F1000Research
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Background: Violence is common among security personnel. To the best of the authors' knowledge no recent studies have investigated this problem. This study aimed to estimate the prevalence and associated factors of violence against hospital security personnel and describe circumstances of violence, type of perpetrators, and victims' response. ⋯ Patients and their relatives/friends were the commonest perpetrators of violence. Conclusions: Violence is common among hospital security personnel in this setting. Adequate training and recruitment of more security personnel may contribute to decreasing violence.
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Postoperative delirium is a common and harrowing complication in older surgical patients. Those with cognitive impairment or dementia are at especially high risk for developing postoperative delirium; ominously, it is hypothesized that delirium can accelerate cognitive decline and the onset of dementia, or worsen the severity of dementia. Awareness of delirium has grown in recent years as various medical societies have launched initiatives to prevent postoperative delirium and alleviate its impact. ⋯ Non-pharmacologic multicomponent initiatives, such as the Hospital Elder Life Program, have consistently reduced delirium incidence and burden across various hospital settings. However, a substantial portion of delirium occurrences are still not prevented, and effective prevention and management strategies are needed to complement such multicomponent non-pharmacologic therapies. In this narrative review, we examine the current understanding of delirium neurobiology and summarize the present state of prevention and management efforts.
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A recent meta-analysis of nine cohort studies in youths reported that baseline ever e-cigarette use strongly predicted cigarette smoking initiation in the next 6-18 months, with an adjusted odds ratio of 3.62 (95% confidence interval 2.42-5.41). A recent review of e-cigarettes agreed there was substantial evidence for this "gateway effect". However, the number of confounders considered in the studies was limited, so we investigated whether the effect might have resulted from inadequate adjustment, using Waves 1 and 2 of the Population Assessment of Tobacco and Health study. ⋯ We found that confounding is a major factor, explaining most of the observed gateway effect. However, our analyses are limited by small numbers of new smokers considered and the possibility of over-adjustment if taking up e-cigarettes affects some predictor variables. Further analyses are intended using Wave 3 data which should avoid these problems.
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Intensive care unit-acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. ⋯ Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.
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Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill for treatment. This increased attention has resulted in a significant increase in publications on the mitral valve, the majority of which focus on mitral regurgitation and mitral valve surgery/intervention. The focus of this review is on publications in the past few years that offer additional insights into our understanding and management of mitral valve disease and specifically mitral regurgitation. It will discuss mitral valve anatomy, epidemiology of mitral valve disease, changes in the 2017 management guidelines, management of mitral bioprosthetic valves, transcatheter mitral valve procedures and the repair of rheumatic valves.