scholarly journals Prehospital Frailty and Screening Criteria for Palliative Care Services in Critically Ill Older Adults: An Observational Cohort Study

2020 ◽  
Author(s):  
Aluko A. Hope ◽  
Oladunni M. Enilari ◽  
Elizabeth Chuang ◽  
Rahul Nair ◽  
Michelle Ng Gong
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Cohort Study ◽  
Critically Ill ◽  
Observational Cohort Study ◽  
Screening Criteria ◽  
Care Services ◽  
Palliative Care Services ◽  
Observational Cohort

scholarly journals Pharmacokinetic/Pharmacodynamic Target Attainment Based on Measured Versus Predicted Unbound Ceftriaxone Concentrations in Critically Ill Patients with Pneumonia: An Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 557
Author(s):  
Matthias Gijsen ◽  
Erwin Dreesen ◽  
Ruth Van Daele ◽  
Pieter Annaert ◽  
Yves Debaveye ◽  
...  
Keyword(s):  
Renal Function ◽  
Cohort Study ◽  
Protein Binding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Cohort Study ◽  
Target Attainment ◽  
Binding Model ◽  
Observational Cohort ◽  
The Impact

The impact of ceftriaxone pharmacokinetic alterations on protein binding and PK/PD target attainment still remains unclear. We evaluated pharmacokinetic/pharmacodynamic (PK/PD) target attainment of unbound ceftriaxone in critically ill patients with severe community-acquired pneumonia (CAP). Besides, we evaluated the accuracy of predicted vs. measured unbound ceftriaxone concentrations, and its impact on PK/PD target attainment. A prospective observational cohort study was carried out in adult patients admitted to the intensive care unit with severe CAP. Ceftriaxone 2 g q24h intermittent infusion was administered to all patients. Successful PK/PD target attainment was defined as unbound trough concentrations above 1 or 4 mg/L throughout the whole dosing interval. Acceptable overall PK/PD target attainment was defined as successful target attainment in ≥90% of all dosing intervals. Measured unbound ceftriaxone concentrations (CEFu) were compared to unbound concentrations predicted from various protein binding models. Thirty-one patients were included. The 1 mg/L and 4 mg/L targets were reached in 26/32 (81%) and 15/32 (47%) trough samples, respectively. Increased renal function was associated with the failure to attain both PK/PD targets. Unbound ceftriaxone concentrations predicted by the protein binding model developed in the present study showed acceptable bias and precision and had no major impact on PK/PD target attainment. We showed suboptimal (i.e., <90%) unbound ceftriaxone PK/PD target attainment when using a standard 2 g q24h dosing regimen in critically ill patients with severe CAP. Renal function was the major driver for the failure to attain the predefined targets, in accordance with results found in general and septic ICU patients. Interestingly, CEFu was reliably predicted from CEFt without major impact on clinical decisions regarding PK/PD target attainment. This suggests that, when carefully selecting a protein binding model, CEFu does not need to be measured. As a result, the turn-around time and cost for ceftriaxone quantification can be substantially reduced.

Peripheral muscular ultrasound as outcome assessment tool in critically ill patients on mechanical ventilation: An observational cohort study

2021 ◽  
Author(s):  
Diogo Oliveira Toledo ◽  
Branca Jardini de Freitas ◽  
Rogério Dib ◽  
Flavia Julie do Amaral Pfeilsticker ◽  
Dyaiane Marques dos Santos ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Outcome Assessment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Assessment Tool ◽  
Observational Cohort Study ◽  
Observational Cohort

Death in delirious palliative-care patients occurs irrespective of age: A prospective, observational cohort study of 229 delirious palliative-care patients

2020 ◽  
pp. 1-9
Author(s):  
Annina Seiler ◽  
David Blum ◽  
Caroline Hertler ◽  
Markus Schettle ◽  
Carl Moritz Zipser ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Observational Cohort Study ◽  
Adverse Outcomes ◽  
Prospective Observational Cohort Study ◽  
Precipitating Factors ◽  
Observational Cohort

Abstract Objectives Patients with terminal illness are at high risk of developing delirium, in particular, those with multiple predisposing and precipitating risk factors. Delirium in palliative care is largely under-researched, and few studies have systematically assessed key aspects of delirium in elderly, palliative-care patients. Methods In this prospective, observational cohort study at a tertiary care center, 229 delirious palliative-care patients stratified by age: <65 (N = 105) and ≥65 years (N = 124), were analyzed with logistic regression models to identify associations with respect to predisposing and precipitating factors. Results In 88% of the patients, the underlying diagnosis was cancer. Mortality rate and median time to death did not differ significantly between the two age groups. No inter-group differences were detected with respect to gender, care requirements, length of hospital stay, or medical costs. In patients ≥65 years, exclusively predisposing factors were relevant for delirium, including hearing impairment [odds ratio (OR) 3.64; confidence interval (CI) 1.90–6.99; P < 0.001], hypertonia (OR 3.57; CI 1.84–6.92; P < 0.001), and chronic kidney disease (OR 4.84; CI 1.19–19.72; P = 0.028). In contrast, in patients <65 years, only precipitating factors were relevant for delirium, including cerebral edema (OR 0.02; CI 0.01–0.43; P = 0.012). Significance of results The results of this study demonstrate that death in delirious palliative-care patients occurs irrespective of age. The multifactorial nature and adverse outcomes of delirium across all age in these patients require clinical recognition. Potentially reversible factors should be detected early to prevent or mitigate delirium and its poor survival outcomes.

scholarly journals Incidence and short-term consequences of delirium in critically ill patients: A prospective observational cohort study

2012 ◽  
Vol 49 (7) ◽  
pp. 775-783 ◽  
Author(s):  
Mark van den Boogaard ◽  
Lisette Schoonhoven ◽  
Johannes G. van der Hoeven ◽  
Theo van Achterberg ◽  
Peter Pickkers
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Short Term ◽  
Observational Cohort

scholarly journals Inequalities in primary care management of knee pain and disability in older adults: an observational cohort study

Rheumatology ◽  
2011 ◽  
Vol 50 (10) ◽  
pp. 1869-1878 ◽  
Author(s):  
C. Jinks ◽  
K. Vohora ◽  
J. Young ◽  
J. Handy ◽  
M. Porcheret ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Cohort Study ◽  
Knee Pain ◽  
Care Management ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
Primary Care Management
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