Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Remifentanil for labour pain relief

Labour is thought to be one of the most intense and painful experiences in a woman’s life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as “unbearable” and 60% describe the pain as “very intense”. Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, probably because it has been used for the longest period of time, despite its disadvantages and the risk that its use entails. The drug that is nearest to ideal is remifentanil. The countries in which it is widely used as an alternative type of labour anaesthesia have developed practice standards or guidelines practice. Guidelines and alternatives to pethidine protocols for effective labour analgesia in Poland might be merited.Labour is thought to be one of the most intense and painful experiences in a woman’s life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as “unbearable” and 60% describe the pain as “very intense”. Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, probably because it has been used for the longest period of time, despite its disadvantages and the risk that its use entails. The drug that is nearest to ideal is remifentanil. The countries in which it is widely used as an alternative type of labour anaesthesia have developed practice standards or guidelines practice. Guidelines and alternatives to pethidine protocols for effective labour analgesia in Poland might be merited

Predisposition of functional genetic variants of A-kinase anchoring protein 10 toward acquired repolarization disorders in high-risk vascular surgery patients

Jowita Biernawska,1 Joanna Solek-Pastuszka,1 Arkadiusz Kazimierczak,2 Krzysztof Safranow,3 Mariusz Kaczmarczyk,4 Malgorzata Zegan-Baranska,5 Maciej Zukowski,5 Katarzyna Kotfis5 1Department of Anesthesiology and Intensive Therapy, Pomeranian Medical University, Szczecin,&nbsp;Poland; 2Department of Angiology and Vascular Surgery, Pomeranian Medical University, Szczecin, Poland; 3Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin,&nbsp;Poland; 4Department of Clinical and Molecular Biochemistry, Pomeranian Medical University, Szczecin, Poland; 5Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland Purpose: We aimed at assessing the predisposition of A-kinase anchoring protein 10 (AKAP10) polymorphism toward acquired repolarization disorders in high-risk vascular surgery patients. Patients and methods: One hundred adult patients (age =44&ndash;85 years), scheduled for an elective high-risk &ldquo;open&rdquo; vascular surgery procedure, were recruited. The electrocardiogram Holter monitor was used to assess repolarization stability from the beginning of the operation up to 24 hours afterward. The AKAP10 gene rs203462 polymorphism and cardiac complications were analyzed. Results: Repolarization disturbances defined as QT interval duration corrected for heart rate (QTc) interval prolongation &gt;500 ms and QTc interval dispersion &gt;65 ms were recorded in 46 patients. A model of multivariate logistic regression showed that only the presence of allele G of the AKAP10 polymorphism was an independent risk factor for repolarization disturbances in the perioperative period (odds ratio =14.35; 95% CI =4.65&ndash;44.23; p&lt;0.0001). Conclusion: When the acquired QTc interval prolongation or QTc dispersion is associated with AKAP10 polymorphism, it may remain clinically silent. Keywords: AKAP10, repolarization, vascular surgery, QTc, Holte

Unhealthy Food Choices among Healthcare Shift Workers: A Cross-Sectional Study

Shift healthcare workers are a group particularly exposed to an increased risk of poor eating habits and are affected by many diseases. The aim of the study was to evaluate the dietary patterns (DPs), including the Polish-adapted Mediterranean Diet (Polish-aMED&reg;) score, and dietary fat intake in association with the shift work of healthcare workers. This cross-sectional study involved 445 healthcare workers from the West Pomeranian in Poland. Dietary data were collected using an FFQ-6&reg;. A posteriori DPs were derived with a Principal Component Analysis (PCA). The Polish-aMED&reg; score and the individual&rsquo;s percentage of energy from dietary fat (Pfat) were calculated. Healthcare shift work compared to the daily work was associated with approximately 2-times higher odds of adherence to the &lsquo;Meat/fats/alcohol/fish&rsquo; DP in the upper tertile (OR: 2.38; 95% Cl: 1.27&ndash;4.47; p &lt; 0.01) and higher Pfat &gt;35% of total energy intake (OR: 1.73; 95% Cl: 1.06&ndash;2.83; p &lt; 0.05). Healthcare shift work compared to the daily work was associated with approximately 50% lower odds of adherence to the &lsquo;Pro-healthy&rsquo; DP in the middle tertile (OR: 0.48; 95% Cl: 0.26&ndash;0.89; p &lt; 0.05) and a higher level of the Polish-aMED&reg; score (OR: 0.57; 95% Cl: 0.33&ndash;0.98; p &lt; 0.05), as well as lower odds of the constants of mealtime (OR: 0.54; 95% Cl: 0.33&ndash;0.89; p &lt; 0.05). The obtained findings highlight the unhealthy food choices among shift healthcare workers. Thus, to avoid the negative health consequences, there is a need for nutritional education for healthcare workers, especially those working shifts