An Evaluation of Time to Therapeutic Range of Intravenous Unfractionated Heparin After Transitioning From Direct Oral Factor Xa Inhibitors.

Purpose: Direct oral factor Xa inhibitors (Xa inhibitor) may falsely elevate anti-Xa assays, creating a challenge when patients transition from Xa inhibitors to intravenous unfractionated heparin (IV UFH). This study compared the time to therapeutic anti-Xa range in patients transitioning from Xa inhibitors to IV UFH to those not previously anticoagulated and initiated on IV UFH. Methods: This single-center, retrospective study included adults receiving IV UFH from August 2018 through August 2019. The study group received apixaban or rivaroxaban prior to the initiation of IV UFH, and the control group was not previously anticoagulated. The primary outcome was the time to reach therapeutic range. Secondary outcomes included the number of anti-Xa levels drawn to reach therapeutic range, incidence of treatment failure, and incidence of major bleeding episodes. Categorical and continuous data were analyzed with chi-square and Mann-Whitney U tests, respectively. Results: The time to reach therapeutic range was a median of 18.5 hours in the study group (IQR 14.9-26.9) compared to 7.3 hours (IQR 5.9-14.7) in the control group (P < .001). Two anti-Xa levels were drawn in the study group (IQR 1-4) compared to 1 (IQR 1-2) in the control group (P < .001). There was no difference in the incidence of treatment failures (P = .981) or major bleeding episodes (P = .972). Conclusions: In patients transitioning from Xa inhibitors to IV UFH, the time to therapeutic range was longer and required additional laboratory tests compared to those not previously anticoagulated. Further research is needed to examine the incidence of treatment failures or major bleeding episodes.

An exploration of midwives' role in the promotion and provision of antenatal influenza immunisation: A mixed methods inquiry.

PROBLEM: No South Australian study has previously investigated the role of midwives in the promotion and provision of antenatal influenza immunisation. BACKGROUND: Influenza acquired in pregnancy can have serious sequalae for both mother and foetus. Recent studies have demonstrated that influenza vaccine in pregnancy is both safe and effective. Despite this, evidence suggests that vaccine uptake in pregnancy is suboptimal in both Australia and worldwide. AIM: The aim of this study was to investigate the role of midwives in the promotion and provision of antenatal influenza vaccine and, to provide a statistical and thematic description of the barriers and enablers midwives encounter. METHODS: This mixed method study incorporated a cross sectional on-line survey and in-depth interviews conducted with midwives, employed in urban and regional South Australia. FINDINGS: Quantitative data were available for 137 midwives and 10 midwives participated in the interviews. Recruitment for the interview phase was through the last question on the survey. Whilst all midwives indicated that education and vaccine promotion were part of their role, immunisation knowledge varied between Registered Nurse/Midwives (RM/RN) 80% and Registered Midwives (RM) 48.90% (p = 0.001). Quantitative data showed that only 43% of midwives felt sufficiently educated to provide the vaccine. Midwives who had received formal immunisation training were more likely to recommend the vaccine 93.7% (p = 0.001). Qualitative data confirmed these results and identified the lack of immunisation education as a barrier to practise. CONCLUSION: Midwives identified an immunisation knowledge deficit. Midwives who had received immunisation education were more likely to actively promote and provide the vaccine to pregnant women. These findings indicate the need for more immunisation education of midwives in both tertiary and practice settings.

Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition).

The Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition, utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight for height/length, body mass index for age, length/height for age, or mid-upper arm circumference when a single data point is available. When two or more data points are available, indicators may also include weight-gain velocity (younger than 2 years of age), weight loss (2 to 20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population (ages 1 month to 18 years). The indicators are intended for use in multiple settings, such as acute, ambulatory care/outpatient, residential care, etc. Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population, and help to further ensure the provision of high-quality, cost-effective, nutrition care.