Home About us Contact
|
Home About us Contact | ||
|
|
||
Clinical Determinants (clinical + determinant)
Selected AbstractsFavorable Long-Term Survival in Patients Undergoing Stent PCI of Unprotected Left Main Coronary Artery Compared to Predicted Short-Term Prognosis of CABG Estimated by EuroSCORE: Clinical Determinants of Long-Term OutcomeJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2009RALF LEHMANN M.D. Aims/Methods: The long-term outcome of patients (pts) undergoing percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) is unclear so far. We prospectively investigated the outcome of 102 consecutive patients who underwent stent PCI of unprotected LMCA. Patients were divided according to clinical indication for PCI: stable coronary artery disease (CAD) (N = 60), NSTEMI (N = 18), STEMI (N = 24). Expected in-hospital mortality of coronary artery bypass grafting (CABG) was calculated using the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and compared to the observed survival rate during long-term follow-up (mean 1.8 ± 1.2 years). Results: The observed 30-day mortality was 1.7% (1/60 pts) in patients with stable CAD, 11% (2/18 pts) in NSTEMI patients, and 13% (3/24 pts) in STEMI patients. The observed mortality was lower than the predicted mortality of CABG as calculated by the logistic EuroSCORE. Using receiver-operator characteristics curves (ROC), EuroSCORE demonstrated a high predictive value for both 30-day mortality as well as 1-year mortality (AUC > 0.8; P < 0.01). Prognostically relevant patient related factors (P < 0.01) included severely reduced left ventricular ejection fraction (HR 3.24), ACS (HR 3.18), STEMI (HR: 3.01), Killip class IV (HR 7.69), occurrence of neoplastic disease (HR 3.97), and elevated CRP (HR 3.86). Conclusions: LMCA-PCI was associated with lower long-term mortality rates compared to the estimated mortality of CABG. This prospective observational study suggests that DES-PCI of unprotected LMCA in "all-comers" can be carried out with reasonable risk. [source] Urban,rural differences in psychiatric rehabilitation outcomesAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2010Srinivasan Tirupati Abstract Objective:,Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants. Design:,The study employed a retrospective, cross-sectional analysis of patient outcome and characteristics. Setting:,Community-based psychiatric rehabilitation service in regional and rural Australia. Participants:,A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community-based and suffered from a chronic mental illness. Main outcome measure(s):,Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16-item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study. Results:,Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as ,Improved' on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts. Conclusions:,For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital. [source] Microbial and clinical determinants of time-to-positivity in patients with bacteraemiaCLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2007J. A. Martínez Abstract Time-to-positivity is useful in the diagnosis of catheter-related bacteraemia and as a predictor of an endovascular source in patients with Staphylococcus aureus bacteraemia. However, this parameter has been evaluated for only a limited number of microorganisms. In the present study, time-to-positivity was recorded for 1872 episodes of significant monomicrobial bacteraemia diagnosed at a teaching hospital during a 2-year period, and the associated microbial and clinical variables were investigated. According to multivariate analysis, Streptococcus pneumoniae, ,-haemolytic streptococci, Escherichia coli, Klebsiella, Enterobacter, Citrobacter and Aeromonas were characterised by fast growth, with an endovascular source, shock, liver cirrhosis and neutropenia also predicting a short time-to-positivity. For patients not receiving appropriate antibiotics, detection of Gram-positive cocci in clusters within 14 h was predictive of Staph. aureus; a time-to-positivity of >21 h ruled out the possibility that a Gram-positive organism in chains was a ,-haemolytic streptococcus or Strep. pneumoniae, and a time-to-positivity of ,12 h meant that it was very unlikely that a Gram-negative bacillus was a non-fermenter. A time-to-positivity of ,8 h was predictive of a non-urinary tract source in patients with E. coli bacteraemia, and detection of growth within 13 h predicted an endovascular source in those with Staph. aureus bacteraemia. In conclusion, time-to-positivity depended on the microorganism, original source and clinical variables involved. Although this measurement may provide some early clues concerning the microorganisms involved and the source of bacteraemia, its clinical impact remains to be defined. [source] Heart rate variability and its determinants in patients with severe or mild essential hypertensionCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 5 2001Hanna Mussalo How cardiac autonomic nervous control is related to the severity of essential hypertension in patients receiving long-term antihypertensive therapy is not well known. The aim of this study was to examine heart rate variability (HRV), a non-invasive measure of cardiac autonomic function, in patients with long-term and medically treated mild and severe essential hypertension and healthy control subjects, and to assess the clinical determinants of HRV in these patients. Thirty-four patients with severe essential hypertension (SEHT) and 29 with mild essential hypertension (MEHT) as well as healthy age- and sex-matched control subjects were studied. HRV was assessed from 10 min ECG-recordings during paced (0·2 Hz) breathing at rest and expressed as time and frequency domain measures. In the SEHT group time (SDNN, RMSSD) and frequency domain measures (total power, low-frequency (LF) power and high-frequency (HF) power of HRV in absolute units, and LF and HF power of HRV in normalized units) of HRV were significantly lower when compared with those of the control group. The MEHT and control groups did not differ from each other with respect to time or frequency domain measures of HRV. Comparison between the hypertensive groups showed that SDNN, total power, LF power and HF power were lower in the SEHT group compared with the MEHT group (P<0·05 for all). Among hypertensive patients RR-interval, age, gender, systolic finger blood pressure and diastolic office blood pressure as well as 24-h blood pressure were significant determinants of HRV. In conclusion, we found that the severity of chronic essential hypertension seems to be related to the severity of impairment of cardiac autonomic control. [source] | ||||||||||