BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential t...BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.展开更多
Drug overdose is a common reason for emergency department admissions.Although pharmacobezoars due to drug overdose are rare,they can increase the length of hospital stay and risk of mortality.^([1]) Currently,no clear...Drug overdose is a common reason for emergency department admissions.Although pharmacobezoars due to drug overdose are rare,they can increase the length of hospital stay and risk of mortality.^([1]) Currently,no clear procedure for the management of gastric pharmacobezoars exists.We report a case of a patient with pharmacobezoars caused by high-dose oral drug poisoning.The patient recovered completely after gastroscopy,gastric lavage,and symptomatic treatments.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological ...BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.展开更多
The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing ...The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient.It also reduces burden on nursing staff and counsellors.Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population.It may be difficult to apply this tool on elderly patients with failing eyesight,multiple physical comorbidities.Also,there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling.We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patie...BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.展开更多
BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily comb...BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
Introduction: In recent times, satisfaction studies have gained importance in the health sector as a way to monitor services and products. The main aim of this study was to explore patient satisfaction with pharmaceut...Introduction: In recent times, satisfaction studies have gained importance in the health sector as a way to monitor services and products. The main aim of this study was to explore patient satisfaction with pharmaceutical care provided in Nampula healthcare centers. Material and Methods: The study was conducted at the 25 de Setembro, 1˚ de Maio, and Muhala-Expansão healthcare centers in Nampula. The sample consisted of 381 patients, with 127 from each center, selected for accessibility. Data were collected through a questionnaire with an internal consistency of 0.816, calculated using McDonald’s total Omega (ωt). The analysis included frequencies, descriptive statistics (mean and standard deviation), and inferential statistics like Binary Logistic Regression. Results: Overall satisfaction was 3.62 ± 0.627 on a scale of 1 to 5, or 69.8%. The binary regression associated a higher education level with dissatisfaction (COR 0.204, 95% CI: −2.752 to −0.427) and living in Marrere (COR 0.083, 95% CI: -5.098 to 0.120) and Muahivir-Expansão (COR 0.589, 95% CI: −1.824 to 0.767) with dissatisfaction as well. Conclusion: Satisfaction was generally high, mainly influenced by the availability of medicines and medical supplies, and less by other factors such as healthcare center accessibility, facility quality, and relationships with pharmacy professionals. Although variables like sex, religion, age, marital status, profession, occupation, and the number of pharmacy visits in the last five years were not statistically significant for general satisfaction in this study, they should be considered in future studies as they are often linked to pharmaceutical satisfaction.展开更多
Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for m...Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by in...Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by integrating literature analysis,clinical practice research,and multidisciplinary experts’consensus.Focusing on the differentiated needs of patients,the study proposes a dual-track management framework of‘precise diagnosis and treatment standard’and‘humanistic care practice’,and innovatively designs a multidisciplinary collaborative mechanism,an information-based follow-up platform,and a social support network.Through the role of‘care consultant’,the programme connects the medical team with the individual needs of patients,strengthens treatment compliance and improves the quality of life,and provides a theoretical basis and practical reference for the optimization of the whole management mode of lymphoma patients.展开更多
Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptio...Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptions of empathy,patient satisfaction,and the quality of recovery in elderly patients undergoing postoperative care for lower extremity fractures under spinal anesthesia.Methods:In the present cross-sectional study,138 elderly patients who underwent surgery for lower extremity fracture and spinal anesthesia were selected for inclusion in the study.The questionnaire included demographic characteristics,the Jefferson Scale of Patient Perception of Physician Empathy,the Patient Satisfaction Scale,and the Postoperative Quality of Recovery Score.Multivariate regression was performed to evaluate the associations between patient-reported factors and satisfaction.Results:The overall average scores for patient perception of empathy,quality of recovery,and patient satisfaction were 20.30(1.18),110.11(8.26),and 156.86(5.44),respectively.There was a statistically significant positive correlation between patient quality of recovery and patient perception of empathy and patient satisfaction(p<0.01).Conclusions:This finding could also inform policymaking and the development of guidelines aimed at improving the quality of healthcare delivery.This study encouraged healthcare organizations and institutions to foster empathy in healthcare interactions,which may positively impact patient satisfaction and subsequent recovery outcomes,and patient-centered care.展开更多
Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchron...Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchronization therapy defibrillators improve morbidity,quality of life,and mortality in eligible patients with heart failure who are on optimal medical therapy.However,these devices may adversely affect the patients’psychological status after the delivery of shock therapies or even because of the fear of impending therapy.On the other hand,the potential of effective treatment of malignant arrhythmias may provide a‘safety’sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability.During the past few years,an increasing number of reports have investigated psychological distress,including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients.However,heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited.Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident.Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender,younger age,and device shock therapies.Moreover,depression and anxiety may have an adverse impact on patients’clinical outcomes exacerbating heart failure and increasing the arrhythmic risk.In this brief review article,we provide a concise and critical overview of the current literature on this topic,and we also discuss unresolved and conflicting issues delineating future perspectives.展开更多
Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO regist...Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO registry(IMPACT of Time of Intervention in patients with Myocardial Infarction with Non-ST seGment elevation.ManaGement and Outcomes)prospectively included 1020 patients with NSTEACS undergoing invasive coronary angiography between April and May 2021.For this sub-study,patients≥65 years were selected.Frailty was assessed according to FRAIL scale.We studied all-cause mortality and the composite of all-cause mortality or all-cause hospitalizations at one-year follow-up after discharge.Results Five hundred and sixty seven patients(mean age:75.8±6.7 years,28.2%women)were included:316(55.7%)were robust,183(32.3%)prefrail,and 68(12.0%)frail.Frail patients were significantly older,more often women,and presented a worse baseline clinical profile.There were no differences among groups regarding pretreatment with a P2Y12 inhibitor.An urgent angiography(<24 h)was less frequently performed in frail patients,with no differences regarding revascularization approach or in main in-hospital adverse events,although acute kidney disease occurred more frequently in frail patients.At 1-year follow-up,20 patients died(3.6%).Chronic kidney disease was independently associated with 1-year all-cause death,although a trend towards higher mortality was observed in frail patients(HR=3.01;95%CI:0.93-9.78;P=0.065).Frailty was independently associated with higher 1-year all-cause mortality or all-cause rehospitalizations(HR=2.23;95%CI:1.43-3.46;P<0.001)Conclusions In older patients with NSTEACS,frailty independently associates higher all-cause mortality or all-cause hospital admissions at one-year follow-up.展开更多
Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA ...Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA is increasing annually,and the in-hospital survival rate of CA patients is only approximately 28.7%.^([3])Echocardiography has been widely used as an important monitoring tool in critical care and helps to identify the cause of shock,monitor hemodynamics,and guide fluid therapy utilization.^([4])One study reported that approximately one-third of patients underwent formal echocardiography during hospitalization in the intensive care unit (ICU).展开更多
Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung ...Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung injury.[1]Intensive care unit-acquired weakness (ICU-AW)is a prevalent complication in critically ill patients.[2] The recovery of recipients undergoing LT for COVID-19-related respiratory failure may face impediments due to ICU-AW,which negatively affects early mobilization and functional improvement. This study describes two cases of successful bilateral LT for severe COVID-19-related ARDS with the occurrence of ICU-AW and subsequent successful discharge.展开更多
Background Data on drug-coated balloon(DCB)treatment in elderly patients are limited.This study was to evaluate the efficacy of DCB treatment in percutaneous coronary intervention(PCI)among elderly patients.Methods A ...Background Data on drug-coated balloon(DCB)treatment in elderly patients are limited.This study was to evaluate the efficacy of DCB treatment in percutaneous coronary intervention(PCI)among elderly patients.Methods A retrospective analysis included 232 patients aged 75 years or older with coronary artery disease who underwent successful PCI using either DCB alone or in combination with drug-eluting stent(DES)based on pre-dilation results(DCB-based PCI).These patients were compared with 1818 elderly patients who underwent second-generation DES implantation(DES-only PCI).The endpoint was major adverse cardiovascular events(MACE)at 2-year follow-up.Results In the DCB-based PCI,61.2%of patients received DCB-only treatment.Compared to DES-only PCI,the DCB-based PCI group had fewer stents(0.5±0.7 and 1.7±0.8,P<0.001),shorter stent lengths(13.3±20.9 mm and 37.4±23.0 mm,P<0.001),and lower usage of small stents with a diameter of 2.5 mm or less(15.6%and 28.7%,P=0.010).The DCB-based PCI group exhibited lower rate of MACE(5.5%and 13.1%,P=0.003),target vessel revascularization(1.1%and 5.6%,P=0.017)and major bleeding(0.7%and 5.1%,P=0.009)at 2-year follow-up.The reduced risk in 2-year MACE was consistently observed across various matching procedures,with the most significant reduction noted in target vessel revascularization and major bleeding.Conclusion The DCB-based PCI reduced stent burden,particularly in the usage of small diameter stents,and was associated with lower risks of MACE,target vessel revascularization,and major bleeding compared to DES-only PCI in elderly patients.展开更多
BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevatio...BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.展开更多
The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a...The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.展开更多
文摘BACKGROUND Cognitive frailty and depression are prevalent among the elderly,significantly impairing physical and cognitive functions,psychological well-being,and quality of life.Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.AIM To evaluate the effects of exercise-cognitive dual-task training on frailty,cognitive function,psychological status,and quality of life in elderly patients with cognitive frailty and depression.METHODS A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023.Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care.Frailty,cognitive function,balance and gait,psychological status,and quality of life were assessed before and after the intervention.RESULTS After the intervention,the frailty score of the observation group was(5.32±0.69),lower than that of the control group(5.71±0.55).The Montreal cognitive assessment basic scale score in the observation group was(24.06±0.99),higher than the control group(23.43±1.40).The performance oriented mobility assessment score in the observation group was(21.81±1.24),higher than the control group(21.15±1.26).The self-efficacy in the observation group was(28.27±2.66),higher than the control group(30.05±2.66).The anxiety score in the hospital anxiety and depression scale(HADS)for the observation group was(5.86±0.68),lower than the control group(6.21±0.64).The depression score in the HADS for the observation group was(5.67±0.75),lower than the control group(6.27±0.92).Additionally,the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).CONCLUSION Exercise-cognitive dual-task training is beneficial for improving frailty,enhancing cognitive function,and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.
基金supported by the Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-007A)Beijing Union Medical Foundation-Rui E Emergency Medicine Research Funding (PUMF01010010-2024-18)。
文摘Drug overdose is a common reason for emergency department admissions.Although pharmacobezoars due to drug overdose are rare,they can increase the length of hospital stay and risk of mortality.^([1]) Currently,no clear procedure for the management of gastric pharmacobezoars exists.We report a case of a patient with pharmacobezoars caused by high-dose oral drug poisoning.The patient recovered completely after gastroscopy,gastric lavage,and symptomatic treatments.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
基金Supported by Beijing Ditan Hospital Affiliated to Capital Medical University“Sailing Plan”,No.DTQH-202405.
文摘BACKGROUND Empathetic psychological care improves mood and enhances the quality of life in critically ill patients.AIM To study the impact of combining 222-nm ultraviolet(UV)disinfection with empathetic psychological care on emotional states,nosocomial infection rates,and quality of life in critically ill patients.METHODS A total of 202 critically ill patients admitted to Beijing Ditan Hospital(December 2023 to May 2024)were randomly assigned to control(Ctrl,n=101)or observation groups(Obs,n=101).The Ctrl group received 222-nm UV disinfection and routine care,while the Obs group received 222-nm UV disinfection with empathetic psychological care.Emotional states[Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)],hospital infection rates,quality of life(36-Item Short Form Health Survey),and patient satisfaction were evaluated.RESULTS At baseline,there were no significant differences in SAS and SDS scores between the groups(P>0.05).Following care,both groups demonstrated reductions in SAS and SDS scores,with the Obs group exhibiting a significantly greater reduction(P<0.05).The Obs group also experienced a significantly lower overall hospital infection rate(P<0.05).Similarly,while baseline 36-Item Short Form Health Survey scores did not differ significantly between the groups(P>0.05),post-care scores improved in both groups,with a greater improvement observed in the Obs group(P<0.05).Additionally,the Obs group reported higher patient satisfaction ratings(P<0.05).CONCLUSION The combination of 222-nm UV disinfection and empathetic psychological care improves emotional states,reduces hospital infection rates,enhances the quality of life,and increases patient satisfaction among critically ill patients.
文摘The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment.It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient.It also reduces burden on nursing staff and counsellors.Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population.It may be difficult to apply this tool on elderly patients with failing eyesight,multiple physical comorbidities.Also,there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling.We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.
基金Supported by the China Health Promotion Foundation Young Doctors'Research Foundation for Inflammatory Bowel Disease,the Taishan Scholars Program of Shandong Province,China,No.tsqn202306343National Natural Science Foundation of China,No.82270578.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.
文摘BACKGROUND Traumatic injuries,such as falling,car accidents,and crushing mostly cause spinal fractures in young and middle-aged people,and>50%of them are thoracolumbar fractures.This kind of fracture is easily combined with serious injuries to peripheral nerves and soft tissues,which causes paralysis of the lower limbs if there is no timely rehabilitation treatment.Young patients with thoracolumbar fractures find it difficult to recover after the operation,and they are prone to depression,low self-esteem,and other negative emotions.AIM To investigate the association between anxiety,depression,and social stress in young patients with thoracolumbar spine fractures and the effect on rehabilitation outcomes.METHODS This study retrospectively analyzed 100 patients admitted to the orthopedic department of Honghui Hospital,Xi’an Jiaotong University who underwent thoracolumbar spine fracture surgery from January 2022 to June 2023.The general data of the patients were assessed with the Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),life events scale,and social support rating scale(SSRS)to identify the correlation between anxiety,depression scores,and social stress and social support.The Japanese Orthopedic Association(JOA)was utilized to evaluate the rehabilitation outcomes of the patients and to analyze the effects of anxiety and depression scores on rehabilitation.RESULTS According to the scores of HAMD and HAMA in all patients,the prevalence of depression in patients was 39%(39/100),and the prevalence of anxiety was 49%(49/100).Patients were categorized into non-depression(n=61)and depression(n=39),non-anxiety(n=51),and anxiety(n=49)groups.Statistically significant differences in gender,occupation,Pittsburgh Sleep Quality Index(PSQI)score,and monthly family income were observed between the non-depression and depression groups(P<0.05).A significant difference in occupation and PSQI score was found between the non-anxiety and anxiety groups.Both depression(r=0.207,P=0.038)and anxiety scores(r=0.473,P<0.001)were significantly and positively correlated with negative life events.The difference in negative life event scores as well as SSRS total and item scores was statist-ically significant between patients in the non-depression and depression groups(P<0.05).The difference between the non-anxiety and anxiety groups was statistically significant(P<0.05)in the negative life event scores as well as the total SSRS scores.Additionally,JOA scores were significantly lower in both anxious and depressed patients.CONCLUSION Young patients with thoracolumbar fractures are prone to anxiety and depression.Patients’anxiety and depression are closely associated with social pressure,which reduces the life pressure of young patients with thoracolumbar fractures,enhances social support,and improves the psychology of anxiety and depression.,which affects patients’recovery.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
文摘Introduction: In recent times, satisfaction studies have gained importance in the health sector as a way to monitor services and products. The main aim of this study was to explore patient satisfaction with pharmaceutical care provided in Nampula healthcare centers. Material and Methods: The study was conducted at the 25 de Setembro, 1˚ de Maio, and Muhala-Expansão healthcare centers in Nampula. The sample consisted of 381 patients, with 127 from each center, selected for accessibility. Data were collected through a questionnaire with an internal consistency of 0.816, calculated using McDonald’s total Omega (ωt). The analysis included frequencies, descriptive statistics (mean and standard deviation), and inferential statistics like Binary Logistic Regression. Results: Overall satisfaction was 3.62 ± 0.627 on a scale of 1 to 5, or 69.8%. The binary regression associated a higher education level with dissatisfaction (COR 0.204, 95% CI: −2.752 to −0.427) and living in Marrere (COR 0.083, 95% CI: -5.098 to 0.120) and Muahivir-Expansão (COR 0.589, 95% CI: −1.824 to 0.767) with dissatisfaction as well. Conclusion: Satisfaction was generally high, mainly influenced by the availability of medicines and medical supplies, and less by other factors such as healthcare center accessibility, facility quality, and relationships with pharmacy professionals. Although variables like sex, religion, age, marital status, profession, occupation, and the number of pharmacy visits in the last five years were not statistically significant for general satisfaction in this study, they should be considered in future studies as they are often linked to pharmaceutical satisfaction.
文摘Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘Based on the perspective of caring,this study constructs a whole-cycle management programme for lymphoma patients,and systematically explores the pathway of patients’health management from diagnosis to recovery by integrating literature analysis,clinical practice research,and multidisciplinary experts’consensus.Focusing on the differentiated needs of patients,the study proposes a dual-track management framework of‘precise diagnosis and treatment standard’and‘humanistic care practice’,and innovatively designs a multidisciplinary collaborative mechanism,an information-based follow-up platform,and a social support network.Through the role of‘care consultant’,the programme connects the medical team with the individual needs of patients,strengthens treatment compliance and improves the quality of life,and provides a theoretical basis and practical reference for the optimization of the whole management mode of lymphoma patients.
文摘Objective:Healthcare service satisfaction focuses not only on the patients but also on the overall quality and effectiveness of the care provided.This study aimed to explore the correlation between patients’perceptions of empathy,patient satisfaction,and the quality of recovery in elderly patients undergoing postoperative care for lower extremity fractures under spinal anesthesia.Methods:In the present cross-sectional study,138 elderly patients who underwent surgery for lower extremity fracture and spinal anesthesia were selected for inclusion in the study.The questionnaire included demographic characteristics,the Jefferson Scale of Patient Perception of Physician Empathy,the Patient Satisfaction Scale,and the Postoperative Quality of Recovery Score.Multivariate regression was performed to evaluate the associations between patient-reported factors and satisfaction.Results:The overall average scores for patient perception of empathy,quality of recovery,and patient satisfaction were 20.30(1.18),110.11(8.26),and 156.86(5.44),respectively.There was a statistically significant positive correlation between patient quality of recovery and patient perception of empathy and patient satisfaction(p<0.01).Conclusions:This finding could also inform policymaking and the development of guidelines aimed at improving the quality of healthcare delivery.This study encouraged healthcare organizations and institutions to foster empathy in healthcare interactions,which may positively impact patient satisfaction and subsequent recovery outcomes,and patient-centered care.
文摘Implantable cardioverter defibrillators(ICDs)represent an established therapeutic strategy for the prevention of sudden cardiac death and reduction of mortality in high-risk patients,while ICDs with cardiac resynchronization therapy defibrillators improve morbidity,quality of life,and mortality in eligible patients with heart failure who are on optimal medical therapy.However,these devices may adversely affect the patients’psychological status after the delivery of shock therapies or even because of the fear of impending therapy.On the other hand,the potential of effective treatment of malignant arrhythmias may provide a‘safety’sensation in most treated patients without significant impairment in the quality of life during periods of clinical stability.During the past few years,an increasing number of reports have investigated psychological distress,including depression and anxiety status in ICD/cardiac resynchronization therapy defibrillator recipients.However,heterogeneous results have been reported while data on the variation of these psychological indexes over time in implanted patients are quite limited.Several intrinsic and extrinsic factors affect the psychological status of these patients while variations of these disturbances in specific populations are evident.Factors that seem to be associated with a greater risk for depression and anxiety in this setting include female gender,younger age,and device shock therapies.Moreover,depression and anxiety may have an adverse impact on patients’clinical outcomes exacerbating heart failure and increasing the arrhythmic risk.In this brief review article,we provide a concise and critical overview of the current literature on this topic,and we also discuss unresolved and conflicting issues delineating future perspectives.
文摘Objective To evaluate the prevalence and one-year prognosis associated with frailty in a contemporary cohort of older patients with non-ST-elevation acute coronary syndrome(NSTEACS).Methods The IMPACT-TIMING-GO registry(IMPACT of Time of Intervention in patients with Myocardial Infarction with Non-ST seGment elevation.ManaGement and Outcomes)prospectively included 1020 patients with NSTEACS undergoing invasive coronary angiography between April and May 2021.For this sub-study,patients≥65 years were selected.Frailty was assessed according to FRAIL scale.We studied all-cause mortality and the composite of all-cause mortality or all-cause hospitalizations at one-year follow-up after discharge.Results Five hundred and sixty seven patients(mean age:75.8±6.7 years,28.2%women)were included:316(55.7%)were robust,183(32.3%)prefrail,and 68(12.0%)frail.Frail patients were significantly older,more often women,and presented a worse baseline clinical profile.There were no differences among groups regarding pretreatment with a P2Y12 inhibitor.An urgent angiography(<24 h)was less frequently performed in frail patients,with no differences regarding revascularization approach or in main in-hospital adverse events,although acute kidney disease occurred more frequently in frail patients.At 1-year follow-up,20 patients died(3.6%).Chronic kidney disease was independently associated with 1-year all-cause death,although a trend towards higher mortality was observed in frail patients(HR=3.01;95%CI:0.93-9.78;P=0.065).Frailty was independently associated with higher 1-year all-cause mortality or all-cause rehospitalizations(HR=2.23;95%CI:1.43-3.46;P<0.001)Conclusions In older patients with NSTEACS,frailty independently associates higher all-cause mortality or all-cause hospital admissions at one-year follow-up.
基金supported by China National High Level Hospital Clinical Research Funding (2022-PUMCH-B-110)。
文摘Despite efforts to develop treatment technology for cardiac arrest (CA),CA incidence and mortality rates are still high.^([1,2])A recent study of CA patients in emergency departments revealed that the incidence of CA is increasing annually,and the in-hospital survival rate of CA patients is only approximately 28.7%.^([3])Echocardiography has been widely used as an important monitoring tool in critical care and helps to identify the cause of shock,monitor hemodynamics,and guide fluid therapy utilization.^([4])One study reported that approximately one-third of patients underwent formal echocardiography during hospitalization in the intensive care unit (ICU).
文摘Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung injury.[1]Intensive care unit-acquired weakness (ICU-AW)is a prevalent complication in critically ill patients.[2] The recovery of recipients undergoing LT for COVID-19-related respiratory failure may face impediments due to ICU-AW,which negatively affects early mobilization and functional improvement. This study describes two cases of successful bilateral LT for severe COVID-19-related ARDS with the occurrence of ICU-AW and subsequent successful discharge.
文摘Background Data on drug-coated balloon(DCB)treatment in elderly patients are limited.This study was to evaluate the efficacy of DCB treatment in percutaneous coronary intervention(PCI)among elderly patients.Methods A retrospective analysis included 232 patients aged 75 years or older with coronary artery disease who underwent successful PCI using either DCB alone or in combination with drug-eluting stent(DES)based on pre-dilation results(DCB-based PCI).These patients were compared with 1818 elderly patients who underwent second-generation DES implantation(DES-only PCI).The endpoint was major adverse cardiovascular events(MACE)at 2-year follow-up.Results In the DCB-based PCI,61.2%of patients received DCB-only treatment.Compared to DES-only PCI,the DCB-based PCI group had fewer stents(0.5±0.7 and 1.7±0.8,P<0.001),shorter stent lengths(13.3±20.9 mm and 37.4±23.0 mm,P<0.001),and lower usage of small stents with a diameter of 2.5 mm or less(15.6%and 28.7%,P=0.010).The DCB-based PCI group exhibited lower rate of MACE(5.5%and 13.1%,P=0.003),target vessel revascularization(1.1%and 5.6%,P=0.017)and major bleeding(0.7%and 5.1%,P=0.009)at 2-year follow-up.The reduced risk in 2-year MACE was consistently observed across various matching procedures,with the most significant reduction noted in target vessel revascularization and major bleeding.Conclusion The DCB-based PCI reduced stent burden,particularly in the usage of small diameter stents,and was associated with lower risks of MACE,target vessel revascularization,and major bleeding compared to DES-only PCI in elderly patients.
文摘BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.
文摘The destruction of the skin barrier and the presence of necrotic tissue in large burns increase the risk of multiple infections,often leading to sepsis,bacteremia,and other complications.Infective endocarditis(IE)is a severe manifestation of organ damage,and if conservative medical treatment fails to control the infection,irreversible pathological changes may occur,including valvular redundancy.
