RESUMO
PURPOSE: Predictive models allow clinicians to identify higher- and lower-risk patients and make targeted treatment decisions. Microalbuminuria (MA) is a condition whose presence is understood to be an early marker for cardiovascular disease. The aims of this study were to develop a patient data-driven predictive model and a risk-score assessment to improve the identification of MA. METHODS: The 2007-2008 National Health and Nutrition Examination Survey (NHANES) was utilized to create a predictive model. The dataset was split into thirds; one-third was used to develop the model, while the other two-thirds were utilized for internal validation. The 2012-2013 NHANES was used as an external validation database. Multivariate logistic regression was performed to create the model. Performance was evaluated using three criteria: (1) receiver operating characteristic curves; (2) pseudo-R (2) values; and (3) goodness of fit (Hosmer-Lemeshow). The model was then used to develop a risk-score chart. RESULTS: A model was developed using variables for which there was a significant relationship. Variables included were systolic blood pressure, fasting glucose, C-reactive protein, blood urea nitrogen, and alcohol consumption. The model performed well, and no significant differences were observed when utilized in the validation datasets. A risk score was developed, and the probability of developing MA for each score was calculated. CONCLUSION: The predictive model provides new evidence about variables related with MA and may be used by clinicians to identify at-risk patients and to tailor treatment. The risk score developed may allow clinicians to measure a patient's MA risk.
Assuntos
Albuminúria/diagnóstico , Biomarcadores/análise , Modelos Estatísticos , Inquéritos Nutricionais/métodos , Medição de Risco/métodos , Adulto , Albuminúria/sangue , Albuminúria/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
PURPOSE: The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety. METHODS: We searched the electronic databases of PubMed, CINAHL, Medline (Ovid), and The Cochrane Library for a period spanning 2000-2011. Articles used in this review included randomized and nonrandomized clinical trials, prospective and retrospective analyses, and case series in peer-reviewed journals. Sackett's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported. RESULTS: Fifteen studies met inclusion criteria and were reviewed. According to Sackett's Levels of Evidence, 9 studies were level 4 evidence, one study was level 3, 4 studies were level 2, and one study was level one evidence. Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories. CONCLUSION: A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit. However, literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes.
RESUMO
A pharmacy prescription database was used to identify patients at high risk for drug-related problems. Of the 1054 patients in the study, 687 had a diagnosis of hypertension. The utilization of antihypertensive medications was captured at three periods over 24 months (12 months before enrollment, at enrollment, and 12 months after enrollment). The diagnosis of hypertension and coexisting diseases were identified at enrollment. There were 238 (34.6%) with diabetes, 333 (48.5%) with coronary artery disease, 64 (9.3%) with congestive heart failure, and 244 (35.5%) with none of these coexisting conditions. At Period 3, 44.7% of patients without coexisting diseases received calcium channel blockers, followed closely by diuretics (41.4%). Calcium channel blockers were used significantly more frequently than any other drug category for these patients (p less than 0.05). For patients with hypertension and diabetes, ACE inhibitors were used by 62%, and this was significantly more frequently than any other category (p less than 0.03). Diuretics (52.1%) were utilized significantly more frequently than calcium channel blockers (42.9%) (p less than 0.043). For patients with hypertension and congestive heart failure, diuretics were utilized significantly more than any other category (70.3%, p less than 0.03), and ACE inhibitors were utilized significantly more often than any other category except diuretics (68.8%, p less than 0.0001). This study examined antihypertensive utilization in specific patients (rather than as a function of total drugs), making the results different from those of previous reports. This study demonstrates better adherence to recommended guidelines than previous studies have suggested. While Beta blockers and diuretics were utilized frequently in these patients, statistics suggest that there is still room for improvement in the utilization of these important drugs. This paper describes the utilization of antihypertensive medications in nine Veterans Affairs Medical Centers. (c)2000 by Le Jacq Communications, Inc.