Diabetes mellitus does not increase the risk of knee stiffness after total knee arthroplasty: a meta-analysis of 7 studies including 246 053 cases

Abstract: Purpose: The association of diabetes mellitus with knee stiffness after total knee arthroplasty is still being debated. The aim of this study was to assess through meta-analysis the impact of diabetes mellitus on the prevalence of postoperative knee stiffness after total knee arthroplasty. Methods: We conducted a literature search for terms regarding postoperative knee stiffness and diabetes mellitus on Embase, CINAHL, and PubMed NCBI. Results: Of 1142 articles, seven were suitable for analysis. Meta-analysis showed that diabetes mellitus does not confer an increased risk of primary or revision total knee arthroplasty-induced postoperative knee stiffness when compared to nondiabetic patients (primary total knee arthroplasty, estimated odds ratio [OR] 1.474 and 95% confidence interval [CI] 0.97–2.23; primary and revision total knee arthroplasty, OR 1.340 and 95% CI 0.97–1.83). Conclusion: There is no strong evidence that diabetes mellitus increases the risk of knee stiffness after total knee arthroplasty. The decision to proceed with total knee arthroplasty, discussion as part of the consent process, and subsequent rehabilitation should not differ between patients with and without diabetes mellitus with regards to risk of stiffness. Level of evidence: Level III (meta-analysis

Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes

Purpose of Review: Nursing home residents are at high risk for colonization and infection with bacterial pathogens that are multidrug-resistant organisms (MDROs). We discuss challenges and potential solutions to support implementing effective infection prevention and control practices in nursing homes. Recent Findings: Challenges include a paucity of evidence that addresses MDRO transmission during the care of nursing home residents, limited staff resources in nursing homes, insufficient infection prevention education in nursing homes, and perceptions by nursing home staff that isolation and contact precautions negatively influence the well being of their residents. Summary: A small number of studies provide evidence that specifically address these challenges. Their outcomes support a paradigm shift that moves infection prevention and control practices away from a pathogen-specific approach and toward one that focuses on resident risk factors

Omega-3 Fatty Acid Supplementation and Cardiovascular Disease

Epidemiological studies on Greenland Inuits in the 1970s and subsequent human studies have established an inverse relationship between the ingestion of omega-3 fatty acids [C₂₀₋₂₂ ω3 polyunsaturated fatty acids (PUFA)], blood levels of C₂₀₋₂₂ ω3 PUFA and mortality associated with cardiovascular disease [CVD]. C₂₀₋₂₂ ω3 PUFA have pleiotropic effects on cell function and regulate multiple pathways controlling blood lipids, inflammatory factors and cellular events in cardiomyocytes and vascular endothelial cells. The hypolipemic, anti-inflammatory, anti-arrhythmic properties of these fatty acids confer cardioprotection. Accordingly, national heart associations and government agencies have recommended increased consumption of fatty fish or ω3 PUFA supplements to prevent CVD. In addition to fatty fish, additional sources of ω3 PUFA are available from plants, algae and yeast. A key question examined in this review is whether non-fish sources of ω3 PUFA are as effective as fatty fish-derived C₂₀₋₂₂ ω3 PUFA at managing risk factors linked to CVD. We have focused on ω3 PUFA metabolism and the capacity of ω3 PUFA supplements to regulate key cellular events linked to CVD. The outcome of our analysis reveals that non-fish sources of ω3 PUFA vary in their capacity to regulate blood levels of C₂₀₋₂₂ ω3 PUFA and CVD risk factors.Keywords: Dyslipidemia, Inflammation, Cardiomyocyte, Single nucleotide polymorphism, Endothelial cell, PUFA metabolismKeywords: Dyslipidemia, Inflammation, Cardiomyocyte, Single nucleotide polymorphism, Endothelial cell, PUFA metabolis

Towards the Determination of Safe Operating Envelopes for Autonomous UAS in Offshore Inspection Missions

From MDPI via Jisc Publications RouterHistory: accepted 2021-07-21, pub-electronic 2021-07-28Publication status: PublishedFunder: Engineering and Physical Sciences Research Council; Grant(s): EP/R026173/1A drive to reduce costs, carbon emissions, and the number of required personnel in the offshore energy industry has led to proposals for the increased use of autonomous/robotic systems for many maintenance tasks. There are questions over how such missions can be shown to be safe. A corollary exists in the manned aviation world for helicopter–ship operations where a test pilot attempts to operate from a ship under a range of wind conditions and provides subjective feedback on the level of difficulty encountered. This defines the ship–helicopter operating limit envelope (SHOL). Due to the cost of creating a SHOL there has been considerable research activity to demonstrate that much of this process can be performed virtually. Unmanned vehicles, however, have no test pilot to provide feedback. This paper therefore explores the possibility of adapting manned simulation techniques to the unmanned world to demonstrate that a mission is safe. Through flight modelling and simulation techniques it is shown that operating envelopes can be created for an oil rig inspection task and that, by using variable performance specifications, these can be tailored to suit the level of acceptable risk. The operating envelopes produced provide condensed and intelligible information regarding the environmental conditions under which the UAS can perform the task

1829. A Systems Approach to Nursing Home Antimicrobial Stewardship

Background: Up to 70% of nursing home (NH) residents receive one or more courses of antibiotics (ATB) annually, of which over half may be inappropriate and risk harm. The current availability of in-house NH data is often insufficient to measure and track appropriateness, due to incomplete data or unusable formatting. Our 3-year project to improve antimicrobial stewardship (AMS) used the Centers for Disease Control and Prevention’s (CDC) Core Elements of AMS for NHs, with guided input from NH providers to develop and implement an electronic ATB de-escalation decision support tool that also captures otherwise inaccessible data. Methods: Our baseline assessment identified wide variation in providers’ knowledge, attitudes, and beliefs regarding ATB prescribing, leading us to identify de-escalation as the most feasible NH AMS intervention. Using facilitated open-ended conversations with leaders from three NH corporations, we developed an electronic decision support tool to systematically prompt de-escalation 48–72 hours post-prescribing. Subsequent site visits with NH clinical teams at a convenience sample of sites allowed us to explore how to incorporate decision support into their electronic health record (EHR). Results: We developed a tool anchored on data capture for the “acute change in condition” that triggers prescriber interactions. It uses clinical and laboratory data to prompt structured communication between nurses and prescribers. Placing this tool in the EHR reduced duplicate charting, enabled guidance from McGeer and Loeb criteria, and promoted its adoption into practice while ensuring data capture to assess appropriateness of ATB prescribing. Conclusion: Our electronic decision support tool captures clinical and laboratory data, which it then uses to systematically prompt conversations about de-escalation between nurses and prescribers, reducing variation in practice. Upon completion, the assessment ensures availability of data to assess, track, and report appropriate prescribing practices among prescribers. This tool proved acceptable to NH providers in three different corporations, suggesting feasibility of further expansion of this approach to a broader group of NH providers

Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement

The emerging crisis in antibiotic resistance and concern that we now sit on the precipice of a post-antibiotic era have given rise to advocacy at the highest levels for widespread adoption of programmes that promote judicious use of antibiotics. These antibiotic stewardship programmes, which seek to optimize antibiotic choice when clinically indicated and discourage antibiotic use when clinically unnecessary, are being implemented in an increasing number of acute care facilities, but their adoption has been slower in nursing homes. The antibiotic prescribing process in nursing homes is fundamentally different from that observed in hospital and clinic settings, with formidable challenges to implementation of effective antibiotic stewardship. Nevertheless, an emerging body of research points towards ways to improve antibiotic prescribing practices in nursing homes. This review summarizes the findings of this research and presents ways in which antibiotic stewardship can be implemented and optimized in the nursing home setting

Potential for Dietary ω-3 Fatty Acids to Prevent Nonalcoholic Fatty Liver Disease and Reduce the Risk of Primary Liver Cancer

Nonalcoholic fatty liver disease (NAFLD) has increased in parallel with central obesity and its prevalence is anticipated to increase as the obesity epidemic remains unabated. NAFLD is now the most common cause of chronic liver disease in developed countries and is defined as excessive lipid accumulation in the liver, i.e., hepatosteatosis. NAFLD ranges in severity from benign fatty liver to nonalcoholic steatohepatitis (NASH), where NASH is characterized by hepatic injury, inflammation, oxidative stress and fibrosis. NASH can progress to cirrhosis; and cirrhosis is a risk factor for primary hepatocellular carcinoma (HCC). The prevention of NASH will lower the risk of cirrhosis and NASH-associated HCC. Our studies have focused on NASH prevention. We developed a model of NASH using Ldlr[superscript -/-] mice fed the western diet (WD). The WD induces a NASH phenotype in these mice that is similar to that seen in humans; and includes robust induction of hepatic steatosis, inflammation, oxidative stress and fibrosis. Using transcriptomic, lipidomic and metabolomic approaches, we examined the capacity of 2 dietary ω3 polyunsaturated fatty acids, eicosapentaenoic acid (20:5ω-3; EPA) and docosahexaenoic acid (22:6ω-3; DHA), to prevent WD-induced NASH. Dietary DHA was superior to EPA at attenuating WD-induced changes in plasma lipids and hepatic injury; and reversing WD effects on hepatic metabolism, oxidative stress, and fibrosis. The outcome of these studies suggests that DHA may be useful in the prevention of NASH and reducing the risk of HCC.This article is a review from the SPLIT D—Surrogate Markers for Cancer Intervention Trials Session presented at the American Institute for Cancer Research (AICR) Conference on Food, Nutrition, Physical Activity and Cancer held 29–31 October 2014 in Washington, DC.Keywords: inflammation, liver cancer, oxidative stress, metabolomics, fibrosis, ω-3 PUFAs, fatty liver diseas