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951.
Fernando G. Zampieri Theodore J. Iwashyna Elizabeth M. Viglianti Leandro U. Taniguchi William N. Viana Roberto Costa Thiago D. Corrêa Carlos Eduardo N. Moreira Marcelo O. Maia Giulliana M. Moralez Thiago Lisboa Marcus A. Ferez Carlos Eduardo F. Freitas Clayton B. de Carvalho Bruno F. Mazza Mariza F. A. Lima Grazielle V. Ramos Aline R. Silva Fernando A. Bozza Jorge. I. F. Salluh Marcio Soares for the ORCHESTRA Study Investigators 《Intensive care medicine》2018,44(9):1512-1520
Purpose
Frail patients are known to experience poor outcomes. Nevertheless, we know less about how frailty manifests itself in patients’ physiology during critical illness and how it affects resource use in intensive care units (ICU). We aimed to assess the association of frailty with short-term outcomes and organ support used by critically ill patients.Methods
Retrospective analysis of prospective collected data from 93 ICUs in Brazil from 2014 to 2015. We assessed frailty using the modified frailty index (MFI). The primary outcome was in-hospital mortality. Secondary outcomes were discharge home without need for nursing care, ICU and hospital length of stay (LOS), and utilization of ICU organ support and transfusion. We used mixed logistic regression and competing risk models accounting for relevant confounders in outcome analyses.Results
The analysis consisted of 129,680 eligible patients. There were 40,779 (31.4%) non-frail (MFI?=?0), 64,407 (49.7%) pre-frail (MFI?=?1–2) and 24,494 (18.9%) frail (MFI?≥?3) patients. After adjusted analysis, frailty was associated with higher in-hospital mortality (OR 2.42, 95% CI 1.89–3.08), particularly in patients admitted with lower SOFA scores. Frail patients were less likely to be discharged home (OR 0.36, 95% CI 0.54–0.79) and had higher hospital and ICU LOS than non-frail patients. Use of all forms of organ support (mechanical ventilation, non-invasive ventilation, vasopressors, dialysis and transfusions) were more common in frail patients and increased as MFI increased.Conclusions
Frailty, as assessed by MFI, was associated with several patient-centered endpoints including not only survival, but also ICU LOS and organ support.952.
Joanna E. Long Saif Khairat Elizabeth Chmelo Mary H. Palmer 《Geriatric nursing (New York, N.Y.)》2018,39(2):230-237
The purpose of this study was to explore the efficacy and acceptability of an innovative, electronically delivered self-management intervention for urinary incontinence (UI) that included daily mindfulness practice, completion of sequential bladder diaries, and bladder health education to improve UI in older women living independently in a retirement community. A mixed methods pilot study was conducted over ten weeks using a custom website or CD. Ten women were recruited and 8 completed the study; 5 of those (71%) experienced fewer daily UI episodes post intervention (p = 0.055). The women also reported a statistically significant decrease in the impact UI had on their everyday life (p = 0.04). Seventy-one percent (N = 5) reported subjective improvement in UI, and high acceptability scores also were achieved. The intervention was both effective in helping older women self-manage UI and acceptable to the population group. Further research is needed with a larger and diverse population of older women. 相似文献
953.
Seelwan Sathitratanacheewin Ruth A. Engelberg Lois Downey Robert Y. Lee James A. Fausto Helene Starks Ben Dunlap James Sibley William Lober Elizabeth T. Loggers Nita Khandelwal J. Randall Curtis 《Journal of pain and symptom management》2018,55(1):75-81
Context
Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.Objectives
To examine recent temporal trends in place of death, and both hospital and intensive care unit (ICU) utilization, for age-stratified decedents with chronic, life-limiting diagnoses (<65 vs. ≥65 years) who received care in a large healthcare system.Methods
Retrospective cohort using death certificates and electronic health records for 22,068 patients with chronic illnesses who died between 2010 and 2015. We examined utilization overall and stratified by age using multiple regression.Results
The proportion of deaths at home did not change, but hospital admissions in the last 30 days of life decreased significantly from 2010 to 2015 (hospital b = ?0.026; CI = ?0.041, ?0.012). ICU admissions in the last 30 days also declined over time for the full sample and for patients aged 65 years or older (overall b = ?0.023; CI = ?0.039, ?0.007), but was not significant for younger decedents. Length of stay (LOS) did not decrease for those using the hospital or ICU.Conclusion
From 2010 to 2015, we observed a decrease in hospital admissions for all age groups and in ICU admissions for those over 65 years. As there were no changes in the proportion of patients with chronic illness who died at home nor in hospital or ICU LOS in the last 30 days, hospital and ICU admissions in the last 30 days may be a more responsive quality metric than site of death or LOS for palliative care interventions. 相似文献954.
Maria Elvén Jacek Hochwälder Elizabeth Dean Anne Söderlund 《Physiotherapy theory and practice》2018,34(5):367-383
Background and Aim: A systematically developed and evaluated instrument is needed to support investigations of physiotherapists’ clinical reasoning integrated with the process of clients’ behavior change. This study’s aim was to develop an instrument to assess physiotherapy students’ and physiotherapists’ clinical reasoning focused on clients’ activity-related behavior and behavior change, and initiate its evaluation, including feasibility and content validity. Methods: The study was conducted in three phases: 1) determination of instrument structure and item generation, based on a model, guidelines for assessing clinical reasoning, and existing measures; 2) cognitive interviews with five physiotherapy students to evaluate item understanding and feasibility; and 3) a Delphi process with 18 experts to evaluate content relevance. Results: Phase 1 resulted in an instrument with four domains: Physiotherapist; Input from client; Functional behavioral analysis; and Strategies for behavior change. The instrument consists of case scenarios followed by items in which key features are identified, prioritized, or interpreted. Phase 2 resulted in revisions of problems and approval of feasibility. Phase 3 demonstrated high level of consensus regarding the instrument’s content relevance. Conclusions: This feasible and content-validated instrument shows potential for use in investigations of physiotherapy students’ and physiotherapists’ clinical reasoning, however continued development and testing are needed. 相似文献
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Taylor C Wallace Jeffrey B Blumberg Elizabeth J Johnson Andrew Shao 《Advances in nutrition (Bethesda, Md.)》2015,6(1):1-4
In the United States, dietary reference intakes describe the relations between nutrient intakes and indicators of adequacy, prevention of disease, and avoidance of excessive intakes among healthy populations for essential nutrients but not dietary bioactive components (DBCs), whose absence from the diet is presumably not deleterious to health (i.e., does not cause a deficiency syndrome). An appropriate framework is needed for establishing recommended intakes for which public health messages and food labeling for DBCs can be derived, because their putative health benefits may not be readily defined in the context of nutritional essentiality. In addition, a myriad of factors make determining their intake and status and investigating their discrete contributions to health particularly challenging. Therefore, the ASN Dietary Bioactive Components Research Interest Section felt it worthwhile to convene a special “hot topic” session at the 2014 Experimental Biology meeting to discuss this issue and serve as a call for future scientific dialogue on establishing a framework for recommended intakes of DBCs. This session summary captures the discussions and presentations that transpired during this session. 相似文献
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