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Shugaa Addin N, Niedermayer F, Thorand B, Linseisen J, Seissler J, Peters A, Rospleszcz S. Association of serum magnesium with metabolic syndrome and the role of chronic kidney disease: A population-based cohort study with Mendelian randomization. Diabetes Obes Metab 2024; 26:1808-1820. [PMID: 38361465 DOI: 10.1111/dom.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES To assess the association of serum magnesium with prevalent and incident metabolic syndrome (MetS) and its individual components in the general population and to examine any effect modification by chronic kidney disease (CKD) status. METHODS We analysed longitudinal data from the population-based KORA F4/FF4 study, including 2996 participants (387 with CKD) for cross-sectional analysis and 1446 participants (88 with CKD) for longitudinal analysis. Associations with MetS, as well as single components of MetS, were assessed by adjusted regression models. Nonlinearity was tested by restricted cubic splines and analyses were stratified by CKD. Causality was evaluated by two-sample Mendelian randomization (MR). RESULTS Serum magnesium (1 SD) was inversely associated with prevalent MetS (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.83, 0.98). The association was more pronounced in individuals with CKD (OR 0.75, 95% CI 0.59, 0.94). Among MetS components, serum magnesium was negatively associated with elevated fasting glucose (OR 0.78, 95% CI 0.71, 0.88) and, again, this association was more pronounced in individuals with CKD (OR 0.67, 95% CI 0.53, 0.84). Serum magnesium was not associated with incident MetS or its components. Restricted cubic spline analysis revealed a significant nonlinear inverse relationship of serum magnesium with MetS and elevated fasting glucose. MR analysis suggested an inverse causal effect of serum magnesium on MetS (OR 0.91, 95% CI 0.85, 0.97). CONCLUSION Serum magnesium is associated with prevalent, but not incident MetS, and this effect is stronger in individuals with CKD. MR analysis implies a potential, albeit weak, causal role of magnesium in MetS.
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Affiliation(s)
- Nuha Shugaa Addin
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
| | - Fiona Niedermayer
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
- Partner Site München-Neuherberg, German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - Jochen Seissler
- Partner Site München-Neuherberg, German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Research Group, LMU-Klinikum; Medizinische Klinik und Poliklinik IV, München, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
- Partner Site München-Neuherberg, German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Munich Heart Alliance, München, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), Munich Heart Alliance, München, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Weigl M, Heinrich M, Rivas J, Bergmann F, Kurz M, Silbereisen C, Dieterich HJ, Kleine B, Riek S, Olivieri M, Hoffmann F, Lieftüchter V. Teamwork and mental workload in postsurgical pediatric patient handovers: Prospective effect evaluation of an improvement intervention for OR-PICU patient transitions. Eur J Pediatr 2023; 182:5637-5647. [PMID: 37819421 PMCID: PMC10746584 DOI: 10.1007/s00431-023-05241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Postsurgical handover of pediatric patients from operating rooms (OR) to pediatric intensive care units (PICU) is a critical step. This transition is susceptible to errors and inefficiencies particularly if poor multidisciplinary teamwork occurs. Despite wide adoption of standardized handover interventions, comprehensive investigations into joint effects for patient care and provider outcomes are scarce. We aimed to improve OR-PICU handovers quality and sought to evaluate the intervention with particular attention to patient care effects and provider outcomes. A prospective, before-after-study design with an interrupted-series and a multi-source, mixed-methods evaluation approach was established. Drawing upon a participative plan-do-study-act approach, a standardized, checklist-based handover process was designed and implemented. For effect assessments, we observed OR-PICU handovers on site (pre implementation: n = 31, post: n = 30), respectively, with standardized expert observation and provider self-report tools (n = 111, n = 110). Setting was a tertiary Pediatric University Hospital. Supplementary qualitative, semi-structured interviews were conducted, and a general inductive content analysis approach was used to identify key facilitators and barriers on implementation. Improvement efforts focused on stepwise implementation of (1) standardized handover process and (2) a checklist for multi-professional OR-PICU handover communication. We observed significant increases in team and patient setup (pre: 79.3%, post: 98.6%, p < .01), enhanced team engagement (pre: 50%, post: 81.7%, p < .01), and comprehensive information transfer by the anesthesia sub-team (pre: 78.6%, post: 87.3%, p < .01). Expert-rated teamwork outcomes were consistently higher, yet self-reported teamwork did not change over time. Provider perceived stress and disruptions did not change, mental workload tended to decrease over time (pre: M = 3.2, post: 2.9, p = .08). Comprehensiveness of post-operative patient information reported by PICU physician increased significantly: pre: 65.9%, post: 76.2%, p < .05. After implementation, providers acknowledged the importance of standardized handover practices and associated benefits for facilitation of information transfer and comprehensiveness. Among reported barriers were obstacles during implementation as well as insufficient consideration of professionals' individual workflow after surgery. CONCLUSION A multidisciplinary intervention for postsurgical pediatric patient handovers was associated with improved expert-rated teamwork and fewer omissions of key patient information over time. Inconsistent results were obtained for provider-rated mental workload and teamwork outcomes. The findings contribute to a better understanding concerning the interplay of teamwork and provider cognitions in the course of establishing safe patient transitions in pediatric care. WHAT IS KNOWN • Transfer of critically ill children conveys significant challenges for interprofessional communication and teamwork. Prospective research into interventions for safe and efficient handover practices of OR PICU patient transitions is necessary. • Checklists are assumed to facilitate cognitive load among providers in acute clinical environments. WHAT IS NEW • A standardized, checklist-based handover intervention was associated with improvements in team set-up and information transfer. Provider outcomes such as mental workload and stress did not change over time. • The combination of teamwork and provider assessments allows a more nuanced understanding of implementation barriers and sustainable effects in course of OR-PICU handover interventions.
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Affiliation(s)
- Matthias Weigl
- Institute for Patient Safety, University Hospital, Bonn, 53127, Germany.
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Martina Heinrich
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Julia Rivas
- Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Matthias Kurz
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Clemens Silbereisen
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Hans-Juergen Dieterich
- Department of Anesthesiology, LMU University Hospital Munich, LMU Munich, Munich, Germany
| | - Beate Kleine
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Riek
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
| | - Victoria Lieftüchter
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital, LMU Munich, Munich, Germany
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