共查询到20条相似文献，搜索用时 31 毫秒
1.
Jana L. Wardian Joshua Tate Irene Folaron Sky Graybill Mark True Tom Sauerwein 《Patient education and counseling》2018,101(8):1490-1495
Objective
We hypothesized that diabetes-related distress would vary by type of diabetes and medication regimen [Type 1 diabetes (T1DM), Type 2 diabetes with insulin use (T2DM-i), Type 2 diabetes without insulin use (T2DM)]. Thus, the aim of this study was to identify groups with elevated diabetes-related distress.Methods
We administered the 17-item Diabetes-related Distress Scale (DDS-17) to 585 patients. We collected demographics, medications, and lab results from patient records.Results
Patients were categorized by type of diabetes and medication: T1DM (n?=?149); T2DM-i (n?=?333); and T2DM (n?=?103). ANOVA revealed significant differences in sample characteristics. ANCOVA were conducted on all four DDS-17 domains [Emotional Burden (EB); Physician-related Distress (PD); Regimen-related Distress (RD); and Interpersonal Distress (ID)]; covariates included in the models were sex, age, duration of diabetes, BMI, and HbA1c. EB was significantly lower in T1DM than T2DM-i, p?<?0.05. In addition, RD was significantly lower in T1DM than either T2DM-i, p?<?0.05 and T2DM, p?<?0.05.Conclusions
EB and RD are higher for those with type 2 diabetes. Thus, interventions to reduce EB and RD need to be considered for patients with type 2 diabetes.Implications
DDS-17 is useful in identifying diabetes-related distress in patients with diabetes. Efforts need to be made to reduce EB and RD. 相似文献2.
Joe Jabbour Haryana M. Dhillon Heather L. Shepherd Puma Sundaresan Chris Milross Jonathan R. Clark 《Patient education and counseling》2018,101(10):1736-1740
Objective
Is there a relationship between decision-making preferences and psychological distress?Methods
Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire.Results
Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p?<?0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p?=?0.024) and gender (OR 1.4 for female, p?=?0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0–28). Significant predictors of psychological distress were age (p?<?0.001), gender (p?<?0.001), primary site (p?<?0.01), and decision preference (p?<?0.01).Conclusion
HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females.Practice implications
: Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support. 相似文献3.
Ola A. Harb Mariem A. Elfeky Basant Sh El Shafaay Heba F. Taha Gamal Osman Ibtsam Shehta Harera Loay M. Gertallah Doaa Metwaly Abdelmonem Ahmed Embaby 《Pathophysiology》2018,25(4):335-345
Background
Clear cell renal cell carcinoma (cc-RCC), is a serious cancer regarding; its fatality, liability for metastases and chemoresistance, so identification of recent therapeutic targets to improve the patients prognosis is needed. SPOP is a BTB/POZ domain containing speckle-type POZ protein, has been identified as an E3 ubiquitin ligase component. ZEB1 is an essential epithelial mesenchymal transition (EMT) activator; E-cadherin is a cell adhesion protein that had been detected in normal epithelial cells membrane.Aim
Was to assess the tissue protein markers SPOP, ZEB1 & E-cadherin expressions in benign areas of neoplastic kidney specimens and in cc-RCC patients, then correlating their expression levels with patients clinicopathological and prognostic data.Methods
We evaluated SPOP, ZEB-1 & E-cadherin expression using immunohistochemistry in samples from 50 cc-RCC and 20 benign areas of neoplastic kidney specimens, then we followed our patients for 5 years and finally we have analyzed correlations between the levels of markers expressions with patients clinicopathological and prognostic criteria in cc-RCC.Results
Positive expression of SPOP & ZEB1 in addition to negative E- cadherin expression was detected in cc-RCC more than benign areas of neoplastic kidney specimens (p?=?0.004 and p?<?0.001 respectively). In cc-RCC Positive expression of SPOP, ZEB1 and negative E- cadherin expression was associated with higher grade (p?=?0.006, 0.007 & <0.001 respectively), advanced AJCC stage (p?=?0.013, 0.023 & <0.001 respectively), presence of L.N metastases (p?=?0.002?=?0.010 and <0.001 respectively), distant metastases (p?=?0.001, 0.003 & 0.035 respectively), poor PFS and OS rates (p?<?0.001 and p?=?0.013 respectively).Conclusion
Positive expression of SPOP& ZEB1 in addition to negative E- cadherin are associated with poor prognosis in cc-RCC patients. 相似文献4.
Haochang Hu Cong Zhou Bin Li Yanfei Chen Jie Dai Yiyi Mao Tianyi Huang Hang Yu Min Chen Jun Zhao Shiwei Duan 《Pathology, research and practice》2018,214(10):1572-1578
Purpose
Ras association domain family 1 isoform A (RASSF1A), a member of Ras association domain family, plays an important role in tumorigenesis. The goal of our meta-analysis was to assess the diagnostic value of RASSF1A hypermethylation in colorectal cancer (CRC).Methods
PubMed, Embase, CNKI and Wanfang databases were used to conduct literature selection. The association between RASSF1A methylation and CRC risk was evaluated by odds ratios (ORs) and 95% confidence intervals (CIs). Summary receiver operating characteristics (SROC) test was used to estimate the diagnostic value of RASSF1A methylation for CRC.Results
A total of 22 articles among 1736 CRC and 811 non-tumor samples were included in the current meta-analysis. Our results showed that RASSF1A hypermethylation was found more frequently in CRC than non-tumor samples (OR?=?6.02, 95% CI?=?4.57–7.93, P?<? 0.001). Our SROC test showed that RASSF1A hypermethylation had an area under the curve (AUC) of 0.71 with a pooled sensitivity of 0.33 (95% CI?=?0.31–0.36), a pooled specificity of 0.86 (95% CI?=?0.84–0.89), a positive-likelihood ratio of 3.18 (95% CI?=?1.99–5.09), a negative-likelihood ratio of 0.71 (95% CI?=?0.63–0.80), and a diagnostic odds ratio of 5.53 (95% CI?=?3.40–9.00). Data mining study indicated that a trend of increased RASSF1A expression was found in the CRC cell line C2C12 after 5-AZA treatment.Conclusions
Our study established that RASSF1A hypermethylation might have a potential value in the clinical diagnosis of CRC. 相似文献5.
Fani Karagianni Agapi Kataki Eythymios Koniaris Sotirios Karamagkiolas Anastasia Derventzi Evangelos Giotakis Manousos Konstandoulakis George Zografos Ioannis Giotakis 《Pathology, research and practice》2018,214(12):2004-2010
Background
Nasal polyposis (NP) and sinonasal inverted papillomas (SIP) are considered benign lesions capable of recurrence or malignant transformation although not with the same prevalence. Since fluctuations of Caveolin-1 and Notch-1 proteins expression have been reported in many pathologies, the current study aimed to investigate their involvement in the epithelial transformation observed in SIPs compared to NP.Methods
Immunohistochemical expression of Caveolin-1 and Notch-1 proteins was assessed in 104 patients with sinonasal lesions (45 NP, 45 SIP and 14 NP with SIP), semiquantively (percentage times intensity). Proteins expression profiles were evaluated statistically for their correlation with patients demographic and clinicopathological variables (grade of dysplasia, inflammation, recurrence) as well as with markers of proliferation (Ki67) and apoptosis (7-AAD) as determined by flow cytometry analysis.Results
SIP lesions presented increased Caveolin-1 immunopositivity compared to NP (62.2%, vs 40.9%; p?=?0.045). Cytoplasmic staining was observed only in epithelium’s basal and suprabasal layers. Caveolin-1 positivity was not related to Ki67 expression, apoptosis, inflammation or dysplasia, eventhough 81.8% of highly immunopositive lesions were dysplastic (p?=?0.03). Also, smokers presented significantly increased immunopositivy (p?=?0.03). In contrast SIP lesions presented reduced Notch-1 expression compared to NP (68.9% vs 100%; p?<?0.001). Dysplastic lesions presented low Notch-1 immunopositivity (p?<?0.001). Enhancement of Notch-1 gene expression was also associated with inflammation.Conclusions
The herein presented data suggest that the expression profiles of Caveolin-1 and Notch-1 proteins in sinonasal pathologies are distinctive and that could be explored as potential targets for the development of alternative therapeutic approaches. 相似文献6.
7.
Silas Antonio Juvencio de Freitas Filho João Paulo Silva Servato Rodrigo Tavares de Sá Carla Silva Siqueira Paulo Rogério de Faria Adriano Mota Loyola Sérgio Vitorino Cardoso 《Pathology, research and practice》2018,214(6):876-880
Objective
Histones regulate chromatin density and therefore influence gene expression and cellular proliferation. These properties are modified by methylation, acetylation and phosphorylation of histones. The aim of this study was to investigate the variation of specific modified histones in actinic cheilitis (AC) and squamous cell carcinoma of the lip (SCCL).Methods
Samples of non-neoplastic tissue of the lip (NNTL, n?=?9), AC (n?=?33), and SCCL (n?=?27) were submitted to immunohistochemistry to detect the modified histones H3K36me3, H3K9ac, H4K12ac, and H3S10?ph.Results
Reactivity for all of the modified histones was significantly decreased from NNTL to AC, but not from AC to SCCL. Dysplasia in AC or histological grade in SCCL were not related to the reactivity of any modified histones.Conclusions
Histone modifications are related to initial actinic damage, but not to malignant transformation in the lip. 相似文献8.
Vincent Kalumire Cubaka Michael Schriver Peter Vedsted Gregory Makoul Per Kallestrup 《Patient education and counseling》2018,101(9):1601-1610
Objective
To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda.Methods
After selection, translation and piloting of the measure, structural validity, test-retest reliability, and differential item functioning were assessed.Results
Identification and adaptation: The 14-item Communication Assessment Tool (CAT) was selected and adapted.Validity and reliability testing
Content validation found all items highly relevant in the local context except two, which were retained upon understanding the reasoning applied by patients. Eleven providers and 291 patients were involved in the field-testing. Confirmatory factor analysis showed a good fit for the original one factor model. Test-retest reliability assessment revealed a mean quadratic weighted Kappa?=?0.81 (range: 0.69–0.89, N?=?57). The average proportion of excellent scores was 15.7% (SD: 24.7, range: 9.9–21.8%, N?=?180). Differential item functioning was not observed except for item 1, which focuses on greetings, for age groups (p?=?0.02, N?=?180).Conclusion
The Kinyarwanda version of CAT (K-CAT) is a reliable and valid patient-reported measure of providers’ communication and interpersonal skills. K-CAT was validated on nurses and its use on other types of providers may require further validation.Practice implication
K-CAT is expected to be a valuable feedback tool for providers in practice and in training. 相似文献9.
Kamuran Ibis Sezer Saglam Esra Kaytan Saglam Pinar Firat Dilek Yilmazbayhan Alper Toker Berker Ozkan Veysel S. Hancer Murat Buyukdogan Rian Disci Kezban Nur Pilanci 《Pathology, research and practice》2018,214(9):1291-1296
Background
To assess the prognostic importance of carbonic anhydrase IX (CA IX), a hypoxic biomarker, after neoadjuvant treatment in Stage III non-small cell lung cancer (NSCLC) patients.Methods
Tissue CA IX expression was examined after surgical resection in 77 patients who had undergone neoadjuvant treatment. The effects of CA IX overexpression and other clinical factors on disease-free survival and overall survival were investigated.Results
In multivariate analysis, number of neoadjuvant chemotherapy (CT) courses and gender emerged as significant independent predictors for disease-free survival, where administration of 2–3 courses of neoadjuvant chemotherapy (CT) (HR, 3.2 [95% CI 1.3–7.6], p?=?0.009) and female gender were associated with poor survival (HR, 3.2 [95% CI 1.3–7.7], p?=?0.009). The only significant independent predictor for overall survival was recurrence (HR, 5.6 [95% CI 2.4–12.8], p?<?0.001). On the other hand, CA IX overexpression was not associated with disease free survival (p?=?0.560) or overall survival (p?=?0.799).Discussion
Our results do not suggest a prognostic role for CA IX overexpression in stage III NSCLC patients who received neoadjuvant treatment. 相似文献10.
Karin Meng Andrea Reusch Gunda Musekamp Bettina Seekatz Bettina Zietz Gero Steimann Robert Altstidl Günter Haug Ulrike Worringen Hermann Faller 《Patient education and counseling》2018,101(9):1630-1638
Objective
To evaluate generic self-management modules (SelMa) as an adjunct to disease-specific educational programs during inpatient medical rehabilitation.Methods
A bi-center cluster-randomized controlled trial with 698 patients with coronary artery disease, metabolic syndrome, or inflammatory bowel disease was conducted. We compared two versions of SelMa, a group with 3?h or a lecture with 1?h, respectively, in addition to disease-related patient education, to usual care (only disease-related education). SelMa aims at providing skills that may help implementing health behavior. The primary outcomes were goal setting and behavior planning at discharge and goal attainment and health behavior at 6- and 12-months follow-up. Secondary outcomes included motivation, knowledge and self-management competences.Results
At discharge, SelMa group, but not SelMa lecture, proved superior to usual care regarding goal setting (p?=?0.007, d?=?0.26), but not behavior planning (p?=?0.37, d?=?0.09). Significant effects were also observed on several secondary outcomes. At later follow-up, however, no effects on primary outcomes emerged. Participants’ satisfaction was higher in the group than the lecture format.Conclusions
These short modules did not succeed in improving self-management skills in the long-term.Practice implications
A self-management group may foster self-management skills in short term. Interventions should be developed to increase sustainability of effects. 相似文献11.
Tomasz Powrózek Radosław Mlak Marcin Dziedzic Teresa Małecka-Massalska Dariusz Sagan 《Pathology, research and practice》2018,214(3):368-373
Introduction
MicroRNA (miRNA) are attractive markers of lung cancer, due to their regulatory role in cell cycle. However, we know more about function of miRNA in cancer development, there is still little known about role of their precursors (primary miRNA; pri-miRNA) in tumorgenesis. In present study we investigated potential role of miRNA-944 and its precursor pri-miRNA-944 in development of squamous-cell lung cancer (SCC) and explored interdependence between miRNA precursor and its mature form. This is a first available literature report analyzing pri-miRNA as a cancer diagnostic marker.Material and methods
Expression of miRNA-944 and its precursor was analyzed in 58 fresh-frozen tissues of non-small cell lung cancer and corresponding adjacent non-cancerous tissues using qRT-PCR. Expression of pri-miRNA-944 was correlated with TP63 and miRNA-944. Using ROC analysis diagnostic accuracy of studied markers was evaluated.Results
miRNA-944 and its precursor were significantly overexspressed in SCC compared to adenocarcinoma (AC) and non-cancerous tissue. pri-miRNA-944 strongly and positively correlated with TP63 (r?=?0.739, p?<?0.001) and with mature miRNA-944 expression (r?=?0.691, p?<?0.001). Also, TP63 expression significantly correlated with mature miRNA (r?=?0.785, p?<?0.001). Combined analysis of pri-miRNA-944 and mature miRNA-944 allowed to distinguish SCC tissue form AC with sensitivity of 93.3% and specificity of 100% (AUC?=?0.978), and SCC from non-cancerous tissue with 92.9% sensitivity and 100% specificity (AUC?=?0.992).Conclusion
We assumed that pri-miRNA-944 and miRNA-944 may be involved in early squamous-type differentiation of lung tumors. Moreover, analysis of both markers provided high diagnostic accuracy for SCC detection. 相似文献12.
Linda Sommese Rossella Paolillo Francesco Cacciatore Vincenzo Grimaldi Chiara Sabia Antonella Esposito Antonio Sorriento Carmela Iannone Nicolò Rupealta Gerardo Sarno Michele Santangelo Paride De Rosa Gianfranco Nicoletti Claudio Napoli 《Advances in medical sciences》2018,63(2):317-322
Purpose
Human leukocyte antigen (HLA)-G is a non-classic major histocompatibility complex HLA class I molecule. HLA-G may have tolerogenic properties which are linked to epigenetic-sensitive pathways. There is a correlation of sHLA-G levels and graft acceptance in transplantation studies. There are previous data on correlation of sHLA-G with graft rejection as well as with viral infections such as hepatitis C virus (HCV) in kidney transplanted patients. Here, we report the sHLA-G expression in patients on the waiting list for kidney transplantation, with and without anti-HCV compared to a control group.Methods
Serum of 67 patients on the waiting list for kidney transplantation (n?=?43 with anti-HCV and n?=?24 without anti-HCV) was analyzed. Among these patients, n?=?39 were on the waiting list for the first transplantation, while n?=?28 were patients who returned in the list. The control group included n?=?23 blood donors with anti-HCV (n?=?13) and without anti-HCV (n?=?10).Results
The expression of sHLA-G was significantly lower in the control group (39.6?±?34.1 U/ml) compared to both - patients on the waiting list for the first transplantation (62.5?±?42.4 U/ml, p=0.031) and patients who returned in the list (76.7?±?53.9 U/ml, p=0.006). No significant differences were observed in all anti-HCV positive groups. A positive linear correlation between sHLA-G and TNF-α, and patient age was observed.Conclusions
Serum sHLA-G values were significantly increased in both - patients on the waiting list for the first transplantation and patients who returned in the list, as compared to control group. Our findings confirm the key tolerogenic role of sHLA-G levels as epigenetic-related marker for measuring the state of kidney allograft acceptance. 相似文献13.
Zhen-ye Lv Zhong-Sheng Zhao Zai-Yuan Ye Yuan-Yu Wang Hui-Ju Wang Qiong Yang 《Pathology, research and practice》2018,214(4):536-541
Background
The present study examined the clinical significance of metastasis-associated protein 1 (MTA1) in the progression and patient survival of gastric cancer.Methods
Paraffin-embedded resected tissues of gastric cancer mucosa (n?=?436) and adjacent normal mucosa (n?=?92) were assessed immunohistochemically for MTA1 protein, and scored according to the percentage of cells positively stained for MTA1 combined with stain intensity. Associations between MTA1 staining scores and clinicopathological factors, including survival time, were evaluated.Results
The staining scores for MTA1 were significantly higher in gastric cancer tissues than in matched normal tissues. MTA1 scores positively correlated with tumor size, depth of invasion, presence of lymph node metastasis, lymphatic involvement, venous invasion, distal metastasis, and advanced clinical staging. Patients with high MTA1 scores in gastric cancer tissues had a significantly lower five-year survival rate compared with patients with low MTA1 scores. The multivariate analysis indicated that MTA1 protein levels in resected gastric cancer tissues, as reflected by immunohistochemical staining, are an independent prognostic index of gastric carcinoma (P?<?0.01).Conclusion
MTA1 immunopositivity was significantly associated with progression of gastric cancer, and may be helpful in gastric cancer prognosis. 相似文献14.
Małgorzata Wilusz Dominik Cieniawski Grzegorz Wasilewski Marek Kuźniewski Władysław Sułowicz Krystyna Sztefko 《Advances in medical sciences》2018,63(2):367-373
Purpose
Diabetes mellitus and hyperlipidemia are frequently observed after organ transplantation. It is known that in these disorders the fatty acid metabolism is impaired. The aim of this study was to compare the fatty acid profile in the heart and renal transplant recipients who developed metabolic disorders since there is no such research available.Materials and methods
The study included 55 patients treated with tacrolimus (Tac) after heart (n?=?14; mean age: 60.4?±?9.1) or renal (n?=?41; mean age: 51?±?13) transplantation. Diabetes and hyperlipidemia was present in 35.7% and 28.5% of heart transplant recipients, and 19.5% and 41% of renal transplant recipients. Concentrations of fatty acid in phospholipids fraction in serum were measured by gas chromatography.Results
The concentration of C20:5 fatty acid was lower in heart transplant recipients, as compared to renal transplant recipients (p?=?0.001), whereas the level of C20+C18:3 fatty acid and the ratio of n-6/n-3 was higher (p?=?0.01; p?=?0.03, respectively). The observed differences were not related to metabolic disorders. Negative correlation between C16:1 and eGFR was seen in heart transplant recipients (p?=?001). In renal transplant recipients with metabolic disorders, the concentration of C20:5 was correlated positively whereas the n-6/n-3 ratio was correlated negatively with eGFR (p?<?0.001, p?=?0.01, respectively). Hyperlipidemic renal transplant recipients had higher concentration of C20:2 (p?=?0.02), C20:4 (p?=?0.05), n-6 (0.04) and total fatty acid (p?=?0.01) than patients without metabolic disorders.Conclusion
The fatty acid profile differs depending on the transplanted organ, but the differences are not related to the metabolic disorders. The role of fatty acid in kidney function varies between heart transplant recipients and renal transplant recipients and depends on type of fatty acid. 相似文献15.
Karen Nieuwenhuijsen Carel T. Hulshof Judith K. Sluiter 《Patient education and counseling》2018,101(7):1291-1297
Objective
To study the influence of the presentation of results of a preventive medical examination on risk perception and willingness to seek help for work-related fatigue or being overweight.Methods
A factorial design experiment was conducted, presenting workers (n?=?82) with vignettes including eight scenarios of test results with and without an emphasis on the risk of a current or future health condition or a probe to seek help. Participants rated perceived risk and willingness to seek help (0–100 Visual Analogue Scale) as if these were their own results. Differences were tested with paired-sample t-tests.Results
In scenarios emphasizing the risk of a current or future disorder, participants perceived higher risk and were more willing to seek help (p-values?<?.00). Slightly higher willingness to seek help scores was observed in all scenarios that included probes (p?<?.00).Conclusion
Risk perception and willingness to seek help of workers participating in a preventive medical examination were higher when they were told that the test results indicate a risk of a current or future disorder and after being advised to seek help.Practice implications
Healthcare providers should take the potential effects on risk perception and help-seeking into account in preventive settings. 相似文献16.
Xiaoqing Shi Bingjie Li Yingying Yuan Liyinghui Chen Yadi Zhang Meng Yang Junjie Wang Dongchun Qin 《Pathology, research and practice》2018,214(8):1142-1148
Purpose
The association between myeloperoxidase (MPO) polymorphism and the risk of cervical cancer is inconclusive. We performed a meta-analysis to clarify if a correlation exists between MPO polymorphism and the risk for developing cervical cancer.Methods
All case-control research studies that determined a relationship between MPO and cervical cancer reported up until March 1, 2018 in PubMed, Web of Science, VIP, WanFang, and the CNKI Database were accessed and included. The strength of association was evaluated with pooled odds ratios (ORs) and their corresponding 95% confidence intervals (95% CIs). We used sensitivity analysis to detect the stability of our results, conducted Q-test to evaluate heterogeneity and applied Begg’s funnel plot and Egger’s test to investigate any publication bias among selected studies.Results
In this meta-analysis, we included 5 eligible studies in the final evaluation, which included 1125 patients with cervical cancer and 1150 cancer-free control patients. A potential association between the MPO ?463 G?>?A polymorphism and cervical cancer risk was observed (recessive model: OR?=?0.65, 95%, CI: 0.43–0.98, P?=?0.038; homozygous model: OR?=?0.65, 95%, CI: 0.43–0.99, P?=?0.045), which indicates that genotype AA reduces the risk of cervical cancer by 35% compared to GG/GA or GG genotypes in our results. A stratified analysis by ethnicity identified a significant correlation among Caucasian patients (recessive model: OR?=?0.57, 95%, CI: 0.34–0.95, P?=?0.029; homozygous model: OR?=?0.60, 95%, CI: 0.36–0.99, P?=?0.048) and a stratified analysis by source of control identified a significant correlation among population-based studies.Conclusions
Our results suggest that the presence of polymorphism, ?463 G?>?A in patients might offer them protection against cervical cancer. By implementing randomized case-control or cohort studies with larger sample sizes, the clinical significance of our results can be further strengthened and verified. 相似文献17.
Gina Bravo Modou Sene Marcel Arcand Élodie Hérault 《Patient education and counseling》2018,101(7):1256-1261
Objective
To investigate how confidence in surrogates’ ability to make consistent decisions in the future change over time, in the context of an ACP intervention that did not improve surrogates’ ability to predict an older adult’s hypothetical treatment preferences.Methods
The study involved 235 older adults and surrogates, randomly allocated to an ACP or control intervention. At baseline, end of intervention, and six months later, participants were asked how confident they were in the surrogate making decisions in the future that would match the older adult’s wishes.Results
By the end of the intervention, confidence had increased among older adults and surrogates involved in ACP (OR?=?3.1 and 5.8 respectively, p?<?0.001), while less change occurred among controls. Over the following six months, confidence remained stable among older adults but decreased among surrogates (OR?=?0.5, p?=?0.005).Conclusion
ACP increases confidence in surrogates’ ability to make consistent decisions, which may lighten the burden of substitute decision making. Efforts to improve substitute decision-making must continue so that participants’ confidence is not based on the mistaken assumption that surrogates can make consistent decisions.Practice implications
Professionals involved in ACP should inform participants that confidence in the surrogate may increase in the absence of enhanced predictive ability. 相似文献18.
Monika Zawadka-Kunikowska Joanna Słomko Maria Kłopocka Ariel Liebert Małgorzata Tafil-Klawe Jacek J. Klawe Julia L. Newton Paweł Zalewski 《Advances in medical sciences》2018,63(2):334-340
Purpose
The aim of the study was to assess cardiac and autonomic function in patients with Crohn’s disease and explore their relation to disease duration using cardiovascular reflex tests.Materials and methods
Cardiovascular parameters, baroreflex sensitivity, spectral-indices of short-term heart rate variability and blood pressure variability were compared between patients with Crohn’s disease in remission (n?=?30) and a control group (n?=?29). Cardiac autonomic function was assessed during response to standing (tilt) and deep breathing test (expiration/inspiration ratio-E/I). Aortic pulse wave velocity, aortic augmentation index and central systolic blood pressure were measured oscillometrically.Results
At rest, Crohn’s disease patients had significantly higher systolic (p?=?0.03) and diastolic (p?=?0.03) blood pressure, total peripheral resistance index (p?=?0.003), sympathetic-parasympathetic ratio (p?=?0.033) and lower baroreceptor effectiveness (p?=?0.047), myocardial variables (stroke index; p?=?0.03, cardiac index; p?=?0.025, Heather index; p?=?0.039, left ventricular ejection time; p?=?0.038), as compared to controls. Orthostatic response to the tilt test in the Crohn’s disease group and the control group was similar, no intergroup differences were observed for E/I ratio and autonomic parameters. In Crohn’s disease patients, disease duration was negatively associated with baroreflex sensitivity and positively correlated with normalised high frequency heart rate variability, sympathetic-parasympathetic ratio at rest and post-tilt changes in Δsystolic blood pressure, p?<?0.05. The control group had significantly lower central systolic blood pressure (p?=?0.043) compared to Crohn’s disease patients.Conclusions
Crohn’s disease patients in remission have preserved cardiac and autonomic function in response to cardiovascular reflex tests with a shift in cardiovascular autonomic regulation towards sympathetic predominate in the rest position. 相似文献19.
20.
Yang Liu Jing Ma Kangjie Yu Mingyang Li Fang Liu Qingguo Yan Zhe Wang Shuangping Guo 《Pathology, research and practice》2018,214(4):507-512