This brief report provides some data on the status of the problem of systemic inflammation in humans. The situation with understanding the causes of systemic inflammation and treatment of this disease progressed slowly. Our group has put forward a medical hypothesis, confirmed by some medical supervision, which consists in the problem of functional disorders of arteriovenous anastomoses.
Background: Despite guideline-driven pharmacological therapies and careful transitional care, the rates of preventable hospital re-admission of heart failure patients and associated costs remain unacceptably high in the SNF populations. Transfer to SNF is one strategy to limit hospitalizations. As such, 25% of patients are still symptomatic at time of discharge.
Purpose: The objective of this study is to identify patient factors affecting re-admissions of HF patients residing in SNF within 30-days. Methods: A retrospective electronic chart review was completed on patients >65 years with HF who were admitted into large medical center between 2012 and 2014. Descriptive statistics and univariate analyses using the chi-square test or Fisher’s exact test for categorical variables and the Mann-Whitney test for continuous data was used to compare patients readmitted within 30 days vs. those who were not readmitted within 30 days. Significant factors associated with readmission in the univariate analysis (p<0.10) were included for a multivariate logistic regression model. A receiver operating characteristic (ROC) curve was constructed to look at the final model’s ability to predict the outcome. A numerical measure of the accuracy of the model was obtained from the area under the curve (AUC), where an area of 1.0 signifies near perfect accuracy. The analysis of LOS was accomplished by applying standard methods of survival analysis, i.e., computing the Kaplan-Meier product limit curves, where the data were stratified by readmission within 30 days (Yes vs. No). No data were considered ‘censored’. The groups were compared using the log-rank test. The median rates for each group were obtained from the Kaplan-Meier/Product-Limit Estimates and their corresponding 95% confidence intervals were computed, using Greenwood’s formula to calculate the standard error. Unless otherwise specified, a result was considered statistically significant at the p<0.05 level of significance.
Results: Fifteen variables: creatinine, weight difference, CKD, Angina, Arrhythmia, VHD, Tobacco, ADL, independent in bathing, independent in the toilet, S3 Heart sounds present, HJR, AF, Nitrates, and Hydralazine, were identified for the multivariate logistic regression as potential risk factors associated with “readmission within 30 days”. Based on 23 readmissions within 30 days, our final model included only 2 predictor variables. Creatinine and ADLs were included in the final model as this subset of predictors was found to be the best for prediction of “readmission within 30 days”. Creatinine (p<0.0087) and ADLs (p<0.0077) were both significantly associated with readmission within 30 days in the final logistic regression model. Every 1-unit increase in creatinine is associated with an 87% increase in the odds of being readmitted within 30 days (OR = 1.87). Those patients who require assistance with ADLs are over 9 times more likely to be readmitted within 30 days (OR=9.25) as compared to patients who are independent.
Ganesh N. Sharma
Background: The nonsurgical treatment of arteries narrowed by atherosclerosis was introduced in 1964, when Dotter and Judkin performed transluminal angioplasty of femoral artery stenoses. In 1970, Gruntzig modified the dilation catheter to allow its use in coronary arteries dilation . Subsequently, In 1977 he performed the first Percutaneous Transluminal Coronary Angioplasty (PTCA) in a patient. Since onward, PTCA has been used in many patients with stable angina, unstable angina or acute myocardial infarction. Its use was initially limited to the treatment of discrete stenoses in proximal segment of a coronary artery, but improvements in equipments and techniques have lead its use in patients with stenoses, that are more complex or located in distal arterial segments and in patients relatively at high risk for complications. Despite the wider application of PTCA, the success rate remained high. Over the past decade, the number of procedure performed has steadily increased, with over 300,000 performed in united state in 1990.
Biocore Publishing Group
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