Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients.

BACKGROUND: The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. OBJECTIVE: To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. METHODS: Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses. RESULTS: Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality. CONCLUSIONS: These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.

Attitudes toward older people among nursing students in Greece.

BACKGROUND: The age profile of the population has shifted globally. Age discrimination has been documented, particularly in the areas of health and employment. AIM: This study aims at examining nursing students' attitudes toward older people and dehumanization of older people among nursing students. METHODS: A cross-sectional design was employed in this study. A structured questionnaire was used to collect data, which included a sociodemographic variables questionnaire, the Kogan's Attitude towards Old People Scale (KAOP) scale, a modified version of the Human Nature & Human Uniqueness Scale, the Ten-Item Personality Inventory (TIPI) and the Toronto Empathy Questionnaire. A total of 410 undergraduate nursing students participated in this study. Descriptive statistics were applied while inferential statistics such as Pearson correlation, and regression analysis with the stepwise method were also performed. The significant level was set as p ≤ .05. SPSS-25 was used for the analysis of data. RESULTS: The total mean score of the KAOP scale was 128.84 ± 14.32, indicating that nursing students had a slightly positive view of older individuals. Nursing students scored higher on the mechanistic dehumanization scale than on the animalistic dehumanization one. A strong negative association was found between Mechanistic and Animalistic dehumanization with the KAOP scale and empathy. Year of study, age, and gender were identified as predictor variables for mechanical dehumanization. CONCLUSION: Personality traits, demographic variables, and nursing students' level of empathy are factors that influence their views about older people and the dehumanization of older people.

Temporal Artery Thermometry in Pediatric Patients: Systematic Review and Meta-Analysis.

PROBLEM: Non-invasive thermometry methods have been used as substitutes for intra-corporeal ones in order to decrease patient discomfort and risk for complications, yet the evaluation of their performance is necessary. Our aim was to synthesize the evidence on the accuracy and precision of temporal artery (TA) thermometry, as well as on its sensitivity and specificity for fever detection. ELIGIBILITY CRITERIA: This systematic review and meta-analysis included method-comparison studies, which compared TA temperature measurements with invasive thermometry ones, were published between 2000 and 2018, and were conducted on patients aged <18 years. SAMPLE: Thirty articles were selected for inclusion in the final analysis after screening those identified by searches in CINAHL, PubMed, Web of Science, Cochrane Library, EMBASE and Scopus. RESULTS: Quantitative synthesis indicated that pooled mean TA temperature was lower than core temperature by 0.01 °C (95% limits of agreement, -0.06 °C to 0.03 °C). Average summary sensitivity and specificity for fever detection were 0.72 (95% confidence interval, 0.66-0.79) and 0.91 (95% confidence interval, 0.86-0.93) respectively. Subgroup analysis indicated a trend toward larger temperature underestimation in febrile patients and in ages ≤4 years. CONCLUSIONS: Despite its satisfactory accuracy, precision and specificity, TA thermometry has low sensitivity when used in pediatric patients, which does not allow satisfactory fever detection. IMPLICATIONS: TA thermometry cannot be recommended for replacing rectal temperature measurement methods in children, due to its high proportion of false negative readings during screening for fever.

Fast-track drug approval in inflammatory bowel diseases.

Fast-track drug designation of safe regimens represents an emerging method of development and approval of new medications targeting debilitating diseases including inflammatory bowel diseases (IBD). The goal of accelerated drug approval pathways is to shorten the time between application and approval of therapies that treat diseases with significant morbidity and mortality. Recently, fast-track drug approval approaches were supported by data deriving from central reading of images, a method of clinical data interpretation that has significantly benefited patients with gastrointestinal disorders. Biological agents and other emerging therapies in IBD represent "game-changing" or "treat-to-target" drugs and have satisfied quite successfully some of the patients' unmet needs. The development of biosimilars is an area where the Federal Drug Administration and the European Agency for Evaluation of Medicinal Products seem to have different approval processes. Biosimilars, including those for IBD, promise cost reductions and wide access to biologic therapies by patients, advantages similar to those already offered by generic drugs. Given the rapid development of IBD drugs and patients' needs, a consensus among the academic community, clinicians, researchers, sponsors, patients and regulatory authorities is required to standardize better the IBD trials and create a productive environment for fast-track approval of any "changing-game" IBD drug.