Details of medications.

<p>Details of medications.</p

Factors associated with cessation of sedation and analgesia.

<p>Factors associated with cessation of sedation and analgesia.</p

Age related inverse dose relation of sedatives and analgesics in the intensive care unit

<div><p>Sedative and analgesic practices in intensive care units (ICUs) are frequently based on anesthesia regimes but do not take account of the important patient related factors. Pharmacologic properties of sedatives and analgesics change when used as continuous infusions in ICU compared to bolus or short-term infusions during anesthesia. In a prospective observational cohort study, we investigated the association between patient related factors and sedatives/analgesics doses in patients on mechanical ventilation (MV) and their association with cessation of sedation/analgesia. We included patients expected to receive MV for at least 24 hours and excluded those with difficulty in assessing the depth of sedation. We collected data for the first 72 hours or until extubation, whichever occurred first. Multivariate analysis of variance, multivariate regression as well as logistic regression were used. The final cohort (N = 576) was predominantly male (64%) with mean (SD) age 61.7 (15.6) years, weight 63.4 (18.2) Kg, Acute Physiology and Chronic Health Evaluation II score 28.2 (8) and 30% hospital mortality. Increasing age was associated with reduced propofol and fentanyl doses requirements, adjusted to the weight (p<0.001). Factors associated with higher propofol and fentanyl doses were vasopressor use (Relative mean difference (RMD) propofol 1.56 (95% confidence interval (CI) 1.28–1.90); fentanyl 1.48 (1.25–1.76) and central venous line placement (CVL, RMD propofol 1.64 (1.15–2.33); fentanyl 1.41 (1.03–1.91). Male gender was also associated with higher propofol dose (RMD 1.27 (1.06–1.49). Sedation cessation was less likely to occur in restrained patients (Odds Ratio, OR 0.48 (CI 0.30–0.78) or those receiving higher sedative/analgesic doses (OR propofol 0.98 (CI 0.97–0.99); fentanyl 0.99 (CI 0.98–0.997), independent of depth of sedation. In conclusion, increasing age is associated with the use of lower doses of sedative/analgesic in ICU, whereas CVL and vasopressor use were associated with higher doses.</p></div

Flowchart showing patient inclusion in the study.

<p>Flowchart showing patient inclusion in the study.</p

Adjusted mean total dose of propofol according to age groups.

<p>Adjusted mean total dose of propofol according to age groups.</p

Demographics, procedures and outcomes.

<p>Demographics, procedures and outcomes.</p

Multivariate association between total propofol and total fentanyl dose adjusted to weight and significant risk factors.

<p>Multivariate association between total propofol and total fentanyl dose adjusted to weight and significant risk factors.</p

Univariate association between total propofol and fentanyl dose adjusted to weight and individual risk factors.

<p>Univariate association between total propofol and fentanyl dose adjusted to weight and individual risk factors.</p

Adjusted mean total dose of fentanyl according to age groups.

<p>Adjusted mean total dose of fentanyl according to age groups.</p

Effect of a mHealth programme on coronary heart disease prevention among working population in Singapore: A single group pretest–post‐test design

Aim: The aim of this study was to develop and examine the effectiveness of a 4‐week Mobile Health (mHealth) programme using the smartphone app Care4Heart on awareness, knowledge, perceived stress, and a heart‐related lifestyle among working population in Singapore. Design: A quasi‐experimental single group pretest and repeated post‐test design. Methods: A total of 160 nonhealth‐related working adults were recruited from February 2016–April 2016. The Care4Heart app was installed on the participants’ phones. Outcome measures, including the Heart Disease Fact Questionnaire‐2, the Behavioral Risk Factor Surveillance System, and the Perceived Stress Scale were collected online at baseline, 4th week, and 6th month from baseline. Results: Compared with the baseline, the participants had significantly higher total mean scores for awareness and knowledge of coronary heart disease (CHD) after study intervention at 4 weeks and 6 months from baseline. However, there were no significant differences in perceived stress levels and heart‐related lifestyle behaviours before and after the intervention. Conclusions: The study contributed some evidence that the mHealth app helped to improve awareness and knowledge of CHD. Impact: Coronary heart disease remains one of the major causes of death and disability. It imposes a heavy financial burden on working adults. However, working adults were less able to identify the risk factors and adopt healthy lifestyles due to gaps in knowledge and awareness. This study demonstrated some effects of a mHealth programme in improving awareness and knowledge of CHD among the working population. mHealth provides a potential avenue for primary prevention of CHD