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991.
Mehdi Torabi Fereshteh Mazidi Sharaf Abadi Mohammad Reza Baneshi 《The American journal of emergency medicine》2018,36(5):816-819
Objectives
Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of multiple trauma patients. The exact time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well established.Methods
This follow-up study was done on multiple trauma patients (> 18 years) with an Injury Severity Scores (ISS) > 16. These patients didn?t have any history of diabetes, underlying disease, or drug or alcohol use. Data collection was done by the questionnaire (checklist), and the patients were followed by the medical records. Cox regression was used to measure the effect of independent variables on the patients' hospital mortality.Results
Of a total of 963 patients, 280 patients were enrolled. Of those, 202 were male (72.1%) and 78 were female (27.9%). Hospital mortality was 18 (6.4%). Cox regression analysis suggested that those who had high blood sugar 3 h after admission had higher hospital mortality (P = 0.04). Changes in blood sugar, ΔBS (BS 3 h after admission – BS on admission), in these patients was also significantly correlated with hospital mortality (P < 0.001). The multivariate model using the backward conditional method showed that ΔBS (P < 0.001), international normalized ration (INR) (P < 0.001), and heart rate (P = 0.036) were significantly correlated with hospital mortality.Conclusions
In multiple trauma patients, blood sugar changes in the early hours of admission to the emergency department may help predict hospital mortality, but further studies are needed. Blood sugar monitoring in these patients during this time frame may be helpful in predicting these patients' outcomes. In addition, coagulopathy and tachycardia were significantly associated with hospital mortality. 相似文献992.
目的:回顾分析该院76例创伤截肢与保肢的病例,为儿童临床截肢手术适应证提供参考。方法回顾总结分析该院1996年7月至2013年5月收治的38例外伤性截肢患儿(试验组),同期38例严重创伤而未截肢的患儿38例(对照组),采用毁损肢体严重程度(MESS)以及保肢指数(LSI)评分重新评估,统计分析两种评分系统与截肢术的吻合度。结果 MESS与 LSI两种评分系统均对儿童截肢术有很高的区分度。结论 M ESS与LSI均可作为儿童截肢参考系统,但LSI评分系统较M ESS更适用于儿童。 相似文献
993.
994.
Judith Bernstein Debbie M. Cheng Na Wang Caitlin Trilla Jeffrey Samet Richard Saitz 《Annals of family medicine》2015,13(3):257-260
Should recreational drug use raise clinical concern? We examined the association between weekend-only recreational drug use at baseline (yes vs no) and any increase in recreational drug use frequency or severity over 6 months among primary care patients who screen positive for drug use. In the weekend-only recreational drug use group (52/483 [10.8%]), 54% (28/52) started using drugs on weekdays. Compared with use not limited to weekends, weekend-only use was associated with lower odds of increasing drug use frequency (AOR 0.48, P = 0.03) and lower odds (non-significant) of increasing severity (AOR 0.56, P = 0.07). Although weekend-only recreational drug use appears prognostically less severe, the findings nonetheless suggest that continued episodic monitoring may be clinically wise. 相似文献
995.
996.
Kazunori Takeda Masamichi Yokoe Tadahiro Takada Keisho Kataoka Masahiro Yoshida Toshifumi Gabata Masahiko Hirota Toshihiko Mayumi Masumi Kadoya Eigoro Yamanouchi Takayuki Hattori Miho Sekimoto Hodaka Amano Keita Wada Yasutoshi Kimura Seiki Kiriyama Shinju Arata Yoshifumi Takeyama Morihisa Hirota Koichi Hirata Tooru Shimosegawa 《Journal of hepato-biliary-pancreatic sciences》2010,17(1):37-44
The assessment of severity at the initial medical examination plays an important role in introducing adequate early treatment and the transfer of patients to a medical facility that can cope with severe acute pancreatitis. Under these circumstances, “criteria for severity assessment” have been prepared in various countries, including Japan, and these criteria are now being evaluated. The criteria for severity assessment of acute pancreatitis in Japan were determined in 1990 (of which a partial revision was made in 1999). In 2008, an overall revision was made and the new Japanese criteria for severity assessment of acute pancreatitis were prepared. In the new criteria for severity assessment, the diagnosis of severe acute pancreatitis can be made according to 9 prognostic factors and/or the computed tomography (CT) grades based on contrast-enhanced CT. Patients with severe acute pancreatitis are expected to be transferred to a specialist medical center or to an intensive care unit to receive adequate treatment there. In Japan, severe acute pancreatitis is recognized as being a specified intractable disease on the basis of these criteria, so medical expenses associated with severe acute pancreatitis are covered by Government payment. 相似文献
997.
Wei-jun Wang Vivian Wing-Yin Hung Tsz-Ping Lam Bobby Kin-Wah Ng Ling Qin Kwong-Man Lee Yong Qiu Jack Chun Yiu Cheng Hiu Yan Yeung 《European spine journal》2010,19(5):726-731
Abnormal anthropometric measurements during the peripubertal growth spurt have been documented in adolescent idiopathic scoliosis
(AIS). Magnetic resonance (MR) imaging studies of the spine have suggested a disproportionate endochondral and membranous
ossification in AIS. The present study aimed at investigating whether disproportional ossification and skeletal growth occurred
in the peripheral bone of AIS patients using the radius as the target bone. Skeletally mature AIS girls with different severity
(n = 290) and age-matched control healthy girls (n = 80) were recruited. The anthropometric parameters were recorded. The midshaft of non-dominant radius was scanned with peripheral
quantitative computed tomography (pQCT) and the radius diameter was calculated from the cross-sectional area. Radius dimension
ratio was derived from the ratio of radius diameter to radius length. The anthropometric parameters were compared between
AIS and control with adjustment for age. The radius dimension ratio was further correlated with curve severity in AIS girls
using Pearson’s correlation test. The analysis showed that the arm span and radius length were slightly longer in AIS girls.
The BMI of AIS girls was significantly lower than the controls. The radius dimension ratio in severe AIS girls was significantly
lower than the controls and the ratio of AIS girls correlated with the curve severity (r = −0.120; p = 0.039). The abnormal radius dimension ratio supported the presence of systemic growth abnormalities in AIS. Disproportional
endochondral-membranous ossification could explain for the observation. The observation of the association of radius dimension
ratio with curve severity provides an important potentially clinically measurable parameter for further longitudinal studies
on the prognostication of curve progression in AIS. 相似文献
998.
Simon W. MartinMohammed Al-Haddad 《Anaesthesia and Intensive Care Medicine》2010,11(11):478-480
Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lungs in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response. These patients can develop septic shock requiring admission to the intensive care unit. The CURB65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigation of severe CAP permits pathogen-specific antibiotic therapy and provides epidemiological data. Complications include parapneumonic effusions and empyema. Outcome from severe CAP can be improved by prompt antibiotic therapy. 相似文献
999.
《Current medical research and opinion》2013,29(9):1679-1687
ABSTRACTObjective: Treatment of chronic obstructive pulmonary disease (COPD) is based on symptom control. This suggests that COPD severity can be determined by analyzing treatment intensity. The objective of this analysis was to develop and validate a severity score for adult COPD based on treatments.Research design: Using principal components analysis, a COPD severity score was developed using data based on treatments extracted from an employer claims database (development group). Variables included were identified from literature review and clinical expert opinion. External validity was tested in a separate group of adult chronic bronchitis patients in whom principal components analysis was re-conducted and factor loadings were compared to the development group. Construct validity was tested by comparing the incidence of acute exacerbations of chronic bronchitis (AECB) in patients with high and lower severity scores. To illustrate the use of the COPD severity score, effectiveness of alternative AECB antibiotic treatments was compared in a separate patient sample categorized by severe versus mild/moderate COPD.Results: In the development group (n = 2068),principal components analysis produced a single main factor for severity scoring. Of the 12 variables contributing to this factor, the 6 with the highest factor loadings were treatment related. The factor performed similarly in the external validity group (n = 9127) as it did in the development group. In construct validity testing, severe COPD patients were 4 times more likely to have AECB episodes than mild/moderate patients. Patients with severe COPD and an AECB were more likely to fail treatment with antibiotics than those with mild/moderate COPD. Based on the COPD severity score developed, we found that treatment of patients with severe COPD and an AECB with fluoroquinolones was more likely to result in treatment failure than treatment with macrolides (OR = 2.01; p = 0.03).Conclusions: The analysis was successful in developing and validating a method to score COPD severity based on treatments. This method may prove useful in providing insights about the benefits of COPD treatments. 相似文献
1000.
《Current medical research and opinion》2013,29(10):1383-1390
Abstract