73 research outputs found
Patient Perspective on the Management of Cancer Pain in Spain
Pain in cancer is often underdiagnosed and undertreated. Breakthrough pain, in particular, severely impacts the quality of life of patients. In this study, we evaluated management and care of pain in Spain from the patient perspective by assessing the experience of 275 patients who had suffered breakthrough pain. Although most patients had suffered moderate-to-severe pain in the last 24 hours, pain relief was achieved in the majority of cases. The body areas with a higher pain intensity was felt varied based on primary cancer. Adherence to treatment was subpar, and patients were moderately concerned about addiction to treatment and adverse events. Doctors did not assess pain in every visit and there is room for improvement in its classification. Education strategies directed toward patients and health care personnel are needed to improve pain assessment, follow-up, and compliance. These could guide shared decision-making and improve communication about cancer pain to improve its care
Prognosis and serum creatinine levels in acute renal failure at the time of nephrology consultation: an observational cohort study
The aim of this study is to evaluate the association between acute
serum creatinine changes in acute renal failure (ARF), before specialized
treatment begins, and in-hospital mortality, recovery of renal function, and
overall mortality at 6 months, on an equal degree of ARF severity, using the
RIFLE criteria, and comorbid illnesses. METHODS: Prospective cohort study of 1008
consecutive patients who had been diagnosed as having ARF, and had been admitted
in an university-affiliated hospital over 10 years. Demographic, clinical
information and outcomes were measured. After that, 646 patients who had
presented enough increment in serum creatinine to qualify for the RIFLE criteria
were included for subsequent analysis. The population was divided into two groups
using the median serum creatinine change (101%) as the cut-off value.
Multivariate non-conditional logistic and linear regression models were used.
RESULTS: A >or= 101% increment of creatinine respect to its baseline before
nephrology consultation was associated with significant increase of in-hospital
mortality (35.6% vs. 22.6%, p < 0.001), with an adjusted odds ratio of 1.81 (95%
CI: 1.08-3.03). Patients who required continuous renal replacement therapy in the
>or= 101% increment group presented a higher increase of in-hospital mortality
(62.7% vs 46.4%, p = 0.048), with an adjusted odds ratio of 2.66 (95% CI:
1.00-7.21). Patients in the >or= 101% increment group had a higher mean serum
creatinine level with respect to their baseline level (114.72% vs. 37.96%) at
hospital discharge. This was an adjusted 48.92% (95% CI: 13.05-84.79) more serum
creatinine than in the < 101% increment group. CONCLUSION: In this cohort,
patients who had presented an increment in serum level of creatinine of >or= 101%
with respect to basal values, at the time of nephrology consultation, had
increased mortality rates and were discharged from hospital with a more
deteriorated renal function than those with similar Liano scoring and the same
RIFLE classes, but with a < 101% increment. This finding may provide more
information about the factors involved in the prognosis of ARF. Furthermore, the
calculation of relative serum creatinine increase could be used as a practical
tool to identify those patients at risk, and that would benefit from an intensive
therapy
Cell Therapy for Cardiovascular Disease: A Comparison of Methods of Delivery
The field of myocardial regeneration utilizing novel cell-based therapies, gene transfer, and growth factors may prove to play an important role in the future management of ischemic heart disease and cardiomyopathy. Phases I and II clinical trials have been published for a variety of biologics utilizing four methods of delivery: systemic infusion, intracoronary infusion, transvenous coronary sinus, and intramyocardial. This review discusses the advantages and disadvantages of the delivery approaches above
The SPARK Study: a phase II randomized blinded controlled trial of the effect of furosemide in critically ill patients with early acute kidney injury
Mitochondrial dysfunction and biogenesis: do ICU patients die from mitochondrial failure?
Mitochondrial functions include production of energy, activation of programmed cell death, and a number of cell specific tasks, e.g., cell signaling, control of Ca2+ metabolism, and synthesis of a number of important biomolecules. As proper mitochondrial function is critical for normal performance and survival of cells, mitochondrial dysfunction often leads to pathological conditions resulting in various human diseases. Recently mitochondrial dysfunction has been linked to multiple organ failure (MOF) often leading to the death of critical care patients. However, there are two main reasons why this insight did not generate an adequate resonance in clinical settings. First, most data regarding mitochondrial dysfunction in organs susceptible to failure in critical care diseases (liver, kidney, heart, lung, intestine, brain) were collected using animal models. Second, there is no clear therapeutic strategy how acquired mitochondrial dysfunction can be improved. Only the benefit of such therapies will confirm the critical role of mitochondrial dysfunction in clinical settings. Here we summarized data on mitochondrial dysfunction obtained in diverse experimental systems, which are related to conditions seen in intensive care unit (ICU) patients. Particular attention is given to mechanisms that cause cell death and organ dysfunction and to prospective therapeutic strategies, directed to recover mitochondrial function. Collectively the data discussed in this review suggest that appropriate diagnosis and specific treatment of mitochondrial dysfunction in ICU patients may significantly improve the clinical outcome
Inventory of current EU paediatric vision and hearing screening programmes
Background: We examined the diversity in paediatric vision and hearing screening
programmes in Europe.
Methods: Themes relevant for comparison of screening programmes were derived from
literature and used to compile three questionnaires on vision, hearing and public-health
screening. Tests used, professions involved, age and frequency of testing seem to influence
sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists,
orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember,
candidate and associate states. Answers were cross-checked.
Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a
nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35
countries, in 71% more than once. First measurement of VA varies from three to seven years
of age, but is usually before the age of five. At age three and four picture charts, including Lea
Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing
screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory
brainstem response (ABR) in premature newborns. The majority of hearing testing
programmes are staged; children are referred after one to four abnormal tests. Vision
screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is
mostly by health insurance or state. Coverage was reported as >95% in half of countries, but
reporting was often not first-hand.
Conclusion: Largest differences were found in VA charts used (12), professions involved in
vision screening (10), number of hearing screening tests before referral (1-4) and funding
sources (8)
Applications of artificial neural networks predicting macroinvertebrates in freshwaters
Dendritic cell tumor in a salivary gland lymph node: a rare differential diagnosis of salivary gland neoplasms
Craniofacial and Dental Characteristics in Patients with Williams-Beuren Syndrome
status: publishe
Accuracy of Optical Coherence Tomography Measurements of Rectus Muscle Insertions in Adult Patients Undergoing Strabismus Surgery
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