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排序方式: 共有394条查询结果,搜索用时 93 毫秒
1.
Ragnhild B. Wijma Marloes Emous Merel van den Broek Anke Laskewitz Anneke C. Muller Kobold André P. van Beek 《Surgery for obesity and related diseases》2019,15(1):73-81
Background
Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).Objective
We performed a mixed-meal tolerance test in patients after RYGB to address the prevalence of early dumping and to gain further insight into its pathophysiology.Setting
The study was conducted in a regional hospital in the northern part of the Netherlands.Methods
From a random sample of patients who underwent primary RYGB between 2008 and 2011, 46 patients completed the mixed-meal tolerance test. The dumping severity score for early dumping was assessed every 30 minutes. A sum score at 30 or 60 minutes of ≥5 and an incremental score of ≥3 points were defined as indicating a high suspicion of early dumping. Blood samples were collected at baseline, every 10 minutes during the first half hour, and at 60 minutes after the start.Results
The prevalence of a high suspicion of early dumping was 26%. No differences were seen for absolute hematocrit value, inactive glucagon-like peptide-1, and vasoactive intestinal peptide between patients with or without early dumping. Patients at high suspicion of early dumping had higher levels of active glucagon-like peptide-1 and peptide YY.Conclusion
The prevalence of complaints at high suspicion of early dumping in a random population of patients after RYGB is 26% in response to a mixed-meal tolerance test. Postprandial increases in both glucagon-like peptide-1 and peptide YY are associated with symptoms of early dumping, suggesting gut L-cell overactivity in this syndrome. 相似文献2.
Bob C. Mulder Merel A. A. van Lelyveld Sigrid C. J. M. Vervoort Anne Marike Lokhorst Cees M. J. van Woerkum Jan M. Prins 《Health communication》2016,31(1):35-46
Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed. 相似文献
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Herbal remedies generate more than 1.8 billion dollars in annual sales in the United States. Herbal products have been associated with a wide spectrum of hepatic toxicities. With the recent Women's Health Initiative Study demonstrating increased risk of breast cancer and cardiovascular events associated with hormone therapy, many women may resort to herbal remedies for persistent menopause symptoms. We report a case of autoimmune hepatitis likely triggered by the use of black cohosh (Actaea racemosa), an agent marketed to treat menopause symptoms. Given this case report, we recommend close monitoring of women using this herbal preparation. 相似文献
8.
Olga Amann Merel J M Visschers Gerry M Dorrestein Ineke Westerhof J T Lumeij 《Avian pathology》2006,35(1):58-62
Exocrine pancreatic insufficiency (EPI) is a well-studied syndrome in domestic animals. EPI occurs when severe progressive loss of tubulo-acinar tissue from atrophy or inflammatory destruction results in insufficient secretion of digestive enzymes and clinical signs of malabsorption. However, the literature on EPI in birds is limited. The syndrome has been previously described in several cases where the diagnosis was based on clinical signs due to malabsorption-like light-coloured voluminous faeces, voracious appetite, coprophagia and weight loss, and on the response to treatment with pancreatic enzyme formulas. To enable a more scientific approach to the diagnosis of pancreatic functional disorders in pigeons, reference values of plasma amylase (382 to 556 IU/l), lipase (0 to 5 IU/l), and faecal activities of amylase (13 to 16 IU/l) and trypsin (11 to 14 IU/l) were determined in 24 adult pigeons. A case of EPI in a racing pigeon (Columba livia domestica) is reported, based on the clinical signs and the measurement of faecal amylase and trypsin activity. 相似文献
9.
Merel H. Harmel 《Journal of clinical monitoring and computing》1987,3(2):147-153
Summary A little over 40 years ago, anesthesiology in the United States became recognized as a specialty. At that time, its practice was largely that of an art, the science of which was yet to come. A finger on the pulse, observation of color, skin turgor, perspiration, and perhaps a blood pressure cuff in adults, and an estimation of the reflex signs of anesthesia were the standards for the assessment of the patient status and the depth of anesthesia. How far have we come in the intervening years? The journey, as reflected in the experience of one physician, will be held up to the looking-glass; easily as astounding as that through which Alice passed.Caught as we are in the socio-economic climate of the present, how shall we react? Has the gadgetry and electronics of this day given us a meaningful cost-effective handle on a decreased morbidity and mortality? What impact is there on decision-making and outcome? What indeed is the contribution of the machine versus the newer agents, techniques, and the advanced educational milieu.The first attempts at monitoring were clearly directed toward the cardiovascular system. The devices developed were simple and non-invasive. The Riva-rocci method of measuring blood pressure was first applied in anesthesia by Harvey Cushing at the turn of the century. But it was 40 years before the electrocardiogram was introduced as an instrument of potential importance. It took another 25 years for it to have general acceptance, and even later for the anesthesiologist to become comfortable with it as a diagnostic tool. In the early 40s, Peterson, at Pennsylvania, began the applications of invasive blood pressure monitoring for clinical purposes. Subsequently, the use of the central venous catheter, and finally the Swan-Ganz catheter, became acceptable. The application for the technology of cardiac output was a long time in gaining clinical credence. However, this last link surely depended on the computer to make it a clinically useful instrument. The measurement of the cardiovascular system was first, because the means were there.The assessment of respiratory function was more cumbersome, and while the pneumotachygraph was available 40 years ago, its vagaries made it a research tool. Meters for respiration also were available, but too cumbersome for clinical use. The integration of respiratory measurements and blood gas analysis have gone hand-in-hand, the latter far outstripping the former in clinical utility. Shall it be invasive or non-invasive, what is the price? Lastly, our technology has introduced the means for what is a meaningful clinical measurement of neurological and neuromuscular activity. Nerve-muscle stimulators, electromyography, processed electroencephalogram, and the evoked potential as devices for assessment are only the beginning. In all this technological advance there is the black box and the electronic marvels that are part of this age. While invasive techniques surely have a place, the utilization of non-invasive techniques like the measurement of oxygen, carbon dioxide, and all the agents that we employ have changed forever the nature of our practice. Finally, the need to document the anesthesia course objectively will, and has already begun, to impact on our practice. How did we get where we are and where are we going will be explored in this personal journey. 相似文献
10.
Renske M.T. ten Ham Merel van Nuland Rick A. Vreman Laurens G. de Graaf Hilde Rosing André M. Bergman Alwin D.R. Huitema Jos H. Beijnen Anke M. Hövels 《Value in health》2021,24(1):121-128
ObjectivesAbiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (Cmin) of abiraterone. Patients with a plasma Cmin below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone Cmin in patients with mCRPC.MethodsA Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER).ResultsMonitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively.ConclusionsMonitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients. 相似文献