Spontaneous intracerebral haemorrhage associated with oral anticoagulants (ICH-OAC) has a high mortality rate. The emergence of new anticoagulant drugs and reversal protocols increases interest in ...this entity.
The main objective is to determine the mortality rate in patients with ICH-OAC (early, in-hospital, global) in our health area and to analyse the main variables related to it. The secondary objective is to determine the efficacy of anticoagulation reversal therapies (ART) as reflected by radiological expansion of the haematoma and the functional prognosis.
A prospective observational study that introduced a protocol aimed at the management of patients with ICH-OAC. It included general measures and neuromonitoring, individualised administration of ART, cranial tomography and a six-month follow-up. Data on the drugs prescribed in the area during this period, mortality and functional prognosis were collected. A bivariate and logistic regression study was designed to investigate mortality-related variables.
Forty-nine patients were included over three years; of these, 71.4% received ART. Mortality was 16.3% (first 24 hours), 53.1% (admission) and 61.2% (180 days). Lower survival was observed among patients with higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001), creatinine value (p = 0.02), International Normalised Index (p = 0.048), bleeding volume (p = 0.008), hydrocephalus (p = 0.015) and acenocoumarol intake (p = 0.030). Patients who did not receive ART had a greater rate of early mortality (p = 0.003). The only variable independently related to overall mortality was the baseline NIHSS score (odds ratio = 1.282; 95% confidence interval: 1.023-1.608; p = 0.031).
ICH-OAC has a high mortality rate, related to the use of acenocoumarol and regardless of the initial clinical situation. A lower rate of early mortality was found among patients who received ART.
Background: Delirium is an acute syndrome of organ dysfunction with long-term consequences which commonly occurs in the Intensive Care Unit (ICU). The incidence of delirium ranges from 30% - 50% in ...low severity ICU patients and up to 80% in mechanically ventilated patients. This condition is frequently under-recognized and daily routine screening is a key strategy to early intervention. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) are the most recommended assessment tools for detecting delirium in the critical ill patient. Objective: The main objective of this study is to educate ICU staff about delirium. In addition, nurses were trained to use the CAM-ICU as a standard screening tool. The intervention was evaluated through a survey aimed at ICU staff. Methods: An educational intervention was started in 2014 in our ICU. An educational package for ICU staff consisted of a didactic brochure and explanatory videos. One-on-one teaching, case based scenarios and didactic teaching were strategies used in the implementation process. The entire intervention was evaluated by means of a survey directed to the professionals. Results: The structure of the didactic brochure was simple in order to have an easy understanding of the CAM-ICU tool. We also created 10-minute videos. According to the results of the satisfaction survey (N=62), disorganized thinking was the most difficult feature of CAM-ICU to interpret. When in doubt, consultation between co-workers was the primary resource selected by unit staff. Conclusion: This initiative achieved the objective of training health care professionals in the application of the CAM-ICU tool with a good level of satisfaction from them. Therefore, ICU staff consider delirium management in the broader picture of critically ill patient care as a major activity of daily practice.
Alcohol consumption in the rural environment Crisanto Gómez Iniesta; Elena Ruiz-Escribano Taravilla; Loreto Tárraga Marcos ...
Journal of negative & no positive results,
11/2019, Letnik:
4, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Objectives. The primary objective of this study is to identify the prevalence of alcohol consumption in the rural environment and to analyze various sociodemographic variables, typical consumption in ...this zone as well as to sort the patients into groups of moderate consumption, high-risk consumption or dangerous consumption. Material and methods. A simple of patients and companions who attended a consultation and who agreed to participate in the study was analyzed, these individuals were provided with an anonymous questionnaire to complete themselves which included the AUDIT alcohol consumption questionnaire. Principal results. The prevalence of consumption in this rural zone of Albacete is in line with the national average but greater than the regional average. A pattern of daily alcohol consumption is more prevalent in middle-aged working men and the retired. Of note is the participation of younger females in alcohol consumption. In young people, the type of consumption is by and large in the form of binge drinking and occurs mainly during the weekends. Conclusions. Alcohol consumption in the rural setting has certain typical social and demographic characteristics, which is why from a Primary Care perspective we must insist on identifying the most vulnerable populations: adult males with established drinking habits, Young females and those who have completed higher education. Patterns of consumption are changing and it is essential to reinforce information and screen the young.
PDF
