OBJECTIVE

The role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D.

Queen guitarist Brian May is recovering after tearing his gluteus maximus during a moment of "over-enthusiastic" gardening.

Kristen B. Campbell
Apr 1, 2004; 22:81-88
Practical Pointers

Birmingham : printed by M. Billing, 1847.

London : J. & A. Churchill, 1887.

Edinburgh : Oliver & Boyd, 1862.

London : Bailliere, Tindall and Cox, 1886.

[London?] : [Endell Street Military Hospital?], [1920] (Harlesden, London N.W. 10 : Leveridge & Co.)

[London] : [Wellcome Trust], [2009]

Modified hospital designs have become necessary as the first wave of the pandemic tears through U.S. communities

The tourism and hospitality industries, which play a large role in the economy of almost every community in northwestern Ontario, are taking a beating during the COVID-19 pandemic. Now, the manager of Tourism Thunder Bay is figuring out how “dire” the situation is, and what could be done to help.

Provincial Police have a suspect in custody after a firearms incident Thursday morning at the hospital in the small northwestern Ontario community of Rainy River.

Parents-to-be who will have their new child delivered at the Thunder Bay Regional Health Sciences Centre have to follow a different set of guidelines than found at many other hospitals across Ontario.

Michigan officials are ordering a Flint hospital to take steps to reduce the risk of exposure to Legionella bacteria and Legionnaires' disease at the facility.

Mathias Colomb Cree Nation is wondering why the federal government ignored their community's proposal for an emergency COVID-19 response space in favour of a Calgary company's. 

Karla Bell was outside an Orangeville hospital waiting to start her nursing shift when she heard a cry for help from a car in the parking lot. She ran up to find a woman in labour in the passenger seat. Natalie Kalata tells us the incredible story of how this baby was born.

Ontario reported its lowest new COVID-19 case count of the week on Saturday with 346 new confirmed cases of the virus. Meanwhile, the government has issued an emergency order allowing school board employees to be voluntarily redeployed to hospitals, long-term care homes, retirement homes and women's shelters.

The Citizens for an Accountable Mega Hospital Planning Process are in court trying to get leave to appeal a ruling that dismissed their appeal to the Local Planning Appeal Tribunal over the location of the mega-hospital.

Of the 58 people who have died due to COVID-19 in Windsor-Essex, 14 of them were patients at Windsor Regional Hospital's field hospital.

A man in Kamloops, B.C., has died and two others are in hospital with life-threatening injuries after a stabbing at a party at an apartment complex Saturday night. 

CNA Staff, Apr 17, 2020 / 07:00 pm (CNA).- Reports of an Indian hospital's segregated wards for Hindu and Muslim coronavirus patients drew concern from the U.S. Commission on International Religious Freedom, though Indian authorities strongly disputed the allegation.

"USCIRF is concerned with reports of Hindu and Muslim patients separated into separate hospital wards in Gujarat,” the commission said on Twitter and Facebook April 15. “Such actions only help to further increase ongoing stigmatization of Muslims in India and exacerbate false rumors of Muslims spreading COVID-19.”

The bipartisan U.S. federal government commission linked to a story in the Indian Express newspaper that cites a hospital official and a patient in the city of Ahmedabad in the western coastal Indian state of Gujarat.

India's Ministry for External Affairs opposed the commission, saying it was spreading “misguided reports” and “adding religious color” that distracts from India's efforts to combat the novel coronavirus.

“No segregation is being done in civil hospitals on the basis of religion, as clarified by the Gujarat government,” the ministry said April 15.

The reports concern Ahmedabad Civil Hospital, where there are some 1,200 beds prepared for patients suffering from the novel coronavirus.

Medical Superintendent Dr. Gunvant. H. Rathod described the hospital division to the Indian Express, saying “generally, there are separate wards for male and female patients. But here, we have made separate wards for Hindu and Muslim patients.”

“It is a decision of the government and you can ask them,” he said.

Deputy Chief Minister and Health Minister Nitin Patel said he was not aware of the situation and would make inquiries. Ahmedabad's district magistrate, K.K. Nirala, also was not aware of any decision, the Indian Express reports.

However, the Indian Express cited a hospital patient who said the names of 28 men in a ward were called out, and they were moved to another ward.

“While we were not told why we were being shifted, all the names that were called out belonged to one community. We spoke to one staff member in our ward today and he said this had been done for ‘the comfort of both communities’,” the patient said.

The Gujarat Health and Family Welfare Department said the reports were “absolutely baseless.” Rather, it said, patients are treated based on symptoms and severity and “according to treating doctors' recommendations.

As of Wednesday, new known cases of coronavirus in Gujarat rose by 127 to 766, with 88 cases in Ahmedabad. The death toll there totals 33, the Times of India reports.

The Indian newspaper The Week reported that the commission had previously criticized India's Citizenship Amendment Act, which became effective in January 2020.

In December 2019 the commission expressed concern about the legislation, which enshrined a pathway to citizenship for immigrants but specifically excluded Muslims. The commission recommended U.S. sanctions on India as a possible response.

The U.S. Commission on Religious Freedom reviews alleged religious freedom violations and makes policy recommendations to the U.S. president, Secretary of State, and Congress.

The commission’s 2019 report said that religious freedom conditions in India “continued a downward trend” in 2018. It said India’s “history of religious freedom has come under attack in recent years with the growth of exclusionary extremist narratives—including, at times, the government’s allowance and encouragement of mob violence against religious minorities—that have facilitated an egregious and ongoing campaign of violence, intimidation, and harassment against non-Hindu and lower-caste Hindu minorities. Both public and private actors have engaged in this campaign.”

Mob violence against Christians by Hindus has been particularly acute.

In August 2019, six suspected members of a radical Hindu group were arrested after dozens of Catholics were attacked on a Marian pilgrimage from Karnataka to the Basilica of Our Lady of Good Health in Velankanni, a coastal town in south east India.

In September, around 500 armed Hindu extremists attacked a Jesuit mission in the Archdiocese of Ranchi. Armed with sticks, chains, iron bars, knives, and pistols, the mob beat tribal students including two who were seriously injured, and also seriously damaged the school’s facilities.

Archbishop Leo Cornelio of Bhopal has said numerous mob lynchings of Christians have occurred in which the victims are accused of eating beef or otherwise harming cattle, which are considered sacred in Hinduism.

Karnataka state suffered a wave of anti-Christian violence in 2008, when Hindu extremist groups led attacks on churches, schools and homes of Christians and physically beat hundreds of people. A 2011 independent report on the violence, known as the Saldhana Report, charged that attacks were pre-planned and backed by the state’s highest government authorities.

 

OM short-term workers visit a Muslim family and enjoy food and conversation, which they hope will help lead the family to the truth.

CNA Staff, May 4, 2020 / 12:01 pm (CNA).- The Congregation for the Doctrine of the Faith has ordered 15 psychiatric hospitals in Belgium which belong to the Brothers of Charity to cease identifying as Catholic institutions after they allowed the euthanization of patients in 2017.

The hospitals are managed by a civil non-profit corporation with the same name as the Brothers of Charity religious congregation which owns them.

The CDF decision was communicated in a letter dated March 30, stating that "with deep sadness" the "psychiatric hospitals managed by the Provincialate of the Brothers of Charity association in Belgium will no longer be able to consider themselves Catholic institutions."

In a statement responding to the CDF's decision, the superior general of the Brothers of Charity, Br. René Stockman, said that "with a heavy heart" the religious congregation "must let go of its psychiatric centers in Belgium."

Br. Stockman pointed out that it is "painful" that the psychiatric centers of the Brothers of Charity in Belgium have lost their Catholic status, considering also that the brothers "were among the pioneers in the field of mental health care in Belgium."

At the same time, Stockman said he recognizes that "the congregation [the Brothers of Charity] has no choice but to remain faithful to the charism of charity, which cannot be reconciled with the practice of euthanasia on psychiatric patients."

The decision by the Vatican's doctrinal office ends three years of disputes between the Brothers of Charity and the corporation which manages their hospitals in Belgium.

In 2017, the board decided to allow euthanasia to be carried out in its hospitals in Belgium, where the euthanasia law is among the most broad.

At the time of the decision, the board of the corporation was composed of 15 members, with only three of them religious brothers of the congregation. 

Two of the three religious brothers among the board members, Luc Lemmens, 61, and Veron Raes, 57, supported the euthanasia decision. Their terms on the board ended at the end of September 2018 and were not renewed.

The religious congregation, especially Stockman, protested the decision, reiterating the Brothers of Charity's rejection of euthanasia in their hospitals.

The brothers appealed to the Vatican, which asked the psychiatric hospitals to change their protocol allowing euthanasia as “a medical act” under certain conditions.

The hospital management responded with a long statement in September 2017, in which it contested a lack of dialogue and maintained the hospital was "perfectly consistent" with Christian doctrine.

The CDF's direction that the hospitals must no longer identify as Catholic was communicated in a letter signed by CDF prefect Cardinal Luis Francisco Ladaria Ferrer and secretary Archbishop Giacomo Morandi.

The letter retraced the developments of the story, recalling that the document allowing euthanasia in the brothers' hospitals "refers neither to God, nor to Holy Scripture, nor to the Christian vision of Man."

According to the letter, the CDF had spoken with the Brothers of Charity and had also informed Pope Francis of the gravity of the situation.

Other audiences had also taken place beginning June 2017, including with the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life, the Secretariat of State, the representatives of the Brothers of Charity and the managing corporation, as well as representatives of the Belgian bishops' conference.

The Holy See also sent Bishop Jan Hendriks, auxiliary of Amsterdam, as an apostolic visitor, but he did not register any steps forward nor a desire to find "a viable solution that avoids any form of responsibility of the institution for euthanasia."

The request of the CDF to the Brothers of Charity and to the managing corporation was clear: “affirm in writing and in an unequivocal way their adherence to the principles of the sacredness of human life and the unacceptability of euthanasia, and, as a consequence, the absolute refusal to carry it out in the institutions they depend on."

The corporation "did not give assurance on these points."

The CDF therefore reiterated that "euthanasia remains an inadmissible act, even in extreme cases," and strengthened the statement by citing St. John Paul II's 1995 encyclical Evangelium vitae, and a Jan. 30 speech by Pope Francis to the CDF.

The CDF stressed that "Catholic teaching affirms the sacred value of human life," the "importance of caring for and accompanying the sick and disabled," as well as "the Christian value of suffering, the moral unacceptability of euthanasia" and "the impossibility of introducing this practice in Catholic hospitals, not even in extreme cases, as well as of collaborating in this regard with civil institutions."

The Brothers of Charity is a religious congregation of lay brothers founded in 1807 in Belgium, whose specialization is care for the sick and those with psychiatric diseases.

At the congregation's July 2018 general chapter the group stressed that the Brothers of Charity "believes in sacredness and absolute respect for every human life, from conception to natural death. The general chapter requires that each brother, associate member and others associated with the mission of the congregation adhere to the doctrine of the Catholic Church on ethical issues."

It is not known whether birth at a pediatric cardiac specialty center or at a hospital with a higher neonatal level of care affects mortality for infants with ductal-dependent congenital heart disease.

For infants with ductal-dependent congenital heart disease, there is no difference in 90-day mortality for those born at specialty centers versus other centers in the state of Washington. (Read the full article)

A number of studies have examined the early impact of the varicella vaccination program on varicella-related hospitalizations and have found evidence of decline after vaccine implementation.

This study further documents the continued decline in varicella-related hospitalizations during the 1-dose varicella vaccination era and demonstrates statistically significant declines of >65% in all age groups. These data suggest that varicella vaccination prevented ~50 000 hospitalizations from 2000 to 2006. (Read the full article)

Corticosteroids inhibit the expression of many proinflammatory cytokines released during the course of community-acquired pneumonia infection. Corticosteroids have been found in some studies to be associated with improved clinical outcomes in adults with pneumonia. No studies have investigated corticosteroid use in children with pneumonia.

Results showed that corticosteroid treatment in children with pneumonia is common and its use is highly variable across institutions. Although corticosteroid therapy may benefit children with acute wheezing treated with β-agonists, corticosteroid therapy may lead to worse outcomes for children without wheezing. (Read the full article)

Approximately 27% of children with rotavirus in the hospital acquire it while hospitalized for another condition. Pediatric rotavirus vaccination greatly decreased the number of children hospitalized with rotavirus from 2007 to 2008.

Routine community-based rotavirus infant vaccination protects hospitalized children from acquiring rotavirus. Thus, community-based vaccination efforts should be encouraged as a strategy to decrease hospital-acquired rotavirus. (Read the full article)

Clinical trials in children with severe traumatic brain injury (TBI) are challenging. To date, no work has been published that permits clinical investigators to estimate the number and compositional features of sites from which to recruit children with severe TBI into clinical trials.

Children with severe TBI are infrequent. Less than 5% of all US hospitals discharged more than 78% of severe TBI cases. To maximize enrollment efficiency for future clinical trials, attention has to be paid to selecting appropriate hospital sites. (Read the full article)

In the United States, drowning is the second leading cause of unintentional injury death among children (1–19), accounting for >1000 deaths per year. Total lifetime costs in 2000 were estimated to be $2.6 billion for children aged 0 to 14.

National trends in pediatric drowning hospitalizations by age and gender have not been reported. This study provides benchmarks that can be used for state and regional comparisons and monitoring of injury prevention efforts. (Read the full article)

Community-acquired pneumonia (CAP) is a common pediatric illness caused by Streptococcus pneumoniae. New pediatric Infectious Diseases Society of America CAP guidelines are now available recommending ampicillin as empirical treatment of children hospitalized with uncomplicated CAP.

This study found that a CAP guideline led to an increase in the narrow-spectrum antibiotic ampicillin. Additionally, an increase in the use of amoxicillin at discharge was observed. Furthermore, change in therapy did not lead to increased adverse outcomes. (Read the full article)

Inhaled nitric oxide for premature infants has been evaluated in multiple studies; however, these trials differed in treatment initiation, duration of therapy, and inclusion criteria. Furthermore, these trials reached differing conclusions regarding the benefit of inhaled nitric oxide.

We used a large sample of infants from children’s hospitals and found that the use of inhaled nitric oxide in premature infants was variable even when controlling for demographic characteristics and disease. (Read the full article)

Tenfold medication error is a well-recognized risk of pharmacotherapy in pediatric practice but little evidence describes the circumstances of such errors.

This study identified 252 tenfold medication errors, 22 of which resulted in patient harm. We identified opioids and other high-risk medications to be associated with tenfold medication error and frequent, recurrent causes, mechanisms, and error enablers that suggest areas for future improvements. (Read the full article)

Trisomy 13 and trisomy 18, common chromosomal abnormalities, are generally considered fatal within the first year after birth, although some children live longer. Little is known, however, about the inpatient medical courses of these infants and children.

Evaluation of nationally representative hospitalization data demonstrates that a significant number of children with trisomy 13 and trisomy 18 live beyond 1 year of age and that the care they receive includes both medical and surgical treatments. (Read the full article)

The presumed causes of neonatal deaths globally have remained unchanged over the past decade and include infections (~30%), prematurity (~30%), and asphyxia (~25%). Great uncertainty surrounds these estimates and, in addition, cases are likely misclassified as stillbirths.

These observational findings indicate that asphyxia accounts for a much higher percentage (60% of early deaths). Prematurity (18%), low birth weight (8%), and overt infection are much less common. The 5-minute Apgar score is an unreliable indicator of birth asphyxia. (Read the full article)

Rural Alaska children have high rates of hospitalization with lower respiratory tract infections from a variety of pathogens. Past studies of risk factors for respiratory syncytial virus infection associated medically high-risk status, household crowding, and infant feeding practices with hospitalization.

This study reveals the importance of medically high-risk status and infant feeding practices as important factors in respiratory hospitalization. In addition, we identified woodstove use and the absence of 2 or more sinks in household as risk factors for hospitalization. (Read the full article)

Most mothers in the United States do not meet recommendations for exclusive breastfeeding; however, little is known about how long mothers intend to exclusively breastfeed or how hospital practices affect achieving these intentions.

Most mothers who want to exclusively breastfeed intend to do so for ≥3 months, but the majority are not meeting their intended duration. Mothers are more likely to achieve their intended duration when their infant is not supplemented in the hospital. (Read the full article)

Adherence to Pediatric Advanced Life Support resuscitation guidelines for children with sepsis is low; however, few studies have been conducted in the tertiary care emergency department setting.

Adherence to septic shock guidelines in a tertiary care pediatric emergency department is low. Adherence to fluid guidelines and the entire PALS algorithm was associated with a shorter hospital length of stay. (Read the full article)

Data suggest that delivery at high-volume, high-technology hospitals reduces neonatal mortality. No study has examined other complications or compared the effects in multiple states by using a study design to control for unmeasured differences in case mix.

The survival benefit to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and varies between states. The survival benefits affect both extremely and moderately preterm infants. Complication rates were similar between hospital types. (Read the full article)

Although the impact of changes in the economy on child physical abuse rates is not well understood, there is concern that increased numbers of children may have been victims of physical abuse as a result of the recent economic recession.

Results of this study demonstrate that the rate of admissions for physical abuse to pediatric hospitals has increased during the past 10 years and suggest an association between that increase and the housing mortgage crisis. (Read the full article)

Because most childhood tuberculosis cases are sputum smear-negative, diagnosis relies largely upon clinical presentation, tuberculin skin testing, and chest radiograph. Diagnostic limitations contribute to treatment delays and high mortality. However, childhood tuberculosis (TB) mortality risk factors are not well documented.

This study demonstrates that false-negative TST is common in children with active TB and is associated with increased risk of death. A negative TST should not delay anti-TB therapy. Improved diagnostic modalities are urgently needed in resource-limited settings. (Read the full article)

Evaluation of neonatal surgical outcomes is necessary to guide improvements in the quality of care. Meaningful comparisons must adjust for factors that alter outcomes independent of the surgical procedures.

Herein is described a method that permits risk adjustment for the broad range of noncardiac neonatal surgery, regardless of gestational age, to permit useful comparisons for quality improvement. (Read the full article)

Although several studies have demonstrated increased morbidity and mortality with pH1N1 in children, others have found its clinical course to be similar to seasonal influenza. Moreover, most studies were conducted at single centers, thus raising concerns about generalizability of findings.

This analysis provides national-level active hospital-based surveillance data comparing pH1N1 with 5 previous years of seasonal influenza A and demonstrates differences in risk factors and clinical presentation but not in ICU admission or mortality. (Read the full article)

Changes in resident work hours are believed to have an impact on resident education and patient safety.

This study provides an understanding of the impact of changes in resident work hours on the staffing strategies of children’s hospitals. (Read the full article)

Findings from 3 studies suggest that the diagnosis of venous thromboembolism in hospitalized US children has increased in recent years.

This study provides additional evidence of an increasing trend in the rate of venous thromboembolism-associated hospitalization in US children, as well as a concurrent increase in the prevalence of venous catheter procedures. (Read the full article)

Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.

Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article)

There are limited data on current testing and treatment patterns for children hospitalized with pneumonia, and on whether institutional guidelines affect care.

The use of institutional clinical practice guidelines was not associated with changes in diagnostic testing, hospital length of stay, or costs for children hospitalized with pneumonia, but was associated with increased use of narrow-spectrum antibiotics. (Read the full article)

Patients living in rural versus urban counties encounter different health care environments. Whether these differences result in different health care utilization for rural versus urban infants is not known.

In this study, infants living in rural California counties were hospitalized less often than infants living in urban counties. Among those hospitalized, infants living in rural counties were hospitalized for fewer cumulative days than infants residing in urban counties. (Read the full article)

Pediatric tuberculosis is significant for public health professionals because it is an indicator of the recent transmission of tuberculosis in the community. Data on incidence and clinical features of pediatric tuberculosis from China are scarce.

We conducted this study to describe the patient characteristics, clinical–epidemiological profile, and treatment outcomes for pediatric tuberculosis in a referral hospital setting in China. (Read the full article)