Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department—Convenience or necessity?

Background Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary.Methods The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose.Results A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink.Conclusions More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis

Effect of exercise on epicardial adipose tissue in adults: a systematic review and meta-analyses

According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD − 0.57, 95%CI − 0.97 to − 0.18) and waist circumference (MD − 2.95 cm, 95%CI − 4.93 to − 0.97). Exercise did not have an effect on BMI (MD − 0.23 kg/m2, 95%CI − 0.73 to 0.27), weight (MD − 0.06 kg, 95%CI − 1.46 to 1.34), or HDL (SMD 0.26, 95%CI − 0.06 to 0.57).VO2 was significantly increased by exercise (SMD 1.58, 95%CI 1.17 to 1.99). Risk of bias was high for 3 studies, and GRADE quality of evidence was very low to moderate. Exercise reduced epicardial adipose tissue and waist circumference, and did not have effect on weight, BMI, or HDL. Newer trials with better design and methods are necessary to improve the quality of the evidence. PROSPERO registration number (CRD42018096581

The effect of exercise and protein source on food intake regulation and characteristics of metabolic syndrome in obese female wistar rats

Background: Beneficial effects of dietary proteins and exercise in treatment of obesity is well-recognized. The effect of exercise and protein source on food intake, body weight and characteristics of metabolic syndrome in obese female Wistar rats was examined. Female Wistar rats received an obesogenic diet for 12 weeks. Then, rats were allocated to four groups and received one of the following treatments for eight weeks: 1- Whey protein Diet + Exercise (WPE), 2- Soy protein diet + exercise (SPE), 3- Whey protein diet, no exercise (WPN), 4- Soy protein diet, no exercise (SPN). The exercise comprised of 30 minutes on a treadmill, three times/week. Body weight (BW) and food intake (FI), blood pressure, pulse, glucose and intake regulatory hormones were measured. Results: FI and plasma ghrelin (2.7 times) were higher in exercise groups compared with non-exercise groups. BW was lower (6.7%) in groups fed a whey protein diet compared with those fed a soy protein diet. Abdominal fat (% BW) was lower (22.8%) in WPE compared with other groups. Diastolic blood pressure (11.1%) and pulse (6%) were lower in groups fed a soy protein diet compared with groups fed a whey protein diet. Conclusion: While exercise affects food intake, source of protein determines BW and BC. Whey protein showed more favorable effect on BW and body composition