Heart & Lung最新文献

Background: Early risk stratification in sepsis is essential for guiding timely clinical decisions in the emergency department (ED). While several prognostic scores exist, many rely on laboratory parameters that may not be immediately available at triage.

Objective: To evaluate the prognostic performance of the S-S.M.A.R.T score for predicting 30-day mortality in patients with Sepsis-3-defined sepsis and to assess whether incorporating comorbidity and biomarker data enhances predictive accuracy.

Methods: This prospective observational study included adult patients (≥18 years) presenting to a ED with sepsis defined by Sepsis-3 criteria. Demographic, clinical, and laboratory data were collected at ED presentation. The S-S.M.A.R.T score, SOFA score, and a novel SSMART-MC model (S-S.M.A.R.T plus malignancy and CRP) were calculated. Logistic regression identified independent predictors of 30-day mortality. Prognostic performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and overall accuracy.

Results: Among 180 patients, 104 (57.8%) died within 30 days. Median S-S.M.A.R.T and SOFA scores were higher in non-survivors (3 vs. 2 and 9 vs. 6; p < .001). S-S.M.A.R.T predicted 30-day mortality with an AUC of 0.718, similar to SOFA (AUC 0.735; p = .701). Incorporating malignancy and CRP, the SSMART-MC model achieved an AUC of 0.867, with 87.3% sensitivity, 72.0% specificity, and 80.8% overall accuracy.

Conclusions: In this Sepsis-3 cohort, the S-S.M.A.R.T score showed performance comparable to qSOFA for predicting 30-day mortality. The incorporation of malignancy and CRP appeared to improve prognostic accuracy. However, given the limited sample size and lack of external validation, the SSMART-MC model should be considered a promising tool that requires confirmation in larger, multicenter studies before routine clinical use.

Background: 'Usual care' is a term that can refer to a variety of control conditions in randomized controlled trials (RCTs). The lack of standardization of usual care groups can lead to problems for clinical decision-making.

Objectives: 1) Systematically describe the types and characterizations of "usual care" interventions in COPD RCTs. 2) Determine how well RCTs report usual care interventions and the extent to which COPD guideline-recommended treatment components are a part of usual care interventions.

Methods: Systematic review design. Two investigators screened studies and independently extracted data. We extracted type of usual care described, quality of reporting, and classification of usual care components as validated (i.e., aligned with guidelines) or unvalidated comparators.

Results: We included 233 studies. The most frequently described usual care intervention included patient education (n = 72, 31%) and continued care with the general practitioner (n = 67, 29%). Only 7% of the studies provided a complete description of the usual care intervention. Almost half of usual care interventions (49%) were deemed unvalidated. Higher PEDro scores were associated with greater odds of the intervention being validated (Exp(B) = 1.32; 95% CI: 1.04 to 1.66).

Conclusion: There is significant variability and frequent lack of reporting in the characterization of 'usual care' comparators in RCTs involving patients with COPD. Usual care is often poorly described, inconsistently delivered, and commonly not aligned with clinical guidelines. Higher quality trials had better odds of providing valid usual care.

Herein, we present a 65-year-old woman with recurrent palpitations and a wide complex tachycardia consistent with atriofascicular (Mahaim) tachycardia. We review Mahaim pathway physiology, embryologic basis, characteristic ECG features, and key electrophysiologic study findings that guide diagnosis and ablation strategy.