An audit of the management of diabetic ketoacidosis at St Luke’s Hospital

Aim: To perform an audit of the protocol used in the management of patients with Diabetic Ketoacidosis, in St Lukes Hospital. Methods: Patients admitted with `Diabetes Ketoacidosis', between 14th August 2004 and 14th August 2005, were identified from the Admission book at the Accident and Emergency Department. Data obtained from patients' medical records were collected according to a preset proforma. The criteria assessed by this audit included parameter monitoring, investigations performed, the type and amount of intravenous fluids given, the insulin regime and potassium supplements used. Results: From a total of fifty six patients, forty seven files were traced, of which seventeen satisfied the criteria for Diabetic Ketoacidosis. Two were excluded and fifteen were analysed. In the population studied the mean age was 28 years with a male predominance of 60%. Ten patients suffered from Type 1 Diabetes whilst two patients had Type 2 Diabetes. Three other patients were newly diagnosed. Only one patient had all parameters checked according to protocol. In the majority of patients, fluids given in the first 22 hours, coincided with the amount of fluids stated in the protocol whilst 6/15 (40%) patients were administered the requested amount of insulin via infusion pump. With regards to potassium replacement, 13/15 (87%) patients were started on potassium supplements at a later stage. The factors influencing the total time for conversion to a fixed insulin regime and the duration of stay in hospital were also analysed. Conclusion: Deviations from the protocol were identified in parameter recording, the type of intravenous fluids given and the doses of insulin and potassium supplementation administered. New Diabetic Ketoacidosis guidelines have now been developed.peer-reviewe

An audit on the provision of telemedicine in primary care in Malta during the COVID-19 pandemic

BACKGROUND: Telemedicine is defined as the use of wireless technology to exchange medical information, and is assuming an increasingly central role in the provision of primary healthcare. The aim of this audit is to provide an overview of the teleconsultation service being provided from a Telemedicine centre on the Mediterranean island of Malta (EU).METHODOLOGY: Data was gathered using the Electronic Patient Records (EPR) system on all documented teleconsultations conducted from 1st-14th November 2021 by GPs/GP trainees (n=2,625). Reasons for consultation and outcomes were noted. Data was transferred to a spreadsheet and analysed using Microsoft Excel™.RESULTS: Adult (17-64 years) calls comprised 51.5%, elderly (65+ years) 38.7% and pediatric (0-16) 9.8% of all teleconsultations. Calls averaged 375 per day, with Mondays and the morning (8am-1pm) shifts being the busiest. Calls related to clinical problems comprised 62.5% of all teleconsultations; 23.5% were for advice on COVID-19 or influenza vaccines, 8.5% were of an administrative nature (e.g. booking appointments), and 5.5% were for treatment-related advice. Around 2 out of every 3 clinical-related calls comprised COVID-19, respiratory or gastrointestinal problems, in all age groups. Importantly, 75% of all calls did not require further action by the GP beyond the teleconsultation.DISCUSSION & KEY RECOMMENDATIONS: The telemedicine service relieved pressure off district health centers, allowing the latter to focus on those cases requiring more urgent face-to-face clinical assessment. Recommendations: encourage more widespread use of telemedicine service; ensure EPR documentation of all telecalls by all GP/GP trainees; increased use of video-conferencing; replicate audit on a longer timeframe.peer-reviewe

Blood Donor Incentives across 63 Countries: The BEST Collaborative Study

Incentives for blood donors are a much-debated strategy intended to ensure a sufficient supply of blood. Yet, there is a fundamental lack of knowledge about which incentives are offered by different blood collectors. We provide a comprehensive description of incentive policies for whole blood donors across 63 countries and 50 states of the United States. We collected data on incentive policies by conducting 2 surveys among representatives of blood collection establishments. Additionally, we integrated incentive data from an existing study and the World Health Organization (WHO). Lastly, we performed a web content analysis of blood collector websites and news releases to extend incentive data for the United States as well as underrepresented regions. We present descriptive analyses illustrating the type and value of incentives and their geographical distribution around the globe. Approximately half of the countries in our sample employ financial incentives, which include cash and tax benefits, but also less conventional incentives, such as healthcare supplements and raffles. Time off work is also commonly offered to blood donors and varies across blood collection establishments in duration and whether it is granted to all donors or only to those whose employer allows it. There is a geographical clustering of incentives, such that neighboring countries are more likely to employ similar incentives. This study provides insights into the strategies used for incentivizing blood donation and highlights the global diversity of incentive policies for whole blood donors. In stark contrast to WHO guidelines, half of the countries surveyed employ some kind of high-value incentive for blood donors. More realistic guidelines that are adapted to the local cultural and institutional context may be needed to maintain an adequate blood supply. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

Multi-functional egg white hydrolysate prevent hypertension and vascular dysfunction induced by cadmium in rats

We have investigated if EWH could counteract or prevent cardiovascular damage induced by high level of Cd exposure in rats. Male Wistar rats were treated for 14 days with: (A) Untreated - intraperitoneal (i.p.) injections of distilled water and tap water by gavage; (B) Cd − 1 mg/kg of bw/day of CdCl2 (i.p.) and tap water by gavage; (C) EWH – distilled water (i.p.) and 1 mg/kg/day of EWH by gavage; (D) CdEWH – both treatments. EWH prevented the increase on systolic blood pressure, vascular dysfunction, and inflammation after Cd exposure; prevent the activation of cyclooxygenase (COX)-2 and its derived contractile protanoids, inhibits angiotensin II by the reduction of ACE activity and prevents the increased oxidative stress mainly mediated by NADPH oxidase. Multifunctional EWH could be considered as a natural alternative therapy to counteract the deleterious effects caused by high level of Cd exposure.Supported by National Council for Scientific and Technological Development – CNPq [Edital Universal/CNPq No 44181/2014-9 and PQ/CNPq 311834/2020-5]; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES); Fundação de Amparo à Pesquisa do Rio Grande do Sul - FAPERGS/ Brazil [PQG:19/2551-0001810-0]; Programa Nacional de Cooperação Acadêmica; Pró-reitoria de Pesquisa - Universidade Federal do Pampa [N. 20180615102630]; FAPES/CNPq/PRONEX [N. 80598773] and Spanish Goverment by the Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER) [AGL2017-89213]; I-COOP+2020 (COOPA 20453). PZM and JEGPJr were supported by CAPES/Brazil, CSM by CNPq/Brazil; CRM and MDR by FAPERGS/ Brazil and GCS by PDA/Unipampa.Peer reviewe

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Acceptability of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomized controlled trial

There is limited evidence to support the effectiveness of falls prevention interventions in the acute hospital setting. The 6-PACK falls prevention program includes a fall-risk tool; 'falls alert' signs; supervision of patients in the bathroom; ensuring patients' walking AIDS are within reach; toileting regimes; low-low beds; and bed/chair alarms. This study explored the acceptability of the 6-PACK program from the perspective of nurses and senior staff prior to its implementation in a randomised controlled trial. A mixed-methods approach was applied involving 24 acute wards from six Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including: Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on program acceptability (suitability, practicality and benefits) was obtained by surveys, focus groups and interviews. Survey data were analysed descriptively, and focus group and interview data thematically. The survey response rate was 60%. Twelve focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Falls were identified as a priority patient safety issue and nurses as key players in falls prevention. The 6-PACK program was perceived to offer practical benefits compared to current practice. Nurses agreed fall-risk tools, low-low beds and alert signs were useful for preventing falls (>70%). Views were mixed regarding positioning patients' walking aid within reach. Practical issues raised included access to equipment; and risk of staff injury with low-low bed use. Bathroom supervision was seen to be beneficial, however not always practical. Views on the program appropriateness and benefits were consistent across nurses and senior staff. Staff perceived the 6-PACK program as suitable, practical and beneficial, and were open to adopting the program. Some practical concerns were raised highlighting issues to be addressed by the implementation plan

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention