Clinical epidemiology
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Clinical epidemiology · Jan 2012
Increase in the proportion of patients hospitalized with acute myocardial infarction with do-not-resuscitate orders already in place between 2001 and 2007: a nonconcurrent prospective study.
Shared decision making and advance planning in end-of-life decisions have become increasingly important aspects of the management of seriously ill patients. Here, we describe the use and timing of do-not-resuscitate (DNR) orders in patients hospitalized with acute myocardial infarction (AMI). ⋯ Although the use of DNR orders in patients hospitalized with AMI was stable during the period under study, in more recent years, patients are increasingly being hospitalized with DNR orders already in place.
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Clinical epidemiology · Jan 2012
Acute respiratory distress syndrome: epidemiology and management approaches.
Acute lung injury and the more severe acute respiratory distress syndrome represent a spectrum of lung disease characterized by the sudden onset of inflammatory pulmonary edema secondary to myriad local or systemic insults. The present article provides a review of current evidence in the epidemiology and treatment of acute lung injury and acute respiratory distress syndrome, with a focus on significant knowledge gaps that may be addressed through epidemiologic methods.
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Clinical epidemiology · Jan 2012
Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis.
Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisions for chronic infection in hip arthroplasties. ⋯ Our results may indicate three additional reinfections per 100 reimplanted patients when performing a one-stage versus two-stage revision. However, the risk estimates were statistically imprecise and the quality of underlying data low, demonstrating the lack of clear evidence that two-stage revision is superior to one-stage revision among patients with chronically infected hip arthroplasties. This systematic review underscores the need for improvement in reporting and collection of high-quality data and for large comparative prospective studies on this issue.
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Clinical epidemiology · Jan 2011
Comparison of Charlson comorbidity index with SAPS and APACHE scores for prediction of mortality following intensive care.
Physiology-based severity of illness scores are often used for risk adjustment in observational studies of intensive care unit (ICU) outcome. However, the complexity and time constraints of these scoring systems may limit their use in administrative databases. Comorbidity is a main determinant of ICU outcome, and comorbidity scores can be computed based on data from most administrative databases. However, limited data exist on the performance of comorbidity scores in predicting mortality of ICU patients. ⋯ The CCI combined with administrative data predict short- and long-term mortality for ICU patients as well as physiology-based scores.
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Clinical epidemiology · May 2010
Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis.
Recent research indicates that sleep disturbances are common in persons with multiple sclerosis (MS), though research to date has primarily focused on the relationship between fatigue and sleep. In order to improve treatment of sleep disorders in MS, a better understanding of other factors that contribute to MS sleep disturbance and use of sleep medications in this population is needed. ⋯ Regression results indicate that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population. More research is needed to explore the possibility of under-treatment of sleep disorders in MS and examine the potential effectiveness of nonpharmaceutical treatment options.