Aim
Infant feeding can be the reason for presentation and/or admission to hospital. The aim of this study was to identify if infant feeding history was documented in charts of infants presenting ...and/or admitted to a paediatric hospital.
Methods
A systematic random sample of hospital charts of infants who had presented to the emergency department between 1 July 2011 and 30 June 2012 was audited for presence of documentation of feeding.
Results
In total, 465 charts were audited, representing 12.5% of infants who presented to the emergency department in the year. Frequency of documentation for feeding measures was as follows: feeding mode, 263 (57%); feeding type, 228 (49%); feeding frequency, 119 (26%); and with changes 89 (19%) since birth. Increasing infant age was significantly associated with less frequent recording of feeding mode, type, frequency and changes.
Conclusion
A comprehensive feeding history is not recorded on many occasions of infant presentation and/or admission to hospital. The recording of feeding mode, type, frequency and changes is needed in order to explore the existence, or otherwise, of a relationship between feeding and the reason for presentation and/or admission.
Infants who present or are admitted to hospital with illness or with inadequate growth and development are those most at risk of decreased nutritional status. However, not all infants who present or ...are admitted to hospital have their growth assessed. The aim of the present study was to identify how frequently anthropometric measurements were documented in charts of infants presenting and/or admitted to a tertiary paediatric hospital.
A systematic random sample of hospital charts of infants who had presented to the emergency department between 1 July 2011 and 30 June 2012 was audited retrospectively for the presence of appropriate documentation of measurement.
In all, 465 charts were audited, representing 10% of infants who presented to the emergency department in the year. The frequency of anthropometric measures was: birthweight 103 (22%), presentation weight 275 (59%), length 8 (2%), head circumference 15 (3%), percentiles 27 (6%) and body mass index score 1 (0%). Age of the infant was significantly associated with recording of birthweight. There were no significant relationships found between gender, socioeconomic status, gestational age, delivery type and recording of diagnosis and birthweight.
Infant measurements were not recorded on many occasions. Assessment of growth as a marker of illness or nutritional deficit has been poorly assessed in this group. This is a missed opportunity to assess infant growth in this population, which has been found to be at risk of decreased nutritional status. Identification and treatment of growth deficits are a cost-effective method of optimising infant health worldwide.
Introduction: Emergency department usage for non-urgent care has been identified as an issue worldwide. Many health professionals have an opinion as to why parents seek care for their children at an ...emergency department. In Australia, although it is known that there is increasing usage of paediatric emergency departments for non-urgent care; there is a paucity of research on the reasons for this high usage. Aim: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department (PED) at a tertiary paediatric hospital seeking care. Method: This study was designed as a cross sectional descriptive survey to ascertain information fiom parents about their care-giving and care-seeking behaviours prior to presenting with their child to the paediatric emergency department (PED) for professional assessment and treatment. Demographic characteristics were compared with those of the general population to ensure representativeness. Results: A total of 355 parents were surveyed in the three-month period between May and July 2005. This represented 8% of the parents/carers who had presented to the PED for nonurgent (Australian Triage Score Category 4 and 5) care of their child. Just over half of the children presenting were male (185 (53%)) with an overall mean age of 5.45 years (*SD 4.25). The factors the study identified as seminal as to why parents sought care for their child at the paediatric emergency department are that parents rated their child's condition as moderate to very serious (242 (68%)) and that two thirds of parents (234 (66%)) had sought advice prior to attending PED. Other pertinent factors identified were that 54% of children attended with an injury (137) presented promptly to PED (i-e. within four hours of injury) whereas of those presenting with illness (88 (41.3%)) presented within two to seven days of the onset of the illness. The majority of children attended with an illness (213 (60%)) and of these, 98% had medication administered prior to presentation to PED. The presenting child was most likely to be the youngest sibling. Conclusions: The results of the study highlight the accuracy of 'parental triage', that is that parents assess their child's health, and generally engage in appropriate care-giving and careseeking behaviours before presenting to paediatric PED. This study highlights the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting. In recognising that presentation is multifactorial, an issue that needs to be addressed is that there will always be non-urgent presentations at the paediatric emergency department and service delivery and W i g models need further development to address the increasing paediatric requirements for care. In identifying these multiple factors, this study will provide a solid base for future planning within paediatric hospitals, the emergency department setting and in provision of care in the community.
Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of ...self-reported positive changes experienced during COVID-19 national lockdown in Scotland.
The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change.
There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health.
Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.
Racial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse outcomes by ...race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration.
Observational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes.
5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 0.89-0.90) and a higher positivity risk (RR = 1.16 1.14-1.18) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 1.28-1.44) and death (RR = 1.17 1.03-1.32) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 1.16-1.22) or die (RR = 1.70 1.53-1.89) compared to women. These racial/ethnic and sex differences were reflected in both health system types.
This study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
To establish the effect of statins on muscle symptoms in people who had previously reported muscle symptoms when taking statins.
Series of randomised, placebo controlled n-of-1 trials.
Primary care ...across 50 sites in the United Kingdom, December 2016 to April 2018.
200 participants who had recently stopped or were considering stopping treatment with statins because of muscle symptoms.
Participants were randomised to a sequence of six double blinded treatment periods (two months each) of atorvastatin 20 mg daily or placebo.
At the end of each treatment period, participants rated their muscle symptoms on a visual analogue scale (0-10). The primary analysis compared symptom scores in the statin and placebo periods.
151 participants provided symptoms scores for at least one statin period and one placebo period and were included in the primary analysis. Overall, no difference in muscle symptom scores was found between the statin and placebo periods (mean difference statin minus placebo -0.11, 95% confidence interval -0.36 to 0.14; P=0.40)). Withdrawals because of intolerable muscle symptoms were 18 participants (9%) during a statin period and 13 (7%) during a placebo period. Two thirds of those completing the trial reported restarting long term treatment with statins.
No overall effect of atorvastatin 20 mg on muscle symptoms compared with placebo was found in participants who had previously reported severe muscle symptoms when taking statins. Most people completing the trial intended to restart treatment with statins. N-of-1 trials can assess drug effects at the group level and guide individual treatment.
ISRCTN30952488, EUDRACT 2016-000141-31, NCT02781064.
The identification of subjects at high risk for Alzheimer's disease is important for prognosis and early intervention. We investigated the polygenic architecture of Alzheimer's disease and the ...accuracy of Alzheimer's disease prediction models, including and excluding the polygenic component in the model. This study used genotype data from the powerful dataset comprising 17 008 cases and 37 154 controls obtained from the International Genomics of Alzheimer's Project (IGAP). Polygenic score analysis tested whether the alleles identified to associate with disease in one sample set were significantly enriched in the cases relative to the controls in an independent sample. The disease prediction accuracy was investigated in a subset of the IGAP data, a sample of 3049 cases and 1554 controls (for whom APOE genotype data were available) by means of sensitivity, specificity, area under the receiver operating characteristic curve (AUC) and positive and negative predictive values. We observed significant evidence for a polygenic component enriched in Alzheimer's disease (P = 4.9 × 10(-26)). This enrichment remained significant after APOE and other genome-wide associated regions were excluded (P = 3.4 × 10(-19)). The best prediction accuracy AUC = 78.2% (95% confidence interval 77-80%) was achieved by a logistic regression model with APOE, the polygenic score, sex and age as predictors. In conclusion, Alzheimer's disease has a significant polygenic component, which has predictive utility for Alzheimer's disease risk and could be a valuable research tool complementing experimental designs, including preventative clinical trials, stem cell selection and high/low risk clinical studies. In modelling a range of sample disease prevalences, we found that polygenic scores almost doubles case prediction from chance with increased prediction at polygenic extremes.
Background:
Intrathecal Drug Delivery Systems are underutilised in the management of refractory cancer pain despite evidence of their efficacy. Not all patients who are offered this treatment ...modality accept it. There is no current evidence that indicates if the use of intrathecal drug delivery systems impacts on place of care for patients with cancer related pain.
Aims:
This service evaluation compared place of care, place of death and morphine equivalent daily dose at end of life for patients in whom Intrathecal Drug Delivery was successfully established versus those who chose comprehensive medical management.
Setting/participants:
A retrospective longitudinal cohort study of 45 patients with cancer pain comparing those who had ongoing analgesia successfully delivered via an implanted Intrathecal Drug Delivery System (n = 28) with those who continued to receive comprehensive medical management (n = 17).
Results:
There was a markedly greater time spent in the community in the intrathecal group than the medical management group (median 126.5vs 25.5 days; p = 0.002) and a lower morphine equivalent daily dose at end of life (median 127.5vs 440.0 p = 0.022).
Conclusion:
In patients with advanced cancer, the successful establishment of intrathecal analgesia is associated with more time in the community and a lower morphine equivalent daily dose at end of life. The study has low numbers, and the sample was retrospectively selected. Nevertheless, these findings suggest the initial investment of time in an inpatient setting may be beneficial. Further research is required, using larger, prospective studies of patient outcomes in this setting.
We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (
...= 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.
BackgroundRacial/ethnic disparities during the first six months of the COVID-19 pandemic led to differences in COVID-19 testing and adverse outcomes. We examine differences in testing and adverse ...outcomes by race/ethnicity and sex across a geographically diverse and system-based COVID-19 cohort collaboration.MethodsObservational study among adults (≥18 years) within six US cohorts from March 1, 2020 to August 31, 2020 using data from electronic health record and patient reporting. Race/ethnicity and sex as risk factors were primary exposures, with health system type (integrated health system, academic health system, or interval cohort) as secondary. Proportions measured SARS-CoV-2 testing and positivity; attributed hospitalization and death related to COVID-19. Relative risk ratios (RR) with 95% confidence intervals quantified associations between exposures and main outcomes.Results5,958,908 patients were included. Hispanic patients had the highest proportions of SARS-CoV-2 testing (16%) and positivity (18%), while Asian/Pacific Islander patients had the lowest portions tested (11%) and White patients had the lowest positivity rates (5%). Men had a lower likelihood of testing (RR = 0.90 0.89-0.90) and a higher positivity risk (RR = 1.16 1.14-1.18) compared to women. Black patients were more likely to have COVID-19-related hospitalizations (RR = 1.36 1.28-1.44) and death (RR = 1.17 1.03-1.32) compared with White patients. Men were more likely to be hospitalized (RR = 1.30 1.16-1.22) or die (RR = 1.70 1.53-1.89) compared to women. These racial/ethnic and sex differences were reflected in both health system types.ConclusionsThis study supports evidence of disparities by race/ethnicity and sex during the COVID-19 pandemic that persisted even in healthcare settings with reduced barriers to accessing care. Further research is needed to understand and prevent the drivers that resulted in higher burdens of morbidity among certain Black patients and men.
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