A smartphone-based shopping mall walking program and daily walking steps
1. Implementation of smartphone-based walking programs in shopping malls resulted in a significant increase of daily steps amongst users during the pandemic.Â
Evidence Rating Level: 2 (Good)
The benefits of physical activity are numerous, especially when it comes to preventing diseases. Walking is a simple exercise that most people can partake in, ultimately benefiting their physical activity levels while reducing disease risk. However, after the initiation of the pandemic, daily steps decreased dramatically. Knowing the benefits of walking, shopping malls implemented smartphone-based walking programs, providing a safe, accessible area to reach daily step goals. Included in the study were 217 344 individuals with a total of 23 638 110 daily steps. Among the participants, 154 616 (71.1%) were women and only 62 728 (28.9%) were men. The mean (SD) daily steps on participation days were 7415 (4686), much higher than the mean daily steps on non-participation days which was 5281 (4339). Individuals participated in walking days over 136 malls with the mean (SD) mall size being 52 908 (20 019) m2. When compared to non-walking days, participation in walking was correlated with 1219 (95% CI, 1205-1232) additional steps daily. In another model, participation was associated with 1130 (95% CI, 1113-1146) additional steps in rural malls, 1403 (95% CI, 1379-1428) in suburban, and 1433 (95% CI, 1408-1457) in urban malls when compared to non-walking days. When separating based on mall size, participation was associated with 1422 (95% CI, 1405-1439) additional steps in bigger malls whereas only 1059 (95% CI, 1041-1077) more steps in smaller malls compared to nonparticipation days. Women were associated with having more steps than men on participation days (728 (95% CI, 698-758)). When looking at age differences, older participants had 228 (95% CI, 183-273) additional steps compared to younger adults. Overall, smartphone use in the mall was associated with greater daily steps, especially for women and older individuals in urban and suburban areas.
1. In patients diagnosed with stage III or IV non-small cell lung cancer (NSCLC), immune checkpoint inhibitors were associated with a greater risk of atherosclerotic cardiovascular disease.
Evidence Rating Level: 2 (Good)
Tumor treatment has become significantly better, specifically with the start of immune checkpoint inhibitors (ICIs). ICIs can be used to target programmed cell death 1 (PD-1), programmed cell death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). An important biomarker is coronary artery calcium (CAC) as it can show direct proof of coronary atherosclerosis which has a high association with atherosclerotic cardiovascular disease (ASCVD). The retrospective cohort study included 1458 individuals over 18 years with a diagnosis of stage III or IV non-small cell lung cancer (NSCLC). Of these participants, 487 (33.4) received ICI therapy whereas 971 (66.6%) did not. Patients in the non-ICI group had more advanced tumours (stage IV, 81.9% vs 71.7%, P<0.001) with the dominant type being adenocarcinoma. In contrast, the proportions of adenocarcinoma and squamous cell carcinoma were quite evenly split in the ICI group (76.4% and 18.0% vs. 44.6% and 48.3%, respectively; P < 0.001). 24 (4.9%) ASCVD events occurred in the ICI group whereas only 14 (1.4%) in the non-ICI group. Further, after propensity score matching (PSM), 24 (5.4%) ASCVD events occurred in the ICI group while 5 (1.1%) occurred in the non-ICI group. For the CAC imaging study cohort, 113 individuals with ICI therapy, and 133 without therapy were enrolled. After PSM, only 75 participants remained in each group. At 12 months, the ICI group had a significantly more severe CAC score progression than the non-ICI group (16.8% vs 6.8%; P = 0.013 before PSM; 20.0% vs 8.0%; P = 0.032 after PSM). In all, receiving ICI therapy was associated with a higher incidence of ASCVD events, possibly due to ICIs accelerating systemic atherosclerosis progression.
Ketamine compared with morphine for out-of-hospital analgesia for patients with traumatic pain
1. Ketamine was non-inferior to morphine at analgesic pain reduction for out-of-hospital pain management.
2. There was, however, an increased number of adverse events in the ketamine group, though the majority of these were associated with emergence phenomenon and did not require intervention.
Evidence Rating Level: 1 (Excellent)
Pain is a common symptom experienced outside of the hospital, which is currently being researched to shore up inadequacies, especially for those experiencing traumatic pain. There is much discussion in this research over which analgesic is the best to prescribe for out-of-hospital pain. A large part of this is due to the US facing an opioid crisis. As such, it is important to find strategies to prevent opioid overprescription and overdose. In this randomized control trial, 251 patients were enrolled in a 1:1 ratio to receive ketamine or morphine as an analgesic. Among these participants, 111 (44.9%) were women and 140 (55.1%) were men with a median age of 51 (IQR, 34-69) years. The ketamine group experienced a mean change in pain score of -3.7 (95% CI, -4.2 to -3.2) while the morphine group had a mean change in pain of -3.8 (95% CI, -4.2 to -3.4) (difference, 0.1 [95% CI, -0.7 to 0.9] points). Noninferiority was demonstrated since the upper limit of the CI was lower than the noninferiority threshold. Comparing pain levels, the ketamine group had a faster decline in pain intensity than the morphine group (mean values of pain points per minute: -0.09 [95% CI, -0.10 to -0.08] in the ketamine group and -0.07 [95% CI, -0.08 to -0.05] in the morphine group) and thus experienced a difference of 0.02 [95% CI, 0.01-0.04; P=.14]. When comparing vitals, there was no significant difference between the two groups. Thirty minutes after receiving the assigned drug, the ketamine group had adverse events in 49 out of 120 patients (40.8% [95% CI, 32.0-49.6%]) while the group receiving morphine had them in 19 of 113 (16.8% [95% CI, 10.4%-25%], reporting a risk difference of 24% (95% CI, 12.8%-35.2%). In the ketamine group, the most commonly seen adverse event was the emergence phenomenon (24 of 120 [20%]) whereas in the morphine group, it was nausea (12 of 113 [10.6%]). The use of ketamine intravenously showed noninferiority compared to morphine usage in pain reduction. Although there were more adverse events in the ketamine group, they were found to be minor thus not requiring intervention. Ketamine was shown to have similar pain relief to morphine as an out-of-hospital pain management option while minimizing further opioid proliferation.
1. A joint Inpatient palliative Care (IPC) approach was effective at reducing patients’ time in the intensive care unit (ICU) and hospital overall.
Evidence Rating Level: 2 (Good)
Patients in the intensive care unit (ICU) would benefit from having an Inpatient Palliative Care (IPC) team to help them through this difficult chapter in their lives. An IPC team usually help patients manage their symptoms and pain along with providing support to them and their families and assisting with communication to ensure realistic expectations. This retrospective study enrolled 857 patients, with 431 in the pre-intervention control group and 426 in the experimental group. The study involved ICP physicians joining already established ICU multidisciplinary rounds, who were briefed on patients that could potentially benefit from IPC care, with their treatments being assessed in terms of impact on ICU length of stay. When compared to the control group, patients in the intervention group spent fewer days in the ICU (3.9 days vs. 3.7 days, p = 0.05) as well as fewer days in the hospital in total (7.8 days vs 7.5 days, p<0.01). Patients who have previously been in palliative care had longer ICU LOS (RR 1.46, 95% CI 1.04-2.06, p = 0.03) compared to patients who received the intervention, which had shorter ICU LOS (RR 0.82, 95% CI 0.70-0.97, p = 0.02). In conclusion, a joint IPC-ICU approach reduced the patients’ time in the ICU and hospital statistically, however, the low magnitude of the changes leaves questions about the general applicability of this study. The broadness of the study may have contributed to the statistical difference, despite the low magnitude. Additionally, the retrospective nature of the study leaves more questions as to the mechanism of how the addition of IPC staff contributed to the decrease in ICU times.
Blood pressure control in patients aged above and below 75 years
1. When comparing cohorts of patients above and below 75 years of age, hypertension had a greater association with mortality, cardio-kidney composite events, and overt dementia in patients aged 45-74 years.
Evidence Rating Level: 2 (Good)
Blood pressure (BP) gets increasingly higher as people begin aging. Not only does hypertension increase, but other risk factors for high BP such as diabetes also have higher prevalence in older individuals. High BP is typically treated with antihypertensives; however, it is important to establish the point where this intervention is needed. The study sought to establish systolic blood pressure (SBP) targets for aging individuals, by comparing negative health outcomes to a lower-aged representative cohort. took place from July to December 2021 using data provided by the National Health Information Database. The participants were classified based on their age range. Included were 24 527 oldest-old (mean age, 87.2; 40.2% men), 271 943 middle-old (mean age, 78.5 years; 39.3% men), 94 918 young-old (mean age, 69.3 years; 44.4% men) and 164 110 middle-aged (mean age, 56.0 years; 51.4%) individuals. The mortality differences between SBP levels were estimated to be -0.9 (95% CI, -6.5 to 5.0) in the oldest-old group, 1.6 (95% CI, 0.6 to 2.6) in the middle-old group, and 1.2 (95% CI, 0.7 to 1.7) in the middle-aged groups all per 1000 person-years. In older participants, the J-curve was different for men and women (P = 0.014 for interaction), whereas in the younger participants, the association did not differ between men and women (P = 0.50 for interaction). When considering risk factors, there was a left shift for association with SBP and cardio or kidney risks for both older (P = 0.001 for interaction) and younger (P = 0.010 for interaction) participants. Overall, BP treatments require a more individualized approach with less aggressive lowering treatments in very old patients or those with few risk factors, however, more strict control in patients with several risk factors, regardless of age.
Image: PD
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