استاد راهنما: دکتر نوروزی

: نوروزی دکتر راهنما استاد

: حیدری الهام دهنده ارائه

Relationship of Vitamin D Deficiency to Clinical Outcomes in

Critically Ill Patients

Title

Topic

• Study identification (Include author, title, year of publication, journal title, pages)

• Author: David M.; Paul E; Kelly M; Stefan H; Alexandra J; and Daren K.• Title:Relationship of Vitamin D Deficiency to Clinical Outcomes in• Critically Ill Patients.• year of publication: November 2012. • journal title:American Society for Parenteral and Enteral Nutrition

(aspen).• Pages:713-720.

4

• Background

• Objective

• Method and material

• Result

• Discussion

• Critical appraisal

کلسترولی D ویتامین • ساختمان

D ویتامینویتامین • سرمی وضع#یت در ای منطقه های . Dتفاوت دارد نقش• , , فرابنفش تابش سطوح جغرافیایی شرایط خورشید نور با مواجهه در تفاوت

, ویتامین, وضعیت بر گذار تاثیر مهم موارد جمله از پوستی Dپیگمانتاسیون. باشند می

Lucas et al 2005

ویتامین • کمبود مشهد Dشیوع بیان% 61/3در. است شده

Heshmat et al 2008

8

• Background

• Objective


• Result

• Discussion


Objective

• The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes.

• We confirm in this study that vitamin D deficiency is common population and is associated with a longer ICU length of stay, may increase the risk of ICU-acquired infections and pneumonia, and may be associated with elevated organ failure scores.

1

2

3 4

10

• Background

• Objective


• Result

• Discussion


Method and material

• The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital.

Sample size

Method and material

•blood sample collection daily for a maximum of 10 days1

•Serum samples were also collected and stored at −80°C prior to analysis2

•They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed

patients prospectively for 28-day outcomes3

Inclusion criteria

• What criteria are used to decide who should be INCLUDED in the study?

• The inclusion criteria of the patients included all consecutive patients 18 years and older who were expected to stay more than 24 hours in the ICU and were enrolled within the first 24 hours of ICU admission.

Exclusion criteria

• What criteria are used to decide who should be EXCLUDED from the study?

• Only patients admitted for overdoses were excluded from• the study.

15

• Background

• Objective


• Result

• Discussion


Result

• Of analyzable patients: 50 (26%) were deficient (≤30 nmol/L) . 109 (56%) were insufficient (>30 and ≤60 nmol/L). • 1) Baseline 25(OH)D levels decreased significantly

in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001).

• 2)25(OH)D status was not significantly associated with 28-day all-cause mortality.

Result

• 3)Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge.

• 4)25(OH)D-deficient patients showed a non statistically significant trend toward a higher infection rate compared with patients with sufficient levels of 25(OH)D.

18

• Background

• Objective


• Result

• Discussion


Discussion

vitamin D deficiency

effect on longer ICU length of stay, ICU-acquired infections , pneumonia

and organ failure scores

The earlier studies

Lee P, (2009)

The earlier studies

Mata-Granados JM, (2010)

22

• Background

• Objective


• Result

• Discussion


Critical appraisal

• Topic• Abstract• Introduction • Method and material• Result• Discussion• Conclusion • References

Topic

Relationship of Vitamin D Deficiency to Clinical Outcomes inCritically Ill Patients

DirectUse simple language

ConciseMemorableInformative

Topic

• Study identification (Include author, title, year of publication, journal title, pages)

• Author: David M.; Paul E; Kelly M; Stefan H; Alexandra J; and Daren K.• Title:Relationship of Vitamin D Deficiency to Clinical Outcomes in• Critically Ill Patients.• year of publication: November 2012. • journal title:American Society for Parenteral and Enteral Nutrition

(aspen).• Pages:713-720.

Critical appraisal


Abstract

Brief Structured:

-Back ground-Objective -Method-Result (specific data, statistically significant) -Conclusion-Keywords

objective

Critical appraisal

• Topic• Abstract• Introduction • Method and material• Result• Discussion• Conclusion • Acknowledgment• References

Introduction

• The reasons• The earlier studies• Objective

The reasons

The earlier studies

Lee P, (2009)

The earlier studies


Objective

• The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes.

• We confirm in this study that vitamin D deficiency is common population and is associated with a longer ICU length of stay, may increase the risk of ICU-acquired infections and pneumonia, and may be associated with elevated organ failure scores.

1

2

3 4

Critical appraisal


Method and material

• Sample size• Type of study• Exclusion criteria• Inclusion criteria• testimonial• Method and material• Statistical analysis

Sample size

samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital.

اشاره • نمونه حجم تعیین روش به. است نشده

Method and material


Cohort

Type of study

prospective study

Method and material


Exclusion criteria

• What criteria are used to decide who should be EXCLUDED from the study?

• Only patients admitted for overdoses vitamin D were excluded from

the study.

Method and material


Inclusion criteria

• What criteria are used to decide who should be INCLUDED in the study?

• The inclusion criteria of the patients included all consecutive patients 18 years and older who were expected to stay more than 24 hours in the ICU and were enrolled within the first 24 hours of ICU admission.

Method and material


Testimonial

Research ethics boards from Queen’s Universityapproved the protocol for the original study; informed consent was obtained from next of kin before enrollment.

Method and material


Method and material

•blood sample collection daily for a maximum of 10 days1

•Serum samples were also collected and stored at −80°C prior to analysis2

•They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed

patients prospectively for 28-day outcomes3

Method and material


STATISTICAL ANALYSIS

• The Student t test was used to compare the means of baseline 25(OH)D between patients with and without pneumonia.

STATISTICAL ANALYSIS

Critical appraisal


Result

Brief and organized

Consist of :

• words

• table

• statistics

words

table

statistics

words

Result

Result

Critical appraisal


Discussion

مطالعه • شرایط از ای خالصهقدیم • های یافته بر مروریمطالعه • نقصهای و محدودیتهازمینه • این در بعدی مطالعات مورد در پیشهاد

مطالعه شرایط از ای خالصه

قدیم های یافته بر مروری

Lee P, (2009)

قدیم های یافته بر مروری


مطالعه نقصهای و محدودیتها 12

مطالعه نقصهای و محدودیتها3

مطالعه نقصهای و محدودیتها

مطالعه نقصهای و محدودیتها

Discussionبعدی • های مطالعه مورد در پیشنهاد

شود داده زمینه :دراین

Critical appraisal


Conclusion

Thanks for your attention

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استاد راهنما: دکتر نوروزی