Browsing by Issue Date, starting with "2005-04"
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- Patients' recollections of experiences in the intensive care unit may affect their quality of life.Publication . GRANJA, C.; LOPES, A.; MOREIRA, S.; DIAS, C.; COSTA‐PEREIRA, A.; CARNEIRO, A.; JMIP STUDY GROUPCrit Care. 2005 Apr;9(2):R96-109. Epub 2005 Jan 31. Patients' recollections of experiences in the intensive care unit may affect their quality of life. Granja C, Lopes A, Moreira S, Dias C, Costa-Pereira A, Carneiro A; JMIP Study Group. Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristinagranja@oninet.pt Comment in: Crit Care. 2005 Apr;9(2):145-6. Abstract INTRODUCTION: We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL). METHODS: We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire. RESULTS: Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30). CONCLUSION: This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL. PMID: 15774056 [PubMed - indexed for MEDLINE]PMCID: PMC1175917Free PMC Article Images from this publication.See all images (1) Free text Figure 1Patients included in and excluded from the study. Survival and recollection questionnaire response rates.Patients' recollections of experiences in the intensive care unit may affect their quality of lifeCrit Care. 2005;9(2):R96-R109.
- The identification of multiple thrombophilic risk factors in an infant with cerebrovascular accidentPublication . NEVES, J.; COSTA, E.; BRANCA, R.; CARRILHO, I.; BARBOT, J.; BARBOT, C.We found 1 article: Rev Neurol. 2005 Apr 16-30;40(8):479-81. [The identification of multiple thrombophilic risk factors in an infant with cerebrovascular accident] [Article in Spanish] Neves J, Costa E, Branca R, Carrilho I, Barbot J, Barbot C. Servicio de Hematología, Hospital de Crianças Maria Pia, 4050-111 Porto, Portugal. Abstract INTRODUCTION: Neonatal stroke (NNS) incidence appears to be increasing over the last years. This is believed to be a consequence of diagnostic accuracy rather than a real amplification of this entity. Nowadays, NNS incidence is estimated to be 1:4000 full newborns. CASE REPORT: Child with left middle cerebral artery territory infarction in which several thromboembolic risk factors were documented both in the child (neonatal sepsis and factor V Leiden) and his mother (lupus anticoagulant, pre-eclampsy and factor V Leiden). CONCLUSIONS: This case supports the increasing evidence in recent reports that association of multiple prothrombotic risk factors (maternal and foetal) is present in NNS genesis. This way the authors agree that wide prothrombotic study may be of crucial interest in identifying subjacent thrombophilic disease, even when an exogenous risk factor is present. PMID: 15861329 [PubMed - indexed for MEDLINE]
- Deaths from ischemic disease, anthropometry and cardiac biometryPublication . LEAL, A.; OLIVEIRA, J.; AMADO, J.; GOMES, L.; MAGALHAES, T.Rev Port Cardiol. 2005 Apr;24(4):521-30. Deaths from ischemic disease, anthropometry and cardiac biometry. [Article in English, Portuguese] Leal A, Oliveira J, Amado J, Gomes L, Magalhães T. Instituto de Ciencias Biomédicas Abel Salazar-Saúde Comunitária, Porto, Portugal. antl@clix.pt Abstract INTRODUCTION: The relation between body mass index (BMI)/obesity and left ventricular hypertrophy (LVH) in ischemic heart disease (IHD) has not been completely established, based on postmortem studies. OBJECTIVE: To study necropsy data of deaths from cardiac ischemia and its relation to macroscopic data of the heart and anthropometry. METHOD: Retrospective study of necropsies conducted by the medical legal services of Porto in 2002-03, with a final diagnosis of "myocardial infarction" or "chronic ischemic heart disease" or with more than 50% obstructive coronary disease. An observation grid was compiled from the necropsy data, with emphasis on anthropometry and cardiac exam. Descriptive and inferential methods (Pearson's correlation, the chi-square test and stepwise multiple regression) were used for the statistical analysis (alpha = 0.05). RESULTS: Of the 231 selected cases, 75.3% were men, of whom 53.7% were diagnosed with myocardial infarction and 46.3% with IHD, with BMI of 26.9 +/- 5.1, body weight of 74.7 +/- 19.9 kg, left ventricular thickness of 16.9 +/- 4.7 mm, and cardiac weight of 517 +/- 163 g. Significant negative correlations (p < 0.001) were found between age, body weight (-0.33), height (-0.33), and BMI (-0.21) and positive correlations between cardiac weight, body weight (0.35), height (0.24), BMI (0.26), and LVH (0.29). Significant differences were found between genders with regard to age, weight, height and heart weight, but no differences in terms of years of education, BMI or left ventricular thickness. Stepwise regression found two predictive variables for heart weight: body weight, accounting for 12.1%, with age increasing this to 15.4%. CONCLUSION: These results seem to confirm objectively by postmortem examination that high values of BMI and body weight, left ventricular hypertrophy and cardiac weight correlate with IHD, with important gender differences to be taken into consideration. Body weight and age are major predictive variables for heart weight. These findings have important public health implications in the prevention of overweight and ischemic heart disease. PMID: 15977776 [PubMed - indexed for MEDLINE]Free Article
- Clinical variables related to propofol effect‐site concentrations at recovery of consciousness after neurosurgical proceduresPublication . NUNES, C.S.; FERREIRA, D.A.; ANTUNES, L.; AMORIM, P.J Neurosurg Anesthesiol. 2005 Apr;17(2):110-4. Clinical variables related to propofol effect-site concentrations at recovery of consciousness after neurosurgical procedures. Nunes CS, Ferreira DA, Antunes L, Amorim P. CECAV, Universidade de Trás-os-Montes de Alto Douro, Vila-Real, Portugal. ccnunes@fc.up.pt Abstract Target controlled infusion (TCI) systems and computer data acquisition software are increasingly used in anesthesia. It was hypothesized that the use of such systems might allow retrieval of information useful to anticipate the effect-site concentrations of propofol at which patients would recover from anesthesia. The goal of the study was to identify variables related to propofol effect-site concentrations at recovery of consciousness (ROC). Sixteen patients with a Glasgow of 15, ASA 1 or 2, subjected to neurosurgical procedures, received TIVA with TCI propofol and remifentanil. Data were collected every 5 seconds from Datex AS3 and Aspect A200XP (BIS). Effect-site TCI was used for propofol (initial effect target 5.0 microg/ml) and for remifentanil (initial plasma target 2.5 ng/ml). All clinical events were noted. Variables possibly related to propofol effect-site concentration at ROC were selected. Data are expressed as mean +/- SD. Effect-site propofol concentration at ROC was 1.3 +/- 0.5 microg/ml. A positive correlation was found between propofol effect-site concentration at ROC and: age (49.3 +/- 17 years) (P = 0.003); mean remifentanil dose during surgery (0.11 +/- 0.05 microg/kg/min) (P = 0.003); mean propofol dose during surgery (0.12 +/- 0.03 mg/kg/min) (P = 0.046); and remifentanil effect-site concentration at ROC (2.85 +/- 2.06 ng/ml) (P = 0.002). Propofol effect-site concentrations were not correlated with: weight, height, LBM, duration of anesthesia, minimum BIS at induction (30.4 +/- 6.8), time till minimum BIS (4.7 +/- 2.2 min), mean and median BIS during surgery (38.2 +/- 4.5 and 37.8 +/- 5.3). BIS-related variables were not useful as ROC predictors. Only drug variables and age correlated with propofol effect-site concentrations at ROC. PMID: 15840999 [PubMed - indexed for MEDLINE]