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Implementation systems that support resilient performance
Published in Frances Rapport, Robyn Clay-Williams, Jeffrey Braithwaite, Implementation Science, 2022
The goal of the studies was to improve the organization’s ability to monitor and respond to patients at risk of physiological collapse. This risk is an example of one of the general forms of adaptive system breakdown, decompensation, and its countermeasure, to support anticipation (Woods and Branlat 2011). The risk of decompensation originates at the level of a patient’s physiology, which occurs when the patient’s body can no longer fully regulate critical physiological functions (e.g., cardiac, respiratory) which then begin to fail. The risk of decompensation also arises at the patient care level, where the care team needs the ability to anticipate and respond to early signs of decompensation, especially because physiological systems can deteriorate quickly. All patients in an acute care or intensive care unit are at some risk of experiencing a decompensation event. As a result, the care system should work to mitigate this risk.
Umbilical artery doppler sonography for fetal surveillance: Principles and practice
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Dev Maulik, David Mundy, Timothy Bennett
In the face of continuing deprivation, compensation gives way to decompensation. For example, growth-restricted human fetuses with abnormal UA waveforms have been shown to develop chronic hypoxia and acidosis. A critical component of fetal homeostatic response involves flow redistribution that favors perfusion of the vital organs (the brain, heart, and adrenals) at the expense of flow to muscle, viscera, skin, and other less critical tissues and organs (26). Underlying this phenomenon are the diverse changes in blood flow impedance in fetal regional circulations. Doppler velocimetry thus elucidates these circulatory changes associated with fetal compromise and allows perinatal prognostication. This constitutes the rationale for using Doppler ultrasound for fetal surveillance in complicated pregnancies.
Introduction to Clinical Surveillance
Published in John R. Zaleski, Clinical Surveillance, 2020
Examples of physiological consequences in patients experiencing respiratory decompensation include “impaired control of breathing, … impaired airway protection (e.g., inability to swallow or maintain a patent airway), … parenchymal lung disease, … increased airway resistance (i.e., work of breathing, WoB), … hydrostatic pulmonary edema, … [and] right ventricular failure” [15]. Common to the identification and early onset detection in all of these conditions are aspects of physiological monitoring achieved through the use of patient care devices (PCDs). Examples of types of data employed for monitoring of these conditions are categorized and summarized in Table 1.2. Many, if not most, of the parameters listed in Table 1.2 can be captured using various types of medical devices (i.e., physiological monitors, mechanical ventilators) both from within and from outside of the hospital environment.
Development and validation of a nomogram to predict recompensation in HBV-related cirrhosis with ascites as the single first decompensating event
Published in Scandinavian Journal of Gastroenterology, 2023
Shifei Wen, Jiajia Ruan, Jiaming Shen, Xia Wang, Guangde Yang, Juanjuan Fu, Li Li, Xiucheng Pan
Cirrhosis is the late stage in the development of chronic liver disease and is divided into compensated and decompensated stages according to whether patients suffered from complications such as ascites, gastrointestinal bleeding, or hepatic encephalopathy [1]. The prognosis of patients with compensated cirrhosis is better, with a 5-year cumulative mortality rate of 3.1%. In contrast, the median survival period for patients in the decompensated stage is only 2–4 years [2,3]. The occurrence of decompensation-related complications is an important factor affecting the prognosis of patients. Since effective control of etiology and treatment or prevention of complications following the onset of decompensation, some patients may not have decompensated events for a longer period (at least 1 year), which is considered recompensation [4]. The liver function of recompensated patients improved, the clinical status tended to be stable, the survival time without liver transplantation was prolonged, and the prognosis was significantly improved [5]. Therefore, it is of great significance to promote more and more patients to achieve recompensation as far as possible.
What do Spanish registries report about worsening events in chronic heart failure? Needs and challenges
Published in Expert Review of Cardiovascular Therapy, 2023
Juan Luis Bonilla Palomas, José Ignacio Morgado García de Polavieja, Miriam Padilla Pérez, Diego Rangel-Sousa, Antonio Castro Fernández, José López Aguilera, Carolina Ortiz Cortés, Francisco Torres Calvo
Thus, those strategies aimed at preventing decompensation are mandatory. A structured follow-up, in HF units, together with the benefits of telemedicine, as an alternative to face-to-face follow-up in some cases, allow for greater optimization of HF treatment [14,19,20]. In this context, the determination of natriuretic peptides may be very useful in the early identification of worsening HF. For example, it has been reported that even in asymptomatic patients, elevations of natriuretic peptides negatively impact on prognosis [23,24]. Furthermore, biomarker-guided management could be useful to reduce health care costs for HF treatment, as it would allow an early optimization of HF therapy [25]. On the other hand, the outpatient dose of furosemide before acute HF admission may predict long-term prognosis and should alert us about the high risk of HF hospitalization and the need for the early adjustment of HF therapy [26]. Importantly, telemedicine may have a potential impact to detect early signs of HF worsening and should be promoted in the management and follow-up of these patients in order to prevent recurrent HF hospitalizations [27].
Two-year free of complications during antiviral therapy predicts stable re-compensation in immediate-treatment HBV-related decompensated cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2023
Zhiying He, Jialing Zhou, Yu Tian, Shanshan Wu, Yameng Sun, Xiaojuan Ou, Jidong Jia, Bingqiong Wang, Xiaoning Wu, Hong You
Baseline clinical characteristics about the first decompensation in three groups are shown in Table 1. In immediate-treatment group, 64 patients (73.6%) were male, with a median age of 54.0 years. Delayed/no treatment patients were younger and male patients were less in on-treatment group (p > 0.05). Median value of HBV DNA level was 5.9 and 5.8 Log10 IU/mL in immediate-treatment and delayed/no treatment group and it was undetectable in on-treatment group (p < 0.001). Immediate-treatment patients had a higher level of ALT, AST, TBIL and lower albumin (p < 0.05). And there were 68.7% and 50.0% of CTP class B patients in immediate-treatment group and delayed/no treatment group, mainly CTP class A patients (47.8%) in on-treatment group (p = 0.010). Entecavir was the predominant treatment in three groups.