Effects of Crawling before Walking: Network Interactions and Longitudinal Associations in 7-Year-Old Children.

BACKGROUND: To study the impact of crawling before walking (CBW) on network interactions among body composition, the cardiovascular system, lung function, motor competence and physical fitness, at age 7, and to assess the longitudinal association between CBW and body composition, the cardiovascular system, lung function, motor competence, physical fitness and physical activity parameters, at age 7. METHOD: CBW, body composition, cardiovascular system, lung function, motor competence, physical fitness and physical activity were assessed in seventy-seven healthy Caucasian children. RESULTS: Network analyses revealed that the crawling group had a greater number of links among all the studied variables compared with the non-crawling group. In the longitudinal study, using multiple regression analyses, crawling was independently associated with fat mass (%), fat-to-muscle ratio and systolic blood pressure, with models explaining up to 56.3%, 56.7% and 29.9% of their variance, respectively. CONCLUSIONS: CBW during child's development is a possible modulator in the network interactions between body systems and it could influence future metabolic and cardiovascular health.

Airway Clearance and Mucoactive Therapies.

The respiratory system is constantly exposed to external pathogens but has different and effective defense systems. The pathophysiology of bronchiectasis affects the defense system considerably in that alterations occur in the airway that reduce its effectiveness in mucociliary clearance and the greater presence of mucins leads to the accumulation of more adherent and viscous mucus. One of the pillars of treatment of this disease should be improvement of mucociliary clearance and a decrease in the adherence and viscosity of the mucus. To this end, the mobilization of secretions must be increased through effective respiratory physiotherapy techniques, which can be manual and/or instrumental. The properties of mucus can be modified to improve its mobilization through the use of a mucoactive agent. Despite the increase in the number and quality of studies, the evidence for these treatments remains scarce, although their application is recommended in all guidelines.

Current developments and future directions in respiratory physiotherapy.

Respiratory physiotherapists have a key role within the integrated care continuum of patients with respiratory diseases. The current narrative review highlights the profession's diversity, summarises the current evidence and practice, and addresses future research directions in respiratory physiotherapy. Herein, we describe an overview of the areas that respiratory physiotherapists can act in the integrated care of patients with respiratory diseases based on the Harmonised Education in Respiratory Medicine for European Specialists syllabus. In addition, we highlight areas in which further evidence needs to be gathered to confirm the effectiveness of respiratory therapy techniques. Where appropriate, we made recommendations for clinical practice based on current international guidelines.

Incidence and Method of Suicide in Hospitals in the United States.

BACKGROUND: There are no reliable estimates of hospital inpatient suicides in the United States. Understanding the rate and the methods used in suicides is important to guide prevention efforts. This study analyzed two national data sets to establish an evidence-based estimate of hospital inpatient suicides and the methods used. METHODS: The study is designed as a cross-sectional analysis of data from 27 states reporting to the National Violent Death Reporting System (NVDRS) for 2014-2015, and from hospitals reporting to The Joint Commission's Sentinel Event (SE) Database from 2010 to 2017. Categorical variables and qualitative reviews of event narratives were used to identify and code suicide events occurring during hospital inpatient treatment. RESULTS: Based on the hospital inpatient suicides reported in the NVDRS during 2014-2015, 73.9% of which occurred during psychiatric treatment, it is estimated that between 48.5 and 64.9 hospital inpatient suicides occur per year in the United States. Of these, 31.0 to 51.7 are expected to involve psychiatric inpatients. Hanging was the most common method of inpatient suicide in both the NVDRS and SE databases (71.7% and 70.3%, respectively). CONCLUSION: The estimated number of hospital inpatient suicides per year in the United States ranges from 48.5 to 64.9, which is far below the widely cited figure of 1,500 per year. Analysis of inpatient suicide methods suggests that hospital prevention efforts should be primarily focused on mitigating risks associated with hanging, and additional suicide prevention efforts may be best directed toward reducing the risk of suicide immediately following discharge.

The Contribution of Sociotechnical Factors to Health Information Technology-Related Sentinel Events.

BACKGROUND: An understanding of how health information technology (health IT) can contribute to sentinel events is necessary to learn how to safely implement and use health IT. An analysis was conducted to explore how health IT may contribute to adverse events that result in death or severe harm to the patient. METHODS: For 3,375 de-identified sentinel events voluntarily reported to The Joint Commission between January 1, 2010, and June 30, 2013, categorical and keyword queries were used to search for potential health IT-related events. Each of the identified events was reviewed on the basis of findings from root cause analyses (RCAs) to determine if health IT contributed to or caused the event, and if so, how and why. The contributing factors were classified using a composite of existing classification schemes. RESULTS: A total of 120 health IT-related sentinel events (affecting 125 patients) were identified. More than half resulted in patient death, 30% resulted in unexpected or additional care, and 11% resulted in permanent loss of function. The three most frequently identified event types were (1) medication errors, (2) wrong-site surgery (including the wrong side, wrong procedure, and wrong patient), and (3) delays in treatment. Contributing factors were most frequently associated with the human-computer interface, workflow and communication, and clinical content-related issues. CONCLUSIONS: The classification of health IT-related contributing factors indicates that health IT-related events are primarily associated with the sociotechnical dimensions of human-computer interface, workflow and communication, and clinical content. Improved identification of health IT-related contributing factors in the context of the sociotechnical dimensions may help software developers, device manufacturers, and end users in health care organizations proactively identify vulnerabilities and hazards, ultimately reducing the risk of harm to patients.

Comparison study of acellular dermal matrices in complicated hernia surgery.

BACKGROUND: Damage control surgery and management of the open abdomen has led to a significant improvement in survival in trauma and emergency surgical patients. However, subsequent abdominal reconstruction has become a significant challenge. The objective of this study was to compare 2 different acellular dermal matrices in regard to hernia recurrence and complications in patients who present with a large complicated ventral hernia as a result of trauma or emergency surgery. STUDY DESIGN: A prospective quasi-experimental time-interrupted series design was used to evaluate the incidence of hernia recurrence in trauma/emergency surgery patients who had a ventral hernia repair with a biologic matrix. From January 2005 to December 2007, 55 patients with a complicated ventral hernia were repaired with AlloDerm (Life Cell Corporation). Beginning in February 2008 to January 2010, 40 patients with the same criteria were repaired with FlexHD (Musculoskeletal Transplant Foundation) and followed prospectively over the following year. The primary outcome for this study was hernia recurrence (functional or real) at 1 year. Other outcomes variables included abdominal laxity, seroma formation, and wound or intra-abdominal infection. RESULTS: There was no significant difference in age, sex, and body mass index between the groups. In addition, there was no significant difference in the mean hernia size and size of the acellular dermis that was inserted. At 1 year postsurgery, all of the AlloDerm patients were diagnosed with recurrence requiring a second formal repair. Eleven patients (31%) whose hernias were repaired with FlexHD were diagnosed with a recurrence requiring a second formal repair. CONCLUSIONS: FlexHD appears to have reduced the recurrence and laxity rates while maintaining a similar complication profile compared with AlloDerm in trauma/emergency surgery patients with large complicated ventral hernias.

Determination of efficacy of novel modified chitosan sponge dressing in a lethal arterial injury model in swine.

BACKGROUND: Chitosan is a functional biopolymer that has been widely used as a hemostat. Recently, its efficacy has been questioned due to clinical failures as a result of poor adhesiveness. The purpose of this study was to compare, in a severe groin injury model in swine, the hemostatic properties of an unmodified standard chitosan sponge with standard gauze dressing and a novel hydrophobically modified (hm) chitosan sponge. Previous studies have demonstrated that hm-chitosan provides greatly enhanced cellular adhesion and hemostatic effect via noncovalent insertion of hydrophobic pendant groups into cell membranes. METHODS: Twenty-four Yorkshire swine were randomized to receive hm-chitosan (n = 8), unmodified chitosan (n = 8), or standard Accu-Sorb gauze dressing (n = 8) for hemostatic control. A complex groin injury involving arterial puncture (4.4-mm punch) of the femoral artery was made after splenectomy. After 30 seconds of uncontrolled hemorrhage, the randomized dressing was applied and compression was held for 3 minutes. Fluid resuscitation was initiated to achieve and maintain the baseline mean arterial pressure and the wound was inspected for bleeding. Failure of hemostasis was defined as pooling of blood outside the wound. Animals were then monitored for 180 minutes and surviving animals were killed. RESULTS: Blood loss before treatment was similar between groups (p < 0.1). Compared with the hm-chitosan sponge group, which had no failures, the unmodified chitosan sponge group and the standard gauze group each had eight failures over the 180-minute observation period. For the unmodified chitosan sponge failures, six of which provided initial hemostasis, secondary rebleeding was observed 44 minutes ± 28 minutes after application. Standard gauze provided no initial hemostasis after the 3-minute compression interval. CONCLUSIONS: Hm-chitosan is superior to unmodified chitosan sponges (p < 0.001) or standard gauze for controlling bleeding from a lethal arterial injury. The hm-chitosan technology may provide an advantage over native chitosan-based dressings for control of active hemorrhage.

New hemostatic dressing (FAST Dressing) reduces blood loss and improves survival in a grade V liver injury model in noncoagulopathic swine.

BACKGROUND: We performed this study to evaluate the hemostatic efficacy of the FAST Dressing in treating a grade V liver injury in noncoagulopathic swine. METHODS: Sixteen female splenectomized, noncoagulopathic swine underwent reproducible grade V liver injuries. The animals were blindly randomized to two treatment groups: (1) FAST Dressing (n = 8) or (2) IgG placebo dressing (n = 8). After 30 seconds of uncontrolled hemorrhage, dressings and manual compression were applied at 4-minute intervals. The number of dressings used, time to hemostasis, total blood loss, mean arterial pressure, blood chemistry, and total resuscitation fluid volume were monitored for 2 hours after injury. RESULTS: The mean total blood loss was 412.5 mL (SD 201.3) for the FAST Dressing group compared with 2296.6 mL (SD 1076.0) in the placebo group (p < 0.001). All animals in the FAST Dressing group achieved hemostasis and survived for the duration of the experiment (2 hours) after injury, whereas none of the animals in the placebo group attained hemostasis or survived to 2 hours after injury (p < 0.001). The mean time to hemostasis was 6.6 minutes (SD 2.5). A median of five dressings (mean absolute deviation 1.0, p = 0.007) was sufficient to control hemorrhage in the FAST Dressing group. CONCLUSION: The FAST Dressing reduced blood loss and improved survival compared with placebo in a noncoagulopathic, grade V liver injury swine model.

[The future of inhaled antibiotic therapy. New products]. / El futuro de la antibioterapia inhalada. Nuevos productos.

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection, especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, major progress in this field has only been made in the last 10 years: the beneficial effects in this indication have been confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaled antibiotic formulations have appeared, administration systems have improved and their use has been broadened to include other infections. The speed of research indicates that major advances will be made in the indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems in the next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaled antibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism or the underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to the concentration achieved in the site of infection. Antibiotic administration through the inhaled route is subject to many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizer used and the patient's characteristics. Many features of the pharmacokinetics of this route remain unknown and, because of its complexity, it should be prescribed and monitored by specialist physicians to avoid underdosing, which could lead to bacterial resistance.

El futuro de la antibioterapia inhalada. Nuevos productos / The future of inhaled antibiotic therapy. New products

Los antibióticos inhalados están siendo utilizados desde hace más de 30 años para tratar la colonización o lainfección bronquial, especialmente en pacientes con fibrosis quística e infección bronquial crónica porPseudomonas. No ha sido hasta los últimos 10 años cuando más se ha avanzado en este campo: se han confirmadolos efectos beneficiosos en esta indicación con la evidencia científica, los ensayos clínicos se han incrementadode forma considerable, han aparecido formulaciones de antibióticos para vía inhalada, han mejoradolos sistemas de administración y se ha extendido su uso en otras infecciones. La velocidad de la investigaciónnos hace suponer que en los próximos 10 años habrá importantes avances en las indicaciones, en el arsenal deantibióticos disponibles por esta vía y en la eficacia de los sistemas de administración.El futuro inmediato de la investigación en este campo sería deseable que fuese dirigido a demostrar la eficaciade los antibióticos inhalados en el tratamiento de cualquier infección bronquial crónica, sea cual sea el microorganismocausante y la patología de base, incluso sin la presencia todavía de bronquiectasias. El efecto delantibiótico está en relación con la concentración que se alcanza en la zona de la infección. La administraciónde antibióticos por vía inhalada está sujeta a muchas variables: dosis administrada, dosis que llega a la zonade la infección, tipo de nebulizador usado y las características del paciente. Todavía desconocemos muchosaspectos de su farmacocinética, y su complejidad hace aconsejable que sea indicada y controlada por facultativosespecializados para evitar infradosificaciones que induzcan resistencias bacterianas(AU)

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection,especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, majorprogress in this field has only been made in the last 10 years: the beneficial effects in this indication havebeen confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaledantibiotic formulations have appeared, administration systems have improved and their use has beenbroadened to include other infections. The speed of research indicates that major advances will be made inthe indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems inthe next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaledantibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism orthe underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to theconcentration achieved in the site of infection. Antibiotic administration through the inhaled route is subjectto many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizerused and the patient’s characteristics. Many features of the pharmacokinetics of this route remain unknownand, because of its complexity, it should be prescribed and monitored by specialist physicians to avoidunderdosing, which could lead to bacterial resistance(AU)

Towards an International Classification for Patient Safety: the conceptual framework.

Global advances in patient safety have been hampered by the lack of a uniform classification of patient safety concepts. This is a significant barrier to developing strategies to reduce risk, performing evidence-based research and evaluating existing healthcare policies relevant to patient safety. Since 2005, the World Health Organization's World Alliance for Patient Safety has undertaken the Project to Develop an International Classification for Patient Safety (ICPS) to devise a classification which transforms patient safety information collected from disparate systems into a common format to facilitate aggregation, analysis and learning across disciplines, borders and time. A drafting group, comprised of experts from the fields of patient safety, classification theory, health informatics, consumer/patient advocacy, law and medicine, identified and defined key patient safety concepts and developed an internationally agreed conceptual framework for the ICPS based upon existing patient safety classifications. The conceptual framework was iteratively improved through technical expert meetings and a two-stage web-based modified Delphi survey of over 250 international experts. This work culminated in a conceptual framework consisting of ten high level classes: incident type, patient outcomes, patient characteristics, incident characteristics, contributing factors/hazards, organizational outcomes, detection, mitigating factors, ameliorating actions and actions taken to reduce risk. While the framework for the ICPS is in place, several challenges remain. Concepts need to be defined, guidance for using the classification needs to be provided, and further real-world testing needs to occur to progressively refine the ICPS to ensure it is fit for purpose.

Towards an International Classification for Patient Safety: a Delphi survey.

OBJECTIVE: Interpretation and comparison of patient safety information have been compromised by the lack of a common understanding of the concepts involved. The World Alliance set out to develop an International Classification for Patient Safety (ICPS) to address this, and to test the relevance and acceptability of the draft ICPS and progressively refine it prior to field testing. DESIGN: Two-stage Delphi survey. Quantitative and qualitative analyses informed the review of the ICPS. SETTING: International web-based survey of expert opinion. PARTICIPANTS: Experts in the fields of patient safety, health policy, reporting systems, safety and quality control, classification theory and development, health informatics, consumer advocacy, law and medicine; 253 responded to the first round survey, 30% of whom responded to the second round. RESULTS: In the first round, 14% felt that the conceptual framework was missing at least one class, although it was apparent that most respondents were actually referring to concepts they felt should be included within the classes rather than the classes themselves. There was a need for clarification of several components of the classification, particularly its purpose, structure and depth. After revision and feedback, round 2 results were more positive, but further significant changes were made to the conceptual framework and to the major classes in response to concerns about terminology and relationships between classes. CONCLUSIONS: The Delphi approach proved invaluable, as both a consensus-building exercise and consultation process, in engaging stakeholders to support completion of the final draft version of the ICPS. Further refinement will occur.

Building a Hospital Incident Reporting Ontology (HIRO) in the Web Ontology Language (OWL) using the JCAHO Patient Safety Event Taxonomy (PSET).

A Hospital Incident Reporting Ontology (HIRO) is being developed in Protégé-OWL to demonstrate feasibility and clinical value of using an ontology to combine, compare, and analyze data from across many public and private reporting systems collecting adverse events and near misses for patient safety. The HIRO is based on the JCAHO Patient Safety Event Taxonomy (PSET) and de-identified hospital incident reports.