Lee Jones

Knowledge of medical imaging radiation dose and risk among doctors

The growth of computed tomography (CT) and nuclear medicine (NM) scans has revolutionised healthcare but also greatly increased population radiation doses. Overuse of diagnostic radiation is becoming a feature of medical practice, leading to possible unnecessary radiation exposures and lifetime‐risks of developing cancer. Doctors across all medical specialties and experience levels were surveyed to determine their knowledge of radiation doses and potential risks associated with some diagnostic imaging.

The children and sunscreen study: a crossover trial investigating children's sunscreen application thickness and the influence of age and dispenser type

OBJECTIVES To measure the thickness at which primary schoolchildren apply sunscreen on school day mornings and to compare it with the thickness (2.00 mg/cm(2)) at which sunscreen is tested during product development, as well as to investigate how application thickness was influenced by age of the child (school grades 1-7) and by dispenser type (500-mL pump, 125-mL squeeze bottle, or 50-mL roll-on). DESIGN A crossover quasiexperimental study design comparing 3 sunscreen dispenser types. SETTING Children aged 5 to 12 years from public primary schools (grades 1-7) in Queensland, Australia. PARTICIPANTS Children (n=87) and their parents randomly recruited from the enrollment lists of 7 primary schools. Each child provided up to 3 observations (n=258). INTERVENTION Children applied sunscreen during 3 consecutive school weeks (Monday through Friday) for the first application of the day using a different dispenser each week. MAIN OUTCOME MEASURE Thickness of sunscreen application (in milligrams per square centimeter). The dispensers were weighed before and after use to calculate the weight of sunscreen applied. This was divided by the coverage area of application (in square centimeters), which was calculated by multiplying the childrens body surface area by the percentage of the body covered with sunscreen. RESULTS Children applied their sunscreen at a median thickness of 0.48 mg/cm(2). Children applied significantly more sunscreen when using the pump (0.75 mg/cm(2)) and the squeeze bottle (0.57 mg/cm(2)) compared with the roll-on (0.22 mg/cm(2)) (P<.001 for both). CONCLUSIONS Regardless of age, primary schoolchildren apply sunscreen at substantially less than 1.00 mg/cm(2), similar to what has been observed among adults. Some sunscreen dispensers seem to facilitate thicker application than others.

Determinants of Maternal Triglycerides in Women With Gestational Diabetes Mellitus in the Metformin in Gestational Diabetes (MiG) Study

OBJECTIVE Factors associated with increasing maternal triglyceride concentrations in late pregnancy include gestational age, obesity, preeclampsia, and altered glucose metabolism. In a subgroup of women in the Metformin in Gestational Diabetes (MiG) trial, maternal plasma triglycerides increased more between enrollment (30 weeks) and 36 weeks in those treated with metformin compared with insulin. The aim of this study was to explain this finding by examining factors potentially related to triglycerides in these women. RESEARCH DESIGN AND METHODS Of the 733 women randomized to metformin or insulin in the MiG trial, 432 (219 metformin and 213 insulin) had fasting plasma triglycerides measured at enrollment and at 36 weeks. Factors associated with maternal triglycerides were assessed using general linear modeling. RESULTS Mean plasma triglyceride concentrations were 2.43 (95% CI 2.35–2.51) mmol/L at enrollment. Triglycerides were higher at 36 weeks in women randomized to metformin (2.94 [2.80–3.08] mmol/L; +23.13% [18.72–27.53%]) than insulin (2.65 [2.54–2.77] mmol/L, P = 0.002; +14.36% [10.91–17.82%], P = 0.002). At 36 weeks, triglycerides were associated with HbA1c (P = 0.03), ethnicity (P = 0.001), and treatment allocation (P = 0.005). In insulin-treated women, 36-week triglycerides were associated with 36-week HbA1c (P = 0.02), and in metformin-treated women, they were related to ethnicity. CONCLUSIONS At 36 weeks, maternal triglycerides were related to glucose control in women treated with insulin and ethnicity in women treated with metformin. Whether there are ethnicity-related dietary changes or differences in metformin response that alter the relationship between glucose control and triglycerides requires further study.

Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study

Maintenance anti‐tumour necrosis factor‐α (anti‐TNFα) treatment for Crohns disease is the standard of care for patients with an inadequate response to corticosteroids and immunomodulators.

Nursing and medical perceptions of a hospital rapid response system: new process but same old game?

Perhaps no other patient safety intervention depends so acutely on effective interprofessional teamwork for patient survival than the hospital rapid response system. Yet, little is known about nurse-physician relationships when rescuing at-risk patients. This study compared nursing and medical staff perceptions of a mature rapid response system at a large tertiary hospital. Findings indicate that the rapid response system may be failing to address a hierarchical culture and systems-level barriers to early recognition and response to patient deterioration.

The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health.

OBJECTIVES The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of womens reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE. STUDY DESIGN InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data. MAIN OUTCOME MEASURES Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes). RESULTS InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41-53), and that at the last follow-up was 56 years (IQR: 48-64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12-13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8-55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9-24.6%) and 5.1% (range 1.3-13.2%), respectively. CONCLUSIONS The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons.

Does Preoperative Oral Carbohydrate Reduce Hospital Stay? A Randomized Trial

Oral carbohydrate-rich fluids are used preoperatively to improve postoperative recovery, but their effectiveness for reducing length of hospital stay is uncertain. We assessed the effectiveness of preoperative loading with carbohydrates on the postoperative outcomes of 44 patients scheduled for elective colorectal surgery who were randomly allocated to a carbohydrate-rich fluid group or a usual care group during their preadmission clinic visit. Our primary outcome was the time patients required to be ready for discharge. Patients in the control group spent an average of 4.3 days (95% confidence interval [CI], 3.2-5.7) in the hospital and patients in the carbohydrate-rich fluid group spent 4.1 days (95% CI, 3.2-5.4) in the hospital until they met discharge criteria (P = .824). We found that the safety of administering preoperative oral carbohydrate-rich fluids is supported, but we were unable to confirm or refute the benefit of this treatment regimen for contributing to shorter hospital stays after elective colorectal surgery.

Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-blinded, Randomized Controlled Trial

BACKGROUND: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss. METHODS: A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming (plus intravenous fluid warming) versus no active preoperative warming (plus intravenous fluid warming) in 50 healthy American Society of Anesthesiologists graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery. The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals. Secondary outcomes included maternal thermal comfort, shivering, mean arterial pressure, agreement between aural temperature, and neonatal outcomes (axillary temperature at birth, Apgar scores, breastfeeding, and skin-to-skin contact). The intention-to-treat population was analyzed with descriptive statistics, general linear model analysis, linear mixed-model analysis, &khgr;2 test of independence, Mann-Whitney, and Bland-Altman analysis. Full ethical approval was obtained, and the study was registered on the Australia and New Zealand Clinical Trials Registry (Trial No: 367160, registered at http://www.ANZCTR.org.au/). RESULTS: Intention-to-treat analysis (n = 50) revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups: F (1, 47) = 1.2, P = .28. There were no other statistically significant differences between groups in any of the secondary outcomes. CONCLUSIONS: A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine. A combination of preoperative and intraoperative warming modalities may be required for this population.

Bacterial comparison of preoperative rinsing and swabbing for oral surgery using 0.2% chlorhexidine

AIM The aim of the present study was to compare bacterial load using preoperative rinsing and swabbing techniques for oral surgery with 0.2% chlorhexidine (CHX). METHODS Participants were healthy volunteers undergoing a general anesthetic for the removal of teeth. Participants were randomly allocated to receive 15 mL of 0.2% CHX for 60 s as either a rinse or have their mouths swabbed. Plaque samples were aseptically collected pre- and post-rinsing from the same sites in all patients (the distal surface of all second molar teeth). RESULTS Patients in the swab group had similar bacteria counts before and after the application of CHX (143.4 vs 138.5 colonies, P = 1.000). After rinsing with CHX, there was an eightfold reduction of bacterial load (71 vs 8.8 colonies, P < 0.001). CONCLUSION The present study demonstrates that the use of CHX as an antimicrobial agent is effective in reducing the overall number of bacterial colonies in the oral cavity. Rinsing is a more effective method of doing this.

The Association Between Gait Speed and Cognitive Status in Community-Dwelling Older People: A Systematic Review and Meta-analysis

BACKGROUND Gait speed and cognitive performance tend to decline with age. A better understanding of the dynamics of the association between gait speed and cognitive status may identify preclinical markers and improve diagnostic assessments. The objective was to quantify the association between gait speed and cognitive status in later life. METHODS A systematic search was undertaken of relevant databases for original articles published prior to June 2017, measuring the association between gait speed and cognition cross-sectionally or longitudinally among the community-dwelling population. A meta-analysis pooled results of the mean difference between concurrent measures of gait speed in the normal cognition group compared to non-normal cognition groups. RESULTS Thirty-six studies were selected, providing data from 29,520 participants. The majority of studies reported a significant association between slower gait speed and worse cognitive function in older people. Results of the meta-analysis of 27 studies showed that, compared to normal controls, clinically meaningful reductions in gait speed ranged from 0.11 m/s in those with cognitive impairment, to 0.20 m/s in those with mild dementia, and to 0.41 m/s in those with moderate dementia. CONCLUSION The strength of evidence for an association between gait speed and cognition was demonstrated by the number and consistency of results, as well as quality of the studies. Identification of diagnostic markers of motor-cognitive risk has led to increasing interest in the effects of interventions for prevention of gait speed loss and cognitive decline in aging.