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Phua J, Lim HF, Tay CK, Aung NW. Public Awareness of Sepsis and Stroke in Singapore: A Population-Based Survey. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n6p269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Management guidelines emphasise the importance of prompt therapeutic intervention for sepsis as well as stroke, both of which are common causes of death. Unfortunately, a rate-limiting step may be delayed presentation to the emergency department by patients themselves. The aim of this study was to assess public awareness of sepsis and stroke in Singapore. Materials and Methods: This was a population-based, structured telephone survey of adults in Singapore. Results: There were 1067 completed surveys (response rate 50.3%). The survey population was mostly comparable with the actual Singapore population. Fifty-three respondents (5.0%) had heard of the term sepsis. Of these, 45 respondents (4.2%) could provide at least one accepted definition of sepsis, the commonest being that of an unspecified infection. Respondents mostly heard about sepsis from school, the Internet, and newspapers. On the other hand, 963 respondents (90.3%) had heard of the term stroke. Of these, 818 respondents (76.7%) could name at least one accepted warning sign of stroke, the commonest being that of numbness, while 806 respondents (75.5%) could name at least one accepted risk factor for stroke, the commonest being hypertension. Respondents mostly heard about stroke from television, newspapers, a relative, a friend, media (unspecified), and the Internet. Conclusion: Our findings reflect the differences in the public profile of sepsis versus stroke in Singapore. More concerted efforts involving healthcare professionals, medical societies, statutory boards, and the mass media are required to improve public awareness of these 2 conditions —especially sepsis.
Key words: Cerebrovascular disorders, Health knowledge, Infection, Questionnaires
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Affiliation(s)
- Jason Phua
- National University Hospital, National University Health System, Singapore
| | - Hui Fang Lim
- National University Hospital, National University Health System, Singapore
| | - Chee Kiang Tay
- National University Hospital, National University Health System, Singapore
| | - Ngu Wah Aung
- School of Health Sciences, Ngee Ann Polytechnic, Singapore
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52
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Reinhart K, Daniels R, Kissoon N, O'Brien J, Machado FR, Jimenez E. The burden of sepsis-a call to action in support of World Sepsis Day 2013. J Crit Care 2013; 28:526-8. [PMID: 23747158 DOI: 10.1016/j.jcrc.2013.04.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/28/2013] [Indexed: 11/19/2022]
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53
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54
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Bader EBMK. Clinical q & a: translating therapeutic temperature management from theory to practice. Ther Hypothermia Temp Manag 2013; 3:28-38. [PMID: 24837637 DOI: 10.1089/ther.2013.1503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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55
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Abstract
Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and add information about screening, diagnosis, risk stratification, and monitoring of the response to therapy. The host response involves hundreds of mediators and single molecules, many of which have been proposed as biomarkers. It is, however, unlikely that one single biomarker is able to satisfy all the needs and expectations for sepsis research and management. Among biomarkers that are measurable by assays approved for clinical use, procalcitonin (PCT) has shown some usefulness as an infection marker and for antibiotic stewardship. Other possible new approaches consist of molecular strategies to improve pathogen detection and molecular diagnostics and prognostics based on transcriptomic, proteomic, or metabolic profiling. Novel approaches to sepsis promise to transform sepsis from a physiologic syndrome into a group of distinct biochemical disorders and help in the development of better diagnostic tools and effective adjunctive sepsis therapies.
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Reinhart K, Kissoon N“T, Daniels R, Marshall J, Dellinger P, Jimenez EJ. What we learned from the first World Sepsis Day. J Crit Care 2012; 27:735-6. [DOI: 10.1016/j.jcrc.2012.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 09/28/2012] [Indexed: 11/27/2022]
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Wiens MO, Kumbakumba E, Kissoon N, Ansermino JM, Ndamira A, Larson CP. Pediatric sepsis in the developing world: challenges in defining sepsis and issues in post-discharge mortality. Clin Epidemiol 2012; 4:319-25. [PMID: 23226074 PMCID: PMC3514048 DOI: 10.2147/clep.s35693] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Indexed: 12/24/2022] Open
Abstract
Sepsis represents the progressive underlying inflammatory pathway secondary to any infectious illness, and ultimately is responsible for most infectious disease-related deaths. Addressing issues related to sepsis has been recognized as an important step towards reducing morbidity and mortality in developing countries, where the majority of the 7.5 million annual deaths in children under 5 years of age are considered to be secondary to sepsis. However, despite its prevalence, sepsis is largely neglected. Application of sepsis definitions created for use in resource-rich countries are neither practical nor feasible in most developing country settings, and alternative definitions designed for use in these settings need to be established. It has also been recognized that the inflammatory state created by sepsis increases the risk of post-discharge morbidity and mortality in developed countries, but exploration of this issue in developing countries is lacking. Research is urgently required to characterize better this potentially important issue.
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Affiliation(s)
- Matthew O Wiens
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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Janisch T, Wendt J, Hoffmann R, Ortlepp JR. Expected and observed mortality in critically ill patients receiving initial antibiotic therapy. Wien Klin Wochenschr 2012; 124:775-81. [PMID: 23135688 DOI: 10.1007/s00508-012-0276-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/15/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the predictors of mortality in critically ill patients receiving initial antibiotic therapy (IAT; < 48 h after admission). METHODS Six hundred thirty-one consecutive patients admitted to an intermediate care (IMC) unit were included. IAT was initiated in 227 patients. Laboratory markers, interventions, medications, systemic inflammatory response syndrome (SIRS) and sepsis criteria, length of stay, and hospital mortality as well as expected mortality, based on the SAPSII-expanded score, were assessed retrospectively. Failure of IAT was defined as a rise in C-reactive protein (CRP) or leukocyte count on day 3 compared with the values on admission. RESULTS Patients with IAT were significantly older (67 ± 14 vs. 64 ± 14 years; p = 0.006) and had a higher prevalence of chronic renal failure (33 vs. 23 %; p = 0.015), chronic obstructive pulmonary disease (COPD; 27 vs. 16 %; p = 0.002), malignoma (17 vs. 9 %; p = 0.007), acute renal failure (11 vs. 4 %; p = 0.001), respiratory failure (22 vs. 7 %; p < 0.001), and a shock index < 1.0 (21 vs. 8 %; p < 0.001). Although patients with IAT did not have significantly different expected mortality compared with patients without IAT (19.2 vs. 14.5 %; p = 0.144), they did have a significantly higher observed mortality (16.7 vs. 3.7 %; p < 0.0001). Based on the number of SIRS criteria (0, 1, 2, or 3-4) or sepsis criteria (no sepsis, sepsis, or severe sepsis) fulfilled, expected mortality (16.4, 18.2, 20.6, or 21.0 %, respectively; p = 0.955/17.5, 18.3, or 23.4 %, respectively; p = 0.689) did not differ in IAT patients. In contrast, observed mortality differed significantly (4.8, 10.6, 20.6, or 29.4 %, respectively; p = 0.029/8.3, 19.7, or 29.3 %, respectively; p = 0.013). Patients who responded to IAT did not differ regarding comorbidities, SIRS or sepsis criteria, but they had a lower observed mortality (11.9 vs. 26.3 %; p = 0.008) than patients who failed to respond to IAT. Central venous lines were more frequently present in patients with failure to IAT when compared with those with response (51 vs. 22 %; p = 0.009). In the subgroup of patients with acute myocardial infarction (AMI), those with IAT (n = 41) were treated less frequently according to the current cardiac guidelines than those without (n = 124) CONCLUSIONS Patients with IAT have a high morbidity burden and higher observed than expected mortality. The SAPSII-expanded score does not seem to precisely estimate the risk of in-hospital mortality in these patients. Failure of response to IAT was associated with an even higher mortality. Whether central venous lines and nonadherence to cardiac care guidelines influence the mortality of patients with IAT should be investigated in further studies.
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Affiliation(s)
- Thorsten Janisch
- Klinik für Operative Intensivmedizin und Intermediate Care, Universitätsklinikum der RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Riley C, Basu RK, Kissoon N, Wheeler DS. Pediatric sepsis: preparing for the future against a global scourge. Curr Infect Dis Rep 2012; 14:503-11. [PMID: 22864953 DOI: 10.1007/s11908-012-0281-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sepsis is a leading cause of morbidity and mortality among children worldwide. As consensus statements emerge regarding early recognition and goal-directed management of sepsis, scrutiny should be given to the unique characteristics of sepsis in children. Pediatric patients are not small adults! Sepsis epidemiology, pathophysiology, and management strategy can vary significantly from those for adults. Herein, we describe the epidemiology of pediatric sepsis, in both resource-rich and resource-poor worlds, and discuss how the pathophysiology of pediatric sepsis differs from that for adults. We discuss the timeline of management of pediatric sepsis, studying how discoveries over the past 50 years have changed the way sepsis is treated. Finally, we discuss the future of pediatric sepsis. We focus on approaches that carry the most substantive impact on the global burden of disease.
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Affiliation(s)
- Carley Riley
- Division of Critical Care Medicine, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Avenue, Division of Critical Care, ML 2005, Cincinnati, OH, 45229, USA
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Abstract
I conducted a personal survey, completely informal, asking groups of doctors during training courses to give me in writing, in a strictly anonymous fashion, a brief operative description of diagnosis. The majority were unfocused and confusing regarding the process and nobody mentioned any probability-based criteria. Objectively, diagnosis is a difficult concept and rich with implications: this is the heart of medical activity and few doctors are able to define it correctly. There exist well-founded reasons to ask ourselves what diagnosis means and how many are the implications and the many environments in which the concept might be declined. We have to accept that even at the end of a complete and exhaustive diagnostic workup, it might not be possible to reach a diagnosis and it is much wiser to admit it rather than giving the patient a label that will abandon them only with extreme difficulty. Whether or not we like it, we behave, even unconsciously, like convinced Bayesians and we should be aware of the fact that the predictive value of your test will vary on how high or low is the presence of the illness. With a very low prevalence, even a very sensitive test might produce an unacceptably high number of false positives. Naturally, it is not necessary to supply a definition of diagnosis to be a good doctor. What counts is that we are aware that the diagnostic process is based on probability and not certainty, we are prone to biases, diagnostic tests can have false positives and false negatives, and having reached a certain threshold of probability and trust in diagnosis we should decide, with our patients, what to do or not do.
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Affiliation(s)
- Rodolfo Sbrojavacca
- Department of Medicine, Udine General and University Hospital, Udine, Italy.
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61
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Vincent JL. Increasing awareness of sepsis: World Sepsis Day. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:152. [PMID: 22971299 PMCID: PMC3682256 DOI: 10.1186/cc11511] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Reinhart K, Kissoon N“T, Daniels R, Jimenez EJ. Stop sepsis—save lives: A call to join the global coalition for the World Sepsis Day. J Crit Care 2012; 27:410-3. [DOI: 10.1016/j.jcrc.2012.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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63
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Perman SM, Goyal M, Gaieski DF. Initial emergency department diagnosis and management of adult patients with severe sepsis and septic shock. Scand J Trauma Resusc Emerg Med 2012; 20:41. [PMID: 22737991 PMCID: PMC3507802 DOI: 10.1186/1757-7241-20-41] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/27/2012] [Indexed: 12/21/2022] Open
Abstract
Severe sepsis is a medical emergency affecting up to 18 million individuals world wide, with an annual incidence of 750,000 in North America alone. Mortality ranges between 28-50% of those individuals stricken by severe sepsis. Sepsis is a time critical illness, requiring early identification and prompt intervention in order to improve outcomes. This observation has led to increased awareness and education in the field of Emergency Medicine; it has also led to the implementation of critical interventions early in the course of patient management, specifically Early-Goal Directed Therapy, and rapid administration of appropriate antimicrobials. This review begins with a brief summary of the pathophysiology of sepsis, and then addresses the fundamental clinical aspects of ED identification and resuscitation of the septic patient.
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Affiliation(s)
- Sarah M Perman
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, USA
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64
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Does U.S. health care need a national institute of critical care? Crit Care Med 2012; 40:1337-8. [PMID: 22425828 DOI: 10.1097/ccm.0b013e31824316b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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65
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Prevention of sepsis in children: a new paradigm for public policy. Crit Care Res Pract 2011; 2012:437139. [PMID: 22216408 PMCID: PMC3246692 DOI: 10.1155/2012/437139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 11/04/2011] [Indexed: 01/16/2023] Open
Abstract
Sepsis is one of the leading causes of death worldwide. While the management of critically ill patients with sepsis is certainly better now compared to 20 years ago, sepsis-associated mortality remains unacceptably high. Annual deaths from sepsis in both children and adults far surpass the number of deaths from acute myocardial infarction (AMI), stroke, or cancer. Given the substantial toll that sepsis takes worldwide, prevention of sepsis remains a global priority. Multiple effective prevention strategies exist. Antibiotic prophylaxis, immunizations, and healthcare quality improvement initiatives are important means through which we may reduce the morbidity and mortality from sepsis around the world. Inclusion of these strategies in a coordinated and thoughtful campaign to reduce the global burden of sepsis is necessary for the improvement of pediatric health worldwide.
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66
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Seymour CW, Carlbom D, Engelberg RA, Larsen J, Bulger EM, Copass MK, Rea TD. Understanding of sepsis among emergency medical services: a survey study. J Emerg Med 2011; 42:666-77. [PMID: 22070877 DOI: 10.1016/j.jemermed.2011.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 02/19/2011] [Accepted: 06/01/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emergency medical services (EMS) personnel commonly encounter sepsis, yet little is known about their understanding of sepsis. STUDY OBJECTIVES To determine the awareness, knowledge, current practice, and attitudes about sepsis among EMS personnel. METHODS We performed an anonymous, multi-agency, online survey of emergency medical technicians (EMTs), firefighter-emergency medical technicians (FF-EMTs), and paramedics in a metropolitan, 2-tier EMS system. We compared responses according to the level of EMS training and used multivariable logistic regression to determine the odds of correctly identifying the definition of sepsis, independent of demographic and professional factors. RESULTS Overall response rate of study participants was 57% (786/1390), and was greatest among EMTs (79%; 276/350). A total of 761 respondents (97%) had heard of the term "sepsis." EMTs and FF-EMTs were at significantly reduced odds of correctly defining sepsis compared to paramedics, independent of age, sex, and years of experience (EMTs: odds ratio 0.44, 95% confidence interval 0.3-0.8; FF-EMTs: odds ratio 0.32, 95% confidence interval 0.2-0.6. Overall, knowledge of the clinical signs and symptoms and recommended treatments for sepsis was typically>75%, though better among paramedics than EMTs or FF-EMTs (p<0.01). The majority of respondents believed sepsis is not recognized by EMS "some" or "a lot" of the time (76%, 596/786). CONCLUSIONS EMS personnel demonstrated an overall sound awareness of sepsis. Knowledge of sepsis was less among FF-EMTs and EMTs compared to paramedics. These results suggest that paramedics could be integrated into strategies of early identification and treatment of sepsis, and EMTs may benefit from focused education and training.
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Affiliation(s)
- Christopher W Seymour
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98107, USA
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Abstract
Sepsis is a significant health problem in both critically ill children and adults. While the mortality rate from sepsis is much lower in children, sepsis is directly responsible for over 4,000 childhood deaths per year in the United States alone. At face value, this number suggests that more children die per year in the United States from sepsis as the primary cause than from cancer. Unfortunately, there are few studies on the epidemiology, pathophysiology, and management of sepsis in children. Moreover, extrapolation of adult data to critically ill children is probably not appropriate due to several key developmental differences in the host response to infection and response to therapy. Therefore, additional studies targeting sepsis in the pediatric population are urgently required.
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Affiliation(s)
- Derek S Wheeler
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, The Kindervelt Laboratory for Critical Care Medicine Research, Cincinnati Children's Research Foundation
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68
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"Sepsis--it ain't so much what you don't know that gets you into trouble, it's what you know for sure that just ain't so."--with apologies to Mark Twain. Crit Care Med 2011; 39:1214-5. [PMID: 21610584 DOI: 10.1097/ccm.0b013e3182148c03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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69
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Abstract
Severe sepsis is defined as organ dysfunction in the setting of systemic inflammatory response due to infection. With changes in population age, comorbidity and the delivery of medical care, severe sepsis is increasingly common, and can present in every area of the hospital. The major obstacles to improved outcomes in severe sepsis are deficiencies in healthcare staffing and education, haphazard recognition and response to early clinical deterioration and deviation from optimal management as defined by international guidelines. Major treatment errors were identified in 30% of patients with bacteraemia in one recent investigation. Against this, substantial reductions in mortality can be achieved by improving recognition, urgent care and resuscitation. With a view to improving survival in sepsis, collaborative efforts are required to measure outcomes, implement guidelines and secure adequate funding for ongoing practice improvement, education and research.
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Affiliation(s)
- P J Huggan
- Divisions of General Medicine and Infectious Disease, National University Health System, Singapore.
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70
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Marshall JC, Reinhart K. The Global Sepsis Alliance: Building New Collaborations to Confront an Under-Recognized Threat. Surg Infect (Larchmt) 2011; 12:1-2. [DOI: 10.1089/sur.2010.9923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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71
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Liu XR, Zheng XF, Ji SZ, Lv YH, Zheng DY, Xia ZF, Zhang WD. Metabolomic analysis of thermally injured and/or septic rats. Burns 2010; 36:992-8. [DOI: 10.1016/j.burns.2010.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 03/17/2010] [Accepted: 03/23/2010] [Indexed: 12/28/2022]
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Lipid-enriched enteral nutrition controls the inflammatory response in murine Gram-negative sepsis. Crit Care Med 2010; 38:1996-2002. [DOI: 10.1097/ccm.0b013e3181eb90d7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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73
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74
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Seymour CW, Iwashyna TJ, Cooke CR, Hough CL, Martin GS. Marital status and the epidemiology and outcomes of sepsis. Chest 2010; 137:1289-96. [PMID: 20173054 DOI: 10.1378/chest.09-2661] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Sepsis is a major public health problem. Social factors may affect health behaviors, economic resources, and immune response, leading to hospitalization for infection. This study examines the association between marital status and sepsis incidence and outcomes in a population-based cohort. METHODS We analyzed 1,113,581 hospitalizations in New Jersey in 2006. We estimated risk-adjusted incidence rate ratios (IRRs) for sepsis among divorced, widowed, legally separated, single, and married subjects using population data from the American Community Survey. We used multivariable logistic regression to estimate marital status-specific hospital mortality. RESULTS We identified 37,524 hospitalizations for sepsis, of which 40% were among married (14,924), 7% were among divorced (2,548), 26% were among widowed (9,934), 2% (763) were among legally separated, and 26% (9355) were among single subjects. The incidence of hospitalization for sepsis was 5.8 per 1,000 population. The age, sex, and race-adjusted IRR for hospitalization with sepsis was greatest for single (IRR = 3.47; 95% CI, 3.1, 3.9), widowed (IRR = 1.38; 95% CI, 1.2, 1.6), and legally separated (IRR = 1.46; 95% CI, 1.2, 1.8) subjects compared with married (referent). We observed that single men and women and divorced men had greater odds of in-hospital mortality compared with married men; widowed and legally separated men and all ever-married women had no excess mortality during hospitalization for sepsis. CONCLUSIONS Hospitalization for sepsis is more common among single, widowed, and legally separated individuals, independent of other demographic factors. Among patients hospitalized for sepsis, single and divorced men and single women experience greater hospital mortality, highlighting the need to characterize the potentially modifiable mechanisms linking marital status to its greater burden of critical illness.
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Affiliation(s)
- Christopher W Seymour
- Division of Pulmonary and Critical Care Medicine, Box 359762, Harborview Medical Center, Seattle, WA 98104, USA.
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Moerer O, Quintel M. Definition, Epidemiologie und ökonomische Aspekte der Sepsis bei Erwachsenen. Internist (Berl) 2009; 50:788, 790-4, 796-8. [DOI: 10.1007/s00108-008-2285-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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76
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Fowler RA, Adhikari NKJ, Scales DC, Lee WL, Rubenfeld GD. Update in critical care 2008. Am J Respir Crit Care Med 2009; 179:743-58. [PMID: 19383928 DOI: 10.1164/rccm.200902-0207up] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert A Fowler
- University of Toronto, Department of Medicine, Sunnybrook Health Sciences Centre, Chief, Program in Trauma, Emergency, and Critical Care, Toronto, ON, M4V 1E5 Canada
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