Tag: 20/1/22

Categories : HospitalsTags :

Standard Saline as Effective as Specialised Intravenous Fluids in ICU

On By ModernMedia
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New research on intravenous fluids used in intensive care shows that commonly used saline is as effective at keeping people alive and their organs functioning as more expensive balanced solutions.

The results not only provide doctors with greater certainty about the safety and benefits of saline solution, but also have broader implications for treatment availability and costs around the world.

“Just about every patient admitted to the Intensive Care Unit (ICU) will receive intravenous fluids for resuscitation or as part of standard treatment,” said Professor Simon Finfer AO, an ICU physician and senior researcher at The George Institute.

“However, the best choice of fluid has been a longstanding issue of debate as some fluids were approved and licensed for use based on trials in small numbers of patients looking only at short term outcomes.”

Plasma-Lyte 148® is a type of intravenous fluid that more closely matches the body’s normal levels of certain minerals, known as balanced multi-electrolyte solutions, or BMES. Use of BMES has risen since concerns were raised about increased rates of kidney injury and death associated with saline, although this had not been proven in clinical trials.

To address this issue, the Plasma-Lyte 148® versUs Saline (PLUS) study recruited over 5000 patients across 53 sites in Australia and New Zealand.

Participants were adult patients admitted to ICUs in need of intravenous fluid resuscitation for their underlying medical condition. The patients were followed for a period of 90 days after treatment as previous research had shown around one in four would be at risk of dying within this timeframe.

At 90 days after the treatment, the same number of patients who had received BMES or saline had died.

Other outcomes including days of mechanical ventilation, kidney dialysis, patient survival time in the ICU and in hospital, as well as major measures of healthcare costs were similar between the groups.

“We found no evidence that using a balanced multi-electrolyte solution in the ICU, compared to saline, reduced risk of death or acute kidney injury in critically ill adults,” said Prof Finfer.

ICU is one of the most expensive aspects of healthcare and ICU resources are in high demand. Even a small difference in outcomes may result in important clinical and economic effects at the population level.

In the early 1990s, up to one in seven people were dying in ICUs across Australia and New Zealand, prompting George Institute researchers to start investigating intravenous fluid resuscitation – one of the most commonly used treatments in intensive care settings.

This started a program of fluid resuscitation research conducted in ICUs that no-one previously thought possible which has resulted in major changes to clinical treatment guidelines worldwide, preventing harmful practices and saving many lives.

The results from this study were published in the New England Journal of Medicine.

Source: EurekAlert!

Categories : Mental HealthTags :

Suicidal Ideation in Adolescents Linked to Risky Driving

On By ModernMedia
Photo by Why Keu on Unsplash

Suicide and motor vehicle traffic accidents are two of the most common forms of death among adolescents. A new study published in JAMA Pediatrics found that adolescents who reported at least one suicide attempt within the last year, compared to those reporting no attempts, were also more likely to report infrequent seat belt use and driving with a drunk driver. There were also over twice as likely to report driving drunk.

The researchers analysed data from over 13 500 U.S. high school students who participated in the 2019 Youth Risk Behavior Survey, and found that 19% of the sample reported suicidal ideation. Texting or e-mailing while driving was the most commonly reported form of risky driving behaviours.

Study lead author Kyle T. Ganson, PhD, assistant professor at the University of Toronto, said: “The findings from this study emphasise the need for mental health support for adolescents experiencing suicidality as a means of increasing safety for themselves and their communities, as accidental injury deaths via car accidents were the leading cause of death among adolescents in 2019.”

“The more severe the suicidality, the stronger the association with risky driving behaviours,” Dr Ganson continued. “Adolescents who reported a suicide injury, such as a poisoning or overdose needing to be treated by a medical professional, had the highest likelihood to report all four risky driving behaviors we examined.”

The researchers stress the importance of the implications their findings have to protect the health and well-being of adolescents. “Health care professionals should consider discussing risky driving behaviours with teens who report suicidality,” said co-author Jason M. Nagata, MD, MSc, assistant professor at the University of California, San Francisco.

Source: News-Medical.Net

Categories : COVID Expert OpinionTags :

SA Scientists Criticise Developed Nations’ ‘Scepticism’ over Omicron

On By ModernMedia
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South African scientists have criticised developed nations for ignoring early evidence that Omicron was “dramatically” milder than the previous strains of the coronavirus, an attitude which could be construed as “racism”.

“It seems like high-income countries are much more able to absorb bad news that comes from countries like South Africa,” said Prof Shabir Madhi, vaccinologist at Wits University.

“When we’re providing good news, all of a sudden there’s a whole lot of scepticism. I would call that racism.”

Prof Salim Karim, former head of the South African government’s COVID advisory committee and vice-president of the International Science Council concurs.

“We need to learn from each other. Our research is rigorous. Everyone was expecting the worst and when they weren’t seeing it, they were questioning whether our observations were sufficiently scientifically rigorous,” he said, though he acknowledged that Omicron’s high number of mutations may have led to an overabundance of caution.

But by early December, anecdotal evidence was already indicating that Omicron caused far fewer hospitalisations than the Delta Wave, despite being more transmissible.

“The predictions we made at the start of December still hold. Omicron was less severe. Dramatically. The virus is evolving to adapt to the human host, to become like a seasonal virus,” said Prof Marta Nunes, senior researcher at the Vaccines and Infectious Diseases Analytics department at Wits

“It didn’t take even two weeks before the first evidence started coming out that this is a much milder condition. And when we shared that with the world there was some scepticism,” Prof Karim added.

While some have argued that Africa’s pandemic experience is different due to factors such as its younger population, any advantage South Africa has is outweighed by poor health, with excess deaths during COVID at 480 per 100 000, one of the highest in the world. Prof Madhi points out a high prevalence of comorbidities such as obesity and HIV.

A majority of those excess deaths are probably due to the pandemic, many SA scientists believe. Half occurred during the Delta wave, but only 3% transpired during the Omicron wave so far, Prof Madhi pointed out.

The government chose not to tighten restrictions during the fourth wave, and criticised the reimposition of travel bans coming from South Africa. South African scientists have mostly welcomed this, even though the WHO continues to warn that Omicron should not be considered “mild”.

“We believe the virus is not going to be eradicated from the human population. We must now learn how to live with this virus and it will learn how to live with us,” said Prof Nunes.

The low death rate from Omicron indicates a different phase of the pandemic. “I’d refer to it as a convalescent phase,” said Prof Madhi. The government has already effectively stopped quarantining and contact tracing.

Source: BBC News

Categories : COVID PaediatricsTags :

COVID is Turning Some Children into ‘Fussy Eaters’

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More and more children could be turning into ‘fussy eaters’ after a bout of COVID, according to smell experts at the University of East Anglia and Fifth Sense, a charity for people affected by smell and taste disorders.

This is because they may be suffering parosmia – a symptom where people experience strange and often unpleasant smell distortions. Once-loved foods like chicken may taste like petrol, for example, making it hard for children to eat those foods and maintain a healthy diet – or even take in enough calories to maintain their weight.

Together, Fifth Sense and leading smell expert Professor Carl Philpott from University of East Anglia, are launching guidance to help parents and healthcare professionals better recognise the disorder.

Prof Carl Philpott said: ”Parosmia is thought to be a product of having less smell receptors working which leads to only being able to pick up some of the components of a smell mixture. It’s a bit like Eric Morecambe famously said to Andre Previn – ‘it’s all the right notes but not necessarily in the right order’.

He said that as COVID swept through classrooms in the UK, there has been a growing awareness that it is affecting children too. “In many cases the condition is putting children off their food, and many may be finding it difficult to eat at all.

“It’s something that until now hasn’t really been recognised by medical professionals, who just think the kids are being difficult eaters without realising the underlying problem. For Prof Philpott, he is seeing teenage patients with parosmia for the first time in his career.

Fifth Sense Chair and founder Duncan Boak said: “We’re hearing anecdotal evidence that children are really struggling with their food after covid.

“If children are suffering smell distortions – and food smells and tastes disgusting – it’s going to be really hard for them to eat the foods they once loved.

“We’ve heard from some parents whose children are suffering nutritional problems and have lost weight, but doctors have put this down to just fussy eating. We’re really keen to share more information on this issue with the healthcare profession so they’re aware that there is a wider problem here.”

Together with Prof Philpott, Fifth Sense have put together guidance for parents and healthcare providers to help recognition and understanding of the problem.

The guidance shows that children should be listened to and believed. Parents can help by keeping a food diary noting those that are safe and those that are triggers.

“Establishing what the triggers are and what tastes ok is really important,” said Prof Philpott.

“There are lots of common triggers – for example cooking meat and onions or garlic and the smell of fresh coffee brewing, but these can vary from child to child.

“Parents and healthcare professionals should encourage children to try different foods with less strong flavours such as pasta, bananas, or mild cheese – to see what they can cope with or enjoy.

“Vanilla or flavour-free protein and vitamin milkshakes can help children get the nutrients they need without the taste. And it may sound obvious, but children could use a soft nose clip or hold their nose while eating to help them block out the flavours.”

‘Smell training’ has emerged as a simple and side-effect free treatment option for various causes of smell loss, and is a final option to consider.

Prof Philpott said: “Smell training involves sniffing at least four different odours – for example eucalyptus, lemon, rose, cinnamon, chocolate, coffee, or lavender – twice a day every day for several months.

“Children should use smells that they are familiar with and are not parosmia triggers. In younger children this might not be helpful, but in teenagers this might be something they can tolerate.”

Source: University of East Anglia

Categories : Medical Research & TechnologyTags :

Why Public ‘Big Data’ Initiatives Failed to Deliver on COVID

On By ModernMedia
Source: Pixabay

Experts from a data-driven initiative to aid the COVID response have outlined major obstacles to making successful use of new data released by technology companies in times of crisis. Harvard University’s Caroline Buckee and colleagues presented these views in the open-access journal PLOS Digital Health.

Technology companies collect vast amounts of data on their users, including their geographic locations. During the COVID pandemic, many companies made some of their user data available in order to aid public health efforts, such as monitoring the impact of social distancing policies or travel restrictions. However, Buckee and colleagues note, many efforts to harness these “data for good” failed to make a significant impact.

The authors are part of Crisis Ready, in which epidemiologists help policy makers understand and use insights from human mobility data released by technology companies. In this capacity, they have now identified challenges that hinder other efforts to use novel forms of data as part of disaster response.

Firstly, data-sharing agreements between researchers and technology companies were hastily arranged during the pandemic. They recommend pre-established agreements that will be ready for implementation in future crises.

Buckee and colleagues also observed that a lack of standardisation, interoperability, and clarity on uncertainties or biases in novel datasets resulted in the need for highly specialised professionals to process this data. To address this challenge, data access and characteristics can be negotiated prior to a disaster.

The authors also call for global investment in training more professionals that can analyse complex data to provide information in a disaster. In addition, they strongly emphasise the need for local response agencies to collaborate closely with regional scientists.

Without such efforts, no amount of data donated by technology companies will be useful in a crisis.

“It is still very difficult to translate the vast amounts of digital data that are owned by companies into useful public health tools, despite their incredible potential for transforming decision-making during health emergencies,” said Buckee. “We need to build a global cohort of data scientists and epidemiologists who can support local governments, and put in place the data pipelines and analysis tools before disasters hit, so that local responders have context-specific information when they need it most.”

Source: News-Medical.Net