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Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The prognosis of HF is usually poor unless the cause can be corrected. After the first hospitalization, 5-year survival is only about 35%, no matter what the ejection fraction is. For overt chronic HF, deaths are based on ventricular dysfunction and symptom severity. Generally, patients experience slow deterioration of health, with occasional severe exacerbations, and eventual death. Modern therapies sometimes prolong life. For some patients, death is sudden, without warning or any worsening of symptoms.
Patient Transfer
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The numbers of a point of contact at both the referring and receiving hospital should be taken. The latter is key in order to pass clinical updates in the event of deterioration so that any interventions can be expedited.
Spinal injuries
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The symptoms from which a spinal injury victim may complain are, for the most part, restricted to local pain, plus awareness of any loss of motor or sensory function. Signs of underlying skeletal damage may include local bruising, swelling, tenderness or deformity but the capacity to search for such signs may be limited, particularly in the victim of polytrauma. Neurological examination is needed as soon as practically possible. In addition to recording power (Table 16.1), together with sensation and reflexes in the limbs, assessment should include the lower cranial nerves and function in the lower sacral dermatomes, including sacral reflexes.1 Findings should be documented, to provide a baseline from which to measure any subsequent deterioration or improvement. The absence of all motor, sensory and reflex function below the level of injury, soon after injury, may be due to spinal shock. This will resolve within 48 hours and, unless the conus has been damaged, sacral reflexes will then return. If, at this point, there is no voluntary motor or sensory function, the lesion is deemed to be complete. If, on the other hand, even a small amount of voluntary lower limb movement is seen, the individual will very likely recover sufficiently to walk again, given proper treatment. If there is sacral sparing evident at the outset, then the chances of functional recovery are also good.
Cost savings through continuous vital sign monitoring in the medical-surgical unit
Published in Journal of Medical Economics, 2023
John W. Beard, Antra Sethi, Weiqi Jiao, Hayden W. Hyatt, Halit O. Yapici, Mary Erslon, Frank J. Overdyk
Respiratory rate (RR), heart rate (HR), blood pressure, arterial blood oxygen saturation (SpO2), and temperature are vital signs that inform clinicians of a patient’s condition at a single point in time or as a trend. Each measurement differs in its ability to identify clinical deterioration, and published studies report variable results on which parameters are most predictive of dangerous changes in a patient’s condition. Churpek et al. found respiratory rate and heart rate were predictors of cardiac arrest while blood pressure and oxygen saturation were not3. Fieselmann et al. concluded that a respiratory rate greater than 27 breaths per minute was a predictor of cardiopulmonary arrest, whereas heart rate was not predictive15. Jones et al. demonstrated that tachycardia was responsible for 19% of RRT activations, whereas increased respiratory rates were responsible for 14%16. The utility of SpO2 measurements was highlighted by the COVID-19 pandemic where decreases in SpO2 were predictive of ICU admission17. In fact, each individual parameter may be most predictive in certain disease states (driven by the underlying pathophysiologic changes), suggesting that a multiparameter continuous monitoring strategy may be most efficacious. Overall, respiratory rate and heart rate may be most predictive of deterioration with additional vital signs, patient age, and clinical characteristics having variable but important predictive values18.
The minimal clinically important difference in the treadmill six-minute walk test in active women with breast cancer during and after oncological treatments
Published in Disability and Rehabilitation, 2023
Irene Cantarero-Villanueva, Paula Postigo-Martin, Catherine L. Granger, Jamie Waterland, Noelia Galiano-Castillo, Linda Denehy
The MCID helps both clinicians and researchers interpret changes in health status objectively, but our study also enables the detection of physical deterioration, a risk factor for poor health, recurrence, and mortality in patients with cancer [54]; thus, it has important clinical and research implications. In addition, identifying patients with physical deterioration and providing them with supportive programs may be useful for determining sample sizes in research studies, establishing new research designs, selecting variables or assessing the effectiveness of new approaches. Additionally, it is important to note that obtaining a reference value, such as the MCID, is necessary for a continuously growing clinical population, such as women with breast cancer. In a clinical context, the use of a treadmill provides a logistical advantage since it is often difficult to find a hallway that is free of distractions.
Severe mental disorders and vaccinations – a systematic review
Published in The World Journal of Biological Psychiatry, 2022
Nina Bonkat, Frederike T. Fellendorf, Nina Dalkner, Eva Z. Reininghaus
As vaccines are inflammatory stressors, they too could potentially lead to worsening of the mental illness (Miller et al. 2013; Slavich and Irwin 2014). Not only did a study report a greater reduction in positive affect from baseline in individuals with depression (Harper et al. 2017), but one also reported a greater decline in mood in individuals with remitted depression (Niemegeers et al. 2016). Vaccines could potentially lead to an illness relapse in remitted patients. It might be necessary to monitor patients closely to observe for a possible deterioration in their state. Only a few studies have investigated side effects in individuals with mental disorders (Allsup and Gosney 2002; De Serres et al. 2015) and none of them focussed on patients with psychotic disorders, so more research is urgently needed on this topic.