-
Zhonghua Er Ke Za Zhi = Chinese Journal... Jul 2024To explore the factors affecting the prognosis of severe pediatric acute respiratory distress syndrome (ARDS) after receiving extracorporeal membrane oxygenation (ECMO)... (Observational Study)
Observational Study
To explore the factors affecting the prognosis of severe pediatric acute respiratory distress syndrome (ARDS) after receiving extracorporeal membrane oxygenation (ECMO) support. It was a multicenter prospective observational study. A total of 95 children with severe ARDS who were treated with ECMO salvage therapy from January 2018 to December 2022 in 9 pediatric ECMO centers in China were enrolled in the study. The general data, disease severity, organ function, comprehensive treatment and prognosis were recorded, and they were divided into survival group and death group according to the outcome at discharge. test, chi-square test, multivariate Logistic regression and mixed linear model were used to analyze the relationship among baseline before ECMO treatment, some important indicators (pediatric critical scores, platelet count, albumin, fibrinogen, etc) during ECMO treatment and prognosis. Among the 95 children with severe ARDS who received ECMO, 55 (58%) were males and 40 (42%) were females, aged 36.9 (0.5, 72.0) months. Twelve children (13%) were immunodeficient. Sixty-eight (72%) children were treated with venous artery (VA) mode and 27 (28%) with venous vein (VV) mode. The discharge survival rates of overall, VA, and VV mode children were 51% (48/95), 47% (32/68), and 59% (16/27), respectively. The number of immunodeficient children in the death group was higher, and there were lower pediatric critical scores, platelet count, albumin, fibrinogen and arterial oxygen partial pressure/fraction of inspired oxygen (PaO/FiO), higher ventilator driving pressure (ΔP), oxygenaion index (OI), and longer ARDS duration before ECMO (all <0.05). There were no statistically significant differences in other indicators, including age, gender, weight, and ECMO mode among different prognostic groups (all >0.05). High ΔP, high OI, low P/F, and low albumin were high-risk factors affecting prognosis(all <0.05). After further grouping, it was found that ΔP≥25 cmHO (1 cmHO=0.098 kPa), P/F≤67 mmHg (1 mmHg=0.133 kPa) and OI≥35 were the thresholds for predicting poor prognosis (<0.05). From 24 h after ECMO, there were significant differences in ΔP, P/F and OI between the dead group and the survival group (all <0.05), and the differences gradually increased with the ECMO process. The platelet level was significant from 7 days after ECMO (<0.05) and gradually expanded. Blood lactate levels showed a significant difference between the 2 groups on before and after ECMO (<0.05) and gradually increased from 24 h after ECMO. The risk factors affecting the prognosis of severe ARDS in ECMO include high ΔP, high OI, low P/F and low albumin purification therapy before ECMO. The gradual decrease of ΔP, OI and increase of P/F from 24 h of ECMO predicted a good prognosis, while the gradual increase of lactate after ECMO application showed a poor prognosis.
Topics: Humans; Extracorporeal Membrane Oxygenation; Male; Female; Prognosis; Prospective Studies; Child, Preschool; Infant; Child; Respiratory Distress Syndrome; Survival Rate; Severity of Illness Index; China; Platelet Count; Infant, Newborn
PubMed: 38955685
DOI: 10.3760/cma.j.cn112140-20231210-00422 -
Zhonghua Er Ke Za Zhi = Chinese Journal... Jul 2024To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis....
To investigate the effects of modified endoscopic retrograde appendicitis therapy (mERAT) on the treatment of children with different severities of acute appendicitis. This study was a case-control study. A total of 586 children with acute appendicitis, who were admitted to the Pediatric Department of Second Affiliated Hospital of Air Force Medical University between January 2019 and November 2023, were selected as the research subjects. According to the severity of the disease, the patients were divided into simple appendicitis group, suppurative appendicitis group and perforated appendicitis group. The baseline data, hospitalization treatment and costs, outcomes, and recurrence in each group were analyzed, and the difference in the effectiveness of mERAT between the groups were compared by Kruskal-Wallis test and test. Among 586 children, there were 338 males and 248 females. The age at onset was 7.0 (4.6, 9.4) years. There were 475 cases of simple appendicitis, 78 cases of suppurative appendicitis, and 33 cases of perforated appendicitis. There were no significant differences in age and gender among the three groups (=0.59, =3.31, both >0.05). However, there were statistically significant differences in body temperature, white blood cell counts, neutrophil percentage, lymphocyte percentage, nausea or vomiting, right lower abdominal pain, umbilical pain, right lower abdominal tenderness, and right lower abdominal rebound pain (=7.56, 161.52, 169.11, and 169.61, =12.05, 13.82, 12.05, 7.74, 20.35, and 94.61, all <0.05). Also, the treatment time, postoperative hospital stay, total hospital stay, and cost showed statistically significant differences (4.70, 33.66, 34.99, 30.37, all <0.05). There was no significant difference in the initial treatment success rate (98.1% (466/475) 98.7% (77/78) 90.9% (30/33), =0.057). During the 30 (23, 36) months of follow-up, the recurrence rate was 7.9% (35/433) in the simple appendicitis group, 20.8% (15/72) in the suppurative appendicitis group, and 30.0% (9/30) in the perforated appendicitis group, with a statistically significant difference (=23.56, 0.001). Among the children with recurrent appendicitis, 15 cases still chose mERAT, of them 11 cases (31.2%) had simple appendicitis, 2 cases (2/15) had suppurative appendicitis, and 2 cases (2/9) had perforated appendicitis.The latest time to recurrence in the 3 groups was 32, 35 and 10 months, respectively. Treatment with mERAT has a good effect in pediatric simple appendicitis, but has a higher recurrence rate despite a better initial treatment success rate in suppurative appendicitis and perforated appendicitis.
Topics: Humans; Appendicitis; Male; Female; Child; Case-Control Studies; Treatment Outcome; Child, Preschool; Appendectomy; Acute Disease; Endoscopy; Severity of Illness Index; Recurrence; Hospitalization; Length of Stay
PubMed: 38955681
DOI: 10.3760/cma.j.cn112140-20240408-00249 -
Zhonghua Er Ke Za Zhi = Chinese Journal... Jul 2024
Topics: Humans; Neonatal Screening; Infant, Newborn; Receptors, Antigen, T-Cell; Consensus; China; Immune System Diseases
PubMed: 38955678
DOI: 10.3760/cma.j.cn112140-20240311-00171 -
Pain Management Nursing : Official... Jul 2024Peripheral intravenous catheter (PIC) implementation is among the most frequent and highly invasive nursing initiatives. PIC leads to anxiety with procedural pain,...
BACKGROUND
Peripheral intravenous catheter (PIC) implementation is among the most frequent and highly invasive nursing initiatives. PIC leads to anxiety with procedural pain, causing individuals to reject these procedures or negatively affecting the process's success.
AIM
The study was conducted to determine the effect of virtual reality glasses (VRG) on pain, anxiety, and patient satisfaction during the peripheral intravenous catheter (PIC) process in adults.
DESIGN
An experimental study.
SETTINGS
An emergency department of a university hospital.
METHODS
Individuals who were admitted to the emergency unit of the university hospital were recruited between the data collection dates. Data from individuals' "Patient Information Form," "Visual Pain Scale," "Visual Anxiety Scale," and "Visual Satisfaction Scale" were collected. "VR-Box 3D Glasses" was used as virtual reality glasses.
RESULTS
In our study, when the pain point averages with VAS were compared during the PIC process, the pain score average of the patients in the control group was 5.78 ± 1.23 visual anxiety scale 5.89 ± 1.23 and patient satisfaction scale 3.86 ± 2.48, The visual pain score average of patients in the VRG group is 4.12 ± 2.16, visual anxiety scale 3.14 ± 1.76 and visual patient satisfaction scale 7.64 ± 3.26. In short, it has been detected that the pain, anxiety, and patient satisfaction score averages of patients in the VRG group are statistically significant compared to the pain score averages of patients in the control group (p < .005). Our study unearthed a statistically significant relationship at an average level of negative direction between PIC post-treatment pain, anxiety, and patient satisfaction (r = - 0.476).
CONCLUSION
Utilization of VRG has been detected to reduce pain and anxiety felt during the PIC process in adult patients and increase process satisfaction. VRG, a non-pharmacological, non-invasive, inexpensive, and feasible nursing initiative, may be recommended for use in pain and anxiety control in patients undergoing PIC treatment.
PubMed: 38955551
DOI: 10.1016/j.pmn.2024.05.009 -
RMD Open Jul 2024To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references.
OBJECTIVES
To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references.
METHODS
Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model.
RESULTS
We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4.
CONCLUSIONS
Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.
Topics: Humans; Female; Male; Osteoarthritis; Aged; Sweden; Middle Aged; Multimorbidity; Adult; Morbidity; Incidence; Chronic Disease; Prospective Studies; Comorbidity
PubMed: 38955511
DOI: 10.1136/rmdopen-2024-004164 -
Violence and Victims Jul 2024To more effectively respond to sexual assault in the United States, some jurisdictions have created sexual assault response teams (SARTs). SARTs involve members of...
To more effectively respond to sexual assault in the United States, some jurisdictions have created sexual assault response teams (SARTs). SARTs involve members of multiple agencies tasked with responding to sexual assault within a jurisdiction, such as law enforcement, advocates, prosecutors, and sexual assault nurse examiners (SANEs). Despite hundreds of jurisdictions utilizing SARTs, and the Department of Justice establishing guidelines, SARTs vary across jurisdictions in their form and function. To clarify this, the current research outlines two studies to better understand the logistics and functioning of one SART. In Study 1, for over nearly 2 years, SART meetings were observed and notes were taken on representation of agencies, time spent on cases, and possible challenges. Overall, the SART met consistently, with representation of major stakeholders at each meeting. Stakeholder agencies remained consistent and most time spent in the meetings was on case review. In Study 2, 10 members of SART were interviewed to assess perceptions of SART. These interviews were independently qualitatively coded for both factual and thematic codes. Areas of focus included perceived logistics of the SART and expertise of members that make up an effective SART. Overall, on average, members had been part of the SART for 3.5 years, felt required to attend the meetings as part of their role, and shared that all members (i.e., law enforcement, district attorney, victim advocates, and SANEs) had expertise on differing subjects that effectively made the SART work well. Importantly, qualitative perceptions from members of the SART (Study 2) lined up with the independent observation of SART meetings (Study 1). Ultimately, the results from this body of research could delineate specific actions that a jurisdiction implementing a SART could utilize.
Topics: Humans; Sex Offenses; United States; Law Enforcement; Female; Crime Victims; Interviews as Topic; Male
PubMed: 38955473
DOI: 10.1891/VV-2021-0220 -
Violence and Victims Jun 2024The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better...
The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth ( = 16) ages 8-16 who had experienced multiple types ( = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.
Topics: Humans; Female; Male; Adolescent; Child; Stress Disorders, Post-Traumatic; Child Abuse; Qualitative Research; Gender Role; Cognitive Behavioral Therapy; Narration; Socialization; Gender Identity; Sex Factors
PubMed: 38955470
DOI: 10.1891/VV-2024-0003 -
Violence and Victims Jun 2024There is growing evidence suggesting an increased perception of control is associated with reduced psychological distress among survivors of sexual trauma. The current...
There is growing evidence suggesting an increased perception of control is associated with reduced psychological distress among survivors of sexual trauma. The current study advances the extant literature by investigating the association between depressive symptoms, sexual trauma, and an external locus of control or the perception life events are outside one's own control. To do so, we analyze data from the New Family Structures Study, a nationally representative survey of U.S. adults ages 18-39. Results from ordinary least square regression analyses suggest sexual trauma and an external locus of control are associated with significantly greater depressive symptoms and that external control exacerbates the association between sexual trauma and depression. Such findings suggest future research should investigate environmental control for sexual trauma survivors in areas such as prenatal care and the justice system.
Topics: Humans; Female; Adult; Internal-External Control; Male; Depression; Young Adult; Sexual Trauma; Adolescent; United States; Survivors; Surveys and Questionnaires
PubMed: 38955469
DOI: 10.1891/VV-2022-0060 -
Saudi Medical Journal Jul 2024The validity of the traditional nutritional assessment tools in intensive care settings might be compromised when the patient has conditions such as oedema and... (Review)
Review
Incorporating ultrasonography to the nutritional assessment process in intensive care settings to improve the prescription of enteral and parenteral nutrition: Benefits, practicality, and challenges.
The validity of the traditional nutritional assessment tools in intensive care settings might be compromised when the patient has conditions such as oedema and inflammation. Ultrasound (US) is considered a non-invasive, bedside tool that can be utilized to assess changes in muscle mass. Hence, US could guide healthcare practitioners in identifying the varying degrees of malnutrition and adjusting the nutritional prescription accordingly. This review discusses the currently available data regarding the feasibility and practicality of using US measurements in intensive care settings. Overall, the data suggest that using US as part of the standard anthropometric assessment for critically ill patients is a promising tool to track variations in muscle mass. This has the potential to enhance nutritional prescription and tailor the provision of protein and energy to critically ill patients based on their lean body mass measurements. Therefore, it is recommended to train dietitians on utilizing US for body composition measurements.
Topics: Humans; Nutrition Assessment; Ultrasonography; Enteral Nutrition; Critical Illness; Parenteral Nutrition; Critical Care; Intensive Care Units; Body Composition; Malnutrition
PubMed: 38955453
DOI: 10.15537/smj.2024.45.7.20240082 -
Saudi Medical Journal Jul 2024To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia.
OBJECTIVES
To assess the prevalence of anabolic steroid use and the level of knowledge on anabolic steroids among the male athletes in Al Madina Al Munawara, Saudi Arabia.
METHODS
A cross-sectional study was conducted on male athletes randomly selected from the private athletic centers in Al Madina Al Munawara over 5 months. Data were collected from all participants using a self-administered anonymous questionnaire with 33 questions. The questionnaire covered the socio-demographic characteristics of the participants, and their knowledge, attitudes, and use of anabolic steroids.
RESULTS
Of the 150 male athletes surveyed, 121 completed the questionnaire (response rate: 80.6%). Over half were aged between 18 and 23 years (56.2%) and were single (79.3%). Thirty-two percent reported using anabolic steroids, mainly to increase muscle mass, following coaches' advice (46.1%). Key sources included the internet (30.7%), coaches (30%), and friends (27.9%), and non-healthcare professionals. The top motivations were price, coach's/physician's advice, and availability. The perceived benefits included increased muscle mass, strength, and endurance, while the perceived adverse effects included kidney/liver damage and sexual problems.
CONCLUSION
One-third of the male athletes surveyed used anabolic steroids, influenced by accessibility and social contact, rather than healthcare guidance. This highlights the need for greater awareness of the long-term health risks, ideally through education provided by sports medicine specialists.
Topics: Humans; Male; Saudi Arabia; Athletes; Young Adult; Cross-Sectional Studies; Anabolic Agents; Adolescent; Adult; Health Knowledge, Attitudes, Practice; Prevalence; Surveys and Questionnaires; Doping in Sports; Anabolic Androgenic Steroids
PubMed: 38955450
DOI: 10.15537/smj.2024.45.7.20240244