Secular trends in the utility of SGLT-2 inhibitors in heart failure patients with type 2 diabetes mellitus across Metro South Health hospitals in South-East Queensland.

BACKGROUND: The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown. AIMS: To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland. METHODS: Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021. RESULTS: A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m2 (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01). CONCLUSIONS: During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.

The Self-care Educational Intervention for Patients With Heart Failure: A Study Protocol.

BACKGROUND: A variety of educational interventions have been implemented to assist patients with heart failure (HF) to maintain their own health, develop self-care behaviors, and decrease readmissions. The most effective approach to education has yet to be established. OBJECTIVE: The aim of this study is to determine the effectiveness of a multimedia educational intervention for patients with HF in reducing hospital readmissions. Secondary outcomes include changes in knowledge and self-care behaviors. METHODS: A randomized controlled trial in a large tertiary referral hospital in Australia has recruited 200 patients and will follow them for 12 months. Patients diagnosed with HF have been randomly allocated 1:1 to either usual education or a multimedia educational intervention. Framed by the principles of adult learning, this individualized intervention was delivered face to face by a specialized HF nurse, with a targeted educational assessment and subsequent development of an educational plan. The multimedia approach combined viewing a DVD and verbal discussion supported by a written manual. The teach-back strategy at the conclusion of the intervention evaluated the patient's learning through 5 key questions about self-management of HF. Readmissions are assessed at 28 days, 3 months, and 12 months. Knowledge and self-care behavior are assessed at baseline, 3 months, and 12 months. CONCLUSIONS: This study evaluates the effectiveness of a targeted multimedia educational intervention. Study results may inform the design of in-hospital education for HF patients.

Ibuprofen intercalation and release from different layered double hydroxides.

AIM: The chemical composition of layered double hydroxides (LDHs) affects their structure and properties. The method of ibuprofen (IBU) intercalation into LDHs may modify its release, reduce adverse effects and decrease the required dosing frequency. METHODOLOGY: This study investigates the effects of four different LDHs; MgAl-LDH, MgFe-LDH, NiAl-LDH and NiFe-LDH on in vitro release of IBU intercalated by coprecipitation and anionic-exchange. RESULTS: MgAl-LDH was the most crystalline and substitution of either cation decreased LDH order. Fourier-transform infrared spectra and power x-ray diffractograms confirmed the intercalation of IBU within the lamellar structure of MgAl-LDH and MgFe-LDH. Intercalation of IBU by anion-exchange resulted in slower, partial, drug release compared with coprecipitation. CONCLUSION: The chemical composition of LDHs affects their crystallinity, IBU intercalation and subsequent release.

Monteggia type IV fracture in a child with radial head dislocation irreducible by closed means: a case report.

BACKGROUND: Fractures of the proximal third of the ulna and radius with associated anterior radial head dislocation are uncommon in children. Early recognition and appropriate management are essential to prevent long-term consequences of loss of forearm rotation, cubitus valgus, elbow instability and chronic pain. CASE PRESENTATION: We present the case of a 3-year-old Caucasian boy who attended the emergency department following an un-witnessed fall, resulting in right elbow and forearm pain, swelling and deformity. Clinical and radiological examination revealed a Monteggia type IV fracture-dislocation.The patient was treated with closed manipulation and percutaneous fixation of both bone forearm fractures with intra-medullary wires. After failed attempts at closed reduction, open reduction of the radial head was required.The block to reduction was due to a buttonholing of the radial head through the anterior joint capsule, with interposition of the capsule in the radiocapitellar joint. Subsequently, alignment was maintained with fracture healing. Follow-up at five months showed a full range of elbow movement with no adverse symptoms. CONCLUSION: Monteggia lesions of the paediatric elbow, albeit uncommon, should be considered in all forearm fractures. Accurate reduction of the radiocapitellar joint is crucial to prevent significant long-term consequences and failed closed reduction requires open reduction. Here we have described the management of a rare type IV lesion in which there was buttonholing of the radial head through the anterior capsule, causing the radiocapitellar dislocation to be irreducible (even after fixation of the radial and ulnar fractures).