ABSTRACT
BACKGROUND: To improve outcomes for patients who present to hospital with suspected sepsis, it is necessary to accurately identify those at high risk of adverse outcomes as early and swiftly as possible. To assess the prognostic accuracy of shock index (heart rate divided by systolic blood pressure) and its modifications in patients with sepsis or community-acquired pneumonia. METHODS: An electronic search of MEDLINE, EMBASE, Allie and Complementary Medicine Database (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (WHO ITRP) was conducted from conception to 26th March 2019. Eligible studies were required to assess the prognostic accuracy of shock index or its modifications for outcomes of death or requirement for organ support either in sepsis or pneumonia. The methodological appraisal was carried out using the Downs and Black checklist. Evidence was synthesised using a narrative approach due to heterogeneity. RESULTS: Of 759 records screened, 15 studies (8697 patients) were included in this review. Shock index ≥ 1 at time of hospital presentation was a moderately accurate predictor of mortality in patients with sepsis or community-acquired pneumonia, with high specificity and low sensitivity. Only one study reported outcomes related to organ support. CONCLUSIONS: Elevated shock index at time of hospital presentation predicts mortality in sepsis with high specificity. Shock index may offer benefits over existing sepsis scoring systems due to its simplicity.
ABSTRACT
Two new species of Oreocharis Benth. from Fan Si Pan, the highest mountain in Vietnam (Sa Pa) are described and illustrated. Oreocharis grandiflora W.H.Chen, Q.H.Nguyen & Y.M.Shui, is similar to O. flavida Merr. from Hainan province, China, but differs mainly by its larger and infundibuliform corolla, stamens adnate to the base of the corolla tube and stamens coherent in two pairs. The second, Oreocharis longituba W.H.Chen, Q.H.Nguyen & Y.M.Shui, is similar to O. hirsuta Barnett, endemic to northern Thailand, but mainly differs in its pubescence, coherent stamens and glabrous filaments.
ABSTRACT
BACKGROUND: Little is currently known about the continuity and monitoring of antidepressant treatment at individual patient level in primary care. AIMS: To assess continuity of antidepressant therapy in a UK primary care setting at the individual patient level and whether this therapy is conducted with appropriate review. Methods A systematic analysis was undertaken in two general practices in Aberdeen, Scotland of primary care records of adults initiated on an antidepressant for a new episode of depression or anxiety within a 12-month period and followed up for three years. Demographic and clinical details were recorded. Uni- and multivariate analyses were performed. Results The sample consisted of 191 patients. Median duration of treatment for the first episode was 180 (inter-quartile range (IQR)=60, 429) days, with 29% of patients receiving an antidepressant for 60 days or less. Age and previous receipt of antidepressants contributed significantly to predicting treatment duration (p <0.01); effect size (R(2) =0.1). The median interval between antidepressant review consultations increased progressively with increasing treatment duration. There were no significant predictors of frequency of antidepressant review. Conclusion Depression management could be improved by assertive review (and better characterisation) of patients who discontinue early; and by scheduled reassessment of treatment in the second and subsequent years of continuation therapy.
