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07; P < .01) and an elevated total bilirubin (HR, 3.56; P = .02) were harmful. The ADI as a continuous variable did not affect survival; however, categorically, a higher ADI was protective (ADI 90-100 HR, 0.07; P = .04).
Socioeconomically disadvantaged patients had noninferior outcomes given appropriate pre-implant optimization and workup.
Socioeconomically disadvantaged patients had noninferior outcomes given appropriate pre-implant optimization and workup.
Patients admitted with cardiogenic shock (CS) have high mortality rates, readmission rates, and healthcare costs. Palliative care services (PCS) may be underused, and the association with 30-day readmission and other predictive factors is unknown. We studied the frequency, etiologies, and predictors of 30-day readmission in CS admissions with and without PCS in the United States.
Using the 2017 Nationwide Readmissions Database, we identified admissions for (1) CS, (2) CS with PCS, and (3) CS without PCS. We compared differences in outcomes and predictors of readmission using multivariable logistic regression analysis accounting for survey design. Of 133,738 CS admissions nationally in 2017, 36.3% died inpatient. Among those who survived, 8.6% used PCS and 21% were readmitted within 30 days. Difference between CS with and without PCS groups included mortality (72.8% vs 27%), readmission rate (11.6% vs 21.9%), most frequent discharge destination (50.2% skilled nursing facilities vs 36.4% home), hospitalizatpatients.
Enhanced platelet reactivity may play a role in cardiac allograft vasculopathy (CAV) progression. The use of antiplatelet agents after heart transplantation (HT) has been inconsistent and although aspirin (ASA) is often a part of the medication regimen after HT, limited evidence is available on its benefit.
CAV progression was assessed by measuring the difference in plaque volume and plaque index between the last follow-up and the baseline coronary intravascular ultrasound examination. Overall, 529 HT recipients were retrospectively analyzed (337 had ≥2 intravascular ultrasound studies). The progression in plaque volume (P = .007) and plaque index (P = .002) was significantly attenuated among patients treated with early ASA (within the first year after HT). Over a 6.7-year follow-up, all-cause mortality was lower with early ASA compared with late or no ASA use (P < .001). No cardiac deaths were observed in the early ASA group, and the risk of CAV-related graft dysfunction was significantly lower in this group (P = .03). However, the composite of all CAV-related events (cardiac death, CAV-related graft dysfunction, or coronary angioplasty) was not significantly different between the groups (P = .16).
Early ASA use after HT may delay CAV progression and decrease mortality and CAV-related graft dysfunction, but does not seem to affect overall CAV-associated events.
Early ASA use after HT may delay CAV progression and decrease mortality and CAV-related graft dysfunction, but does not seem to affect overall CAV-associated events.
The Dietary Approaches to Stop Hypertension (DASH) diet pattern has shown some promise for preventing heart failure (HF), but studies have been conflicting.
To determine whether the DASH diet pattern was associated with incident HF in a large biracial and geographically diverse population.
Among participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study of adults aged ≥45 years who were free of suspected HF at baseline in 2003-2007, the DASH diet score was derived from the baseline food frequency questionnaire. The main outcome was incident HF defined as the first adjudicated HF hospitalization or HF death through December 31, 2016. We estimated hazard ratios for the associations of DASH diet score quartiles with incident HF, and incident HF with reduced ejection fraction and HF with preserved ejection fraction using the Lunn-McNeil extension to the Cox model. We tested for several prespecified interactions, including with age. Compared with the lowest quartile, individuals in the second to fourth DASH diet score quartiles had a lower risk for incident HF after adjustment for sociodemographic and health characteristics quartile 2 hazard ratio, 0.69 (95% confidence interval [CI], 0.56-0.85); quartile 3 hazard ratio, 0.71 (95% CI, 0.58-0.87); and quartile 4 hazard ratio, 0.73 (95% CI, 0.58-0.92). When stratifying results by age, quartiles 2-4 had a lower hazard for incident HF among those age <65 years, quartiles 3-4 had a lower hazard among those age 65-74, and the quartiles had similar hazard among those age ≥75 years (P
= .003). We did not find a difference in the association of DASH diet with incident HF with reduced ejection fraction vs HF with preserved ejection fraction (P = .11).
DASH diet adherence was inversely associated with incident HF, specifically among individuals <75 years old.
DASH diet adherence was inversely associated with incident HF, specifically among individuals less then 75 years old.From donation to transplantation of hematopoietic stem cells, medullary origin, peripheral blood, placental or cord, legal provisions apply to the actors involved. Since 1994, the law on bioethics, its successive revisions and their implementing texts set the fundamental principles, rules and practical procedures to be followed.The French unrelated stem cell donors registry is an operational entity developping bone marrow donation and transplantation. Its national role is linked to that of its international counterparts. Under public law in France, it is managed by the biomedicine agency.When the only geno-identical donor is a minor child with autistic type disorders, the question of consent arises. Reflection on the decision to transplant bone marrow in this specific context.In pediatric oncohematology, a hematopoietic stem cell transplant (HSC) may be offered depending on the pathology and the therapeutic objective. The transplant generates many repercussions, in particular related to the donation and the debt, on the physical and psychological identity of the donor and the recipient, with family changes. The multidisciplinary support of the families is essential so that everyone may find his right place.A bone marrow transplant is often the only hope for a cure for some patients with blood disease. Beyond its medical aspects, it underlies psychological issues for both the recipient and the donor. The transplant brings together the issues of donation, debt, the family romance and the incorporation of a "foreign body", evoking the classic notion of chimera.The nurse coordinator of transplants is an essential function to organize and harmonize the care process for donors and recipients of haematopoietic stem cells. The missions assigned to this professional range from donor research to post-transplant follow-up of recipients.The management of an allogenic HCS raises a number of issues and challenges. The complexity of the field, the vital prognosis, exercise in a closed and protected environment, but also access to a field of knowledge whose scope and richness are constantly evolving require nurses to constantly update their knowledge and adaptation to the patient's needs and experiences.Allogeneic stem cell transplant, used for the first time in 1950s, is the older immunotherapy which can be able to cure malignant hematologic diseases. Indications are becoming larger thanks to supportive care progress and larger donor availability, in particular with haplo-identical donors. Graft versus host disease and infections remain the main complications at the origin of high morbi-mortality (treatment-related mortality of 15 to 25%). Current major issue is to limit post-allogeneic relapse, especially thanks to targeted therapies and immunotherapy.Bone marrow transplant, more recently called hematopoietic stem cell transplant (HSC), is a complex medical procedure in which a patient with or without malignant hematologic disease receives a combination of chemoradiation followed by an injection of HSC, either from the same patient (autologous transplant) or from a healthy donor (allogeneic transplant).Nursing education in Lebanon has integrated the academic world since 1979, but the profession is experiencing difficulties related to the retention of nurses at work and the lack of attraction to the profession. In this context, a study on the professional self-image was conducted among nurses working in hospitals. The results show that nurses have a positive professional self-image, but they find that their image in society is negative and only 20.4% would recommend this career to their children or their entourage.The infection protection and control team and occupational health service come together every year to promote the flu vaccine among health professionals. In 2020, the risk of the co-circulation of the flu virus and SARS-CoV-2 strengthened their case. During the last trimester, we surveyed health professionals to find out their intention with regard to the flu and covid-19 vaccines 42% said they wanted to be vaccinated against the flu, but only 23% were willing to have the covid-19 vaccine.Alcoholic chlorhexidine 2 % is recommended for the prevention of catheter infections. A retrospective study was conducted in a nutritional assistance unit in a cohort of patients with a long-term central venous route. selleck The tolerance (number of skin reactions) and efficacy (number of infections/days of catheters) of this antiseptic used in repeated care in these patients were described.This article provides historical and practical information for business resilience practitioners regarding pandemic planning, suggesting a comprehensive approach not only to help stabilise organisational response to the current novel coronavirus disease (COVID-19), but also identify economic and societal considerations for long-term pandemic planning and response. The article provides historical data regarding the impact of contagious disease, including medical and psychosocial considerations, suggesting the necessity for ongoing independent disease surveillance and a multi-disciplinary approach to ensure the effective management of business operations while supporting workers who may be displaced from their traditional work environments.Terrorist groups resident in weak states are comprised of tribal-like entities conducting numerous attacks against persons and property in developing or struggling regions of the world where socio-economic conditions and governmental controls are problematic. To better understand the environmental conditions and potential impacts that such attacks have on business interests, this paper examines terrorist attack data from 2018. The study utilises a correlative analysis of relationship strengths between predictor variables commonly associated with weak and fragile states experiencing a high volume of terrorist attacks. The study also examines the impact of terrorism on a state's economic and entrepreneurial environment.Defining resilience has remained a challenge despite decades of research across multiple disciplines. This paper proposes that resilience can be better understood when examined through the framework of communication. Resilience is proposed to have three interconnected domains (community, organisation and individual) and two dimensions (physical and social-emotional). This work focuses on the social-emotional components of enacted organisational resilience. The impact of organisational culture on sensemaking, organisational narrative and resilience strategies is explored. Communication-based interventions that organisations can make to improve resilience are identified.