No abstract

Of 1383 orders, 243 were for the management of meningitis. A CSF culture or NLP combination trigger searching the electronic health record since admission yielded the greatest sensitivity for detecting meningitis management (67.5%, P < 0.01 vs others), but dosing error detection was similar if the trigger only searched 48 hours preceding the order (68.8% vs 62.5%, P = 0.125). Using a CSF culture alone and a 48-hour time frame had a higher PPV versus a combination with a 48-hour time frame (97.1% vs 80.9%, P < 0.001), and both triggers had a higher PPV than others ( P < 0.001). Antimicrobials with meningitis order sentences had fewer dosing errors (19.8% vs 43.2%, P < 0.01). Conclusion and Relevance: A meningitis dosing alert triggered by a combination of a CSF culture or NLP system and a 48-hour triggering time frame could provide reasonable sensitivity and PPV for meningitis dosing errors. Order sentences with indication-specific recommendations may provide additional dosing support, but additional studies are needed.

BackgroundReduced sleep duration and poor sleep quality are prevalent complaints in rheumatoid arthritis (RA). These in turn may further deteriorate functional ability and reduce the person’s exercise levels. Current rheumatology guidelines recommend exercise as a key component in the management of RA however, what is lacking is its impact on sleep.ObjectivesTo obtain reliable estimates regarding recruitment rates; retention; protocol adherence; adverse events, in addition to producing estimates of the potential effect sizes of the intervention on changes in outcomes of sleep duration; sleep quality and disturbances; RA related pain; depression; anxiety; functional limitation; disease activity and fatigue.MethodsParticipants were recruited in person at weekly rheumatology clinics at a University Hospital and through self-selected social networking. They were randomised to either a walking based exercise intervention consisting of 28 walking sessions, with 1 per week being supervised by a trained physiotherapist, spread over 8 weeks (2–5 times/week), or a control group who received advice on the benefits of exercise for people with RA. Ethical approval was received. Descriptive statistics and t-tests were used to analyse the data with SPSS v22.ResultsOne hundred and one (101) people were identified through the rheumatology clinics, with 36 contacting the primary investigator through social networking. Of these, 24 met the eligibility criteria, with 20 being randomised (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten exercise participants (100%) and 8 controls (80%) completed final assessments, with both groups being equivalent for all variables at baseline. Exercise participants completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were recorded and through semi-structured interviews the intervention was highly acceptable to exercise participants. Pittsburgh Sleep Quality Index (PSQI) global score showed a significant mean improvement between the exercise group −6.6 (SD 3.3) compared to control −0.25 (SD 1.1) (p=0.012); PSQI subcomponent sleep duration showed a significant improvement in mean hours between the exercise group 1.65 (SD 0.39) and control 0.56 (SD 0.46) (p=0.021); PSQI subcomponent sleep quality indicated those in the exercise group improved their sleep quality from fairly bad/poor to fairly good/very good, while those in control reported no change at fairly bad/poor. Global rating of change indicated exercise participants reporting their sleep was minimally/much improved, while control participants reported no change/minimally worse, post intervention.ConclusionsThe walking based exercise intervention designed to improve sleep was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Adverse events were predominantly mild. This pilot provides a framework for larger intervention studies and based on these...

Regular physical activity (PA) is important for people with rheumatoid arthritis (RA). Poor sleep is a common complaint among people with RA, which may have an influence on their PA levels. There is a lack of objective information regarding total sleep time (TST) and PA duration in this population. A cross-sectional study design was used. SenseWear Pro3 Armband is used to measure TST and total PA duration. Four valid days, with 95% wear time necessary for inclusion in final results. Disease activity and function were measured using the DAS-28, HAQ and VAS. Data analysis carried out using SPSS v22. Seventy-five (75) participants completed monitoring period, with 51 (68%) meeting modified PA duration guidelines. Data with 95% wear time over a minimum of 4 days were available for 32 recorded participants, with a mean TST of 5.7 (SD_1.11) hours per night and a median 1.25 (IQR_1.88) hours of daily PA. TST had a positive significant relationship with PA (p = 0.018); PA demonstrated a negative significant relationship with functional limitations (p = 0.009) and correlated with lower CRP levels; CRP levels had in turn a significant relationship to global health (p = 0.034). Total sleep time was low for people with RA. People with RA who are more physically active have longer TST. These findings provide an objective profile of TST and PA duration in people with RA and suggest a relationship between increased PA duration and longer TST. Further research is needed to confirm these novel findings.