BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.展开更多
Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantati...Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.展开更多
Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibitin...Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.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
BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilizatio...BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.展开更多
This study investigates community identity in Nanjing’s historic Hehuatang community during urban renewal,revealing tensions between heritage preservation and modernization.Through ethnographic research,three key fac...This study investigates community identity in Nanjing’s historic Hehuatang community during urban renewal,revealing tensions between heritage preservation and modernization.Through ethnographic research,three key factors are identified shaping identity:(i)material conditions including series of spatial conflicts around overcrowding,(ii)social tensions such as tenant-aborigine divides and generational misunderstanding,and(iii)institutional governance as top-down policies would exacerbate distrust.Despite 82%of residents expressing place attachment,67%desire relocation due to deteriorating liveability—a paradox highlighting the failure of China’s contemporary performative participation models.The adapted three-layer creativity model underscores the need to reconcile physical renewal with social equity.Findings advocate for co-design processes that integrate resident agency,offering lessons for sustainable urban renewal in rapidly developing contexts.展开更多
BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA...BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.展开更多
Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medicati...Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medication reconciliation in healthcare facilities to reduce them and ensure patients a safe, high-quality healthcare pathway. Objective: This study aimed to detect medication errors by reconciling drug treatments and assess the relevance and feasibility of this standardized practice within the Medical Emergency Unit of the Teaching Pediatric Hospital of Ouagadougou (Burkina Faso). Methods: Patients whose parents gave their consent at their entrance were enrolled. For each patient, the pharmacy team completed a reconciliation form that included the patient’s usual treatment, which was taken and in progress and received upon admission to the medical emergency unit. Patients’ treatments were reviewed to detect and characterize discrepancies. The data of each form were reported and analyzed using KoboCollect, an Android application. Results: 135 records and 412 medication lines were captured over six weeks. The average time of treatment reconciliation per patient was 57 minutes. One thousand one hundred ninety-eight (1198) intentional discrepancies were detected, of which 6.09% were documented. Seventy-one (71) unintentional discrepancies were collected, including 39 omissions, 24 regimen dosing errors, and 8 pharmaceutical form dosage errors. Forty-nine (49) unintentional discrepancies, or 69.01%, were corrected by formulated pharmaceutical interventions toward physicians. Conclusion: Medical treatment reconciliation during hospital admission is critical because discrepancies can compromise the efficacy and/or safety of the patient’s hospital medication.展开更多
BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outc...BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.展开更多
The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolvin...The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.展开更多
Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study...Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study utilized a cross-sectional research design.A convenience non-probability sample of 341 nurses from various private and government hospitals across different emirates in the UAE participated in June 2022.Data were collected using a self-administered questionnaire comprising demographic information,the Moral Distress Scale–Revised.Multivariable logistic regression was used to identify factors associated with intention to leave.Results:The study found that a large majority(71.9%)of ICU nurses experienced severe moral distress,and more than 35%had intention to leave.Futile end-of-life interventions emerged as the most distress-provoking aspect of practice[16.0(0,16.0)].Multivariable analysis revealed nurses experiencing severe moral distress had 3.73 times the odds of intending to leave their job compared with those experiencing mild distress(95%CI:1.81,7.69;P<0.001)and being aged 31–40 years(OR=2.02;95%CI:1.23,3.33;P=0.005)was independently associated with a higher intention to leave.Conclusions:Severe moral distress was prevalent among ICU nurses in the UAE and strongly associated with intention to leave,and also those aged 31–40 years.Promoting ethical support,shared decision-making,and nurse empowerment is vital to improving retention and care quality.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits f...BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.展开更多
BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,whil...BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.展开更多
BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach t...BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.展开更多
In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a h...In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a hallmark of its persistent infections.This study highlights a pivotal role for HBV-encoded microRNA,specifically HBV-miR-3,in undermining the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)-IFN signaling axis.This pathway is critical for recognizing viral DNA and subsequent production of type I interferons,key antiviral cytokines.HBV-miR-3 achieves this immune evasion by directly downregulating the expression of cGAS,an essential DNA sensor,and STING,its downstream adaptor.By silencing these components,HBV-miR-3 disrupts the activation of downstream interferon regulatory factor 3 and Nuclear Factor Kappa-light-chain-enhancer of Activated B Cells transcription factors,thereby blunting interferon beta production and antiviral gene expression.This strategy allows HBV to persist in hepatocytes by dampening innate immune responses and contributes to immune tolerance,fostering chronic infection.Understanding the role of HBV-miR-3 provides novel insights into HBV pathogenesis and identifies potential therapeutic targets to restore antiviral immunity.Targeting HBV-miR-3 or reactivating the cGAS-STING-IFN pathway could offer promising strategies to counteract HBV immune evasion and resolve chronic infection.展开更多
BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.Thes...BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.展开更多
The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the IC...The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the ICU.Psychological first aid(PFA)is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning.The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients,caregivers,and HCWs.This is the first such review to apply PFA to the ICU setting.展开更多
Background:To understand the current situation of loneliness and dementia fear among elderly people in the community;Analyze the influencing factors and clarify the correlation between the two.Methods:Through convenie...Background:To understand the current situation of loneliness and dementia fear among elderly people in the community;Analyze the influencing factors and clarify the correlation between the two.Methods:Through convenience sampling,228 elderly people were selected as the research subjects,and the general demographic characteristics questionnaire,elderly loneliness scale,dementia fear scale,and simplified intelligence status check scale were used for investigation.SPSS 28.0 statistical software was used for data analysis.Results:The total score of loneliness was 96.21±21.83 points,and the total score of dementia fear was 59.34±13.50 points.There were statistically significant differences in dementia fear scores among elderly people in the community in terms of age,gender,marital status,family history of dementia,and number of chronic diseases(P<0.05).Person correlation analysis showed a positive correlation between the total score of dementia fear and loneliness in elderly people in the community(r=0.162,P<0.05).Conclusion:The level of loneliness and dementia fear among elderly people in the community is at a moderate level.Age,gender,marital status,family history of dementia,and number of chronic diseases are important influencing factors of dementia fear among elderly people in the community.The sense of loneliness among elderly people in the community is positively correlated with dementia fear,meaning that the greater the degree of loneliness,the higher the degree of dementia fear among elderly people in the community.展开更多
BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and...BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.展开更多
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
文摘Green transplant refers to the realization of the importance of understanding and improving the environmental footprint of transplantation through sustainable practices.This involves assessing the entire transplantation process including preoperative evaluation,donation,organ and patient transportation,surgery,postoperative recovery,and follow-up.This is a topic that has not been fully addressed yet,but its importance is being increasingly appreciated in surgery.The aim of this study was to investigate the carbon footprint associated with transplantation and propose sustainable mitigating solutions.A comprehensive review of the existing literature on transplantation was conducted and supplemented with findings from the broader fields of surgical and perioperative care,given the scarcity of available data.The analysis identified the most involved environmental factors and attempted to offer practical solutions based on current sustainability practices.Notably,no study has yet examined the carbon footprint associated with the entire transplantation procedure.Only five studies have attempted to assess the environmental impact of kidney or liver transplants,but they focused,almost explicitly,on specific steps of the process.By employing an extrapolative methodology from the broader surgical field,we determined that the primary contributors to the environmental impact of transplantation are energy,consumables and materials,anesthesia and pharmaceuticals,transportation,and water.This review offers practical solutions utilizing the 5R framework,emphasizing sustainability to ensure transplantation remains clinically and environmentally relevant.
文摘Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.
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BACKGROUND Prolonged immobility during intensive care unit(ICU)admission has been a cause of muscle atrophy and worsening functional outcomes with longer recovery times.Prior research has demonstrated that mobilization within a week of ICU admission potentially benefits physical function in critically ill patients.AIM To evaluate the effects of initiating mobilization within 72 hours of ICU admission in critically ill patients through an updated systematic review and meta-analysis.METHODS A systematic search was performed through MEDLINE,Scopus,and Cochrane Library from inception until September 2024 for randomized controlled trials(RCTs)comparing early mobilization(EM)with usual or conventional care in critically ill adult patients.Primary outcomes included length of ICU(days)and ventilation duration(days).Secondary outcomes included muscle strength,functional status,adverse events,all-cause mortality,and quality of life(QOL).A random effects meta-analysis was performed for pooled effect estimates and to derive risk ratios(RR)and corresponding 95%confidence intervals(CI).RESULTS Out of 3487 results,16 RCTs were included with a population of 2385 patients(1195 receiving EM and 1190 with usual care.)A significant reduction in the length of ICU stays[mean difference(MD)=-1.02,95%CI:-1.96 to-0.09;P=0.03;I2=60%]and ventilation duration(MD=-1.07,95%CI:-1.91 to-0.23,P=0.01;I2=57%)was observed in the EM group compared to usual care.EM significantly improved muscle strength[standard MD(SMD)=0.47,95%CI:0.18-0.75,P=0.001;I2=79%]and functional status(SMD=0.70,95%CI:0.40-1.00,P<0.00001;I2=81%)in ICU patients.No statistically significant difference was observed in adverse events(RR=1.72,95%CI:1.01-2.94,P=0.05;I2=31%),all-cause mortality(RR=1.10,95%CI:0.79-1.53,P=0.57;I2=30%),and QOL(SMD=0.04,95%CI:-0.07-0.15,P=0.50;I2=9%)between the two groups.CONCLUSION Initiating mobilization within 72 hours of ICU admission is associated with improved functional outcomes and reduced ICU length of stay and ventilation duration.These findings indicate that EM may be a safe option for ICU patients,contributing to lower recovery times and healthcare costs.Further extensive research is required to validate the long-term effects on survival and QOL.
基金Sponsored by The National Social Science Fundation of China(24BGL216).
文摘This study investigates community identity in Nanjing’s historic Hehuatang community during urban renewal,revealing tensions between heritage preservation and modernization.Through ethnographic research,three key factors are identified shaping identity:(i)material conditions including series of spatial conflicts around overcrowding,(ii)social tensions such as tenant-aborigine divides and generational misunderstanding,and(iii)institutional governance as top-down policies would exacerbate distrust.Despite 82%of residents expressing place attachment,67%desire relocation due to deteriorating liveability—a paradox highlighting the failure of China’s contemporary performative participation models.The adapted three-layer creativity model underscores the need to reconcile physical renewal with social equity.Findings advocate for co-design processes that integrate resident agency,offering lessons for sustainable urban renewal in rapidly developing contexts.
文摘BACKGROUND As red blood cell distribution width(RDW)and albumin have been shown to be independent predictors of mortality from various diseases,this study aimed to investigate the effect of the RDW to albumin ratio(RA)as an independent predictor of the prognosis of patients admitted to the coronary care unit(CCU).AIM To use the RDW and albumin level to predict the prognosis of patients in the CCU.METHODS Data were obtained from the Medical Information Mart Intensive Care III database.The primary outcome was 365-day all-cause mortality,whereas the secondary outcomes were 30-and 90-day all-cause mortality,hospital length of stay(LOS),and CCU LOS.Cox proportional hazards regression model,propen-sity score matching,and receiver operating characteristic curve analyses were used.RESULTS The hazard ratio(95%confidence interval)of the upper tertile(RA>4.66)was 1.62(1.29 to 2.03)when compared with the reference(RA<3.84)in 365-day all-cause mortality.This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis.Similar trends were observed for the secondary outcomes of hospital and CCU LOS.Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment(SOFA)scores,and the C-statistic was higher than that of the SOFA scores(0.733 vs 0.702,P<0.001).CONCLUSION RA is an independent prognostic factor in patients admitted to the CCU.RA combined with the SOFA score can improve the predictive ability of the SOFA score.However,our results should be verified in future prospective studies.
文摘Introduction and Problem Statement: Many medication errors occur during the community and hospital transition. Indeed, the World Health Organization launched the international “High 5S” project to implement medication reconciliation in healthcare facilities to reduce them and ensure patients a safe, high-quality healthcare pathway. Objective: This study aimed to detect medication errors by reconciling drug treatments and assess the relevance and feasibility of this standardized practice within the Medical Emergency Unit of the Teaching Pediatric Hospital of Ouagadougou (Burkina Faso). Methods: Patients whose parents gave their consent at their entrance were enrolled. For each patient, the pharmacy team completed a reconciliation form that included the patient’s usual treatment, which was taken and in progress and received upon admission to the medical emergency unit. Patients’ treatments were reviewed to detect and characterize discrepancies. The data of each form were reported and analyzed using KoboCollect, an Android application. Results: 135 records and 412 medication lines were captured over six weeks. The average time of treatment reconciliation per patient was 57 minutes. One thousand one hundred ninety-eight (1198) intentional discrepancies were detected, of which 6.09% were documented. Seventy-one (71) unintentional discrepancies were collected, including 39 omissions, 24 regimen dosing errors, and 8 pharmaceutical form dosage errors. Forty-nine (49) unintentional discrepancies, or 69.01%, were corrected by formulated pharmaceutical interventions toward physicians. Conclusion: Medical treatment reconciliation during hospital admission is critical because discrepancies can compromise the efficacy and/or safety of the patient’s hospital medication.
文摘BACKGROUND Esophageal cancer patients had the highest intensive care unit(ICU)admitted rate in cancer patients.But their prognosis and evaluation methods were rarely studied.AIM To depict the short-term mortality outcome and identify the potential prognostic factors of esophageal cancer patients admitted into ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at ICU departments of 37 cancer specialized hospitals in China.Patients aged≥14 years with ICU duration≥24 hours were included.Clinical records of patients with primary esophageal cancer diagnosis were reviewed.Patients were separated into groups according to the 90 days survival.Characteristics between groups were compared.Single and multi-variate regression tests were applied to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS Total 180 esophageal cancer patients were included.The 90 days mortality was 22.2%.Patients with mortality outcome showed differences from those survived mostly in disease severity and unplanned transfer from clinical ward.The current evaluation tools,including Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores had low accuracy in prediction of short-term death.ICU admitted esophageal cancer patients have poor prognosis,especially those with acute illness.CONCLUSION The prognostic tools for these patients need to be further optimized.
文摘The second edition of the United Arab Emirates inflammatory bowel disease(IBD)consensus guidance provides updated recommendations for diagnosing,treating,and monitoring IBD.Significant therapeutic advances and evolving treatment paradigms since 2020(including risk stratification and treat-to-target approaches)necessitated this comprehensive update to standardize care across the United Arab Emirates.Developed via Delphi consensus methodology,this guidance incorporates a systematic literature review and key international gui-delines.It presents 188 summary statements covering the full spectrum of IBD care,including complex scenarios like perianal disease and pregnancy.Key updates feature guidance on newer pharmacologic therapies-interleukin-23,Janus kinase,and sphingosine-1-phosphate receptor inhibitors-with refined therapeutic positioning informed by recent head-to-head trials.The consensus emphasizes early,effective treatment to prevent irreversible bowel damage,optimization strategies like therapeutic drug monitoring,and achieving objective treat-to-target goals to improve long-term outcomes.Recognizing local healthcare system challenges,it offers practical recommendations on reducing variability and enhancing equitable access to IBD care.By integrating current clinical evidence with United Arab Emirates-specific considerations,the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors,provide a benchmark for payers and policymakers,optimize treatment outcomes,and improve IBD outcomes,aligning national practice with international standards.
文摘Objectives:The study aimed to examine the severity of moral distress and intention to leave among ICU nurses in the United Arab Emirates(UAE),and explore the influencing factors of intention to leave.Methods:The study utilized a cross-sectional research design.A convenience non-probability sample of 341 nurses from various private and government hospitals across different emirates in the UAE participated in June 2022.Data were collected using a self-administered questionnaire comprising demographic information,the Moral Distress Scale–Revised.Multivariable logistic regression was used to identify factors associated with intention to leave.Results:The study found that a large majority(71.9%)of ICU nurses experienced severe moral distress,and more than 35%had intention to leave.Futile end-of-life interventions emerged as the most distress-provoking aspect of practice[16.0(0,16.0)].Multivariable analysis revealed nurses experiencing severe moral distress had 3.73 times the odds of intending to leave their job compared with those experiencing mild distress(95%CI:1.81,7.69;P<0.001)and being aged 31–40 years(OR=2.02;95%CI:1.23,3.33;P=0.005)was independently associated with a higher intention to leave.Conclusions:Severe moral distress was prevalent among ICU nurses in the UAE and strongly associated with intention to leave,and also those aged 31–40 years.Promoting ethical support,shared decision-making,and nurse empowerment is vital to improving retention and care quality.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
文摘BACKGROUND Pericarditis is the inflammation of the pericardial sac due to a variety of stimuli that ultimately trigger a stereotyped immune response.This condition accounts for up to 5%of emergency department visits for nonischemic chest pain in Western Europe and North America.The most common symptoms of clinical presentation are chest pain and shortness of breath with associated unique electrocardiographic changes.Acute pericarditis is generally self-limited.However,some cases may be complicated by either tamponade or a large pericardial effusion,which carries a significant risk of recurrence.Risk factors for acute pericarditis include viral infections,cardiac surgery,and autoimmune disorders.A rarer cause of pericardial inflammation includes pneumonia,which can induce purulent pericarditis that has been increasingly rare since the advent of antibiotics.Purulent pericarditis carries a high fatality rate,especially in the setting of tamponade,and is invariably deadly without the administration of antibiotics.Bedside transthoracic echocardiogram is a quick and helpful method that can aid in the diagnosis and management.CASE SUMMARY We present the case of a 62-year-old woman who sought medical attention at the emergency department(ED)due to a 5-day history of chest pain,shortness of breath,and subjective fevers.Laboratory findings in the ED were significant for leukocytosis and elevated erythrocyte sedimentation rate and C-reactive protein.A chest X-ray revealed a new focal density within the left lower lung base,and a bedside point-of-care ultrasound showed a pericardial fluid collection.The patient was subsequently admitted,where she underwent pericardiocentesis.Fluid cultures from drainage grew streptococcus pneumoniae.She was started on broadspectrum antibiotics immediately after the procedure.The patient was ultimately discharged in stable condition with cardiology and infectious disease follow-up.CONCLUSION This case report emphasizes a unique complication of community-acquired pneumonia.Purulent pericarditis due to streptococcus pneumonia occurs via intrathoracic spread of the organism to the pericardium.This condition is virtually fatal without the administration of antibiotics.Therefore,in the context of suspected pneumonia and a new pericardial fluid collection on imaging,clinicians should suspect purulent pericarditis until proven otherwise,which requires emergent intervention.
文摘BACKGROUND Atrial fibrillation(AF)represents a common arrhythmia with significant implications and may occur pre-,intra-,or postoperatively(POAF).After cardiac surgery POAF occurs in approximately 30% of patients,while non-cardiac/nonthoracic surgery has a reported incidence between 0.4% to 15%,with new onset POAF occurring at a rate of 0.4% to 3%.While AF has been extensively studied,it has not been well described in emergent non-cardiac surgery associated with increased surgical stress in an intensive care unit setting(ICU).AIM To investigate the incidence/predictors of POAF in emergent non-cardiac surgery and its associations with postoperative outcomes in the ICU.METHODS This retrospective study included patients≥18 years who underwent exploratory laparotomy or lower extremity amputation between October 2012 and September 2023 and were admitted in the ICU.Data of interest included occurrence of POAF,demographic characteristics,comorbidities,laboratory values,administered fluids,medications,and postoperative outcomes.Statistical analyses consisted of identifying predic-tors of POAF and associations of POAF with outcomes of interest.RESULTS A total of 347 ICU patients were included,16.4% had a history of AF,13.0% developed POAF,and 7.9%developed new-onset POAF.Patients with new-onset POAF were older(79.6±9.1 vs 68.1±14.8 years,<0.001),of white race(47.8%vs 28.8,P<0.001),hypertensive(87.0%vs 71.2%,P=0.011),had longer ICU length of stay(ICU-LOS)(13.4 vs 6.7 days,P=0.042),higher mortality(43.5%vs 17.6%,P=0.016)and higher rate of cardiac arrest(34.8%vs 14.6%,P=0.005)compared to patients without new-onset POAF.Multivariable analysis revealed increased POAF risk with advanced age(OR=1.06;95%CI:1.02-1.10,P=0.005),white race(OR=2.85;95%CI:1.26-6.76,P=0.014),high intraoperative fluid(OR>1;95%CI:1.00-1.00,P=0.018),and longer ICU-LOS(OR=1.04;95%CI:1.00-1.08,P=0.023).After adjusting for demographics,new onset POAF significantly predicted mortality(OR=3.07;95%CI:1.14-8.01,P=0.022).CONCLUSION POAF was associated with prolonged ICU-LOS,white race,and high intraoperative fluid.New-onset POAF was associated with increased risk of cardiac arrest and death in critically ill patients.
文摘BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.
文摘In this editorial,we comment on the article by Xu et al published in the recent issue of the World Journal of Hepatology.The hepatitis B virus(HBV)has evolved sophisticated mechanisms to evade host innate immunity,a hallmark of its persistent infections.This study highlights a pivotal role for HBV-encoded microRNA,specifically HBV-miR-3,in undermining the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)-IFN signaling axis.This pathway is critical for recognizing viral DNA and subsequent production of type I interferons,key antiviral cytokines.HBV-miR-3 achieves this immune evasion by directly downregulating the expression of cGAS,an essential DNA sensor,and STING,its downstream adaptor.By silencing these components,HBV-miR-3 disrupts the activation of downstream interferon regulatory factor 3 and Nuclear Factor Kappa-light-chain-enhancer of Activated B Cells transcription factors,thereby blunting interferon beta production and antiviral gene expression.This strategy allows HBV to persist in hepatocytes by dampening innate immune responses and contributes to immune tolerance,fostering chronic infection.Understanding the role of HBV-miR-3 provides novel insights into HBV pathogenesis and identifies potential therapeutic targets to restore antiviral immunity.Targeting HBV-miR-3 or reactivating the cGAS-STING-IFN pathway could offer promising strategies to counteract HBV immune evasion and resolve chronic infection.
文摘BACKGROUND In the intensive care unit(ICU)setting,patients with end-stage gastrointestinal cancer(GIC)frequently bear a heavier symptom burden,see faster functional regression,and struggle with eating impairments.These further increase the demands and complexities of nursing care.AIM To discuss the development of Kano model-driven ICU end-of-life care(ICUEOLC)strategies for patients with GIC and its implications for quality of death(QoD).METHODS This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024.A Kano model-driven ICU-EOLC protocol was applied to the observation group(n=65),contrasting with routine care in the control group(n=50).Pre-intervention and post-intervention comparisons were made in terms of psychological well-being[Hospital Anxiety and Depression Scale(HADS)],quality of life(QoL)[European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version(EORTC QLQ-C15-PAL)],QoD(Chinese version of the Quality of Dying and Death in the ICU Scale),death-related attitudes[Revised Death Attitude Profile(DAP-R)],and nursing care satisfaction.RESULTS Compared with controls,patients in the observation group scored markedly lower on HADS(all domains),EORTC QLQ-C15-PAL(symptom domain),and DAP-R(escape acceptance,fear of death,and death avoidance),while achieving statistically higher scores on EORTC QLQ-C15-PAL(physical function and overall QoL dimensions),C-QDD-ICU,DAP-R(natural and approaching acceptance),and nursing care satisfaction measures.CONCLUSION Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with endstage GIC,and patients’quality of life,QoD,death-related attitudes,and nursing satisfaction were improved.
文摘The intensive care unit(ICU)is a stressful environment for patients and their families as well as healthcare workers(HCWs).Distress,which is a negative emo-tional or physical response to a stressor is common in the ICU.Psychological first aid(PFA)is a form of mental health assistance provided in the immediate aftermath of disasters or other critical incidents to address acute distress and re-establish effective coping and functioning.The aim of this narrative review is to inform the development and utilization of PFA by HCWs in the ICU to reduce the burden of distress among patients,caregivers,and HCWs.This is the first such review to apply PFA to the ICU setting.
文摘Background:To understand the current situation of loneliness and dementia fear among elderly people in the community;Analyze the influencing factors and clarify the correlation between the two.Methods:Through convenience sampling,228 elderly people were selected as the research subjects,and the general demographic characteristics questionnaire,elderly loneliness scale,dementia fear scale,and simplified intelligence status check scale were used for investigation.SPSS 28.0 statistical software was used for data analysis.Results:The total score of loneliness was 96.21±21.83 points,and the total score of dementia fear was 59.34±13.50 points.There were statistically significant differences in dementia fear scores among elderly people in the community in terms of age,gender,marital status,family history of dementia,and number of chronic diseases(P<0.05).Person correlation analysis showed a positive correlation between the total score of dementia fear and loneliness in elderly people in the community(r=0.162,P<0.05).Conclusion:The level of loneliness and dementia fear among elderly people in the community is at a moderate level.Age,gender,marital status,family history of dementia,and number of chronic diseases are important influencing factors of dementia fear among elderly people in the community.The sense of loneliness among elderly people in the community is positively correlated with dementia fear,meaning that the greater the degree of loneliness,the higher the degree of dementia fear among elderly people in the community.
文摘BACKGROUND Ovarian carcinoma has the highest mortality rate among all gynecological cancers.Several reproductive and hormonal risk factors,including early menarche,late menopause,limited use of oral contraceptives,and a low pregnancy rate,have been identified as contributors to the increased susceptibility to ovarian cancer.Advancements in cancer therapy over the past century,including the emergence of precision oncology,underscore the importance of early detection and tailored interventions,factors particularly critical in ovarian cancer,where late-stage diagnosis remains a persistent barrier to survival.This challenge is compounded by the lack of a universally endorsed screening program,resulting in late-stage identification and widespread metastasis.AIM To evaluate demographic differences in ovarian cancer-related mortality from 1999 to 2020 among adult females aged≥25 years within the United States.METHODS Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was used to collect de-identified death certificate data for malignant neoplasm of the ovaries related deaths in female adults aged 25 years and older from the year 1999 to 2020.Crude mortality rates and age-adjusted mortality rates(AAMRs)per 100000 people were calculated.Join point regression program was used to assess annual percent changes in mortality trends,with statistical significance set at P value<0.05.RESULTS Between 1999 and 2020,337619 deaths due to ovarian cancer occurred among United States females aged 25 to>85.The AAMR decreased from 14.62 in 1999 to 10.15 in 2020,with significant declines across various demographics.The AAMRs were highest among non-Hispanic White women,i.e.,13.53.Based on region,they were the highest in the Northeast(13.06)and Midwest(12.94).The steepest decline was observed in metropolitan areas as compared to nonmetropolitan ones.The study highlights significant progress in reducing ovarian cancer mortality across age,race/ethnicity,and geographic regions during this period.CONCLUSION The mortality trends for ovarian carcinoma patients showed an overall decrease,with the highest mortality rates observed among older individuals(65 to>85 years)and non-Hispanic Whites.These disparities underscore the need for equitable healthcare access and targeted policy interventions.
