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Slater Crowder posted an update 6 months, 2 weeks ago
ity scoring in addition to other laboratory and clinical parameters.
Prior studies of rapid response team (RRT) implementation for surgical patients have demonstrated mixed results with respect to reductions in poor outcomes. The aim of this study was to identify predictors of in-hospital mortality and hospital costs among surgical inpatients requiring RRT activation.
We analyzed data prospectively collected from May 2012 to May 2016 at The Ottawa Hospital. We included patients who were at least 18 years of age, who were admitted to hospital, who received either preoperative or postoperative care, and and who required RRT activation. We created a multivariable logistic regression model to describe mortality predictors and a multivariable generalized linear model to describe cost predictors.
We included 1507 patients. The in-hospital mortality rate was 15.9%. The patient-related factors most strongly associated with mortality included an Elixhauser Comorbidity Index score of 20 or higher (odds ratio 3.60, 95% confidence interval 1.96-6.60) and care designations ent safety initiatives.The author singled out the first decade of the 20th century as the time in which the renewal of academic medicine in post-unification Italy was concluded, while the changes that would be induced by the following war had not yet started. A bibliographic research relating to this period was undertaken with the aim of investigating the number and the quality of the studies on kidneys published by Italian scientists. A total of 176 publications of Italian scientists dealing with kidney diseases or physiology was retrieved, 10.8% of which was published on foreign journals. The analysis of the topics treated shows that they were up to date and comparable with the contemporary studies across Europe. Moreover, the issues raised remained of interest throughout the following decades up to our day. Top Italian researchers were fairly cited, especially if they published on international journals. While at the time the state of other organs was mainly assessed by examining physical signs and symptoms, kidney studies required laboratory facilities. This limitation meant that kidney scholars usually belonged to well established medical faculties. From these schools, a few figures stood out among the others for the importance of their studies, both physiological and clinical in nature. The same figures also gave birth to the major Italian schools of internal medicine from which, half a century later, originated the Italian Society of Nephrology. The findings of this research support the conclusion that the basis of modern nephrology can be traced back to that decade.This article collects the personal stories of the young doctors who in the early sixties contributed to the birth and development of the Croff pavilion at the Policlinico Hospital in Milan. Inaugurated on October 19, 1964, this has been the first institute in Italy entirely devoted to patients with kidney diseases. Since its inception, it has significantly contributed to the progress of nephrology thanks to important and pioneering investigations in the main fields of our specialty, which still continue nowadays. The different stories reported here follow the chronological order in which the young doctors arrived at Croff, each story representing a personal narrative that interweaves and integrates that of others. This gives rise to a vivid many-voiced account, from which emerge not only the figures of these young doctors, but also those of patients, nurses, and laboratory technicians.Background Distal arterio-venous fistula (AVF) is considered the gold standard for vascular access in hemodialysis. The aim of this retrospective study is to report our experience on two innovative techniques, Intraoperative Transluminal Angioplasty (ITA) and Vessel Pre-Dilatation (VPD). Methods We collected data from all the consecutive patients directly admitted to our Department from January 2014 to October 2018 in order to create or repair an AVF. Early Failure (EF), Failure to Mature (FTM), Late Failure (LF), Primary and Secondary patency rate were evaluated. Results All patients underwent VPD; of the total 647 AFVs, 128 received an ITA for the presence of suboptimal vessels. 98.3% of AVFs were located on the forearm. EF occurred in 83 cases; in 67 of these a new AVF was successfully created upstream from the previous one. LF occurred in 100 cases; of these, the access was abandoned in 32 cases and we performed a new AVF upstream from the previous one in 68 cases. FTM occurred in 57 cases, 31 of which were treated with Percutaneous Transluminal Angioplasty (PTA) whilst 26 were resolved performing a new anastomosis upstream. Primary and secondary patency at 1, 2, 3 and 4 years were, respectively, 80%, 74%, 68%, 64% and 94%, 91%, 89%, 88%. By dividing patients into an ITA group and a control group, we did not find any difference in primary and secondary patency. 3-O-Acetyl-11-keto-β-boswellic Conclusions VPD and ITA could be useful to increase the incidence and the prevalence of distal AVF.In the last decades there have been important changes in the epidemiology and natural history of bacterial infection-related glomerulonephritides. Once defined as an infancy-onset acute nephritic syndrome following a streptococcal infection, and characterized by a relative benign course, infection-related glomerulonephritis nowadays also affects the adult population, particularly the elderly and the chronically ill. The infectious agents and infection sites have become more diversified, and the prognosis is burdened by a higher rate of mortality, chronic kidney disease, end-stage renal disease and acute overload complications. In this review we highlight the main clinical features of infection-related glomerulonephritis, offering an insight into its pathogenesis and the elements that allow an appropriate differential diagnosis. We also address the uncertainties around the role of immunosuppression in its therapeutic management.Chronic kidney disease is associated with an increased cardiovascular risk. Several uremic toxins are also vascular toxins and may contribute to the increase of the cardiovascular risk through the development of aortic stiffening. In this process, oxidative stress and endothelial dysfunction play an important role. Considering that aortic stiffness is a known cardiovascular risk factor and a vascular biomarker involved in the development of chronic cardiac dysfunction, and that the reduction of aortic stiffness is associated with an improved survival of patients with end-stage kidney disease, we aim at reviewing the therapeutic options to reduce aortic stiffness and potentially the cardiovascular risk.
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