Heart & lung : the journal of critical care
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Comparative Study
Does race affect readmission to hospital after critical illness?
To examine the influence of race on 7-day hospital readmission rates after discharge of critically ill patients. ⋯ Contrary to our hypothesis, race was not associated with rapid readmission or mortality of critically ill patients. Factors independently associated with rapid readmission were mechanical ventilation beyond 29 days and disposition to an acute rehabilitation or skilled nursing facility. Further studies are required to ascertain whether these factors are generalizable or idiosyncratic to our institution.
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Patients in intensive care units (ICUs) can be adversely affected by distressing symptoms. When critically ill patients are unable to self-report symptoms, ICU nurses become proxy reporters. ⋯ Critically ill patients experience a broad range of symptoms. Continued attempts to validate nonverbal measures of symptoms are warranted because lack of such measures may adversely affect symptom treatment for critically ill patients. Furthermore, heightened awareness and increased education of nurses to differentiate between signs and symptoms lay the foundation for increasing attention on symptoms, improving accuracy of symptom assessment, and guiding appropriate symptom management.
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Patients with heart failure require a great deal of information about their disease, but it is also important to know about their preferences for involvement in medical decision making and about factors that may influence their preferences so that patients' needs, values, and preferences can be met by clinicians. ⋯ The results suggest that the preferences of patients with heart failure for a more passive role in decision making may be a stronger independent predictor of patients' perceived involvement in decision making than patients' age.
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Fevers of unknown origin (FUOs) are defined as prolonged fevers of 101 degrees F or greater lasting 3 or more weeks that remain undiagnosed after comprehensive inpatient/outpatient laboratory testing. Tick-borne infections are uncommon causes of FUOs. Any infectious disease accompanied by prolonged fevers can present as an FUO if the diagnosis is not suspected or if specific laboratory testing is not done to confirm the diagnosis. ⋯ He also had an elevated immunoglobulin-M Lyme titer indicating coinfection with Lyme disease. Although his hemolytic anemia persisted for weeks, he only had 3% parasitemia and intact splenic function. We believe this to be the first case of babesiosis presenting as an FUO in a normal host.
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Patent foramen ovale (PFO) is frequent but rarely associated with platypnea-orthodeoxia syndrome and with no pulmonary hypertension. ⋯ PFO may be patent and responsible for hypoxemia without pulmonary hypertension. This condition is easily recognized with transesophageal echocardiography, leading in most cases to a percutaneous closure resulting in a dramatic correction of hypoxemia.