Medicine
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Multicenter Study Comparative Study Observational Study
Association of comorbidities with postoperative in-hospital mortality: a retrospective cohort study.
The purpose of this article is to evaluate the American Society of Anesthesiologists Physical Status (ASA PS) and the Charlson comorbidity index (CCI) for the prediction of postoperative mortality. The ASA PS has been suggested to be equally good as the CCI in predicting postoperative outcome. However, these scores have never been compared in a broad surgical population. ⋯ The SMS predicted postoperative mortality especially well in patients never admitted to an intensive care unit. The newly constructed SMS provides a good estimate of patient's risk of death after surgery. It is capable of identifying those patients at especially high risk and may help reduce postoperative mortality.
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Multicenter Study
Physician's first clinical impression of emergency department patients with nonspecific complaints is associated with morbidity and mortality.
The association between the physician's first clinical impression of a patient with nonspecific complaints and morbidity and mortality is unknown. The aim was to evaluate the association of the physician's first clinical impression with acute morbidity and mortality. We conducted a prospective observational study with a 30-day follow-up. ⋯ The combination of the variables "looking ill," "age," "male sex," and "CCI" resulted in the best prediction of these outcomes (mortality: area under the curve [AUC] 0.77, 95% CI 0.72-0.82; morbidity: AUC 0.68, 95% CI 0.65-0.71). The physician's first impression, with or without additional variables such as age, male sex, and CCI, was associated with morbidity and mortality. This might help in the decision to perform further diagnostic tests and to hospitalize ED patients.
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To compare the proportion, seriousness, preventability of adverse drug events (ADEs) between the older adults (≥ 65 years old) and younger adults (<65 years old) presenting to the emergency department (ED), we conducted a prospective observational cohort study of patients 18 years and older presenting to the ED. For all ED visits between March 1, 2009, and Feb 28, 2010, investigators identified ADEs and assessed cases using the Naranjo adverse drug reaction probability scale. Outcomes (proportion, seriousness, and preventability of ADE, length of ED stay, and hospitalization) and associated variables were measured and compared between younger and older adults. ⋯ In addition, patients in the older group were more likely to be male, to have symptoms of fatigue or altered mental status, to involve cardiovascular, renal, and respiratory systems, and to have higher Charlson comorbidity index scores, higher number of prescription medications, and higher proportion of unintentional overdose. In conclusion, the proportion of ADE-related ED visits in older adults was higher than younger adults, and many of these were preventable. The most common drug categories associated with preventable ADEs in the older adults were antithrombotic agents, antidiabetic agents, and cardiovascular agents.
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The assessment of pulmonary congestion in maintenance hemodialysis (MHD) patients is challenging. Bioelectrical impedance analysis (BIA) can estimate body water compartments. Natriuretic peptides are markers of hemodynamic stress, neurohormonal activation and extracellular volume overload. ⋯ The dynamic changes in B-lines after hemodialysis are correlated to the changes in total body and extra-cellular water, and particularly to lung fluids removal. B-line assessment in MHD patients is highly feasible with a simplified and timely scanning scheme limited to the lateral chest regions. These premises make B-lines a promising biomarker for a bedside assessment of pulmonary congestion in MHD patients.
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Multicenter Study Observational Study
The high prevalence of hypovitaminosis D in China: a multicenter vitamin D status survey.
Vitamin D deficiency, which is usually detected by using immunoassays or the more reliable liquid chromatography tandem mass spectrometry (LC-MS/MS) methods, has recently been considered a public health problem worldwide. However, the vitamin D status in Chinese populations, as measured using the LC-MS/MS method, is not available. The objective of this multicenter study was to determine the vitamin D status and prevalence of vitamin D deficiency by using a reliable method in 5 large cities in China. ⋯ The serum iPTH level showed a significant negative correlation with the 25OHD level (r = -0.23, P < 0.01) after correcting for age and sex. In conclusion, the present study evaluated the vitamin D status using a reliable method, and our results indicate that vitamin D deficiency is prevalent among all age groups in China, especially among younger adults. We also observed significant differences in the 25OHD levels according to sex, age, and region among apparently healthy individuals.