Evaluation of Activated Clotting Times With a Heparin Reversal Protocol Designed to Conserve Protamine During Drug Shortages: A Retrospective, Cohort Study.

OBJECTIVE: To retrospectively evaluate a protamine conservation approach to heparin reversal implemented during times of critical shortages. This approach was aimed at maintaining access to cardiac surgical services. SETTING: In-patient hospital setting. PARTICIPANTS: Eight hundred-one cardiac surgical patients>18 years old. INTERVENTIONS: Patients undergoing cardiac surgery who received >30,000 U of heparin were given a single fixed vial protamine dose of 250 mg or a standard 1 mg of protamine to 100 U of heparin ratio-based dose to reverse heparin. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was differences in post-reversal activated clotting times between the 2 groups. The secondary endpoint was differences in the number of protamine vials used between the 2 reversal strategies. The first activated clotting times values measured after initial protamine administration were not different between the Low Dose and Conventional Dose groups (122.3 s v 120.6 s, 1.47 s, 99% CI -1.47 to 4.94, p = 0.16). The total amount of protamine administered in the Low Dose group was less than that in the Conventional Dose group (-100.5 mg, 99% CI -110.0 to -91.0, p < 0.0001), as were the number of 250 mg vials used per case (-0.69, 99% CI -0.75 to -0.63, p < 0.0001). The mean initial protamine doses between groups were 250 mg and 352 mg, p < 0.0001. The mean protamine vials used were 1.33 v 2.02, p < 0.0001. When the calculations were based on 50 mg vials, the number of vials used per case in the Low Dose group was even less (-2.16, 99% CI -2.36 to -1.97, p < 0.0001).) CONCLUSIONS: Conservation measures regarding critical medications and supplies during times of shortages can maintain access to important services within a community.

Clinical Inquiry: Do statins increase the risk of developing diabetes?

Statin therapy produces a small increase in the incidence of diabetes: one additional case per 255 patients taking statins over 4 years.

Process evaluation results from an environmentally focused worksite weight management study.

There is currently much interest in exploring environmental approaches to combat weight gain and obesity. This study presents process evaluation results from a workplace-based study that tested two levels of environmentally focused weight management interventions in a manufacturing setting. The moderate treatment featured a set of relatively simple, low-cost environmental modifications designed to facilitate healthy eating and physical activity; the intense treatment added elements intended to actively involve and engage management in program efforts. Fidelity varied across the 11 interventions comprising the two treatment conditions but did not vary systematically by treatment condition (moderate vs. intense). Environmental assessments showed improvements in workplace supports for weight management and significant differences by treatment level. Positive shifts in health climate perceptions also occurred, but sites receiving the intense treatment were not perceived as more supportive by employees. Challenges and limitations associated with environmental interventions are discussed with specific reference to activating management support.

Combining environmental and individual weight management interventions in a work setting: results from the Dow chemical study.

OBJECTIVE: To evaluate the comparative effectiveness of environmental weight loss interventions alone versus in combination with an individual intervention. METHODS: A quasi-experimental design compared outcomes for two levels of environmental interventions and for participants who did or did not simultaneously self-select into an individually focused weight loss intervention (YW8). Analysis of covariance and logistic regression techniques were used to examine risk outcomes. RESULTS: Employees who participated in YW8 were no more successful at losing weight than those exposed to only the environmental interventions. Approximately, 13.5% of each group lost at least 5% of their body weight; overall changes in mean body weight and body mass index were negligible in both groups. CONCLUSIONS: Simple worksite environmental modifications may help with weight maintenance, but are not likely to result in substantial weight reductions even when combined with low-intensity individual interventions.

Application of the Environmental Assessment Tool (EAT) as a process measure for a worksite weight management intervention.

OBJECTIVE: To assess the ability of the Environmental Assessment Tool (EAT) to detect changes over time in workplace physical and social environmental supports for physical activity and nutrition; and predict employee engagement, behavior changes, and biometrics. METHODS: Analyses utilized site-level (n = 12) EAT scores. Differences-in-difference regressions tested changes in EAT scores over time across treatment sites. Generalized linear mixed models examined the ability of site-level EAT scores to predict individual-level outcomes. RESULTS: Overall, the EAT captured changes in the workplace environmental supports for health promotion over time. However, the ability of EAT scores to predict intervention outcomes was weak. CONCLUSIONS: The EAT is a useful tool for monitoring changes in workplace environments over time. Further research is needed regarding the dose or intensity of environmental intervention needed to affect changes in employee behaviors and biometrics.

Association of comorbid mental health symptoms and physical health conditions with employee productivity.

OBJECTIVE: This study tests the hypothesis that employees with comorbid physical health conditions and mental health symptoms are less productive than other employees. METHODS: Self-reported health status and productivity measures were collected from 1723 employees of a national retail organization. chi2, analysis of variance, and linear contrast analyses were conducted to evaluate whether health status groups differed on productivity measures. Multivariate linear regression and multinomial logistic regression analyses were conducted to analyze how predictive health status was of productivity. RESULTS: Those with comorbidities were significantly less productive on all productivity measures compared with all other health status groups and those with only physical health conditions or mental health symptoms. Health status also significantly predicted levels of employee productivity. CONCLUSION: These findings provide evidence for the relationship between health statuses and productivity, which has potential programmatic implications.