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Erik D Skarsgard Ying C MacNab Zhenguo Qiu Ruth Little Shoo K Lee 《Journal of perinatology》2005,25(5):315-319
OBJECTIVE: Outcomes analysis in congenital diaphragmatic hernia (CDH) requires a validated risk-adjustment tool. The purpose of this study was to use the Canadian Neonatal Network (CNN) database to validate the Score for Neonatal Acute Physiology, Version II (SNAP-II) for prediction of mortality among CDH infants admitted to a neonatal intensive care unit (NICU), and to compare this to the predictive equation recently developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG). STUDY DESIGN: Infants with CDH in the CNN database were identified. Bivariate and multivariable logistic regression models were used to identify risk factors predictive of mortality. Model predictive performance and calibration were assessed using the area under the receiver operator characteristic curve and the technique of Hosmer-Lemeshow, respectively, and compared with the CDHSG predictive equation. RESULTS: There were 88 patients with CDH among 19,507 admissions to CNN hospitals. The mortality rate among CDH patients surviving to NICU admission was 17%, and 12.5% received extracorporeal membrane oxygenation therapy. Gestational age and admission SNAP-II score predicted mortality. Model predictive performance and calibration were optimized with these variables combined. The CDHSG equation was equally predictive of mortality, but was only marginally calibrated. CONCLUSIONS: SNAP-II is highly predictive of mortality among patients with CDH, and can be used to risk-adjust these patients. 相似文献
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Ruth W Johnson Joan S Tilghman Lorrie R Davis-Dick Barbara Hamilton-Faison 《The ABNF journal》2006,17(2):60-62
The following article is an attempt to encapsulate an historical overview of spirituality in nursing. Despite a plethora of information relative to spirituality in nursing, the decision was to do an eclectic overview that was not reflective of any one spiritual/religious group. The authors at times found this goal difficult when writing about the Pre-Christian and Christian eras. Most of the major religions have their own perspective on the concept of spirituality, and historical personalities recorded maybe reflective of that particular religion. Another factor that impacted on the writing of this article was the concept that spirituality was not always linked specifically to religion. Spirituality was an experiential component of the wonders of nature and life, a domain that the authors took into account but did not expound upon. Finally the authors realized that spirituality has almost always been an aspect of African-American life and certainly of those in nursing. To this end the authors realize that there is a need for more research in this area. 相似文献
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Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy 总被引:1,自引:0,他引:1
Aoife M. Ryan Aine Hearty Ruth S. Prichard Aileen Cunningham Suzanne P. Rowley John V. Reynolds 《Journal of gastrointestinal surgery》2007,11(10):1355-1360
Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma
and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute
albumin level on the first postoperative day was of value in predicting in-hospital complications.
Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and
2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included
in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression
analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level.
Results Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative
complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p < 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22
vs 5%, p < 0.001), respiratory failure (27 vs 8%, p < 0.01) and in-hospital mortality (27 vs 6% (p < 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications
(odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p < 0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and
a return to ICU.
Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative
risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes. 相似文献
16.
Sabine J Presser Guido Schumacher Ruth Neuhaus Peter Thuss-Patience Jens Stieler Peter Neuhaus 《Liver transplantation》2007,13(3):443-450
The purpose of the study was to determine the incidence, risk factors, treatment, and influence on survival of patients with de novo esophageal cancer after liver transplantation (LT). From 1988 to 2006, 1,926 patients underwent LT in our institution. A total of 9 patients (0.5%) developed a de novo esophageal cancer and 1 patient a cancer of the cardia (0.05%). A retrospective analysis was performed to reveal underlying diseases, timeframes between LT and appearance of cancer, predisposing factors, cancer therapy, complications, immunosuppressive regimens, and survival. Of our 10 patients, 7 (70%) suffered from esophageal squamous cell carcinoma (SCC) and 3 patients (30%) developed an adenocarcinoma, including the patient with cancer of the cardia. A total of 9 patients were transplanted due to alcoholic cirrhosis; 1 patient suffered from hepatocellular carcinoma in nonA-nonB hepatitis-related cirrhosis. Median time to tumor diagnosis was 51 months after transplantation. A total of 5 patients were treated conservatively with combined radiochemotherapy and 5 underwent surgical resection. Patients with radiochemotherapy showed a mean survival of 14.8 months vs. 24.8 months for the patients of the surgery group. No major postoperative complication has been observed. A total of 2 patients of the surgery group are still alive after a follow-up of 15 and 89 months. In conclusion, de novo esophageal and cancer of the cardia after LT is a rare event. In spite of immunosuppression, no increased complication rate has been observed. Patients may have a survival benefit from surgical resection. 相似文献
17.
Paul Roderick Ruth Davies Chris Jones Terry Feest Steve Smith Ken Farrington 《Nephrology, dialysis, transplantation》2004,19(3):692-701
BACKGROUND: The demand for renal replacement therapy (RRT) in England has risen steadily, although from a lower base than many other developed countries. Predicting the future demand for RRT and the impact of factors such as the acceptance rate, transplant supply and patient survival, is required in order to inform the planning of such services. METHODS: A discrete event simulation model estimates the future demand for RRT in England in 2010 for a range of scenarios. The model uses current prevalence and current and projected future acceptance rates, survival rates and the transitions between modalities to predict future patient numbers. National population and mortality data, published literature and data from the UK Renal Registry and UK Transplant, are used to estimate unmet need for RRT, the impact of changing demography and incidence of Type 2 diabetes, patient haemodialysis (HD) survival and transplant supply. RESULTS: By 2010 the predicted prevalence will have increased from about 30,000 in 2000 to between 42 and 51,000 (900-1000 p.m.p.), an average annual growth of 4.5-6%. Changing transplant supply has a small effect on overall numbers but changes the proportion of patients with functioning graft by up to 8%. Even with an optimistic increase in transplant supply (11% p.a. for 5 years), numbers on HD will continue to rise substantially, especially in the elderly. The factors most influencing future patient numbers are the acceptance rate and dialysis survival. CONCLUSION: This model predicts a substantial growth in the RRT population to 2010 to a rate approaching 1000 p.m.p., particularly in the elderly and those on HD, with a steady state not being reached for at least 25 years. 相似文献
18.
Ruth McDonald BA MSc PhD Stephen Harrison BSc MPhil PhD 《Health & social care in the community》2004,12(3):194-201
Recent New Labour policy for the ‘modernisation’ of Government places a good deal of emphasis on decentralisation. This emphasis is particularly marked in relation to the organisation of primary care. However, like hospitals and other National Health Service institutions, primary care trusts (PCTs) are subject to a substantial raft of centrally established performance targets and indicators, including those which contribute to the public award of between zero and three performance ‘stars’. This raises questions about the extent to which employees can exercise autonomy in the context of rigid top‐down directives. This paper presents findings from a study using participant observation and interviews to examine the impact of a training course aimed ostensibly at increasing employee autonomy in an English PCT. The suggestion is that attempts to make employees more autonomous can be seen as a strategy for increasing central control based upon the internalisation by the employees of centrally promulgated values. The attraction of such strategies is that they may be potentially more effective and less costly than alternative strategies of direct control. However, the study suggests that the outcome of attempts by such methods as programmes to increase employee autonomy may be very different from those intended. 相似文献
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Ladenstein Ruth; Pearce Rachel; Hartmann Olivier; Patte Catherine; Goldstone Tony; Philip Thierry 《Blood》1997,90(8):2921-2930