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Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge  [cached]
McPhail Steven,Haines Terry
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-94
Abstract: Background Expectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients’ expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life. Methods A prospective longitudinal cohort investigation of agreement between patients’ anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results Overall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses. Conclusions Patients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.
Admission to a psychiatric unit and changes in tobacco smoking  [cached]
Ker Suzy,Owens David
Clinical Practice and Epidemiology in Mental Health , 2008, DOI: 10.1186/1745-0179-4-12
Abstract: Smoking and withdrawal from smoking complicates the assessment and treatment of mental illness. We aimed to establish whether psychiatric inpatients smoke different amounts after admission than beforehand and, if so, to find out why. Forty-three inpatients on a working age adult psychiatry ward completed self-report questionnaires about smoking habits. Those who smoked a different amount after admission had a follow-up interview to find out why they thought this had occurred. The interview incorporated qualitative and quantitative aspects which were analysed accordingly. Fifty-six percent of participants were smokers before admission, rising to 70% afterwards. Of the smokers, 17% smoked less after admission, and 63% smoked more. The average number of cigarettes smoked per person per day increased from five to thirteen. The main reasons for smoking more were boredom, stress and the wish to socialise.
Deciding intensive care unit-admission for critically ill cancer patients  [cached]
Thiery Guillaume,Darmon Michael,Azoulay Elie
Indian Journal of Critical Care Medicine , 2007,
Abstract: Over the last 15 years, the management of critically ill cancer patients requiring intensive care unit admission has substantially changed. High mortality rates (75-85%) were reported 10-20 years ago in cancer patients requiring life sustaining treatments. Because of these high mortality rates, the high costs, and the moral burden for patients and their families, ICU admission of cancer patients became controversial, or even clearly discouraged by some. As a result, the reluctance of intensivists regarding cancer patients has led to frequent refusal admission in the ICU. However, prognosis of critically ill cancer patients has been improved over the past 10 years leading to an urgent need to reappraise this reluctance. In this review, the authors sought to highlight that critical care management, including mechanical ventilation and other life sustaining therapies, may benefit to cancer patients. In addition, criteria for ICU admission are discussed, with a particular emphasis to potential benefits of early ICU-admission.
Frequency of admission in Intensive Care Unit due to road accident
Othon Vlachopoulos,Stergios Voutos,Dimitrios Karagiorgis,Vasilios Tziallas
To Vima tou Asklipiou , 2011,
Abstract: During recent years, it has been noticed a remarkable increase in admission of the young in Intensive Care Unit due to road accident. The aim of the present study was to explore the injuries, the special conditions of admission of young 18-40 years old that were admitted to Intensive Care Unit due to road accident. Method and material: The sample studied consisted of young individuals 18-40 years old that were admitted in the Intensive Care Unit (ICU) of public hospitals in the area of Attica for 3 years. Data were collected by the completion of a special designed questionnaire that apart from demographic variables, the record of injuries and the conditions of treatment it also included variables concerning the type of vehicle that caused the road accident as well as the outcome of patients' course. Data analysis was performed by the statistical package SPSS 13 and the method x2 and t-test. Results: The sample studied consisted of 555 young individuals, of the 13,1% of total admissions in ICU. Of the participants 82,2% were men and 17,8% women, with mean age 26,5 years. Regarding the frequency of various types of injuries, 24,7% of the participants had injuries of upper limbs and 26,4% of lower. 30,2% of the sample had more than 3 fractures, while the 6,9% more than 5. 75,7% of the participants had head injury. Moreover, it was found that the frequency of head injuries was statistical significant lower among those wearing helmet (64,5%) compared to those not wearing (82,5%), p<0,05. Intubation had the 17,9% of he sample, while in coma was the 11,6%. Finally, it was found that patients admitted in ICU from operation room (36,2%) were more likely with statistical significant more to die compared to those admitted by Emergency department (17,8%) by hospital of other town (16,7%) by other hospital (14,3%), or other clinic department (12,5%). Conclusions: Road accidents consist the main reason for admission of the young in ICU. The majority of individuals were multi-injured. Due to the increased incidence of admission, it is judged necessary the institution of ICU in every big hospital.
Admission Hypothermia Among Neonates Presented to Neonatal Intensive Care Unit  [PDF]
Shaheen Akter,Rubiya Parvin,B.H. Nazma Yasmeen
Journal of Nepal Paediatric Society , 2013, DOI: 10.3126/jnps.v33i3.8312
Abstract: Introduction: In developing countries, thermal protection of the newborn is not properly addressed. Neonates presented to Neonatal intensive care unit (NICU) for admission with various problems are frequently found to be hypothermic. The objective of this study was to determine the incidence and associated risk factors for neonatal hypothermia on admission to NICU. Materials and Methods: This was a prospective observational study carried over a period of three years at Enam Medical College and Hospital (EMCH) among the newborns admitted to NICU. Hypothermia has been defined as axillary temperature <36.5°C (<97.7° F). Temperature was measured at admission. Data were collected regarding perinatal and socio economic factors. Bivariate and multivariate analysis has been done to see the association of risk factors. Result: A total of 2310 babies between 0 and 680 h of age (mean 43± 12 hours) were studied. Thirty four percent (785) of the neonates had hypothermia. Mean gestation was 34±3 weeks and 42.5% were inborn. Significant determinants of neonatal hypothermia at admission included factors like preterm (p=0.03), low birth weight (p=0.005), normal delivery (p=0.012), birth asphyxia (p=0.001) below average socioeconomic status (p=0.001) and long distance (>10 km) travelled by the neonate (p=0.03). Independent variables are resuscitation at birth [p=.001, Odds Ratio (OR), 2.43; Confidence Interval (CI), 1.47 to 4.00], (p=0.001), age less than 24 hours (p=.02; OR 2.25; CI, 1.13 to 4.47), low birth weight (p=0.03; OR,2.0; CI, 1.06 to 3.82), caesarean section(C/S) delivery (p=.006; OR 1.35; CI, 1.18-2.12) and below average economic status (p=0.001; OR, 2.76; CI, 1.56 to 5.90). Conclusion: Incidence of admission hypothermia among neonates in our NICU was 34%. Independent risk factors are resuscitation at birth, very low birth weight, C/S delivery, age less than 24 hours and poor socio-economic condition. Proper thermal care should be provided for neonates both at home and hospitals. DOI: http://dx.doi.org/10.3126/jnps.v33i3.8312 ? J. Nepal Paediatr. Soc. 2013;33(3):166-171
Quality of life before intensive care unit admission is a predictor of survival
José GM Hofhuis, Peter E Spronk, Henk F van Stel, Augustinus JP Schrijvers, Jan Bakker
Critical Care , 2007, DOI: 10.1186/cc5970
Abstract: We conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours of admission to assess pre-admission HRQOL of the patient. Mortality was evaluated from ICU admittance until 6 months after ICU discharge. Logistic regression and receiver operating characteristic analyses were used to assess the predictive value for mortality using five models: the first question of the SF-36 on general health (model A); HRQOL measured using the physical component score (PCS) and mental component score (MCS) of the SF-36 (model B); the Acute Physiology and Chronic Health Evaluation (APACHE) II score (an accepted mortality prediction model in ICU patients; model C); general health and APACHE II score (model D); and PCS, MCS and APACHE II score (model E). Classification tables were used to assess the sensitivity, specificity, positive and negative predictive values, and likelihood ratios.A total of 451 patients were included within 48 hours of admission to the ICU. At 6 months of follow up, 159 patients had died and 40 patients were lost to follow up. When the general health item was used as an estimate of HRQOL, area under the curve for model A (0.719) was comparable to that of model C (0.721) and slightly better than that of model D (0.760). When PCS and MCS were used, the area under the curve for model B (0.736) was comparable to that of model C (0.721) and slightly better than that of model E (0.768). When using the general health item, the sensitivity and specificity in model D (sensitivity 0.52 and specificity 0.81) were similar to those in model A (0.45 and 0.80). Similar results were found when using the MCS and PCS.This study shows that the pre-admission HRQOL measured with either the one-item general health question or the complete SF-36 is as good at predicting survival/mortality in ICU patients as the APACHE I
Neurogenic diabetes insipidus presenting in a patient with subacute liver failure: a case report
Manu Shankar Hari, Anthony K Parsons, Andy K Burroughs, Steve Shaw, James O'Beirne, Banwari Agarwal
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-232
Abstract: A 25-year-old man presented with subacute liver failure. While awaiting a liver transplant, the patient developed cerebral edema, which resulted in neurogenic diabetes insipidus secondary to cerebral edema. The patient died before the liver transplantation could be carried out.Neurogenic diabetes insipidus is well recognized in the neurosurgical population as a consequence of cerebral edema and increased intracranial pressure, both of which occur commonly in patients with subacute liver failure.Cerebral edema occurs in patients presenting with fulminant liver failure, resulting in increased intracranial pressure (ICP). The incidence and severity of cerebral edema increases as the onset of liver failure becomes rapid. It occurs in up to 80% of patients with acute and hyperacute fulminant liver failure but less frequently (20%) in those with subacute fulminant liver failure. There is a significant association between the presence of cerebral edema and the development of central diabetes insipidus in patients with traumatic brain injury [1] and in postoperative neurosurgical patients. We present a case of neurogenic diabetes insipidus that developed during the course of subacute fulminant liver failure.A 25-year-old Nigerian man was admitted to our hospital's intensive care unit (ICU), after emergency tracheal intubation and ventilation for worsening encephalopathy and a deteriorating Glasgow Coma Scale score. The working diagnosis was seronegative hepatitis leading to subacute fulminant liver failure and grade three hepatic encephalopathy.His admission to our hospital was preceded by an admission to a local hospital with a ten day history of painless jaundice and malaise, progressing to three days of nausea and vomiting. The patient had no history of encephalopathy or coagulopathy. Liver function tests on admission were abnormal (bilirubin, 381 μmol/L, alanine transferase [ALT], 684 U/L), but an ultrasound scan showed a normal liver. Autoimmune and viral screen result
Methicillin resistant staphylococcus aureus (MRSA) colonization on admission to an intensive care unit  [cached]
Mehmet Yerer,G?khan Metan,Emine Alp,Duygu E?el
Erciyes Medical Journal , 2007,
Abstract: Purpose: Methicillin resistant Staphylococcus aureus (MRSA) infections are frequent in intensive care units (ICUs). This prospective study was implemented to investigate the frequency of MRSA colonization on admission to ICU.Materials and methods: This study was conducted at Erciyes University Faculty of Medicine Gevher Nesibe Hospital Internal Medicine ICU from December 2004 to January 2006. All patients admitted to ICU were included in the study. Nose, axilla and groin swab cultures were carried out within 48 hours of ICU admission then cultivated on mannitol salt agar including 6mg/L oxacillin.Results: A total of 408 patients were followed up during the study. MRSA colonization on admission was detected in 23 (5.64%) patients. MRSA infection was detected in 5 (21.7%) of those colonized patients. Staying in hospital before ICU admission, length of stay in hospital before ICU, previous antibiotic use, duration of previous antibiotic use, decubit ulcers and central venous catheter were statistically significant (p<0.05). Comorbidities, age, sex, APACHE II and SOFA scores were not determined as risk factors.Conclusion: The patients colonized with MRSA before admission to ICU are important sources of MRSA outbreaks. Detection of risk factors may decrease the rate of MRSA infections in ICUs.
Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery  [PDF]
Marco Ranucci,Andrea Ballotta,Serenella Castelvecchio,Ekaterina Baryshnikova,Simonetta Brozzi,Alessandra Boncilli
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013551
Abstract: Operative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality.
Result of the impact of multicomponent intervention in knowledge acquired, support social (AS) and overload of carers immigrants (SCI).
Remedios Rojano-Pérez,Margarita Sánchez-Pavón,Elena E. González-Rodríguez,Lucinda Morales- Infante
NURE Investigación , 2013,
Abstract: General Objectives: determine the acquisition of knowledge of a program aimed at inmigrant caregivers multicomponent intervention and the influence of group intervention in the immigrant, caregiver burden and perception of social support.Specific objectives: profile and socio-labour situation of immigrant caregivers.MethodologyDesign: cross-transverse descriptive study.Intervention multicomponent in seminar-workshop with pre/post test, delivery of support materials. Four sessions of 1 h 30. Study population: 50 IC of the intervention group.Variables: Level of knowledge (variable result), socio-demographic variables, the scales as Duke-UNC, SCI of Zarit.Analysis: To achieve a 90% power to detect differences in the contrast of the null hypothesis H0:p1 = p2 through a bilateral chi-squared test for two independent samples, taking into account the level of significance is 5%, it will be necessary to include 50 CI of the intervention group.Results: The 41.3% (n 20), presented social support, caregiver 38% (n 19) overload, with sufficient care 30% (15 n) knowledge, prior to intervention. Differences after the intervention, were found in the level of knowledge of the 90.4% (n 43). Significant difference was not found in the overload of the carers immigrants, or in social support.Discussion and conclusions: educational workshops have improved levels of knowledge of CI. Different studies show caregivers overload is more "resistant" to this type of intervention. You can influence the lack of significance of the overload of immigrant caregivers and social support, the little sample of participants.
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