scholarly journals Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017035 ◽  
Author(s):  
Chung-Kuan Wu ◽  
Chia-Lin Wu ◽  
Chia-Hsun Lin ◽  
Jyh-Gang Leu ◽  
Chew-Teng Kor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vascular Access ◽  
Secondary Outcome ◽  
Rank Test ◽  
Chronic Haemodialysis ◽  
Short Term ◽  
All Cause Mortality ◽  
The Impact ◽  
Vascular Mortality

ObjectivesTo investigate the impact of vascular access flow (Qa) on vascular and all-cause mortality in chronic haemodialysis (HD) patients.DesignObservational cohort study.SettingSingle centre.ParticipantsAdult chronic HD patients at the HD unit of Shin Kong Wu Ho-Su Memorial Hospital between 1 January 2003 and 31 December 2003 were recruited. Patients were excluded if they had arteriovenous fistula or arteriovenous graft failure within 3 months before the date of Qa measurement, were aged <18 years and had Qa levels of ≥2000mL/min. A total of 378 adult chronic HD patients were eventually enrolled for the study.InterventionsThe selected patients were evaluated with Qa and cardiac index (CI). They were divided into four groups according to three Qa cut-off points (500, 1000 and 1500 mL/min).Primary and secondary outcome measuresShort-term and long-term vascular (cardiovascular or cerebrovascular) and all-cause mortality.ResultsQa was positively correlated with CI (r=0.48, p<0.001). A Qa level of <1000 mL/min was independently associated with 1-year all-cause mortality (adjusted OR, 6.04; 95% CI 1.64 to 22.16; p=0.007). Kaplan-Meier analysis revealed that the cumulative incidence rates of all-cause and vascular mortality were significantly higher in the patients with a Qa level of <1000 mL/min (log-rank test; all p<0.01). Furthermore, a Qa level of <1000 mL/min was independently associated with long-term all-cause mortality (adjusted HR, 1.62; 95% CI 1.11 to 2.37; p=0.013); however, the risk of vascular mortality did not significantly increase after adjustment for confounders.ConclusionsQa is moderately correlated with cardiac function, and a Qa level of <1000 mL/min is an independent risk factor for both short-term and long-term all-cause mortality in chronic HD patients.

scholarly journals Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Da Young Lee ◽  
Kyungdo Han ◽  
Sanghyun Park ◽  
Ji Hee Yu ◽  
Ji A. Seo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
The Elderly ◽  
Glucose Variability ◽  
All Cause Mortality ◽  
Nationwide Observational Study ◽  
The Impact

Abstract Background Previous research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes. Methods This is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017. Results During follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels. Conclusions In diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

scholarly journals Elevated Serum Interleukin-18 Level is Correlated with Vascular Access Dysfunction in Patients on Maintenance Haemodialysis

2020 ◽  
Vol 49 (3) ◽  
pp. 119-126
Author(s):  
Li Li You ◽  
Yuanhao Wu ◽  
Yin Zheng ◽  
Junfeng Liu ◽  
Jun Xue
Keyword(s):  
Logistic Regression ◽  
Vascular Access ◽  
Elevated Serum ◽  
Youden Index ◽  
Chronic Haemodialysis ◽  
Interleukin 18 ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Kaplan Meier ◽  
The Impact

Introduction: We evaluated the impact of serum interleukin-18 (IL-18) level on short-term vascular access (VA) function in chronic haemodialysis (HD) patients. Materials and Methods: Samples were collected from 80 clinically stable patients (58.8% were men) with a mean age of 60.9 years (standard deviation 11.7 years) who were undergoing maintenance HD and were followed up for 1 year. Multivariate logistic regression was used to analyse data on demographics, biochemical parameters and serum IL-18 level to predict VA dysfunction events. The cut-off for IL-18 was derived from the highest score obtained on Youden index. Survival data was analysed using Cox proportional hazards regression analysis and Kaplan-Meier method. Results: Patients were classified as having either low IL-18 (<199.3 pg/mL) or high IL-18 (≥199.3 pg/mL). Multivariate logistic regression showed that serum IL-18 level was independently correlated with VA dysfunction events; patients with high IL-18 had a higher risk of VA dysfunction events than those with low IL-18 (odds ratio 9.47, 95% confidence interval 1.75–51.31, P = 0.009). In patients with high IL-18, Kaplan- Meier survival analysis found that incidence of VA dysfunction was significantly higher than patients with low IL-18 (P = 0.047). After adjustment for age, gender, inflammation (C-reactive protein) and calcium-phosphorus metabolism, decreased serum albumin and increased serum IL-18 levels were found to be independent prognostic predictors of VA dysfunction. Conclusion: HD patients with high IL-18 level tend to have worse rates of VA dysfunction. In HD outpatients, IL-18 is an independent risk factor for short-term VA dysfunction. Key words: Access survival, Cytokines, Short-term

scholarly journals Surgical treatment for colorectal cancer: analysis of the influence of an enhanced recovery programme on long-term oncological outcomes—a study protocol for a prospective, multicentre, observational cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040316
Author(s):  
Jose-M Ramirez-Rodriguez ◽  
Javier Martinez-Ubieto ◽  
Jose-L Muñoz-Rodes ◽  
Jose-R Rodriguez-Fraile ◽  
Jose-A Garcia-Erce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Cohort Study ◽  
Enhanced Recovery ◽  
Intervention Group ◽  
Rank Test ◽  
Control Group ◽  
The Impact

IntroductionThe evidence currently available from enhanced recovery after surgery (ERAS) programmes concerns their benefits in the immediate postoperative period, but there is still very little evidence as to whether their correct implementation benefits patients in the long term. The working hypothesis here is that, due to the lower response to surgical aggression and lower rates of postoperative complications, ERAS protocols can reduce colorectal cancer-related mortality. The main objective of this study is to analyse the impact of an ERAS programme for colorectal cancer on 5-year survival. As secondary objectives, we propose to analyse the weight of each of the predefined items in the oncological results as well as the quality of life.Methods and analysisA multicentre prospective cohort study was conducted in patients older than 18 years of age who are scheduled to undergo surgery for colorectal cancer. The study involved 12 hospitals with an implemented enhanced recovery protocol according to the guidelines published by the Spanish National Health Service. The intervention group includes patients with a minimum implementation level of 70%, and the control group includes those who fail to reach this level. Compliance will be studied using 18 key performance indicators, and the results will be analysed using cancer survival indicators, including overall survival, cancer-specific survival and relapse-free survival. The time to recurrence, perioperative morbidity and mortality, hospital stay and quality of life will also be studied, the latter using the validated EuroQol Five questionnaire. The propensity index method will be used to create comparable treatment and control groups, and a multivariate regression will be used to study each variable. The Kaplan-Meier estimator will be used to estimate survival and the log-rank test to make comparisons. A p value of less than 0.05 (two-tailed) will be considered to be significant.Ethics and disseminationEthical approval for this study was obtained from the Aragon Ethical Committee (C.P.-C.I. PI20/086) on 4 March 2020. The findings of this study will be submitted to peer-reviewed journals (BMJ Open, JAMA Surgery, Annals of Surgery, British Journal of Surgery). Abstracts will be submitted to relevant national and international meetings.Trial registration numberNCT04305314.

scholarly journals 13 Medical Students’ Mood Adversely Affected By COVID-19 Pandemic: An Interim Analysis from the SPICE-19 Prospective Cohort Study Of 2075 Medical Students and Interim Foundation Doctors

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bandyopadhyay ◽  
I Georgiou ◽  
B Baykeens ◽  
C Gillespie ◽  
M de Andres Crespo ◽  
...  
Keyword(s):  
Medical Education ◽  
Cohort Study ◽  
Medical Students ◽  
Multicentre Study ◽  
Interim Analysis ◽  
Workforce Planning ◽  
Short Term ◽  
The United Kingdom ◽  
The Impact

Abstract Introduction In order to appropriately support medical students and foundation year doctors, it is imperative that we understand the impact the COVID-19 pandemic has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought. Method A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. Results A total of 2075 individuals participated. There was a decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic (p &lt; 0.0001). Social distancing negatively impacted the mood of the greatest number of participants. All areas of life included in the study were found to have been significantly more negatively impacted than positively impacted (p &lt; 0.0001). 931 participants wanted more support from their university. Conclusions When medical students return to their universities, there is likely to be a need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce.

scholarly journals Lake Zeiļu Clay Application Induced Changes in Human Skin Hydration, Elasticity, Transepidermal Water Loss and PH in Healthy Individuals

Cosmetics ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 51
Author(s):  
Samanta Marija Misiņa ◽  
Rasma Tretjakova ◽  
Sergejs Kodors ◽  
Aleksejs Zavorins
Keyword(s):  
Water Loss ◽  
Biomedical Application ◽  
Contact Allergy ◽  
Transepidermal Water Loss ◽  
Skin Hydration ◽  
Rank Test ◽  
Short Term ◽  
Significance Level ◽  
The Impact

Clay has a great biomedical application potential, however there are just a few instrumental studies and the impact of lake clay on the skin has not yet been studied. The DermaLab skin analysis system (Cortex Technology) was used for hydration, elasticity, transepidermal water loss (TEWL) and pH measurements after lake clay facial applications. Research included short-term tests (measurements 20 and 60 min after clay application) and long-term tests (application every 4th day for 3 weeks with measurements 20–24 h post-application). Control measurements and application tests to exclude contact allergy were made beforehand. No volunteer (n = 30) had positive allergic reaction. The matched-pairs design was applied: the right and left parts of forehead were used for the test and control groups. The Wilcoxon signed-rank test (significance level p = 0.001) was applied for statistical analysis. There were statistically significant pH changes demonstrated during the short-term measurements. The long-term measurements provided data that clay significantly improves skin hydration and elasticity.

scholarly journals The short-term and long-term effects of industrial pollution on human health in China

2021 ◽  
Vol 2 (1) ◽  
pp. 68-83
Author(s):  
Huali Xiang ◽  
◽  
Jun Yang ◽  
Youye Zhang ◽  
◽  
...  
Keyword(s):  
Human Health ◽  
Oxygen Demand ◽  
Industrial Wastes ◽  
Central China ◽  
Long Term Effects ◽  
Short Term ◽  
Physician Visits ◽  
All Cause Mortality ◽  
The Impact

The impact of environmental pollution on human health has become a consensus. Based on the provincial panel data of China from 2002 to 2017, this paper analyzes the impact of industrial wastes on human health. With respect to human health, average annual frequency of physician visits per capita (AAFPV) is used as a measure for the short-term human health; all-cause mortality is used to illustrate the long-term human health. The results show that in the short term, with the level of industrial smoke dust increasing every 1 percentage, AAFPV would increase by 0.24 percentage. This effect is significant in East China and West China. Central China is affected by industrial waste water, with a rate of increasing AAFPV by 0.12 percent for every 1 percent increase of chemical oxygen demand per unit area. In the long term, water pollution is the main influencing factor of all-cause mortality.

SUMBER-SUMBER RESILIENSI PADA REMAJA AKHIR YANG MENGALAMI KEKERASAN DARI ORANGTUA PADA MASA KANAK-KANAK

Psibernetika ◽  
2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Devina Calista ◽  
Garvin Garvin
Keyword(s):  
Late Adolescents ◽  
Long Term Effects ◽  
Short Term ◽  
Parental Affection ◽  
Resilience Factors ◽  
Childhood Violence ◽  
Past Experiences ◽  
The Impact ◽  
Depth Interviews

<p><em>Child abuse by parents is common in households. The impact of violence on children will bring short-term effects and long-term effects that can be attributed to their various emotional, behavioral and social problems in the future; especially in late adolescence that will enter adulthood. Resilience factors increase the likelihood that adolescents who are victims of childhood violence recover from their past experiences</em><em>,</em><em> become more powerful individuals and have a better life. The purpose of this study was to determine the source of resilience in late adolescents who experienced violence from parents in their childhood. This research uses qualitative research methods with in-depth interviews as a method of data collection. The result shows that the three research participants have the aspects of "I Have", "I Am", and "I Can"; a participant has "I Can" aspects as a source of resilience, and one other subject has no source of resilience. The study concluded that parental affection and acceptance of the past experience have role to the three sources of resilience (I Have, I Am, and I Can)</em></p><p><em> </em></p><p><strong><em>Keyword : </em></strong><em>Resilience, adolescence, violence, parents</em></p>

Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

2020 ◽  
Author(s):  
Erico Castro-Costa ◽  
Jerson Laks ◽  
Cecilia Godoi Campos ◽  
Josélia OA Firmo ◽  
Maria Fernanda Lima-Costa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Old Age ◽  
All Cause Mortality ◽  
The Impact

Patient Education and Sacubitril/Valsartan: A Randomized Comparative Trial

2021 ◽  
pp. 001857872199980
Author(s):  
Christopher Giuliano ◽  
Bradley St. Pierre ◽  
Jamie George
Keyword(s):  
Controlled Trial ◽  
Comparative Trial ◽  
Text Messages ◽  
Phone Call ◽  
Secondary Outcome ◽  
Short Term ◽  
Phone Calls ◽  
Video Education ◽  
Pharmacist Education

Objective: To compare video to pharmacist education for patients taking sacubitril/valsartan. Methods: We conducted a randomized controlled trial comparing video to pharmacist education with a second randomized intervention of education delivered through text or phone call at 14 days. The primary outcome compared the change in short term knowledge between groups and the secondary outcome was long term knowledge at 1 month. Results: Forty-three patients were included. Scores improved significantly ( P < .05) in the pharmacist group from 54.1% to 85.9% and from 64.3% to 86.1% in the video education group, although there was no difference between groups (31.8% vs 22.9%, P = .13). At 30 days, scores were significantly higher than baseline (difference 16.5%, P < .05) although did decrease from the posttest (difference 7.4%, P < .05). There was no difference at 30 days between those that received text messages versus phone calls (−10% vs −5.5%, respectively; P = .36). Conclusion: We saw improvements in both short term and long term knowledge for patients receiving education through pharmacist or video education. Neither approach was more effective than the other. Clinicians can use either approach based on patient preference.

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