Greater Number Of Days Research Articles

Electrodynamic influence on the diurnal behaviour of neutral daytime airglow emissions

Abstract. The diurnal variations in daytime airglow emission intensity measurements at three wavelengths OI 777.4 nm, OI 630.0 nm, and OI 557.7 nm made from a low-latitude location, Hyderabad (17.5° N, 78.4° E; 8.9° N MLAT) in India have been investigated. The intensity patterns showed both symmetric and asymmetric behaviour in their respective diurnal emission variability with respect to local noon. The asymmetric diurnal behaviour is not expected considering the photochemical nature of the production mechanisms. The reason for this observed asymmetric diurnal behaviour has been found to be predominantly the temporal variation in the equatorial electrodynamics. The plasma that is transported across latitudes due to the action of varying electric field strengths over the magnetic equator in the daytime contributes to the asymmetric diurnal behaviour in the neutral daytime airglow emissions. Independent magnetic and radio measurements support this finding. It is also noted that this asymmetric diurnal behaviour in the neutral emission intensities has a solar cycle dependence with a greater number of days during high solar activity period showing asymmetric diurnal behaviour compared to those during a low solar activity epoch. These intensity variations over a long timescale demonstrate that the daytime neutral optical emissions are extremely sensitive to the changes in the eastward electric field over low and equatorial latitudes.

Differential association between unemployment status and mental health among veterans and civilians

ABSTRACTThis study aims to examine the negative effect of unemployment on mental health among 2,762 veterans and 45,095 civilians aged 18 to 50 years. The data were from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used ordinary least squares regression to test the interaction association between employment status and veteran/civilian status with mental health status. Findings revealed that long-term unemployed veterans had a significantly greater number of days with poor mental health than long-term unemployed civilians. The study highlights the need for future research concerning the negative effects of long-term unemployment on veterans’ mental health as well as the reciprocal relationships between mental health and occupational functioning for veterans. The findings challenge researchers to question the meanings that are associated with employment status for veterans as compared to those of their civilian peers. In addition to this, the study raises the need for further exploration into the topics of identity, self-perception, and the notion often present in the military/veteran culture that there is “dignity in labor.”

Peripheral Nerve Catheters in Children

Background Peripheral nerve catheters (PNCs) are used with increasing frequency in children. Although adult studies have demonstrated safety with this technique, there have been few safety studies in children. The main objective of the current investigation was to examine the incidence of PNC complications in children undergoing surgery. Methods This is an observational, multi-institutional study using the Pediatric Regional Anesthesia Network (PRAN) database. Data pertaining to PNCs were entered prospectively into a secure, online database by each participating centre. Patient characteristics, anatomic location, localization techniques, medications used, and complications were recorded for each catheter. All complications and any sequelae were followed until resolution. Results There were 2074 PNCs included in the study. 251 adverse events and complications were recorded, resulting in an overall incidence (95% CI) of complications of 12.1% (10.7–13.5%). The most common complications were catheter malfunction, block failure, infection, and vascular puncture. There were no reports of persistent neurologic problems, serious infection, or local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) of 0.04% (0.001–0.2%). Patients who developed an infection had used the catheters for a greater number of days, median (IQR) of 4.5 (3–7) days compared with 3 (1–3) days in the patients who did not develop an infection, P Conclusions Our data support the safety of placing PNCs in children, with adverse event rates similar to adult studies. Catheter problems are common, yet minor, in severity.

Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation

To determine the associations of breast milk intake after birth with neurological outcomes at term equivalent and 7 years of age in very preterm infants We studied 180 infants born at <30 weeks' gestation or <1250 grams birth weight enrolled in the Victorian Infant Brain Studies cohort from 2001-2003. We calculated the number of days on which infants received >50% of enteral intake as breast milk from 0-28 days of life. Outcomes included brain volumes measured by magnetic resonance imaging at term equivalent and 7 years of age, and cognitive (IQ, reading, mathematics, attention, working memory, language, visual perception) and motor testing at 7 years of age. We adjusted for age, sex, social risk, and neonatal illness in linear regression. A greater number of days on which infants received >50% breast milk was associated with greater deep nuclear gray matter volume at term equivalent age (0.15 cc/d; 95% CI, 0.05-0.25); and with better performance at age 7 years of age on IQ (0.5 points/d; 95% CI, 0.2-0.8), mathematics (0.5; 95% CI, 0.1-0.9), working memory (0.5; 95% CI, 0.1-0.9), and motor function (0.1; 95% CI, 0.0-0.2) tests. No differences in regional brain volumes at 7 years of age in relation to breast milk intake were observed. Predominant breast milk feeding in the first 28 days of life was associated with a greater deep nuclear gray matter volume at term equivalent age and better IQ, academic achievement, working memory, and motor function at 7 years of age in very preterm infants.

The association between unemployment status and physical health among veterans and civilians in the United States

ABSTRACTThis study analyzed data from the 2012 Behavioral Risk Factor Surveillance System to examine the association between unemployment status and physical health among a sample of 170,924 civilians and 12,129 veterans (aged 18–50 years). Multivariate regression analysis was used to test the interaction effect between employment status and veteran/civilian status on physical health. Veterans who were unemployed long term (longer than 27 weeks) reported a significantly greater number of days with poor physical health than civilians who experienced long-term unemployment. Timely prevention and intervention efforts to integrate veterans into the workforce could lead to substantially improved physical health outcomes. Public health policies and programs that are funded to assist veterans in securing and maintaining gainful employment can have lasting implications for their overall improved health and physical well-being.

Sociodemographic and drug use severity differences between medical marijuana users and non-medical users visiting the emergency department.

The purpose of this study is to extend what is known about medical marijuana and non-medical marijuana users who visit the emergency department (ED) by exploring differences in their sociodemographic characteristics and their drug-related problem severity. Of 292 consecutively enrolled exclusive marijuana-only users visiting the ED for any reason, 37% (n = 107) reported using marijuana on the advice of a medical doctor, and 63% (n = 185) reported that they did not use it under the advice of a medical doctor (ie, non-medical user). Participants denied using any other drug with the exception of alcohol. Participants completed the Addiction Severity Index-Lite which provided composite and individual items related to drug use problems, psychiatric problems, medical problems, and alcohol use problems. Self-efficacy for avoiding drug use and sociodemographic characteristics were also collected. In a multivariate model, compared to non-medical marijuana users, medical users reported a higher frequency of days of use, more money spent on marijuana, and lower readiness to change use of marijuana, yet lower frequency of drug problems and tended to be low-risk versus moderate-severe risk users. Medical marijuana use was associated with a greater number of days of psychological problems. Results for medical marijuana users might be interpreted as consistent with that of routine, self-administered treatment for medical or psychological problems. Results suggest behavioral health interventions in acute care settings should consider treating non-medical marijuana users differently than medical users due to the greater drug-related problems associated with non-medical use. (Am J Addict 2016;25:385-391).

Attempts to stop or reduce daily cannabis use: An intensive natural history study.

We attempted to replicate and add to our prior study of attempts to stop or reduce cannabis use among daily cannabis users trying to change on their own, by observing a larger sample and adding further clinically relevant outcomes. Daily users (n = 193) who intended to stop or reduce sometime in the next 3 months called an Interactive Voice Response system each morning for 3 months to report on cannabis use, attempts to stop or reduce, withdrawal symptoms, and so forth, on the prior day. This study replicated our prior findings that (a) cannabis users trying to change make many, and often rapid, transitions among use as usual, reduction, and abstinence; (b) reduction attempts are more common than abstinence attempts; (c) quit and reduction attempts are short-lived and few participants achieve long-term abstinence; (d) alcohol and drug use are not greater on abstinence days; and (e) few users seek treatment. Novel findings included (f) a greater number of days of abstinence or intentional reduction predicted a greater decline in cannabis dependence, (g) most users do not prepare before their quit attempt, (h) coping outcomes during abstinence predict increased duration of abstinence, (i) tobacco use is less common on days of abstinence, and (j) withdrawal symptoms occur even with short quit attempts. Replication tests in more generalizable samples and of longer duration are indicated. Further natural history studies are likely to provide information to help improve the content of psychological treatments for cannabis use. (PsycINFO Database Record

Mood instability and clinical outcomes in mental health disorders: A natural language processing (NLP) study

IntroductionMood instability is an important problem but has received relatively little research attention. Natural language processing (NLP) is a novel method, which can used to automatically extract clinical data from electronic health records (EHRs).AimsTo extract mood instability data from EHRs and investigate its impact on people with mental health disorders.MethodsData on mood instability were extracted using NLP from 27,704 adults receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) for affective, personality or psychotic disorders. These data were used to investigate the association of mood instability with different mental disorders and with hospitalisation and treatment outcomes.ResultsMood instability was documented in 12.1% of people included in the study. It was most frequently documented in people with bipolar disorder (22.6%), but was also common in personality disorder (17.8%) and schizophrenia (15.5%). It was associated with a greater number of days spent in hospital (B coefficient 18.5, 95% CI 12.1–24.8), greater frequency of hospitalisation (incidence rate ratio 1.95, 1.75–2.17), and an increased likelihood of prescription of antipsychotics (2.03, 1.75–2.35).ConclusionsUsing NLP, it was possible to identify mood instability in a large number of people, which would otherwise not have been possible by manually reading clinical records. Mood instability occurs in a wide range of mental disorders. It is generally associated with poor clinical outcomes. These findings suggest that clinicians should screen for mood instability across all common mental health disorders. The data also highlight the utility of NLP for clinical research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

ObjectiveTo investigate whether cannabis use is associated with increased risk of relapse, as indexed by number of hospital admissions, and whether antipsychotic treatment failure, as indexed by number of unique...

Dinâmica do controle químico de Phakopsora pachyrhizi em plantas de soja submetidas a diferentes regimes hídricos

RESUMO: Objetivou-se com este trabalho avaliar a dinâmica do controle químico de Phakopsora pachyrhizi em plantas de soja submetidas a diferentes regimes hídricos. O experimento foi conduzido na área experimental do Instituto Phytus, no município de Itaara, região central do Rio Grande do Sul, na safra 2012/2013. O delineamento experimental utilizado foi inteiramente casualizado, com quatro repetições, em arranjo fatorial (2x6). O fator A foi composto por dois regimes hídricos: 1) déficit hídrico (50-60% da capacidade de campo); 2) sem déficit hídrico (90-100% da capacidade de campo). O fator B consistiu em quatro intervalos de tempo entre a aplicação de fungicidas e a simulação de chuva (0, 30, 60 e 120 min), uma testemunha com aplicação sem chuva e mais uma testemunha sem aplicação de fungicida. Na aplicação foram utilizados os ingredientes ativos trifloxistrobina + protioconazol (60,0 + 70,0 g i.a.ha-1) com adição de Aureo(r) na dose de 0,375 L.p.c ha-1. Os parâmetros avaliados foram o tempo decorrido entre a aplicação e o surgimento da primeira pústula de ferrugem asiática, a severidade da doença, a produtividade e a massa de grãos. Verificou-se que a aplicação de fungicida em plantas sob déficit hídrico proporciona o maior número de dias para o aparecimento da primeira pústula. A simulação de chuva tem grande efeito na remoção de fungicidas independentemente do regime hídrico. O controle de P. pachyrhizi em plantas sob déficit hídrico foi eficaz, resultando em incrementos de produtividade.

Safety, Efficacy, and Determination of the Recommended Phase 2 Dose for the Oral Selective Inhibitor of Nuclear Export (SINE) Selinexor (KPT-330)

Safety, Efficacy, and Determination of the Recommended Phase 2 Dose for the Oral Selective Inhibitor of Nuclear Export (SINE) Selinexor (KPT-330)

Cost-effectiveness analysis of a continuing care intervention for cocaine-dependent adults

IntroductionThe study conducts a cost-effectiveness analysis (CEA) of a continuing care Telephone Monitoring and Counseling (TMC) intervention for adults diagnosed with cocaine dependence. Participants were randomly assigned to a control condition of intensive outpatient treatment only (treatment-as-usual, or TAU; N=108), or to one of two treatment conditions featuring TMC (N=106) and TMC plus incentives (TMC-plus; N=107). Follow-up assessments were conducted over a 2-year period. MethodsIntervention and client costs were collected with the program and client versions of the Drug Abuse Treatment Cost Analysis Program (DATCAP). Effectiveness was measured as the number of days abstinent during follow-up. Secondary analyses consider alternative measures of effectiveness and the reduced societal costs of physical and mental health problems and criminal justice involvement. ResultsFrom the societal perspective, TMC dominates both TAU and TMC-plus as a cost-effective and cost-saving intervention. Results varied by substance-using status, however, with the subgroup of participants in TMC-plus that were using drugs at intake and early in treatment having the greatest number of days of abstinence and generating similar savings during follow-up than the TMC subgroup using drugs at intake. ConclusionsTelephone monitoring and counseling appears to be a cost-effective and potentially cost-saving strategy for reducing substance use among chronic substance users. Providing client incentives added to total intervention costs but did not improve overall effectiveness. Clinical trial registrationClinical Trials.gov Number: NCT00685659.

Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN)

Peripheral nerve catheters (PNCs) are used with increasing frequency in children. Although adult studies have demonstrated safety with this technique, there have been few safety studies in children. The main objective of the current investigation was to examine the incidence of PNC complications in children undergoing surgery. This is an observational, multi-institutional study using the Pediatric Regional Anesthesia Network (PRAN) database. Data pertaining to PNCs were entered prospectively into a secure, online database by each participating centre. Patient characteristics, anatomic location, localization techniques, medications used, and complications were recorded for each catheter. All complications and any sequelae were followed until resolution. There were 2074 PNCs included in the study. 251 adverse events and complications were recorded, resulting in an overall incidence (95% CI) of complications of 12.1% (10.7-13.5%). The most common complications were catheter malfunction, block failure, infection, and vascular puncture. There were no reports of persistent neurologic problems, serious infection, or local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) of 0.04% (0.001-0.2%). Patients who developed an infection had used the catheters for a greater number of days, median (IQR) of 4.5 (3-7) days compared with 3 (1-3) days in the patients who did not develop an infection, P<0.0001. Our data support the safety of placing PNCs in children, with adverse event rates similar to adult studies. Catheter problems are common, yet minor, in severity.

Early Predictors of Outcomes Following Non-Operative Management of ACL Injury

Objectives:Identification of patient characteristics early after injury that influences long-term outcomes is needed to guide appropriate decision-making with regard to surgical management. The purpose of this study was to determine factors early after ACL injury which predict outcomes following non-operative management of ACL injury.Methods:59 (52.5% F; mean age 31.3±10.7 yrs) athletes completed rehabilitation to resolve knee joint range of motion, effusion, pain and gait impairments (quiet knee) after ACL injury. Patients then completed 10 additional rehabilitation sessions over 5 weeks consisting of progressive strengthening and neuromuscular training. Quadriceps strength testing, 4 single-legged hop tests, the Knee Outcome Survey Activities of Daily Living Scale (KOS), Global Rating Scale for Perceived Function (GR), and International Knee Documentation Committee 2000 form (IKDC) were completed following these 10 sessions. Two years after non-operative rehabilitation patients again completed the IKDC. “Normal” knee function was defined as an IKDC score in the top 85% of scores reported by uninjured people of the same age and sex, with “below normal” knee function equal to scores in the bottom 15% of normative data. Fisher's exact tests and Mann-Whitney U tests were used to test differences in baseline and clinical measures after non-operative rehabilitation between those with “normal” and “below normal” knee function at 2 years. A logistic regression model was used to identify factors predictive of 2 year knee function. A prior significance level was set at p≤.05.Results:11 patients (18.6%) reported knee function <15% on the IKDC at 2 years (Normal: 93.8±4.5%, 95% CI: 92.3-95.1; Below Normal: 72.1±12.7%, 95% CI: 63.6-80.6). No group differences existed for age (p=0.613) or sex (p=0.320) between those who scored in the normal range and those who scored <15%. Patients with self-reported IKDC knee function <15% had significantly lower IKDC scores at baseline (p=0.010; Normal: 83.0±10.0%, 95% CI: 80.1-85.9; Below Normal: 72.7±10.8%, 95% CI: 64.9-80.4) and required a greater number of days to achieve a quiet knee after injury (p=0.005; Normal: 58.5±21.9 days, 95% CI: 52.1-64.8; Below Normal: 77.6±17.7 days, 95% CI: 65.7-89.5). A trend toward significance was present for quadriceps strength (p=0.076; Normal: 93.5±9.1%, 95% CI: 90.8-96.1; Below Normal: 88.4±7.4%, 95% CI: 83.4-93.4) but no group differences were present for hop scores (single: p=0.684; crossover: p=0.630; triple: p=0.724; 6-meter timed: p=0.341), KOS (p=0.119), or GR (p=0.136). A logistic regression model including IKDC, days to achieve a quiet knee, and quadriceps strength was statistically significant with IKDC and days to achieve a quiet knee being significant predictors of knee function at 2 years (p=0.001; R2=0.433; IKDC: p=0.040, OR=0.909; days to achieve a quiet knee: p=0.014, OR=1.054; quad strength: p=0.220, OR=0.941).Conclusion:Only 18% of active individuals managed non-operatively after ACL injury had IKDC scores <15% of norms 2 years after injury and rehabilitation. Lower baseline subjective knee function was predictive of poorer self-reported non-operative outcomes despite similar hop scores to those reporting normal knee function at 2 years. Longer time from injury to resolution of initial knee impairments also predicted poorer self-reported knee function, highlighting the importance of early rehabilitation with aggressive intervention to resolve impairments.

195 The effect of aminoglycoside antibiotics therapy on audiovestibular function in cystic fibrosis patients at the All Wales Adult Cystic Fibrosis Centre (AWACFC)

Aims 1.To determine the prevalence and severity of audiovestibular (AV) disease in adult CF patients attending the AWACFC. 2.To examine any potential link between AV disease and number of days of IV aminoglycosides (AG) received and duration of nebulised AG. Method The annual reviews of patients attending the AWACFC between 2009 and 2014 were reviewed retrospectively. Patients who had reported AV symptoms and received an assessment at an AV clinic were included and their cumulative number of days of IV AG and the length of time receiving nebulised AG was collected. Results 30 (12 male) of the 254 (12%), with a mean (SD) age of 34.2 (8.9) years, had described AV symptoms and been seen in AV clinic. 19 of the 30 patients were found to have some sensorineural (SN) hearing loss. Patients with SN hearing loss had a greater mean number of days on IV AG (340 days) than those with measured normal hearing (247 days) but the least days nebulised AG. 7 patients had vestibular dysfunction (VD). Patients with VD had a greater mean number of days on IV AG than those with normal vestibular function (386 vs 152 days). Conclusion The prevalence of SN hearing loss in AWACFC is less than previous reports (CF Trust 2009) perhaps due to underreporting of symptoms. SN hearing loss and VD were associated with greater number of days on IV AG which concurs with previous studies (Mulheran 2001). The greater the number of days on nebulised AG conferred less hearing damage. This may be explained by nebulised AG being withheld during course of IV AG or by greater long term nebulised AG usage resulting in reduced need for more toxic IV courses of AG. However, patient adherence was not assessed.

Low Back Pain in Microgravity and Bed Rest Studies.

The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is important to assess whether a history of LBP could have an operational impact. We evaluated LBP prospectively during short duration spaceflight (15 d; N=20) and compared this with similar data collected during two bed rest studies (N=40). Astronauts completed a questionnaire 5-10 d preflight, during each flight day, and 5-10 d postflight. All astronauts with a history of LBP also developed LBP in flight. These astronauts reported a significantly longer duration of LBP and a different pain location. LBP was most often experienced in the central area of the lower back during spaceflight with an incidence of 70% and a mean pain level of 3 (on a scale of 0-10). Pain resolved within 10 d of flight. No neurological signs were present. The most frequently reported countermeasure was assuming a "knees to chest (fetal tuck) position" combined with stretching. Greater LBP intensity was reported in spaceflight than bed rest with a trend indicating a greater number of days of pain during spaceflight. The current study represents a prospective study of LBP in spaceflight. The results indicate that LBP is self-limiting in spaceflight and should not pose an operational risk. Prior LBP on Earth appears to be a risk factor for LBP in spaceflight.

Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes

ObjectivesMood instability is a clinically important phenomenon but has received relatively little research attention. The objective of this study was to assess the impact of mood instability on clinical outcomes...

Prevalence of concomitant medications in older HIV+ patients and comparison with general population

Objective:The increasing population of human immunodeficiency virus (HIV)-infected elderly patients results in a higher number of comorbidities and greater incidence of polypharmacy in addition to antiretroviral therapy (ART). The aim of this study is to describe the use of concomitant medication in older HIV-infected patients and to compare it with older general population.Methods:The study included HIV-positive outpatients (>49 years) who received ART in 2011. Co-medication dispensed by pharmacies in that year was collected. Defined daily dose (DDD) for each drug was calculated by patient. A comparison was made between the use of co-medication among men between 50 and 64 years old in general population against the HIV-infected population.Results:The study was based on 118 patients (77% men), of which 82% took at least one co-medication and 58% at least five. The commonest co-medications used by HIV-positive patients were antibiotics (44%); analgesics (44%); anti-inflammatories (39%); antacids (38%); and psycholeptics (38%). The medicines used for the greatest number of days per HIV-positive patient were those related to the renin–angiotensin system; anti-diabetics; lipid modifying agents; antithrombotics; and calcium channel blockers. In comparison with the general male population, a higher proportion of HIV-infected patients used antibiotics (42 vs 30%, P = 0.018), antiepileptics (16 vs 5%, P = 0.000), psycholeptics (35 vs 17%, P = 0.000) and COPD medications (14 vs 7%, P = 0.008). The duration of antibiotics and psycholeptic use in HIV-infected patients was longer compared to the general population (P < 0.05).Conclusions:Older HIV-positive patients frequently take a higher number of co-medication, which increases the risk of adverse events, interactions with other medication, and may lead to poorer treatment adherence.

Occluded Tunneled Venous Catheter in Hemodialysis Patients: Risk Factors and Efficacy of Alteplase.

Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to the elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of tunneled CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty infusing or withdrawing fluid from their paths. Alteplase dose was infused to fill the lumen of the occluded catheter and remained for 50 min. As there was no obstruction of the catheter, the procedure was repeated. Three hundred and thirty-nine CVC in 247 patients were evaluated and followed, totalling 67,244 CVC-days. One hundred fifty-seven patients had only one CVC, 88 patients had two CVC during the study, and two patients had three CVC. The median age was 58 (47-66) years, patients were predominantly men (54%), with diabetic nephropathy as the main cause of chronic kidney disease (44%), the internal jugular vein as the main site of implantation (82%), and duration of dialysis before CVC implantation of 119 (41.5 to 585.5) days. Eight hundred and fifteen occlusion episodes were diagnosed (12 episodes/1000 CVC-days), with primary success with alteplase in 596 episodes (77%) and secondary in 81 cases (10%). In 99 episodes (13%), success was not achieved after the second dose of alteplase. Two hundred and thirty CVC were removed during the study and the removal causes were arteriovenous fistula use in 88 patients (38.3%), infectious and mechanical complications in 89 (38.7%) and 21 (9.1%), respectively, and others (transplantation, transfer, or death) in 32 patients (13.9%). Adverse effects were also not observed. In the multivariate analysis, we identified the greatest number of days with CVC (OR = 1.02, CI = 1.01-1.04, P = 0.004), the presence of diabetes (OR = 1.560, CI = 1.351-1.894, P = 0.015), and exit site infection (ESI) (OR = 1.567 CI = 1347-1926, P = 0.023) as factors associated with obstruction. Thrombotic occlusion showed frequent mechanical complication in CVC of HD patients. We observed 12 episodes of obstruction per 1000 CVC-days, with a high success rate after alteplase use (87%). In the multivariate analysis, the time with CVC, the presence of diabetes, and ESI were identified as variables associated with thrombotic obstruction.

Multi-country retrospective observational study of the management and outcomes of patients with Type 2 diabetes during Ramadan in 2010 (CREED).

AimTo describe the characteristics and management of patients with diabetes who chose to fast during Ramadan in 2010.MethodsThis was a multi‐country, retrospective, observational study, supplemented with physician and patient questionnaires, with data captured before, during and after Ramadan. A total of 508 physicians in 13 countries enrolled 3777 patients and a total of 3394 evaluable cases were analysed. We report on the subset of patients with Type 2 diabetes, which included 3250 patients (95.8%).ResultsOral anti‐hyperglycaemic therapy was the predominant pre‐Ramadan therapy for most patients (76.6%). The treatment regimen was modified before Ramadan for 39.3% of all patients (34.9% for patients on oral drugs alone, 47.1% for patients on injectable drugs alone). Almost all physicians (96.2%) reported providing fasting‐specific advice to patients and 62.6% report using guidelines or recommendations for the management of diabetes during Ramadan. In all, 64% of patients reported fasting everyday of Ramadan and 94.2% fasted for at least 15 days.ConclusionsPhysicians have increasingly adopted multiple approaches to the management of fasting during Ramadan, including the adoption of international and/or national guidelines, providing fasting‐specific advice and adjusting treatment regimens, such that patients are able to fast for a greater number of days without acute complications. Additional research is needed to explore physician and patient beliefs and practices to inform the evidence‐based management of diabetes while fasting, both during and outside of Ramadan, and to identify and address barriers to the universal uptake of techniques to facilitate that management.