Polskie Archiwum Medycyny Wewnętrznej
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Pol. Arch. Med. Wewn. · Oct 2019
Predictors of appropriate interventions and mortality in patients with implantable cardioverter-defibrillators.
Additional risk assessment in patients with heart failure referred for implantable cardioverter‑defibrillator (ICD) implantation as primary prevention is needed. A reduction in left ventricular ejection fraction (LVEF) seems to lack sufficient sensitivity and specificity to be used for identification of patients at the highest risk of sudden cardiac death. ⋯ Implantation of ICD or CRT‑D as secondary prevention was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention. In patients with ICD or CRT-D, independent predictors of mortality included: body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter.
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Pol. Arch. Med. Wewn. · Oct 2019
Prognostic value of midregional proadrenomedullin in critically ill patients.
Scoring systems can be used to predict the risk of mortality and outcomes in critically ill patients. Acute kidney injury (AKI) is one of the strongest factors negatively influencing patient outcomes. Midregional proadrenomedullin (MR‑proADM) shows promising results as an outcome predictor in patients with sepsis. ⋯ MR‑proADM can be applied in clinical practice as a prognostic tool for mortality but not incident AKI in the general ICU population with at least similar accuracy as APACHE II and SOFA scores.
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Pol. Arch. Med. Wewn. · Oct 2019
Polypharmacy and medication errors on admission to palliative care.
Many patients at the end of their life are treated with multiple medications while some of the drugs may no longer be beneficial and should be reduced. ⋯ Polypharmacy and increased risk of drug inappropriateness particularly affect elderly patients referred by hospitals, with poor prognosis, low performance, admitted to in‑patient hospice. Therapy reduction may diminish the risk of therapeutic inappropriateness but requires further education within nonspecialist palliative care.