Incidence and Predictor Variables of Pressure Injuries in Patients Undergoing Ventricular Assist Device and Total Artificial Heart Surgeries: An Eight-Year Retrospective Review

BACKGROUND Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored. OBJECTIVES To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year retrospective study of all patients undergoing VAD-TAH surgery at a large academic university medical center. METHODS The preferred reporting items for systematic reviews and meta-analyses or PRISMA statement guided this systematic review. Quality of evidence was determined using the Johns Hopkins Nursing Evidence-Based Practice Rating Scale. Two reviewers independently appraised manuscripts matching the eligibility criteria for study inclusion. Four databases including PubMed, CINAHL, Web of Science, Google Scholar, and hand searches of journals based on reference lists from included studies were utilized. Initial results of this primary search revealed zero studies that met inclusion and this search methodology was confirmed by medical librarian consultation. Therefore, a follow up retrospective study was necessary to identify incidence of PI in the VAD-TAH population. However, a secondary search, dropping keywords of VAD-TAH and instead focusing on studies of on-pump cardiac surgery and mixed surgical studies where cardiac surgery patients were included, was conducted to establish variables to guide a retrospective study of all VAD-TAH surgeries between 2010-2018. The retrospective study evaluated the incidence of pressure ulcers by case, patient and incidence density for each of the respective 1000 patient days during the study period. Univariate statistics are reported by four different VAD-TAH devices. Variables significant in bivariate analysis were entered in a stepwise logistic regression model. RESULTS In the systematic review, 312 articles were identified from the databases with eight additional articles from hand searches. Following abstract review, 208 were excluded for not meeting inclusion criteria or study quality metrics. 77 articles were read in full, with 61 excluded, leaving 16 articles for inclusion. 31 risk factors were identified for PI development in on-pump cardiac surgery patients with 11 risk factors which were identified as significant in multivariate analysis for inclusion in the retrospective study

Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis

BackgroundThe aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. Study DesignWe conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes—Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture—pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes—Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices—are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. ConclusionsThe WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for

Blunted cardiac stress reactors exhibit relatively high levels of behavioural impulsivity

Blunted physiological reactions to acute psychological stress are associated with a range of adverse health and behavioural outcomes. This study examined whether extreme stress reactors differ in their behavioural impulsivity. Individuals showing blunted (N = 23) and exaggerated (N = 23) cardiovascular reactions to stress were selected by screening a healthy student population (N = 276). Behavioural impulsivity was measured via inhibitory control and motor impulsivity tasks. Blunted reactors exhibited greater impulsivity than exaggerated reactors on both stop-signal, F(1,41) = 4.99, p = 0.03, ηp2 = 0.108, and circle drawing, F(1,43) = 4.00, p = 0.05, η p 2 = 0.085, tasks. Individuals showing blunted cardiovascular stress reactions are characterized by greater impulsivity which may contribute to their increased susceptibility to outcomes such as obesity and addiction

Spectropolarimetry of the Luminous Narrow-Line Seyfert Galaxies IRAS 20181-2244 and IRAS 13224-3809

We observed the narrow-line Seyfert 1 galaxies IRAS 20181-2244 and IRAS 13324-3809 with a new spectropolarimeter on the RC spectrograph at the CTIO 4m telescope. Previously it had been suggested that IRAS 20181-2244 was a Type 2 QSO and thus might contain an obscured broad-line region which could be detected by the presence of broad Balmer lines in the polarized flux. We found the object to be polarized at about 2%, and constant with wavelength, (unlike most narrow-line Seyfert 1s), but with no evidence of broad Balmer lines in polarized flux. The spectropolarimetry indicates that the scattering material is inside the BLR. IRAS 13224-3809, notable for its high variability in X-ray and UV wavelengths, has a low polarization consistent with a Galactic interstellar origin.Comment: 19 pages using (AASTEX) aaspp4.sty and 5 postscript figures To be published in the Astrophysical Journa

P-31 magnetization transfer measurements of P-i -> ATP flux in exercising human muscle

Fundamental criticisms have been made over the use of (31)P magnetic resonance spectroscopy (MRS) magnetization transfer estimates of inorganic phosphate (P(i))→ATP flux (V(Pi-ATP)) in human resting skeletal muscle for assessing mitochondrial function. Although the discrepancy in the magnitude of V(Pi-ATP) is now acknowledged, little is known about its metabolic determinants. Here we use a novel protocol to measure V(Pi-ATP) in human exercising muscle for the first time. Steady-state V(Pi-ATP) was measured at rest and over a range of exercise intensities and compared with suprabasal oxidative ATP synthesis rates estimated from the initial rates of postexercise phosphocreatine resynthesis (V(ATP)). We define a surplus P(i)→ATP flux as the difference between V(Pi-ATP) and V(ATP). The coupled reactions catalyzed by the glycolytic enzymes GAPDH and phosphoglycerate kinase (PGK) have been shown to catalyze measurable exchange between ATP and P(i) in some systems and have been suggested to be responsible for this surplus flux. Surplus V(Pi-ATP) did not change between rest and exercise, even though the concentrations of P(i) and ADP, which are substrates for GAPDH and PGK, respectively, increased as expected. However, involvement of these enzymes is suggested by correlations between absolute and surplus P(i)→ATP flux, both at rest and during exercise, and the intensity of the phosphomonoester peak in the (31)P NMR spectrum. This peak includes contributions from sugar phosphates in the glycolytic pathway, and changes in its intensity may indicate changes in downstream glycolytic intermediates, including 3-phosphoglycerate, which has been shown to influence the exchange between ATP and P(i) catalyzed by GAPDH and PGK

Clinical impact and diagnostic accuracy of 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography/computed tomography (PET/CT) brain imaging in patients with cognitive impairment: a tertiary centre experience in the UK

Aim To evaluate the clinical impact of combined 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography/computed tomography (PET/CT) brain imaging performed in selected patients with cognitive impairment at a tertiary referral centre in the UK, and to assess the accuracy of FDG PET/CT to correctly establish the diagnosis of Alzheimer's dementia (AD) in “real-world” clinical practice. Methods and materials Using an institutional radiology database, 136 patients were identified for inclusion in the study. FDG PET/CT was performed using a standard technique and interpreted by dual-trained radiologists and nuclear medicine physicians. Standardised questionnaires were sent to the referring clinicians to establish the final clinical diagnosis and to obtain information about the clinical impact of FDG PET/CT. Results There was a 72% questionnaire return (98/136), with mean patient follow-up of 471 (standard deviation 205) days. FDG PET/CT had an impact on patient management in 81%, adding confidence to the pre-test diagnosis in 43%, changing the pre-test diagnosis in 35%, reducing the need for further investigations in 42%, and resulting in a change in therapy in 32%. There was substantial correlation between the PET/CT diagnosis and final clinical diagnosis with a correlation (k) coefficient of 0.78 (p<0.0001). The accuracy of FDG PET/CT in diagnosis of AD was 94% (95% confidence interval [CI]: 87–99), with a sensitivity of 87% (95% CI: 75–92) and a specificity of 97% (95% CI: 87–99). Conclusion FDG PET/CT brain imaging has a significant clinical impact when performed selectively in patients with cognitive impairment and shows high accuracy in the diagnosis of AD in “real-world” clinical practice

Cardiovascular reactivity patterns and pathways to hypertension: a multivariate cluster analysis

Substantial evidence links exaggerated mental stress induced blood pressure reactivity to future hypertension, but the results for heart rate reactivity are less clear. For this reason multivariate cluster analysis was carried out to examine the relationship between heart rate and blood pressure reactivity patterns and hypertension in a large prospective cohort (age range 55–60 years). Four clusters emerged with statistically different systolic and diastolic blood pressure and heart rate reactivity patterns. Cluster 1 was characterised by a relatively exaggerated blood pressure and heart rate response while the blood pressure and heart rate responses of cluster 2 were relatively modest and in line with the sample mean. Cluster 3 was characterised by blunted cardiovascular stress reactivity across all variables and cluster 4, by an exaggerated blood pressure response and modest heart rate response. Membership to cluster 4 conferred an increased risk of hypertension at 5-year follow-up (hazard ratio=2.98 (95% CI: 1.50–5.90),