Objective
Use of the Sequential Organ Failure Assessment (SOFA) score has been proposed by the Third International Consensus Definitions for Sepsis and Septic Shock. The utility in the ED is not yet ...well established. We retrospectively studied the application of a modified SOFA (mSOFA) score, to assess its ability to predict mortality.
Methods
At our urban tertiary teaching hospital staff recorded patients with probable sepsis in the ED Information System (EDIS). Data was analysed for the year of July 2015 to June 2016. For a sample of the suspected sepsis patients, ED and inpatient clinical records were manually reviewed to ascribe an mSOFA score and assess its performance in predicting mortality, with a primary outcome of death by 30 days.
Results
There were 474 patients recorded over the 1 year with probable sepsis, of whom 228 were manually reviewed. The mSOFA was a significant predictor of mortality at all the time points tested. The 30 day mortality was 22/88 (25%) for those with a positive mSOFA score and 3 out of 140 (2.1%) of those with a negative mSOFA score (OR 15.2, 95% CI 4.4, 52.7; P < 0.001). This equated to a negative predictive value of 97.9% (95% exact CI 93.9–99.6%).
Conclusion
For ED patients thought likely to have sepsis, the mSOFA score distinguished those with a high or low mortality risk. The high negative predictive value could be practically useful. Prospective study of the mSOFA score used in ED will be needed to validate these observations.
Addresses the challenges facing NZ with the COVID-19 (SARSCoV2 virus) vaccination programme in order to achieve a high uptake of vaccination to optimise protective immunity for the population, and ...what is needed in order to meet those challenges. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Association between HACEK bacteraemia and endocarditis HAUR SEN YEW; CHAMBERS, Stephen T; ROBERTS, Sally A ...
Journal of Medical Microbiology/Journal of medical microbiology,
06/2014, Letnik:
63, Številka:
6
Journal Article
Recenzirano
Odprti dostop
We retrospectively examined medical records of 87 patients with bacteraemia caused by members of the HACEK group (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter ...aphrophilus, Aggregatibacter paraphrophilus, Cardiobacterium spp., Eikenella corrodens and Kingella spp.) to determine whether endocarditis was present, as defined by the Duke criteria. The overall positive predictive value (PPV) of HACEK bacteraemia for endocarditis was 60 %. The PPV varied with different HACEK species from 0 % (E. corrodens) to 100 % (A. actinomycetemcomitans).
The SAGE Handbook of Online Research Methods Nigel G Fielding, Raymond M Lee, Grant Blank / Nigel G Fielding, Raymond M Lee, Grant Blank
SAGE Publications Ltd eBooks,
2016, 2017, 2017-12-18
eBook
Odprti dostop
Online research methods are popular, dynamic and fast-changing. Following on from the great success of the first edition, published in 2008, The SAGE Handbook of Online Research Methods, Second ...Edition offers both updates of existing subject areas and new chapters covering more recent developments, such as social media, big data, data visualization and CAQDAS. Bringing together the leading names in both qualitative and quantitative online research, this new edition is organised into nine sections: 1\. Online Research Methods 2\. Designing Online Research 3\. Online Data Capture and Data Collection 4\. The Online Survey 5\. Digital Quantitative Analysis 6\. Digital Text Analysis 7\. Virtual Ethnography 8\. Online Secondary Analysis: Resources and Methods 9\. The Future of Online Social Research The SAGE Handbook of Online Research Methods, Second Edition is an essential resource for anyone interested in the contemporary practice of computer- mediated research and scholarship.
BACKGROUND We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS ...Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. CONCLUSIONS In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.Arch Intern Med. 2009;169(5):463-473-->
We evaluated A/H1N1 influenza in healthcare workers (HCWs) and in a flu room during the 2009 pandemic. The flu room aided HCW care and management by facilitating rapid diagnosis and treatment. ...Absence of fever was common, and symptoms were nonspecific. A higher rate of H1N1 occurred in HCWs deployed in acute services.
Objective
Early sepsis recognition and treatment are essential in order to reduce the burden of disease. Initial assessment of patients with infection is often undertaken by ED nurses and resident ...doctors. This descriptive qualitative study aimed to explore their perceptions and perspectives regarding the factors that impede the identification and management of patients with sepsis.
Methods
This was a qualitative study conducted between 30 January 2020 and 27 February 2020. Semi‐structured focus group interviews were performed to collect data. All participants provided written informed consent and completed a basic demographic and work experience form. Two study investigators facilitated the interviews. Interviews were audio‐recorded and later transcribed. Thematic analysis was performed with the aid of NVivo 12 software.
Results
Six focus group interviews were conducted involving 40 ED nurses and doctors. Interview length ranged from 27 to 38 min (mean 33.5 min). Three major themes were identified: (i) clinical management; (ii) challenges and delays; and (iii) communication. Each of these themes was broken down into subthemes, which are presented in more detail.
Conclusion
ED nurses and doctors have identified important factors that limit and enhance their capacity to recognise and respond to patients with sepsis. Complex interactions exist between clinical and organisational structures that can affect the care of patients and the ability of clinicians to provide optimal care. The three major themes and specific subthemes provide a useful framework and stimulus for service improvements and research that could help foster future sepsis management improvement strategies.
ED nurses and doctors have identified important factors that limit and enhance their capacity to recognise and respond to patients with sepsis. Complex interactions exist between clinical and organisational structures that can affect the care of patients and the ability of clinicians to provide optimal care. The three major themes and specific subthemes provide a useful framework and stimulus for service improvements and research that could help foster future sepsis management improvement strategies.
Sepsis : New Zealand needs a plan Huggan, Paul
New Zealand medical journal,
4 Feb 2022, 20220204, Letnik:
135, Številka:
1549
Journal Article
Recenzirano
Observes the incidence of sepsis in New Zealand. Sums up the first National Sepsis Conference, held 18 to 20 November 2021 to consider topics ranging from acute management of sepsis to the ...evidence-informed design of systems to improve quality of sepsis care. Outlines the focus of the Aotearoa New Zealand National Sepsis Action Plan in this regard. Witnesses the benefits of similar sepsis plans overseas. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
An unexpected diagnosis after unstable angina Tunnicliffe, Georgia, MB; Raymond, Nigel, FRACP; Nowitz, Mike, FFRad
The Lancet (British edition),
03/2007, Letnik:
369, Številka:
9565
Journal Article
Recenzirano
In a study of 91 case reports, only 35% of patients showed the typical clinical triad of acute retrosternal pain, odynophagia or dysphagia, and haematemesis.1 Reported risk factors include increasing ...age, the use of anticoagulants, thrombolytics, or antiplatelet drugs, and bleeding disorders.2-4 Physical examination is normal in most cases. In reported cases in which low-molecular-weight heparin has inadvertently been given, this treatment has been judged to exacerbate bleeding into the oesophageal wall.2,4,5 The characteristic appearance at endoscopy is of a bluish submucosal lesion, commonly on the posterior wall of the oesophagus, terminating abruptly above the squamocolumnar junction.2 Endoscopy does not seem to increase the risk of complications in this setting.2 Prognosis is excellent, with spontaneous resolution of the haematoma in most patients.
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