Tag: 4/1/21

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Interviews Reveal Most Important ICU Outcomes for Patients and Family

On By ModernMedia

A University of Pennsylvania study has explored the important aspects and outcomes attributed to high quality ICU care by patients and their families.

These may not match the metrics assigned by healthcare providers, which could prompt reassessment, especially considering the increasing numbers of patients successfully discharged from the ICU, and in light of the COVID pandemic (although this study was conducted prior to this).ICU care is typically assessed in terms of mortality rates, durations of stay, ventilator-free days, infection rates and other data from patient health records. On discharge from an intensive care unit (ICU), efforts will often address physical and cognitive functioning, and grief and depression.

This research was aimed at improving the understanding of patient- and family-centred care. Researchers from the Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania conducted hour-long semi-structured interviews with 19 ICU survivors, as well as 30 family members of patients who had either survived or died in ICU.

The key aspects of quality care in the ICU experience were communication, patient comfort and sensing that the medical team’s care was exhaustive. The researchers noted that time and effort put into patient communication was highly valued, often leading patients feeling less alone and afraid. Communication and patient comfort were especially important during the ICU experience, and are delivered by high quality nursing care.

Key post-ICU outcomes were consistently given as survival, quality of life, physical functioning and cognitive functioning. Although survival alone was commonly seen by 25% of participants as a key ICU outcome, some outcomes were seen as worse than death by many. These included an inability to communicate, having a severe physical disability or dependence on machines, and living with severe or constant pain.

Source: Newswise

Journal information: Auriemma, C.L., et al. (2020) What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study. American Journal of Critical Care. doi.org/10.4037/ajcc2021398.

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Media Imagery Should Match the Safety Message

On By ModernMedia

A new study at Ohio State University (OSU) has shown the importance of using matching imagery to reinforce social media safety messages. After viewing safety messages on social media posts, parents of young children were better able to recall important points such as how to put a baby safely to sleep when the posts’ images aligned with the message being delivered, the researchers found.

An example would be pictures of children wearing safety helmets in messages advising parents to ensure their children wear safety helmets when they ride bicycles. Liz Klein, associate professor of public health at OSU, said: “Many times, scientists and safety experts aren’t involved in decisions about social media for health agencies and other organizations, and we end up seeing images that have nothing to do with the safety message or, worse, images that contradict the guidance.”

“In this study, we were trying to understand how much those mismatches matter — do people understand the message even if the picture isn’t right? Does the picture really matter?” Klein said.

The researchers sought these answers by using eye-tracking technology to assess how 150 parents reacted to three posts with aligned messages and three with messages that were not aligned with the images. Their eyes lingered longer on the aligned posts – (5.3 seconds) than they did on the misaligned posts (3.3 seconds). Klein said that she understood that those managing social media accounts might be tempted to use attention-grabbing imagery over message-aligned imagery, but the research showed that alignment was more important. Additionally, after adjusting for health literacy and social media use, health safety knowledge recall was improved by 2.8% for each additional second spent in viewing the social media post.Klein said that there implications beyond safety messaging for children aimed at adults, to wider health and safety communication. “We need to pay more attention to how we communicate with the people we’re trying to influence with health and safety guidance. All of us can do a better job of thinking about how we use our social media accounts to contribute to better public health,” she said.

Source: Ohio State University

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2020 Saw Huge Growth in Metformin Recalls

On By ModernMedia

The year 2020 saw huge numbers of metformin products being removed from shelves due to contamination concerns. Metformin is an antidiabetic agents used to treat type 2 diabetes mellitus, and comes as immediate-release and extended-release products.

In May 2020, the US Food and Drug Administration (FDA) announced that it had recommended certain extended-release metformin products to be removed from shelves, as they were contaminated with N-nitrosodimethylamine (NDMA), a potential carcinogen. This followed a December 2019 announcement that the FDA was aware of there being low levels of NDMA in metformin products outside of the US. Lab studies showed NDMA in US products in February, although the FDA only recommended voluntary recalls of metformin products on May 28. Participating in the recall of extended-release metformin were five companies, of which one, Apotex and Amneal, recalled all of its lots.

Whilst NDMA is ubiquitous in daily life, found in cured and grilled foods as well as contaminated water, the daily limit was set at 96ng, specifically because such a dose would lead to a 1 in 100 000 increase in cancer risk after 70 years of exposure.

Prompted by a report from a private laboratory stating that 16 of 38 metformin products tested exceeded the daily NDMA limit, the FDA released its own article in the journal American Association of Pharmaceutical Scientists, stating the reasoning behind its recommendation for voluntary recall. The FDA noted that its own testing only found eight products of the 38 exceeded the NDMA limit, and explained that N,N-dimethylformamide (DMF) conflated levels in mass spectrometry measurements.

However, this was followed in July by an additional set of recalls, and yet more in August and October. Separately, Sun Pharmaceuticals issued a recall for its relatively new extended-release oral suspension (brand name Riomet ER; 500 mg/5 mL) which had only received approval in February.However, none of the FDA’s recalls have extended to immediate-release metformin, which is the most commonly prescribed form of the drug.

Source: MedPage Today

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COVID Vaccinations for Those Who Have Recovered?

On By ModernMedia

As mass COVID vaccination programmes get underway around the world, an Op-Ed in MedPage Today debates whether people who have recovered from COVID should receive a vaccination.

Even given that there are over 200 vaccines in development, with a typical 7% success rate for vaccines, the 80-95% efficacy reported for the various vaccines being administered and the numbers of successful vaccines is a great outcome. Despite this, considering the great difficulty in producing enough vaccines for the world, should perhaps people who recovered from COVID not receive the vaccine, as they now are protected by a level of immunity?

The perspectives of immunology and bioethics indicate why such a person should also be vaccinated. There would be no difference in vaccinating a person who has had COVID to a person who has recovered then been re-exposed or re-infected. In both cases, a rapid immune response will be mounted in either individual, and either will be asymptomatic or present with mild, manageable symptoms. A re-exposure to the SARS-CoV-2 virus or receiving a vaccine might strengthen such a person’s immunity to future COVID infections.The immune system maintains an immunological library in our lymphatic system which stores memory lymphocytes (B cells) that respond to any past infection encountered by an individual. On a second or third exposure to a particular pathogen, these B cells are mobilised and rapidly prevent re-infection. Vaccines are designed to mimic a viral exposure without eliciting a dangerous viral infection. B cells don’t cause illness, only prompting the immune system, mitigating the infection.
Furthermore, vaccinations confer additional protections beyond just that of the disease which they are meant to protect against. There are abundant data that shows that vaccinations against measles, influenza, or TB generate lymphocytes that even help protect vaccinated individuals against COVID. In one theory on why young children do not present with severe COVID, standard childhood vaccinations are believed to  boost their overall level of immunity.

With so many factors complicating vaccine administration, it is best not to add yet another wrinkle, and there is also no information to suggest that vaccinating someone who has recovered from a virus will cause harmful effects. On the contrary, re-exposure to a virus or a subsequent vaccination against that virus could generate superior lymphocytes to combat further infection.

Source:MedPage Today

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New Year Sees SA Hospitals Battling for Resources Amid COVID Surge

On By ModernMedia

As the new year begins, South African hospitals are struggling as unprecedented numbers of COVID cases in the second wave are pushing resources to the limit. Hospitals are having to cope with the situation even as their own workers are off sick or self-isolating.

Last week, at least one province was reported to have reached out to the army to request additional personnel to help cope with the additional burden. Wester Cape premier Alan Winde said the province was recruiting an additional 1 300 health care workers (HCWs)In a weekly media briefing, KwaZulu-Natal premier Sihle Zikalala stated on Sunday that a total of 8 723 public sector HCWs had been infected with COVID since the start of the pandemic.

“Of the total infected, 98 have sadly succumbed to the disease. The majority of the infected health-care workers are nurses,” he said. HCWs are also struggling with burnout and illness.  Experts had long been predicting the impact the second wave would have on South Africa’s already weakened health infrastructure. As of Sunday, 3rd January, there were a total of 167 492 active cases in the country.  

Dr Kams Govender, who works west of Durban, said: “What we are experiencing now is just the tremor, the tsunami is yet to come in mid January. It’s hit us hard and it’s going to hit us even harder then. We are physically and emotionally exhausted, and worse, losing our health-care colleagues every single day. But still we push on and show up and pray for better days where there is more light than darkness.”

The hospital at Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, KZN, was reported to be full and bodies had to be taken to funeral homes within 48 hours.

One nurse at PMMH said, “The hospital is full, the Covid wards are full, the normal wards are full. There are no beds for our outpatients, they lie in the passage on stretchers waiting for beds. The Covid patients will be placed with one another in a consultation room. We try to separate them but it’s not a proper place for patients to be in because there are no beds, just the stretchers. We are running out of oxygen points because there are so many patients that need oxygen. We tend to prioritise who needs it more, but right now everyone needs it.”
Source: Sowetan Live