scholarly journals Recurrence and mortality 1 year after hospital admission for non-fatal self-harm: a nationwide population-based study

2019 ◽  
Vol 29 ◽  
Author(s):  
A. Vuagnat ◽  
F. Jollant ◽  
M. Abbar ◽  
K. Hawton ◽  
C. Quantin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Drug Overdose ◽  
Psychiatric Inpatient ◽  
National Level ◽  
Significant Risk ◽  
Medical Decision ◽  
Short Term ◽  
Predictive Values ◽  
Self Harm

Abstract Aims A large number of people present each day at hospitals for non-fatal deliberate self-harm (DSH). Examination of the short-term risk of non-fatal recurrence and mortality at the national level is of major importance for both individual medical decision-making and global organisation of care. Methods Following the almost exhaustive linkage (96%) of two national registries in France covering 45 million inhabitants (i.e. 70% of the whole population), information about hospitalisation for DSH in 2008–2009 and vital status at 1 year was obtained. Individuals who died during the index hospital stay were excluded from analyses. Results Over 2 years, 136,451 individuals were hospitalised in medicine or surgery for DSH. The sample comprised 62.8% women, median age 38 in both genders, with two peaks at 16 and 44 years in women, and one peak at 37 years in men. The method used for DSH was drug overdose in 82.1% of cases. Admission to an intensive care unit occurred in 12.9%. Following index hospitalisation, 71.3% returned home and 23.7% were transferred to a psychiatric inpatient care unit. DSH recurrence during the following year occurred in 12.4% of the sample, within the first 6 months in 75.2%, and only once in 74.6%. At 1 year, 2.6% of the sample had died. The overall standardised mortality ratio was 7.5 but reached more than 20 in young adults. The causes were natural causes (35.7%), suicide (34.4%), unspecified cause (17.5%) and accident (12.4%). Most (62.9%) deaths by suicide occurred within the first 6 months following index DSH. Violent means (i.e. not drug overdose) were used in 70% of suicide cases. Concordance between means used for index DSH and for suicide was low (30% overall), except for drug overdose. Main suicide risk factors were older age, being male, use of a violent means at index DSH, index admission to an intensive care unit, a transfer to another medical department or to a psychiatric inpatient unit, and recurrence of DSH. However, these factors had low positive predictive values individually (below 2%). Conclusions Non-fatal DSH represent frequent events with a significant risk of short-term recurrence and death from various causes. The first 6 months following hospital discharge appear to be a critical period. Specific short-term aftercare programs targeting all people with a DSH episode have to be developed, along other suicide prevention strategies.

Presepsin - New Marker of Sepsis Romanian Neonatal Intensive Care Unit Experience

2019 ◽  
Vol 70 (8) ◽  
pp. 3008-3013
Author(s):  
Silvia Maria Stoicescu ◽  
Ramona Mohora ◽  
Monica Luminos ◽  
Madalina Maria Merisescu ◽  
Gheorghita Jugulete ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Sepsis ◽  
Predictive Value ◽  
Neonatal Intensive Care ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Receiver Operating Curve ◽  
Predictive Values

Difficulties in establishing the onset of neonatal sepsis has directed the medical research in recent years to the possibility of identifying early biological markers of diagnosis. Overdiagnosing neonatal sepsis leads to a higher rate and duration in the usage of antibiotics in the Neonatal Intensive Care Unit (NICU), which in term leads to a rise in bacterial resistance, antibiotherapy complications, duration of hospitalization and costs.Concomitant analysis of CRP (C Reactive Protein), procalcitonin, complete blood count, presepsin in newborn babies with suspicion of early or late neonatal sepsis. Presepsin sensibility and specificity in diagnosing neonatal sepsis. The study group consists of newborns admitted to Polizu Neonatology Clinic between 15th February- 15th July 2017, with suspected neonatal sepsis. We analyzed: clinical manifestations and biochemical markers values used for diagnosis of sepsis, namely the value of CRP, presepsin and procalcitonin on the onset day of the disease and later, according to evolution. CRP values may be influenced by clinical pathology. Procalcitonin values were mainly influenced by the presence of jaundice. Presepsin is the biochemical marker with the fastest predictive values of positive infection. Presepsin can be a useful tool for early diagnosis of neonatal sepsis and can guide the antibiotic treatment. Presepsin value is significantly higher in neonatal sepsis compared to healthy newborns (939 vs 368 ng/mL, p [ 0.0001); area under receiver operating curve (AUC) for presepsine was 0.931 (95% confidence interval 0.86-1.0). PSP has a greater sensibility and specificity compared to classical sepsis markers, CRP and PCT respectively (AUC 0.931 vs 0.857 vs 0.819, p [ 0.001). The cut off value for presepsin was established at 538 ng/mLwith a sensibility of 79.5% and a specificity of 87.2 %. The positive predictive value (PPV) is 83.8 % and negative predictive value (NPV) is 83.3%.

Short-term outcomes in older intensive care unit patients with dementia*

2005 ◽  
Vol 33 (6) ◽  
pp. 1371-1376 ◽  
Author(s):  
Margaret A. Pisani ◽  
Carrie A. Redlich ◽  
Lynn McNicoll ◽  
E Wesley Ely ◽  
Rebecca J. Friedkin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Short Term

Analysis of diagnostic criteria for ventilator-associated pneumonia: a cohort study

2021 ◽  
Vol 74 (6) ◽  
Author(s):  
Caroline Gonçalves Pustiglione Campos ◽  
Aline Pacheco ◽  
Maria Dagmar da Rocha Gaspar ◽  
Guilherme Arcaro ◽  
Péricles Martim Reche ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Diagnostic Criteria ◽  
Statistical Tests ◽  
Significant Risk ◽  
Diagnostic Methods ◽  
Ventilator Associated Pneumonia

ABSTRACT Objectives: to analyze the diagnostic criteria for ventilator-associated pneumonia recommended by the Brazilian Health Regulatory Agency and the National Healthcare Safety Network/Centers for Disease Control and Prevention, as well as its risk factors. Methods: retrospective cohort study carried out in an intensive care unit throughout 12 months, in 2017. Analyses included chi-square, simple linear regression, and Kappa statistical tests and were conducted using Stata 12 software. Results: the sample was 543 patients who were in the intensive care unit and under mechanical ventilation, of whom 330 (60.9%) were men and 213 (39.1%) were women. Variables such as gender, age, time under mechanical ventilation, and oral hygiene proved to be significant risk factors for the development of ventilator-associated pneumonia. Conclusions: patients submitted to mechanical ventilation need to be constantly evaluated so the used diagnostic methods can be accurate and applied in an objective and standardized way in Brazilian hospitals.

scholarly journals Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

2021 ◽  
Vol 41 (1) ◽  
pp. e17-e23
Author(s):  
Barbara M. Geven ◽  
Jolanda M. Maaskant ◽  
Catherine S. Ward ◽  
Job B.M. van Woensel
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Cumulative Dose ◽  
Withdrawal Syndrome ◽  
Significant Risk ◽  
Pediatric Intensive Care ◽  
Significant Risk Factor ◽  
Preventive Effect ◽  
Iatrogenic Withdrawal Syndrome

Background Iatrogenic withdrawal syndrome is a well-known adverse effect of sedatives and analgesics commonly used in patients receiving mechanical ventilation in the pediatric intensive care unit, with an incidence of up to 64.6%. When standard sedative and analgesic treatment is inadequate, dexmedetomidine may be added. The effect of supplemental dexmedetomidine on iatrogenic withdrawal syndrome is unclear. Objective To explore the potentially preventive effect of dexmedetomidine, used as a supplement to standard morphine and midazolam regimens, on the development of iatrogenic withdrawal syndrome in patients receiving mechanical ventilation in the pediatric intensive care unit. Methods This retrospective observational study used data from patients on a 10-bed general pediatric intensive care unit. Iatrogenic withdrawal syndrome was measured using the Sophia Observation withdrawal Symptoms-scale. Results In a sample of 102 patients, the cumulative dose of dexmedetomidine had no preventive effect on the development of iatrogenic withdrawal syndrome (P = .19). After correction for the imbalance in the baseline characteristics between patients who did and did not receive dexmedetomidine, the cumulative dose of midazolam was found to be a significant risk factor for iatrogenic withdrawal syndrome (P < .03). Conclusion In this study, supplemental dexmedetomidine had no preventive effect on iatrogenic withdrawal syndrome in patients receiving sedative treatment in the pediatric intensive care unit. The cumulative dose of midazolam was a significant risk factor for iatrogenic withdrawal syndrome.

Evaluation of short-term consequences of hypoglycemia in an intensive care unit*

2006 ◽  
Vol 34 (11) ◽  
pp. 2714-2718 ◽  
Author(s):  
Titia M. Vriesendorp ◽  
J Hans DeVries ◽  
Susanne van Santen ◽  
Hazra S. Moeniralam ◽  
Evert de Jonge ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Short Term

Correlation Properties and Complexity of Perioperative RR-Interval Dynamics in Coronary Artery Bypass Surgery Patients

2000 ◽  
Vol 93 (1) ◽  
pp. 69-80 ◽  
Author(s):  
Timo T. Laitio ◽  
Heikki V. Huikuri ◽  
Erkki S. H. Kentala ◽  
Timo H. Mäkikallio ◽  
Jouko R. Jalonen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Artery Bypass ◽  
Scaling Exponent ◽  
Short Term ◽  
Cabg Surgery ◽  
Rr Interval ◽  
Heart Rate Dynamics ◽  
Dynamic Measures

Background Dynamic measures of heart rate variability (HRV) may uncover abnormalities that are not easily detectable with traditional time and frequency domain measures. The purpose of this study was to characterize changes in RR-interval dynamics in the immediate postoperative phase of coronary artery bypass graft (CABG) surgery using traditional and selected newer dynamic measures of HRV. Methods Continuous 24-h electrocardiograph recordings were performed in 40 elective CABG surgery patients up to 72 h postoperatively. In one half of the patients, Holter recordings were initiated 12-40 h before the surgery. Time and frequency domain measures of HRV were assessed. The dynamic measures included a quantitative and visual analysis of Poincaré plots, measurement of short- and intermediate-term fractal-like scaling exponents (alpha1 and alpha2), the slope (beta) of the power-law regression line of RR-interval dynamics, and approximate entropy. Results The SD of RR intervals (P < 0.001) and the ultra-low-, very-low-, low-, and high-frequency power (P < 0.01, P < 0.001, P < 0.001, P < 0.01, respectively) measures in the first postoperative 24 h decreased from the preoperative values. Analysis of Poincaré plots revealed increased randomness in beat-to-beat heart rate behavior demonstrated by an increase in the ratio between short-term and long-term HRV (P < 0.001) after CABG. Average scaling exponent alpha1 of the 3 postoperative days decreased significantly after CABG (from 1.22 +/- 0.15 to 0.85 +/- 0.20, P < 0.001), indicating increased randomness of short-term heart rate dynamics (i.e., loss of fractal-like heart rate dynamics). Reduced scaling exponent alpha1 of the first postoperative 24 h was the best HRV measure in differentiating between the patients that had normal (</= 48 h, n = 33) or prolonged (> 48 h, n = 7) intensive care unit stay (0.85 +/- 0.17 vs. 0.68 +/- 0.18; P < 0.05). In stepwise multivariate logistic regression analysis including typical clinical predictors, alpha1 was the most significant independent predictor (P < 0.05) of long intensive care unit stay. None of the preoperative HRV measures were able to predict prolonged intensive care unit stays. Conclusions In the selected group of patients studied, a decrease in overall HRV was associated with altered nonlinear heart rate dynamics after CABG surgery. Current results suggest that a more random short-term heart rate behavior may be associated with a complicated clinical course. Analysis of fractal-like dynamics of heart rate may provide new perspectives in detecting abnormal cardiovascular function after CABG.

Medical Outcome Prediction for Intensive Care Unit Patients

2012 ◽  
pp. 251-262
Author(s):  
Simone A. Ludwig ◽  
Stefanie Roos ◽  
Monique Frize ◽  
Nicole Yu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Decision Support Systems ◽  
Support Systems ◽  
Medical Decision ◽  
Adult Intensive Care Unit ◽  
Medical Decision Support ◽  
Elimination Algorithm ◽  
Medical Decision Support Systems

The rate of people dying from medical errors in hospitals each year is very high. Errors that frequently occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. Medical decision support systems play an increasingly important role in medical practice. By assisting physicians in making clinical decisions, medical decision support systems improve the quality of medical care. Two approaches have been investigated for the prediction of medical outcomes: “hours of ventilation” and the “mortality rate” in the adult intensive care unit. The first approach is based on neural networks with the weight-elimination algorithm, and the second is based on genetic programming. Both approaches are compared to commonly used machine learning algorithms. Results show that both algorithms developed score well for the outcomes selected.

Medical Outcome Prediction for Intensive Care Unit Patients

2012 ◽  
pp. 1068-1079
Author(s):  
Simone A. Ludwig ◽  
Stefanie Roos ◽  
Monique Frize ◽  
Nicole Yu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Decision Support Systems ◽  
Support Systems ◽  
Medical Decision ◽  
Adult Intensive Care Unit ◽  
Medical Decision Support ◽  
Elimination Algorithm ◽  
Medical Decision Support Systems

The rate of people dying from medical errors in hospitals each year is very high. Errors that frequently occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. Medical decision support systems play an increasingly important role in medical practice. By assisting physicians in making clinical decisions, medical decision support systems improve the quality of medical care. Two approaches have been investigated for the prediction of medical outcomes: “hours of ventilation” and the “mortality rate” in the adult intensive care unit. The first approach is based on neural networks with the weight-elimination algorithm, and the second is based on genetic programming. Both approaches are compared to commonly used machine learning algorithms. Results show that both algorithms developed score well for the outcomes selected.

scholarly journals The views of intensive care nurses regarding short-term deployment

Curationis ◽  
2015 ◽  
Vol 38 (1) ◽  
Author(s):  
Mokgadi C. Matlakala
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Focus Group Interviews ◽  
Short Term ◽  
Gauteng Province ◽  
Intensive Care Nurses ◽  
Hospital Units ◽  
Policies And Procedures ◽  
Group Interviews ◽  
Purposive Sample

Background: Short-term deployment of nurses is usually used within the hospital units in order to ‘balance the numbers’ or to cover the shortage of staff in the different units. Often nurses in the intensive care unit (ICU) are sent to go and assist in other units, where there is not enough nursing staff or when their own unit is not busy.Objectives: The objective of this study was to explore the views of the ICU nurses regarding short-term deployment to other units.Method: A qualitative design was used, following interpretivism. The study was conducted in the ICUs of two hospitals in Gauteng Province, South Africa. Data were collected through focus group interviews with a purposive sample of registered nurses working in the selected ICUs, transcribed verbatim and analysed using open coding.Results: The participants shared a similar view that deployment to other units should be based on a formal agreement, with policies and procedures. Consultation and negotiation are recommended prior to deployment of staff. Management should recognise and acknowledge expertise of ICU nurses in their own speciality area.Conclusion: The findings call for redesign of a deployment policy that will suit nurses from the speciality areas such as ICU.

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