1. Receiving at least 1 dose of COVID-19 vaccine during pregnancy was not associated with increased risk of preterm birth (<37 weeks), very preterm birth (<32 weeks), small for gestational age (SGA), or stillbirth.
Evidence Rating Level: 2 (Good)
COVID-19 infection during pregnancy is known to be associated with adverse maternal and fetal outcomes, including preterm birth, stillbirth, and postpartum hemorrhage. Although vaccination against COVID-19 is recommended against pregnancy, reports show that there is lower uptake of vaccines amongst pregnant women compared to other women of reproductive age. As well, three cohort studies have shown no association of vaccination during pregnancy with adverse birth outcomes. This current retrospective study also examined the association between COVID-19 vaccination during pregnancy and adverse birth outcomes such as preterm birth (<37 weeks), very preterm birth (<32 weeks), small for gestational age (SGA), and stillbirth. This study based out of Ontario, Canada included 85,162 births between May and December 2021, with 50.6% of individuals having received at least one dose of vaccine during pregnancy. The results showed no association with preterm birth, which occurred at a rate of 6.5% among those vaccinated in pregnancy and 6.9% among those not vaccinated in pregnancy (adjusted hazard ratio 1.02, 95% CI 0.96-1.08). There was also no association of receiving 1 or more doses of COVID-19 vaccine during pregnancy with very preterm birth (HR 0.80, 95% CI 0.67-0.95), SGA (aHR 0.98, 95% CI 0.93-1.03), or stillbirth (aHR 0.65, 95% CI 0.51-0.84). Overall, this study added to the growing body of literature demonstrating the safety of COVID-19 vaccination during pregnancy, with regards to adverse birth outcomes.
1. A self-monitoring blood pressure (SMBP) program enhanced with smartphone patient engagement features was not associated with a significant difference in BP reduction, compared to a standard SMBP program.
Evidence Rating Level: 1 (Excellent)
For individuals with uncontrolled blood pressure (BP), guidelines from around the world recommend self-monitoring of BP (SMBP) as a component of management, paired with interventions that emphasize patient engagement or counselling. As a result, some programs have been initiated that build on SMBP by transmitting data from these devices to healthcare providers, to optimize pharmacotherapy and patient education. However, these are also associated with significant costs and transformation to healthcare record systems. Another strategy is enhanced SMBP, which transmits data from the BP machine to a patient’s smartphone, and allows the patient to receive reminders, data visualization, and recommendations, without further cost to the healthcare system. Because the efficacy of this is unclear, this randomized controlled trial aimed to compare the changes in systolic BP after 6 months amongst patients who received standard versus enhanced SBMP. This study was conducted across 23 health systems, with the population consisted of adults who self-reported a systolic BP greater than 145 mmHg at a clinic visit, had an interest in lowering their BP, and had a smartphone. 1050 patients were randomized to standard SMBP, and 1051 to enhanced SMBP. BP machines and instructions were mailed to all participants, and systolic BPs in clinic were compared at baseline and at 6 months follow-up. The study population had a mean (SD) age of 58 (13) years and the comfort level with the technology was reported as a 4.1 (1.1) out of 5. The results showed no difference in the mean change in systolic BP, with a mean difference of -10.6 (18) mmHg in the standard SMBP group and a difference of -10.8 (18) mmHg in the enhanced SMBP group (difference -0.19, 95% CI -1.83 to 1.44, p = 0.81). Other outcomes such as change in diastolic BP, proportion of individuals with systolic BP reduction > 10 mmHg, and proportion of individuals with BP controlled below 130/80 were not significantly different, whereas the proportion of individuals with BP controlled below 140/90 favoured the enhanced SMBP group (32% vs 29%, odds ratio 1.15, 95% CI 1.01-1.34, p = 0.03). Overall, this study demonstrated that there was no significant advantage to an enhanced SMBP program with device-initiated patient engagement tools, compared to a standard SMBP group.
1. Prehospital needle decompression (PHND) was associated with decreased odds of 24-hour mortality in trauma patients, compared to patients receiving an emergent tube thoracotomy.
Evidence Rating Level: 2 (Good)
Chest trauma is a contributory factor to trauma mortality in 60% of cases. The practice of prehospital needle compression (PHND) is aimed at treating tension pneumothorax in patients prior to hospital arrival, but its effectiveness at preventing mortality is unclear, with only smaller scale studies available, often lacking a comparator group. Therefore, this cohort study aimed to examine the association between PHND and risk of 24-hour mortality in trauma cases, with the comparator group being patients who received an emergent tube thoracostomy within 15 minutes of hospital arrival. The study population consisted of 8469 trauma patients from 44 trauma centres between 2000 and 2020. The results showed that the rate of PHND was stable throughout the study period, between 0.2 and 0.5%. 15.8% of patients included in the study underwent PHND and 84.2% underwent emergent tube thoracostomy, with patient factors and emergency medical service (EMS) agency accounting for 12% and 88% of the variation in PHND rates respectively. There was a significant decrease in 24-hour mortality associated with PHND (odds ratio 0.75, 95% CI 0.61-0.94, p = 0.01). The lower odds remained significant amongst patients with severe chest injury (OR 0.72, 95% CI 0.55-0.93, p = 0.01) and patients without a severe traumatic brain injury (OR 0.65, 95% CI 0.45-0.95, p = 0.03). This was also significant when 92% of PHND patients were propensity-matched to emergent tube thoracostomy patients, with a 21% lower odds of 24-hour mortality (OR 0.9, 95% CI 0.62-0.98, p = 0.04). Overall, this study showed that the practice of PHND is associated with a reduction in 24-hour mortality, compared to trauma patients just receiving an emergent tube thoracostomy.
1. An improvement in cardiovascular disease (CVD) outcomes was found at 3 months and 6 months after smoking cessation, but with no difference in individuals randomized to treatments such as nicotine-containing e-cigarettes, nicotine-free e-cigarettes, and nicotine replacement therapy (NRT).
Evidence Rating Level: 1 (Excellent)
Smoking is a leading risk factor for numerous health conditions, including lung cancer and cardiovascular disease (CVD). Although nicotine replacement therapy (NRT) and behavioural encouragement are most effective in smoking cessation, high relapse rates demonstrate the need for alternative cessation strategies. For instance, e-cigarettes and vaping products are used by 27% of smokers interested in stopping, in contrast to the 18% who use NRT. However, there is limited evidence on the effects of e-cigarettes on cardiovascular health. Therefore, this randomized controlled trial aimed to compare CVD outcomes at 3 months and 6 months follow-up, for smokers randomized to being treated with nicotine-containing e-cigarettes, nicotine-free e-cigarettes, or NRT. The study population consisted of 248 individuals who smoked more than 10 cigarettes daily, and were wanting to stop smoking. The CVD outcomes measured include flow-mediated dilation (%FMD), mean arterial pressure (MAP), and peak cutaneous vascular conductance (CVCmax) responses to acetyolcholine (ACh) and sodium nitroprusside (SNP). The results showed that %FMD was improved in all 3 groups, at 3 months (β=3.33, 95% CI 2.61-4.05, p = 0.0001) and at 6 months (β=2.69, 95% CI 2.02-3.35, p < 0.0001). There were also no significant differences amongst the 3 treatment groups for other CVD outcomes, such as the CVCmax response to ACh and SNP, and MAP. Overall, this study found an improvement in CVD outcomes 3 and 6 months following smoking cessation, but that this improvement did not vary significantly between treatment groups.
1. For patients with gallbladder disease requiring cholecystectomy, no differences in clinical outcomes were found between white and non-white minority patients.
Evidence Rating Level: 2 (Good)
Cholecystectomies are common procedures for patients presenting with gall stones or other gallbladder disease. For individuals who lack insurance, are from minority groups, or are of lower socioeconomic status (SES), there may be increased barriers to accessing care. Delayed access to care can lead to more severe gallbladder disease on presentation, perioperative complications, and may require an open procedure instead of a laparoscopic one. Therefore, the current retrospective study aimed to elucidate the differences between white and minority individuals with gallbladder disease requiring cholecystectomy, with regards to morbidity, mortality, and cost of hospital admission. The study population consisted of 1539 patients undergoing cholecystectomies at a single centre between 2013 and 2018, 36.9% of whom were white and 63.1% of whom were non-white minorities. The results showed that the likelihood of an emergent admission was greater in minority than white patients (76.2% vs 68.4%), and that the mean age was younger in minorities than white (45.5 vs 53.9 years, p < 0.01). However, minority patients had a greater likelihood of a laparoscopic procedure (88.7% vs 79.0%). As well, there were no differences between minorities and whites in length of hospital stay (4.8 vs 4.4 days, p = 0.42), no significant difference in the percentage of minority vs white patients admitted to the ICU (3.4% vs 5.3%), and no differences in intraoperative or postop complications (p = 0.07). With regards to cost, more minority patients were uninsured (32.1% vs 6.5%), and the charge for uninsured patients was lower than Medicare by 39.3 per 1000 dollars (p < 0.001). Overall, this study demonstrated that while the presentation of minorities with gallbladder disease is younger and more emergent, the clinical outcomes are the same.
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