Evaluation of the effectiveness of inveterate Achilles tendon rupture V-Y plasty with immediate subsequent weight-bearing and rehabilitation. Case study

In our paper, we would like to present two cases of treatment of the Achilles tendon ruptures by means of surgical V-Y technique, and implementation of immediate rehabilitation and weight-bearing. V-Y plasty on ruptured tendons was performed. The continuity of the tendon was restored. The sheath of the tendon was stitched together. Dressing was put on; the foot was immobilized in a Walker-type shoe in pes equinus with heel pads and compression underwear. From the first hour after the procedure, the wound area was cooled with a Game Ready device. From the first day after the procedure, both patients were allowed to apply full weight to the limb in the shoe. The crutches were put away as soon as possible. Rehabilitation began right away on the next day; during its course, attempts were made to reduce the use of the shoe to a minimum and to achieve the full range of foot motion as soon as possible. In both patients, the full range of motion was reached approximately 2 weeks after the surgery. The video support for the article is available at: https://youtu.be/bi3xuwOT9v

Implementation of a Virtual Interprofessional ICU Learning Collaborative: Successes, Challenges, and Initial Reactions From the Structured Team- Based Optimal Patient-Centered Care for Virus COVID-19 Collaborators

IMPORTANCE: Initial Society of Critical Care Medicine Discovery Viral Infection and Respiratory illness Universal Study (VIRUS) Registry analysis suggested that improvements in critical care processes offered the greatest modifiable opportunity to improve critically ill COVID-19 patient outcomes. OBJECTIVES: The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 ICU Collaborative was created to identify and speed implementation of best evidence based COVID-19 practices. DESIGN, SETTING, AND PARTICIPANTS: This 6-month project included volunteer interprofessional teams from VIRUS Registry sites, who received online training on the Checklist for Early Recognition and Treatment of Acute Illness and iNjury approach, a structured and systematic method for delivering evidence based critical care. Collaborators participated in weekly 1-hour videoconference sessions on high impact topics, monthly quality improvement (QI) coaching sessions, and received extensive additional resources for asynchronous learning. MAIN OUTCOMES AND MEASURES: Outcomes included learner engagement, satisfaction, and number of QI projects initiated by participating teams. RESULTS: Eleven of 13 initial sites participated in the Collaborative from March 2, 2021, to September 29, 2021. A total of 67 learners participated in the Collaborative, including 23 nurses, 22 physicians, 10 pharmacists, nine respiratory therapists, and three nonclinicians. Site attendance among the 11 sites in the 25 videoconference sessions ranged between 82% and 100%, with three sites providing at least one team member for 100% of sessions. The majority reported that topics matched their scope of practice (69%) and would highly recommend the program to colleagues (77%). A total of nine QI projects were initiated across three clinical domains and focused on improving adherence to established critical care practice bundles, reducing nosocomial complications, and strengthening patient- and family-centered care in the ICU. Major factors impacting successful Collaborative engagement included an engaged interprofessional team; an established culture of engagement; opportunities to benchmark performance and accelerate institutional innovation, networking, and acclaim; and ready access to data that could be leveraged for QI purposes. CONCLUSIONS AND RELEVANCE: Use of a virtual platform to establish a learning collaborative to accelerate the identification, dissemination, and implementation of critical care best practices for COVID-19 is feasible. Our experience offers important lessons for future collaborative efforts focused on improving ICU processes of care

Evaluation of dairy products available on the Polish market in the context of nutrient profiles. Clear arguments for reformulation of foodstuffs

Background. Dairy products, which are one of the main groups of products in the diet, are expected to have high nutritional value. The development of food technology often involves changing the nutritional parameters of foodstuffs. Objective. The aim of this study was to determine the nutritional value of dairy products, in the context of nutrient profiles. Material and Methods. The tested products included yoghurts, yoghurt drinks, kefir, cream cheeses and milk desserts available on the Polish market, basing on the information from unit product packaging. Results. The average sugar content in the group of all products was 11 g/100 g. Milk desserts contained the largest amount of sugar (average 14.7 g/100g), whereas kefir – the smallest amount (average 6 g/100 g) (p <0.0001). Yoghurts and yoghurt drinks intended for children had higher sugar content than products for the general population (14.4 g vs. 10.5 g/100 g) (p <0.0001). As many as 75% of products were sweetened. Taking into account the natural content of lactose, the estimated amount of added sugar ranged from 6.9 - 12.3 g/100 g. The average fat content in the group of all products amounted to 3.8 g/100 g. In the view of WHO profiles, 71% of products exceeded the permissible sugar content (≤ 10 g/100 g) and 36% exceeded the permissible content of saturated fatty acids (≤ 2 g/100 g). Using more liberal profiles developed by the food industry, the proportion of such products was smaller, but still quite high (34% in case of sugar and 26% in case of saturated fatty acids). In terms of the sugar content, according to regulation introduced in Poland, only 29% of the analyzed dairy products could be offer for children at schools. Among them there are all natural (not sweetened) yoghurts and kefir and only 6% of other sweetened products. Conclusions. There is a justified need for the reformulation of dairy products, especially in terms of added sugar.Wprowadzenie: Od przetworów mlecznych, które są jedną z podstawowych grup produktów w diecie człowieka oczekuje się wysokiej wartości odżywczej. Rozwój technologii żywności często jednak pociąga za sobą zmiany parametrów odżywczych produktów. Cel: Charakterystyka wartości odżywczej przetworów mlecznych, w kontekście wymagań profili żywieniowych. Materiał i metody: Ocenie poddano jogurty, napoje jogurtowe, kefiry, serki i desery mleczne dostępne na rynku polskim, bazując na informacjach z opakowań jednostkowych produktów. Wyniki: Średnia zawartość cukrów w produktach mlecznych wynosiła 11 g/100 g. Największą ilość cukru zawierały desery mleczne (średnia 14,7 g/100 g), a najmniejszą kefiry (średnia 6 g/100 g) (p <0.0001). Jogurty i napoje jogurtowe adresowane do dzieci miały większą zawartość cukru, niż produkty dla ogółu populacji (14,4 g vs. 10,5 g/100 g) (p<0,0001). Aż 75% produktów zawierało dodatek różnych form cukru. Po uwzględnieniu zawartości naturalnej laktozy oszacowana ilość cukru dodanego kształtowała się w przedziale 6,9 - 12,3 g/100 g. Średnia zawartość tłuszczu w grupie wszystkich produktów wynosiła 3,8 g/100 g. Dopuszczalną, w świetle profili WHO, zawartość cukru (≤ 10g/100 g) przekroczyło 71% produktów, a zawartość nasyconych kwasów tłuszczowych (≤ 2 g/100 g) 36% produktów. Przyjmując wartości profili opracowanych przez przemysł spożywczy odsetek takich produktów był mniejszy, ale wciąż znaczny (34% w przypadku cukru i 26% w przypadku tłuszczów nasyconych). W świetle wprowadzonych ostatnio wymagań, dotyczących wartości odżywczej żywności oferowanej w szkołach, biorąc pod uwagę zawartość cukru tylko 29% analizowanych produktów mogłoby być przeznaczone dla dzieci. Wśród nich byłyby wszystkie naturalne jogurty i kefiry, a tylko 6% stanowiłby inne słodzone produkty. Wnioski: Istnieje uzasadniona potrzeba modyfikacji receptur przetworów mlecznych, szczególnie w zakresie ilości dodawanego cukru

Dietary intake of DHA during pregnancy: a significant gap between the actual intake and current nutritional recommendations

Background: Docosahexaenoic acid (DHA) is indispensable to ensure proper development of the fetal central nervous system and pregnancy duration. Daily intake of DHA should be at least 100 mg higher as compared to the pre-pregnancy values. Objectives: The aim of the study was to evaluate DHA intake during pregnancy and compare it to the current recommendations. Material and methods: A total of 100 pregnant women presenting for labor at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw, were included in the study. DHA intake from the following sources: fish and eggs, and DHA preparations collected based on the questionnaire was investigated. Results: Low dietary DHA intake (median: 60 mg/day) was observed. The values were only slightly higher (median: 90 mg/day) after DHA preparations were taken into consideration because only 28% of the pregnant women used DHA preparations. Overall, 92% of the subjects consumed <200 mg of DHA a day, which was the result of insufficient fish consumption (mean: 15 g/day). Only 10% of the respondents ate fish twice a week, in which case the DHA dietary intake was statistically significantly higher (median: 160 mg/day) (p=0.0232). Total median dietary DHA and EPA intake in the study population was 79 mg/day. Conclusions: The diet of pregnant women is largely deficient as far as DHA intake is concerned. Importantly, it is not possible to comply with current recommendations without dietary supplementation.Wprowadzenie: Kwas dokozaheksaenowy (DHA) jest niezbędny dla prawidłowego rozwoju centralnego układu nerwowego płodu, a także czasu trwania ciąży. Jego spożycie przez kobiety ciężarne powinno być co najmniej o 100 mg większe, niż przed zajściem w ciążę. Cel: Celem badania było oszacowanie wielkości spożycia DHA przez kobiety ciężarne, w kontekście aktualnych zaleceń żywieniowych. Materiał i metody: Badanie przeprowadzono wśród 100 kobiet ciężarnych, zgłaszających się do porodu w Klinice Położnictwa, Chorób Kobiecych i Ginekologii Onkologicznej Warszawskiego Uniwersytetu Medycznego. Spośród produktów spożywczych źródłami DHA były ryby i jaja, których częstość i wielkość spożycia ustalono w oparciu o ankietę. Ponadto uwzględniono przyjmowanie przez kobiety ciężarne preparatów zawierających DHA. Wyniki: Stwierdzono małe spożycie DHA z dietą (mediana: 60 mg dziennie). Po uwzględnieniu suplementacji diety spożycie to wzrosło nieznacznie (mediana: 90 mg), ponieważ tylko 28% kobiet przyjmowało preparaty DHA. Ogółem 92% kobiet spożywało mniej, niż 200 mg DHA w ciągu dnia. Niewielkie spożycie DHA było konsekwencją zbyt małego spożycia ryb – średnio 15 g/dzień. Tylko 10% kobiet jadło ryby dwa razy w tygodniu i w przypadku takiego spożycia pobranie DHA z dietą było istotnie statystycznie większe (mediana: 160 mg dziennie) (p=0.0232). Łączne spożycie DHA i EPA w całej grupie kobiet wynosiło – mediana 79 mg dziennie. Wnioski: Dieta kobiet ciężarnych jest w dużym stopniu niedoborowa w DHA. Bez suplementacji diety nie jest możliwa realizacja zaleceń, dotyczących spożycia tego składnika w okresie ciąży

Assessing patients’ attitudes towards dietary supplements

Background. There is currently many over the counter products on the market that exert nutritional or physiological effects on the human body. The differences between dietary supplements and non-prescription drugs are however poorly understood by the average consumer and may thus affect their expectations as to the desired effect produced on the body. Objectives. To evaluate patients’ knowledge and attitudes towards dietary supplements as compared to non-prescription drugs. Materials and Methods. Subjects were 335 patients of the Mazowiecki Voivodeship Hospital in Warsaw, Poland. The data were collected from a face-to-face interview using a single and multiple choice questionnaire with 10 questions on dietary supplements. Statistical analysis used the Chi-square (χ2) test. Results. The majority of respondents were found to be familiar with the term ‘dietary supplements’, but had difficulties in classifying these products into appropriate categories. Over 55% do not consider dietary supplements to be foodstuffs and more than 40% considered such products to be drugs. Most respondents thought that the main purpose of taking dietary supplements is to improve nutrition, but over one third expected them to also treat disease. Over 70% declared taking notice to which category the non-prescription products they bought belongs to ie. whether non-prescription drugs (medicinal products) or dietary supplements. Conclusions. Many patients mistakenly believe that dietary supplements are drugs and can be used to treat disease and health disorders.Wprowadzenie. W obrocie handlowym znajduje się wiele preparatów, dostępnych bez recepty, przeznaczonych do stosowania w celach odżywczych lub fizjologicznych w organizmie. Przeciętny konsument może nie dostrzegać różnicy pomiędzy suplementami diety a preparatami farmaceutycznymi, co z kolei może wpływać na jego oczekiwania dotyczące działania tych preparatów. Cel badań. Celem badań była ocena wiedzy i postaw pacjentów wobec suplementów diety oraz ocena tych produktów na tle innych preparatów dostępnych bez recepty. Materiał i metody. Badanie zostało przeprowadzone wśród 335 pacjentów Mazowieckiego Szpitala Wojewódzkiego w Warszawie za pomocą bezpośredniego wywiadu. Wyniki. Badania wykazały, że większości ankietowanym znane jest określenie „suplement diety”, ale trudności sprawiała im kwalifikacja tych produktów do właściwej kategorii. Ponad 55% ankietowanych nie traktuje suplementów diety, jako żywność, a ponad 40% zalicza je do leków. Najwięcej respondentów uważało, że głównym celem stosowania suplementów diety jest poprawa sposobu odżywiania, ale ponad jedna trzecia z nich oczekuje również leczenia chorób. Ponad 70% respondentów zadeklarowało, że kupując preparat bez recepty zwraca uwagę na kategorię (lek – suplement diety). Wnioski. Wielu pacjentów błędnie sądzi, że suplementy diety to leki, które mogą być stosowane do leczenia chorób i zaburzeń stanu zdrowia

Identification of acute respiratory distress syndrome subphenotypes de novo using routine clinical data: A retrospective analysis of ARDS clinical trials

Objectives The acute respiratory distress syndrome (ARDS) is a heterogeneous condition, and identification of subphenotypes may help in better risk stratification. Our study objective is to identify ARDS subphenotypes using new simpler methodology and readily available clinical variables. Setting This is a retrospective Cohort Study of ARDS trials. Data from the US ARDSNet trials and from the international ART trial. Participants 3763 patients from ARDSNet data sets and 1010 patients from the ART data set. Primary and secondary outcome measures The primary outcome was 60-day or 28-day mortality, depending on what was reported in the original trial. K-means cluster analysis was performed to identify subgroups. Sets of candidate variables were tested to assess their ability to produce different probabilities for mortality in each cluster. Clusters were compared with biomarker data, allowing identification of subphenotypes. Results Data from 4773 patients were analysed. Two subphenotypes (A and B) resulted in optimal separation in the final model, which included nine routinely collected clinical variables, namely heart rate, mean arterial pressure, respiratory rate, bilirubin, bicarbonate, creatinine, PaO 2, arterial pH and FiO 2. Participants in subphenotype B showed increased levels of proinflammatory markers, had consistently higher mortality, lower number of ventilator-free days at day 28 and longer duration of ventilation compared with patients in the subphenotype A. Conclusions Routinely available clinical data can successfully identify two distinct subphenotypes in adult ARDS patients. This work may facilitate implementation of precision therapy in ARDS clinical trials