Descending aortic calcification increases renal dysfunction and in-hospital mortality in cardiac surgery patients with intraaortic balloon pump counterpulsation placed perioperatively : a case control study

Introduction: Acute kidney injury (AKI) after cardiac surgery increases length of hospital stay and in-hospital mortality. A significant number of patients undergoing cardiac surgical procedures require perioperative intra-aortic balloon pump (IABP) support. Use of an IABP has been linked to an increased incidence of perioperative renal dysfunction and death. This might be due to dislodgement of atherosclerotic material in the descending thoracic aorta (DTA). Therefore, we retrospectively studied the correlation between DTA atheroma, AKI and in-hospital mortality. Methods: A total of 454 patients were retrospectively matched to one of four groups: -IABP/-DTA atheroma, +IABP/-DTA atheroma, -IABP/+DTA atheroma, +IABP/+DTA atheroma. Patients were then matched according to presence/absence of DTA atheroma, presence/absence of IABP, performed surgical procedure, age, gender and left ventricular ejection fraction (LVEF). DTA atheroma was assessed through standard transesophageal echocardiography (TEE) imaging studies of the descending thoracic aorta. Results: Basic patient characteristics, except for age and gender, did not differ between groups. Perioperative AKI in patients with -DTA atheroma/+IABP was 5.1% versus 1.7% in patients with -DTA atheroma/-IABP. In patients with +DTA atheroma/+IABP the incidence of AKI was 12.6% versus 5.1% in patients with +DTA atheroma/-IABP. In-hospital mortality in patients with +DTA atheroma/-IABP was 3.4% versus 8.4% with +DTA atheroma/+IABP. In patients with +DTA atheroma/+IABP in hospital mortality was 20.2% versus 6.4% with +DTA atheroma/-IABP. Multivariate logistic regression identified DTA atheroma > 1 mm (P = *0.002, odds ratio (OR) = 4.13, confidence interval (CI) = 1.66 to 10.30), as well as IABP support (P = *0.015, OR = 3.04, CI = 1.24 to 7.45) as independent predictors of perioperative AKI and increased in-hospital mortality. DTA atheroma in conjunction with IABP significantly increased the risk of developing acute kidney injury (P = 0.0016) and in-hospital mortality (P = 0.0001) when compared to control subjects without IABP and without DTA atheroma. Conclusions: Perioperative IABP and DTA atheroma are independent predictors of perioperative AKI and in-hospital mortality. Whether adding an IABP in patients with severe DTA calcification increases their risk of developing AKI and mortality postoperatively cannot be clearly answered in this study. Nevertheless, when IABP and DTA are combined, patients are more likely to develop AKI and to die postoperatively in comparison to patients without IABP and DTA atheroma

Development of a workplace wellness promotion pilot framework : a case study of the Blue Care Staff Wellness Program

Workplace wellness initiatives are currently unreflective of the multidimensional and holistic nature of the wellness construct. There exists an opportunity for promoters of health to move toward models of workplace wellness promotion that more fully appreciate the interconnected nature of health dimensions and promote them even-handedly. The Blue Care Staff Wellness Program framework was developed in response to a recognised need for consistent and wellnessfocused constructs for workplace wellness promotion and dissemination. The framework promotes and supports the individualand organisational wellness of the Blue Care employee population by providing a comprehensive and sustainable employee wellness program. This has been achieved by the adoption of consistent wellness principles to guide the framework conception and theory based development. The use of the framework in a pilot program will provide insight into the frameworks effectiveness in promoting a comprehensive workplace wellness program, and go further to establish the relationship between wellness and productivity in the workplace

Development of a workplace wellness promotion pilot framework : a case study of the Blue Care Staff Wellness Program

Workplace wellness initiatives are currently unreflective of the multidimensional and holistic nature of the wellness construct. There exists an opportunity for promoters of health to move toward models of workplace wellness promotion that more fully appreciate the interconnected nature of health dimensions and promote them even-handedly. The Blue Care Staff Wellness Program framework was developed in response to a recognised need for consistent and wellnessfocused constructs for workplace wellness promotion and dissemination. The framework promotes and supports the individualand organisational wellness of the Blue Care employee population by providing a comprehensive and sustainable employee wellness program. This has been achieved by the adoption of consistent wellness principles to guide the framework conception and theory based development. The use of the framework in a pilot program will provide insight into the frameworks effectiveness in promoting a comprehensive workplace wellness program, and go further to establish the relationship between wellness and productivity in the workplace