Determination of functional prognosis in hospitalized patients following an intensive care admission

AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).RESULTS Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P < 0.05) were the KATZ and MRC on admission, age, sepsis(no), and total length of stay(TLS). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLS(AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLS(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the ΔMRCTOT.CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

Chinese Medicine Pattern Differentiation and Its Implications for Clinical Practice

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field： general pattern differentiation; genitourinary （recurrent cystitis）; cardiovascular （coronary heart disease; arterial hypertension; angina pectoris）; neurology （stroke）; surgery; metabolic （diabetes mellitus）; hepatic （cirrhosis）; gastrointestinal （chronic superficial gastritis）; orthopedic （low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis）; oncology （gastric mucosal dysplasia; lung cancer）; gynecologic and obstetric manifestations （nausea and vomiting）. The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.