Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study

AbstractThis study investigated the impact of bronchiectasis on patients admitted to the intensive care unit (ICU) at a hospital in Korea. Patients with bronchiectasis were diagnosed using results of chest computed tomography performed before ICU admission. The severity of bronchiectasis was based on the number of affected lobes, and patients with ≥ 3 bronchiectatic lobes were classified into the severe bronchiectasis group. Overall, 823 patients were enrolled. The mean age was 66.0 ± 13.9 years, and 63.4% were men. Bronchiectasis and severe bronchiectasis were present in 148 (18.0%) and 108 (13.1%) patients, respectively. The increase in the number of bronchiectatic lobes was related to the rise in ICU mortality (P for trend = 0.012) and in-hospital mortality (P for trend = 0.004). Patients with severe bronchiectasis had higher odds for 28-day mortality [odds ratio (OR) 1.122, 95% confidence interval (CI) 1.024–1.230], ICU mortality (OR 1.119, 95% CI 1.023–1.223), and in-hospital mortality (OR 1.208, 95% CI 1.092–1.337). The severe bronchiectasis group showed lower overall survival (log-rank P < 0.001), and the adjusted hazard ratio was 1.535 (95% CI 1.178–2.001). Severe bronchiectasis had a negative impact on all-cause mortality during ICU and hospital stays, resulting in a lower survival rate.

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Relationship between 24-h venous blood glucose variation and mortality among patients with acute respiratory failure

Scientific Reports ◽

10.1038/s41598-021-87409-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoling Zhang ◽

Jingjing Zhang ◽

Jiamei Li ◽

Ya Gao ◽

Ruohan Li ◽

...

Keyword(s):

Blood Glucose ◽

Respiratory Failure ◽

Hospital Mortality ◽

Acute Respiratory Failure ◽

Venous Blood ◽

Sensitivity Analyses ◽

Icu Mortality ◽

Logistic Regression Models ◽

The Mean ◽

The Relationship

AbstractEvidence indicates that glucose variation (GV) plays an important role in mortality of critically ill patients. We aimed to investigate the relationship between the coefficient of variation of 24-h venous blood glucose (24-hVBGCV) and mortality among patients with acute respiratory failure. The records of 1625 patients in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database were extracted. The 24-hVBGCV was calculated as the ratio of the standard deviation (SD) to the mean venous blood glucose level, expressed as a percentage. The outcomes included ICU mortality and in-hospital mortality. Participants were divided into three subgroups based on tertiles of 24-hVBGCV. Multivariable logistic regression models were used to evaluate the relationship between 24-hVBGCV and mortality. Sensitivity analyses were also performed in groups of patients with and without diabetes mellitus. Taking the lowest tertile as a reference, after adjustment for all the covariates, the highest tertile was significantly associated with ICU mortality [odds ratio (OR), 1.353; 95% confidence interval (CI), 1.018–1.797] and in-hospital mortality (OR, 1.319; 95% CI, 1.003–1.735), especially in the population without diabetes. The 24-hVBGCV may be associated with ICU and in-hospital mortality in patients with acute respiratory failure in the ICU, especially in those without diabetes.

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POS0998 SPONDYLOARTHRITIS AND SLEEP DISORDERS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2909 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 767.2-768

Author(s):

S. Lahrichi ◽

K. Nassar ◽

S. Janani

Keyword(s):

Functional Impairment ◽

Sleep Disturbances ◽

Negative Impact ◽

University Hospital ◽

Quality Of Sleep ◽

The Mean ◽

Sleep Deficit ◽

Impaired Sleep ◽

The Impact

Background:Spondyloarthropathies (SpA) are a group of chronic and progressive diseases, characterized in particular by a progressive stiffening of the spine, spreading to neighboring joints or to certain tissues, which could lead in the long term to progressive stiffening and functional impairment. This conditioncancauseinsomnia problems and impaired sleep quality.Objectives:To assess the impact of SpA on the quality of sleep.Methods:This is a retrospective study over a period of 4 years from January 2015 to December 2019, including all the medical records of patients with SpA followed in the Department of Rheumatology of the University Hospital of Ibn Rochd, Casablanca. We evaluated for each patient two validated scores: the Epworth somnolence scale rated from 0 to 24, and the Pittsburgh sleep score rated from 0 to 21 with 7 components. Patients with a psychiatric history or who were followed up for neurological pathologies were excluded.Results:178 patients were included. 60.67% were men with an average age of 36.32 years (14-68 years). 45.01% had axial SpA, 29.77% had psoriatic arthritis, and 25.22% were followed for SpA associated with inflammatory bowel disease. 45% had associated comorbidities: there were 18 diabetics and 34 hypertensive, 16.58% were smokers. Clinically, 85.42% presented a back pain initially on examination, 55% presented a polyarthralgia, and 39.88% an oligoarthritis. 63% had radiological sacroiliitis, and 35.14% had bilateral coxitis. 13.48% had a positive HLA B27 and 58.89% had a positive inflammatory assessment with very high activity indices,with a mean of 4.6. 64.66% of the patients received NSAIDs,of which 11% responded well. 57% were treated with csDMARDs, and 17.86% were treated with biologics. At the time of our study, the mean visual analog scale was 5.84 ± 1.7 out of 10 (2-9). The mean Epworth score was 8.38 ± 5.2 (0-21). 56.1% of patients had no sleep debt, 33.3% had a sleep deficit, and only 10.6% had signs of drowsiness. For the overall Pittsburgh score, the mean was 7.02 ± 3.6 (1-18). The mean of “subjective quality of sleep” was 1.12, “sleep latency” was 1.22, “duration of sleep” was 1.06, “usual sleep efficiency” was 0.74, “Sleep disturbance” of 1.28, “use of a sleep medication” of 0.54, and the average of the component concerning “poor shape during the day” was 1.03 out of 3. The LEQUESNE index went from an average of 6 to 8, which corresponds to an average handicap (P = 0.2) over a period of 3 years. 68% of the patients had an alteration in the quality of sleep, starting on average three years after the onset of symptoms. 11% reported having experiencedanxiety and depressive symptoms, and reported having used antidepressants or anxiolytics in the past 5 years.Conclusion:Our study showed the negative impact of SpA on the duration and overall quality of sleep. The degree of pain as well as functional impairment can cause and worsen sleep disturbances in SpA. We have shown that the Pittsburg score increases significantly with the increase of pain.The Lequesne score and that the Epworth score increase with disease activity[1].References:[1]StolwijkC,vanTubergenA,Castillo-OrtizJD,BoonenA.Prevalenceofextra-articularmanifestationsinpatientswithankylosingspondylitis:asystematicreviewandmeta-analysis.AnnRheumDis2015;74:65—73.Disclosure of Interests:None declared.

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Changes in care in the fourth trimester in Ireland: 2010–2020

British Journal of Midwifery ◽

10.12968/bjom.2021.29.12.683 ◽

2021 ◽

Vol 29 (12) ◽

pp. 683-691

Author(s):

Jean Doherty ◽

Mary Brosnan ◽

Lucille Sheehy

Keyword(s):

Negative Impact ◽

Maternity Hospital ◽

Care Needs ◽

High Quality ◽

Midwifery Care ◽

Hospital Stays ◽

Current Context ◽

Discharge From Hospital ◽

The Impact

Background There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital.

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Short-term prognostic effect of prior cerebrovascular and peripheral artery disease in patients with acute coronary syndrome: Can we do better?

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617716388 ◽

2017 ◽

Vol 7 (7) ◽

pp. 652-660 ◽

Cited By ~ 5

Author(s):

Filipa Cordeiro ◽

Pedro S Mateus ◽

Alberto Ferreira ◽

Silvia Leao ◽

Miguel Moz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Confidence Interval ◽

Hospital Mortality ◽

Odds Ratio ◽

Composite Endpoint ◽

Short Term ◽

Coronary Syndrome ◽

Artery Disease ◽

The Impact ◽

Prior Stroke

Background: We sought to evaluate the impact of prior cerebrovascular and/or peripheral arterial disease (PAD) on in-hospital outcomes in patients with acute coronary syndromes. Methods: From 1 October 2010 to 26 February 2016, 13,904 acute coronary syndrome patients were enrolled in a national multicentre registry. They were divided into four groups: prior stroke/transient ischaemic attack (stroke/TIA); prior PAD; prior stroke/TIA and PAD; none. The endpoints included in-hospital mortality and a composite endpoint of death, re-infarction and stroke during hospitalization. Results: 6.3% patients had prior stroke/TIA, 4.2% prior PAD and 1.4% prior stroke/TIA and PAD. Prior stroke/TIA and/or PAD patients were less likely to receive evidence-based medical therapies (dual antiplatelet therapy: stroke/TIA= 88.6%, PAD= 86.6%, stroke/TIA+PAD= 85.7%, none= 92.2%, p<0.001; β-blockers: stroke/TIA= 77.1%, PAD= 72.1%, stroke/TIA+PAD= 71.9%, none= 80.8%, p<0.001; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: stroke/TIA= 86.3%, PAD= 83.6%, stroke/TIA+PAD= 83.2%, none= 87.1%, p=0.030) and to undergo percutaneous revascularization (stroke/TIA= 52.8%, PAD= 45.6%, stroke/TIA+PAD= 43.7%, none= 67.9%, p<0.001), despite more extensive coronary artery disease (three-vessel disease: stroke/TIA= 29.1%, PAD= 38.3%, stroke/TIA+PAD= 38.3%, none= 20.2%, p<0.001). In a multivariable analysis, prior stroke/TIA+PAD was a predictor of in-hospital mortality (odds ratio= 2.828, 95% confidence interval 1.001–7.990) and prior stroke/TIA (odds ratio= 1.529, 95% confidence interval 1.056–2.211), prior PAD (odds ratio= 1.618, 95% confidence interval 1.034–2.533) and both conditions (odds ratio= 3.736, 95% confidence interval 2.002–6.974) were associated with the composite endpoint. Conclusion: A prior history of stroke/TIA and/or PAD was associated with lower use of medical therapy and coronary revascularization and with worst short-term prognosis. An individualized management may improve their poor prognosis.

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Association between the Use of Backpack and Static Foot Posture in Schoolchildren with Static Pronated Foot Posture: A 36-Month Cohort Study

Children ◽

10.3390/children8090800 ◽

2021 ◽

Vol 8 (9) ◽

pp. 800

Author(s):

Pilar Alfageme-García ◽

Julián Fernando Calderón-García ◽

Alfonso Martínez-Nova ◽

Sonia Hidalgo-Ruiz ◽

Belinda Basilio-Fernández ◽

...

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Cohort Study ◽

Prospective Study ◽

Odds Ratio ◽

Univariate Analysis ◽

Foot Posture ◽

The Mean ◽

The Impact

Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the association of the backpack use on static foot posture in schoolchildren with a pronated foot posture over 36 months of follow-up. Methods: This observational longitudinal prospective study was based on a cohort of consecutive healthy schoolchildren with pronated feet from fifteen different schools in Plasencia (Spain). The following parameters were collected and measured in all children included in the study: sex, age, height, weight, body mass index, metatarsal formula, foot shape, type of shoes, and type of schoolbag (non-backpack and backpack). Static foot posture was determined by the mean of the foot posture index (FPI). The FPI was assessed again after 36 months. Results: A total of 112 participants used a backpack when going to school. Over the 36-month follow-up period, 76 schoolchildren who had a static pronated foot posture evolve a neutral foot posture. Univariate analysis showed that the schoolchildren using backpacks were at a greater risk of not developing neutral foot (odds ratio [OR]: 2.09; 95% CI: 1.08–4.09). The multivariate analysis provided similar results, where the schoolchildren using a backpack (adjusted OR [aOR]: 1.94; 95% CI: 1.02–3.82) had a significantly greater risk of not developing a neutral foot posture. Conclusions: A weak relationship was found between backpack use and schoolchildren aged from five to eleven years with static pronated feet not developing a neutral foot posture over a follow-up period of 36 months.

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Rapid Muscle Loss Negatively Impacts Survival in Critically Ill Patients With Cirrhosis

Journal of Intensive Care Medicine ◽

10.1177/0885066618775706 ◽

2018 ◽

Vol 35 (7) ◽

pp. 663-671 ◽

Cited By ~ 3

Author(s):

Sunmi Ju ◽

Sun Mi Choi ◽

Young Sik Park ◽

Chang-Hoon Lee ◽

Sang-Min Lee ◽

...

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Muscle Mass ◽

Critically Ill Patients ◽

Mass Change ◽

Apache Ii Score ◽

Muscle Loss ◽

Icu Mortality ◽

Skeletal Muscle Index ◽

The Impact

Purpose: To assess the impact of rapid muscle loss before admission to intensive care unit (ICU) in critically ill patients with cirrhosis. Materials and Methods: Patients with cirrhosis who had undergone 2 or more recent computed tomography scans before admission to the medical ICU were included. Muscle cross-sectional area at the level of the third lumbar vertebra was quantified using OsiriX software. The rate of muscle mass change and skeletal muscle index (SMI) were also calculated. Multivariable Cox proportional hazards regression was used to evaluate the association between muscle loss and mortality. Results: Among 125 patients, 113 (90.4%) patients were classified as having sarcopenia. The mean body mass index was 22.6 (3.9) kg/m2. Thirty-nine (31.2%) patients were within the normal range for muscle mass change, while 86 (68.8%) patients demonstrated rapid decline in muscle mass before admission to the ICU. Patients with rapid muscle loss showed high ICU mortality (59.3%) and in-hospital mortality (77.9%). Multivariate Cox analysis showed that ICU mortality and in-hospital mortality were independently associated with malignancy, Acute Physiology and Chronic Health Evaluation (APACHE) II score, SMI, and rapid muscle loss. Conclusion: Rapid muscle decline is correlated with increased ICU mortality and in-hospital mortality in critically ill patients with cirrhosis.

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Total Blood Lymphocyte Count Alteration During and after Pregnancy

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.633 ◽

2016 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Gökçen Örgül ◽

Burcu Soyak ◽

Oytun Portakal ◽

Meral Beksaç ◽

M. Sinan Beksaç

Keyword(s):

Lymphocyte Count ◽

Blood Lymphocyte ◽

Complete Blood Count ◽

Negative Impact ◽

Post Partum ◽

University Hospital ◽

Base System ◽

Total Blood ◽

The Mean ◽

The Impact

Objective: To investigate the impact of gestational changes on blood lymphocyte count in healthy pregnancies. Study Design: This retrospective study is consisted of 108 consecutive normal pregnancies who delivered at our department in December 2015. High-risk pregnancies with poor neonatal outcome and pregnancies with maternal disorders which may affect lymphocyte counts were excluded from the study. “Complete blood count” results of the patients were obtained from the computerized data base system of Hacettepe University Hospital. Blood samples of patients which were withdrawn a) prior to pregnancy (1-6 months before getting pregnant), b) during pregnancy (11-14th gestational weeks) and c) post-partum first day were used in this study. Results: The mean blood lymphocyte count was 2049.07 (±758.69) in patients before their pregnancies. The mean lymphocyte count decreased to 1850.93 and 1625 during pregnancy and after delivery respectively. A statistically significant decrease was found between three periods (before, during, and postpartum 1st day) (p:0.003). Conclusion: We have shown a significant decrease in total lymphocyte levels during pregnancy, consistent with the data presented in the literature. Pregnancy and related hormones have a negative impact on total blood lymphocyte level.

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The Impact of a Nanocellulose-Based Wound Dressing in the Management of Thermal Injuries in Children: Results of a Retrospective Evaluation

Life ◽

10.3390/life10090212 ◽

2020 ◽

Vol 10 (9) ◽

pp. 212

Author(s):

Julia Cattelaens ◽

Laura Turco ◽

Luc M. Berclaz ◽

Birgit Huelsse ◽

Wolfgang Hitzl ◽

...

Keyword(s):

Wound Dressing ◽

Pediatric Patients ◽

Wound Dressings ◽

Retrospective Evaluation ◽

Thermal Injuries ◽

Hospital Stays ◽

The Mean ◽

The Impact ◽

First Time

The aim of this retrospective study is to evaluate for the first time the impact of a nanocellulose-based wound dressing in the treatment of pediatric patients with both partial- and deep-thickness burns. Usability and effectiveness were defined based on parameters such as frequency of dressing changes under narcosis, duration of hospital stay, onset of complications, need for additional treatments, and follow up scar formation assessment. Fifty-six children who sustained burns in the year 2018 and were treated with a nanocellulose-based wound dressing were included in the trial. The mean stay in hospital was 6.7 days. Patients underwent dressing changes under narcosis 2.4 times on average, and none had wound-associated infection. In all, 82% of the patients were treated only with nanocellulose-based wound dressings, and reepithelialization occurred after ten days. The majority of patients had scars with normal pigmentation (98%), vascularization (91%), height (92%), and pliability (92%). In conclusion, using a nanocellulose-based wound dressing for the treatment of both superficial, partial-thickness and deep, full-thickness burns has several advantages. Compared with the results published in literature on other wound dressings, it requires a moderate number of dressing changes under narcosis and results in short hospital stays. Additionally, it has a low associated infection rate and promotes wound healing.

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Abstract 17423: Impact of Hypertriglyceridemia on ST-Elevation Myocardial Infarction Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.17423 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mehmet Yildiz ◽

Christian Schmidt ◽

Santiago Garcia ◽

Ross Garberich ◽

Larissa I Stanberry ◽

...

Keyword(s):

Systems Of Care ◽

All Cause Mortality ◽

History Of ◽

St Elevation ◽

Premature Cad ◽

The Mean ◽

Heart Center ◽

Study Participants ◽

Event Rates ◽

The Impact

Introduction: There has been conflicting data regarding the impact of hypertriglyceridemia (HTG) on STEMI outcomes, including reports of a “lipid paradox” defined as lower event rates in patients with HTG. Therefore, the association between HTG and outcomes in STEMI deserves further investigation especially given the results of REDUCE-IT trial. Methods: A prospective, multicenter database of the Midwest STEMI Consortium was examined. The Midwest STEMI Consortium is a unique association of 4 large STEMI systems of care: Iowa Heart Center, Minneapolis Heart Institute Foundation, Prairie Cardiovascular, and The Christ Hospital. We included all consecutive STEMI patients between age of 40 and 75. Those with missing TG levels were excluded (23%). We compared 3 groups of TG levels: normal (<150 mg/dl), moderate (150 to 499 mg/dl), and severe (>500 mg/dl) for MACE (death, MI, or stroke) and all-cause mortality. Results: Of 6492 consecutive STEMI patients from 03/2003 to 01/2020, 3760 (58%) met inclusion criteria. The mean (SD) age was 59.1 ± 9.2 and male gender was predominant (76%). A little over one-third of the study participants had moderate HTG (35%). Patients with higher TG levels had lower HDL levels and increased rates of history of premature CAD, DM, and HTN (Table). Moderate HTG was not a risk factor for MACE or all-cause mortality. Severe HTG was significantly associated with increased in-hospital (p=0.016) but not 1-year all-cause mortality (p=0.21) (Figure). Conclusions: In STEMI patients, higher TG levels were associated with increased in-hospital but not 1-year all-cause mortality.

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Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study

American Journal of Critical Care ◽

10.4037/ajcc2021453 ◽

2021 ◽

Vol 30 (5) ◽

pp. 397-400

Author(s):

Joao Gabriel Rosa Ramos ◽

Gabriel Machado Naus dos Santos ◽

Marina Chetto Coutinho Bispo ◽

Renata Cristina de Almeida Matos ◽

Gil Mario Lopes Santos de Carvalho ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Observational Study ◽

Hospital Mortality ◽

Odds Ratio ◽

Intermediate Care ◽

Icu Mortality ◽

Patient Transfers ◽

Reason For Admission

This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.

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