Admission Braden Skin Score Independently Predicts Mortality in Cardiac Intensive Care Patients

ObjectiveTo determine whether a low Braden skin score (BSS), reflecting increased risk for skin pressure injury, would predict lower survival in cardiac intensive care unit (CICU) patients after adjustment for illness severity and comorbidities.Patients and MethodsThis retrospective cohort study included consecutive unique adult patients admitted to a single tertiary care referral hospital CICU from January 1, 2007, through December 31, 2015, who had a BSS documented on CICU admission. The primary outcome was all-cause hospital mortality, using elastic net penalized logistic regression to determine predictors of hospital mortality. The secondary outcome was all-cause post-discharge mortality, using Cox proportional hazards models to determine predictors of post-discharge mortality.ResultsThe study included 9552 patients with a mean age of 67.4±15.2 years (3589 [37.6%] were females) and a hospital mortality rate of 8.3%. Admission BSS was inversely associated with hospital mortality (unadjusted odds ratio, 0.70; 95% CI, 0.68-0.72; P<.001; area under the receiver operator curve, 0.80; 95% CI, 0.78-0.82), with increased short-term mortality as a function of decreasing admission BSS. After adjustment for illness severity and comorbidities using multivariable analysis, admission BSS remained inversely associated with hospital mortality (adjusted odds ratio, 0.88; 95% CI, 0.85-0.92; P<.001). Among hospital survivors, admission BSS was inversely associated with post-discharge mortality after adjustment for illness severity and comorbidities (adjusted hazard ratio, 0.89; 95% CI, 0.88-0. 90; P<.001).ConclusionThe admission BSS, a simple inexpensive bedside nursing assessment potentially reflecting frailty and overall illness acuity, was independently associated with hospital and post-discharge mortality when added to established multiparametric illness severity scores among contemporary CICU patients.     

Mortality and risk factor analysis for Candida blood stream infection: A multicenter study

Candida blood stream infection (candidemia) is severe systemic infection mainly develops after intensive medical cares. The mortality of candidemia is affected by the underlying conditions, causative agents and the initial management. We retrospectively analyzed mortality-related risk factors in cases of candidemia between April 2011 and March 2016 in five regional hospitals in Japan. We conducted bivariate and multivariate analysis of factors including causative Candida species, patients' predisposing conditions, and treatment strategies, such as empirically selected antifungal drug and time to appropriate antifungal treatment, to elucidate their effects on 30-day mortality. The study enrolled 289 cases of candidemia in adults. Overall 30-day mortality was 27.7%. Forty-nine cases (17.0%) were community-acquired. Bivariate analysis found advanced age, high Sequential Organ Failure Assessment (SOFA) score, and prior antibiotics use as risk factors for high mortality; however community-acquired candidemia, C. parapsilosis candidemia, obtaining follow-up blood culture, and empiric treatment with fluconazole were associated with low mortality. Logistic regression revealed age ≥65 years (adjusted odds ratio, 2.13) and sequential organ failure assessment (SOFA) score ≥6 (6.30) as risk factors for 30-day mortality. In contrast, obtaining follow-up blood culture (0.38) and empiric treatment with fluconazole (0.32) were found to be protective factors. The cases with candidemia in associated with advanced age and poor general health conditions should be closely monitored. Obtaining follow-up blood culture contributed to an improved prognosis.     

Effects of pharmacologic hyperglucagonemia on plasma amino acid concentrations in normal and diabetic man

Four normal and five insulin dependent diabetic men received a 2 h pharmacologic glucagon infusion (50 ng/kg/min) resulting in plasma glucagon levels (4400 pg/ml) similar to those seen in glucagonoma patients. In normal subjects in whom plasma insulin concentrations rose significantly (239 uU/ml) and the blood level of 15 of the 18 amino acids measured fell significantly. In contrast, in the diabetic men who secreted no insulin in response to glucagon (no rise in C-peptide levels), only 10 of 18 amino acid levels fell significantly. The branched chain amino acids valine, leucine and isoleucine, as well as tyrosine and phenylalanine were among the 8 amino acids which showed no change in response to glucagon in the diabetics. Thus, glucagon appears to have no acute affect on branched chain amino acid levels in man.     

Transcapillary fluid balance in immature rats. Interstitial fluid pressure,serum and interstitial protein concentration,and colloid osmotic pressure

Several of the factors governing transcapillary fluid balance were studied in anesthetized rats from the age of 1 to 60 days. Serum albumin and total protein concentrations rose from 1.7 and 2.4 g/100 ml at birth to 4.1 and 6.2 g/100 ml in adult rats, while colloid osmotic pressure rose from 5.3 to about 20 mm Hg. Interstitial fluid collected from subcutis by the wick technique showed protein concentrations of approximately 60% of serum values in all age groups, and its colloid osmotic pressure rose from about 3 to 10 mm Hg during maturation. Arterial pressure rose from about 50 mm Hg in newborn rats to 120 mm Hg in adult animals. Iliac venous pressure was only 0.5–1 mm Hg in 10-day-old rats compared to 3 mm Hg in adult animals. Interstitial fluid pressures of 0 to ?1 mm Hg were obtained in all age groups with the “wick-in-needle” technique. The data suggest an average capillary pressure of less than 5 mm Hg in newborn animals and a pre- to postcapillary resistance ratio similar to that of adult animals. The safety factors against edema formation seem to be small in immature rats.     

Changes in spatial QRS-T angle and QTc interval in patients with traumatic brain injury with or without intra-abdominal hypertension

Introduction

Traumatic brain injury (TBI) affects cardiac electrical function, and several extra-cerebral factors, including intra-abdominal pressure (IAP), might further modulate this brain-heart interaction. The purpose of this study was to investigate the impact of TBI, and of increased IAP during TBI, on cardiac electrical function as measured by vectorcardiographic (VCG) variables.

肾与心力衰竭相关性的研究进展

心力衰竭是一种常见疾病,是多种心血管疾病的终末阶段,中医上属“心悸”“喘证”范畴,临床多表现心悸、气喘、水肿等。肾为一身阴阳之本,百病之极,穷必及肾,心力衰竭亦受肾变化的影响。现代研究发现,肾功能损伤可通过神经激素系统调节、炎症反应、氧化应激等病理环节参与心力衰竭的发生、发展。因此,认识肾与心力衰竭的相互联系在临床诊治中尤为重要。现基于“心肾相交”理论,阐述肾与心的关系,认为肾与心力衰竭具有相关性。从中西医角度,分析肾的生理功能和病理变化,即肾主水、肾主纳气及肾气、肾阴和肾阳亏虚对心力衰竭的影响,研究肾功能损伤与心力衰竭的相互作用,重新梳理心力衰竭的病机,为临床诊疗提供新思路。     

护理专业生理学课程思政实施效果的调查研究

目的 为推动思想政治教育与专业课的深度融合,实现知识与能力的传授与价值引领相结合的理念,探究护理专业生理学课程思政教育融入的效果与存在的问题。方法 选取2021年2月至7月春季学期2020级护理学专业200名学生为研究对象,在生理学授课中融入思政教育。课程结束后利用微信问卷星进行问卷调查,了解、分析学生对德育教育的认知、生理学课程思政的态度及实施满意度等。结果 大多数的学生认为自己具有一定的社会责任感并愿意为理想而努力。93.37%的学生认为大学是思想品德构建的关键时刻,对课程思政有较强需求,对现行生理学课程思政实践认可度及满意度均很高。此外,学生对课程思政的内容与形式也提出自己的建议与想法。结论 针对护理学专业进行生理学课程思政是学生的需求,对学生能力的培养具有重要意义。