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1.
Anupama Kizhakkeveettil Kevin A. Rose Gena E. Kadar Eric L. Hurwitz 《Journal of manipulative and physiological therapeutics》2017,40(3):201-213
Objectives
The objective of this study was to assess the feasibility of conducting a large-scale randomized controlled trial (RCT) examining whether an integrative care model combining spinal manipulative therapy (SMT) and acupuncture can lead to better outcomes for low back pain (LBP) than either therapy alone.Methods
This study was conducted at a complementary and alternative medicine university health center. Participants with acute or chronic LBP were randomized to (1) acupuncture, (2) SMT, or (3) integrative acupuncture and SMT groups. Treatments were provided over 60 days by licensed doctors of chiropractic and acupuncturists. Acupuncture treatments consisted of needling of acupoints combined with electrotherapy, moxibustion, cupping, and Tui Na. SMT used specific contact points on vertebral processes, along with soft tissue therapy and physiotherapy. Primary outcome measures were the Roland-Morris LBP Disability Questionnaire and 0 to 10 Numeric Rating Scale for LBP.Results
Participants in all 3 groups experienced clinically meaningful improvements in the primary outcome measures; however, no between-group differences in outcomes were apparent.Conclusions
This study indicated that it is feasible to conduct an RCT to compare the effectiveness of integrative acupuncture and SMT for LBP to either therapy alone. Future studies should include a larger sample to increase the power for detecting clinically meaningful differences between groups. 相似文献2.
Geng Qian Rong-jie Jin Zhen-hong Fu Yong-qiang Yang Hong-liang Su Wei Dong Jun Guo Jing Jing Yuan-lin Guo Yun-dai Chen 《The American journal of emergency medicine》2017,35(4):589-593
Background
Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with poor prognosis. The aim of this study was to develop and validate practical risk score to predict the CR after STEMI.Methods
A total of 11,234 STEMI patients from 7 centers in China were enrolled in our study, we firstly developed a simplified fast-track CR risk model from 7455 STEMI patients, and then prospectively validated the CR risk model using receiver-operating characteristic (ROC) curves by the other 3779 consecutive STEMI patients. This trial is registered with ClinicalTrials.gov, number NCT02484326.Results
The incidence of CR was 2.12% (238/11,234), and the thirty-day mortality in CR patients was 86%. We developed a risk model which had 7 independent baseline clinical predictors (female sex, advanced age, anterior myocardial infarction, delayed admission, heart rate, elevated white blood cell count and anemia). The CR risk score system differentiated STEMI patients with incidence of CR ranging from 0.2% to 13%. The risk score system demonstrated good predictive value with area under the ROC of 0.78 (95% CI 0.73–0.84) in validation cohort. Primary percutaneous coronary intervention decreased the incidence of CR in high risk group (3.9% vs. 6.2%, p < 0.05) and very high risk group (8.0% vs. 15.2%, p < 0.05).Conclusions
A simple risk score system based on 7 baseline clinical variables could identify patients with high risk of CR, for whom appropriate treatment strategies can be implemented. 相似文献3.
Yi-Ping Chang Kao-Shang Shih Hongsen Chiang Hsiao-Li Ma Leou-Chyr Lin Wei-Chen Peng Che-Sheng Wen Hsing-Kuo Wang 《PM & R》2017,9(1):32-39
Background
Early microcirculatory responses after experimental tenotomy are critical to the healing of tendons and their ultimate tensile strength. The effects of changes in microcirculation on the outcomes of tendon healing, however, have not been determined.Objectives
To assess microcirculation values in injured Achilles tendons in the first 3 months after surgical repair and to correlate the inter-limb microcirculatory changes with functional outcomes at 3 and 6 months after surgery.Design
Case-control study.Setting
A university sports physiotherapy laboratory.Participants
Thirteen subjects (median age: 45 years; range: 34.8-51.9 years) with a repaired Achilles tendon were recruited.Methods or Intervention
Surgical repair.Main Outcome Measurements
Measurements were obtained at 1, 2, 3, and 6 months after surgery. Bilateral measurements of tendon microcirculation (total hemoglobin [THb] and oxygen saturation [StO2]) were recorded at the first 3 time points, whereas outcome measures of a Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire, one-leg hopping distance, the star excursion balance test, and the heel raise index were conducted at the third and fourth time points. Correlations between the inter-limb microcirculatory changes, eg, between the measurements at 2 months and 1 month (2-1) after surgery, at 3 months and 2 months (3-2) after surgery, and at 3 months and 1 month (3-1) after surgery, and the outcome measures were investigated.Results
Compared with the noninjured tendons, the repaired Achilles demonstrated greater THb (at 1, 2, and 3 months; P = .017, .008, and .012 respectively) and StO2 (at 3 months; P = .017). Furthermore, the THb2-1 and THb3-2, StO2 2-1, and StO2 3-2 showed correlations with the heel raise index, differences in the star excursion balance test and one-leg hopping distance between the noninjured leg and injured leg, and Taiwan Chinese version of the Victorian Institute of Sport Assessment Scale-Achilles questionnaire scores (rho ?0.921 to 0.855).Conclusions
Changes in the inter-limb microcirculation shortly after Achilles repair were correlated with subsequent symptoms and functional symmetry.Level of Evidence
III 相似文献4.
Carolina Santiago de Araújo Pio Susan Marzolini Maureen Pakosh Sherry L. Grace 《Mayo Clinic proceedings. Mayo Clinic》2017,92(11):1644-1659
Objective
To ascertain the effect of cardiac rehabilitation (CR) dose (ie, duration × frequency/wk; categorized as low [<12 sessions], medium [12-35 sessions], or high [≥36 sessions]) on mortality and morbidity.Methods
The Cochrane, CINAHL, EMBASE, PsycINFO, and MEDLINE databases were systematically searched from inception through November 30, 2015. Inclusion criteria included randomized or nonrandomized studies with a minimum CR dose of 4 or higher and presence of a control/comparison group. Citations were considered for inclusion, and data were extracted in included studies independently by 2 investigators. Studies were pooled using random-effects meta-analysis and meta-regression where warranted (covariates included study quality, country, publication year, and diagnosis).Results
Of 4630 unique citations, 33 trials were included comparing CR to usual care (ie, no dose). In meta-regression, greater dose was significantly related to lower all-cause mortality (high: ?0.77; SE, 0.22; P<.001; medium: ?0.80; SE, 0.21; P<.001) when compared with low dose. With regard to morbidity, meta-analysis revealed that dose was significantly associated with fewer percutaneous coronary interventions (high: relative risk, 0.65; 95% CI, 0.50-0.84; medium/low: relative risk, 1.04; 95% CI, 0.74-1.48; between subgroup difference P=.03). This reduction was also significant in meta-regression (high vs medium/low: ?0.73; SE, 0.20; P<.001). Publication bias was not evident. No dose-response association was found for cardiovascular mortality, all-cause hospitalization, coronary artery bypass graft surgery, or myocardial infarction.Conclusion
A minimum of 36 CR sessions may be needed to reduce percutaneous coronary interventions. Future studies should examine the effect of actual dose of CR, and trials are needed comparing different doses.5.
Sean P. Wilson Taher Vohra McKenna Knych Jared Goldberg Christopher Price Sean Calo Meredith Mahan Joseph Miller 《The American journal of emergency medicine》2017,35(5):701-703
Introduction
Delay in current nucleic acid amplification testing for Neisseria gonorrhoeae and Chlamydia trachomatis has led to recommendations for presumptive treatment in patients with concern for infection and unreliable follow-up. In the urban setting, it is assumed that many patients have unreliable follow-up, therefore presumptive therapy is thought to be used frequently. We sought to measure the frequency of disease and accuracy of presumptive treatment for these infections.Methods
This was an observational cohort study performed at an urban academic Level 1 trauma center ED with an annual census of 95,000 visits per year. Testing was performed using the APTIMA Unisex swab assay (Gen-Probe Incorporated, San Diego, CA). Presumptive therapy was defined as receiving treatment for both infections during the initial encounter without confirmation of diagnosis.Results
A total of 1162 patients enrolled. Infection was present in 26% of men, 14% of all women and 11% of pregnant women. Despite high frequency of presumptive treatment, > 4% of infected patients in each category went untreated.Conclusion
Inaccuracy of presumptive treatment was common for these sexually transmitted infections. There is an opportunity to improve diagnostic accuracy for treatment. 相似文献6.
Steve Karas Albert Pannone 《Journal of manipulative and physiological therapeutics》2017,40(2):118-125
Objective
The purpose of this scoping review was to identify any available evidence regarding T4 syndrome.Methods
Databases were searched from inception through October 2015 and included PubMed, CINAHL, PEDro, Google Scholar, Osteomed-DR; Index to Chiropractic Literature, PROSPERO, and Chiroaccess. All studies with information about T4 syndrome that were published in a peer-reviewed journal or textbook were included. The information was organized in the format of the International Classification of Functioning, Disability, and Health. Studies were ranked using Sackett’s levels of evidence.Results
Eight articles met the inclusion criteria. Studied areas included theoretical pathophysiology and symptom etiology, diagnosis, symptoms, treatment, and outcomes of T4 syndrome. The methodological quality of included studies was low.Conclusion
T4 syndrome is a diagnosis of exclusion that appears to be rare. It has been treated conservatively in the literature using mobilization and exercise. There is no high-quality evidence published about T4 syndrome, and we caution clinicians when considering it as a primary means to determine patient care. 相似文献7.
8.
Daniel J. Berman Hamza Ijaz Mohammad Alkhunaizi Paige E. Kulie Khashayar Vaziri Lorna M. Richards Andrew C. Meltzer 《The American journal of emergency medicine》2017,35(12):1919-1921
Objectives
Small bowel obstructions (SBOs) occur 300,000 times annually leading to $1.3 billion in cost. Approximately 20% of patients require a laparotomy to manage the obstruction and either prevent or treat intestinal ischemia. Early management may play a role in reducing these complications. Nasogastric decompression is commonly used for early management. Our primary objective was to determine if NGD was associated with lower rates of surgery, bowel ischemia or length of stay.Methods
We retrospectively enrolled 181 ED patients with SBO from 9/2013 to 9/2015 in order to determine if nasogastric decompression was associated with a reduction in rates of surgery, bowel ischemia or hospital length of stay.Results
Our subject population was 46% female, median age of 60.27% of patients received surgery. Nasogastric decompression was used in 51% of patients. There was no association with a reduction in rates of surgery (p = 0.20) or bowel resection (p = 0.41) with patients receiving Nasogastric decompression, and no difference in baseline characteristics. Nasogastric decompression was associated with a two-day increase in hospital length of stay. Factors that were significantly associated with surgical exploration of SBO were: female (OR 2.32 (95% CI: 1.01–5.31)) and “definite SBO” on CT (OR 3.29 (95% CI: 1.18–9.20)). Abnormal vital signs, obstipation, and lab values were not predictors of surgery.Conclusion
Nasogastric decompression is not associated with a reduction in need for surgery or bowel resection, but is associated with a 2-day increase in median LOS. Women were more likely to receive surgery than men. 相似文献9.
Megan Sutter Laiene Olabarrieta Landa Amilkar Calderón Chagualá Helmer Chacón Peralta Gina Vergara Torres Paul B. Perrin Juan Carlos Arango-Lasprilla 《PM & R》2017,9(1):8-14
Background
Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.Objective
To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.Design
Cross-sectional study.Setting
The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.Participants
Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).Methods
Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnairesMain Outcome Measurements
Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.Results
Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.Conclusions
This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.Level of Evidence
I 相似文献10.
Ruth Ann LaMar 《Teaching and Learning in Nursing》2017,12(1):53-58
Objective
Registered nurses must remain current with evidence-based practice knowledge to meet job demands in an evolving health care climate. This pilot study's purpose was to investigate a virtual journal club's effect on satisfaction, knowledge, and practice.Background
On-line learning is used to convey information while meeting diverse learner needs, and journal clubs are used to disseminate and discuss evidence-based practice knowledge. Combining the 2 concepts into a virtual journal club creates an opportunity to meet learner needs while discussing information that promotes evidence-based practice knowledge and implementation.Setting/Population
Sixteen critical care nurses from one midwestern teaching hospital's intensive care unit.Methodology
Researchers used the Kirkpatrick Learning Evaluation Model in a 4-week-long, mixed methods pilot study. Researchers presented 1 article about sepsis in an on-line discussion forum. Nurses took a pretest before participation and a Likert-type satisfaction survey and posttest after participation. Two weeks following journal club participation, researchers sent participants e-mails asking if/how nurses applied knowledge to practice. Researchers analyzed pre?/posttest results using McNemar's Test.Results
Sixteen nurses actively participated. Ten nurses took satisfaction surveys, choosing mostly 4 s (agree) and 5 s (strongly agree), reflecting statistically significant satisfaction. Sixteen nurses took pre- and posttests and demonstrated improvement in knowledge; however, only answers to 2 questions demonstrated statistically significant improvement. Eight nurses responded to the evaluation surveys with comments surrounding increased confidence in caring for septic patients and increased awareness of symptomology, testing, and treatments. Two nurses noted that their practice was not impacted by participation.Practice Implications
Choose relevant articles and make hard copies of the article available for easy access. The virtual journal club discussion forum should promote ease of use and be moderated by someone well positioned to participate frequently and knowledgably. In addition, consider offering continuing education credits to encourage participation. 相似文献11.
Kelvin J. Murray Tom Molyneux Michael R. Le Grande Aurora Castro Mendez Franz K. Fuss Michael F. Azari 《Journal of manipulative and physiological therapeutics》2017,40(5):320-329
Objective
The purpose of this study was to evaluate the correlation between mild leg length discrepancy (LLD) and degenerative joint disease (DJD) or osteoarthritis.Methods
We evaluated standard postural lumbopelvic radiographs from 255 adults (121 women and 134 men) who had presented with spinal pain for chiropractic care. Symmetry of femoral head diameters was used to exclude magnification errors. Pearson’s partial correlation was used to control for age and derive effect sizes for LLD on DJD in the hip and lower lumbar motion segments. Krippendorff’s α was used for intraobserver and interobserver reliability.Results
A strong correlation was found between LLD and hip DJD in men (r = 0.532) and women (r = 0.246). We also found a strong correlation between LLD and DJD at the L5-S1 motion segment in men (r = 0.395) and women (r = 0.246). At the L4-5 spinal level this correlation was much attenuated in men (r = 0.229) and women (r = 0.166).Conclusions
These findings suggest an association between LLD and hip and lumbar DJD. Cause–effect relationships between mild LLD and DJD deserve to be properly evaluated in future longitudinal cohort studies. 相似文献12.
Dong Hun Lee Byung Kook Lee Kyung Woon Jeung Yong Hun Jung Sung Min Lee Yong Soo Cho Seong-Woo Yun Yong Il Min 《The American journal of emergency medicine》2017,35(11):1617-1623
Purpose
We aimed to examine the serial changes in coagulofibrinolytic markers that occurred after the restoration of spontaneous circulation (ROSC) in cardiac arrest patients, who were treated with targeted temperature management (TTM). We also evaluated the association between the disseminated intravascular coagulation (DIC) score and clinical outcomes.Methods
This was a single-centre, retrospective observational study that included cardiac arrest patients who were treated with TTM from May 2012 to December 2015. The prothrombin time (PT) and partial thromboplastin time (PTT), along with the levels of fibrinogen, fibrin degradation products (FDP), and D-dimer were obtained after ROSC and on day 1, 2, and 3. The DIC score was calculated after ROSC. The primary outcome was the neurologic outcome at discharge and the secondary outcome was the 6-month mortality.Results
This study included 317 patients. Of these, 222 (70.0%) and 194 (61.2%) patients had a poor neurologic outcome at discharge and 6-month mortality, respectively. The PT, PTT, and fibrinogen level significantly increased over time, while the FDP and D-dimer levels decreased during first three days after ROSC. Multivariate logistic analyses revealed that the DIC score remained a significant predictor for poor neurologic outcome (odds ratio [OR], 1.800; 95% confidence interval [CI], 1.323–2.451) and 6-month mortality (OR, 1.773; 95% CI, 1.307–2.405).Conclusion
The activity of coagulation and fibrinolysis decreased over time. An increased DIC score was an independent prognostic factor for poor neurologic outcome and 6-month mortality. 相似文献13.
Brian Clemency Kaori Tanaka Paul May Johanna Innes Sara Zagroba Jacqueline Blaszak David Hostler Derek Cooney Kevin McGee Heather Lindstrom 《The American journal of emergency medicine》2017,35(2):222-226
Introduction
Guidelines endorse intravenous (IV) and intraosseous (IO) medication administration for cardiac arrest treatment. Limited clinical evidence supports this recommendation. A multiagency, retrospective study was performed to determine the association between parenteral access type and return of spontaneous circulation (ROSC) in out of hospital cardiac arrest.Methods
This was a structured, retrospective chart review of emergency medical services (EMS) records from three agencies. Data was analyzed from adults who suffered OHCA and received epinephrine through EMS established IV or IO access during the 18-month study period. Per regional EMS protocols, choice of parenteral access type was at the provider's discretion. Non-inferiority analysis was performed comparing the association between first access type attempted and ROSC at time of emergency department arrival.Results
1310 subjects met inclusion criteria and were included in the analysis. Providers first attempted parenteral access via IV route in 788 (60.15%) subjects. Providers first attempted parenteral access via IO route in 552 (39.85%) subjects. Rates of ROSC at time of ED arrival were 19.67% when IV access was attempted first and 19.92% when IO access was attempted first. An IO first approach was non-inferior to an IV first approach based on the primary end point ROSC at time of emergency department arrival (p = 0.01).Conclusion
An IO first approach was non-inferior to an IV first approach based on the end point ROSC at time of emergency department arrival. 相似文献14.
Danilo de Oliveira Silva Fernando Henrique Magalhães Nathálie Clara Faria Deisi Ferrari Marcella Ferraz Pazzinatto Evangelos Pappas Fábio Mícolis de Azevedo 《Archives of physical medicine and rehabilitation》2017,98(1):114-119
Objective
To determine the association between the amplitude of vastus medialis (VM) Hoffmann reflex (H-reflex) and pain level, self-reported physical function, and chronicity of pain in women with patellofemoral pain (PFP).Design
Cross-sectional study.Setting
Laboratory of biomechanics and motor control.Participants
Women diagnosed with PFP (N=15) aged 18 to 35 years.Interventions
Not applicable.Main Outcome Measures
Data on worst pain level during the previous month, self-reported physical function, and symptom duration (chronicity) were collected from the participants. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve and peak-to-peak amplitudes of normalized maximal H-reflexes (maximal Hoffmann reflex/maximal motor wave ratios) of the VM were calculated. A Pearson product-moment correlation matrix (r) was used to explore the relations between the amplitude of VM H-reflex and worst pain during the previous month, self-reported function, and chronicity of pain.Results
Strong negative correlations were found between the amplitude of VM H-reflex and worst pain in the previous month (r=?.71; P=.003) and chronicity (r=?.74; P=.001). A strong positive correlation was found between the amplitude of VM H-reflex and self-reported physical function (r=.62; P=.012).Conclusions
The strong and significant relations reported in this study suggest that women with PFP showing greater VM H-reflex excitability tend to have lower pain, better physical function, and more recent symptoms. Therefore, rehabilitation strategies designed to increase the excitability of the monosynaptic stretch reflex should be considered in the treatment of women with PFP if their effectiveness is demonstrated in future studies. 相似文献15.
16.
Gardner Yost Laura Coyle Kristen Milkevitch Roy Adair Antone Tatooles Geetha Bhat 《PM & R》2017,9(1):40-45
Background
Left ventricular assist devices (LVADs) have become an increasingly popular and effective means for treating advanced heart failure. LVAD implantation requires extensive surgery and postoperative rehabilitation. The Functional Independence Measure (FIM) has been used to quantify functional gains in numerous patient populations, including those with stroke and spinal cord injury. This study investigated functional improvements in patients undergoing LVAD implantation using the FIM score.Objective
To assess functional improvements in patients with advanced heart failure who underwent LVAD implantation.Design
Retrospective.Setting
Inpatient rehabilitation unit.Subjects
Ninety consecutive patients who received acute inpatient rehabilitation after continuous flow LVAD implantation.Methods
Demographic, laboratory, and functional outcomes data including inpatient rehabilitation unit (IRU) length of stay (LOS), discharge disposition, and FIM score were collected for all patients. Paired t-tests were used to assess change in functional measures and laboratory data.Main Outcome Measures
Primary outcome measures included FIM gain, FIM efficiency, discharge disposition, rates of readmission after discharge from rehabilitation, and LOS in the rehabilitation unit.Results
The FIM gain was statistically significant at 28.4 ± 12.3 (P < .001) and compared favorably with benchmarks for mean FIM gains at our facility (26.4), regionally (21.5), and nationally (22.7) for patients admitted to IRUs with a cardiac diagnosis. FIM efficiency (FIM gain/IRU LOS) was 1.9 ± 1.0 compared with the mean FIM efficiency at our facility (2.2), regionally (2.1), and nationally (2.2). Seventy-four percent (n = 67) of patients were discharged directly home after inpatient rehabilitation, 17% (n = 16) were readmitted to the acute hospital service, and 8% (n = 7) required additional rehabilitation at a subacute rehabilitation facility. The IRU LOS was 16.2 ± 6.9 days.Conclusions
Our study indicates that most patients with an LVAD achieve clinically meaningful functional gains from acute inpatient rehabilitation, with the majority of patients being discharged home. Further studies need to be performed to analyze clinical outcomes after acute inpatient rehabilitation.Level of Evidence
IV 相似文献17.
John B. Harringa Rebecca L. Bracken Scott K. Nagle Mark L. Schiebler Brian W. Patterson James E. Svenson Michael D. Repplinger 《The American journal of emergency medicine》2017,35(1):146-149
Objective
Our aim was to validate the previously published claim of a positive relationship between low blood hemoglobin level (anemia) and pulmonary embolism (PE).Methods
This was a retrospective study of patients undergoing cross-sectional imaging to evaluate for PE at an academic medical center. Patients were identified using billing records for charges attributed to either magnetic resonance angiography or computed tomography angiography of the chest from 2008 to 2013. The main outcome measure was mean hemoglobin levels among those with and without PE. Our reference standard for PE status included index imaging results and a 6-month clinical follow-up for the presence of interval venous thromboembolism, conducted via review of the electronic medical record. Secondarily, we performed a subgroup analysis of only those patients who were seen in the emergency department. Finally, we again compared mean hemoglobin levels when limiting our control population to an age- and sex-matched cohort of the included cases.Results
There were 1294 potentially eligible patients identified, of whom 121 were excluded. Of the remaining 1173 patients, 921 had hemoglobin levels analyzed within 24 hours of their index scan and thus were included in the main analysis. Of those 921 patients, 107 (11.6%; 107/921) were positive for PE. We found no significant difference in mean hemoglobin level between those with and without PE regardless of the control group used (12.4 ± 2.1 g/dL and 12.3 ± 2.0 g/dL [P = .85], respectively).Conclusions
Our data demonstrated no relationship between anemia and PE. 相似文献18.
Nathalie Lund Klas Gränsbo Camilla Wernersson Olle Melander 《The American journal of emergency medicine》2017,35(4):610-614
Background
Acute dyspnea affects a large heterogeneous patient group with high mortality and readmission rates.Purpose
To investigate if cardiometabolic biomarkers and clinical characteristics predict readmission and death in patients hospitalized for acute dyspnea.Methods
65 dyspnea patients at a general internal medicine ward were followed for six months. The combined endpoint was readmission or death.Measurements and results
Cardiometabolic biomarkers at admission were related to the endpoint in Cox proportional hazard models (adjusted for sex, age, oxygen saturation, respiratory rate and C-reactive protein (CRP)). The biomarkers tissue-type plasminogen activator (tPA), prolactin (PRL), tumor necrosis factor receptor superfamily member 6 (FAS) and C-C motif chemokine 3 (CCL3) were independently and significantly related to the endpoint and combined into a biomarker risk score (BRS). Each SD increment of the BRS conferred a hazard ratio (HR) of 2.13 (1.39–3.27) P = 0.001. The top vs bottom tertile of the BRS conferred a HR of 4.75 (1.93–11.68) P = 0.001. Dyspnea severity was also associated with worse outcome, HR = 3.43 (1.28–9.20) P = 0.014. However, when mutually adjusted the BRS remained significant (P = 0.004) whereas dyspnea severity was not. The BRS was related to the endpoint among patients with mild to moderate dyspnea (P = 0.016) but not among those with severe dyspnea.Conclusion
A score of tPA, PRL, FAS and CCL3 predicts 6-month death and readmission in patients hospitalized for acute dyspnea and may prove useful to optimize length of stay and follow-up. Although the BRS outweighs dyspnea severity in prediction of the endpoint, its prognostic role is strongest in mild-moderate dyspnea. 相似文献19.
Daisuke Kudo Shigeki Kushimoto Atsushi Shiraishi Hiroshi Ogura Akiyoshi Hagiwara Daizoh Saitoh 《The American journal of emergency medicine》2017,35(1):62-65
Purpose
The purpose of this study was to determine whether preinjury medication with antithrombotic agents was related to an increase in hemostatic interventions in patients with severe trauma without traumatic brain injury.Methods
Consecutive trauma patients who were admitted to the emergency departments of the study hospitals with an injury severity score ≥16 were enrolled in this retrospective, observational, multicenter study of coagulation in the acute phase of severe trauma. Patients without a traumatic brain injury with an abbreviated injury scale ≥3 were evaluated. Patients were divided into those with and those without preinjury medication with antithrombotic agents. The impact of preinjury antithrombotic medication on the composite primary outcome, defined as administration of fresh frozen plasma ≥10 U and/or hemostatic treatment (surgery and/or interventional radiology) within 24 hours, was analyzed.Results
The preinjury medication group consisted of 20 (6.4%) of the total 312 patients. Preinjury medication was one of the independent risk factors for the composite outcome (odds ratio, 3.16; 95% confidence interval, 1.08-9.10; P < .05) adjusting for age, sex, and injury severity score on multivariate analysis. Preinjury antithrombotic therapy was also associated with hemostatic treatments within 24 hours (odds ratio, 3.40; 95% confidence interval, 1.16-9.85; P = .026). Survival time was not different between the 2 groups on Cox regression analysis.Conclusions
Preinjury antithrombotic medication in severe trauma patients without traumatic brain injury may be associated with a higher risk of hemostatic interventions. 相似文献20.