethnic Southeast-Asian population. ⋯ Increased magnitudes of acute perioperative glycemic fluctuations are associated with a significantly increased risk of POAF and length of ICU stay; and should therefore be minimised but balanced against the risks of hypoglycemia so as to avoid POAF and optimise patient outcomes.
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The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. ⋯ Younger adults are significantly more likely as older counterparts to use the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.
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Sport-related concussion (SRC), a mild form of traumatic brain injury (TBI), is a common injury in contact sports. Health care professionals rely on subjective criteria (e.g., symptoms), as there is no objective marker for identification of athletes with SRC. Blood-based biomarkers have shown promise as diagnostic and prognostic tools following TBI and SRC. ⋯ Further, no difference was found between preseason baseline and all post-SRC samples for tau (p = 0.22) or NF-L (p = 0.98). The total number of symptoms reported on the Standardized Assessment of Concussion- 3rd Edition (SCAT3) and associated symptom severity scores increased from preseason to 6-days post-SRC but returned to baseline values at 14-days (p = 0.02 and p = 0.003, respectively). These results suggest that the severity of neuronal injury in this cohort of contact sport athletes with clinical uncomplicated SRC was too low to be detected by tau and NF-L measurements in blood samples obtained at 6- and 14-days post-injury.
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Review Meta Analysis
The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials.
Adverse drug events (ADEs) impose a major clinical and cost burden on acute hospital services. It has been reported that medicines reconciliation provided by pharmacists is effective in minimizing the chances of hospital admissions related to adverse drug events. ⋯ Pharmacists-led interventions were effective in reducing medication discrepancies. However, these interventions did not lead to a significant reduction in potential and preventable ADEs and healthcare utilization.
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Review Meta Analysis
The relationship between famine exposure during early life and body mass index in adulthood: A systematic review and meta-analysis.
Previous epidemiologic studies have reported famine exposure during early life association with overweight or obesity in adulthood, but a consistent perspective has not been established to date. ⋯ The systematic review and meta-analysis indicates that famine exposure during early life may increase BMI, the risk of overweight and obesity, especially for female, fetal famine exposure or subject age less than 50. Furthermore, famine exposure group the risk of overweight and obesity in cross-sectional studies, Asian studies, famine cause by natural disaster or paper published from 2015 to the present studies are higher than that of non-exposed group.