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1.
Genny Raffaeli Francesco Canesi Federica Conigliaro Stefano Ghirardello Mara Vanzati Chiara Baracetti Monica Fumagalli Fabrizio Ciralli Federico Schena Nicola Pesenti Laura Plevani Fabio Mosca Giacomo Cavallaro 《Heart & lung : the journal of critical care》2018,47(6):638-645
Background
Advances in cardiorespiratory monitoring have made the extracorporeal membrane oxygenation (ECMO) technique safer for the patient. Noninvasive, continuous tools are available, although data on their applications in the neonatal ECMO setting are lacking.Objective
We retrospectively described the neonatal clinical application of this continuous, noninvasive ECMO monitor and compared the analyzed parameters from those derived from blood gas analysis.Materials and methods
We performed 897 h of cardiorespiratory monitoring during neonatal venoarterial-ECMO (VA-ECMO) for four patients affected by (cardio-) respiratory failure, to compare the reliability of a noninvasive, continuous monitoring Spectrum M4® (M4) (Spectrum Medical, Gloucester, England) to an invasive, intermittent co-monitoring with blood gas analyzer (Radiometer Medical ApS, Brønshøj, Denmark).Results
A range of 117 pairs (time-matched BGA-derived vs. M4-derived parameters) was retrospectively analyzed. T-test, linear regression and Bland–Altman analysis for hemoglobin, hematocrit, venous oxygen saturation, oxygen delivery, oxygen consumption, oxygen extraction ratio, oxygen partial pressure, and carbon dioxide partial pressure showed a strong relationship between the two monitors for all parameters analyzed (p < 0.0001).Conclusions
Continuous, noninvasive cardiorespiratory monitoring appears to be feasible and reliable, although its accuracy needs to be verified in a more extensive cohort. 相似文献2.
SHEILA L. Klassen ROBERT J.H. MILLER ROBIN HAO J. WAYNE WARNICA NOWELL M. FINE MAHENDRA CARPEN DEBRA L. ISAAC 《Journal of cardiac failure》2018,24(12):835-841
Background
Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.Methods
We performed an interrupted time-series cohort study of heart failure (HF) patients admitted to the Georgetown Public Hospital Corporation from January to December 2015 and July 2016 to December 2017. The primary outcome was discharge on guideline-directed medical therapy (GDMT). Secondary outcomes included length of hospitalization and all-cause mortality.Results
We identified 740 patients, 347 (46.9%) of whom were admitted after service implementation. The postimplementation cohort was more likely to be discharged on a beta-blocker (66.6% vs 41.7%; P < .01) and mineralocorticoid receptor antagonist (31.7% vs 15.3%; P?=?.01). They were also more likely to undergo echocardiography (60.8% vs 40.5%; P < .01) and chest x-rays (70.6% vs 46.6%; P < .01). Hospitalization length (10.0 ± 13.1 vs 9.8 ± 10.1 days) and readmissions within 90 days (19.0% vs 19.1%) were not significantly different. There were fewer deaths in the postimplementation cohort compared with the preimplementation cohort (12/347 vs 28/393).Conclusions
Establishment of a multidisciplinary inpatient cardiology service demonstrated increased adherence to GDMT without extending length of hospitalization. 相似文献3.
Rachel Wells Deborah Ejem J. Nicholas Dionne-Odom Gulcan Bagcivan Konda Keebler Jennifer Frost Andres Azuero Alan Kono Keith M. Swetz Marie Bakitas 《Heart & lung : the journal of critical care》2018,47(6):533-538
Background
Little has been reported about protocol-driven outpatient palliative care consultation (OPCC) for advanced heart failure (HF).Objectives
To describe evaluation practices and treatment recommendations made during protocol-driven OPCCs for advanced HF.Methods
We performed content analysis of OPCCs completed as part of ENABLE CHF-PC, an early palliative care HF intervention, conducted at sites in the Northeast and Southeast. T-tests, Fisher's exact, and Chi-square tests were used to evaluate sociodemographic, outcome measures, and site content differences.Results
Of 61 ENABLE CHF-PC participants, 39 (64%) had an OPCC (Northeast, n=27; Southeast, n=12). Social and medical history assessed most were close relationships (n=35, 90%), family support (n=33, 85%), advance directive status (n=33, 85%), functional status (n=30, 77%); and symptoms were mood (n= 35, 90%), breathlessness (n=28, 72%), and chest pain (n=24, 62%). Treatment recommendations focused on care coordination (n=13, 33%) and specialty referrals (n=12, 31%). Between-site OPCC differences included assessment of family support (Northeast vs. Southeast: 100% vs. 50%), code status (96% vs. 58%), goals of care discussions (89% vs. 41.7%), and prognosis understanding (85% vs. 33%).Conclusion
OPCCs for HF focused on evaluating medical and social history, along with goals of care and code status discussions. Symptom evaluation commonly included mood disorders, pain, dyspnea, and fatigue. Notable regional differences were found in topics evaluated and OPCC completion rates. 相似文献4.
Richard V. Milani Robert M. Bober Carl J. Lavie Jonathan K. Wilt Alexander R. Milani Christopher J. White 《The American journal of medicine》2018,131(8):961-966
Background
Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short- and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions. We wished to evaluate measures directed at improving circadian rhythm and access to daily health information on hospital outcomes.Methods
We evaluated 3425 consecutive patients admitted to a medical-surgical unit comprised of an intervention wing (n?=?1185) or standard control wing (n?=?2240) over a 2.5-year period. Intervention patients received measures to improve sleep that included reduction of nighttime noise, delay of routine morning phlebotomy, passive vital sign monitoring, and use of red-enriched lighting after sunset, as well as access to daily health information utilizing an inpatient portal.Results
Intervention patients accessed the inpatient portal frequently during hospitalization seeking personal health and care team information. Measures impacting the quality and quantity of sleep were significantly improved. Length of stay was 8.6hours less (P?=?.04), 30- and 90-day readmission rates were 16% and 12% lower, respectively (both P ≤ .02), and self-rated emotional/mental health was higher (69.2% vs 52.4%; P?=?0.03) in the intervention group compared with controls.Conclusions
Modest changes in routine hospital care can improve the hospital environment impacting sleep and access to health knowledge, leading to improvements in hospital outcomes. Sleep-wake patterns of hospitalized patients represent a potential avenue for further enhancing hospital quality and safety. 相似文献5.
Kristin M. Kostick Courtenay R. Bruce Charles G. Minard Robert J. Volk Andrew Civitello Selim R. Krim Douglas Horstmanshof Vinay Thohan Matthias Loebe Mazen Hanna Brian A. Bruckner J.S. BlumenthalBarby Jerry D. Estep 《Journal of cardiac failure》2018,24(10):661-671
Background
Studies indicate that decision making and informed consent among patients considering left ventricular assist device (LVAD) support for advanced heart failure could be improved. In the VADDA (Ventricular Assist Device Decision Aid) trial, we tested a patient-centered decision aid (DA) to enhance the quality of decision making about LVAD therapy.Methods
After an extensive user-centered design process, we conducted a multisite randomized trial of the DA compared with standard education (SE) among inpatients considering LVAD treatment for advanced heart failure The main outcome was LVAD knowledge at 1 week and 1 month after administration of the DA versus the SE, according to a validated scale. Secondary measures included prespecified quality decision making measures recommended by the International Patient Decision Aid Standards collaboration.Results
Of 105 eligible patients, 98 consented and were randomly assigned to the DA and SE arms. Patients receiving the VADDA exhibited significantly greater LVAD knowledge than the SE group at 1 week of follow-up (P?=?.01) but not at 1 month (P?=?.47). No differences were found between DA and SE patients in rates of acceptance versus decline of LVAD treatment (85% vs 78%; P?=?.74). Recipients in the DA arm reported greater satisfaction with life after implantation compared with nonrecipients (28 vs 23 out of 30; P?=?.008), although both arms reported high satisfaction. Patients rated the DA high in acceptability and usability.Conclusions
The VADDA enhances LVAD knowledge, particularly in the short term (1 week) during the peak period of decision making. The DA does not encourage decision direction and reflects patient, caregiver, and physician preferences for content and format.Clinical Trial Registration
https://clinicaltrials.gov/ct2/show/NCT02248974. The trial is registered with clinicaltrials.gov (NCT02248974). 相似文献6.
Jun Hyuk Son Hee Seung Lee Sang Hyub Lee Seungmin Bang Jinwoo Kang Woo Hyun Paik Ji Kon Ryu Yong-Tae Kim 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(5):437-442
Background
Endoscopic biliary decompression using bilateral self-expandable metallic stent (SEMS) placed using the stent-in-stent (SIS) technique is considered favorable for unresectable malignant hilar biliary obstruction (MHBO). However, occlusion of the bilateral SIS placement is frequent and revision can be challenging. This study was performed to investigate the efficacy, the long-term patency and the appropriate approach for revision of occluded bilateral SIS placement in unresectable MHBO.Methods
From January 2011 to July 2016, thirty-eight patients with unresectable MHBO underwent revision of occluded bilateral SIS placement. Clinical data including success rates and patency of revision, were retrospectively analyzed.Results
The technical success rate of revision was 76.3%. The clinical success rate of revision was 51.7% and mean patency of revision was 49.1 days. No significant predictive factor for clinical failure of revision was observed. The cell size of SEMS was not found to have significant effects on clinical success rates or revision patency.Conclusions
Revision of occluded bilateral SIS placement for MHBO showed fair patency and clinical success rate. Revision method and cell size of SEMS were not found to influence clinical outcomes. 相似文献7.
Howard Lan Lee Ann Hawkins Michael Kashner Elena Perez Christopher J. Firek Helme Silvet 《Heart & lung : the journal of critical care》2018,47(6):546-552
Background
In our prior study of 250 outpatient veterans with heart failure (HF), 58% had unrecognized cognitive impairment (CI) which was linked to worsened medication adherence. Literature suggests HF patients with CI have poorer clinical outcomes including higher mortality.Objective
The study is to examine mortality rates in outpatients with HF and undiagnosed CI compared to their cognitively intact peers.Methods
This is a retrospective study for all-cause mortality.Results
During the 3-year follow up, 64/250 (25.6%) patients died: 20/106 (18.9%) with no CI, 29/104 (27.9%) with mild CI, and 15/40 (37.5%) with severe CI. Patients with CI were at increased risk for mortality (hazard ratio 1.82, p?=?0.038). Those with severe CI had the worst outcome (hazard ratio 2.710, p?=?0.011).Conclusions
CI was an independent risk factor for mortality in patients with heart failure when controlling for age and markers of disease severity. Cognitive screening should be performed routinely to identify patients at greater risk for adverse outcomes. 相似文献8.
Brittany O. Dulmage Lisa Akintilo Leah J. Welty Matthew M. Davis Maria Colavincenzo Shuai Xu 《The American journal of medicine》2018,131(9):1130-1134.e6
IMPORTANCE
Residency applicants often use social media to discuss the positive and negative features of prospective training programs. An examination of the content discussed by applicants could provide guidance for how a medical education faculty can better engage with prospective trainees and adapt to meet the educational expectations of a new generation of digital-native physicians.OBJECTIVE
The objective was to identify unstructured social media data submitted by residency applicants and categorize positive and negative statements to determine key themes.DESIGN
The study design was qualitative analysis of a retrospective cohort.SETTING
Publicly available datasets were used.PARTICIPANTS
The participants were anonymized medical trainees applying to residency training positions in 9 specialties—dermatology, general surgery, internal medicine, obstetrics/gynecology, plastic surgery, otolaryngology, physical medicine and rehabilitation, pediatrics, and radiology—from 2007 to 2017.MAIN OUTCOMES AND MEASURES
After we developed a standardized coding scheme that broke comments down into major features, themes, and subthemes, all unstructured comments were coded by two independent researchers. Positive and negative comments were coded separately. Frequency counts and percentages were recorded for each identified feature, theme, and subtheme. The percent positive and negative comments by specialty were also calculated.RESULTS
: Of the 6314 comments identified, 4541 were positive and 1773 were negative. Institution was the most commonly cited major feature in both the positive (n?=?767 [17%]) and negative (n?=?827 [47%]) comments. Geography was the most cited theme, and City, Cost of Living, and Commute were commonly cited subthemes. Training was the next most cited major feature in both positive (n?=?1005 [22%]) and negative (n?=?291 [16%]) comments, with Clinical Training being more commonly cited compared to Research Opportunities. Overall, 72% of comments from all were positive; however, the percent of comments that were positive comments varied significantly across the 9 specialties. Pediatrics (65%), dermatology (66%), and internal medicine (68%) applicants were more likely to express negative comments compared with the global average, but physical medicine and rehabilitation (85%), radiology (82%), otolaryngology (81%), and plastic surgery (80%) applicants were more likely to express positive comments.CONCLUSIONS AND RELEVANCE
This qualitative analysis of positive and negative themes as posted by applicants in recent matching years is the first and provides new detailed insights into the motivations and desires of trainees. 相似文献9.
Shu-Fen Su Ying-Chin Liao Meng-Shan Wu 《Heart & lung : the journal of critical care》2018,47(6):576-583
Background
Transfemoral percutaneous coronary intervention (PCI) requires strict bed rest, causing pain and discomfort in patients. However, no studies have investigated this issue.Objectives
To investigate the predictors of discomfort in transfemoral PCI patients.Methods
A cross-sectional sample of 110 patients from two coronary care units completed questionnaires on demographic and clinical characteristics, visual analogue pain scale, and discomfort.Results
Eight factors predicted overall discomfort: physiologic pain, physiological discomfort, psychological discomfort, analgesic use after sheath removal, hemostasis method, and bed rest duration. Psychological discomfort was associated with age, chronic obstructive pulmonary disease, analgesic use after sheath removal, successful hemostasis, and hematoma >5 cm. A hierarchical regression model explained 70.5% of the variance in overall discomfort.Conclusions
Age and physiologic pain are major predictors of overall discomfort, especially in patients aged <60 years having high pain sensitivity. Critical care providers should note patients’ physiological and psychological issues throughout the PCI process. 相似文献10.
Christopher S. Lee Quin E. Denfeld Bradley E. Aouizerat Corrine Y. Jurgens Christopher V. Chien Emily Aarons Jill M. Gelow Shirin O. Hiatt James O. Mudd 《Heart & lung : the journal of critical care》2018,47(6):565-575
Background
We have a limited understanding of the biological underpinnings of symptoms in heart failure (HF).Objectives
The purpose of this paper was to compare relationships between peripheral biomarkers of HF pathogenesis and physical symptoms between patients with advanced versus moderate HF.Methods
This was a two-stage phenotype sampling cohort study wherein we examined patients with advanced HF undergoing ventricular assist device implantation in the first stage, and then patients with moderate HF (matched adults with HF not requiring device implantation) in the second stage. Linear modeling was used to compare relationships among biomarkers and physical symptoms between cohorts.Results
Worse myocardial stress, systemic inflammation and endothelial dysfunction were associated with worse physical symptoms in moderate HF (n=48), but less physical symptom burden in advanced HF (n=48).Conclusions
Where patients are in the HF trajectory needs to be taken into consideration when exploring biological underpinnings of physical HF symptoms. 相似文献11.
Maria Daniel Stefan Agewall Felix Berglund Kenneth Caidahl Olov Collste Christina Ekenbäck Mats Frick Loghman Henareh Tomas Jernberg Karin Malmqvist Karin Schenck-Gustafsson Jonas Spaak Örjan Sundin Peder Sörensson Shams Y-Hassan Claes Hofman-Bang Per Tornvall 《The American journal of medicine》2018,131(9):1118-1124
Background
Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries.Methods
We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event.Results
Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P = .006) and similar to that of patients with coronary heart disease (30%; P = .954). Using the HADS anxiety subscale, we found that the prevalence of anxiety in patients with myocardial infarction with non-obstructive coronary arteries (27%) was higher than in healthy controls (9%; P = .002) and similar to that of patients with coronary heart disease (21%; P = .409). Using the HADS depression subscale, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (17%) was higher than in healthy controls (4%; P = .003) and similar to that of patients with coronary heart disease (13%; P = .466). Patients with myocardial infarction with non-obstructive coronary arteries and takotsubo syndrome scored higher on the HADS anxiety subscale than those without (P = .028).Conclusions
This is the first study on the mental health of patients with myocardial infarction with non-obstructive coronary arteries to show that prevalence rates of anxiety and depression are similar to those in patients with coronary heart disease. 相似文献12.
Dong Kyu Oh Jong-Min Song Duk-Woo Park Sang Young Oh Jin-Sook Ryu Jaewon Lee Sang Do Lee Jae Seung Lee 《Heart & lung : the journal of critical care》2019,48(1):28-33
Background
Although guidelines have recommended that patients with chronic thromboembolic pulmonary hypertension (CTEPH) should be managed by a multidisciplinary team (MDT), there is a lack of clinical data indicating that the MDT improves CTEPH management.Objectives
The study aimed to identify the effect of an MDT on CTEPH management.Methods
We divided the study period into pre-MDT and post-MDT eras and compared the implementation rates of major diagnostic and therapeutic procedures.Results
Of 116 patients with CTEPH, 42 (36.2%) were diagnosed in the post-MDT era. The implementation rates of right heart catheterization (10.8% vs. 97.6%, p < 0.001) and pulmonary endarterectomy (32.4% vs. 59.5%, p < 0.005) were significantly increased in the post-MDT era. Balloon pulmonary angioplasty was not performed in the pre-MDT era but was performed in the post-MDT era.Conclusions
The MDT appears to be associated with improved CTEPH management. 相似文献13.
Stuti J. Jaiswal Thomas J. McCarthy Nathan E. Wineinger Dae Y. Kang Janet Song Solana Garcia Christoffel J. van Niekerk Cathy Y. Lu Melissa Loeks Robert L. Owens 《The American journal of medicine》2018,131(9):1110-1117.e4
Purpose
Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20%-30% of hospitalized older adults that is associated with increased morbidity and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism.Methods
This was a randomized clinical trial measuring the impact of 3 mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age ≥65 years, admitted to internal medicine wards (non-intensive care units). Delirium incidence was measured by bedside nurses using the confusion assessment method. Objective sleep measurements (nighttime sleep duration, total sleep time per 24 hours, and sleep fragmentation as determined by average sleep bout length) were obtained via actigraphy. Subjective sleep quality was measured using the Richards Campbell Sleep Questionnaire.Results
Delirium occurred in 22.2% (8/36) of subjects who received melatonin vs in 9.1% (3/33) who received placebo (P?=?.19). Melatonin did not significantly change objective or subjective sleep measurements. Nighttime sleep duration and total sleep time did not differ between subjects who became delirious vs those who did not, but delirious subjects had more sleep fragmentation (sleep bout length 7.0 ± 3.0 vs 9.5 ± 5.3 min; P?=?.03).Conclusions
Melatonin given as a nightly dose of 3 mg did not prevent delirium in non-intensive care unit hospitalized patients or improve subjective or objective sleep. 相似文献14.
Simon Nennstiel Isolde Tschurtschenthaler Bruno Neu Hana Algül Monther Bajbouj Roland M.Schmid Stefan von Delius Andreas Weber 《Hepatobiliary & pancreatic diseases international : HBPD INT》2018,17(1):49-54
Background: Occlusion of self-expanding metal stents(SEMS) in malignant biliary obstruction occurs in up to 40% of patients. This study aimed to compare the different techniques to resolve stent occlusion in our collective of patients.Methods: Patients with malignant biliary obstruction and occlusion of biliary metal stent at a tertiary referral endoscopic center were retrospectively identified between April 1, 1994 and May 31, 2014. The clinical records were further analyzed regarding the characteristics of patients, malignant strictures, SEMS,management strategies, stent patency, subsequent interventions, survival time and case charges.Results: A total of 108 patients with biliary metal stent occlusion were identified. Seventy-nine of these patients were eligible for further analysis. Favored management was plastic stent insertion in 73.4% patients. Second SEMS were inserted in 12.7% patients. Percutaneous transhepatic biliary drainage and mechanical cleansing were conducted in a minority of patients. Further analysis showed no statistically significant difference in median overall secondary stent patency(88 vs. 143 days, P = 0.069), median survival time(95 vs. 192 days, P = 0.116), median subsequent intervention rate(53.4% vs. 40.0%, P = 0.501)and median case charge(€5145 vs. €3473, P = 0.803) for the treatment with a second metal stent insertion compared to plastic stent insertion. In patients with survival time of more than three months,significantly more patients treated with plastic stents needed re-interventions than patients treated with second SEMS(93.3% vs. 57.1%, P = 0.037).Conclusions: In malignant biliary strictures, both plastic and metal stent insertions are feasible strategies for the treatment of occluded SEMS. Our data suggest that in palliative biliary stenting, patients especially those with longer expected survival might benefit from second SEMS insertion. Careful patient selection is important to ensure a proper decision for either management strategy. 相似文献
15.
16.
Yue-Nan Ni He Yu Hui Xu Wei-jing Li Bin-miao Liang Ling Yang Zong-An Liang 《The American journal of the medical sciences》2019,357(3):213-222
Background
We aimed to further determine the relationship between the areas of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and the ratio of VAT to SAT (VAT/SAT) with the outcomes of acute respiratory distress syndrome (ARDS) patients.Methods
A retrospective study was performed on patients with ARDS in 7 intensive care units (ICU) of West China Hospital, Sichuan University.Results
A total of 169 patients were included in the analysis. Abdominal computed tomography scans of each patient within 24 hours of being admitted to the ICU were assessed by at least 2 investigators. Higher VAT/SAT was related with higher hospital mortality (22% vs. 44%, P?=?0.003; adjusted odds ratio [aOR] 0.699, 95% CI 0.530-0.922 ([P?=?0.011]). On the contrary, higher SAT and VAT were related to lower hospital mortality in ARDS (aOR 1.077, 95% CI 1.037-1.119 [P < 0.001]; aOR 1.017, 95% CI 1.004-1.030 [P?=?0.011], respectively). Patients with higher SAT and VAT had shorter length of ICU stay (ICU LOS) (26.26 vs. 15.83 days, P?=?0.031; 25.16 vs. 14.19 days, P?=?0.007, respectively), while VAT/SAT was not related with ICU LOS. Moreover, we did not find any significant relationship either between VAT/SAT and mechanical ventilation-free days or between SAT and mechanical ventilation-free days.Conclusions
This study suggests that VAT/SAT can contribute to adverse outcomes of patients with ARDS. However, higher SAT and VAT were related to better prognosis of ARDS patients. 相似文献17.
JUSTIN L. GRODIN JAVED BUTLER MARCO METRA G. MICHAEL FELKER ADRIAAN A. VOORS JOHN J. MCMURRAY PAUL W ARMSTRONG ADRIAN F. HERNANDEZ CHRISTOPHER O&#x;CONNOR RANDALL C. STARLING W.H. WILSON TANG 《Journal of cardiac failure》2018,24(8):512-519
Background
Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear.Methods
Baseline, 48–72-hour, and 30-day plasma cTnI was measured with the use of a new highly sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes.Results
The median (interquartile range) cTnI was 16.4 (9.3–31.6) ng/L at baseline, 14.1 (7.8–29.7) ng/L at 48–72 hours, and 11.6 (6.8–22.5) ng/L at 30 days. After additional adjustment for N-terminal pro–B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline (odds ratio [OR] 1.25; P?=?.03) and 48–72-hour (OR 1.43; P?=?.001) cTnI were associated with higher risk for death or worsening HF before discharge. However, only cTnI at 30 days was associated with 180-day death (hazard ratio 1.25; P?=?.007). There were no curvilinear associations between changing cTnI and clinical outcomes.Conclusions
Circulating cTnI level was associated with clinical outcomes in ADHF, but these observations diminished with additional adjustment for NT-proBNP. Although they likely represent a spectrum of risk in ADHF, these findings question the implications of changing cTnI levels during treatment. 相似文献18.
Quan M. Bui Oscar O. Braun Michela Brambatti Yan K. Gernhofer Holly Hernandez Victor Pretorius Eric Adler 《Heart & lung : the journal of critical care》2019,48(2):85-89
Background
The Stanford integrated psychosocial assessment for transplantation (SIPAT) is a validated psychosocial evaluation tool in the transplant population.Objective
We evaluated SIPAT in predicting post-left ventricular assist device (LVAD) outcomes, including cumulative re-admissions, driveline infections, pump malfunction, pump thrombosis, gastrointestinal bleeding, major bleeding, stroke and right ventricular failure.Methods
This retrospective study included 50 LVAD patients at an academic institution in the United States who had a pre-implant SIPAT score during the years 2015-2017. Patients were split into two groups based on SIPAT score, separating a “excellent”/“good” from a “minimally acceptable”/“poor” candidate. Poisson regression, using SIPAT as both a categorical and continuous variable, was used to compare the incidence rates of the primary outcome of cumulative re-admissions and secondary outcomes of LVAD complications.Results
The patient cohort was predominantly male 93.5% vs 89.4% (p = 0.629) with a median age of 67.0 vs 58.0 years (p = 0.037), planned destination therapy 48.4% vs 68.4% (p = 0.242) and median LVAD follow-up time of 241 vs 379 days (p = 0.10) in the low- and high- SIPAT groups, respectively. SIPAT was not a significant predictor for cumulative re-admissions, but there was an association between higher SIPAT scores and major bleeding.Conclusion
In this single-center retrospective study, SIPAT did not predict cumulative re-admissions. Further study is required to validate SIPAT before clinical implementation. 相似文献19.
Paul D. Stein Fadi Matta Frank R. Lawrence Mary J. Hughes 《The American journal of medicine》2018,131(9):1104-1109
Background
Immortal time bias is a possible confounding factor in cohort studies. In this investigation, we assessed mortality with inferior vena cava (IVC) filters in unstable patients with pulmonary embolism using a design to control for immortal time bias.Methods
Data were from the Premier Healthcare Database, 2010-2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used. Unstable patients with pulmonary embolism and an admitting diagnosis of pulmonary embolism, as well as a primary diagnosis of pulmonary embolism, were included. A time-dependent analysis was used according to the day of insertion of the IVC filter to control for immortal time bias.Results
Among all unstable patients, irrespective of the use of thrombolytic therapy, in-hospital all-cause mortality was 35 of 180 (19.4%) in those who received an IVC filter vs 122 of 299 (40.8%) with no filter (P < .0001). Mortality was lower in patients in whom the IVC filter was inserted on days 1 or 2 (on day 1, 21.4% compared with 40.8%, P?=?.017, and on day 2, 14.8% compared with 29.2%, P?=?.023), but it was not lower in those in whom the filter was inserted on subsequent days.Conclusions
Mortality in unstable patients with pulmonary embolism appeared to be reduced with IVC filters only when the filter was inserted on the first or second day of admission. The design used for these analyses controlled for immortal time bias as a cause of the lower mortality with IVC filters. 相似文献20.
Karl E. Minges Behnood Bikdeli Yun Wang Robert R. Attaran Harlan M. Krumholz 《The American journal of medicine》2018,131(10):1200-1208