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Gudrun Aspelund Elaa M Mahdi David H Rothstein Derek S Wakeman 《Journal of gastroenterology and hepatology》2019,34(6):966-974
Choledochal cysts (CDCs) and biliary atresia (BA) are rare pediatric hepatobiliary anomalies that require surgical intervention due to increased risk of malignancy and liver failure, respectively. The underlying disease and operative procedures place patients at risk for long‐term complications, which may continue to affect them into adulthood. Lack of a transitional care model in the health‐care system potentiates the challenges they will face following aging out of their pediatric providers' care. We sought to elucidate the long‐term complications and challenges patients with CDCs and BA face, review the current literature regarding transitioning care, and propose guidelines aiding adult providers in continued care and surveillance of these patients. A literature review was performed to assess short‐term and long‐term complications after surgery and the current standards for transitioning care in patients with a history of CDCs and BA. While transitional programs exist for patients with other gastrointestinal diseases, there are few that focus on CDCs or BA. Generally, authors encourage medical record transmission from pediatric to adult providers, ensuring accuracy of information and compliance with treatment plans. Patients with CDCs are at risk for developing biliary malignancies, cholangitis, and anastomotic strictures after resection. Patients with BA develop progressive liver failure, necessitating transplantation. There are no consensus guidelines regarding timing of follow up for these patients. Based on the best available evidence, we propose a schema for long‐term surveillance. 相似文献
3.
Benedikt W. Burkhardt Andreas Simgen Matthias Dehnen Gudrun Wagenpfeil Wolfgang Reith Joachim M. Oertel 《The spine journal》2019,19(4):587-596
BACKGROUND CONTEXT
Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear.PURPOSE
To assess whether CP accelerates the degeneration of the adjacent and adjoining segments.STUDY DESIGN/SETTING
This is an imaging cohort study.PATIENT SAMPLE
Retrospectively, a total of 84 patients who underwent ACDF or ACDF+CP were identified. At final follow-up, an MRI was performed and evaluated in this study.MATERIALS AND METHODS
An MRI of 84 patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed. The mean follow-up was 24 years (17–45 years). None of the patients had a repeat procedure in the cervical spine. The grade of degeneration of the segments adjacent and adjoining to the fusion was assessed via a five-step grading system (segmental degeneration index, or SDI) that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis. Furthermore, the disc height (DH) and sagittal segmental angle (SSA) of fused segments were measured.RESULTS
A significantly (p<.001) greater SDI was identified at the caudal adjacent segment following ACDF compared to ACDF+CP. No other significant differences were identified in patients following ACDF and ACDF+CP. Between 50% and 96% of all segments showed severe degenerative changes according to SDI. There was no significant difference in DH between the patients following ACDF and ACDF+CP. The SSA in patients who underwent ACDF+CP was significantly greater than in the ACDF patients (p=.002).CONCLUSIONS
In this cohort of patients, cervical plating had no significant impact on segmental degeneration and decrease of DH in the adjacent and adjoining segments. ACDF+CP seem to preserve the lordotic alignment more with respect to the SSA than ACDF. 相似文献4.
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Interprofessional collaboration and communication in nursing homes: a qualitative exploration of problems in medical care for nursing home residents – study protocol 下载免费PDF全文
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Runar Vilhjalmsson PhD Gudrun Gudmundsdottir RN MSc 《Scandinavian journal of caring sciences》2014,28(2):273-280
The study focuses on use of different healthcare providers in connection with elevated levels of psychological distress. The study used a prospective design based on two waves of a national health survey. Participants were Icelandic citizens, age 18–75, randomly drawn from the National Register (N = 1592). Distressed individuals chose a wide range of providers. The choice of provider was based in part on the type of distress experienced, although most individuals turned to the general medical sector. Psychophysiological symptoms were primarily related to visiting physicians (other than psychiatrists). Depression was related to visiting psychiatrists, and anxiety was related to visiting psychiatrists, psychologists and nurses. Anger/aggression was primarily related to visiting clergy. Between 10% and 16% of distressed individuals did not receive any help from the formal healthcare system within 1 year. Studies addressing professional help‐seeking for psychological distress should closely consider the various factors facilitating and hampering use of health services for different forms of distress. 相似文献
8.
Andy?K.?S.?Yeo Annette?B?Ahrberg Jan?D.?Theopold Sebastian?Ewens Gudrun?Borte Christoph?Josten Johannes?K.?M.?FaklerEmail author 《Patient safety in surgery》2015,9(1):39
Background
Radiographic parameters and indices obtained from hip x-rays are a potential tool to promptly estimate bone quality in elderly hip fracture patients. Preoperative decision in whether to use cemented or cement augmented implants might be supported by this information and thus improve patient safety. Subsequently, this study was conducted to evaluate radiographic parameters as a prescreening tool for bone quality.Methods
A retrospective analysis of 112 elderly patients with a femoral neck fracture after low-energy trauma was performed (81 % female, 19 % male). Three radiological indices were calculated on hip x-rays: cortical index antero-posterior CTI (ap), cortical index lateral CTI (lat) and canal to calcar ratio CCR. These indices were analyzed for correlations with DXA T-Scores and serum 25-hydroxyvitamin D (25(OH)D) using the Spearman test.Results
Median age of patients was 80 (IQR 72–86) years. A linear correlation was found for CTI (lat) and T-Score at the total hip (p?<?0.001, r?=?0.589), femoral neck (p?=?0.005, r?=?0.405) and the lumbar spine (p?=?0.002, r?=?0.299). A significant correlation was also indicated between CTI (lat) and 25(OH)D (p?=?0.002, r?=?0.293). CTI (lat) at a cut-off level of 0.4 showed a sensitivity of 79 % and a specificity of 56 % in predicting a T-score?≤??2.5 at the total hip. Gender specific analysis revealed a higher sensitivity (100 %) and specificity (73 %) of CTI (lat) at a cut-off level of 0.4 for men. For severe vitamin D deficiency (<10 ng/ml) sensitivity and specificity were 75 % and 65 %.Conclusion
Radiographic indices as the CTI (lat) exhibit a direct correlation to BMD and serum 25OH vitamin D levels. A CTI (lat) cut-off level of 0.4 is recommended for identifying patients at risk of osteoporosis expressed by T-Scores?≤??2.5 and severe vitamin D deficiency.9.
10.
Abstract . Traumatization of oral hard and soft tissues connected with mechanical oral hygiene procedures has been reported in the dental literature. Definitions, classifications and localization of such lesions are listed, and in vivo and in vitro experiments within the field are reviewed. Existing literature suggests that hard tissue lesions are mainly due to abrasives in dentifrices, whereas gingival lesions may be caused by toothbrushing per se. Factual knowledge about the prevalence, severity and critical significance, as well as relevant and reliable experiments, is scarce and further research on these topics seems to be indicated. 相似文献