Frequency Of Deterioration Research Articles

Влияние иммуномодулирующей терапии на течение острых респираторных инфекций вирусной этиологии: метаанализ клинических исследований эффективности и безопасности препарата Эргоферон в лечении гриппа и других острых респираторных вирусных инфекций

Objective. To evaluate the efficacy and safety of Ergoferon in children and adults with acute respiratory viral infections (ARVIs). Material and methods. We have analyzed the results of 10 randomized controlled trials involving 1732 patients. The outcome measures included duration of fever, disease severity, frequency of deteriorations, number of adverse events (AEs), and assessment of drug interaction. We have conducted statistical analysis of pooled data and meta-analysis using logistic regression. Results. Patients receiving Ergoferon were 1.5 times more likely to have shorter period of fever than those receiving placebo (ОR = 1.499, р = 0.0002). Patients in the Ergoferon group had milder ARVI and influenza than patients in the placebo group (according to the AUC analysis: 32.83 ± 18.12 vs 36.94 ± 19.08 units in the placebo group, p = 0.0083). The frequency of deterioration in the Ergoferon group was 7 times lower than that in the placebo group (0.6% vs 4.4% of cases). Treatment safety was confirmed by fewer patients having AEs in the experimental group (0.6% vs 10.8%, p = 0.0006.) and no drug interactions. Conclusion. Our findings suggest that Ergoferon significantly reduced duration of fever in patients with ARVI and influenza compared to placebo. Ergoferon alleviated the disease and reduced the incidence of bacterial complications. Moreover, this drug demonstrated good tolerability and compatibility with other drugs. Key words: ARVI, influenza, meta-analysis, ARVI treatment, influenza treatment, Ergoferon

Resource Allocation: Stable Patients Remain Stable 12-24h Post-tPA.

Stroke patients are currently monitored for neurological deterioration for 24h following treatment with intravenous tissue plasminogen activator (IV tPA) or mechanical thrombectomy. This requires low nursing ratios and an intensive-care-like setting. As the half-life of IV tPA is short, many patients may not require such prolonged intensive monitoring and could be downgraded much earlier. We evaluate the frequency of neurological deterioration in the 0-12 and 12-24h post-treatment windows. Patients presenting with acute ischemic stroke treated with IV tPA and/or thrombectomy at our institution from 2016-2018 were prospectively followed per protocol for 24h post-therapy (examinations every 15min for 2h, every 30min for 6h, and hourly thereafter). Neurological deteriorations were recorded along with interventions and complications. Frequency of deterioration within the 0-12 and 12-24h post-treatment windows was determined, along with factors associated with decline at each time point. A total of 172 patients were treated (IV:135, IA:65, both:30). Thirty-six (21%) experienced a documented neurologic deterioration [8 due to intracerebral hemorrhage (4.7%)]. Five patients deteriorated in the 12-24h window; all but one had experienced earlier examination changes. Elevated NIHSS was associated with a higher likelihood of deterioration overall. Early fluctuation was associated with decline after 12h. New onset of neurologic deterioration is rare 12-24h after treatment of acute stroke. Stable patients with low NIHSS scores and no ICU needs may not require intensive monitoring greater than 12h post-treatment.

The Effect of Cartilage Lesion in the Lateral Compartment of the Knee on the Surgical Outcome of Medial Open-Wedge High Tibial Osteotomy

The aim of this study was to identify the effect of cartilage lesion in the lateral compartment of the knee on the surgical outcome of medial open-wedge high tibial osteotomy (MOWHTO). A total of 172 consecutive patients who underwent MOWHTO were evaluated retrospectively. Among the patients who underwent second-look arthroscopic assessment, 30 patients with lateral compartment cartilage lesion (group 1: ≥ grade 2 cartilage lesion according to the International Cartilage Repair Society [ICRS] grading system) and 64 patients with normal or near-normal lateral compartment cartilage (group 2: grade 0 or 1 cartilage lesion according to the ICRS grading system) were included in the analysis. Each patient was evaluated for the following variables: clinical scores, radiographic osteoarthritis grade, and comparative measurement under arthroscopy. All clinical scores were similar between the two groups preoperatively and at the time of second-look operation. Group 1 showed a significantly higher osteoarthritis grade in the lateral compartment of the knee on the 30 degree flexed posteroanterior view according to the International Knee Documentation Committee grading system preoperatively (p = 0.005) and at the time of second-look operation (p = 0.002). In regard to the comparative measurement under arthroscopy, the size of cartilage lesion on the medial compartment decreased by time in both groups (p = 0.000), whereas the size of cartilage lesion on the lateral compartment increased by time in both groups (p = 0.004). However, the degree of change in the cartilage lesion size in each compartment of the knee over time did not significantly differ between the two groups. Regarding the cartilage lesion grade in the lateral compartment, there was no statistically significant difference in the frequency of deterioration between the two groups. As a result, the presence of cartilage lesion of ICRS grade 2 or 3 in the lateral compartment of the knee, either subtle or not detected during the preoperative evaluation, would not affect the surgical outcome of MOWHTO. This is a Level IV, therapeutic case series study.

How can the health situation and well-being of staff at German schools for the severely handicapped be improved?

The aim of the study was to describe measures suggested by staff at German schools for the severely handicapped regarding possibilities to improve their health situation and well-being at work. We further wanted to analyze whether sociodemographic, occupation-related, and health-related characteristics influence the type of measures proposed. The cross-sectional study was carried out between August 2010 and August 2012 at 13 schools for the handicapped focusing on motoric and/or holistic development of severely handicapped pupils. Data of teachers and educational staff were surveyed using written questionnaires. The analysis is based on free-text answers regarding the question: "What specific occupation-related measures would lead to an improvement of your well-being or health situation at the workplace?" A total of 395 persons (response proportion: 59.7 %) with a mean age of 45 years and predominantly female (86.8 %) participated in our survey. A total of 205 persons answered the study question providing 456 improvement suggestions, which were classified into 6 main and 13 subcategories. The main categories were professional education and supervision, organization of working tasks and time, work safety and work equipment, social aspects of work, human resources and contractual framework, and other. Measures proposed were influenced by gender, burden by nursing activities, teaching, and administrative tasks, and frequency of deterioration in working atmosphere. Proposed measures raise awareness for job-related health stressors and are a starting point to improve working conditions at these schools. Since suggestions vary widely by school and composition of staff, individual priorities have to be set and discussed with the school management.

Deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project.

The aim of this study was to investigate the frequency, possible predictive factors, and prognosis of deteriorating ischemic stroke in 4 clinical categories according to the classification of the Oxfordshire Community Stroke Project (OCSP). A total of 350 patients with first-ever ischemic stroke who presented within 24 hours of onset were enrolled. Based on the OCSP criteria, cerebral infarctions were divided into the following 4 clinical categories: total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacunar infarcts (LACI), and posterior circulation infarcts (POCI). Clinical deterioration was defined as a decrease of >/=1 points in the Canadian Neurological Scale (CNS) (in TACI, PACI, and LACI) or Rankin Scale (RS) (in POCI) during 7 days from the onset. In each clinical category, deteriorating (D) and nondeteriorating (ND) patients were compared in terms of their background characteristics, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization. The acute-phase mortality and functional outcome were also compared. The subjects comprised 86 patients (24.6%) with TACI, 63 (18.0%) with PACI, 141 (40.3%) with LACI, and 60 (17.1%) with POCI. Overall, 90 patients (25.7%) deteriorated. The frequency was very high in TACI (41.9%), followed by LACI (26.2%) and POCI (21.7%), whereas it was very low in PACI (6. 3%). There were some clinical variables that differed significantly between D and ND groups. In the patients with TACI, early abnormalities of the cranial CT and significant stenoses in corresponding arteries were more frequent in the D than the ND group. In those with LACI, the CNS and hematocrit were lower in the D than the ND group. In those with POCI, cerebral atrophy was more severe and significant stenoses in vertebrobasilar arteries were more frequent in the D than ND group. The mortality of the D groups of patients with TACI and POCI exceeded 35%, and the functional outcome was worse in the D group than in the ND group of patients with TACI, LACI, and POCI. The frequency of deterioration in acute ischemic stroke significantly differed among the OCSP subgroups, and deterioration worsened the prognosis. There were some factors that could predict deterioration: early CT findings in TACI, large-artery atherosclerosis in TACI and POCI, and stroke severity in LACI. Further research to find sophisticated radiological and chemical markers appears to be needed.

A simple method to quantify the changes in activities of daily living of long-stay nursing home populations.

This report describes a simple method to quantify changes in the activities of daily living (ADLs) over a 6-month time period in long-stay VA nursing home populations. In these institutions, each resident receives a score of one to five every 6 months describing the degree of dependence in eating, mobility, transfer and toileting ("patient assessment instrument" or PAI). From these data, quantitative indicators can be calculated for the studied population: the average score for each ADL at the beginning and end of the period, and the average 6-month change in this score; the proportions of all residents whose ADL score improved, remained unchanged or worsened; the proportion of initially independent residents whose ADL score worsened, and the proportion of initially dependent residents whose score improved. The method was applied in two VA nursing homes (A and B). The profiles of ADL outcomes in the two nursing homes differed in several respects. For example, in nursing home A, 80% or more of the population either remained unchanged or improved in ADLs and only 2 to 18% deteriorated. In nursing home B, on the other hand, only 50 to 60% of the population remained unchanged or improved and 36 to 50% deteriorated. For the initially independent residents, the frequency of deterioration of ADLs in nursing home B was several times greater than that in nursing home A. The described method of quantifying ADL outcomes could readily be applied to the PAI data that are available in all VA nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of ipriflavone on bone mineral density of lumbar spine of aged women

Aged women with osteoporosis were followed for 6 months with or without ipriflavone (IP) 600 mg/day, and lumbar bone mineral density (BMD) and bone mineral content (BMC) were evaluated by dual-photon absorptiometry. Although a significant reduction of lumbar BMD was observed in the control group at the end of the experiment, the group treated with IP showed insignificant change. The frequency of deterioration was lower in the IP group compared to the control group. Additionally, the IP effect was more apparent in patients with lower calcitonin and higher bone gla-protein (BGP) levels. These results suggest that IP effectively maintains BMD and BMC of lumbar bone among aged women with osteoporosis, and its activity may be enhanced in patients with low calcitonin and high BGP levels.

高令者に発症した習慣性肩関節脱臼の経験

The frequency of deterioration toward Recurrent dislocation of the shoulder is approximately 20%. Recurrent dislocation is likely to occur in the patients with joint laxity and especially in youth who had unproperly short length of immobilization, however, as for the aged, recurrent dislocation is rarely seen.The research is performed this time on the cases of over 50-year-old to find the relationships between traumatic dislocation and recurrent dislocation of the shoulder. The items of research are as follows; condition of injury, length of immobilization, the number of times of dislocation, joint laxity, Hill-Sacks lesion, and Bankart lesion. As the results, the cause of recurrence in our five cases seems to be by Hill-Sachs lesion rather than joint laxity.

EFFECT OF 1 YEAR OF NEAR-NORMAL BLOOD GLUCOSE LEVELS ON RETINOPATHY IN INSULIN-DEPENDENT DIABETICS

30 insulin-dependent diabetic patients with background retinopathy were randomised to conventional treatment (UCT) or treatment with continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 1 year with fortnightly seven-sample home blood glucose measurements and retinal examinations every 6 months. Mean blood glucose and stable haemoglobin A 1c during months 3-12 were significantly lower in the CSII than the UCT group. Retinal morphology deteriorated during the year with no significant differences between UCT and CSII groups. The frequency of deterioration was highest in the CSII group, especially among the 10 patients with best glycaemic control, Proliferative retinopathy developed in 3 patients—2 of these were CSII treated. Retinal function (oscillatory potential, macular recovery time, and posterior vitreous fluorophotometry) improved significantly with CSII treatment and deteriorated significantly with UCT. Changes in retinal function were most pronounced in patients with the best and the poorest regulated glycaemic control.

Multidisciplinary studies of illness in aged persons: III. Prognostic Indices in Fracture of the Hip

In continuing studies at The Benjamin Rose Hospital, data were accumulated concerning the course of chronic illnesses. This report deals with patients who were admitted with fracture of the hip. Certain nursing, physical, and psychologic characteristics were prognostically related to mortality and to deterioration in activities of daily living, in walking, and in nature of residence. The significance of the relationships is discussed. Deterioration in activities of daily living and in walking increased in frequency with increasing age, and a relatively large proportion of the youngest study patients showed deterioration in activities of daily living. Thirty per cent of surviving study patients 50 to 79 years old were at deteriorated levels in activities of daily living 1 year after the occurrence of the fracture, and 68 per cent of those 80 years or older were at deteriorated levels. Among surviving patients at 1 year after fracture, all but 1 (97 per cent) in the 60 to 79 years of age group were walking independently, while more than 40 per cent of those older than 79 were not. The mortality rate was 14 to 18 per cent at 1 year in patients aged 80 or more. Patients who required relatively more nursing aid during the ninth and tenth weeks after fracture had a higher mortality rate and more frequent deteriorations in activities of daily living and in walking. Mortality was 27 per cent at 1 year in the more dependent group. At both 6 months and 1 year after fracture, the proportions of deteriorations were greater in patients with congestive heart failure or with recent or remote myocardial infarction than in patients without any of these abnormalities; however, the differences were not statistically significant. At 1 year, the proportions of deterioration in the cardiac group were 67 per cent in activities of daily living, 40 per cent in walking, and 20 per cent in residence. The mortality rate reached a maximum of 21 per cent at 1 year in the cardiac group. There was a trend toward more frequent deterioration in activities of daily living in patients with lower intelligence quotients as determined by the Wechsler Adult Intelligence Scale. Of interest were the high mortality rate and frequent deteriorations among the few patients in whom testing was incomplete because they were psychotic or aggressively hostile in refusing testing. The frequency of deterioration in activities of daily living was greater in patients who had been disabled prior to fracture than in those who had not, and such prior disability was more common in the youngest and oldest patients. The presence of prior disability in the youngest group was, furthermore, closely related to the presence of rheumatoid arthritis or prior stroke. Continuing efforts are being made to define other primary disabilities associated with fracture of the hip as a preliminary step toward defining groups of aged persons with increased susceptibility to this fracture. In such groups, it might be possible to initiate mechanical or educational measures that would decrease the number of fractures and hence the number of instances of chronic mobility limitation in the United States.