A Canadian survey of perceptions and practices related to ordering of blood tests in the intensive care unit

PURPOSE

The ordering of routine blood test panels in advance is common in intensive care units (ICUs), with limited consideration of the pretest probability of finding abnormalities. This practice contributes to anemia, false positive results, and health care costs. We sought to understand practices and attitudes of Canadian adult intensivists regarding ordering of blood tests in critically ill patients.

METHODS

We conducted a nationwide Canadian cross-sectional survey consisting of 15 questions assessing three domains (global perceptions, test ordering, daily practice), plus 11 demographic questions. The target sample was one intensivist per adult ICU in Canada. We summarized responses using descriptive statistics and present data as mean with standard deviation (SD) or count with percentage as appropriate.

RESULTS

Over seven months, 80/131 (61%) physicians responded from 77 ICUs, 50% of which were from Ontario. Respondents had a mean (SD) clinical experience of 12 (9) years, and 61% worked in academic centres. When asked about their perceptions of how frequently unnecessary blood tests are ordered, 61% responded "sometimes" and 23% responded "almost always." Fifty-seven percent favoured ordering complete blood counts one day in advance. Only 24% of respondents believed that advanced blood test ordering frequently led to changes in management. The most common factors perceived to influence blood test ordering in the ICU were physician preferences, institutional patterns, and order sets.

CONCLUSION

Most respondents to this survey perceived that unnecessary blood testing occurs in the ICU. The survey identified possible strategies to decrease the number of blood tests.

Bowel Habit Pattern of Patients with Self-Reported Constipation at Out Patient Department in North East Part of Bangladesh

The aim of this study was to observe the symptoms and bowel habit pattern experienced by patients presenting with self reporting constipation at Out Patient Department in a tertiary care hospital. It was a cross-sectional study which was conducted in Out Patient Department of gastroenterology in North East Medical College Hospital, Sylhet, Bangladesh from January 2017 to December 2018. Total 228 consecutive patients with self reported constipation were enrolled in this study. Patients with history of abdominal surgery, known chronic disease, age below 18 years, pregnant women, patients using drugs like anti-depressant, anti-psychotic and patients unwilling to take part in the study were excluded. Demographic data, symptoms, bowel habit pattern and character of stool were recorded at enrollment in a pre-designed data sheet. Total 228 patients, male 130(57.0%) and female 98(43.0%), age varying from 18-81 years (mean age 38.7±15.10 years) were included. Among them 127 patients (55.7%) was experienced daily bowel motion with frequency varying from one to seven and 99 patients (44.3%) had infrequent stools. Sixteen (16) patients (7.0%), 182 patients (79.8%) and 30 patients (13.2%) had feeling of complete bowel evacuation all time, few days in a week and almost never respectively. Among the patients 127(55.7%), 29(12.7%), 06(2.6%), 02(0.9%) and 64(28.1%) complained of hard, soft, semi liquid, liquid and stool of variable consistency respectively. In this study 159(63.73%), 21(9.21%) and 43(18.85%) patients were regularly taking Proton pump inhibitor (PPI), anti- diabetic drugs and anti-hypertensive drugs respectively. The finding suggests that there was a wide variation of self perception of constipation among the patient. The study concludes that patient's perception regarding constipation does not always match the traditional medical definition. Overall findings signify that symptoms like stool consistency, volume, and feeling of incomplete evacuation are more important rather than frequency of bowel per week in patients' perception regarding constipation. However, further study with large sample size in different hospitals in different areas could explain this observation more precisely.

A Study of Association between H. Pylori Genotype and Chronic Gastritis

The prevalence of Helicobacter pylori (HP) infection is very high in Bangladesh. Chronic gastritis due to H. pylori is commonly associated with important gastric diseases such as peptic ulcer diseases or gastric carcinoma and MALT-oma. The natural course of chronic gastritis is HP-associated antral gastritis or pangastritis or rarely atrophies. This study was done to see the association of H. pylori genotypes with chronic gastritis. This observational cross sectional study was carried out at Bangabandhu Sheikh Mujib Medical University from July 2012 to April 2013 to find out the association of H. pylori genotypes with chronic gastritis in dyspeptic patients of Bangladesh. A total of 50 dyspeptic subjects were involved in the study whose upper GI endoscopies were carried out in presence of an experienced endoscopist. During the procedure four biopsies were taken, two from the antrum and two from body of the stomach. Endoscopic diagnosis was categorized into normal and erosive gastritis. Two (one from antrum and one from body) biopsy samples were collected in phosphate buffer saline and PCR analysis carried out by Multiplex PCR assay. Another two were collected in 10% formalin and histopathological examination was done according to updated Sydney system of classification. Among 50 patents only 34 were PCR positive. So, only 34 subjects were included in the study. Among them 21 patients (61.8%) were male and 13 patients (38.2%) were female, with the mean age of 29.91 years. Endoscopy revealed erosive gastritis in 5(14.7%) patients and normal findings in 29(86.3%) patients. Amongst the strains, cagA gene was detected in 58.8% and was not significantly associated with severity of any parameter of chronic gastritis such as H. pylori density, inflammation (mononuclear infiltration), activity (neutrophilic infiltration), atrophy and intestinal metaplasia. All the strains were positive for vacA allele. s1m1 (55.9%) genotype was most predominant. No vacA allele (s1m1, s1m2, s2m1 and s2m2) were significantly associated with severity of chronic gastritis. In this study, H. pylori genotype -cagA, vacA-s1, s2, m1, m2 allele and histological grading of chronic gastritis according to updated Sydney system of classification is identified. This study will identify the genotypes associated with severe gastritis in our country and thereby help us to take appropriate preventive measure. Further study with larger sample size may be carried out to establish proper association between different genotypes and parameters of chronic gastritis.

Unraveling systematic inventory of Echinops (Asteraceae) with special reference to nrDNA ITS sequence-based molecular typing of Echinops abuzinadianus

The present study explored the systematic inventory of Echinops L. (Asteraceae) of Saudi Arabia, with special reference to the molecular typing of Echinops abuzinadianus Chaudhary, an endemic species to Saudi Arabia, based on the internal transcribed spacer (ITS) sequences (ITS1-5.8S-ITS2) of nuclear ribosomal DNA. A sequence similarity search using BLAST and a phylogenetic analysis of the ITS sequence of E. abuzinadianus revealed a high level of sequence similarity with E. glaberrimus DC. (section Ritropsis). The novel primary sequence and the secondary structure of ITS2 of E. abuzinadianus could potentially be used for molecular genotyping.

Coronary artery calcification, cardiovascular events, and death: a prospective cohort study of incident patients on hemodialysis

Background

Coronary calcification in patients with end-stage renal disease (ESRD) is associated with an increased risk of cardiovascular outcomes and death from all causes. Previous evidence has been limited by short follow-up periods and inclusion of a heterogeneous cluster of events in the primary analyses.

Objective

To describe coronary calcification in patients incident to ESRD, and to identify whether calcification predicts vascular events or death.

Design

Prospective substudy of an inception cohort.

Setting

Tertiary care haemodialysis centre in Ontario (St Joseph’s Healthcare Hamilton).

Participants

Patients starting haemodialysis who were new to ESRD.

Measurements

At baseline, clinical characterization and spiral computed tomography (CT) to score coronary calcification by the Agatston-Janowitz 130 scoring method. A primary outcome composite of adjudicated stroke, myocardial infarction, or death.

Methods

We followed patients prospectively to identify the relationship between cardiac calcification and subsequent stroke, myocardial infarction, or death, using Cox regression.

Results

We recruited 248 patients in 3 centres to our main study, which required only biochemical markers. Of these 164 were at St Joseph’s healthcare, and eligible to participate in the substudy; of these, 51 completed CT scanning (31 %). Median follow up was 26 months (Q₁, Q₃: 14, 34). The primary outcome occurred in 16 patients; 11 in the group above the median and 5 in the group below (p = 0.086). There were 26 primary outcomes in 16 patients; 20 (77 %) events in the group above the coronary calcification median and 6 (23 %) in the group below (p = 0.006). There were 10 deaths; 8 in the group above the median compared with 2 in the group below (p = 0.04). The hazard ratios for coronary calcification above, compared with below the median, for the primary outcome composite were 2.5 (95 % CI 0.87, 7.3; p = 0.09) and 1.7 (95 % CI 0.55, 5.4; p = 0.4), unadjusted and adjusted for age, respectively. For death, the hazard ratios were 4.6 (95 % CI 0.98, 21.96; p = 0.054) and 2.4 (95 % CI 0.45, 12.97; p = 0.3) respectively.

Limitations

We were limited by a small sample size and a small number of events.

Conclusions

Respondent burden is high for additional testing around the initiation of dialysis. High coronary calcification in patients new to ESRD has a tendency to predict cardiovascular outcomes and death, though effects are attenuated when adjusted for age.

The impact of co-resident spouses and sons on elderly mortality in rural Bangladesh

This paper uses prospective data from the Matlab surveillance system in rural Bangladesh to demonstrate that initially co-resident spouses and sons have a major impact on the subsequent mortality of old people, with significant differences by the sex of the elderly person, and the age of the son. Spouses significantly reduce mortality by similar magnitudes for both elderly men and women. On the other hand, co-resident adult sons reduce mortality for elderly women much more than for elderly men, with younger sons being more beneficial than older sons. Furthermore, both married and unmarried females appear to benefit equally from co-resident adult sons. Finally, this analysis suggests that the impact of spouses and sons on mortality in old age is not substantially mediated through changes in elderly economic status.

Gender differences in functioning for older adults in rural Bangladesh. The impact of differential reporting?

BACKGROUND

The purpose of this study is to examine gender differences in functional ability among older adults in rural Bangladesh in terms of both self-reported activities of daily living and observed physical performance and to evaluate the extent to which differential reporting by gender contributes to disparities between the two measures.

METHODS

In 1996, the Matlab Health and Socio-Economic Survey collected data on self-reported activities of daily living (ADLs) and observed physical performance for 1,893 men and women aged 50 and older in the Matlab Surveillance area in rural Bangladesh. Gender differences were examined in both self-reported ADLs and physical-performance measures. With physical-performance measures as the gold standard, logistic regression was used to determine how much of the gender difference in the self-reported function was explained by physical-performance ability controlling for age.

RESULTS

Older women in this study population consistently had more limitations than men in both self-reported ADLs and observed physical performance. For the same level of observed physical performance, however, older women were more likely than men were to report a higher level of ADL limitation. This reported female health disadvantage varied considerably depending on the nature of the ADLs being examined and the type of scoring system used for the ADLs.

CONCLUSIONS

One has to be somewhat cautious in interpreting gender differences in self-reported ADL limitations, as they are affected by the gender-specific nature of the reported activity and by gender differences in the perception of response categories.

Age and gender variation in the impact of household structure on elderly mortality

BACKGROUND

There is little information about the impact of household structure and composition on elderly mortality in developing countries. This study examines the impact of relationship to head of household, and the presence of co-resident spouses and sons on elderly mortality in rural Bangladesh with a particular focus on age and gender differences.

METHODS

A total of 9365 individuals aged > or = 60 at baseline (5128 males and 4237 females) in the Matlab Surveillance area in rural Bangladesh were followed for a period of 8 years (1974-1982) with all predictors (the presence of a spouse, one or more co-resident adult sons, relationship to head of household, household economic status, age and disability status) being measured at the beginning of follow-up. Cox proportional hazard models were used in the analysis.

RESULTS

Being the head of household had a significant impact on reducing elderly mortality for both men and women. The presence of a spouse reduced mortality for all elderly men but had a significant beneficial impact only on women whose husbands were heads of households. Finally the presence of one or more co-resident adult sons reduced mortality for elderly women but not for elderly men. For all three of the above predictors there was a decline in effect with the age of the elderly.

CONCLUSIONS

Relationship to head of household and the presence of spouses and sons have powerful impacts on reducing mortality for elderly men and women in rural Bangladesh with the effects varying significantly by gender and age. Furthermore, individual rather than joint access to material resources is an important determinant of elderly mortality.

An analysis of serum estradiol and serum progesterone in postmenopausal women of karachi suffering from breast cancer

The cancer patients (39) and control (12) were subjected to postmenopausal hormonal evaluation in which serum estradiol and serum progesterone values were found to be 54.56 +/- 10.20 pg/ml as compared to 18.66 +/- 6.31 pg/ml and 0.170 +/- 0.01 ng/ml as compared to 0.229 +/- 0.01 ng/ml respectively. Consequently it was inferred that in cancer postmenopausal patients when serum estradiol level increases the serum progesterone level decrease and vice versa.

Health related response to natural disasters: the case of the Bangladesh cyclone of 1991

This paper evaluates the health related response to large natural disasters using the example of the recent Bangladesh cyclone of 1991. After providing a description of the extent of the health response, it focuses on three major issues: (i) assessment of needs (ii) coordination of major groups involved in health relief and rehabilitation efforts and (iii) appropriateness and effectiveness of the health response in terms of definable outcome criteria. The conclusions are that in the case of the Bangladesh cyclone: (a) the assessment of needs was more reactive rather than anticipatory and was not based on any systematic data gathering from the field; (b) in contrast to previous disaster situations there was excellent coordination of the major groups involved in the aid process (the government, the armed forces and non-governmental organizations) and (c) given the caveat of inadequate baseline information, it appears that the health response was prompt and effective in preventing any increase in mortality from diarrheal diseases and measles. The reasons for the deficiencies and successes of the health response are analysed and finally a list of detailed recommendations to facilitate future disaster/cyclone management and response is provided.

American families: policy issues

"Increases in the number of children living in single-parent (usually female-headed) households and in the proportion of mothers who work outside their homes have raised concern in the United States about the effects of these trends on the well-being of children and the possible need for policy intervention. This paper discusses the arguments for and against policies that affect families. We review a number of such policies and what research suggests about their likely effects. The policies discussed...include those concerning child support, welfare, income taxes, child and dependent care, family leave, family planning, programs to improve parenting skills and family function, and economic growth."