Comparative study of serum lipid profile between prehypertensive and normotensive

Background: Prehypertensive subjects have greater risk of developing hypertension than the normotensive subjects. Studies have shown that lipid profile is altered in hypertensive patients as compare to normotensive subjects. But not much is documented about lipid profile in prehypertensives. So the present study is done to compare the serum lipid profile among prehypertensive and normotensives and to correlate the blood pressure and lipid profile in prehypertensives.Methods: 50 prehypertensive and 50 normotensive subjects were recruited from the general population. Blood pressures were recorded and serum lipid profiles were measured and compare using student t test. Correlation of serum lipid profile and blood pressure was done using person correlation.Results: The study results showed significant increased in total cholesterol, LDL, VLDL and serum triglyceride level in prehypertensives compare to normotensives. While there is no significant change in HDL level in prehypertensive compare to normotensive. And there is also a significant correlation between blood pressure and lipid profile in prehypertensive subjects.Conclusion: Lipid profile is altered in prehypertensives compare to normotensives. That’s why timely diagnoses and life style modification is required in prehypertensives.

Effect of Yoga on pulmonary function tests

Background: Yoga is considered to be a very good exercise for maintaining proper health. The present work was planned to find effects of 10 weeks Yoga practice on some pulmonary function tests.Methods: The present study was conducted on 40 subjects, (30 males and 10 females) who came voluntarily as subjects for the project with written and informed consent. It was a prospective study on healthy volunteers from both sex of age between 20 to 65 years. Various Pulmonary Function Tests (PFTs) were measured.Results: Respiratory rate was decreased while Breath Holding Time (BHT) and Maximum Ventilatory Volume (MVV) were found to be increased in both male and female subjects.Conclusions: From this study we conclude that yoga practice can be advocated to improve respiratory efficiency for   healthy individuals as well as an alternative therapy or as adjunct to conventional therapy in respiratory diseases.

Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study

Background Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. Objective To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Results Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. Conclusions A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites

The Fragility Index in a Cohort of Pediatric Randomized Controlled Trials

Data suggest inadequacy of common statistical techniques for reporting outcomes in clinical trials. The Fragility Index can measure how many events the statistical significance hinges on, and may facilitate better interpretation of trial results. This study aimed to assess the Fragility Index in pediatric randomized controlled trials (RCTs) with statistically significant findings published in high-quality medical journals. A Fragility Index was calculated on included trials with dichotomous positive outcomes. Analysis of the relationship between trial characteristics and the Fragility Index was performed. Of the 429 abstracts screened, 17 met the inclusion criteria and underwent analysis. The median Fragility Index was 7 with an interquartile range of 2–11. In 41% of the studies, the number of patients lost to follow-up or withdrawn prior to analysis was equal to or greater than the Fragility Index. There was no correlation between the RCT sample size and the Fragility Index (r = 0.249, p = 0.335) nor the event group size and the Fragility Index (r = 0.250, p = 0.334). There was a strong negative correlation between the original p-value and the Fragility Index (r = −0.700, p = 0.002). The Fragility Index is a calculated metric that may assist in applying clinical relevance to statistically significant outcomes in pediatric randomized controlled trials with dichotomous outcomes

PICU fellow entrustment: How do faculty make supervision decisions?

Introduction Academic faculty make supervision decisions which balance the goals of trainee competency with patient safety. Previous work shows significant variability and potential bias in these entrustment decisions. Given the high stakes, understanding how these decisions are made is vital. Qualitative studies established traits that influence entrustment decisions, but the relative contribution of each has not been described. We aim to characterize the influence of these traits on entrustment decisions for Pediatric Critical Care Medicine (PCCM) fellows. Methods We surveyed faculty who supervise PCCM trainees at three PCCM departments. Based on 8 vignettes, faculty chose the level of supervision for a fellow performing an endotracheal intubation- direct or indirect supervision with the attending, direct or indirect supervision of a fellow supervising a junior trainee, or unsupervised. Each vignette varied by 3 traits: 1) patient condition 2) trainee-supervisor relationship and 3) trainee experience. There was a 72% response rate (n=51/70). We created a logistic regression model using the 3 traits and faculty attributes (gender, primary unit, education role) as predictors of direct supervision. We also compared faculty attributes for those selecting direct supervision for e4 cases and \u3c4 cases using Fischer\u27s exact test and Wilcoxon Rank Sum. Results The majority of vignettes (78%, 311/396) were rated direct supervision. Of vignettes with a 3rd year fellow, 59% (118/199) were rated direct supervision compared with 97% (193/197) for a 1st year. Trainee-supervisor relationship, patient status and primary unit were significant predictors of direct supervision in the regression model. Compared with cardiac ICU faculty, the odds ratio for pediatric ICU faculty to entrust fellows was 2.27 (95% CI 1.07-4.81) and 4.68 (95% CI 1.54-14.19) for mixed cardiac/pediatric ICU faculty. Odds ratios were 2.14 (95% CI 1.47-3.12) for 1 week on service with the fellow (ref: never worked together) and 0.09 (95% CI 0.04-0.17) for a rapidly deteriorating patient (ref: stable patient). Faculty selecting direct supervision for e or \u3c 4 cases did not differ significantly. Conclusion PCCM entrustment decisions are influenced by the patient\u27s condition, supervisor\u27s relationship with the trainee and supervisor\u27s primary unit

Faculty decision making in ad hoc entrustment of pediatric critical care fellows: A national case-based survey

Phenomenon: Ad hoc entrustment decisions reflect a clinical supervisor\u27s estimation of the amount of supervision a trainee needs to successfully complete a task in the moment. These decisions have important consequences for patient safety, trainee learning, and preparation for independent practice. Determinants of these decisions have previously been described but have not been well described for acute care contexts such as critical care and emergency medicine. The ad hoc entrustment of trainees caring for vulnerable patient populations is a high-stakes decision that may differ from other contexts. Critically ill patients and children are vulnerable patient populations, making the ad hoc entrustment of a pediatric critical care medicine (PCCM) fellow a particularly high-stakes decision. This study sought to characterize how ad hoc entrustment decisions are made for PCCM fellows through faculty ratings of vignettes. The authors investigated how acuity, relationship, training level, and task interact to influence ad hoc entrustment decisions. Approach: A survey containing 16 vignettes that varied by four traits (acuity, relationship, training level, and task) was distributed to U.S. faculty of pediatric critical care fellowships in 2020. Respondents determined an entrustment level for each case and provided demographic data. Entrustment ratings were dichotomized by high entrustment versus low entrustment (direct supervision or observation only). The authors used logistic regression to evaluate the individual and interactive effects of the four traits on dichotomized entrustment ratings. Findings: One hundred seventy-eight respondents from 30 institutions completed the survey (44% institutional response rate). Acuity, relationship, and task all significantly influenced the entrustment level selected but did not interact. Faculty most frequently selected direct supervision as the entrustment level for vignettes, including for 24% of vignettes describing fellows in their final year of training. Faculty rated the majority of vignettes (61%) as low entrustment. There was no relationship between faculty or institutional demographics and the entrustment level selected. Insights: As has been found in summative entrustment for pediatrics, internal medicine, and surgery trainees, PCCM fellows often rated at or below the direct supervision level of ad hoc entrustment. This may relate to declining opportunities to practice procedures, a culture of low trust propensity among the specialty, and/or variation in interpretation of entrustment scales

Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study

Background Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. Objective To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. Methods A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Results Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. Conclusions A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites

Prevalence of Errors in Anaphylaxis in Kids (PEAK): A Multicenter Simulation-Based Study

Multi-institutional, international practice variation of pediatric anaphylaxis management by health care providers has not been reported. To characterize variability in epinephrine administration for pediatric anaphylaxis across institutions, including frequency and types of medication errors. A prospective, observational, study using a standardized in situ simulated anaphylaxis scenario was performed across 28 health care institutions in 6 countries. The on-duty health care team was called for a child (patient simulator) in anaphylaxis. Real medications and supplies were obtained from their actual locations. Demographic data about team members, institutional protocols for anaphylaxis, timing of epinephrine delivery, medication errors, and systems safety issues discovered during the simulation were collected. Thirty-seven in situ simulations were performed. Anaphylaxis guidelines existed in 41% (15 of 37) of institutions. Teams used a cognitive aid for medication dosing 41% (15 of 37) of the time and 32% (12 of 37) for preparation. Epinephrine autoinjectors were not available in 54% (20 of 37) of institutions and were used in only 14% (5 of 37) of simulations. Median time to epinephrine administration was 95 seconds (interquartile range, 77-252) for epinephrine autoinjector and 263 seconds (interquartile range, 146-407.5) for manually prepared epinephrine (P = .12). At least 1 medication error occurred in 68% (25 of 37) of simulations. Nursing experience with epinephrine administration for anaphylaxis was associated with fewer preparation (P = .04) and administration (P = .01) errors. Latent safety threats were reported by 30% (11 of 37) of institutions, and more than half of these (6 of 11) involved a cognitive aid. A multicenter, international study of simulated pediatric anaphylaxis reveals (1) variation in management between institutions in the use of protocols, cognitive aids, and medication formularies, (2) frequent errors involving epinephrine, and (3) latent safety threats related to cognitive aids among multiple sites