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1.
Background Tradition treatment of sepsis and new therapies, including high dose corticosteroids and non-steroidal anti-inflammatory drugs, have proven unsuccessful in improving survival. This study aimed to evaluate the potential efficacy of immunomodulating therapy using Ulinastatin (UTI) plus Thymosin al (Tal) for improving organ function and reducing mortality in patients with severe sepsis. Methods A prospective study was carried out with randomized and controlled clinical analysis of 114 patients conforming to the enrollment standard. All patients had severe sepsis and received standard supportive care and antimicrobial therapy. Fifty-nine patients were also administered UTI plus Tal (defined as Group A), 55 patients were given a placebo (defined as Group B). Clinical parameters were determined by evaluation with the Acute Physiology and Chronic Health Evaluation II (APACHE II), multiple organ failure (MOF) and the Glasgow Coma Scores (GCS) on entry and after therapy on the 3rd, 8th, and 28th day. By flow cytometery and ELISA lymphocyte subsets and cytokines were analyzed. Survival analysis was determined by the Kaplan-Meier method at 28, 60, and 90 days. Results Based on comparison of the two groups, patients in Group A exhibited a better performance in organ failure scores which was noticeable soon after initiation of treatment. Patients in Group A also demonstrated a better resolution of pre-existing organ failures during the observation period. After initiation of treatment, significant improvements in the CD4^+/CD8^+ ratio, a quicker balance between proinflammatory mediators such as tumor necrosis factor a, interleukin 6 and anti-inflammatory cytokines including interleukin 4 and interleukin 10 were found. This was followed by cumulative survival increases of 17.3% at 28 days, 28.9% at 60 days, and 31.4% at 90 days in Group A. The reduction in mortality was accompanied by a considerably shorter stay in the ICU and a shorter length of supportive ventilation, antimicrobial and dopamine therapy. Conclusion UTI plus Tal has a beneficial role in the treatment of severe sepsis. 相似文献
2.
Background: Preconception health and care aims to reduce parental risk factors before pregnancy through health promotion and intervention. Little is known about the preconception interventions that general practitioners (GPs) provide. The aim of this study was to examine GPs’ knowledge, attitudes, and views towards preconception health and care in the general practice setting. Methods: As part of a large mixed-methods study to explore preconception care in England, we surveyed 1,173 women attending maternity units and GP services in London and interviewed women and health professionals. Seven GPs were interviewed, and the framework analysis method was used to analyse the data. Findings: Seven themes emerged from the data: Knowledge of preconception guidelines; Content of preconception advice; Who should deliver preconception care?; Targeting provision of preconception care; Preconception health for men; Barriers to providing preconception care; and Ways of improving preconception care. A lack of knowledge and demand for preconception care was found, and although reaching women before they are pregnant was seen as important it was not a responsibility that could be adequately met by GPs. Specialist preconception services were not provided within GP surgeries, and care was mainly targeted at women with medical conditions. GPs described diverse patient groups with very different health needs. Conclusion: Implementation of preconception policy and guidelines is required to engage women and men and to develop proactive delivery of care with the potential to improve pregnancy and neonatal outcomes. The role of education and of nurses in improving preconception health was acknowledged but remains under-developed. 相似文献
3.
Objective: The aim of this study was to assess the “Health Care Town in
Kyoto” project designed to promote health and safety for health conscious people in a
small community. We conducted a survey involving the users of the salon and local
residents to examine the effects of the activities in the salon.Methods: We recorded the activities of salon and conducted semi-structured
interviews with ten local residents to ask their opinions about the salon. The data from
the interviews were analyzed using the Grounded Theory Approach. We distributed a
questionnaire and collected 215 valid responses (valid response rate: 67.8%).Results: 1) Purpose of using the salon was categorized into health
consultation, conversation with others, rest and other purpose. 2) The significance of the
salon for users was categorized into usability, acquisition of useful information, changes
in daily habits and their maintenance, diversion, interaction with other people and
acceptance by the shopping center. 3) The results of the questionnaire survey showed
marked relations between Well-Being Index (WHO-5), age, employment and family budget,
self-rated health and ability to perform daily activities (TMIG), whereas use of the salon
was not associated with Well-Being Index (WHO-5). On the other hand, there were marked
relations between loneliness (LSO), educational background and use of the salon,
demonstrating that the facility helped its users reduce loneliness (LSO).Conclusion: In this town, the salon has served as a place providing
effective preventive support for the health of individual users. 相似文献
4.
One hundred and sixty-eight specimens of intestinal metaplasia(IM)with variousaccompanying lesions in gastric mucosa were studied with mucohistochemical and ABCimmunohistochemical staining,The quantitative analysis of cell DNA was done withflowcytometry for 36 specimens.The results indicated that the incidence of type Ⅱb IM wassignificantly higher in the groups of dysplasia(34.6%)and mucosa adjacent to gastric cancer(GC)(51.7%)than in the chronic atrophic gastritis(CAG)group(16.0%)(P<0.01).The expres-sion rate of monoclonal antibody MG7 related antigen(MG7-Ag)in type Ⅱb IM(473%)wasalso significantly higher than those in type la(29.7%),Ib(26.1%)and Ⅱa IM(28.3%)(P<0.05).Expression rate of MG7-Ag,DNA aneuploid rate and percentage of S phase cell werestatistically higher in the type Ⅱb IM with dysphsia(62.5%,62.5% and 143±32)than in typeⅡb 1M without dysplasia(47.3%,12.5%and12.7±2.9)(P<0.05 and P<0.01).These findingssuppor the supposed progressive process:CAG→type Ⅱb IM→dysplasia→GC,andtype Ⅱb IM with dysplasia is closely associated with GC. 相似文献
5.
Objectives: Despite the increasing utilization of in-home services, the
assessment of in-home services used by those that have certified levels of care needs has
been limited to the actual changes in individual outcomes. The purpose of the present
study was to determine factors affecting how the utilization of in-home services could
have sustained and/or improved or deteriorated the care needs levels of frail persons. We
also examined the effect of in-home services used in the lower level of care needs
subgroup and the higher level of care needs subgroup during a two-year period.Subjects and Methods: We used longitudinal data from Izumo City of those
individuals with certified levels of care needs to analyze the changes in care need levels
in Izumo City between 2002 to 2004. In 2002, 2,651 persons had certified levels of care
needs. All permanent residents of care facilities, at care needs level 5 in 2002, those
who died since 2002 and people who could not be traced during the two-year follow-up
period were excluded. The remaining data from 1,788 frail persons were ultimately
analyzed. We arbitrarily divided the changes in care needs levels into two categories:
sustained/improved and deteriorated. The care needs levels were also stratified into a
lower level of care needs subgroup and a higher level of care needs subgroup at the
baseline. Simple statistical analysis and binary logistic regression analysis were used to
analyze factors that were thought to be related to in-home service utilization data to
predict changes in care needs levels.Results: Approximately 63.3% of the respondents had a sustained or improved
care needs level, and 36.7% of the respondents showed deteriorated of care needs levels.
In the lower level of care needs subgroup, utilization of home help/bathing (OR=2.59) was
associated with significant sustained/improved care needs levels. In the higher level of
care needs subgroup, day care service (OR=0.90) and short stay services (OR=0.87) were
significantly related to deteriorated care needs levels, respectively.Conclusions: This study shows that home help/bathing care in the lower level
of care needs subgroup was a significant predictor of sustained/improved levels of care
needs for frail persons but that short stay services and day care services in the higher
level of care needs subgroup have a negative impact on sustained/improved levels of care
needs. Our results suggest that utilization of home help services can prevent
deterioration of these levels of care needs in frail persons. 相似文献
6.
One of the most important legacies of Sir William Osler was his textbook The Principles and Practice of Medicine. A common criticism of the book when it was first published was its deficiency in the area of therapeutics. In this article, the 1st edition of The Principles and Practice of Medicine is compared with the 11th edition of Harrison's Principles of Internal Medicine. The analysis focuses on the treatment recommendations for 4 conditions that were covered in both books (diabetes mellitus, ischemic heart disease, pneumonia and typhoid fever). Osler's textbook dealt with typhoid fever and pneumonia at greater length, whereas Harrison's placed more emphasis on diabetes mellitus and ischemic heart disease. Notwithstanding Osler's reputation as a therapeutic nihilist, the 2 books devoted equivalent space to treatment (in terms of proportion of total sentences for the conditions). For all conditions except ischemic heart disease, Osler concentrated on general measures and symptomatic care. Throughout Osler's textbook numerous negative comments are made about the medicinal treatment of various conditions. A more accurate statement about Osler's therapeutic approach was that he was a "medicinal nihilist." His demand for proof of efficacy before use of a medication remains relevant. 相似文献
7.
Objective: To explore a method of extracting tumor interstitial fluid (TIF) which is similar to muddy phlegm in Chinese medicine (CM), interleukin-8 (IL-8) in concentration was taken as the representative of the content of TIF, analyzed in the extracted TIF and the original tumor tissue, and examined to see whether TIF has an interfering effect on tumor recurrence. Methods: Tumor tissue was ground, centrifuged, and filtered for intercellular substances. Tumor-bearing Kunming S180 mice were raised for 21 days and then the tumors were removed to observe the influence of intervention with TIF, normal saline (NS) and a blank control on tumor recurrence. Results: The content of IL-8 in the filtered and unfiltered tumor tissue was not significantly different (P0.05). Postoperative tumor recurrence in TIF intervention group was significantly higher than that in the NS intervention and control groups (60%, 12/20 vs. 20%, 4/20 vs. 15%, 3/20, χ2=11.058, P0.01). Tumor cells grew vigorously and infiltrated to muscular tissue in TIF intervention group. Large numbers of tumor cells were seen necrotic in the NS intervention group, and small numbers of tumor cells were seen necrotic in the blank control group. Conclusions: TIF can be effectively extracted by the means described. It does not contain tumor cells, but its contents such as IL-8 may stimulate tumor cell growth and promote postoperative tumor recurrence, which provided preliminary experimental basis for hypothesis of "tumor-phlegm microenvironment". 相似文献
8.
ObjectiveTo quantify and compare the time doctors and nurses spent on direct patient care, medication-related tasks, and interactions before and after electronic medication management system (eMMS) introduction. MethodsControlled pre–post, time and motion study of 129 doctors and nurses for 633.2 h on four wards in a 400-bed hospital in Sydney, Australia. We measured changes in proportions of time on tasks and interactions by period, intervention/control group, and profession. ResultseMMS was associated with no significant change in proportions of time spent on direct care or medication-related tasks relative to control wards. In the post-period control ward, doctors spent 19.7% (2 h/10 h shift) of their time on direct care and 7.4% (44.4 min/10 h shift) on medication tasks, compared to intervention ward doctors (25.7% (2.6 h/shift; p=0.08) and 8.5% (51 min/shift; p=0.40), respectively). Control ward nurses in the post-period spent 22.1% (1.9 h/8.5 h shift) of their time on direct care and 23.7% on medication tasks compared to intervention ward nurses (26.1% (2.2 h/shift; p=0.23) and 22.6% (1.9 h/shift; p=0.28), respectively). We found intervention ward doctors spent less time alone (p=0.0003) and more time with other doctors (p=0.003) and patients (p=0.009). Nurses on the intervention wards spent less time with doctors following eMMS introduction (p=0.0001). ConclusionseMMS introduction did not result in redistribution of time away from direct care or towards medication tasks. Work patterns observed on these intervention wards were associated with previously reported significant reductions in prescribing error rates relative to the control wards. 相似文献
9.
ObjectiveTo model inconsistencies or distortions among three realities: patients'' physical reality; clinicians'' mental models of patients'' conditions, laboratories, etc; representation of that reality in electronic health records (EHR). To serve as a potential tool for quality improvement of EHRs. MethodsUsing observations, literature, information technology (IT) logs, vendor and US Food and Drug Administration reports, we constructed scenarios/models of how patients'' realities, clinicians'' mental models, and EHRs can misalign to produce distortions in comprehension and treatment. We then categorized them according to an emergent typology derived from the cases themselves and refined the categories based on insights gained from the literature of interactive sociotechnical systems analysis, decision support science, and human computer interaction. Typical of grounded theory methods, the categories underwent repeated modifications. ResultsWe constructed 45 scenarios of misalignment between patients'' physical realities, clinicians'' mental models, and EHRs. We then identified five general types of misrepresentation in these cases: IT data too narrowly focused; IT data too broadly focused; EHRs miss critical reality; data multiplicities–perhaps contradictory or confusing; distortions from data reflected back and forth across users, sensors, and others. The 45 scenarios are presented, organized by the five types. ConclusionsWith humans, there is a physical reality and actors'' mental models of that reality. In healthcare, there is another player: the EHR/healthcare IT, which implicitly and explicitly reflects many mental models, facets of reality, and measures thereof that vary in reliability and consistency. EHRs are both microcosms and shapers of medical care. Our typology and scenarios are intended to be useful to healthcare IT designers and implementers in improving EHR systems and reducing the unintended negative consequences of their use. 相似文献
10.
Objective: The objective of this study was to verify the recognition of
dangers and obstacles within a house in the elderly when walking based on analyses of gaze
point fixation.Materials and Methods: The rate of recognizing indoor dangers was compared
among 30 elderly, 14 middle-aged and 11 young individuals using the Eye Mark Recorder.Results: 1) All of the elderly, middle-aged and young individuals showed a
high recognition rate of 100% or near 100% when ascending outdoor steps but a low rate of
recognizing obstacles placed on the steps. They showed a recognition rate of about 60%
when descending steps from residential premises to the street. The rate of recognizing
middle steps in the elderly was significantly lower than that in younger and middle-aged
individuals. Regarding recognition indoors, when ascending stairs, all of the elderly,
middle-aged and young individuals showed a high recognition rate of nearly 100%. When
descending stairs, they showed a recognition rate of 70-90%. However, although the
recognition rate in the elderly was lower than in younger and middle-aged individuals, no
significant difference was observed. 2) When moving indoors, all of the elderly,
middle-aged and young individuals showed a recognition rate of 70%-80%. The recognition
rate was high regarding obstacles such as floors, televisions and chests of drawers but
low for obstacles in the bathroom and steps on the path. The rate of recognizing steps of
doorsills forming the division between a Japanese-style room and corridor as well as
obstacles in a Japanese-style room was low, and the rate in the elderly was low, being 40%
or less.Conclusion: The rate of recognizing steps of doorsills as well as obstacles
in a Japanese-style room was lower in the elderly in comparison with middle-aged or young
individuals. 相似文献
11.
Background: The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF.Methods: This cross-sectional study was conducted in Chinese People’s Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or withou... 相似文献
13.
Background: Coronary artery disease (CAD) is the commonest cause of heart failure (HF), whereas pulmonary hypertension (PH) has not been established or reported in this patient population. Therefore, we assessed the prevalence, risk factors, and survival in CAD-associated HF (CAD-HF) complicated with PH.Methods: Symptomatic CAD-HF patients were continuously enrolled in this prospective, multicenter registry study. Echocardiography, coronary arteriography, left and right heart catheterization (RH... 相似文献
18.
BackgroundOne of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public. MethodsDuring six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany. ResultsQuestionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers ( P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% ( P < 0.0001). ConclusionsAlready a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society. 相似文献
19.
Background The expression of genes encoding a number of pathogenetic pathways involved in colorectal cancer could potentially act as prognostic markers. Large prospective studies are required to establish their relevance to disease prognosis.
Methods We investigated the relevance of 19 markers in 790 patients enrolled in a large randomised trial of 5-fluorouracil using immunohistochemistry and chromogenic in situ hybridisation. The relationship between overall 10-year survival and marker status was assessed.
Results Minichromosome maintenance complex component 2 (MCM2) and cyclin A were significantly associated with overall survival. Elevated MCM2 expression was associated with a better prognosis (HR=0.63, 95%CI: 0.46–0.86). Cyclin A expression above the median predicted an improved patient prognosis (HR=0.71, 95%CI: 0.53–0.95). For mismatch repair deficiency and transforming growth factor β receptor type II (TGFBRII) overexpression there was a borderline association with a poorer prognosis (HR=0.69, 95%CI: 0.46–1.04 and HR=2.11, 95%CI: 1.02–4.40, respectively). No apparent associations were found for other markers.
Conclusion This study identified cell proliferation and cyclin A expression as prognostic indicators of patient outcome in colorectal cancer. 相似文献
20.
Severe ischemic stroke carries a high rate of disability and death. The severity of stroke is often assessed by the degree of neurological deficits or the extent of brain infarct, defined as severe stroke and large infarction, respectively. Critically severe stroke is a life-threatening condition that requires neurocritical care or neurosurgical intervention, which includes stroke with malignant brain edema, a leading cause of death during the acute phase, and stroke with severe complications of... 相似文献
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