To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endopro... more To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion in patients with lower limb ischemia. Patients undergoing local intra-arterial thrombolysis for lower limb ischemia between 2001 and 2010 were identified in the prospective database for endovascular intervention, and analysis was performed retrospectively. There was an increase in thrombolysis for occluded endoprosthesis and a decrease in thrombolysis for occluded bypasses during the study period (p=0.001). The technical success rate for thrombolysis in occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. The overall major amputation rate, mortality rate and amputation-free survival rate at 1 year was 19%, 14% and 73%, respectively, without differences between groups. The major amputation rate at long-term was highest, 45%, for patients with occluded synthetic bypass grafts. Female gender (HR 1.7; 95% CI 1.1-2.7), ischemic heart disease (HR 1.8; 95% CI 1.1-2.8), anemia at admission (HR 1.9; 95% CI 1.2-3.0), foot ulcer (HR 4.4; 95% CI 2.4-8.0), motor deficit at admission (HR 2.5; 95% CI 1.4-4.3), occluded synthetic bypass graft (HR 3.3; 95% CI 1.9-5.7) and failure of thrombolysis (HR 4.8; 95% CI 2.9-7.7) were independently associated with an increased long-term risk of major amputation. Thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion was effective. Female gender, ischemic heart disease, anemia, foot ulcer, motor deficit, occluded synthetic bypass graft and failure of thrombolysis were independently associated with an increased risk of major amputation.
In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognit... more In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional use of early warning scoring, structured observation charts, and clinical algorithms for bedside action. A prospective non-randomized controlled study of unexpected in-hospital death before and after implementation of a clinical intervention in a medical and surgical ward setting at an urban Danish university hospital. Information was obtained over three four-month study periods - a pre-interventional one in 2009 (1st March-30th June), and two postinterventional ones in 2010 (1st September-31st December) and 2011 (1st March-30th June). The incidence of unexpected patient death, the primary study outcome, was calculated as the rate of unexpected patient mortality based on in-hospital risk time. The adjusted unexpected patient mortality rate was significantly lower during the second postinterventional study period than before the intervention, 17 versus 61 per 100 adjusted patient years (P=0.013), corresponding to a rate ratio of 0.271 (95% confidence interval (CI) 0.097-0.762). A tendency to reduced unexpected mortality was found during the first postinterventional study period (25 versus 61 per 100 adjusted patient years, P=0.053; rate ratio 0.404, CI 0.161-1.012). Clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart, and an algorithm for bedside management, implemented by interprofessional teaching, training, and optimization of communication and collaboration, may significantly reduce unexpected in-hospital mortality.
To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endopro... more To report contemporary outcomes, and evaluate differences after thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion in patients with lower limb ischemia. Patients undergoing local intra-arterial thrombolysis for lower limb ischemia between 2001 and 2010 were identified in the prospective database for endovascular intervention, and analysis was performed retrospectively. There was an increase in thrombolysis for occluded endoprosthesis and a decrease in thrombolysis for occluded bypasses during the study period (p=0.001). The technical success rate for thrombolysis in occluded endoprosthesis, bypasses and native artery occlusion was 91%, 89% and 73%, respectively. The overall major amputation rate, mortality rate and amputation-free survival rate at 1 year was 19%, 14% and 73%, respectively, without differences between groups. The major amputation rate at long-term was highest, 45%, for patients with occluded synthetic bypass grafts. Female gender (HR 1.7; 95% CI 1.1-2.7), ischemic heart disease (HR 1.8; 95% CI 1.1-2.8), anemia at admission (HR 1.9; 95% CI 1.2-3.0), foot ulcer (HR 4.4; 95% CI 2.4-8.0), motor deficit at admission (HR 2.5; 95% CI 1.4-4.3), occluded synthetic bypass graft (HR 3.3; 95% CI 1.9-5.7) and failure of thrombolysis (HR 4.8; 95% CI 2.9-7.7) were independently associated with an increased long-term risk of major amputation. Thrombolysis for occluded endoprosthesis, bypasses and native artery occlusion was effective. Female gender, ischemic heart disease, anemia, foot ulcer, motor deficit, occluded synthetic bypass graft and failure of thrombolysis were independently associated with an increased risk of major amputation.
In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognit... more In-hospital patients may suffer unexpected death because of suboptimal monitoring. Early recognition of deviating physiological parameters may enable staff to prevent unexpected in-hospital death. The aim of this study was to evaluate short- and long-term effects of systematic interprofessional use of early warning scoring, structured observation charts, and clinical algorithms for bedside action. A prospective non-randomized controlled study of unexpected in-hospital death before and after implementation of a clinical intervention in a medical and surgical ward setting at an urban Danish university hospital. Information was obtained over three four-month study periods - a pre-interventional one in 2009 (1st March-30th June), and two postinterventional ones in 2010 (1st September-31st December) and 2011 (1st March-30th June). The incidence of unexpected patient death, the primary study outcome, was calculated as the rate of unexpected patient mortality based on in-hospital risk time. The adjusted unexpected patient mortality rate was significantly lower during the second postinterventional study period than before the intervention, 17 versus 61 per 100 adjusted patient years (P=0.013), corresponding to a rate ratio of 0.271 (95% confidence interval (CI) 0.097-0.762). A tendency to reduced unexpected mortality was found during the first postinterventional study period (25 versus 61 per 100 adjusted patient years, P=0.053; rate ratio 0.404, CI 0.161-1.012). Clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart, and an algorithm for bedside management, implemented by interprofessional teaching, training, and optimization of communication and collaboration, may significantly reduce unexpected in-hospital mortality.
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