Operating Room Teams Display Acceptable Levels of Patient Safety Behaviors During Surgical Cases.

INTRODUCTION: Cornerstones of patient safety include reliable safety behaviors proposed by Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) practices. A better quantification of these behaviors is needed to establish a baseline for future improvement efforts. METHODS: At one large academic medical center, OR Teams were prospectively assigned to be observed during surgical cases, and patient safety behaviors were quantified using the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument. Mean scores of each TENTS behavior were calculated with 95% confidence intervals and compared using a paired t-test with a false discovery rate (FDR) control. Using the TENTS instrument, one hundred one surgical cases were observed by purposefully trained medical student volunteers. The average with 95% confidence interval (CI) of observed safety behaviors quantified using the TENTS instrument (including 20 types of safety behaviors scored 0 = expected but not observed, 1 = observed but poorly performed or counterproductive, 2 = observed and acceptable, and 3 = observed and excellent). RESULTS: All safety behaviors averaged slightly above 2, and the lower bound of 95% CI was above 2 for all behaviors except one. Statistically significant differences (p < 0.05) were detected between a few safety behaviors, with the lowest-rated safety behavior being "employs conflict resolution" (2.07, 95% CI: 1.96-2.18) and the highest-rated behavior being "willingness to support others across roles" (2.36, 95% CI: 2.27-2.45). There were no significant differences (p > 0.05) based on the number of persons present during the case, case duration, or by surgical department. CONCLUSIONS: Given the persistent patient safety incidents in ORs nationwide, it might be necessary to advance these behaviors from acceptable to exceptional to advance patient safety.

Combined effects of sugar-sweetened beverage consumption, screen-based sedentary behavior, and sleep duration on South Korean adolescent obesity: a cross-sectional study.

PURPOSE: This study examined the combined effects of sugar-sweetened beverage (SSB) consumption, screen-based sedentary behaviors, and sleep duration on adolescent obesity. METHODS: It followed a cross-sectional study design and conducted secondary analysis on data from 20,497 high school students who participated in the 17th (2021) Korea Youth Risk Behavior Web-based Survey. This study underwent logistic regression analysis in complex sampling analysis. RESULTS: The combinations of low and medium consumption of SSBs, excessive screen-based sedentary behaviors, and short sleep durations were associated with a 1.18 and 1.12 fold increased likelihood of obesity (95% confidence interval [CI]=1.03-1.35) and (95% CI=1.02-1.22), respectively. The combination of high SSB consumption, appropriate screen-based sedentary behaviors, and short sleep duration (adjusted odds ratio [aOR]=1.15, 95% CI=1.01-1.31) and high SSB consumption, excessive screen-based sedentary behaviors, and short sleep duration (aOR=1.40, 95% CI=1.16-1.69) were associated with obesity. CONCLUSION: Integrated and tailored programs considering combination patterns of SSB consumption, screen-based sedentary behaviors, and short sleep duration need to be developed for preventing adolescent obesity.

Potential health risks to disinfection workers from exposure to active substances in COVID-19 biocidal products.

The importance of disinfection has recently been emphasized due to the increasing risk of the spread of infections such as coronavirus disease-2019 (COVID-19). In addition, disinfection for preventing the spread of COVID-19 is highly recommended. The increased use of biocidal products raises concerns regarding the potential health risks from exposure among disinfection workers. This study aimed to assess these exposure and health risks using questionnaires targeting disinfection workers who were exposed to the active substances in biocidal products used for disinfection during the COVID-19 pandemic. A follow-up survey was conducted among 271 disinfection workers for 10 working days within two weeks, and exposure factors with reference to disinfection were evaluated through interview-administered questionnaires. An exposure algorithm was used to evaluate the exposure of disinfection workers during disinfection. The hazard index (HI) was calculated by dividing the inhalation concentration obtained using the exposure algorithm and the dermal dose according to occupational exposure limits (OEL). A sensitivity analysis was conducted to identify the exposure factors with the greatest impact on the inhalation and dermal exposure algorithms. A logistic regression analysis was performed to verify the relationship with health effects and sociodemographic and exposure characteristics. The average number of disinfections performed during 10 working days was 17.5 ± 12.3 times. The type of disinfection work was divided into 2806 cases of COVID-19 prevention and disinfection and 1956 cases of regular pesticide application to prevent and remove any pests. The HI was ≥1, indicating a potential health risk, with the use of ethanol (6.50E+00), quaternary ammonium compounds (QACs; 1.49E+01), and benzalkonium chloride (BKC; 1.73E+00). Dermal exposure was more hazardous than inhalation exposure for 6 of the 11 active substances in biocidal products. The weight fraction and exposure time were the factors that most significantly influenced the inhalation and dermal exposure algorithms in the sensitivity analysis. Higher exposure concentrations were more likely to affect health (AOR: 3.239, 95% CI: 1.155-9.082). This study provides valuable information regarding the exposure and risk of disinfection workers to 11 biocidal active substances included in common disinfectants. Our results suggest that the use of ethanol, BKC, and QACs has potential health risks to disinfection workers, with a higher possibility of negative health impacts with increasing exposure concentration.

Analysis of patient safety event report categories at one large academic hospital.

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.

Developing a Novel Read-Across Concept for Ecotoxicological Risk Assessment of Phosphate Chemicals: A Case Study.

This study introduces a novel concept approach for a read-across assessment, considering species sensitivity differences among phosphate chemicals within structurally similar compound groups. Twenty-five organic chemicals, with a log Kow of 5 or less, were categorized into three functional groups based on acetylcholinesterase (AChE) inhibition as a specific mode of action (MOA). The short-term aquatic toxicity data (LC50) for fish, crustaceans, and insects were collected from the U.S. EPA Ecotoxicology (ECOTOX) Knowledgebase. A geometric mean calculation method was applied for multiple toxic endpoints. Performance metrics for the new read-across concept, including correlation coefficient, bias, precision, and accuracy, were calculated. Overall, a slightly higher overestimation (49.2%) than underestimation (48.4%) in toxicity predictions was observed in two case studies. In Case study I, a strong positive correlation (r = 0.93) between the predicted and known toxicity values of target chemicals was observed, while in Case study II, with limited information on species and their ecotoxicity, showed a moderate correlation (r = 0.75). Overall, the bias and precision for Case study I were 0.32 ± 0.01, while Case study II showed 0.65 ± 0.06; however, the relative bias (%) increased from 37.65% (Case study I) to 91.94% (Case study II). Bland-Altman plots highlight the mean differences of 1.33 (Case study I) and 1.24 (Case study II), respectively. The new read-across concept, focusing on AChE inhibition and structural similarity, demonstrated good reliability, applicability, and accuracy with minimal bias. Future studies are needed to evaluate various types of chemical substances, diverse modes of action, functional groups, toxic endpoints, and test species to ensure overall comprehensiveness and robustness in toxicity predictions.

Factors associated with the combination of general and abdominal obesity in middle-aged and older Korean women: a cross-sectional study.

BACKGROUND: To identify factors associated with general and abdominal obesity in middle-aged and older Korean women based on the biopsychosocial model. METHODS: Data from 4,076 women aged ≥45 years who participated in the Korea National Health and Nutrition Examination Survey from 2015 to 2020 were analyzed. Complex sampling analysis was performed using IBM SPSS ver. 26.0. RESULTS: The combination of general and abdominal obesity was positively associated with age ≥65 years, postmenopausal status, and without breastfeeding experience among biomedical factors; depressive symptoms and prolonged (≥8 hours a day) sedentary behavior among psychosocial factors; and an educational level lower than middle or high school graduation and the first and second income quantiles among biosocial factors. CONCLUSION: Healthcare providers in communities and public societies should screen for risk factors for the combination of general and abdominal obesity while considering non-modifiable biomedical (e.g., age) and biosocial factors (e.g., educational level). In addition, intervention strategies should be developed by considering modifiable psychosocial factors such as sedentary behavior.

Transcriptome analysis reveals differences in developmental neurotoxicity mechanism of methyl-, ethyl-, and propyl- parabens in zebrafish embryos.

Studies on the comparison of developmental (neuro) toxicity of parabens are currently limited, and unharmonized concentrations between phenotypic observations and transcriptome analysis hamper the understanding of their differential molecular mechanisms. Thus, developmental toxicity testing was conducted herein using the commonly used methyl- (MtP), ethyl- (EtP), and propyl-parabens (PrP) in zebrafish embryos. With a benchmark dose of 5%, embryonic-mortality-based point-of-departure (M-POD) values of the three parabens were determined, and changes in locomotor behavior were evaluated at concentrations of 0, M-POD/50, M-POD/10, and M-POD, where transcriptome analysis was conducted to explore the underlying neurotoxicity mechanism. Higher long-chained parabens were more toxic than short-chained parabens, as determined by the M-POD values of 154.1, 72.6, and 24.2 µM for MtP, EtP, and PrP, respectively. Meanwhile, exposure to EtP resulted in hyperactivity, whereas no behavioral effect was observed with MtP and PrP. Transcriptome analysis revealed that abnormal behaviors in the EtP-exposed group were associated with distinctly enriched pathways in signaling, transport, calcium ion binding, and metal binding. In contrast, exposure to MtP and PrP mainly disrupted membranes and transmembranes, which are closely linked to abnormal embryonic development rather than neurobehavioral changes. According to the changes in the expressions of signature mRNAs, tentative transcriptome-based POD values for each paraben were determined as MtP (2.68 µM), EtP (3.85 µM), and PrP (1.4 µM). This suggests that different molecular perturbations initiated at similar concentrations determined the extent and toxicity outcome differently. Our findings provide insight into better understanding the differential developmental neurotoxicity mechanisms of parabens.

Duration of antimicrobial treatment for complicated intra-abdominal infections after definitive source control: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma

Recent studies have evaluated outcomes associated with duration of antimicrobial treatment for complicated intra-abdominal infections (cIAI). The goal of this guideline was to help clinicians better define appropriate antimicrobial duration in patients who have undergone definitive source control for cIAI. A working group of Eastern Association for the Surgery of Trauma (EAST) performed a systematic review and meta-analyses of the available data pertaining to the duration of antibiotics after definitive source control of cIAI in adult patients. Only studies that compared patients treated with short vs. long duration antibiotic regimens were included. The critical outcomes of interest were selected by the group. Noninferiority of short compared with long duration of antimicrobial treatment was defined as an indicator for a potential recommendation in favor of shorter antibiotics course. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of the evidence and to formulate recommendations. Sixteen studies were included. The short duration ranged from 1 dose to ≤10 days, with an average of 4 days, and the long duration ranged >1 day to 28 days, with an average of 8 days. There were no differences between short and long duration of antibiotics in terms of mortality (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56-1.44), rate of surgical site infection (OR, 0.88; 95% CI, 0.56-1.38); persistent/recurrent abscess (OR, 0.76; 95% CI, 0.45-1.29); unplanned interventions (OR, 0.53; 95% CI, 0.12-2.26); hospital length of stay (mean difference, -2.62 days; CI, -7.08 to 1.83 days); or readmissions (OR, 0.92; 95% CI, 0.50-1.69). The level of evidence was assessed as very low. The group made a recommendation for shorter (four or less days) versus longer duration (eight or more days) of antimicrobial treatment in adult patients with cIAIs who had definitive source control.

Duration of antimicrobial treatment for complicated intra-abdominal infections after definitive source control: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.

BACKGROUND: Recent studies have evaluated outcomes associated with duration of antimicrobial treatment for complicated intra-abdominal infections (cIAI). The goal of this guideline was to help clinicians better define appropriate antimicrobial duration in patients who have undergone definitive source control for cIAI. METHODS: A working group of Eastern Association for the Surgery of Trauma (EAST) performed a systematic review and meta-analyses of the available data pertaining to the duration of antibiotics after definitive source control of cIAI in adult patients. Only studies that compared patients treated with short vs. long duration antibiotic regimens were included. The critical outcomes of interest were selected by the group. Noninferiority of short compared with long duration of antimicrobial treatment was defined as an indicator for a potential recommendation in favor of shorter antibiotics course. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of the evidence and to formulate recommendations. RESULTS: Sixteen studies were included. The short duration ranged from 1 dose to ≤10 days, with an average of 4 days, and the long duration ranged >1 day to 28 days, with an average of 8 days. There were no differences between short and long duration of antibiotics in terms of mortality (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56-1.44), rate of surgical site infection (OR, 0.88; 95% CI, 0.56-1.38); persistent/recurrent abscess (OR, 0.76; 95% CI, 0.45-1.29); unplanned interventions (OR, 0.53; 95% CI, 0.12-2.26); hospital length of stay (mean difference, -2.62 days; CI, -7.08 to 1.83 days); or readmissions (OR, 0.92; 95% CI, 0.50-1.69). The level of evidence was assessed as very low. CONCLUSION: The group made a recommendation for shorter (four or less days) versus longer duration (eight or more days) of antimicrobial treatment in adult patients with cIAIs who had definitive source control. LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis; Level III.

Combination of sugar-sweetened beverage consumption, screen-based sedentary time, and sleep duration and their association with South Korean adolescents' mental health.

Introduction: This study examines the combinations of sugar-sweetened beverage (SSB) consumption, screen-based sedentary time, and sleep duration and their association with adolescents' depressive symptoms and suicidal ideation. Methods: This research followed a crosssectional study design. Secondary data analysis was conducted on the data collected from 21,046 high school students who had participated in the 17th Korea Youth Risk Behavior Web-Based Survey in 2021. A complex sampling analysis, including descriptive and logistic regression analyses, was conducted in SPSS Statistics 26.0. Results: The combination of low SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. In addition, a combination of medium/high SSB consumption, appropriate/excessive screen-based sedentary time, and short sleep duration was associated with an increase in depressive symptoms. Finally, the combination of high SSB consumption, excessive screen-based sedentary time, and short sleep duration was associated with an increase in suicidal ideation. Discussion: The findings demonstrate that healthcare providers should develop and conduct family-and school-based programs to restrict SSB consumption, screen-based sedentary behaviors, and sleep duration to improve adolescents' mental health.

A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study.

BACKGROUND: Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. OBJECTIVE: We aim to assess the effect of VR training on health care workers' (HCWs') understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. METHODS: This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs' understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. RESULTS: Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. CONCLUSIONS: Our findings will help assess the effectiveness of VR training in improving HCWs' understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties.

Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students.

This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.

Sex differences in factors associated with prediabetes in Korean adults.

OBJECTIVES: Identifying the factors associated with prediabetes is necessary for the early detection and management of high-risk individuals with prediabetes. The purpose of this study was to identify the factors associated with prediabetes according to sex in Korean adults. METHODS: Using the Korean National Health and Nutrition Examination Survey from 2015 to 2019, a total of 13,595 adults (5,565 males and 8,030 females) aged ≥20 years were included in the data analysis. Logistic regression analysis was performed to identify the factors associated with prediabetes according to sex in Korean adults. RESULTS: In both males and females, age and a family history of type 2 diabetes were associated with prediabetes. In males, current and past smoking habits were associated with increased prediabetes. In addition, low-intensity physical activity and prolonged sedentary behavior were associated with a higher prevalence of prediabetes. Females with a lower education level (less than middle school graduation) showed a higher risk of prediabetes. CONCLUSION: Sex-specific prevention strategies for prediabetes should be developed. In addition, older individuals and those with a family history of type 2 diabetes should be screened for prediabetes.

National Surgical Quality Improvement Program Adverse Events Combined With Clavien-Dindo Scores Can Direct Quality Improvement Processes in Surgical Patients.

OBJECTIVE: The burden of postoperative adverse events (AE) weighs immediately on the patient as unanticipated stress and on the healthcare system as unreimbursed cost. Applying the Clavien-Dindo (C-D) system of AE gradation as a surrogate of cost, we analyzed 4 years' data from a single-state National Surgical Quality Improvement Program (NSQIP) collaboration, hypothesizing that trends of AE were consistent over time and that more frequently performed cases would be associated with less and more minor AE. METHODS: The NSQIP defined AEs, consisting of 21 listed postoperative occurrences, which were analyzed using deidentified 30-day postoperative data for 2015 to 2018. Each AE was graded using (C-D) severity (1, lowest; 4, highest with survival). The C-D severity weight, as defined in previous multi-institutional studies, was used as a surrogate for cost and unplanned patient burden. Adverse event incidence was calculated as sum AE/case volume, and population burden as total AE burden/case volume. RESULTS: There were 12,567 surgical cases recorded by members of the state collaborative. The overall data demonstrated no significant difference in AE incidence; however, the burden of AE increased by 18.8%. The 8 most common Current Procedural Terminology codes had approximately 50% lower AE incidence compared with overall cases; however, the incidence increased by 56.0% and the AE burden/case increased by 48.0%. CONCLUSIONS: Although the 8 most common Current Procedural Terminology codes showed a 50% lower AE incidence compared with overall cases, the incidence increased over the study period. Surgical quality initiatives should be patient centered and focus on high burden AE.

Consumption of sugar-sweetened beverages and fast foods deteriorates adolescents' mental health.

Introduction: Sugar-sweetened beverage (SSB) and fast-food consumption is significantly associated with adolescents' poor mental health. Furthermore, sugar-sweetened beverage and fast-food consumption might form clustered diet patterns with significant positive associations in adolescent high school students. Thus, the combined consumption of SSBs and fast foods may have more negative effects on mental health with synergetic effects than the sum of their independent consumption. Methods: This study aimed to identify the effects of combining the consumption of sugar-sweetened beverages and fast foods on mental health, including stress, depressive symptoms, and suicidal ideation among Korean high school students. Secondary data from 24,006 high school students were analyzed from the 17th Korea Youth Risk Behavior Web-based Survey, 2021. For statistical analysis, complex sampling analysis using the SPSS Statistics 26.0 software was applied for descriptive statistics and logistic regression analysis. Results: In Korean adolescents, combining more than medium consumption of sugar-sweetened beverages and fast foods was associated with more stress, depressive symptoms, and suicidal ideation than their independent consumption. In addition, combining high consumption of sugar-sweetened beverages and low to high consumption of fast foods might have dose-dependent negative effects on stress, depressive symptoms, and suicidal ideation in Korean adolescents. Discussion: Based on the results of this study, healthcare providers in schools and communities might develop various interventions including school/community-based feeding programs and policies targeting the restriction of SSB and fast-food consumption to improve adolescents' mental health.

PICC versus midlines: Comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications.

INTRODUCTION: To decrease the complications related to central catheters there has been an increasing utilization of peripherally inserted central catheters (PICC) and ultrasound-guided long peripheral intravenous catheters (i.e. midlines). While the complications of PICC lines are well described there is less reported data on complications related to midline catheters. Our study aims are to compare the incidences of infectious and deep venous thrombosis (DVT) and sepsis related to PICCs and Midlines. METHODS: We performed a single-center retrospective review at an academic hospital. Data were collected on patients admitted between 1/1/2014-5/31/2016. Patient demographics, hospital length of stay (LOS), and ventilator days were collected. Outcomes of interest were line-related infections and thromboembolic events after the placement of these catheters. Endpoints were compared between three groups (PICC group, midline group and PICC placement followed by midline placement group). Univariate and multivariable analyses were used to compare across the three groups. RESULTS: The study included 3560 unique patients with 5058 catheters. There was an increase in use of midlines over the observed study period (245% increase from the end of 2015 to the middle of 2016). We found no significant differences in the rates of DVT among the three groups (PICC 4%, midline 3% and PICC-midline 4%; p = 0.12). There were no differences across the groups for sepsis (PICC 29%, midline 27%, and PICC-midline 32%; p = 0.14) or septic shock (PICC 7%, midline 8%, and PICC-midline 6%; p = 0.39). Adjusted means LOS were higher for patients with PICC lines compared to midlines, in both females and males. PICC group stayed longer, on average, on the ventilator compared to the midline group. No other significant differences were seen among groups. CONCLUSION: Increased utilization of midline catheters were not associated with decreased risk of DVT or sepsis when compared to peripherally inserted central catheters.

Bradycardia resulting in cardiac arrest in a critically ill patient receiving dexmedetomidine.

Dexmedetomidine is an alpha-2 agonist sedative and analgesic used in anesthesia practice, and it has become more prevalent in the critically ill patients requiring short-term mechanical ventilation. While dexmedetomidine is known to have minimal effects on respiratory drive, it has been well-documented to cause bradycardia and hypotension, especially in patients with existing comorbidities. We present a patient without cardiovascular comorbidities who was in the surgical ICU under dexmedetomidine sedation. The patient went into asystole cardiac arrest after vagal stimulation. Return of spontaneous circulation was achieved using ACLS protocol. We offer a review of reported cases and make recommendations on the management of similar situations that may arise given the increasing use of dexmedetomidine.

Combined Effects of Metabolic Abnormalities and Obesity on Cardiovascular Diseases among Korean Postmenopausal Women.

Combined effects of metabolic abnormalities, including metabolic syndrome and obesity, should be identified to screen postmenopausal women at risk of developing cardiovascular diseases. The purpose of this study was to identify the combined effects of metabolic abnormalities and obesity on cardiovascular diseases among postmenopausal Korean women (aged 40-83 years). Data of 5959 postmenopausal women from the Korean National Health and Nutrition Examination Survey (2015-2018) were secondarily analyzed. Using complex simple analysis procedures, logistic regression analysis was performed to identify the combined effect of metabolic abnormalities and obesity on cardiovascular diseases among postmenopausal Korean women. In combination, metabolic syndrome (more than three metabolic abnormalities) and obesity (overweight [≥23 kg/m2 and <25 kg/m2 in body mass index] and obese [>25 kg/m2 in body mass index]) increased the likelihood of developing cardiovascular diseases but combining more than one metabolic abnormality and obesity did not. Combining metabolic syndrome and non-obesity (underweight and normal weight) increased the likelihood of the prevalence of cardiovascular diseases but combining more than one metabolic abnormality and non-obesity did not. Increased cardiovascular diseases in postmenopausal women may be more commonly associated with metabolic syndrome having multiple metabolic abnormalities, but not obesity. Thus, instead of simple weight control, early management of metabolic syndrome is recommended to prevent cardiovascular disease among postmenopausal Korean women.

Combined Effects of Unhealthy Lifestyle Behaviors on Metabolic Syndrome among Postmenopausal Women.

This study aimed to identify the combined effects of unhealthy lifestyle behaviors, including diet, sedentary behavior, and physical activity on metabolic syndrome (MS) and components of MS among postmenopausal women. Secondary data analysis was conducted using the Korean National Health and Nutrition Examination Survey (2014-2018) with a cross-sectional study design. Logistic regression analysis was conducted with data from 6114 Korean postmenopausal women. While no significant effects of unhealthy lifestyle behaviors, either individually or as a combination, were found for MS, prolonged sedentary behavior without poor dietary behavior and insufficient physical activity was associated with increased likelihood of abdominal obesity (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.10-2.29) and impaired fasting glucose (AOR: 1.54, 95% CI: 1.13-2.10). The combination of poor dietary behavior and prolonged sedentary behaviors was also associated with increased likelihood of abdominal obesity (AOR: 1.48, 95% CI: 1.10-2.00) and impaired fasting glucose (AOR: 1.49, 95% CI: 1.14-1.96). In addition, prolonged sedentary behavior and insufficient physical activity together were associated with increased likelihood of abdominal obesity (AOR: 2.81, 95% CI: 1.90-4.20) and impaired fasting glucose (AOR: 1.59, 95% CI: 1.13-2.24). Finally, combining poor dietary behavior, prolonged sedentary behavior, and insufficient physical activity was also associated with increased likelihood of abdominal obesity (AOR: 2.05, 95% CI: 1.50-2.80) and impaired fasting glucose (AOR: 1.71, 95% CI: 1.32-2.23). Strategies for replacing sedentary behavior of postmenopausal women with activities are warranted for prevention of abdominal obesity and impaired fasting glucose.

Olfactory Stimulation of Preterm Infants with Breast Milk.

Maintaining stable physiological responses may be important for the growth and development of preterm infants. The purpose of our study was to evaluate the effects of olfactory stimulation with maternal breast milk on the occurrence of abnormal physiological responses in preterm infants. With a non-equivalent control group pretest-posttest design, 13 preterm infants in the experimental group and 18 preterm infants in the control group completed the intervention. The intervention was implemented three times a day for 5 days in a row with 2 hours of administration per intervention. The frequency of abnormal physiological responses was assessed over 6 days (one day before intervention administration and 5 days during intervention administration). With repeated-measures analysis of variance, the experimental group showed a significantly lower frequency of apnea than the control group (p = .021). Olfactory stimulation with maternal breast milk may be an effective nursing intervention for reducing apnea episodes in preterm infants.