Are there accurate predictors of long-term vital and functional outcomes in cardiac surgical patients requiring prolonged intensive care?

BACKGROUND AND OBJECTIVE: The decision to maintain intensive treatment in cardiac surgical patients with poor initial outcome is mostly based on individual experience. The risk scoring systems used in cardiac surgery have no prognostic value for individuals. This study aims to assess (a) factors possibly related to poor survival and functional outcomes in cardiac surgery patients requiring prolonged (> or = 5 days) intensive care unit (ICU) treatment, (b) conditions in which treatment withdrawal might be justified, and (c) the patient's perception of the benefits and drawbacks of long intensive treatments. METHODS: The computerized data prospectively recorded for every patient in the intensive care unit over a 3-year period were reviewed and analyzed (n=1859). Survival and quality of life (QOL) outcomes were determined in all patients having required > or =5 consecutive days of intensive treatment (n=194/10.4%). Long-term survivors were interviewed at yearly intervals in a standardized manner and quality of life was assessed using the dependency score of Karnofsky. No interventions or treatments were given, withhold, or withdrawn as part of this study. RESULTS: In-hospital, 1-, and 3-year cumulative survival rates reached 91.3%, 85.6%, and 75.1%, respectively. Quality of life assessed 1 year postoperatively by the score of Karnofsky was good in 119/165 patients, fair in 32 and poor in 14. Multivariate logistic regression analysis of 19 potential predictors of poor outcome identified dialysis as the sole factor significantly (p=0.027) - albeit moderately - reducing long-term survival, and sustained neurological deficit as an inconstant predictor of poor functional outcome (p=0.028). One year postoperatively 0.63% of patients still reminded of severe suffering in the intensive station and 20% of discomfort. Only 7.7% of patients would definitely refuse redo surgery. CONCLUSIONS: This study of cardiac surgical patients requiring > or =5 days of intensive treatment did not identify factors unequivocally justifying early treatment limitation in individuals. It found that 1-year mortality and disability rates can be maintained at a low level in this subset of patients, and that severe suffering in the ICU is infrequent.

The year-long unprecedented European heat and drought of 1540 – a worst case

The heat waves of 2003 in Western Europe and 2010 in Russia, commonly labelled as rare climatic anomalies outside of previous experience, are often taken as harbingers of more frequent extremes in the global warming-influenced future. However, a recent reconstruction of spring–summer temperatures for WE resulted in the likelihood of significantly higher temperatures in 1540. In order to check the plausibility of this result we investigated the severity of the 1540 drought by putting forward the argument of the known soil desiccation-temperature feedback. Based on more than 300 first-hand documentary weather report sources originating from an area of 2 to 3 million km2, we show that Europe was affected by an unprecedented 11-month-long Megadrought. The estimated number of precipitation days and precipitation amount for Central and Western Europe in 1540 is significantly lower than the 100-year minima of the instrumental measurement period for spring, summer and autumn. This result is supported by independent documentary evidence about extremely low river flows and Europe-wide wild-, forest- and settlement fires. We found that an event of this severity cannot be simulated by state-of-the-art climate models.

Die Schulregeln der hebräischen Grammatik : nach den Ergebnissen der neueren Sprachwissenschaft zum Memorieren und Repetieren

bearb. von Karl Ludwig

Kurzer Lehrgang der hebräischen Sprache : ein Elementarbuch

von Karl Ludwig

Zur Propaganda der national-konstitutionellen Partei

Boberach: Auf der Grundlage des Gothaer Programms sollen sich die nationalkonstitutionellen Kräfte vereinigen, um durch die im Dreikönigsbündnis vorgesehenen Institutionen gegen Konservative und Demokraten auf dem Weg der Reform doch noch einen freiheitlich kleindeutschen Staat zu schaffen. Ein zentraler Reichsverein soll den Wahlkampf führen und in der Presse, u.a. durch eine Pressekorrespondenz, für die Ziele der Partei wirken. Das Dreiklassenwahlrecht wird zwar abgelehnt, trotzdem aber zur Beteiligung an den Wahlen für das preußische Abgeordnetenhaus wegen der Folgen für die Bildung des Staatenhauses aufgerufen

Ein Mensch und sein Denkmal : (aus der "Voss. Ztg." vom 12. Dezember 1901)

Karl Emil Franzos

Allerlei Jüdisches

Karl Emil Franzos

Die Juden in China

Karl von Scherzer

Die gegner der zweiten schlesischen schule,

Disbound Original Held in Oak Street Library Facility.

Elements of banking /

Mode of access: Internet.

Cornelius Tacitus /

1. bd. Ab excessu divi Augusti I-VI (2nd ed.).--2. bd. Ab excessu divi Augusti XI-XVI.

Aufsätze literarhistorischen und biographischen Inhalts /

Introduction signed 1911.

Die geographische verbreitung der thiere.

Mode of access: Internet.

Die geographische verbreitung der thiere.

Mode of access: Internet.

Die geographische verbreitung der thiere.

Mode of access: Internet.