Review of code blue system and audit

Background: Code Blue systems are communication systems that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. Code blue was established in Bharati Hospital and Research Centre in Sept 2011 in order to reduce morbidity and mortality in wards. The aim of the study was to evaluate the current code blue system and suggest possible interventions to strengthen the system.Methods: It was retrospective observational descriptive study. The study population included all consecutive patients above the age of 18 years for whom code blue had been activated. Data was collected using code blue audit forms. The data was analysed using SPSS (Statistical Package for social sciences) software.Results: A total of 260 calls were made using the blue code system between September 2011 to December 2012. The most common place for blue code activation was casualty. The wards were next, followed by dialysis unit and OPD. The indications for code blue team activation were cardio-respiratory arrest (CRA) (88 patients, 33.84%), change in mental status (52 patients, 20%), road traffic accidents RTA (21, 8.07%), convulsions (29 patients 11.15%), chest pain (19 patients, 8.46%), breathlessness (18 patients,6.92%) and worry of staff about the patient (17 patients, 6.53%), presyncope (10 patients, 3.84%), and others (6 patients, 2.30%). The average response time was 1.58±0.96 minutes in our study. Survival rate was more in medical emergency group 46.15% than in CRA group 31.61%. Initial success rate was 35.2% and a final success rate was 34.6%.Conclusions: Establishment of code blue team in the hospital enabled us to provide timely resuscitation for patients who had “out of ICU” CRA. Further study is needed to establish the overall effectiveness and the optimal implementation of code blue teams. The increasing use of an existing service to review patients meeting blue code criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization

Advances in Social Media Research:Past, Present and Future

Social media comprises communication websites that facilitate relationship forming between users from diverse backgrounds, resulting in a rich social structure. User generated content encourages inquiry and decision-making. Given the relevance of social media to various stakeholders, it has received significant attention from researchers of various fields, including information systems. There exists no comprehensive review that integrates and synthesises the findings of literature on social media. This study discusses the findings of 132 papers (in selected IS journals) on social media and social networking published between 1997 and 2017. Most papers reviewed here examine the behavioural side of social media, investigate the aspect of reviews and recommendations, and study its integration for organizational purposes. Furthermore, many studies have investigated the viability of online communities/social media as a marketing medium, while others have explored various aspects of social media, including the risks associated with its use, the value that it creates, and the negative stigma attached to it within workplaces. The use of social media for information sharing during critical events as well as for seeking and/or rendering help has also been investigated in prior research. Other contexts include political and public administration, and the comparison between traditional and social media. Overall, our study identifies multiple emergent themes in the existing corpus, thereby furthering our understanding of advances in social media research. The integrated view of the extant literature that our study presents can help avoid duplication by future researchers, whilst offering fruitful lines of enquiry to help shape research for this emerging field

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The lived experience of Australian opioid replacement therapy recipients in a community‐based program in regional Victoria

Introduction and Aims Treatment of opioid dependence through opioid replacement therapy is widely recognised as effective. Nonetheless, while there has been a community-based program in the state of Victoria for over two decades, consumer experiences have received little attention. This study aimed to describe the experiences of opioid replacement therapy consumers living in rural and regional areas of the state. Design and Methods A qualitative design employed an interpretative phenomenological approach. Sixteen consumers were interviewed. Thematic analysis was conducted by the researchers to examine the phenomena of consumers ' experiences and findings were verified by a stakeholder group. Results Findings centred on themes of consumers ' experience of becoming recipients; consumer perceptions of pharmacists and pharmacy settings and psychosocial impacts on consumers. A majority of participants believed opioid replacement therapy brought increased normality to their life, however systemic and psychosocial barriers impacted on well-being. The pharmacy setting itself as a public dosing space commonly provoked feelings of stigma and discrimination among consumers. Other barriers prominently reported were restrictions on number of takeaways, cost of dispensing and lack of access to medical practitioners and allied supports. Discussion and Conclusions There were psychosocial impacts on opioid replacement therapy consumers relating to financial and social burdens, stigma and discrimination. Access to medical care and a choice of pharmacy appeared to be restricted in rural regions. The findings suggest a need to address, in particular, the financial and dispensing point burdens experienced by consumers to facilitate program retention

Prevalence of specific learning disabilities among primary school children in a south Indian city

Objective To measure the prevalence of specific learning disabilities (SpLDs) such as dyslexia, dysgraphia and dyscalculia among primary school children in a South Indian city. Methods A cross-sectional multi-staged stratified randomized cluster sampling study was conducted among children aged 8-11 years from third and fourth standard. A six level screening approach that commenced with identification of scholastic backwardness followed by stepwise exclusion of impaired vision and hearing, chronic medical conditions and subnormal intelligence was carried out among these children. In the final step, the remaining children were subjected to specific tests for reading, comprehension, writing and mathematical calculation. Results The prevalence of specific learning disabilities was 15.17% in sampled children, whereas 12.5%, 11.2% and 10.5% had dysgraphia, dyslexia and dyscalculia respectively. Conclusions This study suggests that the prevalence of SpLDs is at the higher side of previous estimations in India. The study is unique due to its large geographically representative design and identification of the problem using simplified screening approach and tools, which minimizes the number and time of specialist requirement and spares the expensive investigation. This approach and tools are suitable for field situations and resource scarce settings. Based on the authors' experience, they express the need for more prevalence studies, remedial education and policy interventions to manage SpLDs at main stream educational system to improve the school performance in Indian children