Diuretics use in the management of bronchopulmonary dysplasia in preterm infants: A systematic review.

AIM: Bronchopulmonary dysplasia (BPD), a respiratory complication associated with neonatal prematurity, presents opportunities for pharmacological intervention due to its contributing risk factors. Despite diuretics' controversial usage in BPD treatment and varying institutional practices, this review aims to consolidate evidence from clinical trials regarding diuretic use in BPD. METHODS: We conducted a systematic review following PRISMA guidelines, searching EMBASE, Medline, Web of Science and CINAHL databases (PROSPERO 2022: CRD42022328292). Covidence facilitated screening and data extraction, followed by analysis and formatting in Microsoft Excel. RESULTS: Among 430 screened records, 13 were included for analysis. Three studies assessed spironolactone and chlorothiazide combinations, two studied spironolactone and hydrochlorothiazide, while eight examined furosemide. All studies evaluated drug effects on dynamic pulmonary compliance and pulmonary resistance, serving as comparative measures in our review. CONCLUSION: Diuretics' effectiveness in treating bronchopulmonary dysplasia remains uncertain. The limited number of identified randomised controlled trials (RCTs) hampers high-level evidence-based conclusions when applying the Population, Intervention, Comparison, Outcome (PICO) approach. Conducting large prospective studies of good quality could provide more definitive insights, but the rarity of outcomes and eligible patients poses challenges. Further research, primarily focusing on RCTs assessing diuretics' safety and efficacy in this population, is warranted.

Changes in diet, exercise and stress behaviours using the stages of change model in cardiac rehabilitation patients.

The behavioural changes initiated during Phase III cardiac rehabilitation programmes were recorded using Prochaska and Diclemente's "stages of change" model. This study aimed to ascertain if changes were initiated, maintained or further developed during Phase III programmes and 6 months after the programmes with a view to ascertaining the usefulness of this tool in providing stage matched individualised care. The risk factors examined were: exercise, diet and stress. The stages were recorded quantitatively and were numerically designated a value of 1-5. The results were analysed using SPSS. The sample number was one hundred and eighty seven patients. Significant improvements were made by the end of the programme (6 or 8 weeks) indicating that most patients had modified their behaviour during the programme. There was no significant additional improvement in the risk factors 6 months later. These results are a further indication of the need for support post Phase III programmes. Patients entered Phase III rehabilitation at different stages in their risk behaviours and with regard to exercise this stage at commencement influences the final stage achieved. "Stages of change" is a useful simple method of recording behavioural change and this type of routine monitoring of a patient could be used effectively as part of the individual care plan during the programme.

Cognitive change 5 years after coronary artery bypass surgery.

A longitudinal study of cognitive function after coronary artery bypass surgery examined 107 participants using 11 tests, preoperatively and at 6 days, 8 weeks, and 5 years after surgery. The overall neuropsychological (NP) change score declined at 6 days, showed some recovery at 8 weeks, and declined again at 5 years. The number of microemboli recorded during surgery, postoperative short-term cognitive change, and degree of recovery at 8 weeks were identified as predictors of change in NP score to 5 years. This suggests that even over a 5-year period, operative damage is detectable. Patients' vulnerability to short-term deterioration and resilience or ability to recover over a few weeks from operative cerebral insult are important processes of unknown mechanisms.