Nutrient profiling and adherence to components of the UK national dietary guidelines association with metabolic risk factors for CVD and diabetes: Airwave Health Monitoring Study.

CVD is the leading cause of death worldwide. Diet is a key modifiable component in the development of CVD. No official UK diet quality index exists for use in UK nutritional epidemiological studies. The aims of this study are to: (i) develop a diet quality index based on components of UK dietary reference values (DRV) and (ii) determine the association between the index, the existing UK nutrient profile (NP) model and a comprehensive range of cardiometabolic risk markers among a British adult population. A cross-sectional analysis was conducted using data from the Airwave Health Monitoring Study (n 5848). Dietary intake was measured by 7-d food diary and metabolic risk using waist circumference, BMI, blood lipid profile, glycated Hb (HbA1c) and blood pressure measurements. Diet quality was assessed using the novel DRV index and NP model. Associations between diet and cardiometabolic risk were analysed via multivariate linear models and logistic regression. A two-point increase in NP score was associated with total cholesterol (ß -0·33 mmol/l, P<0·0001) and HbA1c (ß -0·01 %, P<0·0001). A two-point increase in DRV score was associated with waist circumference (ß -0·56 cm, P<0·0001), BMI (ß -0·15 kg/m2, P<0·0001), total cholesterol (ß -0·06 mmol/l, P<0·0001) and HbA1c (ß -0·02 %, P=0·002). A one-point increase in DRV score was associated with type 2 diabetes (T2D) (OR 0·94, P=0·01) and obesity (OR 0·95, P<0·0001). The DRV index is associated with overall diet quality and risk factors for CVD and T2D, supporting its application in nutritional epidemiological studies investigating CVD risk in a UK population.

The initial impact of COVID-19 on Australasian Sonographers Part 1: Changes in scan numbers and sonographer work hours.

Introduction: COVID-19 has seen a series of lockdowns and suspension on non-urgent elective surgeries. Subsequently, there was a drop in the number of diagnostic imaging services billed in April, May, 2020. A survey was undertaken from March to June 2020 to determine the initial impact of COVID-19 on Australasian Sonographers. This article, the first in a 3-part series presents and discusses the results of this survey pertaining to changes in the number of scans performed, and changes in the working hours of sonographers. The remaining two articles in this series address other initial COVID-19 impacts on Australasian Sonographers. Methods: An online survey was conducted containing questions regarding changes to work hours and examination numbers. Results: 444 participants answered the survey. Seventy eight percent of sonographers reported a decrease in the number of examinations being performed in their department A decrease in work hours was reported by 68% of sonographers with almost a quarter of these reporting that they had lost all their hours. A higher percentage of work hours changes were seenin private practices. Many reductions in work hours were reported to be voluntary. Conclusion: Scan numbers in ultrasound departments were affected by COVID-19, as were sonographers' work hours.

The initial impact of COVID-19 on Australasian sonographers part 2: Changes to sonographic examination protocols and access to personal protective equipment.

INTRODUCTION: COVID-19 brought with it the requirement for healthcare workers to limit community transmission of the virus as much as possible by limiting patient contact and wearing Personal Protective Equipment (PPE). This study aimed to capture the initial adaptations to sonographic examination protocols within ultrasound departments and sonographer access to PPE. METHODS: An online survey was used to gather data on sonographer reflections of sonographic examination protocol changes seen in their departments and access to PPE between the 11th of March 2020 and the 14th of June 2020. RESULTS: To reduce the time sonographers spent with the patients and hence reduce the risk of exposure to COVID-19, sonographers reported adjustments to sonographic examination protocols including their duration and scheduling. Access to PPE was reported as poor. CONCLUSION: Numerous sonographic examination protocol changes were observed within ultrasound departments in Australasia in the initial response to COVID-19. Access to PPE was varied along with sonographer feelings around the impact of these changes.

The initial impact of COVID-19 on Australasian sonographers part 3: Sonographer professional, personal, and social wellbeing.

INTRODUCTION: The wellbeing of front-line healthcare workers can be impacted during a pandemic. This paper reports the initial impact on the wellbeing of COVID-19 on Australasian sonographers. METHODS: An online qualitative and quantitative survey was conducted between March and June 2020 to explore the wellbeing of Australasian sonographers in the early stages of the COVID-19 pandemic. RESULTS: Whilst most sonographers felt supported at work (300/379), those working in public hospitals felt more so than those in private practice. Sonographers in private practice felt more as though their job was at risk and were more likely to consider an alternate source of income. Sonographers felt they were working on the front line and many felt anxious about themselves (74%) or family (78%) contracting COVID-19 due to their employment. Forty-one percent of sonographers felt more isolated than normal, with younger age groups (18-34 years) feeling less like they had enough hobbies or selfcare activities to get them through. Twelve percent of sonographers reported never, or rarely, coping with the juggle of work and home life. CONCLUSION: The initial impact of the COVID-19 pandemic on the wellbeing of sonographers is evident. Longitudinal data will enable wellbeing to be tracked over time.

Fluoroscopic Guidance Increases the Incidence of Thoracic Epidural Catheter Placement Within the Epidural Space: A Randomized Trial.

BACKGROUND AND OBJECTIVES: Thoracic epidural analgesia can reduce postoperative pain and cardiopulmonary morbidity, but it is associated with a high rate of clinical failure. Up to 50% of clinical failure is thought to be related to technical insertion. In this study, patients undergoing thoracic surgery were randomized to one of two catheter insertion techniques: fluoroscopically guided or conventional loss of resistance with saline/air. Our primary aim was to examine whether fluoroscopic guidance could increase the incidence of correct catheter placement and improve postoperative analgesia. Our secondary aim was to assess the potential impact of correct epidural catheter positioning on length of stay in the postanesthesia care unit and total hospital length of stay. METHODS: This randomized clinical trial was conducted at Dartmouth-Hitchcock Medical Center over 25 months (January 2012 to February 2014). Patients (N = 100) undergoing thoracic surgery were randomized to fluoroscopic guidance (n = 47) or to loss of resistance with saline/air (n = 53). Patients were followed for the primary outcomes of 24-hour morphine use, 24-hour numeric pain scores, and the incidence of epidural catheter positioning within the epidural space. Postanesthesia care unit and total hospital lengths of stay were evaluated as secondary outcome measurements and compared for patients with correct epidural catheter positioning and those without correct epidural catheter positioning. RESULTS: One hundred patients were included in an intention-to-treat analysis. Numeric pain scores and 24-hour morphine consumption were no different between groups. Fluoroscopic guidance was associated with an increased incidence of epidural catheter placement within the epidural space compared with loss of resistance with air/saline [fluoroscopic guidance, epidural in 98% (46/47) versus loss of resistance with saline/air, epidural in 74% (39/53)]. There was a significant increase in correct catheter positioning with (odds ratio, 21.07; 95% confidence interval, 2.07-214.38; P = 0.010) or without (odds ratio, 16.15; 95% confidence interval, 2.03-128.47; P = 0.009) adjustment for potentially confounding variables. In an adjusted analysis, correctly positioned thoracic epidural catheters were associated with shorter postanesthesia care unit (5.87 ± 5.39 hours vs 4.30 ± 1.171 hours; P = 0.044) and total hospital length of stay (5.77 ± 4.94 days vs 4.93 ± 2.79 days; P = 0.031). CONCLUSIONS: Fluoroscopic guidance increases the incidence of epidural catheter positioning within the epidural space and may reduce postanesthesia care unit and hospital lengths of stay. Future work should validate the effectiveness of this approach.This clinical trial is registered with ClinicalTrials.gov (NCT02678039).

Dietary assessment of British police force employees: a description of diet record coding procedures and cross-sectional evaluation of dietary energy intake reporting (The Airwave Health Monitoring Study).

OBJECTIVES: Dietary intake is a key aspect of occupational health. To capture the characteristics of dietary behaviour that is affected by occupational environment that may affect disease risk, a collection of prospective multiday dietary records is required. The aims of this paper are to: (1) collect multiday dietary data in the Airwave Health Monitoring Study, (2) describe the dietary coding procedures applied and (3) investigate the plausibility of dietary reporting in this occupational cohort. DESIGN: A dietary coding protocol for this large-scale study was developed to minimise coding error rate. Participants (n 4412) who completed 7-day food records were included for cross-sectional analyses. Energy intake (EI) misreporting was estimated using the Goldberg method. Multivariate logistic regression models were applied to determine participant characteristics associated with EI misreporting. SETTING: British police force employees enrolled (2007-2012) into the Airwave Health Monitoring Study. RESULTS: The mean code error rate per food diary was 3.7% (SD 3.2%). The strongest predictors of EI under-reporting were body mass index (BMI) and physical activity. Compared with participants with BMI<25 kg/m2, those with BMI>30 kg/m2 had increased odds of being classified as under-reporting EI (men OR 5.20 95% CI 3.92 to 6.89; women OR 2.66 95% CI 1.85 to 3.83). Men and women in the highest physical activity category compared with the lowest were also more likely to be classified as under-reporting (men OR 3.33 95% CI 2.46 to 4.50; women OR 4.34 95% CI 2.91 to 6.55). CONCLUSIONS: A reproducible dietary record coding procedure has been developed to minimise coding error in complex 7-day diet diaries. The prevalence of EI under-reporting is comparable with existing national UK cohorts and, in agreement with previous studies, classification of under-reporting was biased towards specific subgroups of participants.