Survival predictors in elderly patients with acute respiratory distress syndrome: a prospective observational cohort study.

Acute respiratory distress syndrome (ARDS) has a high mortality rate in intensive care units (ICU). The elderly patients remain to be increased of ICU patients. The aim is to investigate the survival predictors of elderly patients with ARDS. We reported a prospective observational cohort research, including the patients with ARDS between October 2012 and May 2015. Demographic, comorbidities, severity, lung mechanics, laboratory data and survival outcomes were analyzed. A total of 463 patients with ARDS were ≥65 years old were enrolled and analyzed. Multivariate logistic regression analysis identified Charlson comorbidity index (CCI) [odds ratio (OR) 1.111, 95% CI 1.010-1.222, p = 0.031], Sequential Organ Failure Assessment (SOFA) score (OR 1.127, 95% CI 1.054-1.206, p < 0.001) and peak inspiratory pressure (PIP) (OR 1.061, 95% CI 1.024-1.099, p = 0.001) which were independently associated with hospital mortality. Regarding the subgroups patients as 65-74 years old, 75-84 years old and ≥85 years old, the baseline characteristics were not significant difference and the hospital mortality rates were also not significant difference. In conclusion, CCI, SOFA score and PIP were identified as survival predictors in elderly patient with ARDS. Assessing comorbidities with CCI is essential in predicting the survival for elderly patients with ARDS.

Predictive factors of in-hospital mortality in ventilated intensive care unit: A prospective cohort study.

Although it is clear that ventilated intensive care unit (ICU) patients have worse outcomes than those who are not, information about the risk factors of in-hospital mortality remains important for medical groups to target interventions for these patients.The purpose of this study was to identify predictive factors of in-hospital mortality in ventilated ICU patients with an admission diagnosis of acute respiratory failure.We conducted a prospective cohort study in 3 medical ICUs in a 3600-bed university hospital. Consecutive patients with acute respiratory failure who received mechanical ventilation (MV) for at least 96 hours without evidence of pre-existing neuromuscular diseases were followed until discharge. Upon inclusion, the following parameters were collected or evaluated: demographics, clinical history (admission body mass index [BMI], etiology of acute respiratory failure, comorbidity, Charlson comorbidity index, laboratory data), Acute Physiology and Chronic Health Evaluation (APACHE) II, and right and left quadriceps femoris muscle force. The days of MV before extubation, ICU length of stay, survival status at discharge, and hospital length of stay were recorded from the hospital discharge summary. The primary endpoint was in-hospital mortality.In all, 113 patients (65.49% males) were recruited with a mean age of 69.78 years and mean APACHE II score of 22.63. The mean ICU length of stay was 14.88 ±â€Š9.79 days. Overall in-hospital mortality was 25.66% (29 out of 113 patients). Multivariate analysis showed that the essential factors associated with increased in-hospital mortality were lower BMI (P = .013), and lower scores on the right or left quadriceps femoris muscle force (P = .002 and .010, respectively).Our study suggests that lower BMI and lower scores on lower limb muscle force may be associated with increased in-hospital mortality in ventilated ICU patients.

Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: an experimental pilot study.

BACKGROUND: This study explored the effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy. PATIENTS AND METHODS: For this experimental study, 57 subjects were randomly assigned to three groups: acupressure with essential oils (n=17), acupressure only (n=24), and sham acupressure (n=16). Acupoints were Hegu (LI4), Zusanli (ST36), and Sanyingjiao (SP6). All subjects received acupressure once every morning for 5 months, with each acupoint pressed for 1 min. Fatigue, functional status, anxiety, depression, and sleep quality were measured before initial chemotherapy (T0), on Day 1 of third chemotherapy (T1), and on Day 1 of sixth chemotherapy (T2). Outcome differences between groups were analyzed at T0, T1, and T2 by general estimating equations. RESULTS: After controlling for baseline outcome values, age, and adherence to acupressure, subjects who received acupressure with essential oils and acupressure had significantly less fatigue in daily living activities and sleep better quality at T1 than subjects who received sham acupressure. Subjects who received acupressure with essential oils had significantly better sleep quality at T2 than the sham acupressure group. Subjects who received acupressure with or without essential oils had greater odds of better functional status at T1 than the sham group. CONCLUSION: It is plausible that acupressure with or without essential oils helps lung cancer patients undergoing chemotherapy reduce cancer-related fatigue and increase activity level. Further study is wanted to test this hypothesis.

Acupressure improves the weaning indices of tidal volumes and rapid shallow breathing index in stable coma patients receiving mechanical ventilation: randomized controlled trial.

Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation. Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n = 32) or two days (n = 31) and standard care (n = 31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5 hrs, 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, 3.5 hrs, and 4 hrs after the start of treatment. Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1 hr, and 2 hrs after adjustment for covariates. Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours.

[Development of an add-on module for the WHOQOL-BREF on patients with allergic rhinitis].

The purpose of this study was to develop an add-on module for the Taiwan-version WHOQOL-BREF for assessing the quality of life of people with allergic rhinitis. A cross-sectional survey design was used. In accordance with the seven steps for the development of population-specific modules of the WHOQOL, the instrument added new items on the basis of opinions of expert groups, including patients, families and physicians, to the Taiwan-version WHOQOL-BREF measure. The new questionnaire, comprising 52 items, was tested on 252 patients with allergic rhinitis. For content validity, each item was significantly correlated with the domain to which it belonged (r= .157-.715, p< .05); and each domain was significantly correlated with each other domain (r= .211-.535, p< .01). The construct validity was examined by means of the multitrait-multimethod method. The total score and the scores on the physiological and environmental subscales showed convergent validity with the score for IgE (r= -.317 - -.380, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= -.202 - -.360, p< .01). The scores on the body constitution subscale also showed convergent validity with the score for IgE (r= .329, p< .01) and with the total score and the scores on the subscale of the allergic rhinitis symptom questionnaire (r= .187-.261, p< .01). This result supports the appropriateness of this new questionnaire specifically for assessing the quality of life of people with allergic rhinitis. As regards concurrent validity, the total score was significantly correlated with the score of all subscales in the Medical Outcomes Study Short Form Taiwan-version (SF-36) (r= .256-.542, p< .01). The internal consistency reliability established by Cronbach's alpha ranged for each domain from .73-.81. The test-retest reliability correlated for each domain of the instrument was .719-.794 (p< .01). In conclusion, the add-on module developed in this paper for the Taiwan-version WHOQOL-BREF for patients with allergic rhinitis is reliable, valid and specific.

[A conceptual framework of the effectiveness of acupuncture].

The term, "Acupuncture," is used in its broadest senses to refer to needling, moxibustion, acupressure, laser acupuncture, electric acupuncture, and microsystem acupuncture, such as ear, face, hand and scalp acupuncture. Numerous surveys show that, of all the complementary medical systems, acupuncture enjoys the most credibility in the medical community. This article introduces a conceptual framework of the effectiveness of acupuncture from the perspective of responses to acupuncture shown in extensive, basic scientific evidence. The researchers hope, through this review of literature, to enable medical personnel to gain something of an understanding of acupuncture.