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Department: CLINICAL ROUNDS

Clinical Rounds

doi: 10.1097/01.NURSE.0000769876.33804.ce
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In Brief

RACIAL DISPARITIES

Black adults experience higher rates of adverse safety events

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According to a new analysis by the Urban Institute, black adults experience higher rates of adverse safety events compared with White patients treated in the same hospital.

In 6 out of 11 safety indicators, Black adult patients experienced significantly worse patient safety outcomes compared with White patients in the same age group, of the same gender, and treated in the same hospital.

For Black adults, adverse safety events involving surgical measures occurred more frequently than general patient safety indicators. Relative to White patients, Black adults experienced higher rates of pressure injuries, catheter-related infections, perioperative hemorrhage or hematoma, postoperative respiratory failure, perioperative pulmonary embolism, and postoperative sepsis. Even when comparing patients with similar types of insurance coverage, Black-White disparities in patient safety within the same hospital were prevalent.

“Studies show the healthcare system fails Black patients regardless of their age, gender, insurance status, or where they access care,” said Mona Shah, senior program officer at the Robert Wood Johnson Foundation, which funded the analysis. “The way care is delivered to diverse patients must fundamentally change and achieving equitable outcomes needs to be a healthcare priority.”

Sources: Gangopadhyaya A. Do Black and White patients experience similar rates of adverse safety events at the same hospital? Urban Institute. July 20, 2021. www.rwjf.org/en/library/research/2021/07/do-black-and-white-patients-experience-similar-rates-of-adverse-safety-events-at-the-same-hospital.html.

Davis C. Black patients suffered worse patient safety outcomes than White patients in the same hospitals. HealthLeaders. July 20, 2021. www.healthleadersmedia.com/clinical-care/black-patients-suffered-worse-patient-safety-outcomes-white-patients-same-hospitals.

COVID-19 TESTING

Teens using soft drinks to fake positive COVID-19 tests

According to a British news website, videos uploaded to social media with the hashtag #fakecovidtest showing teens applying different liquids to rapid COVID-19 tests have been viewed millions of times as of July 1, 2021. Teens in the videos have figured out how to use soft drinks to fake a positive COVID-19 test.

Due to the popularity of these videos, researchers at the University of Liverpool are studying the effects of applying soft drinks and artificial sweeteners to COVID-19 test swabs. Four artificial sweeteners were tested and produced negative results on rapid COVID-19 tests, as did spring water. But of the 14 soft drinks tested, 10 produced positive or weakly positive results, the researchers reported ahead of peer review, with no apparent link between the test results and the soft drinks' ingredients.

Since early March 2021, UK school officials have asked students without symptoms to be tested for COVID-19 twice a week, as one positive test can result in an entire class having to quarantine at home. Based on their findings, the University of Liverpool researchers are advising that testing “should be performed first thing in the morning, prior to the consumption of any food or drinks, and supervised where feasible.”

Source: Medscape. Some teens are faking positive COVID-19 tests. July 13, 2021. www.medscape.com/viewarticle/954622?src=WNL_mdpls_210716_mscpedit_nurs&uac=218507DK&spon=24&impID=3508912&faf=1.

PACEMAKERS

New pacemaker dissolves in the body

The first-ever transient pacemaker—a wireless, battery-free, fully implantable device that disappears after it is no longer needed—has been developed by researchers at Northwestern and George Washington universities. The thin, flexible, lightweight pacemaker could be used in patients who need temporary pacing after cardiac surgery or while they are waiting for a permanent pacemaker. Fully biocompatible, the pacemaker components naturally absorb into the body's biofluids in 5 to 7 weeks, and no surgical extraction is needed. By varying the composition and thickness of the materials in the pacemaker, the medical team can control the exact number of days that the pacemaker remains functional before dissolving.

Using the same technology that smartphones use for electronic payments, the device wirelessly harvests energy from an external, remote antenna. Bulky batteries and rigid hardware, including leads, are not needed. Leads can introduce infection and become enveloped in scar tissue, causing damage when removed.

“The transient electronics platform opens an entirely new chapter in medicine and biomedical research,” said George Washington University's Igor Efimov, who co-led the study. “The bioresorbable materials at the foundation of this technology make it possible to create a whole host of diagnostic and therapeutic transient devices for monitoring progression of diseases and therapies, delivering electrical, pharmacological, cell therapies, gene reprogramming and more.”

Sources: Choi YS, Yin RT, Pfenniger A, et al. Fully implantable and bioresorbable cardiac pacemakers without leads or batteries. Nat Biotechnol. [e-pub June 28, 2021]

ReachMD. New transient pacemaker dissolves inside the body. July 2, 2021. https://reachmd.com/news/new-transient-pacemaker-dissolves-inside-the-body/1953130.

HEART FAILURE AND SUBSTANCE USE

Substance use disorders rise in patients with HF

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According to research in Circulation: Heart Failure, a temporal increase was seen in the prevalence of all forms of psychoactive substance use disorders in patients hospitalized for HF from 2008 to 2017. “Commonly abused substances such as tobacco, alcohol and opioids have a high addiction potential and are implicated in increased hospital readmission in patients with HF,” said Muhammad Shahzeb Khan, MD, MSc, assistant professor of medicine at the University of Mississippi. “Despite the deleterious health effects of these substances, the burden and prevalence of substance abuse among patients with HF is not well characterized. We sought to assess the temporal trends in the prevalence of substance abuse disorders among patients hospitalized with HF in the US over the past decade.” Khan and colleagues used the National Inpatient Sample database to identify hospitalizations among adults, excluding pregnant women, with a primary diagnosis of HF from 2008 to 2017.

The researchers found that patients with HF hospitalizations were older and more likely to be men (mean age, 72.3 years; 49.3% women) compared with patients with non-HF hospitalizations (mean age, 48.3 years; 57.8% women). The most common psychoactive substance use disorder correlated with HF hospitalizations was tobacco (9.6%), followed by alcohol (2.5%) and opioids (0.4%).

In their research, Khan and colleagues say, “Future studies should identify underlying reasons for the increase in observed prevalence and propose strategies, which may effectively curtail the increasing burden of substance abuse among patients with HF.”

Sources: Khan MS, Sreenivasan J, Shahid I, et al. Trends in substance abuse disorders among patients hospitalized for heart failure in the United States. Circ Heart Fail. 2021;14(7):e008147.

Healio. Psychoactive substance use disorders rise in patients with HF. July 16, 2021. www.healio.com/news/cardiology/20210716/psychoactive-substance-use-disorders-rise-in-patients-with-hf.

September health awareness observances

DIABETES MELLITUS

Diabetes control worsened over the past decade

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According to research published in The New England Journal of Medicine, the percentage of US adults with diabetes meeting glycemic and BP control targets declined from 2010 to 2018 after years of progress from 1999 to 2010. Elizabeth Selvin, PhD, MPH, a professor in the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, and colleagues conducted a cross-sectional analysis of 6,653 participants in the National Health and Nutrition Examination Survey from 1999 to 2018. Participants were age 20 or older, not pregnant, and reported being diagnosed with diabetes. Glycemic control was defined as having an HbA1c under 7%, and BP control was defined as having a mean systolic and diastolic BP under 140/90 mm Hg. Lipid control was defined as having a non-HDL cholesterol level under 130 mg/dL and an LDL cholesterol level under 100 mg/dL. Medication use during the past 30 days was determined by reviewing participants' pill bottles.

The percentage of participants achieving glycemic targets increased from 44% in 1999 to 2002 to 57.4% in 2007 to 2010 before declining to 50.5% in 2015 to 2018. BP control also increased, from 64% in 1999 to 2002 to 74.2% in 2011 to 2014 before falling to 70.4% in 2015 to 2018. The percentage of adults achieving lipid targets increased from 25.3% in 1999 to 2002 to 52.3% in 2007 to 2010 and 55.7% in 2015 to 2018. The proportion of participants achieving glycemic, BP, and lipid control more than doubled from 9% in 1999 to 2002 to 24.9% in 2007 to 2010 before plateauing at 22.2% in 2015 to 2018. According to Dr. Selvin, “The backing off on glucose and BP control may be part of the reason we are seeing increases in some complications of diabetes. These findings are concerning and suggest we need to do a better job with controlling diabetes.”

Sources: Fang M, Wang D, Coresh J, Selvin E. Trends in diabetes treatment and control in U.S. adults, 1999-2018. N Engl J Med. 2021;384:2219-2228. Healio. Fewer US adults with diabetes achieving glycemic, BP targets since 2010. July 13, 2021. www.healio.com/news/endocrinology/20210712/fewer-us-adults-with-diabetes-achieving-glycemic-bp-targets-since-2010.

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