Background
Frailty is a multidimensional vulnerability resulting from age‐associated decline. The impact of frailty on outcomes was assessed in a cohort of vascular surgical patients.
Methods
The ...study included patients aged over 65 years with length of hospital stay (LOS) greater than 2 days, who were admitted to a tertiary vascular unit over a single calendar year. Demographics, mode of admission, diagnosis, mortality, LOS and discharge destination were recorded, as well as a variety of frailty‐specific characteristics. The impact of frailty on LOS, discharge destination, survival and readmission rate was assessed using multivariable regression techniques. The ability of the models to predict these outcomes was also assessed.
Results
In total, 413 patients of median age 77 years were followed for a median of 18 (range 12–24) months. The in‐hospital, 3‐ and 12‐month mortality rates were 3·6, 8·5 and 13·8 per cent respectively. Receiver operating characteristic (ROC) curve analysis revealed that frailty‐based regression models were excellent predictors of 12‐month mortality (area under the ROC curve (AUC) = 0·81), prolonged LOS (AUC = 0·79) and discharge to a care institution (AUC = 0·84). A simple additive frailty score using six key features retained strong predictive power for 12‐month mortality (AUC = 0·83), discharge to a care institution (AUC = 0·78) and prolonged LOS (AUC = 0·74). This frailty score was also strongly associated with readmission rates (P < 0·001).
Conclusion
Frailty in vascular surgery patients predicts a multiplicity of poorer outcomes. Optimal management should include identification of at‐risk patients and treatment of modifiable risk factors.
Predicts adverse outcomes
Introduction Acute kidney injury (AKI) following ruptured abdominal aortic aneurysm (rAAA) repair is common and multifactorial. A standard definition of AKI after endovascular repair (EVAR), the ...Aneurysm Renal Injury Score (ARISe), has been proposed to facilitate standardised reporting and thus improve understanding of this issue. Methods Data were collected retrospectively on AKI in a prospectively maintained database of all patients treated for rAAA in a single tertiary referral centre since the availability of routine out of hours emergency EVAR. The ARISe score was used to describe the degree of AKI and factors which correlated with poor renal outcomes were assessed. Results Two-hundred and five patients were treated between January 2006 and April 2014. Of these, 125 were treated with open repair (OSR) and 80 were treated with EVAR. Severe AKI (defined as ARISe score ≥3) occurred in 36% of patients. After correction for confounders, patients treated with OSR were significantly more likely to develop severe AKI (43% vs. 26%, p = .02). There was no significant difference in preoperative serum creatinine between groups, but increased preoperative serum creatinine was strongly associated with severe AKI postoperatively ( p < .001). Age, sex, endograft type, and preoperative CT scanning were not associated with differences in renal outcomes. Clamp position above renal arteries was predictive of severe AKI in patients treated with OSR ( p < .01). Patients suffering severe AKI had significantly higher mortality at 30 days and 12 months (28% vs. 5% and 44% vs. 13%, p < .001 for both comparisons). Conclusion Severe AKI is common following successful repair of rAAA. In this large case series of high-risk patients, OSR was associated with significantly higher rates of severe AKI compared with EVAR, despite the increased dose of contrast involved in EVAR and the older age of these patients. In turn, severe AKI was associated with higher mortality rates.
This study examined the acceleration demands associated with changing direction and the subsequent physiological consequences of acceleration during running at 3 submaximal speeds. 10 male ...professional footballers completed four 600 m running bouts at 3 speeds (2.50, 3.25 & 4.00 m·s(-1)). Each bout was in the format of either: i) 3 laps of a 200 m track (CON), ii) ten 60 m shuttles (S60), iii) twenty 30 m shuttles (S30), or iv) thirty 20 m shuttles (S20). Peak heart rate (HRPEAK), blood lactate concentration (BLa) and RPE (Borg CR-10) were recorded for each bout. A single change of direction required 1.2, 1.5 and 2.0 s of acceleration at running speeds of 2.50, 3.25 and 4.00 m s(-1) respectively. An increase in time spent accelerating produced a linear increase in BLa (r=0.43-0.74) and RPE (r=0.81-0.93) at all speeds. Acceleration increases linearly with change of direction frequency during submaximal shuttle running. Increased time spent accelerating elicits proportional increases in perceived exertion, BLa and HRPEAK. The current study further underlines the need to consider acceleration when quantifying training load during activities involving numerous changes of direction.
Aliment Pharmacol Ther 2011; 34: 219–228
Summary
Background The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are widely used as prognostic ...markers in critical care settings and could improve triage of high‐risk paracetamol (acetaminophen) overdose patients.
Aim To evaluate the prognostic accuracy of the SIRS and SOFA scores following single time point paracetamol overdose.
Methods Analysis of 100 single time point paracetamol overdoses admitted to a tertiary liver centre, with subsequent prospective validation of identified thresholds. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post‐overdose, and the daily SOFA and SIRS scores calculated.
Results A total of 74 (74%) patients developed the SIRS, which occurred significantly earlier in patients who died (n = 21) compared with spontaneous survivors (n = 53, P = 0.05). The SIRS occurred in 70 (70%) patients by 96 h post‐overdose, with a 30% mortality rate; compared with 0% mortality in the 30 non‐SIRS patients (P = 0.001). Median SOFA scores were significantly higher in nonsurvivors at 48 (P = 0.009), 72 (P < 0.001), and 96 h (P < 0.001). A SOFA score >7 during the first 96 h post‐overdose predicted death/transplantation with a sensitivity of 95.0 (95% CI 78.5–99.1) and specificity of 70.5 (95% CI 66.3–71.6). A validation cohort of 38 single time point paracetamol overdoses confirmed the extremely high negative predictive value of both the SIRS and SOFA thresholds.
Conclusions The absence of either a SOFA score >7 or a SIRS response during the first 96 h following paracetamol overdose could improve triage and reduce transfers of lower risk patients to tertiary liver centres.
Mice that lack the Nrf2 basic-region leucine-zipper transcription factor are more sensitive than wild-type (WT) animals to the cytotoxic and genotoxic effects of foreign chemicals and oxidants. To ...determine the basis for the decrease in tolerance of the Nrf2 homozygous null mice to xenobiotics, enzyme assay, Western blotting and gene-specific real-time PCR (TaqMan) have been used to examine the extent to which hepatic expression of GSH-dependent enzymes is influenced by the transcription factor. The amounts of protein and mRNA for class Alpha, Mu and Pi glutathione S-transferases were compared between WT and Nrf2 knockout (KO) mice of both sexes under both constitutive and inducible conditions. Among the class Alpha and class Mu transferases, constitutive expression of Gsta1, Gsta2, Gstm1, Gstm2, Gstm3, Gstm4 and Gstm6 subunits was reduced in the livers of Nrf2 mutant mice to between 3% and 60% of that observed in WT mice. Induction of these subunits by butylated hydroxyanisole (BHA) was more marked in WT female mice than in WT male mice. TaqMan analyses showed the increase in transferase mRNA caused by BHA was attenuated in Nrf2(-/-) mice, with the effect being most apparent in the case of Gsta1, Gstm1 and Gstm3. Amongst class Pi transferase subunits, the constitutive hepatic level of mRNA for Gstp1 and Gstp2 was not substantially affected in the KO mice, but their induction by BHA was dependent on Nrf2; this was more obvious in female mutant mice than in male mice. Nrf2 KO mice exhibited reduced constitutive expression of the glutamate cysteine ligase catalytic subunit, and, to a lesser extent, the expression of glutamate cysteine ligase modifier subunit. Little variation was observed in the levels of glutathione synthase in the different mouse lines. Thus the increased sensitivity of Nrf2(-/-) mice to xenobiotics can be partly attributed to a loss in constitutive expression of multiple GSH-dependent enzymes, which causes a reduction in intrinsic detoxification capacity in the KO animal. These data also indicate that attenuated induction of GSH-dependent enzymes in Nrf2(-/-) mice probably accounts for their failure to adapt to chronic exposure to chemical and oxidative stress.
A series of
K
d
tracer batch experiments were conducted to assess the absorptive-desorption properties of Biochar as a potential agent to selectively sequester labile soil Cs or otherwise help reduce ...the uptake of Cs isotopes into plants. A parallel experiment was conducted for strontium. Fine-grained fractionated Woodlands tree Biochar was found to have a relatively high affinity for Cs ions (
K
d
> 100) relative to coral soil (
K
d
< 10) collected from the Marshall Islands. The Biochar material also contains an abundance of K (and Mg). These findings support a hypothesis that the addition of Biochar as a soil amendment may provide a simple yet effective method for reducing soil-to-plant transfer of Cs isotopes in contaminated environments.
Experiential Avoidance and Behavioral Disorders Hayes, Steven C; Wilson, Kelly G; Gifford, Elizabeth V ...
Journal of consulting and clinical psychology,
12/1996, Letnik:
64, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly ...connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to develop the functional classification approach, and experiential avoidance is described as 1 such dimension. A wide range of research is reviewed showing that many forms of psychopathology can be conceptualized as unhealthy efforts to escape and avoid emotions, thoughts, memories, and other private experiences. It is argued that experiential avoidance, as a functional diagnostic dimension, has the potential to integrate the efforts and findings of researchers from a wide variety of theoretical paradigms, research interests, and clinical domains and to lead to testable new approaches to the analysis and treatment of behavioral disorders.
Summary
Background
The sequential organ failure assessment (SOFA) score is an effective triage marker following single time point paracetamol (acetaminophen) overdose, but has not been evaluated ...following staggered (multiple supratherapeutic doses over >8 h, resulting in cumulative dose of >4 g/day) overdoses.
Aim
To evaluate the prognostic accuracy of the SOFA score following staggered paracetamol overdose.
Methods
Time‐course analysis of 50 staggered paracetamol overdoses admitted to a tertiary liver centre. Individual timed laboratory samples were correlated with corresponding clinical parameters and the daily SOFA scores were calculated.
Results
A total of 39/50 (78%) patients developed hepatic encephalopathy. The area under the SOFA receiver operator characteristic for death/liver transplantation was 87.4 (95% CI 73.2–95.7), 94.3 (95% CI 82.5–99.1), and 98.4 (95% CI 84.3–100.0) at 0, 24 and 48 h, respectively, postadmission. A SOFA score of <6 at tertiary care admission predicted survival with a sensitivity of 100.0% (95% CI 76.8–100.0) and specificity of 58.3% (95% CI 40.8–74.5), compared with 85.7% (95% CI 60.6–97.4) and 75.0% (95% CI 65.2–79.5) , respectively, for the modified Kings College criteria. Only 2/21 patients with an admission SOFA score <6 required renal replacement therapy or intracerebral pressure monitoring. SOFA significantly outperformed the Model for End‐stage Liver Disease, but not APACHE II, at 0, 24‐and 48‐h following admission.
Conclusions
A SOFA score <6 at tertiary care admission following a staggered paracetamol overdose,is associated with a good prognosis. Both the SOFA and APACHE II scores could improve triage of high‐risk staggered paracetamol overdose patients.
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