Prevention of contrast-induced acute kidney injury in patients undergoing cardiovascular procedures : a systematic review and network meta-analysis

BACKGROUND: Interventional diagnostic and therapeutic procedures requiring intravascular iodinated contrast steadily increase patient exposure to the risks of contrast-induced acute kidney injury (CIAKI), which is associated with death, nonfatal cardiovascular events, and prolonged hospitalization. The aim of this study was to investigate the efficacy of pharmacological and non-pharmacological treatments for CIAKI prevention in patients undergoing cardiovascular invasive procedures with iodinated contrast.METHODS AND FINDINGS: MEDLINE, Google Scholar, EMBASE and Cochrane databases as well as abstracts and presentations from major cardiovascular and nephrology meetings were searched, up to 22 April 2016. Eligible studies were randomized trials comparing strategies to prevent CIAKI (alone or in combination) when added to saline versus each other, saline, placebo, or no treatment in patients undergoing cardiovascular invasive procedures with administration of iodinated contrast. Two reviewers independently extracted trial-level data including number of patients, duration of follow-up, and outcomes. Eighteen strategies aimed at CIAKI prevention were identified. The primary outcome was the occurrence of CIAKI. Secondary outcomes were mortality, myocardial infarction, dialysis and heart failure. The data were pooled using network meta-analysis. Treatment estimates were calculated as odds ratios (ORs) with 95% credible intervals (CrI). 147 RCTs involving 33,463 patients were eligible. Saline plus N-acetylcysteine (OR 0.72, 95%CrI 0.57-0.88), ascorbic acid (0.59, 0.34-0.95), sodium bicarbonate plus N-acetylcysteine (0.59, 0.36-0.89), probucol (0.42, 0.15-0.91), methylxanthines (0.39, 0.20-0.66), statin (0.36, 0.21-0.59), device-guided matched hydration (0.35, 0.12-0.79), prostaglandins (0.26, 0.08-0.62) and trimetazidine (0.26, 0.09-0.59) were associated with lower odds of CIAKI compared to saline. Methylxanthines (0.12, 0.01-0.94) or left ventricular end-diastolic pressure-guided hydration (0.09, 0.01-0.59) were associated with lower mortality compared to saline.CONCLUSIONS: Currently recommended treatment with saline as the only measure to prevent CIAKI during cardiovascular procedures may not represent the optimal strategy. Vasodilators, when added to saline, may significantly reduce the odds of CIAKI following cardiovascular procedures

Seasonal influenza vaccination of healthcare workers: a narrative review

Influenza is an acute respiratory disease caused by the influenza virus which often occurs in outbreaks and epidemics worldwide. The World Health Organization recommends annual vaccination of healthcare workers (HCWs) against influenza, because most of them are involved in the direct care of patients with a high risk of influenza-related complications. Given the significance of the disease burden, a targeted literature review was conducted to assess issues related to influenza vaccination among HCWs. The primary aim of this review was to assess the incidence of influenza among medical personnel and healthcare-associated influenza, and to outline the benefits of influenza vaccination for patients and HCWs themselves. Vaccination of HCWs seems to be an important strategy for reducing the transmission of influenza from healthcare personnel to their patients and, therefore, for reducing patient morbidity and mortality, increasing patient safety, and reducing work absenteeism among HCWs. The benefits of influenza vaccination for their patients and for HCWs themselves are addressed in literature, but the evidence is mixed and often of low-quality

Influenza vaccination in healthcare workers – vaccination coverage, determinants, possible interventions

Szczepienia przeciw grypie są zalecane każdego roku wszystkim pracownikom medycznym jako kluczowy element działań mających na celu m.in. zapobieganie transmisji grypy w placówkach opieki zdrowotnej. Biorąc pod uwagę to zalecenie oraz znaczenie takich szczepień, dokonano przeglądu niesystematycznego literatury, by ocenić kwestie związane z poziomem zaszczepienia, deklarowanymi motywami oraz barierami dotyczącymi szczepień, a także interwencjami, których celem jest zwiększenie wskaźnika szczepień w tej grupie zawodowej. Dane z dostępnych publikacji wskazują, że wskaźnik realizacji szczepień przeciw grypie wśród pracowników medycznych jest ogólnie niski i zróżnicowany w czasie, lokalnie, a także wśród poszczególnych zawodów medycznych. Głównym motywem szczepienia przeciw grypie jest chęć ochrony siebie i rodziny. Wśród licznych barier wymienia się najczęściej błędne przekonania dotyczące bezpieczeństwa i skuteczności szczepień oraz bariery organizacyjne. Wskazuje się, że jest duża potrzeba prowadzenia działań edukacyjnych oraz promocyjnych będących kluczowymi elementami zwiększania poziomu zaszczepienia w strategii dobrowolnych szczepień.Influenza vaccination, as a key element of control activities intended, inter alia, to prevent nosocomial influenza transmission, is recommended each year for all healthcare workers (HCWs). Due to these recommendations and the importance of influenza vaccination among HCWs, a targeted literature review was conducted to assess issues related to vaccination coverage, declared motivators and barriers, as well as interventions to increase vaccination coverage in this professional group. Data obtained from the available publications implies that influenza vaccination rates among WHCs are universally low and vary over time as well as between regions and different types of healthcare professionals (physicians/nurses). One of the main determinants of influenza vaccine uptake is the desire to protect oneself and one’s family. On the other hand, practical considerations and misconceptions about the safety and effectiveness of vaccines are the most frequently mentioned preventative causes. There is an urgent need to implement well-organized educational campaigns as this is key to increasing vaccination rates as part of a non-mandatory vaccination strategy. Med Pr. 2021;72(3):305–1