Purpose
Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion ...variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock.
Methods
This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock. All patients received sequential sublingual measurements using a sidestream-dark field (SDF) video microscope at admission to the intensive care unit (± 4 h) and 24 (± 4) hours later that was performed blindly to the treatment team. Patients were randomized to usual routine or to integrating sublingual microcirculatory perfusion variables in the therapy plan. The primary endpoint was 30-day mortality, secondary endpoints were length of stay on the ICU and the hospital, and 6-months mortality.
Results
Overall, we included 141 patients with cardiogenic (
n
= 77), post cardiac surgery (
n
= 27), or septic shock (
n
= 22). 69 patients were randomized to the intervention and 72 to routine care. No serious adverse events (SAEs) occurred. In the interventional group, significantly more patients received an adjustment (increase or decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%,
p
= 0.009) within the next hour. Microcirculatory values 24 h after admission and 30-day mortality did not differ crude: 32 (47.1%) patients versus 25 (34.7%), relative risk (RR) 1.39 (0.91–1.97); Cox-regression: hazard ratio (HR) 1.54 (95% confidence interval (CI) 0.90–2.66,
p
= 0.118).
Conclusion
Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all.
Graphical Abstract
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective
Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who ...were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey.
Methods
This was a multicentre, observational, cross‐sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE‐DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE‐DAPT scores.
Results
The mean PRECISE‐DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE‐DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE‐DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P ˂ .001). Among the females, the rate of patients with a PRECISE‐DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P ˂ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P ˂ .001). The in‐hospital bleeding rates were higher among the patients with high PRECISE‐DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE‐DAPT scores had a higher in‐hospital mortality rate compared with those with low PRECISE‐DAPT scores (1% vs 0%, P = .11).
Conclusions
The mean PRECISE‐DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed that the PRECISE‐DAPT score may help physicians determine the type and duration of DAPT, especially in patients with ACS in Turkey.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction: The competencies needed for information and communication technologies (ICT) integration in the teaching-learning process are related to the use of technology, pedagogical attitudes, ...and content planning. These qualifications are all interrelated and should not be seen separately (Becuwe et al., 2017). In this context, ICT and TPACK competencies are important for ICT integration. The standards of ISTE for educators define the ICT skills that teachers should have as designers and facilitators (International Society for Technology Education ISTE, 2020). These standards are gathered within the framework of ICT literacy, digital literacy, and ICT competence (Tondeur et al., 2017). The concept of ICT competence discussed in this study refers to the integrated and functional use of digital knowledge, skills and attitudes (Hatlevik et al., 2015). In this study, the ICT integration competencies of pre-service teachers (PSTs) were examined as ICT competencies and TPACK competencies in terms of a range of variables. For this purpose, the following question was asked: "Is there any significant difference in the ICT integration competencies of PSTs according to a range of variables?" Methods: This study is based on causal-comparative research. The research was conducted in the autumn term of the 2019-2020 academic year. A convenience sampling method was used. In this regard, 413 PSTs, who are students of faculties of education at ten state universities located in different cities in Turkey, participated voluntarily in the study. The "Pre-service Teachers' ICT Competencies Scale" developed by Tondeur et al. (2017) and the "TPACK-Deep Scale" developed by Kabakçi Yurdakul et al. (2012) were used to collect the data in the study. In addition to the scales, seven questions were asked about gender, grade, department, GPA, ICT course grade, owning a computer for educational purposes, and one's perceived ability to use technology. Two methods have been adopted to collect data. The first was to collect the printed forms that were completed in pen by the PSTs, and the second was to prepare the electronic form and deliver it to the PSTs via e-mail and social media applications and then collect the data. To analyse the data, descriptive statistics, independent samples t-test and one-way analysis of variance (ANOVA) were used. Results: ICT and TPACK competencies of PSTs differ according to grade, having one's own computer for educational purposes, and one's perceived ability to use technology, but do not differ by gender. There is no significant difference in ICT and TPACK competencies according to the gender of PSTs. There is a significant difference in ICT and TPACK competencies according to the grade of PSTs and this difference is in favour of fourth grades. There is a significant difference in terms of ICT competencies and TPACK competencies according to computer ownership for educational purposes. This difference is in favour of PSTs who have their own computers. According to the perceived ability to use the technology of PSTs, there is a significant difference in ICT competencies and TPACK competencies. This difference is in favour of PSTs who think they can use technology at the advanced or expert level. Discussion: In the face of constantly developing and changing technology, an important consideration is the competencies teachers and PSTs should have for ICT integration. Factors contributing to the explanation of the ICT integration process such as skills and competencies, pedagogical beliefs and self-efficacy, professional development and teacher experiences, ICT infrastructure, and access and tools are seen to have a positive effect on ICT use (Kaya & Usluel, 2011). It has been suggested that competence and pedagogical knowledge regarding ICT integration as perceived by teachers are important when starting to integrate ICT into teaching practices (Aslan & Zu, 2015). In this study, it was found that there is a difference in ICT integration competencies of PSTs in favour of those who have their own computers and those who think they can use technology at the advanced or expert level. As the PSTs experience an increase in their perceived level of skill in their use of technology, their ICT integration competencies increase. This study also shows that PSTs' computer ownership has an impact on their education and improves their technological skills, making a difference in terms of ICT integration competencies. Limitations: This study was limited to PSTs who studied at the faculty of education at state universities in Turkey. In addition, two scales related to ICT integration and one demographic questionnaire were used. Also, the convenience sampling method was used and the sampling was confined to 413 PSTs. Conclusions: There is a need for educational processes that emphasise technology's educational value and enable teachers to improve themselves pedagogically and plan more effective teaching-learning processes using this pedagogical knowledge. To meet the needs of the learners of this century, teachers must first be equipped with the necessary knowledge and skills in their educational processes (Yildirim, 2000; Zhou et al., 2010). PSTs should experience this process in their teaching-learning process, and should receive training in the integration of ICT in the teaching-learning process (Çubukçu et al., 2017). Research shows that the learning experiences of PSTs in this sense and the integration of ICT with their subject areas are closely related to understanding the educational value of ICT (Mumcu & Usluel, 2015). Academics, who take a role in teacher education, should use technology effectively in their lessons, and PSTs should experience the educational uses of technology through their education (Basal, 2015). In this sense, academics who take part in teacher education have important duties.
Background
Asprosin is an emerging biomarker that plays a role in metabolic diseases. This study investigates asprosin as a predictive marker for coronary artery disease (CAD) severity in diabetic ...patients.
Methods
Diabetic patients (
n
= 181) and healthy controls (
n
= 60) were analyzed. CAD severity was assessed using SYNTAX score. Diabetic patients were divided into 3 groups. Group 1 = patients without CAD, group 2 = patients with low SYNTAX score, and group 3 = patients with moderate-high SYNTAX score. Asprosin levels were measured for all participants using an enzyme-linked immunosorbent assay (ELISA).
Results
Asprosin levels were significantly higher in patient group compared to control group (
p
< 0.001). Asprosin levels were significantly higher in group 3 compared to group 1 and group 2 (
p
= 0.002). In logistic regression analysis, asprosin levels independently predicted patients with moderate-high SYNTAX scores. According to this analysis, 1 ng/mL increase in asprosin level was found to increase the risk of having moderate-high SYNTAX score by 14.1%. When the threshold value of asprosin level was set as 22.17 ng/mL, it predicted patients with moderate-high SYNTAX score with 63.6% sensitivity and 62.6% specificity. In multivariate regression analysis, SYNTAX score independently correlated with asprosin level.
Conclusion
This is the first study in the literature to demonstrate a positive correlation between asprosin levels and SYNTAX scores in diabetic patients with CAD. More comprehensive studies with larger groups are needed.
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