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11.
In multiple clinical trials, patients who received drug-eluting stents instead of plain stents during percutaneous coronary interventions had rates of restenosis that were lower by roughly one half to three fourths, depending on how restenosis was defined and on the population studied. These stents will likely be used more and more as their indications evolve. 相似文献
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Rachel N Manongi Fortunata R Nasuwa Rose Mwangi Hugh Reyburn Anja Poulsen Clare IR Chandler 《Human resources for health》2009,7(1):50
Background
Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. 相似文献14.
The efficacy of removable devices to offload and heal neuropathic plantar forefoot ulcers in people with diabetes: a single‐blinded multicentre randomised controlled trial 下载免费PDF全文
Sicco A Bus Jaap J van Netten Anke IR Kottink Erik A Manning Maximilian Spraul Arend‐Jan Woittiez Jeff G van Baal 《International wound journal》2018,15(1):65-74
Non‐removable offloading is the ‘gold standard’ treatment for neuropathic diabetic plantar forefoot ulcers. However, removable offloading is the common ‘standard of care’. We compared three removable offloading devices for ulcer healing efficacy. In this multicentre, randomised controlled trial, 60 persons with neuropathic diabetic plantar forefoot ulcers were randomly assigned to wear a custom‐made knee‐high cast [BTCC (bivalved TCC)], custom‐made ankle‐high cast shoe or a prefabricated ankle‐high forefoot‐offloading shoe (FOS). Primary outcome was healing at 12 weeks. Dynamic plantar pressures, daily stride count and treatment adherence were assessed on a randomly selected subset (n = 35). According to intention‐to‐treat analysis, 58% of patients healed with BTCC [OR 0·77 (95% CI 0·41–1·45) versus FOS], 60% with cast shoe [OR 0·81 (95% CI 0·44–1·49) versus FOS] and 70% with FOS (P = 0·70). Mean ± SD peak pressure in kPa at the ulcer site was 81 ± 55 for BTCC, 176 ± 80 for cast shoe and 107 ± 52 for FOS (P = 0·005); stride count was 4150 ± 1626, 3514 ± 1380 and 4447 ± 3190, respectively (P = 0·71); percentage of 2‐week intervals that patients wore the device <50% of time was 17·3%, 5·2% and 4·9%, respectively. Non‐significant differences in healing efficacy between the three devices suggest that, when non‐removable offloading is contraindicated or not available, each can be used for plantar forefoot ulcer offloading. Efficacy is lower than previously found for non‐removable offloading maybe because suboptimal adherence and high stride count expose the patient to high repetitive stresses. These factors should be carefully considered in decision making regarding ulcer treatment. 相似文献
15.
Arvind Dubey Wen-Shan Sung Mark Shaya Ravish Patwardhan Brian Willis Donald Smith Anil Nanda 《Surgical neurology》2009,72(4):369-375
BackgroundThe complication of the posterior fossa surgery is seldom described in the literature. The purposes of this retrospective study are to draw attention to the potential complications associated with posterior fossa surgery and to critically review the predisposing factors that might influence the complication rate.MethodsWe undertook a 10-year (1992-2002) retrospective study of all posterior fossa surgery performed at LSUHSC. A total of 500 patients were obtained from the operation database, and they were categorized into 5 groups based on the surgical approaches: (1) cerebellopontine angle lesion, (2) microvascular decompression for facial pain and spasm, (3) cerebellar lesions, (4) Chiari I decompression, and (5) petroclival lesions. Data collected for analysis included patient demographics, pathological characteristics of the lesions, and the postoperative complications that occurred as unexpected and undesirable events that prolonged hospital stay and may require surgical/medical intervention.ResultsOf the 500 patients reviewed, 220 (44%) patients had tumor resections at the cerebellopontine angle; 110 (22%) patients had microvascular decompression for trigeminal neuralgia and hemifacial spasm; 86 (17.2%) patients had cerebellar lesions; 60 (12%) patients had Chiari I decompression; and 24 (4.8%) patients required transpetrosal approaches for petroclival lesions. The overall complication rate in our study was 31.8%, affecting 159 patients. Cerebrospinal fluid leaks were the most frequently encountered, presenting in 65 (13%) patients followed by meningitis in 46 (9.2%) patients, wound infection in 35 (7%) patients, and CN palsies in 24 (4.8%) patients. Other complications that were observed to develop almost exclusively in patients undergoing cerebellar parenchymal tumor resection included cerebellar edema in 25 (5%) patients, hydrocephalus in 23 (4.6%) patients, cerebellar hematoma in 15 (3%) patients, and cerebellar mutism in 6 (1.2%) patients. The overall mortality rate related to surgery was 2.6% occurring in 13 patients.ConclusionPosterior fossa surgery involves greater morbidity and mortality and has a wider variety of complications than surgery in the supratentorial compartment. These complications may be avoided by careful perioperative planning, strict adherence to aseptic technique, meticulous microsurgical dissection, proper wound closure, and the judicious use of prophylactic agent. A thorough understanding of the patient's history, neurological findings, imaging studies, operative anatomy, as well as all potential adverse events associated with the procedure is also essential to minimize complications. 相似文献
16.
Devbhandari MP Jeeji R Bewsher M Odom N 《Interactive Cardiovascular and Thoracic Surgery》2009,8(1):164-165
A 19-year-old primigravida, with a history of mechanical mitral prosthesis at the age of six years following previous repair of an atrioventricular septal defect, presented at 26 weeks' gestation with cardiogenic shock secondary to obstruction of the mitral prosthesis. She underwent successful emergency redo mitral valve replacement and caesarean section. At operation the prosthesis was found to be virtually completely obstructed with pannus. Both mother and baby had an excellent outcome following surgery. The case report is presented with a brief review of the literature. 相似文献
17.
Sudarshan MK Giri MS Mahendra BJ Venkatesh GM Sanjay TV Narayana DH Ravish HS 《Human vaccines》2007,3(3):87-89
Fourteen pregnant women who received rabies post-exposure prophylaxis (PEP) at the anti-rabies clinic (ARC) of Kempegowda Institute of Medical Sciences (KIMS) were followed up for assessing the safety of modern rabies vaccines and equine rabies immunoglobulin (ERIG) in pregnancy. The women were in the age range of 18-28 years, mostly from urban area (64%) and exposed to suspect rabid dogs (86%). They had received purified vero cell rabies vaccine (Verorab = 8 and Abhayrab = 4), purified chick embryo cell vaccine (Rabipur = 2) by Essen regimen; and equine rabies immunoglobulin (Equirab = 7 and Pasteur anti-rabies serum = 1). None of the pregnant women reported any adverse events to either vaccine or equine rabies immunoglobulin. All had safe vaginal deliveries and in all cases both the mother and the child were found to be healthy and normal. 相似文献
18.
IR Makhoul H Abulhija T Smolkin N Shehadeh Z Hochberg 《Acta paediatrica (Oslo, Norway : 1992)》2012,101(11):e496-e499
Aim: A methodological inadequacy in anthropometric measurements of children exists because of an age‐dependent decelerating contribution of the head to body weight (Wt) and height (Ht). Hence, we aimed to assess the contribution of head measurements to anthropometry (Ht, Wt and BMI) in healthy prepubertal children. Methods: This prospective study was conducted in 300 2‐ to 9‐year‐old typically growing children. Head‐excluded (HE) Ht was determined by a stadiometer that measured the distance from the foot plate to the lower margin of protuberance occipitalis externa. Head’s weight was calculated from the head volume using three different measurements of the head circumference. Results: In the typically growing children, the HE/standard (STD) ratios for Wt and Ht increased significantly with age (p < 0.001 for both), but the HE/STD ratio for BMI did not increase with age. Conclusion: Measurement of body Wt and Ht while excluding the head’s Wt and Ht provides a new dimension to standard anthropometry by eliminating the age‐dependent head bias with its unique pattern of growth and minimal adipose tissue. 相似文献
19.
Andrew IR Maas 《Critical care (London, England)》2009,13(6):1016-2
Great variability exists in data collection and coding of variables in studies on traumatic brain injury (TBI). This confounds
comparison of results and analysis of data across studies. The difficulties in performing a meta-analysis of individual patient
data were recently illustrated in the IMPACT project (International Mission on Prognosis and Clinical Trial Design in TBI):
merging data from 11 studies involved over 10 person years of work. However, these studies did confirm the great potential
for advancing the field by this approach. Although randomized controlled trials remain the prime approach for investigating
treatment effects, these can never address the many uncertainties concerning multiple treatment modalities in TBI. Pooling
data from different studies may provide the best possible source of evidence we can get in a cost efficient way. Standardisation
of data collection and coding is essential to this purpose. Recommendations hereto have been proposed by an interagency initiative
in the US. These proposals deserve to be taken forward at an international level. This initiative may well constitute one
of the most important steps forwards, paving the road for harvesting successful results in the near future. 相似文献
20.