Elliot Hospital

<bold>Background:</bold> Acute hypercapnic respiratory failure (AHRF) is a medical emergency that requires prompt ventilatory support and reliable monitoring of carbon dioxide.Arterial blood gas (ABG) analysis is the reference test for PaCO₂, but it is invasive, only provides intermittent results, and is often painful for patients. Transcutaneous carbon dioxide (TcCO₂) monitoring offers continuous,noninvasive measurement,though its accuracy and clinical value during acute noninvasive ventilation (NIV) remain debated. <bold>Methods:</bold> We performed a systematic review and meta-analysis in line with PRISMA-DTA guidelines. . Studies were eligible if they compared TcCO₂ with PaCO₂ in adults receiving NIV. Two reviewers independently screened records, assessed study quality with QUADAS-2,and extracted data on correlation, agreement, tolerability, and clinical impact. <bold>Results:</bold> Seven studies enrolling just over 400 patients were included.Correlation between TcCO₂ and PaCO₂ was consistently high (0.85–0.97), with a pooled estimate of r=0.91.Bland–Altman plots showed acceptable bias and clinically useful limits of agreement. TcCO₂ monitoring was well tolerated, lowered the need for repeated ABGs,and provided real-time information that guided bedside management. No device-related adverse effects were reported. <bold>Conclusion:</bold> TcCO₂ shows strong agreement with PaCO₂ and appears to be a safe and practical adjunct to ABG analysis in adults on NIV for AHRF.Continuous, noninvasive monitoring may improve comfort and workflow by reducing invasive sampling. Larger, prospective studies are needed to confirm its impact on outcomes and assess cost-effectiveness.

Background: Stroke is still one of the leading causes of morbidity and mortality. Social Vulnerability Index (SVI) identifies vulnerable counties at risk for many health related issues. Northern New England (NNE) (Vermont, New Hampshire, and Maine) has a high percentage of rural areas, making this area especially vulnerable due to limited accessibility to healthcare. We sought to explore the association between SVI and age-adjusted prevalence of stroke in this region. Materials and Method: SVI scores were obtained from the 2022 Centers for Disease Control and Prevention (CDC) Agency for Toxic Substances and Disease Registry SVI database (2018-2022, 5 year data). Age-adjusted prevalence of stroke was obtained from CDC PLACES: Local Data for Better Health. Data was analyzed on Microsoft Excel with Data Analysis toolpack. Simple linear regression was used to examine the bivariate relationship between SVI and age-adjusted prevalence of stroke. Adjusted R 2 as a measure of strength of association and a p value &lt; 0.05 was considered as indicator of statistical significance. This study was considered exempt by the Institutional Review Board. Results: As shown in figure 1, across the counties in Northern New England, SVI shows a positive association with age-adjusted prevalence of stroke. The adjusted R 2 was 0.45 with a p value &lt; 0.001. Discussion: In our study, we showed the significant positive association between SVI and age-adjusted prevalence of stroke in the counties of NNE. These findings support prior literature showing the association SVI and other cardiovascular outcomes as well as suggesting that SVI may be a useful measure of assessing regions at risk. Conclusion: In conclusion, across counties in NNE there was a significant positive association between SVI and age adjusted prevalence of stroke. Future efforts should focus on preventive strategies to mitigate the higher risk as shown by SVI.

We hypothesized that outborn neonates in three rural states would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH). Multicenter retrospective study comparing outcomes for low (<500 births/year), medium (501-1500 births/year), and high (>1500 births/year) birth volume hospitals in Northern New England. Multivariable logistic regression assessed the combined outcome of death/severe gray matter injury on MRI, controlling for encephalopathy severity and time to initiation of TH. Death occurred for 35/531 neonates: 15/120 (12%) low, 7/193 (4%) medium, and 13/218 (6%) for high birth volume hospitals (p = 0.008). Severe gray matter injury occurred in 8%, 6% and 7% of low, medium, and high birth volume hospitals, respectively (p = 0.7). Odds of the combined outcome were 4.3-fold higher in low versus high volume hospitals (95% CI = 1.6, 12.1, p = 0.004). Neonates born in low volume birth hospitals had significantly higher odds of death following treatment with TH.

Denna artikel ställer sig positiv till en tilltagande ekumenisk samstämmighet kring betydelsen av profetisk diakoni och undersöker hur väl detta begrepp fungerar i Sverige, där diakonalt arbete ofta sker i samverkan med det offentliga i olika typer av partnerskap. Finns det en kontrast mellan det som beskrivs som profetisk diakoni och diakoni som sker i samverkan med det offentliga? För att undersöka detta ställer jag samtida perspektiv på profetisk diakoni i dialog med en intervjustudie med ledare inom fyra svenska (fri)kyrkliga organisationer som bedriver diakonalt arbete. Artikeln vill undersöka om, och i så fall hur dessa organisationer kan förstås som utförare av profetisk diakoni. För att fördjupa analysen sätts materialet i dialog med samtida teologiska perspektiv på profetisk diakoni samt Luke Brethertons perspektiv på profetiskt tal och handling kopplat till kyrkan som bärare av demokratiska praktiker.

Introduction: Peripheral venous pressure (PVP) has been shown to accurately correlate with central venous pressure (CVP) when measured using a conventional manometer and pressure tubing. We investigated the correlation between PVP as measured by a novel pressure transducer and CVP in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients. Methods: A prospective, cross-sectional study examining PVP from February 2022 to May 2023 was conducted. The analysis was limited to patients undergoing right heart catheterization (RHC) admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. PVP was transduced from an antecubital or more distal peripheral intravenous (IV) catheter site using a miniature digital, disposable pressure transducer (Centurion Compass Universal HG, Medline). Pressures were compared using Pearson’s correlation coefficient. Results: 99 patients were enrolled with a mean age of 62 ± 12 years and a mean ejection fraction (EF) of 41 ± 21%. 74% of the patients had heart failure, 17% were HTx patients, and 9% were LVAD patients. The PVP measured with the novel pressure transducer was found to be highly correlated to CVP measured by RHC (r=0.80, p &lt; 0.0001) (Figure). High correlation was also noted when broken down by HF (r=0.77, p &lt; 0.0001), HTx (r=0.95, p &lt; 0.0001), and LVAD groups (r=0.90, p &lt; 0.0003). There was a high degree of correlation for HF patients with EF &lt; 50% (r=0.74, p &lt; 0.0001) and EF &gt; 50% (r=0.90, p &lt; 0.0001). A high degree of correlation was found for all peripheral IV insertion sites: antecubital (r=0.86, p=0.000071), forearm (r=0.76, p&lt;0.00001), and hand (r=0.84, p&lt;0.00001). Conclusions: There is a high degree of correlation between PVP measured by a novel pressure transducer and CVP in HF, HTx, and LVAD patients. PVP measurements using this transducer are a reliable estimate of volume status in these patient populations.

The purpose of this study was to investigate the effects of the smartphone-based meditation app Ten Percent Happier on stress, mindfulness, well-being, and resilience in pharmacy students. Pharmacy students in a professional year of study were recruited to participate. Students were instructed to meditate using the Ten Percent Happier app for at least 5 days a week for 4 weeks. Students could use the app at their discretion for weeks 5 to 12. Baseline, week 4, and week 12 responses were collected from the following instruments: the Perceived Stress Scale, the Five-Facet Mindfulness Questionnaire-15, the Flourishing Scale, and the Brief Resilience Scale. Eighty-nine pharmacy students volunteered for the study. Sixty (67%) enrolled by completing the baseline survey. Of these, 28 (47%) completed the week 4 survey and 22 (37%) completed the week 12 survey. Participants experienced a reduction in perceived stress (P = 0.0005) and increases in resilience (P < 0.0001) and well-being (P = 0.0006). Increases in mindfulness were seen in 4 of the 5 subscales of the Five-Facet Mindfulness Questionnaire-15 (P ≤ 0.05). These benefits were noted at week 4 and maintained at week 12. Pharmacy students who practiced mindful meditation through the Ten Percent Happier app for an average of 5 days a week for 4 weeks experienced reduced stress and improved mindfulness, well-being, and resilience. Benefits experienced during the intervention were maintained at the 8-week follow-up, despite app usage decreasing to an average of 4 days a week.