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1.
Sanisah Saidi Siti Nur Iliani Jaafar Azlina Daud Ramli Musa Nik Noor Fatnoon Nik Ahmad 《Enfermería clínica》2018
Objective
The aim of this study was to investigate the correlation between levels of depression symptoms and age, thyroid-stimulating hormone levels, and stressful life events of the participants.Method
Patients above 18 years old, with any thyroid disorders, and without psychiatric disorders were included in this study. All participants completed the Depression Anxiety Stress Scale 21 (DASS-21). The depression symptom score was calculated and interpreted as follows: less than 9: no depression; between 10 and 13: mild depression; between 14 and 20: moderate depression; between 21 and 27: severe depression, and more than 28: extremely severe depression.Results
The total number of participants in this study was 199. There was no correlation between age, thyroid stimulating hormone, and the DASS score. There was also no significant difference in the DASS-21 score between genders. However, there was a positive correlation between depression symptoms and stressful life events (r = 0.201, n = 199, p < 0.05).Conclusions
These findings would suggest that increased depression symptom scores correlate with increased stressful life events. A larger study should be undertaken to confirm these findings. 相似文献2.
Purpose
Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients.Methods
Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression.Results
Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels.Conclusions
Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction. 相似文献3.
Mina Delavari Sakineh Mohammad-Alizadeh-Charandabi Mojgan Mirghafourvand 《Archives of Psychiatric Nursing》2018,32(2):263-267
Aim
To determine the relationship between maternal-fetal attachment and postpartum depression.Methods
This longitudinal study was done on 242 primiparous women in 2016. The data collection tools used included a socio-demographic characteristics questionnaire and Cranley's Maternal-Fetal Attachment Scale – which was completed at 32–37 weeks of pregnancy – and obstetrics information questionnaire and the Edinburgh Postnatal Depression Scale –which was completed at 6–8 weeks after birth. A multivariate linear regression was used to estimate the extent to which maternal-fetal attachment affected postpartum depression.Results
The mean Maternal-Fetal Attachment score was 90.0 (SD: 10.3) from the attainable score of 23 to 115. The mean depression score was 8.0 (SD: 3.8) from the attainable score of 0 to 30. Pearson's correlation test showed a significant inverse relationship between maternal-fetal attachment and postpartum depression (r = ? 0.196, p < 0.001). The multivariate linear regression model showed that postpartum depression correlated significantly with the mother's age and two dimensions of attachment including differentiation of self from fetus and attributing characteristics to the fetus.Conclusion
According to the findings, maternal-fetal attachment is one of the factors contributing to postpartum depression. Greater emphasis should be placed on the preparation of pregnant women for accepting their maternal role, so that the maternal-neonatal relationship can be enhanced and postpartum depression thus reduced. 相似文献4.
5.
The present cross-sectional study discussed the relationship between comorbid depression, demographic characteristics, clinical characteristics, and dietary self-efficacy among Taiwanese community-dwelling elderly patients with heart failure (HF). Specifically, the study examined 175 community-dwelling elderly patients with HF between July 2013 and June 2014. In total, 47.13% of the patients exhibited symptoms of depression. Those without a spouse, who were currently employed, who had an ejection fraction < 30%, who had been readmitted to the hospital 2 or more times, and who had a high level of HF symptom distress were significantly more likely to be depressed. Therefore, it is crucial that care programs designed for these patients include the self-management of HF symptoms, psychological consultations, cognitive behavioral therapy, and physical exercise. 相似文献
6.
Badroddin Najmi Zahra Heidari Awat Feizi Silva Hovsepian Farzaneh Momeni Seied Mohammad Masood Azhar 《Archives of Psychiatric Nursing》2018,32(3):396-402
BACKGROUND/OBJECTIVE
We aimed at assessing the parenting stress levels among mothers of children with different disabilities and its association with various mothers' psychological characteristics.METHODS
In this cross-sectional study, 302 mothers of 6–12 years old children suffering from sensory motor mental, chronic physical and psychological disabilities were enrolled. Parenting stress, coping stratyles, marital satisfaction and psychological problems of mothers were assessed using validated questionnaires.RESULTS
In this study, mothers of 302 children with sensory-motor mental (n = 64), psychological (n = 149) and chronic physical (n = 89) disabilities were investigated. Mean total score of parenting stress was significantly higher in mothers of children with psychological disabilities (F = 4.285, P < 0.05). There was positive significant relationship between emotion oriented coping style and parenting stress scores (β = 0.56, P < 0.05). Parenting stress had significant negative association with marital satisfaction (β = ? 0.3, P < 0.001).CONCLUSIONS
Our findings indicated different parenting stress levels among mothers of children with different disabilities. Mother's psychological characteristics such as marital satisfaction, psychological problems and coping styles are significant determinants of parenting stress. These findings provide baseline information for designing future interventional studies and developing more effective approaches for managing the parenting stress. 相似文献7.
8.
Blood pressure variability as an indicator of sepsis severity in adult emergency department patients
Jacob E. Nouriel Scott R. Millis Jonathon Ottolini John M. Wilburn Robert L. Sherwin James H. Paxton 《The American journal of emergency medicine》2018,36(4):560-566
Study objective
Quantify the correlation between blood pressure variability (BPV) and markers of illness severity: serum lactate (LAC) or Sequential Organ Failure Assessment (SOFA) scores.Methods
We performed a secondary analysis of data from a prospective, observational study evaluating fluid resuscitation on adult, septic, ED patients. Vital signs and fluid infusion volumes were recorded every 15 min during the 3 h following ED arrival. BPV was assessed via average real variability (ARV): the average of the absolute differences between consecutive BP measurements. ARV was calculated for the time periods before and after 3 fluid infusion milestones: 10-, 20-, and 30-mL/kg total body weight (TBW). Spearman's rho correlation coefficient analysis was utilized. A p-value < 0.05 was considered statistically significant.Results
Forty patients were included. Mean fluid infusion was 33.7 mL/kg TBW (SD 22.1). All patients received fluid infusion ≥ 10 mL/kg TBW, 25 patients received fluid infusion > 20 mL/kg TBW, and 16 patients received fluid infusion > 30 mL/kg TBW. Mean initial LAC was 4.0 mmol/L (SD 3.2). Mean repeat LAC was 3.1 mmol/L (SD 3.2), obtained an average of 6.6 h (SD 5.3) later. Mean SOFA score was 7.0 (SD 4.4). BPV correlated with both follow-up LAC (r = 0.564; p = 0.023) and SOFA score (r = 0.544; p = 0.024) among the cohort that received a fluid infusion > 20-mL/kg TBW.Conclusion
With the finding of a positive correlation between BPV and markers of illness severity (LAC and SOFA scores), this pilot study introduces BPV analysis as a real-time, non-invasive tool for continuous sepsis monitoring in the ED. 相似文献9.
Kerr CW Drake J Milch RA Brazeau DA Skretny JA Brazeau GA Donnelly JP 《Journal of pain and symptom management》2012,43(1):68-77
ContextFatigue is highly prevalent in populations with advanced illness and is often associated with depressed mood. The role of psychostimulant therapy in the treatment of these conditions remains ill defined.ObjectivesTo evaluate the response of fatigue and depression in patients with advanced illness to titrated doses of methylphenidate (MP) as compared with placebo.MethodsIn a randomized, double-blind, placebo-controlled trial, 30 hospice patients, both inpatients and outpatients, who had fatigue scores of at least four on a scale of zero to 10 (0 = no fatigue and 10 = worst fatigue), were randomly assigned to receive either 5 mg of MP at 8 am and 1 pm or placebo. Doses of MP were titrated every three days according to response and adverse effects. Home care patients were monitored daily by telephone and visited by a research nurse on Study Days 0 (baseline), 3, 7, and 14. Fatigue was assessed using the Piper Fatigue Scale as the primary outcome measure and validated by the Visual Analogue Scale for Fatigue and the Edmonton Symptom Assessment Scale (ESAS) fatigue score. Subjects in inpatient facilities were interviewed or assessed by staff on an identical schedule. Depressive symptoms were assessed by the Beck Depression Inventory-II, Center for Epidemiologic Studies Depression Scale, and the ESAS depression score. Primary statistical analysis was conducted using repeated-measures multivariate analysis of the variance.ResultsBoth MP- and placebo-treated groups had similar measures of fatigue at baseline. Patients taking MP were found to have significantly lower fatigue scores (Piper Fatigue Scale, Visual Analogue Scale for Fatigue, and ESAS) at Day 14 compared with baseline. The improvement in fatigue with MP treatment was dose-dependent; the mean average effective dose was 10 mg on Day 3 and 20 mg on Day 14 (dose range of 10–40 mg). Placebo-treated individuals showed no significant improvement in fatigue. For patients with clinically significant depression on Day 0, treatment with MP was associated with a significant reduction in all test indices for depressed mood. For the placebo group, the changes in measures of depression were less than observed in the treatment group but were inconsistent between assessment tools. No significant toxicities were observed.ConclusionMP reduced symptoms of fatigue and depression when compared with placebo. The effect of MP on fatigue was dose-dependent and sustained over the duration of the study. 相似文献
10.
Yasemin Yildirim Ozen Onen Sertoz Meltem Uyar Cicek Fadiloglu Ruchan Uslu 《European Journal of Oncology Nursing》2009,13(2):81-86
The purpose of this study was to investigate the hopelessness level and the relationship of depression, anxiety and disease-related factors to the presence of hopelessness among Turkish patients with cancer. Ninety-five patients hospitalized for cancer treatments were recruited for current study. Data were collected by using a demographic questionnaire, the Pain Numeric Rating Scale, the Beck Hopelessness Scale, and the Hospital Anxiety Depression Scale. The mean hopelessness score was 5.20 ± 4.39. There were significant differences in terms of hopelessness between the patients who had metastasis and pain as compared with those without metastasis and pain (p < 0.05). There were also found that significant correlation between hopelessness and depression and between hopelessness and anxiety (r = 0.721; r = 0.645, respectively, p < 0.001). Foreword stepwise multiple regression analysis revealed that the independent predictors of hopelessness were depression score and thr presence of metastasis (F = 55.133; p < 0.001). The findings suggest that levels of hopelessness among cancer patients with pain and metastasis are higher than among those without pain and metastasis, and that the severity of pain, anxiety, and depression is positively correlated with hopelessness level. The assessment of hopelessness, pain, anxiety and depression levels of the patients with cancer should be an essential part of health care practice. Therefore, when arranging care assessment, to evaluate hopelessness could help professionals to appropriately refer patients to further psychological care resources. 相似文献
11.
Jeff Dubin Eric Kiechle Matt Wilson Christian Timbol Rahul Bhat Dave Milzman 《The American journal of emergency medicine》2017,35(1):122-125
Background
The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience.Methods
We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE. Electrocardiograms were graded by consensus between 3 physicians. We used analysis of variance to determine the difference in mean HEART scores between providers, Fisher's exact test to determine difference in MACE by duration of training, and logistic regression to determine predictors of low-risk admission (HEART score ≤ 3).Results
The average mean HEART score for 19 full-time physicians was 4.41 (SD 0.43). Individually, there was no difference in mean scores (P = .070), but physicians with 10-15 years of experience had significantly higher mean scores than those with 0-5 years of experience (mean HEART score 4.65 vs 3.93, P = .012). Those with 10-15 years of experience also had a significantly higher proportion of MACE in their admitted cohort (15.3%, P = .002).Conclusions
More experienced providers admitted higher-risk patients and were more likely to admit patients who would experience a MACE. More research is needed to determine whether adding the HEART score for clinical decision making can be used prospectively to increase sensitivity for admitting patients at high risk for MACE and to decrease admissions for chest pain in lower-risk patients by less experienced providers. 相似文献12.
Fangyan Wang Zengyou Jin Kaiyi Shen Tingting Weng Zhisong Chen Jiahui Feng Zhengzheng Zhang Jiaming Liu Xiaolong Zhang Maoping Chu 《The American journal of emergency medicine》2017,35(3):402-409
Objectives
The depressed heart function is the main complication to cause death of septic patients in clinic. It is urgent to find effective interventions for this intractable disease. In this study, we investigated whether butyrate could be protective for heart against sepsis and the underlying mechanism.Methods
Mice were randomly divided into three groups. Model group challenged with LPS (30 mg/kg, i.p.) only. Butyrate group received butyrate (200 mg/kg·d) for 3 days prior to LPS administration (30 mg/kg). Normal group received saline only. 6 h and 12 h after LPS administration were chosen for detection the parameters to estimate the effects or mechanism of butyrate pretreatment on heart of sepsis.Results
The data showed that septic heart depression was attenuated by butyrate pretreatment through improvement of heart function depression (P < 0.01) and reduction of morphological changes of myocardium. The overexpression of proinflammatory factors, TNF-α, IL-6 and LTB4, in heart tissues induced by sepsis was significantly alleviated by butyrate pretreatment (P < 0.01). As oxidative stress indicators, SOD and CAT activity, and MDA content in heart were deteriorated by LPS challenge, which was noticeably ameliorated by butyrate pretreatment (P < 0.01 or P < 0.05).Conclusions
In conclusion, pretreatment with butyrate attenuated septic heart depression via anti-inflammation and anti-oxidation. 相似文献13.
A.J. Singer M.P. Than S. Smith P. McCullough T.W. Barrett R. Birkhahn M. Reed H.C. Thode W.D. Arnold L.B. Daniels C. de Filippi G. Headden W.F. Peacock 《The American journal of emergency medicine》2017,35(5):704-709
Study objectives
Few studies have prospectively compared multiple cardiac risk prediction scores. We compared the rate of missed acute myocardial infarction (AMI) in chest pain patients prospectively categorized as low risk by unstructured clinical impression, and by HEART, TIMI, GRACE, and EDACS scores, in combination with two negative contemporary cardiac troponins (cTn) available in the U.S.Methods
We enrolled 434 patients with chest pain presenting to one of seven emergency departments (ED). Risk scores were prospectively calculated and included the first two cTn. Low risk was defined for each score as HEART ≤ 3, TIMI ≤ 0, GRACE ≤ 50, and EDACS ≤ 15. AMI incidence was calculated for low risk patients and compared across scores using Χ2 tests and C statistics.Results
The patients' median age was 57, 58% were male, 60% white, and 80 (18%) had AMI. The missed AMI rate in low risk patients for each of the scores when combined with 2 cTn were HEART 3.6%, TIMI 0%, GRACE 6.3%, EDACS 0.9%, and unstructured clinical impression 0%. The C-statistic was greatest for the EDACS score, 0.94 (95% CI, 0.92–0.97).Conclusions
Using their recommended cutpoints and non high sensitivity cTn, TIMI and unstructured clinical impression were the only scores with no missed cases of AMI. Using lower cutpoints (GRACE ≤ 48, TIMI = 0, EDACS ≤ 11, HEART ≤ 2) missed no case of AMI, but classified less patients as low-risk. 相似文献14.
Tom Schoeman Krishnaswamy Sundararajan Svatka Micik Pooja Sarada Suzanne Edwards Alexis Poole Marianne Chapman 《Australian critical care》2018,31(6):382-389
Background
There is rising prevalence of post-traumatic-stress-disorder (PTSD) in patients and their relatives after ICU discharge. The impact of ICU diaries on PTSD in relatives of critically ill patients in Australia has not been fully evaluated.Objectives
To determine if relatives of an Australian critically ill population were interested in using ICU diaries. To determine the prevalence and impact of ICU diaries upon symptoms of PTSD, depression and anxiety in relatives of an Australian critically ill population.Methods design
Prospective, observational, exploratory study.Setting
Royal Adelaide Hospital (RAH), Adelaide, Australia.Participants
One hundred and eight consecutive patients, staying >48 h in a level 3 ICU were identified. A survey using DASS-21, IES-R questionnaires was performed on admission followed by a repeat survey 90 days post discharge from ICU. An IES-R score >33 was used to define severe PTSD symptoms. A comparison between subjects who did and did not complete their diaries was performed.Results
Forty subjects refused to participate, eight were excluded, and sixty family members were included for analysis, thirty-six of whom completed diaries. There was no statistically significant difference between PTSD symptom scores at follow-up controlling for useful diary completion (complete – see methods) and PTSD at baseline. There was a statistically significant association between PTSD and unemployment, controlling for PTSD at baseline (P value = 0.0045). Family members had significantly higher odds of PTSD at baseline compared to 3 month follow up (P value = 0.0092, Odds Ratio = 3.3, 95% CI: 1.3, 8.2). This was independent of the completeness of the diaries and adjusted for clustering on subject. Family members with incomplete diaries were less likely to report depressive symptoms at baseline (P value = 0.0218, estimate = ?4.6, 95% CI: ?8.5, ?0.7). Diary completion was not indicative of the likelihood of family members to report PTSD symptoms (P value = 0.5468, estimate = ?1.6, 95% CI: ?6.8, 3.6).Conclusion
ICU diaries were often not completed and completion did not appear to be related to the incidence of stress, anxiety, depression and PTSD symptoms in the families of patients in the ICU. This may be because Australian families are generally not interested in maintaining a diary. 相似文献15.
Catherine A. Marco Dennis Mann Jordan Rasp Michael Ballester Oswald Perkins Michael B. Holbrook Kyle Rako 《The American journal of emergency medicine》2018,36(6):1009-1013
Introduction
Treatment for pain and related conditions has been identified as the most common reason for Emergency Department (ED) visits. Concerns exist regarding the effects of opioid pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. This study was undertaken to identify cognitive skills before and after opioid pain medication in the ED setting.Methods
This was a prospective study comparing performance on the Mini-Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) before and after administration of opioid pain medications. Eligible participants included ED patients with pain, who received opioid treatment. Participants were randomized to receive either the MMSE before pain medication and the MoCA after medication, or the reverse. MoCA scores were converted to MMSE equivalent scores for comparison.Results
Among 65 participants, the median age was 36 and median triage pain score was 8. 35% of patients were considered cognitively impaired based on their MMSE score prior to any opioid medication (MMSE < 27). There was a median decrease in pain scores of 1 point following pain medication, p-value < 0.001. There was a median decrease in MMSE scores of 1 point following pain medication, p-value = 0.003. The range of change in scores (post minus pre) on the MMSE-equivalent was ? 7 to 3. 35 patients (56%) had a decrease in scores, 6 (10%) had no change, and 21 (34%) had an increase. After medication, 31 (48%) were abnormal (MMSE score < 27). No differences in MMSE scores were identified by gender, ethnicity, mode of arrival, insurance, age, triage pain scores, opioid agent given, or ED diagnosis.Conclusions
There is an association between opioid pain medication and decrease in cognitive performance on the MMSE. Because of the wide range of cognitive performance following opioid pain medication, assessment of individual patients' cognitive function is indicated. 相似文献16.
James A. Chenoweth Aaron M. Hougham Daniel K. Colby Jonathan B. Ford Jordan Sandhu Timothy E. Albertson Mark E. Sutter 《The American journal of emergency medicine》2018,36(5):777-779
Introduction
Prolongation of the QT interval is a well-recognized complication associated with many commonly used medications. Emergency Department monitoring of the corrected QT (QTc) both before and after medication administration is typically performed using the 12?lead electrocardiogram (ECG). The purpose of this study is to compare the QTc reported on the 12?lead ECG to that reported by single brand of bedside monitor.Methods
A convenience sample of emergency department patients over the age of 18 undergoing bedside monitoring and who had an ECG ordered by their treating physician were enrolled. These patients underwent simultaneous ECG and monitor QTc calculation. The primary outcome of interest was the correlation between the monitor and ECG QTc. Secondary outcomes included ability of each method to identify patients with a QTc > 500 ms and the ability of each method to identify patients with a QTc < 450 ms.Results
A total of 125 patients had simultaneous ECG and monitor QTc measurements recorded. There was moderate correlation between the monitor and ECG QTc (Pearson's correlation coefficient = 0.55). The median difference between the ECG QTc and the monitor QTc (ECG QTc minus monitor QTc) was ? 7 ms (IQR ? 23 to 11 ms).Conclusion
We found that there was moderate correlation between the QTc reported on the 12 lead ECG and that reported by the bedside monitor. This correlation is not strong enough to support the use of the bedside monitor as a substitute for the 12?lead ECG when evaluating a patient's QTc. 相似文献17.
Shervin Farahmand Hadid Hamrah Mona Arbab Mojtaba Sedaghat Hamed Basir Ghafouri Shahram Bagheri-Hariri 《The American journal of emergency medicine》2018,36(7):1231-1235
Introduction
This study was designed to assess the possible superiority of intravenous lidocaine to morphine for pain management.Methods
This was a randomized double blind controlled superiority trial, carried on in the emergency department (ED). Traumatic patients older than 18-year-old with the complaint of acute pain greater than 4 on a numeric rating scale (NRS) from 0 to 10 on their extremities were eligible. One group received IV lidocaine (1.5 mg/kg), and the other received IV morphine (0.1 mg/kg). Pain scores and adverse effects were assessed at 15, 30, 45 and 60 minutes and patients' satisfaction was evaluated two hours later. A minimum pain score reduction of 1.3 from baseline was considered clinically significant.Results
Fifty patients with the mean age of 31.28 ± 8.7 were enrolled (78% male). The demographic characteristics and pain scores of the two groups was similar. The on-arrival mean pain scores in two groups were, lidocaine: 7.9 ± 1.4 and morphine: 8.0 ± 1.4 (p = 0.57) and after 1 hour were, lidocaine: 2.28 ± 1.2 and morphine: 3.2 ± 1.7. Although the pain score decreased significantly in both group (p = 0.027), there were not any clinically and statistically significant difference between the two groups (p = 0.77). Patients' satisfaction with pain management in both groups were almost similar (p = 0.49).Conclusion
The reduction in pain score using IV lidocaine is not superior to IV morphine in adult ED patients with traumatic limb pain. 相似文献18.
ObjectiveDepression is a common bio-psycho-social problem in hemodialysis (HD) patients. Traditional Chinese medicine has been used for symptom management in patients with depression. Identification of the specific constitution in traditional Chinese medicine is critical for personalized care. However, the association between depression and specific constitution in HD patients is unknown.MethodsWe conducted a cross-sectional study in all chronic HD patients (HD for more than 3 months) at China Medical University Hospital in Taiwan. The depression symptom severity was determined using the Beck Depression Inventory II (BDI-II). Clinical patterns in Chinese medicine were determined using the Constitution in Chinese Medicine Questionnaire. The association between constitution and depression was analyzed using logistic regression.ResultsWe recruited 467 chronic hemodialysis patients, including 219 females and 248 males, with a mean age of 63 ± 12 years. The mean duration of HD was 5.8 years. The mean score for the BDI-II was 11 (interquartile range 8–14). The major constitution was Yang-deficiency (43.7%) among these chronic HD patients. Qi-deficiency was correlated with a duration of HD of more than 5.8 years (p = 0.04). Qi-deficiency [odds ratio (OR): 4.05, 95% confidence interval (CI): 1.69–9.72, p < 0.01] was also associated with depression in logistic regression with adjustments for confounders, including calcium, phosphorus and hemoglobin levels.ConclusionQi-deficiency constitution in Chinese medicine is associated with depression in chronic HD patients. Further studies are needed to determine whether treating Qi-deficiency integrating Chinese medicine treatment can improve patients’ depression symptoms. 相似文献
19.
Hiroaki Takada Toru Hifumi Hayato Yoshioka Ichiro Okada Nobuaki Kiriu Junichi Inoue Kohei Morimoto Junichi Matsumoto Yuichi Koido Hiroshi Kato 《The American journal of emergency medicine》2018,36(7):1155-1159
Objectives
The inferior vena cava (IVC) diameter is associated with shock and increased mortality in trauma patients. However, there are no reports examining the association between the IVC diameter and massive transfusion (MT) requirements in trauma patients. The aim of this study was to evaluate the association between IVC diameter and MT requirements in patients with blunt trauma.Methods
We retrospectively reviewed all patients who were consecutively hospitalized with blunt trauma (Injury Severity Score [ISS] ≥ 16) between from November 1, 2011 to March 30, 2016. Univariate and multivariate analyzes were performed to identify the independent predictors of MT (defined as > 10 units of red cell concentrate transfusions within 24 h of admission). Receiver operating characteristic curve and the area under the curve (AUC) were estimated.Results
Of the 222 patients included in this study, MT occurred in 22.5% patients. On multiple regression analysis, IVC diameter [Odds ratio (OR), 0.88; 95% confidence interval (CI), 0.80–0.96; p < 0.01], fibrin degradation product (FDP; OR, 1.01; 95% CI, 1.00–1.01; p < 0.01), and fibrinogen level (OR, 0.99; 95% CI, 0.98–1.00; p < 0.01) were strong predictors of MT. IVC diameter demonstrated moderate accuracy (AUC, 0.74; cutoff level, 13.0 mm; sensitivity, 67%; specificity, 73%). Combined cutoff levels of FDP < 80.5 μg/ml, fibrinogen ≥ 165 mg/dl, and IVC diameter ≥ 13 mm could also determine how unnecessary a MT was with 100% accuracy.Conclusions
Initial IVC diameter is a predictor of MT in blunt trauma patients. 相似文献20.
Negar Firouzabadi Nader Tajik Ehsan Bahramali Hooman Bakhshandeh Soltan Ahmed Ebrahimi Mohsen Maadani Maryam Rasoulian Tahereh Mobasheri Massoumeh Shafiei 《Clinical biochemistry》2012,45(16-17):1347-1352
ObjectivesMajor depressive disorder (MDD) is an increasingly recognized risk factor of coronary artery disease (CAD). The aim of this study was to assess the relationship between renin-angiotensin system (RAS) genetic polymorphisms and CAD in a sample of depressed Iranian patients.Design and methodsA total of 191 patients with a history of unipolar depression were enrolled in a case/control study. The presence of MDD was reconfirmed at study entry using DSM-IV criteria and CAD was diagnosed by coronary angiography. Genotyping of six RAS genes polymorphisms was performed by a modified PCR-RFLP method.ResultsDD genotype of ACE I/D was independently associated with the incidence of CAD in depressed patients (P = 0.011, OR = 9.41, 95% CI: 1.68–17.81). Moreover, serum creatinine (P = 0.033, OR = 11.91, 95%CI: 7.23–15.62) was an independent predictor of CAD among depressed individuals.ConclusionACE I/D polymorphism may play a major role in the development of CAD amongst Iranian depressed patients. 相似文献