Abstract Background Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis. Objective Our aim was to compare the area under the receiver operating curve ...(AUROC), sensitivity, specificity, and likelihood ratios of qSOFA vs. systemic inflammation response syndrome (SIRS) in predicting in-hospital mortality among emergency department (ED) patients with suspected infection admitted to intensive care units (ICUs). Methods We conducted a retrospective cohort chart review study of ED patients admitted to an ICU with suspected infection from August 1, 2012 to February 28, 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotics administered in the ED. Trained chart abstractors blinded to the study hypothesis double-entered data from each patient's electronic medical record including demographic characteristics, vital signs, laboratory study results, physical examination findings, and in-hospital mortality. We then calculated the AUROC, sensitivity, specificity, and likelihood ratios for qSOFA and SIRS for predicting in-hospital mortality. Results Of 214 patients admitted to an ICU with presumed sepsis, 39 (18.2%) died during hospitalization. The AUROC value was 0.65 (95% confidence interval CI 0.56–0.74) for SIRS vs. 0.66 (95% CI 0.57–0.76) for qSOFA; 2+ qSOFA criteria predicted in-hospital mortality with 89.7% sensitivity, 27.4% specificity, 1.2 positive likelihood ratio, and 0.4 negative likelihood ratio. Conclusions Among ED patients admitted to an ICU, the SIRS and qSOFA criteria had comparable prognostic value for predicting in-hospital mortality. These prognostic values are similar to those reported by the Sepsis-3 guidelines for ICU encounters.
Compared maternally obtained swabs for GBS with the current gold standard of physician-obtained swabs performed on the same patient. The women were asked who they would prefer to do their swabs in ...the offices of 5 family physicians and 8 obstetricians at Mount Sinai Hospital, a tertiary-care teaching hospital, between 1 November 1995 and 31 March 1996. The patients were consecutive pregnant women presenting for their 26-28 weeks antenatal visit. Patient-collected vaginal and anorectal swabs for GBS are at last as sensitive as the current practice of physician-performed swabs. (Original abstract-amended)
Abstract Background Older adults are at increased risk of atrial fibrillation (AF), its thromboembolic complications, and bleeding. A significant percentage of octogenarians do not receive ...anticoagulation therapy. The objective of this study was to investigate the effect of thromboembolic risk, bleeding risk, and frailty on the anticoagulation status of octogenarians hospitalized with AF. Methods A cross-sectional study was conducted in 682 hospitalized patients aged 80 years and older with AF or atrial flutter in Montreal, Québec. Consumption of warfarin or a new oral anticoagulant was documented. Medical record data were used to determine each patient's frailty status using the Clinical Frailty Scale (CFS) and to evaluate the risk of stroke (CHADS2 C ongestive Heart Failure, H ypertension, A ge, D iabetes, S troke/Transient Ischemic Attack) and bleeding (HAS-BLED H ypertension, A bnormal renal/liver function, S troke, B leeding history or predisposition, L abile international normalized ratio, E lderly (> 65 years) D rugs/alcohol concomitantly). Univariable and multivariable logistic regression analyses were used to examine the effect of frailty status and the risk of stroke and bleeding on the probability of receiving anticoagulation therapy. Results Seventy percent of octogenarians with AF received anticoagulation therapy (n = 475). A high risk of stroke (CHADS2 = 3 compared with CHADS2 = 1, odds ratio OR, 3.58; 95% confidence interval CI, 1.09-11.77), and the absence of severe frailty (CFS < 7; OR, 3.41; 95% CI, 1.84-6.33) were independently associated with anticoagulant use in multivariable analyses. A high risk of bleeding (HAS-BLED score ≥ 3; OR, 0.33; 95% CI, 0.12-0.86) was associated with the absence of anticoagulation. Conclusions Our study suggests a higher prevalence of appropriate anticoagulation among octogenarians with AF than reported in previous studies. Further work is needed to develop and disseminate tools to optimize the use of anticoagulants in this high-risk population.
Drug-eluting stent failures were associated with various clinical factors. However, the clinical impact of stent deployment technique was unknown. This study was designed to evaluate the frequency ...and impact of suboptimal percutaneous coronary intervention on long-term outcomes of 1,557 patients treated with sirolimus-eluting stents (SESs) in 41 US hospitals. All steps of the interventional procedure were scrutinized by an independent core laboratory to determine the occurrence of geographic miss (GM). GM included longitudinal (LGM; injured or diseased segment not covered by SES) or axial GM (balloon-artery size ratio <0.9 or >1.3) mismatches. Patients with and without GM were stratified (GM vs no-GM group). Patients, investigators, and the independent clinical event adjudication committee were blind to study group assignments. The primary end point was 1-year target-vessel revascularization (TVR) rate. Incidences and predictors of GM and safety outcomes were secondary end points. GM occurred in 943 patients (66.5%): 47.6% had LGM, 35.2% had axial GM, and 16.5% had both. One-year TVR rates were 5.1% in the GM group versus 2.5% in the no-GM group (p = 0.025). TVR was 6.1% in the LGM versus 2.6% in the no-LGM subgroups (p = 0.001). The association of GM with 1-year TVR was independent of clinical or anatomic factors (hazard ratio 2.0, 95% confidence interval 1.0 to 4.02, p = 0.05). There was a 3-fold increase in myocardial infarction rates associated with GM (2.4% vs 0.8%; p = 0.04). In conclusion, GM occurred frequently during SES implantation and was associated with increased risk of TVR and myocardial infarction at 1 year. These results emphasized the need for improvement in contemporary percutaneous coronary intervention practices and technologies.
The Model for the Assessment of Psychosocial Problems (MAPP) can help family medicine residents effectively assess patients with psychosocial problems. Following a patient-centred clinical method, ...MAPP provides a guide to exploring problems and an approach that allows residents and patients jointly to define problems and decide upon management. Emphasis is placed on clarifying patients' expectations of physicians.
Masculinity is a social construction that defines itself according to context. Older men constitute an unseen minority when it comes to their health, and thus the study of masculinity as it relates ...to health in older men requires deeper understanding. This article offers insights into how gender, health, and ageing interact for older men and explores how men negotiate the concept of masculinity in later life. The findings from two complementary studies are presented and discussed. The first study, a qualitative analysis of focus group discussions held with 48 community-dwelling older men, indicates that the desire to uphold hegemonic ideals of independence, self-reliance, and imperviousness to pain and illness are embedded in older men’s health-related beliefs and behaviors. Ill health and help seeking are often perceived as a threat to the masculine identity, and taking action for health is considered only when health status jeopardizes independence. In the second study, more than 2,000 men aged 55 to 97 years responded to a postal survey on health behaviors and masculinity. Results of the survey indicated that age predicts health behaviors and health care seeking better than scores on a masculinity index, which tended to remain stable regardless of age. Both the qualitative and quantitative findings support the hypothesis that with age men will succeed in incorporating actions into their daily lives in a way that does not conflict with their perceived resilience to frailty and weakness, even if such actions involve seeking help for illness or adopting healthier lifestyle behaviors.
Fifty percent of sexually active older men and women complain of 1 or more sexual problems. Sexual dysfunction involves a complex interplay of partner factors, relationship factors, individual ...factors, concomitant mental health disorders, life stressors, medical comorbidity, and medication intake. Although lower urinary tract symptoms are associated with decreased sexual activity, it is unclear whether the relationship is causal or influenced by shared risk factors, or the presence of overall poor health and function. Taking a complete sexual history in patients with lower urinary tract symptoms is the first step toward detection and possible treatment.
Abstract The purpose of this study was to compare the acetabular version between male and female pelvises. We hypothesized that female acetabula would demonstrate more retroversion because ...Pincer-type femoroacetabular impingement (FAI) is associated with acetabular retroversion, which is more commonly observed in females. 120 bony pelvic specimens were randomly collected. The version was measured at three different axial sections of each acetabulum: cranial, central, and caudal. Males demonstrated significantly less anteversion than females in every section. The global version (the average of all three measurements) was also significantly different between males and females (16° ± 7° and 19° ± 8° respectively, P < 0.001). Of the 240 examined acetabuli, 21 demonstrated cranial retroversion (16 males & 5 females). The data showed no significant difference ( P = 0.353) between global version of African Americans (18° ± 9°) and Caucasians (17° ± 7°). The results of this study suggest that symptomatic FAI in the female population likely reflects a complex interplay of femoral and acetabular dysmorphology and cannot be explained by differences in acetabular version alone.
Non-adherence to treatment presents a significant obstacle to achieving favourable health outcomes. We have studied consumers' adherence to an online disease management system for depression, called ...Recovery Road. Recovery Road was implemented on a pilot basis for mental health care in Western Australia. Recovery Road was available for use by consumers and clinicians to augment usual treatment. One hundred and thirty consumers who had been diagnosed with major depression were enrolled. Consumers who used Recovery Road (n = 98) were provided with education, progress monitoring, e-consultation, e-diary and online evidenced-based therapy. Consumers received either standard, automated adherence reminders by email (n = 69), or case management, which included personalized email and telephone follow-up in response to non-adherence (n = 29). After the first eight sessions, the adherence was 84% in the case management group and 55% in the automatic reminders group. The results suggest that case management increases adherence to online disease management systems.
The presently available scanning laser polarimeter (SLP) has a fixed corneal compensator (FCC) that neutralizes corneal birefringence only in eyes with birefringence that matches the population mode. ...A prototype variable corneal compensator (VCC) provides neutralization of individual corneal birefringence based on individual macular retardation patterns. The aim of this study was to evaluate the relative ability of the SLP with the FCC and with the VCC to discriminate between normal and glaucomatous eyes.
Prospective, nonrandomized, comparative case series.
Algorithm-generating set consisting of 56 normal eyes and 55 glaucomatous eyes and an independent data set consisting of 83 normal eyes and 56 glaucomatous eyes.
Sixteen retardation measurements were obtained with the SLP with the FCC and the VCC from all subjects.
Dependency of parameters on age, gender, ethnic origin, and eye side was sought. Logistic regression was used to evaluate how well the various parameters could detect glaucoma. Discriminant functions were generated, and the area under the receiver operating characteristic (ROC) curve was determined.
Discrimination between normal and glaucomatous eyes on the basis of single parameters was significantly better with the VCC than with the FCC for 6 retardation parameters: nasal average (
P = 0.0003), superior maximum (
P = 0.0003), ellipse average (
P = 0.002), average thickness (
P = 0.003), superior average (
P = 0.010), and inferior average (
P = 0.010). Discriminant analysis identified the optimal combination of parameters for the FCC and for the VCC. When the discriminant functions were applied to the independent data set, areas under the ROC curve were 0.84 for the FCC and 0.90 for the VCC (
P<0.021). When the discriminant functions were applied to a subset of patients with early visual field loss, areas under the ROC curve were 0.82 for the FCC and 0.90 for the VCC (
P<0.016).
Individual correction for corneal birefringence with the VCC significantly improved the ability of the SLP to distinguish between normal and glaucomatous eyes and enabled detection of patients with early glaucoma.
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