Discharge of dependent patients directly from the intensive care units after a critical illness: a single-center retrospective cohort study.

OBJECTIVE: This study aimed to determine the mortality and predictive factors affecting mortality of patients discharged directly from the intensive care unit (ICU) at the third- and sixth-month post-discharge. Additionally, it assessed the rate of hospital readmissions within 30 days post-discharge and the satisfaction level of family members with post-ICU care. PATIENTS AND METHODS: In this single-center, retrospective, observational cohort study, dependent patients discharged directly from the ICU between July 1, 2019, and July 1, 2022, were included. Data on patients' demographics, reasons for admission, pre-existing diseases, length of ICU stay, advanced clinical interventions, discharge destination, physiological status on discharge, readmission within 30 days, and clinical outcomes and mortality at the third- and sixth-months post-discharge were collected. RESULTS: The study included 240 patients, representing 45.8% of all patients discharged directly from the ICU. Of these, 122 were discharged to their homes, and 118 to intermediate care units intermediate care units (IMCUs). The mean age was 71 years [interquartile range (IQR): 22.8]. Among the patients, 113 (47.1%) were readmitted within 30 days post-discharge, and 23 (20.35%) were re-hospitalized. The overall mortality rate in the third and sixth months was 25.4% and 32.5%, respectively. Logistic regression identified age, readmission within 30 days, and Glasgow Outcome Scale-Extended (GOS-E) at discharge as predictive factors for short-term and long-term mortality. Patients discharged to IMCUs had significantly higher long-term mortality. Family members of patients discharged to their homes had significantly higher satisfaction with post-ICU care (p=0.002). CONCLUSIONS: Discharging patients directly from the ICU to their homes may yield better outcomes in selected patients compared to discharging to IMCUs. This approach may also enable more efficient use of hospital resources and reduce ICU occupancy and associated costs.

The role of chest X-ray in coronavirus disease 2019 (COVID-19) infection: findings and correlation with clinical outcome.

OBJECTIVE: It is possible to diagnose coronavirus disease 2019 (COVID-19) faster and more accurately with chest X-ray (CXR) and chest computed tomography (CT) than with reverse transcriptase PCR (RT-PCR) tests. The aim of this study was to verify the possibility of reducing the use of CT in diagnosis and follow-up of COVID-19 infection by using CXR. PATIENTS AND METHODS: A total of 326 COVID-19 patients who were hospitalized in Ankara City Hospital were included in this retrospective study. RESULTS: A total of 326 patients were RT-PCR positive for COVID-19 infection; 178 were male (54.6%) and 148 were female (45.4%), with a median age of 45. Considering the results, the baseline CXR sensitivity in our experience was approximately 72%. The CXRs of 113 patients with abnormal CT were divided into 2 groups, the CXR normal and abnormal groups, and were then compared. In the 1st group with abnormal CXR, the mean age, the number of patients over 65 years old, and the comorbidity rate were higher. Additionally, it was determined that the number of patients requiring respiratory support and intensive care unit (ICU) admission in this 1st group was higher than in the 2nd group (with normal CXR). Most of the patients who died (91%, 10/11) were in Group 1. In the group with normal CXR, no patients in the critically ill category needed invasive or non-invasive mechanical ventilators. CONCLUSIONS: CXR can help in detecting clinically moderate and severe cases of COVID-19. CXR can assist clinicians in patient management and treatment planning regarding the clinical course, respiratory support, ICU need, and mortality and can help them prepare for potential negative outcomes.

Erectile dysfunction in patients with psoriasis: potential impact of the metabolic syndrome.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease that affects up to 5.5% of world population and is associated with erectile dysfunction (ED). Aim of the present study was to investigate impact of metabolic syndrome (MetS) on association between psoriasis and ED as well as to improve our understanding of this association via studying other possible causes of ED such as psychological factors and disease effects. PATIENTS AND METHODS: The patient group included 37 male psoriasis patients and control group 28 healthy men. Severity of psoriasis was determined using Psoriasis Area and Severity Index (PASI), and ED was evaluated using International Index of Erectile Function (IIEF) Scale. Psychiatric state of the patients were determined using Beck Depression Inventory (BDI). MetS was diagnosed using the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: MetS, ED prevalence and BDI score were significantly higher in psoriasis patient group (p = 0.032, p = 0.018 and p < 0.001). Average IIEF score of psoriasis patients with and without MetS, on the other hand, was not different (p = 0.073). IIEF score had negative correlations with age, BDI and PASI scores. In multiple linear regression analysis, BDI score, old age and smoking (but not MetS) were found to be independent predictors of ED. CONCLUSIONS: ED, MetS and depression frequencies were significantly higher in psoriasis patient group. In addition, psoriasis severity and ED parameters were closely associated. Depression, old age and smoking were found to be independent risk factors for ED.