Abstract
Patients undergoing cardiac surgery represent a challenge in terms of pain management due to multiple factors relating to the patients and to the procedure itself. Our aim was to identify ...the influence of levels of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery and explore associations between preoperative anxiety, postoperative pain, analgesic requirements, and sex. We present a prospective cohort study of 116 patients undergoing cardiac surgery between January and April 2020. Preoperative anxiety was evaluated using the State-Trait Anxiety Inventory and the amount of morphine needed to keep pain intensity below 4 on the verbal numerical rating scale was recorded for 48 h post-surgery. Given the extracorporeal circulation time, type of surgery and body surface, it was observed that every percentile increase in preoperative state anxiety led to an extra 0.068 mg of morphine being administered. For each extra year of age, the amount of morphine needed decreased by 0.26 mg, no difference was observed between men and women in terms of preoperative anxiety or postoperative analgesics requirements. It may be concluded that in cardiac surgery, postoperative analgesic requirements increased with higher levels of preoperative state anxiety and decreased for every extra year of age.
Aim
To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators.
Background
Nursing records support clinical decision‐making and encourage continuity of ...care, hence the importance of auditing their completion in order to take corrective action where necessary.
Method
This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID‐19 hospital units during three observation periods: pre‐pandemic, first wave, and second wave.
Results
A significant reduction in nursing record completion rates was observed between pre‐pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit.
Conclusions
The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions.
Implications for Nursing Management
Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.
To evaluate the influence of delirium on the functional and cognitive capacity of patients included in the DELIPRECAS study, as well as on their quality of life, in the 3–4 years after cardiac ...surgery.
Prospective observational study.
Assessment of cognitive and functional status from hospital discharge to the present, 3 years after cardiac surgery.
313 patients undergoing cardiac surgery consecutively, aged 18 years or over.
The primary outcome measure was the cognitive and functional status of the patients 3 years after cardiac surgery, evaluated by telephone interview, and the possible influence on them of delirium diagnosed by the Confusion Assessment Method in Intensive Care Units (CAM-ICU) during their stay in the intensive care unit after cardiac surgery.
Postoperative delirium acts as an independent risk factor for the long-term development of memory problems (OR 6.11, 95% CI 2.54 to 14.68, p < 0.001), concentration (OR 11.20, 95% CI 3.58 to 35.09, p > 0.001), confusion/disorientation (OR 10.93, 95% CI 3.61 to 33.12, p > 0.001), sleep problems (OR 5.21, 95% CI 2 0.29 to 11.84, p < 0.001), nightmares (OR 8.99, 95% CI 1.98 to 40.90, p = 0.004), emotional problems (OR 4.30, 95% CI 1.87 to 9.91, p = 0.001) and poorer mobility after hospital discharge (OR 2.436, 95% CI 1.06 to 5.61, p = 0.037). The number of hospital readmissions was also significantly higher in those patients who developed delirium after cardiac surgery (27% vs 13.8%, p = 0.022).
Postoperative delirium is a risk factor for decreased quality of life in patients 3 years after heart surgery, being associated with greater cognitive and functional deterioration, as well as greater risk of hospital readmission. Therefore, emphasis should be placed on both prevention and early recognition and treatment of delirium to improve long-term outcomes for patients after cardiac surgery.
•Postoperative delirium is a risk factor for impaired quality of life in patients 3 years after cardiac surgery.•Postoperative delirium is independently associated with greater cognitive impairment, and greater risk of hospital readmission.•Both prevention and early recognition and treatment of delirium are essential to improve long-term outcomes
Anemia can predict organ failure in acute pancreatitis Ruiz Rebollo, María Lourdes; Muñoz Moreno, Maria Fe; Piñerúa-Gonsálvez, Jean Félix ...
Revista española de enfermedades digestivas
116, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Acute pancreatitis (AP) is the leading hospital admission in Gastroenterology and has a variable clinical course. Identifying severity of AP patients in its early stages is of foremost importance to ...improve prognosis. The revised Atlanta Classification grades AP severity by the presence of organ failure and local complications.
Anomalous self-experiences (ASEs) are prevalent in schizophrenia, but its underpinnings are not completely understood. Given the likely complex substrate of the experience of the self, neurocognitive ...functions requiring coordinate cerebral activity may relate to ASEs. Moreover, cognitive deficits functioning may be involved in the link between self-experience disturbances and some aspects of social dysfunction in schizophrenia. We have assessed ASEs in 41 schizophrenia patients (11 first episodes) using the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE), and the general cognition using the Brief Assessment of Cognition in Schizophrenia (BACS). Besides, social cognition was assessed using two complementary tools Meyer, Salovey and Caruso Emotional Intelligence Test (MSCEIT) and GEOPTE (Grupo Español para la Optimización del Tratamiento de la Esquizofrenia). The results revealed that Self-awareness/presence and Somatization IPASE scores were inversely explained by motor speed in the BACS; Consciousness IPASE scores were inversely explained by problem solving performance in the BACS. These data reveal a significant relationship between certain domains of general cognition and anomalous self-experiences, that may be useful in further investigation on the substrates of ASEs.
To develop and validate a delirium risk prediction preoperative model for patients undergoing cardiac surgery.
Observational prospective multicentre study.
Six intensive care units in Spain.
689 ...patients undergoing cardiac surgery consecutively, aged ≥18 years.
The primary outcome measure was the development of delirium, diagnosed using the Confusion Assessment Method in Intensive Care Units (CAM-ICU), during the stay in the intensive care unit after cardiac surgery.
The model was developed with 345 consecutive patients undergoing cardiac surgery at six hospitals and validated with another 344 patients from the same hospitals. The prediction model contained four preoperative risk factors: age over 65 years, Mini-Mental State Examination (MMSE) score of 25–26 points (possible impairment of cognitive function) or < 25 (impairment of cognitive function), insomnia needing medical treatment and low physical activity (walk less than 30 min a day). The model had an area under the receiver operating characteristics curve of 0.825 (95% confidence interval: 0.76–0.89). The validation resulted in an area under the curve of 0.79 (0.73–0.85) and the pooled area under the receiver operating characteristics curve (n = 689) was 0.81 (0.76–0.85). We stratified patients in groups of low (0%–20%), moderate (> 20%–40%), high (> 40%–60%) and very high (> 60%) risk of developing delirium, with a positive and negative predictive value for the very high risk group of 70.97% and 85.56%, respectively.
The DELIPRECAS model (DELIrium PREvention CArdiac Surgery), consisting of four well-defined clinical risk factors, can predict in the preoperative period the risk of developing postoperative delirium in patients undergoing cardiac surgery. An automatic version of the risk calculator is available.
•A delirium prediction model has been developed and validated for cardiac surgery patients.•The DELIPRECAS model predicts the risk of postoperative delirium with 4 preoperative risk factors.•This new model facilitates the use of preventive measures in high-risk patients.
Introducción y objetivo: El incremento de traqueotomías en las unidades de cuidados críticos aumenta notablemente la morbimortalidad en la sala general. Para revertirlo, hemos implementado un ...programa de seguimiento multidisciplinar basado en la formación, la estandarización de los cuidados y la adopción de nuevas estrategias. Metodología: Estudio de cohorte prospectivo y observacional del seguimiento de 150 pacientes en un hospital universitario de tercer nivel, que carece de unidad de cuidados intermedios. Registramos y analizamos las variables clínicas, epidemiológicas y la evolución tras la aplicación del programa. Resultados: La edad media de los pacientes fue de 61 años, 67% varones y el 42% neurocríticos. 71% con traqueotomía percutánea. La mortalidad general fue del 17% y la de los pacientes con accidente cerebrovascular del 6,3%. Hubo un 8% de reingresos en la unidad de críticos. Detectamos un 23% de complicaciones de escasa gravedad. Se decanuló durante el ingreso a un 43% de pacientes y el 38% volvió a su domicilio, siendo dados de alta un 55% con alimentación oral. El tiempo medio de estancia en la unidad de críticos fue de 34 días y de 70 días la media de ingreso hospitalario. Conclusiones: Este trabajo describe los resultados obtenidos tras aplicar un protocolo de seguimiento multidisciplinar en la sala de hospitalización, del paciente traqueotomizado que procede de las UCC. La finalidad de este seguimiento es mejorar la seguridad de estos pacientes, a fin de disminuir su morbimortalidad. Las aplicación de nuevas estrategias permitirá su evaluación en relación con los datos obtenidos de este estudio.
Pneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We ...prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four groups according to the severity of respiratory symptoms. Twenty-eight healthy volunteers were used for normalization of the results. Multiple cytokines showed statistically significant differences between mild and critical patients. High HGF levels were associated with the critical group (OR = 3.51; p < 0.001; 95%CI = 1.95–6.33). Moreover, high IL-1α (OR = 1.36; p = 0.01; 95%CI = 1.07–1.73) and low IL-27 (OR = 0.58; p < 0.005; 95%CI = 0.39–0.85) greatly increased the risk of ending up in the severe group. This model was especially sensitive in order to predict critical status (AUC = 0.794; specificity = 69.74%; sensitivity = 81.25%). Furthermore, high levels of HGF and IL-1α showed significant results in the survival analysis (p = 0.033 and p = 0.011, respectively). HGF, IL-1α, and IL 27 at hospital admission were strongly associated with severe/critical COVID-19 patients and therefore are excellent predictors of bad prognosis. HGF and IL-1α were also mortality biomarkers.
Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity ...of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank:
= 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665),
< 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878),
= 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.
Resumen Introducción El nacimiento por cesárea programada de los recién nacidos pretérmino tardíos y a término precoces aumenta el riesgo de distrés respiratorio. La administración de corticoides ...antenatales en estos casos podría disminuir el distrés respiratorio y su gravedad. Objetivos Determinar la repercusión del uso de corticoides antenatales en las cesáreas programadas en el distrés respiratorio del recién nacido de 35 a 38+6 semanas de edad gestacional (SEG). Pacientes y métodos Estudio analítico retrospectivo en un hospital de tercer nivel, de las cesáreas de 35+0 a 38+6 SEG desde enero de 2013 hasta abril de 2017. Recogida de datos de las historias clínicas de las gestantes y recién nacidos tras la instauración de un nuevo protocolo de administración de una dosis de betametasona a las gestantes con cesáreas programadas de esta edad gestacional. Análisis en 2 subgrupos: recién nacidos pretérmino (RNPT) 35-36 SEG y a término (RNT) 37-38 SEG. Resultados En este periodo se realizaron 208 cesáreas programadas. Se administraron corticoides en 97 casos (46,6%). El porcentaje de distrés fue mayor en el grupo de cesáreas programadas de RNPT comparado con los RNT (29 vs. 8,8%; p < 0,001) y entre los RNT fue mayor a menor edad gestacional. Entre las cesáreas programadas tratadas y no tratadas con corticoides no se encontraron diferencias significativas en cuanto al desarrollo de distrés respiratorio (RNPT 30 vs. 30%; p=1; RNT 9,1 vs. 6.9%; p = 0,6). Conclusiones En este estudio no se encontraron diferencias estadísticamente significativas a favor del beneficio de la administración de una dosis antenatal de betametasona en la disminución del distrés respiratorio del recién nacido en las cesáreas programadas de 35+0 a 38+6 SEG. El retraso en la indicación de cesáreas programadas, siempre que sea posible, podría contribuir a disminuir la incidencia de distrés respiratorio.
PDF
