Factors associated with the incidence of serious adverse events in patients admitted with COPD acute exacerbation.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common cause of hospitalization. Patient outcome and prognosis following AECOPD are variable. The aim of this study is to identify the factors associated with the incidence of serious adverse events (SAE), defined as need for ICU admission, noninvasive ventilation, death during hospitalization or early readmission, in those patients admitted with AECOPD. METHODS: We conducted a retrospective study by reviewing the medical records of all patients admitted with AECOPD in the University Hospital Complex of Santiago de Compostela in 2007 and 2008. To identify variables independently associated with SAE incidence, we conducted a logistic regression including those variables which proved to be significant in the univariate analysis. RESULTS: 757 patients were assessed (mean age 74.8 years, SD 11.26), 77.2 % male, and 186 (24.6 %) of the patients assessed experienced an SAE. Factors associated with SAE in multivariate analysis were anticholinergic therapy (OR 3.19; CI 95 %: 1.16; 8.82), oxygen therapy at home (OR 3.72; CI 95 %: 1.62; 8.57), oxygen saturation at admission (OR 0.93; CI 95 %: 0.88; 0.99) and serum albumin (OR 0.26; CI 95 %: 0.1; 0.66). CONCLUSION: Oxygen therapy at home, anticholinergic therapy as baseline treatment, lower oxygen saturation at admission and lower serum albumin level seem to be associated with higher incidence of SAE in patients with AECOPD.

Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy.

IMPORTANCE: Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE: We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. DESIGN: Prospective cohort sub-study of a randomized trial. SETTING: The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. PARTICIPANTS: Consenting survivors to discharge. MAIN OUTCOME MEASURES: Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). RESULTS: Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. CONCLUSIONS AND RELEVANCE: The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.

[Family typology and deterioration related to opioids use, in a methadone treatment patients group]. / Tipología familiar y deterioro asociado al consumo de opiáceos, en un grupo depacientes en tratamiento con metadona.

In this article the familiar functioning of subjects addict to opioids included in a maintenance programme with methadone will be analyzed, trying to identify whether belonging to one type of family (family typology) or another, according to Olson's Familiar Functioning Model, is related to the level of deterioration or severity of addiction of the different areas associated to consumption . The sample is composed by 69 subjects (N=69) users of the Servicio de Atención a las Drogodependencias (SAD) in Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Seville). In order to evaluate the functioning and the family typology of these subjects the Escala de Cohesión y Adaptación Familiar--CAF-1--Spanish version of FACES III was used. In order to evaluate the level of deterioration, the Spanish version of the 5th edition of the personal, clinical semistructured interview Addiction Severity Index--ASI4--was applied. The results indicate that the subjects included in balanced families present more addiction severity in two dimensions of the ASI: Alcohol and Employment/Support and are, moreover, the ones that take greater doses of methadone.

Tipología familiar y deterioro asociado al consumo de opiáceos, en un grupo de pacientes en tratamiento con metadona / Family typology and deterioration related to opioids use, in a methadone treatment patients group

En este artículo se analiza el funcionamiento familiar de los sujetos adictos a opiáceos incluidos en un programa de mantenimiento con metadona, tratando de identificar si la pertenencia a un tipo u otro de familia (tipología familiar) según el Modelo de Funcionamiento Familiar de Olson, se relaciona con el nivel de deterioro o severidad de la adicción de las distintas áreas asociadas al consumo. La muestra está compuesta por 69 sujetos (N=69) usuarios del Servicio de Atención a las Drogodependencias (SAD) del Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Sevilla). Para evaluar el funcionamiento y la tipología familiar, de estos sujetos se utilizó la Escala de Cohesión y Adaptación Familiar –CAF-1, versión española del FACES III2. Para evaluar el nivel de deterioro, aplicamos la versión española 3 de la 5ª edición de la entrevista clínica personal semiestructurada Addiction Severity Index-ASI4. Los resultados obtenidos nos indican que los sujetos incluidos en familias equilibradas presentan más severidad de la adicción en dos dimensiones del ASI: Alcohol y Empleo/Apoyo y son, además, los que consumen una dosis más elevada de metadona (AU)

In this article the familiar functioning of subjects addict to opioids included in a maintenance programme with methadone will be analized, trying to identify whether belonging to one type of family (family typology) or another according to Olson’s Familiar Functioning Model, is related to the level of deterioration or severity of addiction of the different areas associated to consumption . The sampleis composed by 69 subjects (N=69) users of the Servicio de Atención a las Drogodependencias (SAD) in Centro de Servicios Sociales Comunitarios del Ayuntamiento de Alcalá de Guadaíra (Seville). In order to evaluate the functioning and the family typology of these subjects the Escalade Cohesión y Adaptación Familiar –CAF-1, Spanish version of FACES III was used 2. In order to evaluate the level of deterioration, the Spanish version3 of the 5th edition ofthe personal, clinical semistructured interview Addiction Severity Index-ASI4 was applied. The results indicate that the subjects included in balanced families present more addiction severity in two dimensions of the ASI: Alcohol and Employment/ Support and are, moreover, the onesthat take greater doses of methadone (AU)

Cerebral hemodynamics during coronary artery bypass graft surgery: the effect of carotid stenosis.

Carotid stenosis is a frequent coexisting condition in patients undergoing coronary artery bypass graft (CABG) surgery. The impact of carotid stenosis on cerebral perfusion is not fully understood. The purpose of this study was to determine the impact of carotid stenosis on cerebral blood flow velocity in patients undergoing CABG. Seventy-three patients undergoing CABG were prospectively recruited and underwent preoperative Duplex carotid ultrasound to evaluate the degree of carotid stenosis. Intraoperatively, transcranial Doppler ultrasound was used to record the mean flow velocity (MFV) within the bilateral middle cerebral arteries. In addition, during the period of cardiopulmonary bypass, regulators of cerebral hemodynamics such as hematocrit, partial pressure of carbon dioxide and temperature were recorded. The ipsilateral middle cerebral artery mean flow velocity was compared in arteries with and without carotid stenosis using a repeated measures analysis. Seventy-three patients underwent intraoperative monitoring during CABG and 30% (n=22) had carotid stenosis. Overall, MFV rose throughout the duration of CABG including when the patient was on cardiopulmonary bypass. However, there was no significant MFV difference between those arteries with and without stenosis (F=1.2, p=.21). Further analysis during cardiopulmonary bypass, demonstrated that hemodilution and partial pressure of carbon dioxide may play a role in cerebral autoregulation during CABG. Carotid stenosis did not impact mean cerebral blood flow velocity during CABG. The cerebrovascular regulatory process appears to be largely intact during CABG.

Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review.

BACKGROUND: Much attention in the literature has focused on the relationship between perioperative microemboli during cardiac and vascular surgery and postoperative cognitive decline. Transcranial Doppler ultrasonography (TCD) has been used to measure high-intensity transient signals (HITS), which represent microemboli during cardiac, vascular, and orthopedic surgery. The purpose of this study was to systematically examine the literature with respect to HITS and postoperative cognitive function. METHODS: Systematic PubMed searches identified articles related to the use of TCD and cognitive function in the surgical setting. RESULTS: The literature remains largely undecided on the role of HITS and cognitive impairment after surgery, with most studies being underpowered to show a relationship. Although the cognitive effects of HITS may be difficult to detect, subclinical microemboli present potential harm, which may be modifiable. CONCLUSIONS: TCD represents a tool for intraoperative cerebral monitoring to reduce the number of HITS during surgery.

Microemboli are not associated with delirium after coronary artery bypass graft surgery.

Delirium is an acute change in cognition which occurs frequently after coronary artery bypass graft (CABG) surgery. Cerebral microemboli, from plaque, air, or thrombus, have been hypothesized to contribute to delirium and cognitive decline after CABG. The purpose of this study was to determine if there was an association between cerebral microemboli and delirium after cardiac surgery. Non-delirious patients (n=68) were prospectively enrolled and underwent intraoperative monitoring of the middle cerebral arteries with transcranial Doppler (TCD). TCD signals were saved and analyzed postoperatively for microemboli manually, according to established criteria. Postoperatively, patients were assessed for delirium with a standardized battery. Thirty-three patients (48.5%) developed delirium after surgery. Microemboli counts (mean + or - SD) were not significantly different in those with and without delirium (303 + or - 449 vs. 299 + or - 350; p=0.97). While intraoperative microemboli were not associated with delirium after CABG, further investigation into the source and composition of microemboli can further elucidate the long-term clinical impact of microemboli.

[Determination of dose calibrator setting of the capintec CRC-35R for samarium-153]. / Determinación del factor de calibración para el samario-153 en el activímetro de dosis CRC-35R.

OBJECTIVE: The aim of this work is to determine the calibration factor for Sm-153 and evaluate the influence of the geometry in the activity measurements in order to administer accurately the activity to the patient. METHODS: The calibration factor for Sm-153 was determinated using the Sm-153 sources commonly used in clinical practice and the calibrator response in a known calibration setting. The geometry correction factor for the vial and the plastic syringe was calculated using the real activity indicated by the manufacturer and the activity measured in the vial and in the plastic syringe. RESULTS: The calibration factor obtained is 239 +/- 4 and the correction factor which takes in consideration the geometry is 0,87 +/- 0,07. The activity measured in the syringe is eighteen percent higher to activity measured in the vial. CONCLUSION: This method allows to measure accurately the activity of Sm-153 in vial and syringe applying this geometry correction factor to determine accurately the activity administered to the patient.

Use of a large bore syringe creates significantly fewer high intensity transient signals (HITS) into a cardiopulmonary bypass system than a small bore syringe.

INTRODUCTION: High intensity transient signals (HITS) have been reported to occur following perfusionist intervention during cardiac surgery. This study investigates the relationship of the syringe bore, injection rate, and HITS created. METHODS: Syringes (10 mL) with a male luer-lock connection (Large Bore) and Abboject 'jet syringes' with a 20 GA needle and male luer-lock connector (Small Bore) were filled with 10 mL of 0.9 N saline. A perfusionist was randomly assigned a set of four similar syringes followed by the other syringe bore. Each of the four syringes was injected into an in vitro saline-primed cardiopulmonary bypass (CPB) system over 5, 10, 15, or 20 sec. Sixteen randomizations of small and large bore syringes were completed at the four injection times (128 injections). HITS in the CPB arterial line were detected with transcranial Doppler (TCD) probes, were recorded for the 2 min following the injection, and were counted independently off-line by two reviewers. RESULTS: The use of a large bore syringe compared to a small bore syringe created significantly fewer HITS (29 +/- 6 versus 145 +/- 17 [mean +/- SEM], p<0.001) introduced into the CPB arterial line. Injection over a longer time produced significantly fewer HITS than shorter injection times (p<0.001). CONCLUSION: Significantly fewer HITS are introduced into the CPB system by using standard syringes and slower injection time.

Low levels of vitamin B12 and venous thromboembolic disease in elderly men.

OBJECTIVES: Hyperhomocysteinaemia is a well-known risk factor for venous thromboembolic disease (VTD). However, it is not clear whether homocysteine (Hc) itself or a related metabolite or a cofactor is primarily responsible for VTD. We carried out a case-control study to investigate whether vitamin concentrations that are involved in the Hc metabolism are associated or not with an elevated risk of VTD. DESIGN: Case-control study. METHODS: We measured serum vitamin B12, folate, creatinine and albumin concentrations and plasma Hc concentrations in 101 consecutive patients with VTD, diagnosed by image tests and 101 control subjects, matched for age and sex. RESULTS: Serum vitamin B12 concentrations were significantly lower in VTD patients than in the control subjects. There were no differences in plasma Hc or serum folate concentrations between the groups. Among the male subgroup aged more than 70 years, serum vitamin B12 concentrations were significantly lower (240.88 +/- 103.07 vs. 421.20 +/- 314.31 pmol L(-1); P = 0.03) and plasma Hc concentrations were significantly higher (13.1 +/- 4.18 vs. 10.56 +/- 3.06 micromol L(-1); P =0.04) in VTD patients than in the control group. On multivariate analysis, in patients aged more than 70 years, serum vitamin B12 concentrations were independently associated with VTD. Compared with the highest quartile of vitamin B12 (>512.6 pmol L(-1)) the odds ratio (OR) for VTD in the lowest quartile (<230.9 pmol L(-1)) was 3.8 (95% CI 1.44-10.18; P = 0.01). In the VTD group, lowest vitamin B12 concentrations (percentile 10 <152.8 pmol L(-1)) were associated with the factor V Leiden mutation (OR = 6.07, 95% CI 0.93-38.55; P = 0.04). CONCLUSIONS: Measuring vitamin B12 concentrations in elderly males may help in identifying people at risk of venous thromboembolism in our population.