Sedation protocols to reduce duration of mechanical ventilation in the ICU: a Cochrane Systematic Review

AIMS: Assess the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in mechanically ventilated intensive care unit patients. BACKGROUND: Sedation is a core component of critical care. Sub-optimal sedation management incorporates both under- and over-sedation and has been linked to poorer patient outcomes. DESIGN: Cochrane systematic review of randomized controlled trials. DATA SOURCES: Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, CINAHL, Database of Abstracts of Reviews of Effects, LILACS, Current Controlled Trials and US National Institutes of Health Clinical Research Studies (1990-November 2013) and reference lists of articles were used. REVIEW METHODS: Randomized controlled trials conducted in intensive care units comparing management with and without protocol-directed sedation were included. Two authors screened titles, abstracts and full-text reports. Potential risk of bias was assessed. Clinical, methodological and statistical heterogeneity were examined and the random-effects model used for meta-analysis where appropriate. Mean difference for duration of mechanical ventilation and risk ratio for mortality, with 95% confidence intervals, were calculated. RESULTS: Two eligible studies with 633 participants comparing protocol-directed sedation delivered by nurses vs. usual care were identified. There was no evidence of differences in duration of mechanical ventilation or hospital mortality. There was statistically significant heterogeneity between studies for duration of mechanical ventilation. CONCLUSIONS: There is insufficient evidence to evaluate the effectiveness of protocol-directed sedation as results from the two randomized controlled trials were conflicting.

Effect of nativity and duration of residence on chronic health conditions among Asian immigrants in Australia: a longitudinal investigation

This study examined the effect of Asian nativity and duration of residence in Australia on the odds of reporting a chronic health condition (cancer, respiratory problems, cardiovascular disease (CVD) and diabetes mellitus). Data were from waves 3, 7 and 9 of the Household Income and Labour Dynamics in Australia (HILDA) longitudinal survey, and multi-level group-mean-centred logistic regression models were used for the analysis. After covariate adjustment, Asian immigrants were less likely to report cancer and respiratory problem compared with native-born Australians. While there was no significant difference in reporting CVD, they were more likely to report diabetes than native-born people. Asian immigrants maintained their health advantage with respect to cancer regardless of duration of residence. However, after 20 years of stay, Asian immigrants lost their earlier advantage and were not significantly different from native-born people in terms of reporting a respiratory problem. In contrast, Asian immigrants were not measurably different from native-born Australians in reporting diabetes if their length of stay in Australia was less than 20 years, but became disadvantaged after staying for 20 years or longer. There was no measurable difference in the odds of reporting CVD between Asian immigrants and native-born Australians for any duration of residence. On the whole this study found that health advantage, existence of healthy immigrant effect and subsequent erosion of it with increasing duration of residence among Asian immigrants depends upon the chronic health condition.

Short duration heat acclimation in Australian football players

This study examined if five sessions of short duration (27 min), high intensity, interval training (HIIT) in the heat over a nine day period would induce heat acclimation in Australian football (AF) players. Fourteen professional AF players were matched for VO2peak (mL∙kg-1∙min-1) and randomly allocated into either a heat acclimation (Acc) (n = 7) or Control (Con) group (n = 7). The Acc completed five cycle ergometer HIIT sessions within a nine day period on a cycle ergometer in the heat (38.7 ± 0.5 °C; 34.4 ± 1.3 % RH), whereas Con trained in thermo-neutral conditions (22.3 ± 0.2 °C; 35.8 ± 0. % RH). Four days prior and two days post HIIT participants undertook a 30 min constant load cycling test at 60% V̇O2peak in the heat (37.9 ± 0.1 °C; 28.5 ± 0.7 % RH) during which VO2, blood lactate concentration ([Lac-]), heart rate (HR), rating of perceived exertion (RPE), thermal comfort, core and skin temperatures were measured. Heat acclimation resulted in reduced RPE, thermal comfort and [Lac-] (all p < 0.05) during the submaximal exercise test in the heat. Heart rate was lower (p = 0.007) after HIIT, in both groups. Heat acclimation did not influence any other measured variables. In conclusion, five short duration HIIT sessions in hot dry conditions induced limited heat acclimation responses in AF players during the in-season competition phase. In practice, the heat acclimation protocol can be implemented in a professional team environment; however the physiological adaptations result-ing from such a protocol were limited.

Sleep duration and risk of obesity among a sample of Victorian school children

BACKGROUND: Insufficient sleep is potentially an important modifiable risk factor for obesity and poor physical activity and sedentary behaviours among children. However, inconsistencies across studies highlight the need for more objective measures. This paper examines the relationship between sleep duration and objectively measured physical activity, sedentary time and weight status, among a sample of Victorian Primary School children.

METHODS: A sub-sample of 298 grades four (n = 157) and six (n = 132) Victorian primary school children (aged 9.2-13.2 years) with complete accelerometry and anthropometry data, from 39 schools, were taken from a pilot study of a larger state based cluster randomized control trial in 2013. Data comprised: researcher measured height and weight; accelerometry derived physical activity and sedentary time; and self-reported sleep duration and hypothesised confounding factors (e.g. age, gender and environmental factors).

RESULTS: Compared with sufficient sleepers (67 %), those with insufficient sleep (<10 hrs/day) were significantly more likely to be overweight (OR 1.97, 95 % CI:1.11-3.48) or obese (OR 2.43, 95 % CI:1.26-4.71). No association between sleep and objectively measured physical activity levels or sedentary time was found.

CONCLUSION: The strong positive relationship between weight status and sleep deprivation merits further research though PA and sedentary time do not seem to be involved in the relationship. Strategies to improve sleep duration may help obesity prevention initiatives in the future.

DoSTra: Discovering common behaviors of objects using the duration of staying on each location of trajectories

Since semantic trajectories can discover more semantic meanings of a user's interests without geographic restrictions, research on semantic trajectories has attracted a lot of attentions in recent years. Most existing work discover the similar behavior of moving objects through analysis of their semantic trajectory pattern, that is, sequences of locations. However, this kind of trajectories without considering the duration of staying on a location limits wild applications. For example, Tom and Anne have a common pattern of Home→Restaurant → Company → Restaurant, but they are not similar, since Tom works at Restaurant, sends snack to someone at Company and return to Restaurant while Anne has breakfast at Restaurant, works at Company and has lunch at Restaurant. If we consider duration of staying on each location we can easily to differentiate their behaviors. In this paper, we propose a novel approach for discovering common behaviors by considering the duration of staying on each location of trajectories (DoSTra). Our approach can be used to detect the group that has similar lifestyle, habit or behavior patterns and predict the future locations of moving objects. We evaluate the experiment based on synthetic dataset, which demonstrates the high effectiveness and efficiency of the proposed method.

Sleep education improves the sleep duration of adolescents: a randomized controlled pilot study

PURPOSE: To determine the feasibility and pilot a sleep education program in New Zealand high school students.

METHODS: A parallel, two-arm randomized controlled pilot trial was conducted. High school students (13 to 16 years) were randomly allocated to either a classroom-based sleep education program intervention (n = 15) or to a usual curriculum control group (n = 14). The sleep education program involved four 50-minute classroom-based education sessions with interactive groups. Students completed a 7-day sleep diary, a sleep questionnaire (including sleep hygiene, knowledge and problems) at baseline, post-intervention (4 weeks) and 10 weeks follow-up.

RESULTS: An overall treatment effect was observed for weekend sleep duration (F 1,24 = 5.21, p = 0.03). Participants in the intervention group slept longer during weekend nights at 5 weeks (1:37 h:min, p = 0.01) and 10 weeks: (1:32 h:min, p = 0.03) compared to those in the control group. No differences were found between groups for sleep duration on weekday nights. No significant differences were observed between groups for any of the secondary outcomes (sleep hygiene, sleep problems, or sleep knowledge).

CONCLUSIONS: A sleep education program appears to increase weekend sleep duration in the short term. Although this program was feasible, most schools are under time and resource pressure, thus alternative methods of delivery should be assessed for feasibility and efficacy. Larger trials of longer duration are needed to confirm these findings and determine the sustained effect of sleep education on sleep behavior and its impact on health and psychosocial outcomes.

Associations between step duration variability and inertial measurement unit derived gait characteristics

Inertial measurement units (IMU) provide a convenient tool for gait stability assessment. However, it is unclear how various gait characteristics relate to each other and whether gait characteristics can be obtained from resultant acceleration. Therefore, step duration variability was measured in treadmill walking from 39 young ambulant volunteers (age 24.2 [± 2.5] y; height 1.79 [± 0.09] m; mass 71.6 [± 12.0] kg) using motion capture. Accelerations and gyrations were simultaneously recorded with an IMU. Harmonic ratio, maximum Lyapunov exponents, and multiscale sample entropy (MSE) were calculated. Step duration variability was positively associated with MSE with coarseness levels = 3-6 (r = -.33 to -.42, P ≤ .045). Harmonic ratio and MSE with all coarseness levels were negatively associated (r = -.45 to -.57, P ≤ .004). The MSE with coarseness level = 2 was negatively associated with short-term maximum Lyapunov exponents (r = -.32, P = .047). The agreement between resultant and vertical acceleration derived gait characteristics was excellent (ICC = 0.97-0.99). In conclusion, MSE with varying coarseness levels was associated with the other gait characteristics evaluated in the study. Resultant and vertical acceleration derived results had excellent agreement, which suggests that resultant acceleration is a viable alternative to considering the acceleration dimensions independently.

Influence of rest interval duration on muscular power production in the lower-body power profile

There is a paucity of evidence-based support for the allocation of rest interval duration between incremental loads in the assessment of the load-power profile. We examined the effect of rest interval duration on muscular power production in the load-power profile and sought to determine if greater rest is required with increasing load (i.e., variable rest interval). Ten physically trained men completed 4 experimental conditions in a crossover balanced design. Participants performed jump squats across incremental loads (0-60 kg) on 4 occasions, with an allocated recovery interval of 1, 2, 3, or 4 minutes. The mean log-transformed power output at each load was used for comparison between conditions (rest intervals). Unloaded jump squats (0 kg) maximized power output at each condition. The maximal mechanical power output was 66.6 ± 6.5 W·kg (1 minute), 66.2 ± 5.2 W·kg (2 minutes), 67.1 ± 5.9 W·kg (3 minutes), and 66.2 ± 6.5 W·kg (4 minutes). Trivial or unclear differences in power output were observed between rest intervals at each incremental load. As expected, power declined per 10 kg increment in load, the magnitude of decrease was 13.9-14.5% (confidence limits [CL]: ±1.3-2.0%) and 13.4-14.6% (CL: ±2.4-3.9%) for relative peak and mean power, respectively, yet differences in power output between conditions were likely insubstantial. The prescription of rest intervals between loads that are longer than 1 minute have a likely negligible effect on muscular power production in the jump squat incremental load-power profile. Practitioners should select either a 1- to 4-minute rest interval to best accommodate the logistical constraints of their monitoring sessions.

Mycobacterium ulcerans treatment - can antibiotic duration be reduced in selected patients?

Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received < 56 days of antibiotics and 51 (82%) of these patients underwent concurrent surgical excision. Most received a two-drug regimen of rifampicin combined with either ciprofloxacin or clarithromycin for a median 29 days (IQR 21–41days). Cessation rates were 55% for adverse events and 36% based on clinician decision. The overall success rate was 95% (98% with concurrent surgery; 82% with antibiotics alone) with a 50% success rate for those who received < 14 days of antibiotics increasing to 94% if they received 14–27 days and 100% for 28–55 days (p<0.01). A 100% success rate was seen for concurrent surgery and 14–27 days of antibiotics versus 67% for concurrent surgery and < 14 days of antibiotics (p = 0.12). No previously identified risk factors for treatment failure with surgery alone were associated with reduced treatment success rates with < 56 days of antibiotics. In selected patients, antibiotic treatment durations for M. ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.