EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland.

Background: Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. Methods: We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. Results: In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%-3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02-1.06), admission lactate (OR 1.10, 95% CI 1.05-1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10-4.29) and use of adrenaline (OR 2.73, 95% CI 1.40-5.40) were associated with mortality. Conclusions: In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.

Customizable pre-printed consent forms: a solution in light of the Montgomery ruling.

INTRODUCTION: This article presents an audit cycle supported quality improvement project addressing best practice in the consent process for lower limb arthroplasty which takes into account the new standard in surgical consent and the importance of material risks. METHODS: 50 consecutive total hip and total knee replacement consent forms over a 3-month period were reviewed for legibility and completeness. Following the introduction of a new, pre-printed but customizable consent form the review process was repeated. RESULTS: The introduction of a customizable, pre-printed consent form that can be adjusted to reflect the individualized material risks of each patient increased legibility, reduced inappropriate human error variation and abolished the use of abbreviations and medical jargon. CONCLUSIONS: When used as part of an extended consent process, the authors feel that the use of pre-printed but customizable consent forms improves legibility, completeness and consistency and also provides the ability to highlight those complications that are of particular importance for that patient to satisfy the new accepted standard in surgical consent.

Are antenatal weight management interventions effective in preventing pre-eclampsia? Systematic review of randomised control trials.

INTRODUCTION: Pre-eclampsia, defined as the development of hypertension and proteinuria after 20weeks gestation, carries significant maternal and foetal risk. Pre-pregnancy BMI is the most useful predictor of pre-eclampsia. As the prevalence of obesity increases, prevention of pre-eclampsia by weight management strategies needs to be trialed. AIMS AND OBJECTIVES: To review the randomised controlled trials studying clinical effectiveness of antenatal weight management interventions compared to routine care in decreasing the incidence of pre-eclampsia in women with BMI 26kg/m(2) or greater. METHODS: Electronic bibliographic databases were searched using a systematic search strategy to identify relevant trials. All trials involving weight management during pregnancy were considered. Using pre-determined inclusion criteria, six trials were included in this review and were independently assessed using standardised evaluation criteria. RESULTS: Three studies found a significant difference in gestational weight gain; amongst the intervention groups, the smallest was 5.0kg, whereas the largest was 13.6kg. In sub-group analysis, one trial found a significant difference in the incidence of pre-eclampsia between adherent (2/90) and non-adherent participants (5/26). However, no significant difference was found in the overall incidence of pre-eclampsia across all intervention and control groups. CONCLUSION: There was no evidence to suggest that antenatal weight management interventions were effective in reducing the incidence of pre-eclampsia in women with a BMI⩾26kg/m(2).

Single vs. multiple drug prevention: is more always better?: a pilot study.

OBJECTIVE: The purpose of this study was to compare the effects of a single drug, i.e., alcohol, against a multiple drug preventive intervention. METHODS: A controlled trial was conducted with 448 8th grade students (mean age = 13 years old) from an inner-city middle school (n = 216) and a rural junior high school (n = 232) in 2000-2001. Students were randomized within school, and 3-month post-intervention follow-up data were collected. RESULTS: Two risk/protective factors were found to differ significantly in favor of youth receiving the single drug alcohol intervention (p's = 0.03), while the frequency of alcohol use and two additional risk/protective factors approached significance (p's < 0.10). CONCLUSION: These findings support the potential efficacy of a brief, single drug preventive intervention over a brief, multi-drug intervention in producing short-term alcohol outcomes for adolescents, and indicate differential effects of interventions for subgroups of substance using youth.

A sport-based intervention for preventing alcohol use and promoting physical activity among adolescents.

This study tested the potential of a novel intervention addressing alcohol prevention within the context of a sport program. Study participants were randomly assigned to one of three groups, with one group receiving the sport consultation (Sport), a second the sport consultation plus an alcohol consultation (Sport Plus), and a third a sport consultation, alcohol consultation, and mailed parent print materials (Sport Plus Parent). Researchers recruited 465 eighth graders from three schools in the northeast Florida region to participate in the study. The Youth Alcohol and Health Survey was used to collect data on alcohol and drug consumption, alcohol use risk and protective factors, and exercise habits at baseline and three-month post-intervention. Significant time effects (p's < .05) were found on three of six alcohol measures, both exercise measures, and four risk/protective factors, with all but one risk factor showing improvements over time. Time by assignment by current drinking status (yes/no) interaction effects (p's < .05) were found on alcohol initiation, length of alcohol use, quantity, heavy use, moderate physical activity, and four risk/protective factors, with preintervention drinking adolescents exposed to the Sport intervention showing the greatest improvements on all but two measures. Findings suggest that a brief sport-based screen and consultation tailored to adolescents' health habits, with and without parent materials, may potentially reduce alcohol use while increasing exercise frequency.

Iatrogenic effects of alcohol and drug prevention programs.

OBJECTIVE: Understanding prevention program risks and the contextual factors associated with negative program outcomes is critical to assisting the development of public policy that is aimed at avoiding future prevention-related harm while maximizing prevention success. The purpose of this review was to systematically analyze published studies evaluating substance use prevention programs, to determine whether iatrogenic effects have occurred, and if so, what types of harmful effects resulted and under what circumstances. METHOD: A search of electronic bibliographic databases in allied health, education, medicine, psychology and general literature was conducted, spanning the years from 1980 to the present. RESULTS: Evidence of negative program effects was found in 17 evaluation studies for which 43 negative outcomes were documented. The most common type of negative outcome resulting from prevention programs was behavioral effects consisting primarily of increases in consumption, especially alcohol use. Drug prevention programs resulted in greater increases in alcohol use, cigarette use, marijuana use and multiple drug use than did alcohol prevention programs. Negative program outcomes appear to exist as three possible scenarios, described in this article. CONCLUSIONS: Researchers, publishers and practitioners should pay special attention to measuring, monitoring and reporting negative outcomes of prevention programs in the future, so that we might learn more about which program elements interact with which contextual factors to cause harm to which groups of youth.