RESUMO
BACKGROUND: Hospital-acquired venous thromboembolism (VTE) is one of the leading preventable causes of in-hospital mortality. However, its risk assessment in medically ill inpatients is complicated due to the patients' heterogeneity and complexity of currently available risk assessment models (RAMs). The simplified Geneva score provides simplicity but has not yet been prospectively validated. Immobility is an important predictor for VTE in RAMs, but its definition is inconsistent and based on subjective assessment by nurses or physicians. In this study, we aim to prospectively validate the simplified Geneva score and to examine the predictive performance of a novel and objective definition of in-hospital immobilization using accelerometry. METHODS AND ANALYSIS: RISE is a multicenter prospective cohort study. The goal is to recruit 1350 adult inpatients admitted for medical illness in three Swiss tertiary care hospitals. We collect data on demographics, comorbidities, VTE risk and thromboprophylaxis. Mobility from admission to discharge is objectively measured using a wrist-worn accelerometer. Participants are followed for 90 days for the occurrence of symptomatic VTE (primary outcome). Secondary outcomes are the occurrence of clinically relevant bleeding, and mortality. The evolution of autonomy in the activities of daily living, the length of stay, and the occurrence of readmission are also recorded. Time-dependent area under the curve, sensitivity, specificity, and positive and negative predictive values are calculated for each RAM (i.e. the simplified and original Geneva score, Padua, and IMPROVE score) with and without the objective mobility measures to assess their accuracy in predicting hospital-acquired VTE at 90 days. ETHICS AND EXPECTED IMPACT: The ethics committee approved the protocol and the study was registered on ClinicalTrials.gov as NCT04439383. RISE has the potential to optimize VTE risk stratification, and thus to improve the quality of care of medically hospitalized patients.
Assuntos
Tromboembolia Venosa , Atividades Cotidianas , Anticoagulantes/uso terapêutico , Hospitais , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/prevenção & controleRESUMO
Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted.
La psychothérapie diminue les rechutes de dépression lors de la réduction ou de l'arrêt des antidépresseurs. En cas d'infection respiratoire communautaire, l'antibiothérapie retardée est efficace et sûre. La réadaptation physique après une décompensation cardiaque aiguë est utile chez les patients fragiles. Un sommeil de 6 heures semble être associé à un risque plus élevé de démence chez les personnes de 50 à 70 ans. Les patients modifient le recours aux soins de santé après la cessation d'activité de leur médecin référent. La recherche de fibrillation auriculaire chez les patients de 65 ans ou plus en bonne santé n'est pas bénéfique. Les compétences médicales de lecture d'ECG diminuent en l'absence de formation régulière. Les patients hospitalisés pour un Covid-19 sont souvent impactés aux niveaux clinique, psychologique et économique.
Assuntos
Fibrilação Atrial , COVID-19 , Antidepressivos , Humanos , Medicina Interna , SARS-CoV-2RESUMO
Neuroborreliosis affects approximately 15â % of people infected with Borrelia burgdorferi. The symptoms are very varied, which can sometimes delay the diagnosis. We can diagnose a neuroborreliosis in front of a compatible clinic and laboratory examinations, in particular a lumbar puncture showing a pleocytosis, an intrathecal synthesis of antibodies against B. burgdorferi, and an increased level of chemokine CKCL13. We present the case of a patient in whom the diagnosis was delayed in connection with non-specific symptoms and we review the latest recommendations in terms of treatment of neuroborreliosis.
La neuroborréliose touche entre 10 et 15â % des personnes infectées par Borrelia burgdorferi. Les symptômes sont très variés, ce qui peut parfois retarder le diagnostic. Celui-ci est posé en présence d'une clinique compatible et des examens de laboratoire, notamment une ponction lombaire montrant une pléocytose, une synthèse intrathécale d'anticorps contre B. burgdorferi et une augmentation de la chimiokine CXCL13. Nous présentons le cas d'un patient chez qui le diagnostic a mis du temps à être posé en lien avec des symptômes peu spécifiques et revoyons les dernières recommandations en termes de traitement de la neuroborréliose.
