Mean Hours Research Articles

Quality of sleep in young onset Parkinson's disease: Any difference from older onset Parkinson's disease.

Sleep disorders occur commonly in Parkinson's disease and are often under-recognized and under treated in clinical practice. To determine the quality of sleep in patients with Young onset Parkinson's disease (YOPD) and to note whether there is any difference in quality of sleep from those patients with older onset Parkinson's disease (OOPD). One hundred and fifty six patients with Parkinson's disease (YOPD-51, OOPD-105) were clinically examined and quality of sleep was determined using Pittsburgh sleep quality index (PSQI), Parkinson's disease Sleep Scale (PDSS) and Epworth Sleep Scale (ESS). Other scales included Unified Parkinson's Disease Rating Scale -part III (UPDRS-III), Hoehn & Yahr Stage, Mini Mental Status Examination, Hamilton anxiety rating scale and Hamilton depression rating scale. The frequency of insomnia was higher in OOPD (55.2%) as compared to YOPD (27.5%) group (p = 0.001). The frequency of nightmares was lower in YOPD (7.8%) when compared to OOPD (24.8%) group (p = 0.012). The mean hours of actual sleep per night were higher in YOPD patients. Global PSQI score was better in YOPD indicating good overall sleep quality in YOPD patients. The total ESS score was significantly lower in YOPD (p = 0.019). The total PDSS score was significantly better in YOPD patients (p = 0.018). Patients with YOPD had an overall better quality of sleep with lesser incidence of insomnia, nightmares, daytime sleepiness and restlessness during sleep.

Real-world affected upper limb activity in chronic stroke: an examination of potential modifying factors

Background:Despite improvement in motor function after intervention, adults with chronic stroke experience disability in everyday activity. Factors other than motor function may influence affected upper limb (UL) activity.Objective:To characterize affected UL activity and examine potential modifying factors of affected UL activity in community-dwelling adults with chronic stroke.Methods:Forty-six adults with chronic stroke wore accelerometers on both ULs for 25 hours and provided information about potential modifying factors [time spent in sedentary activity, cognitive impairment, depressive symptomatology, number of comorbidities, motor dysfunction of the affected UL, age, activities of daily living (ADL) status, and living arrangement]. Accelerometry was used to quantify duration of affected and unaffected UL activity. The ratio of affected-to-unaffected UL activity was also calculated. Associations within and between accelerometry-derived variables and potential modifying factors were examined.Results:Mean hours of affected and unaffected UL activity were 5.0 ± 2.2 and 7.6 ± 2.1 hours respectively. The ratio of affected-to-unaffected UL activity was 0.64 ± 0.19, and hours of affected and unaffected UL activity were strongly correlated (r = 0.78). Increased severity of motor dysfunction and dependence in ADLs were associated with decreased affected UL activity. No other factors were associated with affected UL activity.Conclusions:Severity of motor dysfunction and ADL status should be taken into consideration when setting goals for UL activity in people with chronic stroke. Given the strong, positive correlation between affected and unaffected UL activity, encouragement to increase activity of the unaffected UL may increase affected UL activity.

Obesity, physical inactivity, and cardiorespiratory fitness of high school students in Urban Ludhiana, North West India: A survey

Context: The level of cardiorespiratory fitness (CRF) among the early adolescent would provide a measure of future burden of cardiovascular disease in Ludhiana, North West India. Aims: The aim was to estimate the level of CRF with the help of multi-stage-fitness (Bleep) test in high school students. Settings and Design: Cross sectional study in urban Ludhiana. Subjects and Methods: Totally, 200 school children were selected by simple random sampling from four schools. After the consent, a pretested questionnaire was administered, and the Bleep test performed. Statistical Analysis Used: Frequencies and proportions were calculated, Chi-square and t -test were the tests of significance. Results: The prevalence of obesity was 2.5%, overweight, severe thinness, and thin was15.5%, 1.5%, and 5%, respectively. There were more extreme weights among boys compared to girls (Chi-square = 7.59 and P = 0.022). The mean hours of weekly vigorous sports activity was 2.14 ± 0.63. The mean maximum aerobic capacity was 26.80 ± 4.37. CRF scores of very poor in 72.0% with only 7.05% scoring as Fair. More boys (93.8%) had very poor CRF scores compared to girls (43.7%). Score of Fair CRF in 16.0% girls and 0.9% boy. Conclusions: The high school children in urban Ludhiana, Northwest India exhibit high levels of physical inactivity, worsening obesity, and low levels of CRF, boys are more affected compared to girls. The bleep test is a low-cost and feasible quantitative tool to measure cardio respiratory fitness in limited resource setting.

To study the incidence and risk factors of early onset neonatal sepsis in an out born neonatal intensive care unit of India

Objectives: The objective was to study the Incidence and risk factors of early-onset neonatal sepsis in an out born neonatal intensive care unit (NICU) of New Delhi, India. Study Design and Setting: Prospective descriptive study over a period of 1 year. Patients and Methods: All out born neonates admitted within 72 h of life, with clinical features of sepsis with two or more high-risk factors for sepsis were enrolled and samples for sepsis screen and cultures were taken prior to administration of antibiotics in all cases. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Bacterial isolates were identified, and their resistance patterns were analyzed using the Vitek 2 C system. Results : Among the 440 admissions to NICU during the study period, 82 neonates (19%) with early onset sepsis were enrolled. The mean (standard deviation) weight and hours of life at admission were 2016 ± 724.04 g and 23.05 ± 2.89 h, respectively. Incidence of early onset sepsis was 18/1000 patient. Twenty-eight (34%) neonates were home delivered. Low birth weight (68%), prematurity (46%), and poor hygiene/cord care (46%) were common risk factors while lethargy/refusal to feed (77%), hypothermia (47.5%), and respiratory distress (44%) were common clinical presentations. Sepsis screen and blood culture were positive in 57% and 18% (n = 15), respectively. Klebsiella pneumonie (36%), Staphylococcus aureus (21%), and Escherichia coli (14%) were common organisms. Case fatality rate was 14% (12/82). Conclusion: Clinical sepsis along with sepsis screen is a good marker of neonatal sepsis: Incidence of early onset sepsis varies in out born neonates and many factors affect it like place of delivery, perinatal risk factors, and immediate practices done in newborn.

Short-term disability in solid tumor patients with bone metastases and skeletal-related events

Objective:The skeleton is a common site of metastasis in patients with solid tumors. These patients often experience pain and reduced quality-of-life. This analysis evaluated the time and costs associated with short-term disability use among solid tumor patients with bone metastases (BM) and skeletal-related events (SREs).Methods:Data from patients 18–64 years old with solid tumors and BM, eligible for short-term disability benefits between January 1, 2002 and December 31, 2010, were extracted from MarketScan Research Databases. Short-term disability hours and costs associated with BM and SREs were evaluated.Results:Overall, 1098 patients met the criteria. For all patients with BM, the monthly mean short-term disability hours were 17.7 h pre-BM diagnosis and increased to 60.2 h post-BM diagnosis (p < 0.001). The corresponding mean monthly short-term disability costs were $277 and $963 in the pre- and post-BM diagnosis periods, respectively (p < 0.001). Monthly mean short-term disability hours were higher for the cohort of patients with SREs (21.2 h pre-SRE diagnosis and 67.4 h post-SRE diagnosis) than for those without an SRE (8.6 h pre-SRE diagnosis and 14.4 h post-SRE diagnosis) (p < 0.001). Similarly, the corresponding monthly mean short-term disability costs were higher for patients with SREs ($625 and $1259 pre- and post-SRE diagnosis, respectively) than for patients without an SRE ($452 and $612 pre- and post-SRE diagnosis, respectively) (p < 0.001). Results of a multivariate analysis indicated that SREs were associated with an additional 39.4 short-term disability hours and $613 in short-term disability costs per month (p < 0.001).>Conclusion:Short-term disability hours and costs increased significantly when patients with solid tumors developed BM and SRE.

Reversal of Hyperglycemia: Effects on Nitric Oxide Signaling

BackgroundHyperglycemia in patients with acute coronary syndromes is associated with poor outcomes, and its rapid correction with insulin infusion has been shown to restore platelet responsiveness to nitric oxide and to suppress superoxide (O2−) generation. Thioredoxin-interacting protein has emerged recently as a pivotal modulator of hyperglycemia-induced inflammation, O2− production, and impairment of nitric oxide signaling, but it is not known whether its expression in platelets can be downregulated rapidly. MethodsIn 12 hyperglycemic patients with acute coronary syndrome, we evaluated the putative role of thioredoxin-interacting protein suppression in the platelet nitric oxide response after reversal of hyperglycemia with insulin infusion. ResultsInsulin infusion for 13.0 ± 0.8 (standard error of the mean) hours decreased blood glucose level from 16.6 ± 1.6 mmol/L to 8.7 ± 1.4 mmol/L (P = .002). This induced (1) sensitization of antiaggregatory response to nitric oxide (from 6.5% ± 7.7% to 39.7% ± 7.0%, P < .0001); (2) improved endothelial progenitor cell function (from a median of 45 to 180 colony-forming units, P < .05); and (3) decreases of whole blood reactive oxygen species content (P < .05). However, there was no significant suppression of platelet thioredoxin-interacting protein expression (mean decrease, 59 arbitrary units; 95% confidence interval, −193 to +74). ConclusionsCorrection of hyperglycemia in patients with acute coronary syndrome rapidly reverses oxidative stress, restoring both platelet nitric oxide responsiveness and endothelial progenitor cell function, but this process is largely or entirely independent of thioredoxin-interacting protein.

Abstract 13352: Work Absenteeism, Short Term Disability and Related Indirect Costs Associated with Cardiovascular Events and Related Clinical Procedures

Objectives: To examine work absenteeism (WA) and short-term disability (STD) hours and related indirect costs associated with cardiovascular events and related procedures (CVERP): myocardial infarction (MI), ischemic stroke (IS), unstable angina (UA), heart failure (HF), transient ischemic attack (TIA), coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI). Methods: Full-time employees aged 18-64, with WA or STD benefits, hyperlipidemia or lipid-lowering therapy, and ≥1 CVERP in 2003-2011 were extracted from a large claims and productivity database. Index date was the date of the first CVERP. All patients had data for ≥1 year pre-index and ≥1 month post-index. Per patient per month (PPPM) WA and STD hours were measured during the acute 1 month and 1 year post-index periods. Indirect costs associated with these hours were calculated using the Bureau of Labor Statistics wage rates (in 2013 $). Results: A total of 5,803 patients were included in the WA analysis (mean age 53, 86% male, mean Charlson comorbidity index [CCI] 0.6) and 21,074 in the STD analysis (mean age 53, 82% male, mean CCI 0.7). Patients with CABG as the first CVERP type had the highest mean PPPM costs and hours during the acute 1 month and the 1 year post-index periods (Fig. 1), followed by MI (for WA acute 1 month and 1 year, for STD acute 1 month) and HF (for STD 1 year). Mean PPPM WA hours ranged between 31 - 61 (indirect cost: $998 - $1842) and STD hours between 31- 121 (indirect cost: $532 - $2154) during the acute 1 month post-index period. Compared with the mean PPPM hours lost from work in the pre-index period, mean PPPM WA hours went up by 22.5 hours (indirect cost by $647) in the acute 1 month post-index period, and STD went up by 53 hours ($916). Conclusions: CVERP were associated with substantial work loss and related indirect costs, especially in the acute first month period following CVERP. Prevention of CVERP could result in potential WA and STD related cost savings for employers.

Services provided by community pharmacies in Wayne County, Michigan: A comparison by ZIP code characteristics

To document the availability of selected pharmacy services and out-of-pocket cost of medication throughout a diverse county in Michigan and to assess possible associations between availability of services and price of medication and characteristics of residents of the ZIP codes in which the pharmacies were located. Cross-sectional telephone survey of pharmacies coupled with ZIP code-level census data. 503 pharmacies throughout the 63 ZIP codes of Wayne County, MI. The out-of-pocket cost for a 30 days' supply of levothyroxine 50 mcg and brand-name atorvastatin (Lipitor-Pfizer) 20 mg, availability of discount generic drug programs, home delivery of medications, hours of pharmacy operation, and availability of pharmacy-based immunization services. Census data aggregated at the ZIP code level included race, annual household income, age, and number of residents per pharmacy. The overall results per ZIP code showed that the average cost for levothyroxine was $10.01 ± $2.29 and $140.45 + $14.70 for Lipitor. Per ZIP code, the mean (± SD) percentages of pharmacies offering discount generic drug programs was 66.9% ± 15.0%; home delivery of medications was 44.5% ± 22.7%; and immunization for influenza was 46.7% ± 24.3% of pharmacies. The mean (± SD) hours of operation per pharmacy per ZIP code was 67.0 ± 25.2. ZIP codes with higher household income as well as higher percentage of residents being white had lower levothyroxine price, greater percentage of pharmacies offering discount generic drug programs, more hours of operation per week, and more pharmacy-based immunization services. The cost of Lipitor was not associated with any ZIP code characteristic. Disparities in the cost of generic levothyroxine, the availability of services such as discount generic drug programs, hours of operation, and pharmacy-based immunization services are evident based on race and household income within this diverse metropolitan county.

Value Management Program: Performance, Quantification, and Presentation of Imaging Value-Added Actions

Health care is in a state of transition, shifting from volume-based success to value-based success. Hospital executives and referring physicians often do not understand the total value a radiology group provides. A template for easy, cost-effective implementation in clinical practice for most radiology groups to demonstrate the value they provide to their clients (patients, physicians, health care executives) has not been well described. A value management program was developed to document all of the value-added activities performed by on-site radiologists, quantify them in terms of time spent on each activity (investment), and present the benefits to internal and external stakeholders (outcomes). The radiology value-added matrix is the platform from which value-added activities are categorized and synthesized into a template for defining investments and outcomes. The value management program was first implemented systemwide in 2013. Across all serviced locations, 9,931.75 hours were invested. An annual executive summary report template demonstrating outcomes is given to clients. The mean and median individual value-added hours per radiologist were 134.52 and 113.33, respectively. If this program were extrapolated to the entire field of radiology, approximately 30,000 radiologists, this would have resulted in 10,641,161 uncompensated value-added hours documented in 2013, with an estimated economic value of $2.21 billion.

Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study.

IntroductionPatients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown.MethodsIn total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg.ResultsATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort (P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00).ConclusionAngiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min.Trial registrationClinicaltrials.gov NCT01393782. Registered 12 July 2011.

THU0355 The Prevalence of Sleep Disorders and their Determinants in Patients with Chronic Neck Pain

ObjectivesAssessing the quality of sleep and the prevalence of sleep disorders in patients with chronic neck pain and identify its determinants.MethodsCross-sectional study is conducted among patients, older than 18 years...

ORGANISATION, FUNDING AND REVIEW OF UNDERGRADUATE PALLIATIVE CARE (PC) TEACHING IN UK MEDICAL SCHOOLS: A SURVEY OF EDUCATIONAL LEADS

BackgroundSome recently-qualified doctors report that undergraduate teaching has not sufficiently prepared them to manage PC patients. Individuals at UK medical schools trying to improve PC training may encounter obstacles1. Little...

Depression May Reduce Adherence during CPAP Titration Trial

Depression is a risk factor for medication non-compliance. We aimed to identify if depression is associated with poorer adherence during home-based autotitrating continuous positive airway pressure (autoPAP) titration. Mixed retrospective-observational study. Academic center. Two-hundred forty continuous positive airway pressure-naïve obstructive sleep apnea (OSA) patients. Patients underwent approximately 1 week of home-based autoPAP titration with adherence data downloaded from the device. Electronic hospital records were reviewed in a consecutive manner for inclusion. Three areas of potential predictors were examined: (i) demographics and clinical factors, (ii) disease severity, and (iii) device-related variables. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Scores on the subscales were categorized as normal or clinical diagnoses of depression (≥ 8) and anxiety (≥ 11). The primary outcome variable was the mean hours of autoPAP used per night. Patients were diagnosed with OSA by either attended polysomnography (n = 73, AHI 25.5[15.1-41.5]) or unattended home oximetry (n = 167, ODI3 34.0[22.4-57.4]) and had home-based autoPAP titration over 6.2 ± 1.2 nights. Mean autoPAP use was 4.5 ± 2.4 hours per night. Multiple linear regression analysis revealed that depression and lower 95(th) percentile pressures significantly predicted lesser hours of autoPAP use (R(2) = 0.19, p < 0.001). Significantly milder OSA in those requiring lower pressures may have confounded the relationship between 95(th) percentile pressure and autoPAP use. Depression was independently associated with poorer adherence during home-based autoPAP titration. Depression may be a potential target for clinicians and future research aimed at enhancing adherence to autoPAP therapy.

Motility Abnormalities in Irritable Bowel Syndrome

Background/Aims: The intestinal pathophysiology in irritable bowel syndrome (IBS) is largely unknown. The lactulose breath test has been used to identify small bowel bacterial overgrowth in these patients. Methods: We studied intestinal transit in patients with IBS using of the SmartPill® (SP) wireless pH/pressure recording capsule and performed lactulose breath tests to look for physiologic abnormalities. Results: A total of 35/46 (76%) of the IBS patients had prolonged gastric emptying times. Constipation-predominant disease was associated with prolonged gut transit times. The mean hours ± SD for colonic transit time in the constipation group was 71.7 ± 61.1 (n = 13) compared with 22.5 ± 14.9 (n = 14) for diarrhea-predominant and 26.4 ± 21.5 (n = 20) for mixed clinical subtype (p = 0.0010). No correlation between small bowel transit time and abnormal breath hydrogen or methane excretion in the 46 combined patients with IBS was seen. Conclusions: Delayed gastric emptying was identified in IBS and in some patients may contribute to at least a component of their symptoms. Constipation-predominant IBS is associated with prolonged gut transit times. Otherwise, transit abnormalities do not appear to be important in IBS. Intestinal transit did not correlate with breath test results.

Comparison of some risk factors for diabetes across different social groups: a cross-sectional study.

Background:In fast, developing economies such as India, the population is undergoing rapid social transition, which can increase the risk profile for diabetes. Market forces promoting lifestyles such as sedentary habits, alcohol and tobacco use, which earlier were more prevalent among affluent urban populations are now trickling into the urban poor and rural populations.Aim:The aim of the present research was to compare the prevalence of risk factors for diabetes among three distinct social groups-the urban affluent, the urban poor and the rural poor.Subjects and Methods:A total of 775 adult population over 18 years and belonging to both genders were surveyed for prevalence of some of the risk factors for diabetes such as physical inactivity, obesity, alcohol, and tobacco use. The sample comprised of three distinct social groups as follows; 125 medical students representing the affluent, 400 subjects from urban slums, and 250 subjects from rural areas. Obesity was measured by body mass index (BMI) while central obesity was ascertained by waist hip ratio (WHR). Alcohol and tobacco use were elicited by interview.Results:The overall response rate was 88.52% (686/775). Medical students were more sedentary with mean hours spent each day sitting or reclining at 10.47 (3.25) h, compared to corresponding figures of 6.34 (3.1) h and 7.49 (3.74) h for the rural and urban slum residents respectively (P < 0.001). However, all types of leisure time physical activities were significantly more among the medical students compared to the other groups (P < 0.001). BMI was significantly highest among the rural population with mean of 24.22 (4.17) kg/m2 when compared to the other groups, (P < 0.001). Villagers also had higher WHR and had a higher proportion of persons above the WHR cut-off for gender (P < 0.001). Experimentation with alcohol was more prevalent among the medical students while the urban slum residents were more frequent and heavy drinkers. Smoking was most prevalent among the medical students, while smokeless tobacco use was more among the other groups.Conclusions:Physical inactivity, obesity, including central obesity, alcohol and tobacco use were found in various degrees in the study samples. An important finding was that both obesity and central obesity ascertained by BMI and WHR respectively were highest among the rural population implying the impact of social change on diabetic risk factors.

Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation

ObjectivesAnxiety and concerns in daily life may result in sleep problems and consistent evidence suggests that inadequate sleep has several negative consequences on cognitive performance, physical activity, and health. The aim of our study was to evaluate the association between mean hours of sleep per night, psychologic distress, and behavioral concerns. MethodsA cross-sectional analysis of the correlation between the number of hours of sleep per night and the Zung Self-rating Anxiety Scale (Z-SAS), the Paykel Suicidal Scale (PSS), and the Strengths and Difficulties Questionnaire (SDQ), was performed on 11,788 pupils (mean age±standard deviation [SD], 14.9±0.9; 55.8% girls) from 11 different European countries enrolled in the SEYLE (Saving and Empowering Young Lives in Europe) project. ResultsThe mean number of reported hours of sleep per night during school days was 7.7 (SD, ±1.3), with moderate differences across countries (r=0.06; P<.001). A reduced number of sleeping hours (less than the average) was more common in girls (β=0.10 controlling for age) and older pupils (β=0.10 controlling for sex). Reduced sleep was found to be associated with increased scores on SDQ subscales of emotional (β=−0.13) and peer-related problems (β=−0.06), conduct (β=−0.07), total SDQ score (β=−0.07), anxiety (Z-SAS scores, β=−10), and suicidal ideation (PSS, β=−0.16). In a multivariate model including all significant variables, older age, emotional and peer-related problems, and suicidal ideation were the variables most strongly associated with reduced sleep hours, though female gender, conduct problems measured by the SDQ, and anxiety only showed modest effects (β=0.03–0.04). ConclusionsOur study supports evidence that reduced hours of sleep are associated with potentially severe mental health problems in adolescents. Because sleep problems are common among adolescents partly due to maturational processes and changes in sleep patterns, parents, other adults, and adolescents should pay more attention to their sleep patterns and implement interventions, if needed.

Is there a correlation between of the epworth sleepiness scale and the CPAP adherence?

The aim of this study is determinate if there is a correlation between the adherence to the cpap treatment and the epworth scale. We have an specific protocol for the adherence in our sleep nurse consultation. We studied a cohort of patients with Obstructive Sleep Apnea that begins the treatment with cpap between January and December 2012. Scope: 2nd Level Hospital (reference population 340,458 habitants). Variables: Sex, age,pathology, Epworth Scale, Apnea Hipoapnea Index ( IAH ), Hours of daily use of cpap and Pressure of treatment. We analyzed 183 patients ( CI 95 % ).Sex: Male (142) 75%,Women (41)23%. Epworth Scale <10: Mean age 57 ± 25; Mean IAH 43 ± 33; Mean hours of daily use of CPAP 5 ± 3 h; mean pressure of treatment 8 ± 3 ccH2O. Epworth Scale >10: Mean age 55 ± 20; Mean IAH 43.5 ± 32; Mean hours of daily use of CPAP 5.5;± 3 h; mean pressure of treatment 8 ± 3 ccH 2 O. The similars results obtained in the two groups studies shows that the Epworth Scale is not a predictor of the correct use of the CPAP treatment. The epworth scale results are very subjective.There are many factors that influence the correct adherence to the cpap treatment that we don’t measure in our study, probably the interface ( mask ) has an important role in the adherence. To the Agencia Sanitaria Costa del Sol and the sleep nurse consultation of the Hospital.

Exploring the Cost-Effectiveness of Unit-Based Health Promotion Activities for Nurses

The Stepping Stones to Wellness program, offered on one hospital unit by the organization's wellness team and nurse practitioner students, was evaluated for its return on investment (ROI), level of participation, and satisfaction among staff and students. Interventions included (1) biometric screening, (2) participation incentives, and (3) education delivered by staff and nurse practitioner students on the unit. Using the hours of unscheduled absence as a proxy for staff wellness, ROI was calculated using 75% of the difference between the mean hours of unscheduled absence during the intervention compared to the previous 3 years. Average hourly rate (including benefits) was multiplied by unscheduled absence ($11,409.17). The total cost of program delivery ($7,662.50) for 80 employees yielded an ROI of $3,746.67. Participation improved and satisfaction increased. Graduate nursing students and an employer wellness team can deliver a successful unit-based health promotion program and possibly affect absenteeism.

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Introduction: Device related pressure ulcers (PUs) from non-invasive ventilation (NIV) masks result in skin integrity alterations and patient discomfort. NIV mask related PU rates in our ICUs were above national PU benchmarks The primary purpose of the study was to examine PU outcomes and comfort of patients using a nasal-oral (N-O) mask (Performatrak, Respironics, Philips Healthcare) compared to a full face (FF) mask (Performax, Philips Healthcare). Methods: A before-after study of a convenience sample of patients with NIV orders in 5 ICUs was conducted. Two groups of 100 subjects each received either the N-O mask (first group) or the FF mask. Skin was assessed prior to mask application and every 12 hours and with mask removal. Comfort levels were assessed every 12 hours on a 1-5 Likert Scale (1 most comfortable). Adherence time was recorded every 12 hours. Data on the following variables were also recorded: indication for NIV, reason for study exit, total NIV days, invasive mechanical ventilation (MV) requirements, and demographic information. Results: In the N-O group, 20% developed a facial PU (16 Stage I and 4 Stage II); in the FF mask group, 1% developed a facial PU (Stage II) and 1% developed a scalp PU under the mask strap (p < .001). Comfort scores were significantly lower (more comfortable) with the FF mask (mean 1.9 ± 1.1) compared to N-O mask (mean 2.7 ± 1.2, p < .001). There was no significant difference in mean hours worn or % adherence: 28.9 hours ± 27.2, 92% for FF and 25 ± 20.7, 92% for N-O. Total NIV days (p <.001) and need for subsequent NIV (p = .022) were significantly higher with N-O mask due to switch to FF mask upon PU identification. No subjects who developed a PU with the N-O mask developed a PU with the FF mask. No significant differences between groups were found for ICU or hospital LOS, MV use prior or after NIV and total MV days, age, APACHE II, gender, race or indication for NIV. Conclusions: The FF mask resulted in significantly less PUs and was more comfortable for patients. The FF mask is a reasonable alternative to traditional N-O masks to decrease NIV mask related PU incidence.

Childhood injury in Tower Hamlets, one of the most deprived inner-city London boroughs: prospective audit data from the Royal London Hospital

BackgroundThe most socioeconomically deprived children are at greatest risk of injury. Tower Hamlets is one of the most deprived areas in England. Data obtained for injuries are routinely inadequate to inform or assess prevention strategies. Enhanced injury data collection could contribute towards the establishment of national injury surveillance. MethodsWe did a prospective audit of injuries in patients aged less than 16 years presenting to paediatric A&E, Royal London Hospital, between June and December, 2012. Staff gathered patient data by hand 24 h a day, 7 days a week using a questionnaire based on the enhanced injury dataset of the College of Emergency Medicine. The sample gathered was an opportunistic sample and the inclusion criteria were all children presenting with injury within the specified period. Seriously injured patients, assessed by the trauma team, had data recorded in the paediatric intensive care unit database, which was then used to supplement our audit sample. The questionnaire was used to identify injury characteristics, date and time of the injury, and the patient's medical record number (MRN). Age, sex, ethnic origin, and hour of arrival were extracted from the NHS Care Record Service (CRS) dataset with the MRN. Primary outcomes were location and activity at the time of injury, sport involvement, mechanism of injury, substance involvement, and whether intentional or unintentional. The association between location and injury rates was tested by Spearman's rank correlation coefficients. FindingsThe audit captured 471 of the 6358 under-16 injury-related attendances recorded on CRS, of which 414 (6·5%) had valid MRN numbers. Of these 414, 97 were subsequently admitted. The audit dataset was representative of the CRS dataset for sex but not for age or arrival time at A&E; figures compared with the CRS dataset were men 64·0% versus 59·8% (p=0·0813); mean age 8·3 years versus 6·7 years (p<0·0001); and mean hour of arrival 1545 h versus 1510 h (p=0·0035). Leisure (32·9%, 95% CI 28·3–37·4), sport (18·1%, 14·4–21·8), and road traffic collisions (11·4%, 8·3–14·4) were the three most common activities. Falls (49·8%, 95% CI 44·9–54·6) and blunt force (16·2%, 12·6–19·7) were the most common injury mechanisms. Injuries occurred mainly at home (32·9%, 95% CI 28·3–37·4), in schools (22·0%, 18·0–26·0%), and on roads (20·3%, 16·4–24·2). Patients subsequently admitted were more likely to have been involved in a road traffic collision than those simply attending A&E (29·9% vs 11·4%; p<0·0001) or to have had a fall from a height above 1 m (24·7% vs 7·5%; p<0·0001), and 32·0% (95% CI 22·7–41·3) of admissions had head injuries. There was a positive correlation between injury rates by home address and income deprivation (p<0·0001). InterpretationThis study highlights the importance of including routine injury data in existing computerised admission systems. Data collection was labour intensive and needed staff commitment. Despite efforts made to inform all medical staff and promote a uniform collection of data, data collection proved suboptimum with variability across shifts, and our final sample was small and unrepresentative of age and time of arrival. The retrospective entry of the trauma patients might have led to over-representation of serious injuries. FundingNone.