International journal of clinical practice
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Int. J. Clin. Pract. · May 2021
Disagreements between Emergency Patients and Physicians regarding Chief Complaint Patient Factors and Prognostic Implications.
The predictive power of chief complaints reported at presentation to the emergency department (ED) is well known. However, there is a lack of research on the coherence of patient versus physician reported chief complaints. The aim of this study was to determine the rate of disagreement between patients and physicians regarding chief complaint and its significance for the prediction of the outcomes number of resources used during ED work-up, hospitalisation, ICU admission, in-hospital mortality and hospital length of stay. ⋯ Disagreement on chief complaint between patient and physician may be an early marker for a complex work-up, requiring more resources and hospitalisations. The relevance of this finding is the newly identified signal of chief complaint replacement. It is easy to identify and should generate attention, as it affects a certain phenotype (older male patients with higher numbers of complaints).
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Int. J. Clin. Pract. · May 2021
Role of a multidimensional prognosis in-hospital monitoring for older patients with prolonged stay.
The Multidimensional Prognostic Index (MPI) is a prognostic tool-amongst others-validated for mortality, length of hospital stay (LHS) and rehospitalisation risk assessment. Like the Comprehensive Geriatric Assessment (CGA), the MPI is usually obtained at hospital admission and discharge, not during the hospital stay. The aim of the present study was to address the role of an additional CGA-based MPI measurement during hospitalisation as an indicator of "real-time" in-hospital changes. ⋯ A CGA-based MPI evaluation during hospitalisation can be used as an objective instrument to detect changes in multidimensional health course. Prompt identification of the latter may enable quick tailored interventions to ensure overall better outcomes at and after discharge.
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Int. J. Clin. Pract. · May 2021
Observational StudySocioeconomic status is not associated with delivery of care in people with diabetes but does modify HbA1c levels: an observational cohort study (ELZHA-cohort 1).
Structured primary diabetes care within a collectively supported setting is associated with better monitoring of biomedical and lifestyle-related target indicators amongst people with type 2 diabetes and with better HbA1c levels. Whether socioeconomic status affects the delivery of care in terms of monitoring and its association with HbA1c levels within this approach, is unclear. This study aims to understand whether, within a structured care approach, (1) socioeconomic categories differ concerning diabetes monitoring as recommended; (2) socioeconomic status modifies the association between monitoring as recommended and HbA1c. ⋯ Within a structured diabetes care setting, socioeconomic status is not associated with recommended monitoring. Socioeconomic differences in the association between recommended monitoring and HbA1c levels advocate further exploration of practice and patient-related factors contributing to appropriate monitoring and for care adjustment to population needs.
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Int. J. Clin. Pract. · May 2021
Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy.
Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce. ⋯ PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR ≥ 30 mL/(min-1.73 m2 ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.
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Int. J. Clin. Pract. · May 2021
Safety Analysis regarding Acute Kidney Injuries for Chloride-Restrictive Intravenous Fluid Administration against that of Chloride-Liberal for Patients Admitted in the Medical Intensive Care Unit: A Non-Randomized Retrospective (ChraChl-MIC) Study.
Acute kidney injuries are common in the medical intensive care unit. Generally, intravenous normal saline is administered in critically ill patients but it is associated with acute kidney injury. Current knowledge of chloride and its effect on the physiological functions of the kidney is limited. The objectives of the study were to compare the safety of chloride-restrictive intravenous fluid administration against that of chloride-liberal regarding acute kidney injuries. ⋯ The chloride-restrictive intravenous fluid administration has reduced the chances of acute kidney injuries in the intensive medical care unit.