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1.
Hualiang Lin Yonghui Zhang Yanjun Xu Tao Liu Jianpeng Xiao Yuan Luo Xiaojun Xu Yanhui He Wenjun Ma 《PloS one》2013,8(7)
Objective
The current study aimed to examine the effects of daily change of the Shenzhen Stock Exchange Index on cardiovascular mortality in Guangzhou and Taishan, China.Methods
Daily mortality and stock performance data during 2006–2010 were collected to construct the time series for the two cities. A distributed lag non-linear model was utilized to examine the effect of daily stock index changes on cardiovascular mortality after controlling for potential confounding factors.Results
We observed a delayed non-linear effect of the stock index change on cardiovascular mortality: both rising and declining of the stock index were associated with increased cardiovascular deaths. In Guangzhou, the 15–25 lag days cumulative relative risk of an 800 index drop was 2.08 (95% CI: 1.38–3.14), and 2.38 (95% CI: 1.31–4.31) for an 800 stock index increase on the cardiovascular mortality, respectively. In Taishan, the cumulative relative risk over 15–25 days lag was 1.65 (95% CI: 1.13–2.42) for an 800 index drop and 2.08 (95% CI: 1.26–3.42) for an 800 index rising, respectively.Conclusions
Large ups and downs in daily stock index might be important predictor of cardiovascular mortality. 相似文献2.
Background
Cardiovascular diseases are the leading causes of death worldwide, especially for developed countries. Elevated mortality from cardiovascular diseases has been shown related to extreme temperature. We thus assessed the risk of mortality from cerebrovascular diseases, heart diseases, and ischemic heart disease (IHD) in relation to temperature profiles in four subtropical metropolitans (Taipei, Taichung, Tainan, and Kaohsiung) from 1994 to 2007 in Taiwan.Methods
Distributed lag non-linear models were applied to estimate the cumulative relative risks (RRs) with confidence intervals of cause-specific mortality associated with daily temperature from lag 0 to 20 days, and specific effect of extreme temperature episodes with PM10, NOx, and O3, and other potential confounders controlled. Estimates for cause-specific mortalities were then pooled by random-effect meta-analysis.Results
Comparing to centered temperature at 27°C, the cumulative 4-day (lag 0 to 3) risk of mortality was significantly elevated at 31°C for cerebrovascular diseases (RR = 1.14; 95% CI: 1.00, 1.31) and heart diseases (RR = 1.22; 95% CI: 1.02, 1.46) , but not for IHD (RR = 1.09; 95% CI: 0.99, 1.21). To the other extreme, at 15°C, the cumulative 21-day (lag 0 to 20) risk of mortality were also remarkably increased for cerebrovascular diseases, heart diseases, and IHD (RRs = 1.48 with 95% CI: 1.04, 2.12, 2.04 with 95% CI: 1.61, 2.58, and 1.62 with 95% CI: 1.30, 2.01, respectively). Mortality risks for cardiovascular diseases were generally highest on the present day (lag 0) of extreme heat. No particular finding was detected on prolonged extreme temperature event by pooling estimations for cause-specific mortality.Conclusions
Low temperature was associated with greater risk of mortality from cardiovascular diseases in comparison with that of high temperature. Adverse effects of extreme temperatures are acute at the beginning of exposure. 相似文献3.
Background
The river Göta Älv is a source of freshwater for 0.7 million swedes. The river is subject to contamination from sewer systems discharge and runoff from agricultural lands. Climate models projects an increase in precipitation and heavy rainfall in this region. This study aimed to determine how daily rainfall causes variation in indicators of pathogen loads, to increase knowledge of variations in river water quality and discuss implications for risk management.Methods
Data covering 7 years of daily monitoring of river water turbidity and concentrations of E. coli, Clostridium and coliforms were obtained, and their short-term variations in relation with precipitation were analyzed with time series regression and non-linear distributed lag models. We studied how precipitation effects varied with season and compared different weather stations for predictive ability.Results
Generally, the lowest raw water quality occurs 2 days after rainfall, with poor raw water quality continuing for several more days. A rainfall event of >15 mm/24-h (local 95 percentile) was associated with a three-fold higher concentration of E. coli and 30% higher turbidity levels (lag 2). Rainfall was associated with exponential increases in concentrations of indicator bacteria while the effect on turbidity attenuated with very heavy rainfall. Clear associations were also observed between consecutive days of wet weather and decreased water quality. The precipitation effect on increased levels of indicator bacteria was significant in all seasons.Conclusions
Rainfall elevates microbial risks year-round in this river and freshwater source and acts as the main driver of varying water quality. Heavy rainfall appears to be a better predictor of fecal pollution than water turbidity. An increase of wet weather and extreme events with climate change will lower river water quality even more, indicating greater challenges for drinking water producers, and suggesting better control of sources of pollution. 相似文献4.
Hualiang Lin Yonghui Zhang Yanjun Xu Xiaojun Xu Tao Liu Yuan Luo Jianpeng Xiao Wei Wu Wenjun Ma 《PloS one》2013,8(6)
Background
Many studies have shown that high temperatures or heat waves were associated with mortality and morbidity. However, few studies have examined whether temperature changes between neighboring days have any significant impact on human health.Method
A distributed lag non-linear model was employed to investigate the effect of temperature changes on mortality in summer during 2006–2010 in two subtropical Chinese cities. The temperature change was defined as the difference of the current day’s and the previous day’s mean temperature.Results
We found non-linear effects of temperature changes between neighboring days in summer on mortality in both cities. Temperature increase was associated with increased mortality from non-accidental diseases and cardiovascular diseases, while temperature decrease had a protective effect on non-accidental mortality and cardiovascular mortality in both cities. Significant association between temperature changes and respiratory mortality was only found in Guangzhou.Conclusion
This study suggests that temperature changes between neighboring days might be an alternative temperature indicator for studying temperature-mortality relationship. 相似文献5.
Background
This study estimated the effects of ambient temperature and relative humidity on hospital admissions for ischemic stroke during 1990–2009 in Jinan, China.Methods
To account for possible delayed effects and harvesting effect, we examined the impact of meteorological factors up to 30 days before each admission using a distributed lag non-linear model; we controlled for season, long-term trend, day of week and public holidays in the analysis. Stratified analyses were also done for summer and winter.Results
A total of 1,908 ischemic stroke hospital admissions were observed between 1990 and 2009. We found a strong non-linear acute effect of daily temperatures on ischemic stroke hospital admission. With the mean temperature 15°C as the reference, the relative risk (RR) was 1.43 (95% confidence interval (CI): 1.10–1.85) for 0°C daily temperature on the same day, and 0.43 (95% CI: 0.31–0.59) for 30°C daily temperature on the same day, respectively. The effect of ambient temperature was similar in summer and winter. No significant association was observed between relative humidity and ischemic stroke hospitalization.Conclusions
Low temperature might be a risk factor for ischemic stroke, and high temperature might be protective factor of ischemic stroke occurrence in Jinan, China. 相似文献6.
Pierachille Santus Antonio Russo Enzo Madonini Luigi Allegra Francesco Blasi Stefano Centanni Antonio Miadonna Gianfranco Schiraldi Sandro Amaducci 《Respiratory research》2012,13(1):95
Background
Environmental pollution is a known risk factor for multiple diseases and furthermore increases rate of hospitalisations. We investigated the correlation between emergency room admissions (ERAs) of the general population for respiratory diseases and the environmental pollutant levels in Milan, a metropolis in northern Italy.Methods
We collected data from 45770 ERAs for respiratory diseases. A time-stratified case-crossover design was used to investigate the association between air pollution levels and ERAs for acute respiratory conditions. The effects of air pollutants were investigated at lag 0 to lag 5, lag 0–2 and lag 3–5 in both single and multi-pollutant models, adjusted for daily weather variables.Results
An increase in ozone (O3) levels at lag 3–5 was associated with a 78% increase in the number of ERAs for asthma, especially during the warm season. Exposure to carbon monoxide (CO) proved to be a risk factor for pneumonia at lag 0–2 and in the warm season increased the risk of ERA by 66%. A significant association was found between ERAs for COPD exacerbation and levels of sulphur dioxide (SO2), CO, nitrate dioxide (NO2), and particulate matter (PM10 and PM2.5). The multipollutant model that includes all pollutants showed a significant association between CO (26%) and ERA for upper respiratory tract diseases at lag 0–2. For chronic obstructive pulmonary disease (COPD) exacerbations, only CO (OR 1.19) showed a significant association.Conclusions
Exposure to environmental pollution, even at typical low levels, can increase the risk of ERA for acute respiratory diseases and exacerbation of obstructive lung diseases in the general population. 相似文献7.
Water stress-induced xylem hydraulic failure is a causal factor of tree mortality in beech and poplar 总被引:1,自引:0,他引:1
Têtè Sévérien Barigah Olivia Charrier Marie Douris Marc Bonhomme Stéphane Herbette Thierry Améglio Régis Fichot Frank Brignolas Hervé Cochard 《Annals of botany》2013,112(7):1431-1437
Background and Aims
Extreme water stress episodes induce tree mortality, but the physiological mechanisms causing tree death are still poorly understood. This study tests the hypothesis that a potted tree''s ability to survive extreme monotonic water stress is determined by the cavitation resistance of its xylem tissue.Methods
Two species were selected with contrasting cavitation resistance (beech and poplar), and potted juvenile trees were exposed to a range of water stresses, causing up to 100 % plant death.Key Results
The lethal dose of water stress, defined as the xylem pressure inducing 50 % mortality, differed sharply across species (1·75 and 4·5 MPa in poplar and beech, respectively). However, the relationships between tree mortality and the degree of cavitation in the stems were similar, with mortality occurring suddenly when >90 % cavitation had occurred.Conclusions
Overall, the results suggest that cavitation resistance is a causal factor of tree mortality under extreme drought conditions. 相似文献8.
Background
A seasonality of low birth weight (LBW) and preterm birth (PTB) has been described for most regions and there is evidence that this pattern is caused by ambient outdoor temperature. However, the association as such, the direction of effect and the critical time of exposure remain controversial.Methods
Logistic, time-series regression was performed on nearly 300,000 births from two German states to study the association between season and daily mean temperature and changes in daily proportions of term LBW (tLBW) or PTB. Analyses were adjusted for time-varying factors. Temperature exposures were examined during different periods of pregnancy.Results
Weak evidence for an association between season of conception, season of birth or ambient outdoor temperature and tLBW or PTB was found. Results of analyses of temperature were not consistent between the two states. Different sources of bias which would have artificially led to stronger findings were detected and are described.Conclusions
No clear evidence for an association between season of conception, season of birth or temperature and tLBW or PTB was found. In the study of pregnancy outcome different sources of bias can be identified which can potentially explain heterogeneous findings of the past. 相似文献9.
Lauren B. Carrington M. Veronica Armijos Louis Lambrechts Thomas W. Scott 《PLoS neglected tropical diseases》2013,7(4)
Background
Environmental factors such as temperature can alter mosquito vector competence for arboviruses. Results from recent studies indicate that daily fluctuations around an intermediate mean temperature (26°C) reduce vector competence of Aedes aeygpti for dengue viruses (DENV). Theoretical predictions suggest that the mean temperature in combination with the magnitude of the diurnal temperature range (DTR) mediate the direction of these effects.Methodology/Principal Findings
We tested the effect of temperature fluctuations on Ae. aegypti vector competence for DENV serotype-1 at high and low mean temperatures, and confirmed this theoretical prediction. A small DTR had no effect on vector competence around a high (30°C) mean, but a large DTR at low temperature (20°C) increased the proportion of infected mosquitoes with a disseminated infection by 60% at 21 and 28 days post-exposure compared to a constant 20°C. This effect resulted from a marked shortening of DENV extrinsic incubation period (EIP) in its mosquito vector; i.e., a decrease from 29.6 to 18.9 days under the fluctuating vs. constant temperature treatment.Conclusions
Our results indicate that Ae. aegypti exposed to large fluctuations at low temperatures have a significantly shorter virus EIP than under constant temperature conditions at the same mean, leading to a considerably greater potential for DENV transmission. These results emphasize the value of accounting for daily temperature variation in an effort to more accurately understand and predict the risk of mosquito-borne pathogen transmission, provide a mechanism for sustained DENV transmission in endemic areas during cooler times of the year, and indicate that DENV transmission could be more efficient in temperate regions than previously anticipated. 相似文献10.
Background
The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.Methods
We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0–21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.Results
The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5–6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.Conclusion
An increase in nurse advice calls relating to gastrointestinal illnesses around 5–6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment. 相似文献11.
Background
There is limited evidence for the impacts of meteorological changes on asthma hospital admissions in adults in Shanghai, China.Objectives
To quantitatively evaluate the short-term effects of daily mean temperature on asthma hospital admissions.Methods
Daily hospital admissions for asthma and daily mean temperatures between January 2005 and December 2012 were analyzed. After controlling for secular and seasonal trends, weather, air pollution and other confounding factors, a Poisson generalized additive model (GAM) combined with a distributed lag non-linear model were used to explore the associations between temperature and hospital admissions for asthma.Results
During the study periods, there were 15,678 hospital admissions for asthma by residents of Shanghai, an average 5.6 per day. Pearson correlation analysis found a significant negative correlation (r = −0.174, P<0.001) between asthma hospitalizations and daily mean temperature (DMT). The DMT effect on asthma increased below the median DMT, with lower temperatures associated with a higher risk of hospital admission for asthma. Generally, the cold effect appeared to be relatively acute, with duration lasting several weeks, while the hot effect was short-term. The relative risk of asthma hospital admissions associated with cold temperature (the 25th percentile of temperature relative to the median temperature) was 1.20 (95% confidence interval [CI], 1.01∼1.41) at lag0-14. However, warmer temperatures were not associated with asthma hospital admissions.Conclusions
Cold temperatures may trigger asthmatic attacks. Effective strategies are needed to protect populations at risk from the effects of cold. 相似文献12.
Amar J. Mehta Itai Kloog Antonella Zanobetti Brent A. Coull David Sparrow Pantel Vokonas Joel Schwartz 《PloS one》2014,9(9)
Background
The underlying mechanisms of the association between ambient temperature and cardiovascular morbidity and mortality are not well understood, particularly for daily temperature variability. We evaluated if daily mean temperature and standard deviation of temperature was associated with heart rate-corrected QT interval (QTc) duration, a marker of ventricular repolarization in a prospective cohort of older men.Methods
This longitudinal analysis included 487 older men participating in the VA Normative Aging Study with up to three visits between 2000–2008 (n = 743). We analyzed associations between QTc and moving averages (1–7, 14, 21, and 28 days) of the 24-hour mean and standard deviation of temperature as measured from a local weather monitor, and the 24-hour mean temperature estimated from a spatiotemporal prediction model, in time-varying linear mixed-effect regression. Effect modification by season, diabetes, coronary heart disease, obesity, and age was also evaluated.Results
Higher mean temperature as measured from the local monitor, and estimated from the prediction model, was associated with longer QTc at moving averages of 21 and 28 days. Increased 24-hr standard deviation of temperature was associated with longer QTc at moving averages from 4 and up to 28 days; a 1.9°C interquartile range increase in 4-day moving average standard deviation of temperature was associated with a 2.8 msec (95%CI: 0.4, 5.2) longer QTc. Associations between 24-hr standard deviation of temperature and QTc were stronger in colder months, and in participants with diabetes and coronary heart disease.Conclusion/Significance
In this sample of older men, elevated mean temperature was associated with longer QTc, and increased variability of temperature was associated with longer QTc, particularly during colder months and among individuals with diabetes and coronary heart disease. These findings may offer insight of an important underlying mechanism of temperature-related cardiovascular morbidity and mortality in an older population. 相似文献13.
Michael B. Rothberg Penelope S. Pekow Aruna Priya Marya D. Zilberberg Raquel Belforti Daniel Skiest Tara Lagu Thomas L. Higgins Peter K. Lindenauer 《PloS one》2014,9(1)
Background
Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data.Objectives
To develop and validate a mortality prediction model using administrative data available in the first 2 hospital days.Research Design
After dividing the dataset into derivation and validation sets, we created a hierarchical generalized linear mortality model that included patient demographics, comorbidities, medications, therapies, and diagnostic tests administered in the first 2 hospital days. We then applied the model to the validation set.Subjects
Patients aged ≥18 years admitted with pneumonia between July 2007 and June 2010 to 347 hospitals in Premier, Inc.’s Perspective database.Measures
In hospital mortality.Results
The derivation cohort included 200,870 patients and the validation cohort had 50,037. Mortality was 7.2%. In the multivariable model, 3 demographic factors, 25 comorbidities, 41 medications, 7 diagnostic tests, and 9 treatments were associated with mortality. Factors that were most strongly associated with mortality included receipt of vasopressors, non-invasive ventilation, and bicarbonate. The model had a c-statistic of 0.85 in both cohorts. In the validation cohort, deciles of predicted risk ranged from 0.3% to 34.3% with observed risk over the same deciles from 0.1% to 33.7%.Conclusions
A mortality model based on detailed administrative data available in the first 2 hospital days had good discrimination and calibration. The model compares favorably to clinically based prediction models and may be useful in observational studies when clinical data are not available. 相似文献14.
Objective
To determine the incidence and effect on mortality of early acute kidney injury in severely injured trauma patients using the Acute Kidney Injury Network creatinine criteria.Design
A retrospective cohort study of severely injured trauma patients admitted to the shock trauma intensive care unit.Setting
Texas Trauma Institute, a state designated level I trauma unit certified by the American College of Surgeons Committee on Trauma.Patients
901 severely injured trauma patients admitted over a 15 month period to the shock trauma intensive care unit.Interventions
Retrospective analysis of prospectively collected data abstracted from an electronic trauma database.Measurements and Main Results
Of 901 eligible patients admitted to the shock trauma intensive care unit after traumatic injury, 54 patients (6%) developed acute kidney injury, of whom 10 (19%) required renal replacement therapy. The 30-day mortality rate for the entire cohort was 83/901 (9.2%). Patients with early acute kidney injury had a mortality rate of 16/54 (29.6%). When corrected for multiple covariates including injury severity scores, the development of early acute kidney injury was associated with a significantly higher risk of death at 30 days with an OR of 3.4 (95% CI 1.6-7.4).Conclusions
Applying the Acute Kidney Injury Network creatinine criteria in severely injured trauma patients, the incidence of early acute kidney injury was 6%. After correction for injury severity, development of early acute kidney injury was independently associated with significantly higher 30-day mortality. 相似文献15.
Brunella Morandi Luigi Manfrini Pasquale Losciale Marco Zibordi Luca Corelli Grappadelli 《Annals of botany》2010,105(6):913-923
Background and Aims
The kiwifruit berry is characterized by an early stage of rapid growth, followed by a relatively long stage of slow increase in size. Vascular and transpiration flows are the main processes through which water and carbon enter/exit the fruit, determining the daily and seasonal changes in fruit size. This work investigates the biophysical mechanisms underpinning the change in fruit growth rate during the season.Methods
The daily patterns of phloem, xylem and transpiration in/outflows have been determined at several stages of kiwifruit development, during two seasons. The different flows were quantified by comparing the diurnal patterns of diameter change of fruit, which were then girdled and subsequently detached while measurements continued. The diurnal courses of leaf and stem water potential and of fruit pressure potential were also monitored at different times during the season.Key Results
Xylem and transpiration flows were high during the first period of rapid volume growth and sharply decreased with fruit development. Specific phloem import was lower and gradually decreased during the season, whereas it remained constant at whole-fruit level, in accordance with fruit dry matter gain. On a daily basis, transpiration always responded to vapour pressure deficit and contributed to the daily reduction of fruit hydrostatic pressure. Xylem flow was positively related to stem-to-fruit pressure potential gradient during the first but not the last part of the season, when xylem conductivity appeared to be reduced.Conclusions
The fruit growth model adopted by this species changes during the season due to anatomical modifications in the fruit features. 相似文献16.
Background
Several randomized controlled trials (RCTs) have evaluated the effect of intra-aortic balloon counterpulsation pump(IABP) on the mortality of acute myocardial infarction (AMI).Objectives
To analyze the relevant RCT data on the effect of IABP on mortality and the occurrence of bleeding in AMI.Data Sources
Published RCTs on the treatment of AMI by IABP were retrieved in searches of Medline, EMBASE, Cochrane and other related databases. The last search was conducted on July 20, 2014.Study Eligibility Criteria
Randomized clinical trials comparing IABP to controls as treatment for AMI.Participants
Patients with AMI.Synthesis Methods
The primary endpoint was mortality, and the secondary endpoint was bleeding events. To account for to heterogeneity, a random-effects model was used to analyze the study data.Results
Ten trials with a total population of 973 patients that were included in the analysis showed no significant difference in 2-month mortality between the IABP and the control groups. The 6-month mortality in the IABP group was not significantly lower than in the control group in the four RCTs that enrolled 59 AMI patients with CS. But in the four that enrolled AMI 66 patients without CS, the data showed opposite conclusion.Conclusions
IABP cannot reduce within 2 months and 6–12 months mortality of AMI patients with CS as well as within 2 months mortality of AMI patients without CS, but can reduce 6–12 months mortality of AMI patients without CS. In addition, IABP can increase the risk of bleeding. 相似文献17.
Cristina Granja Pedro Póvoa Cristina Lobo Armando Teixeira-Pinto António Carneiro Altamiro Costa-Pereira 《PloS one》2013,8(1)
Introduction
PIRO is a conceptual classification system in which a number of demographic, clinical, biological and laboratory variables are used to stratify patients with sepsis in categories with different outcomes, including mortality rates.Objectives
To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction.Methods
Patients were selected from the Portuguese ICU-admitted community-acquired sepsis study (SACiUCI). Variables concerning the R and O component included repeated measurements along the first five days in ICU stay. The trends of these variables were summarized as the initial value at day 1 (D1) and the slope of the tendency during the five days, using a linear mixed model. Logistic regression models were built to assess the best set of covariates that predicted hospital mortality.Results
A total of 891 patients (age 60±17 years, 64% men, 38% hospital mortality) were studied. Factors significantly associated with mortality for P component were gender, age, chronic liver failure, chronic renal failure and metastatic cancer; for I component were positive blood cultures, guideline concordant antibiotic therapy and health-care associated sepsis; for R component were C-reactive protein slope, D1 heart rate, heart rate slope, D1 neutrophils and neutrophils slope; for O component were D1 serum lactate, serum lactate slope, D1 SOFA and SOFA slope. The relative weight of each component of PIRO was calculated. The combination of these four results into a single-value predictor of hospital mortality presented an AUC-ROC 0.84 (IC95%:0.81–0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368.Conclusions
We identified specific variables associated with each of the four components of PIRO, including biomarkers and a dynamic view of the patient daily clinical course. This novel approach to PIRO concept and overall score can be a better predictor of mortality for patients with community-acquired sepsis admitted to ICUs. 相似文献18.
G Capellier H Mockly C Charpentier D Annane G Blasco T Desmettre A Roch C Faisy J Cousson S Limat M Mercier L Papazian 《PloS one》2012,7(8):e41290
Purpose
The optimal treatment duration for ventilator-associated pneumonia is based on one study dealing with late-onset of the condition. Shortening the length of antibiotic treatment remains a major prevention factor for the emergence of multiresistant bacteria.Objective
To demonstrate that 2 different antibiotic treatment durations (8 versus 15 days) are equivalent in terms of clinical cure for early-onset ventilator-associated pneumonia.Methods
Randomized, prospective, open, multicenter trial carried out from 1998 to 2002.Measurements
The primary endpoint was the clinical cure rate at day 21. The mortality rate was evaluated on days 21 and 90.Results
225 patients were included in 13 centers. 191 (84.9%) patients were cured: 92 out of 109 (84.4%) in the 15 day cohort and 99 out of 116 (85.3%) in the 8 day cohort (difference = 0.9%, odds ratio = 0.929). 95% two-sided confidence intervals for difference and odds ratio were [−8.4% to 10.3%] and [0.448 to 1.928] respectively. Taking into account the limits of equivalence (10% for difference and 2.25 for odds ratio), the objective of demonstrative equivalence between the 2 treatment durations was fulfilled. Although the rate of secondary infection was greater in the 8 day than the 15 day cohort, the number of days of antibiotic treatment remained lower in the 8 day cohort. There was no difference in mortality rate between the 2 groups on days 21 and 90.Conclusion
Our results suggest that an 8-day course of antibiotic therapy is safe for early-onset ventilator-associated pneumonia in intubated patients.Trial Registration
ClinicalTrials.gov NCT01559753相似文献19.
Sajid Shahul Michele R. Hacker Victor Novack Ariel Mueller Shahzad Shaefi Bilal Mahmood Syed Haider Ali Daniel Talmor 《PloS one》2014,9(9)
Importance
The association between hospital volume and inpatient mortality for severe sepsis is unclear.Objective
To assess the effect of severe sepsis case volume and inpatient mortality.Design Setting and Participants
Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011.Exposures
The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles.Main Outcomes and Measures
Inpatient mortality.Results
Compared with the highest tertile of severe sepsis volume (>60 cases per year), the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year) was 1.188 (95% CI: 1.074–1.315), while the odds ratio was 1.090 (95% CI: 1.031–1.152) for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64–38.03) for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51–32.64) for hospitals with the highest volume.Conclusions and Relevance
We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients. 相似文献20.
Yannael Coisel Sabri Bousbia Jean-Marie Forel Sami Hraiech Bernard Lascola Antoine Roch Christine Zandotti Matthieu Million Samir Jaber Didier Raoult Laurent Papazian 《PloS one》2012,7(12)