Association between Low House Cleaning Frequency, Cough and Risk of Miscarriage: A Case Control Study in China

This study investigated the association between house cleaning frequency and the risk of miscarriage in a case control sample of Chinese population. We recruited 59 pregnant women with clinical pregnancy loss as cases and 122 women who chose to conduct induced abortion as controls. All participants were aged 20~40 years and completed a questionnaire of lifestyle exposure with a trained nurse. The effect of frequency of cleaning up on risk of miscarriage was estimated using multivariable logistic regressions, adjusting for potential confounders. In the present study, it was shown that house cleaning of less than twice per week was significantly associated with cough during day or night with odds ratio (OR) of 2.97 (95% CI: 1.36~6.75, p = 0.007), and cough during day or night was significantly associated with risk of miscarriage with OR of 2.69 (95% CI: 1.22~6.02, p = 0.014). Thus, house cleaning of less than twice per week was statistically significantly associated with miscarriage with OR of 3.05 (95% CI: 1.51~6.31, p = 0.002). We found that females who have their house cleaned less than twice per week are at elevated risk for miscarriage. Therefore, the home of pregnant woman should be cleaned at least twice per week in order to avoid miscarriage.

Utilizzo del protossido di azoto nella riduzione del dolore e dell’ansia da procedura in Pediatria

<b>Background -</b> To prevent and control the procedural pain includes an adequate analgesia and the reduction of the anxiety/distress related to the procedure itself. A useful tool that combines the analgesic and sedative effects is nitrous oxide combined in different percentages with oxygen. <br> <b>Objective -</b> The goal of this study is to evaluate the efficiency of the nitrous oxide in the management of procedural pain and distress in a paediatric environment, also considering the possibility that a pre-made solution of nitrous oxide and oxygen 50/50 could be given independently of the inmate by a properly trained nurse. <br> <b>Methods -</b> An observational study at the Paediatric First Aid Department in Sant’Anna Hospital (Como, Italy) was performed by creating a special procedure that was applied to children older than 1 year old that needed to undergo low to mild painful procedures between July 6th 2017 and December 31st 2019. The blend was dosed by a demand valve. For each procedure a form was filled in with personal data, side effects, parameters and an evaluation of the pre-procedure and post-procedure pain. All the staff then took a satisfaction questionnaire.<br> <b>Results -</b> The study corroborates that preblended nitrous oxide 50/50 is safe and efficient, and also guarantees analgesic and anxiolytic effects for a vast case of mildly painful procedures. The little use of other drugs and the absence of opioids in the treatment is likely the main reason for the absence of major side effects. <br> <b>Conclusions -</b> The collected data suggest that a 50/50 blend of nitrous oxide and oxygen is still used considering its efficiency and manageability in the procedural sedation and also confirm that using the same concentrations and avoiding combination with opioids is safe and available to properly formed nurses.

Hand hygiene implementation: an easy step to improve public health

The World Health Organization has declared 2020 the “Year of the Nurse and Midwife”. On May 5th of this year, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, the WHO highlighted the critical role of nurses and midwives in promoting public health. Increasing well-trained nurse staffing will enable nurses and midwives to improve quality of care and prevent infections. The implications for improved nursing and health policy are many. Investing in nurses ensures better care for patients, reduces infections and the economic burden of healthcare-associated infections on countries' economies.

Practice recommendations for the use of sedation in routine hospital-based colonoscopy

ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

Penetration of topical diclofenac into synovial tissue and fluid of osteoarthritic knees: a multicenter, randomized, placebo-controlled, pharmacokinetic study

Background: Topical diclofenac, a nonsteroidal anti-inflammatory drug, has proven efficacy and safety in the management of osteoarthritis pain. We investigated penetration of topical diclofenac into knee synovial tissue and fluid (primary objective) and evaluated relative exposure in the knee versus plasma (secondary objective). Methods: In this phase I, double-blind, multicenter study, patients scheduled for arthroplasty for end-stage knee osteoarthritis were randomly assigned 2:1 to 4 g diclofenac diethylamine 2.32% w/w gel (92.8 mg diclofenac diethylamine, equivalent to 74.4 mg diclofenac, per application) or placebo gel, applied to the affected knee by a trained nurse/designee every 12 h for 7 days before surgery. Diclofenac concentrations were measured in synovial tissue, synovial fluid and plasma from samples obtained during surgery ⩾12 h after last application. Treatment-emergent adverse events (TEAEs) were evaluated. Results: Evaluable synovial tissue or fluid samples were obtained from 45 (diclofenac n = 29; placebo n = 16) of 47 patients. All diclofenac-treated participants had measurable diclofenac concentrations in synovial tissue [geometric mean 1.57 (95% confidence interval (CI) 1.12, 2.20) ng/g] and fluid [geometric mean 2.27 (95% CI 1.87, 2.76) ng/ml] ⩾12 h after the last dose. Geometric mean (95% CI) ratio of diclofenac in synovial tissue:plasma was 0.32 (0.23, 0.45) and in synovial fluid:plasma was 0.46 (0.40, 0.54). TEAE rates were similar for diclofenac (55.2%) and placebo (58.8%); none were treatment related. Conclusions: Topical diclofenac diethylamine 2.32% w/w gel penetrated into the osteoarthritic knee after repeated application and remained detectable in synovial tissue and fluid at the end of the final 12 h dosing cycle.

‘A Rich Tapestry’

This chapter presents a micro-history of Sir Anand Satyanand, New Zealand’s first governor general of Asia-Pacific origin. Sir Anand Satyanand’s maternal and paternal great-grandparents migrated from India to Fiji as indentured labourers in the 1880s. His father moved to Auckland for his medical education and practice and his mother was a trained nurse in Auckland. Sir Anand was trained as a lawyer and eventually was appointed New Zealand’s governor general. His life story reflects the colonial and postcolonial interconnections between India and the Antipodes and the strength of the Indian contribution to the making of New Zealand. This chapter demonstrates how racial boundaries are transcended by Indian migrants through struggle, educational priority, familial relations, and intergenerational mobility.