共查询到20条相似文献，搜索用时 31 毫秒
1.
S.L. O’Reilly J.A. Dunbar J.D. Best V. Versace D. Ford D. Young S. Shih R. Bills W. Shepherdley E.D. Janus 《Primary Care Diabetes》2019,13(2):134-141
Aims
Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice.Methods
Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months.Results
Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%–60%. Diabetes prevention planning consultations did not show the same level of increase (0%–10%). The recording of body mass index improved overall (51%–69%) but the number of women with normal body mass index did not.Conclusions
GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice. 相似文献2.
Cayetano Alegre 《Reumatología clinica》2019,15(3):170-172
Objective
To establish the percentage of Catalonian rheumatologists who attended to private patients, to understand the most common processes in private practice, to determine the dedication to patient care and the necessary activities to guarantee proper care, such as continuing education and office management, and to know what techniques were most widely used.Material and methods
A personalized survey of Catalonian rheumatologists whose e-mail addresses were made available to us. Fifty-two responses were analyzed.Results
The percentage of men (52%) and women (48%) was similar; 33% worked exclusively in private rheumatology (PR), most of them in hospitals or medical teams; 11% worked alone; 27% were in training. The disease most frequently treated was osteoarthritis; 51% were involved in studies or clinical trials in the field of RP.Conclusions
The concept of RP as a private business is changing and is progressively being transformed into working units with a structure similar to public hospitals with formal training.This report provides new data on the activities and characteristics of private rheumatologists. 相似文献3.
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Anna Testa Eleonora Giannetti Antonio Rispo Matilde Rea Erasmo Miele Elena Scarpato Anna Opramolla Olga Maria Nardone Nicola Imperatore Imma Di Luna Annamaria Staiano Fabiana Castiglione 《Digestive and liver disease》2019,51(4):524-528
Introduction and aim
The transitional process of young patients affected by inflammatory bowel disease from pediatric to adult care is a crucial step. Our study aimed to investigate the 1-year success outcome of this transitional process.Methods
From 2013 to 2018, we evaluated the transitional process of patients with Crohn’s disease or ulcerative colitis. For each patient, the following parameters 12 months before and 12 months after the transition were evaluated: Body Mass Index, disease activity and smoker status, number of outpatient visits and the pharmacological therapy, the number of disease exacerbations, hospitalizations and surgical interventions.Results
We enrolled 106 patients with IBD. No statistically significant difference was found between patients’ Body Mass Index before and after transition. There was a significant reduction in the number of exacerbations and hospitalizations in the 12 months post-transition (pre-transition exacerbations: 0.74?±?0.79, post-transition exacerbations: 0.35?±?0.57, p?<?0.001; pre-transition hospitalizations: 0.28?±?0.44, post-transition hospitalizations: 0.1?±?0.3, p?<?0.001). In contrast, there was no significant difference in the number of outpatient visits (3.40?±?1.4 vs 3.25?±?1.2; p?=?ns) and of patients undergoing surgery (0.9% vs 1.8%, p?=?ns).Conclusion
The parameters used as success indicators of the transition program confirm the achievement of continuity of care from Pediatrics to adult Gastroenterology, in a critical phase of the natural history of IBD patients. 相似文献6.
Pablo Olivera Silvio Danese Lieven Pouillon Stefanos Bonovas Laurent Peyrin-Biroulet 《Digestive and liver disease》2019,51(3):327-334
Background
Biologics against tumor necrosis factor (anti-TNF) have dramatically changed the management of moderate-to-severe ulcerative colitis (UC). In pivotal clinical trials, golimumab showed efficacy as induction and maintenance therapy in anti-TNF naïve UC patients. However, confirmatory data on effectiveness in the real world setting are needed.Aim
to summarize recent evidence on the effectiveness of golimumab in observational real-world studies.Methods
A literature search was conducted using Medline, Embase, and congresses databases for English language articles or abstracts on the effectiveness of golimumab published between January 1, 2014 and May 15, 2018. Pooled short-term (6–14 weeks) and mid- and long-term (24–54 weeks) clinical response and remission rates were calculated.Results
24 abstracts were included; of those 8 were published full-text articles and 16 were abstracts from medical conferences. Overall, pooled short-term clinical response and remission rates were 59.3% (range 35–85.5%; 13 studies; 1429 patients) and 35.9% (range 14–51.7%; 9 studies; 666 patients), respectively. Pooled mid- and long-term clinical response and remission rates were 60.3% (range 37.1–89.5%; 4 studies; 356 patients) and 39.2% (range 12–84%; 8 studies; 822 patients), respectively.Conclusions
Results: of observational studies confirm that golimumab is an effective therapy for UC in clinical practice. 相似文献7.
Aim
To describe quality management processes and appropriate interpretation with respect to HbA1c point-of-care (POC) testing in a national diabetes and cardiovascular risk screening programme.Methods
We compared HbA1c results from capillary blood, measured by the cobas b 101 (Roche Diagnostics) POC testing system, with results from venous blood measured by accredited laboratory analysers to inform national screening practice and a (separately-reported) randomised controlled trial. Difference plots and regressions were used to aid interpretation around 40 and 50 mmol/mol, the cut-offs used to identify “pre-diabetes” and diabetes in New Zealand.Results
After initial acceptable tests, subsequent batches delivered POC results that varied from laboratory HbA1c by +6 to ?14 mmol/mol around the clinical cut-offs. Ten faulty batches of discs were recalled worldwide. POC testing was suspended in one region, as was the planned trial. The manufacturing defect was rectified, accuracy of the new batches was confirmed, and testing resumed.Conclusion
POC testing must be conducted within stringent quality assurance processes prior to and while in use. Within such a system, POC testing for HbA1c can be sufficiently accurate for screening and diagnosis of diabetes. 相似文献8.
Estibaliz Gamboa Moreno Maider Mateo-Abad Lourdes Ochoa de Retana García Kalliopi Vrotsou Emma del Campo Pena Álvaro Sánchez Perez Catalina Martínez Carazo Juan Carlos Arbonies Ortiz M. Ángeles Rúa Portu Koldo Piñera Elorriaga Amaya Zenarutzabeitia Pikatza Miren Nekane Urquiza Bengoa Tomás Méndez Sanpedro Ana Oses Portu Miren Bakarne Aguirre Sorondo Rafael Rotaeche del Campo 《Primary Care Diabetes》2019,13(2):122-133
Aim
The purpose of this study was to assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region.Methods
A two-year follow-up randomised controlled trial. The intervention consisted of 6 weekly structured peer-to-peer workshops. The primary outcome was change in HbA1c levels. Secondary outcomes included other clinical measures, quality of life, self-efficacy, life-style changes, medication and use of healthcare services. Mixed effect models were fitted.Results
n=297 patients were recruited in each study arm. Baseline HbA1c levels were comparable in both groups with an overall mean 7.1 (SD=1.2). The intervention did not significantly modify HbA1c, or other cardiovascular variables. Significant improvements were seen in self-efficacy, and in particularly its disease control component. Certain differences were also observed in the use of healthcare resources and medication consumption. High workshop participation and satisfaction rates were achieved.Conclusion
HbA1c reductions are difficult to obtain in adequately controlled patients. On the other hand, raising awareness on one’s disease can increase disease control self-efficacy. This finding, accompanied by reduced medication consumption and healthcare use rates, highlights that usual care would be benefited by incorporating certain SDSMP aspects.Trial registration: ClinicalTrials.gov identifier NCT01642394 相似文献9.
Anna Viola Daniela Pugliese Sara Renna Federica Furfaro Flavio Caprioli Renata D’Incà Fabrizio Bossa Stefano Mazza Giuseppe Costantino Massimo Claudio Fantini Gionata Fiorino Angela Alibrandi Ambrogio Orlando Alessandro Armuzzi Walter Fries 《Digestive and liver disease》2019,51(4):510-515
Background
Anti-TNF therapies infliximab (IFX), adalimumab (ADA), and golimumab (GOL) are approved for treating moderate to severe ulcerative colitis (UC). In UC, only the switch from IFX to ADA has been investigated, reaching no more than 10–43% remission rates at 12 months.Aim
Of the present study was to investigate disease outcome after a switch from subcutaneous (SC) agents to the intravenous (IV) agent (IFX).Methods
In this retrospective multicentre study, we analysed the charts of UC patients unresponsive/intolerant or with secondary loss of response (LOR) to ADA or GOL who were switched to IFX. We evaluated clinical response and remission together with adverse events at 3, 6, and 12 months follow-up.Results
Seventy-six patients were included; 38 patients started ADA and 38 started GOL for a mean therapy duration of 6?±?6 months. Indications for switch were adverse events in 3%, primary failure in 79%, and LOR in 18% of patients. Clinical remission was reached by 47%, 50%, and 77% of patients, respectively. Patients that switched for LOR did numerically, but not statistically, better than patients who switched for primary failure.Conclusions
Our data show a superior remission rate in SC to IV anti-TNF switch in UC compared to the IV to SC switch reported in literature. 相似文献10.
Introduction
Chikungunya virus infection causes arthralgia and arthritis in the acute phase of the disease but, in more than half of the cases, musculoskeletal manifestations can be prolonged over time and, in some cases, become chronic. Although polyarthralgia is the most frequent chronic manifestation, forms with polyarthritis, tenosynovitis and enthesopathy are also common.Objective
To analyze the clinical characteristics of patients with persistent articular manifestations after infection with the Chikungunya virus.Patients
Report of 3 cases of chronic arthritis after infection with chikungunya virus diagnosed at outpatient care in a university hospital of Catalonia, all of them imported after exposure in areas of epidemic infection between 2013-2015.Results
All three patients had inflammatory joint pain for more than one year after acute disease (3, 2 and 1 years, respectively). In all cases, it appeared as polyarthritis with involvement of small joints of hands and feet (pseudorheumatoid arthritis-like). Laboratory tests showed a slight elevation of acute phase reactants, and analyses for immune markers were negative. Two of the patients required treatment with glucocorticoids and hydroxychloroquine. The course led to slow clinical improvement, but only one of them came to be completely asymptomatic.Conclusion
In the differential diagnosis of chronic polyarthritis, Chikungunya virus disease should also be considered in areas in which it is not endemic. 相似文献11.
Fangyuan Gao Qianqian Zhang Yao Liu Guozhong Gong Dewen Mao Zuojiong Gong Jun Li Xinla Luo Xiaoliang Li Guoliang Chen Yong Li Wenxia Zhao Gang Wan Hai Li Kewei Sun Xianbo Wang 《Digestive and liver disease》2019,51(3):425-433
Background
The current definitions and etiologies of acute-on-chronic liver failure (ACLF) are clearly very different between East and West.Aims
This study aimed to develop an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure (ACHBLF) as defined by the Asia Pacific Association for the Study of the Liver (APASL).Methods
The nomogram was based on a retrospective study of 573 patients with ACHBLF, defined according to the APASL, at the Beijing Ditan Hospital. The results were validated using a bootstrapped approach to correct for bias in two external cohorts, including an APASL ACHBLF cohort (10 hospitals, N?=?329) and an EASL-CLIF ACHBLF cohort (Renji Hospital, N?=?300).Results
Multivariate analysis of the derivation cohort for survival analysis helped identify the independent factors as age, total bilirubin, albumin, international normalized ratio, and hepatic encephalopathy, which were included in the nomogram. The predictive value of nomogram was the strongest compared with CLIF-C ACLF, MELD and MELD-Na and similar to COSSH-ACLF in both the derivation and prospective validation cohorts with APASL ACHBLF, but the CLIF-C ACLF was better in the EASL-CLIF ACHBLF cohort.Conclusions
The proposed nomogram could accurately estimate individualized risk for the short-term mortality of patients with ACHBLF as defined by APASL. 相似文献12.
Giuseppina Brancaccio Alessandra Nardi Salvatore Madonia Massimo Fasano Gabriella Verucchi Marco Massari Sergio Maimone Carlo Contini Fabio Levantesi Arianna Alfieri Caius Gavrila Pietro Andreone Michele Milella Giovanni B. Gaeta 《Digestive and liver disease》2019,51(3):438-442
Background
Chronic hepatitis B virus (HBV) infection remains a primary cause of morbidity and mortality worldwide.Aim
The study is aimed at updating the clinical and epidemiological profile of chronic HBV infection in Italy.Methods
A cross-sectional multicenter prospective study enrolled consecutive HBsAg positive patients seen in 73 Italian centers in the period 2012–2015. Individual patient data were collected using an electronic platform and analyzed using standard statistical methods.Results
Among 2877 HBsAg positive individuals (median age 49.8?years, 68% males), 27% were non-Italian natives (NINs); 20% had chronic infection, 58.5% chronic hepatitis and 21.5% cirrhosis. Among NINs, age was younger, male gender was less prevalent and liver disease less advanced than in Italians (all p?<?0.0001). HBeAg positive cases were 23.6% among NINs vs 8.2% in Italians (p?<?0.0001); HDV coinfections 11.1% vs 7.3% (p?=?0.006) and HCV coinfections 2.3% vs 4.2% (p?=?0.017), respectively. Anti-HDV or anti-HCV antibodies were detected more frequently in patients with cirrhosis. Fifty percent of NINs with cirrhosis were aged below 45?years.Conclusion
The study offers an insight into the evolving burden of chronic hepatitis B virus infection in the near future and highlights new territories for public health interventions. 相似文献13.
A.-L. Borel R. Tamisier P. Böhme P. Priou A. Avignon P.-Y. Benhamou H. Hanaire J.-L. Pépin L. Kessler P. Valensi P. Darmon F. Gagnadoux 《Diabetes & metabolism》2019,45(2):91-101
Aim
Because type 2 diabetes (T2D) is related to obesity, it is often associated with obstructive sleep apnoea syndrome (OSAS), although OSAS is also frequently diagnosed in patients with type 1 diabetes (T1D) and may promote gestational diabetes. Thus, this systematic review of the scientific evidence aimed to evaluate the epidemiological association between OSAS and all forms of diabetes, the current understanding of the pathophysiological mechanisms behind these associations, the expected benefits and limitations of OSAS treatment in patients with diabetes and, finally, to propose which patients require screening for OSAS.Methods
A panel comprising French expert endocrinologists and pneumologists was convened. Two of these experts made a search of the relevant literature for each subpart of the present report; all panel experts then critically reviewed the entire report separately as well as collectively.Results
There is little evidence to support the notion that OSAS treatment improves glycated haemoglobin, although it may improve nighttime blood glucose control and insulin sensitivity. However, there is robust evidence that OSAS treatment lowers 24-h blood pressure.Conclusion
The high prevalence of OSAS in patients with T1D and T2D justifies screening for the syndrome, which should be based on clinical symptoms, as the benefits of OSAS treatment are mainly improvement of symptoms related to sleep apnoea. There are also several clinical situations wherein screening for OSAS seems justified in patients with diabetes even when they have no symptoms, particularly to optimalize control of blood pressure in cases of resistant hypertension and microvascular complications. 相似文献14.
Alessandro Loglio Mauro Viganò Glenda Grossi Sara Labanca Maria Goldaniga Alessandra Pompa Lucia Farina Mariagrazia Rumi Paolo Corradini Floriana Facchetti Giovanna Lunghi Luca Baldini Pietro Lampertico 《Digestive and liver disease》2019,51(3):419-424
Backgound
A significant proportion of hepatitis B surface antigen (HBsAg) negative/anti-hepatitis B core antigen (anti-HBc) positive patients with non-Hodgkin lymphoma (NHL) undergoing rituximab-based chemotherapy (R-CT) may suffer hepatitis B virus (HBV) reactivation.Aims
We wanted to assess efficacy and safety of lamivudine (LMV) prophylaxis to prevent this complication.Methods
Eighty-five consecutive HBsAg negative/anti-HBc positive NHL patients (71 years, 100% serum HBV DNA undetectable, 74% anti-HBs positive) received LMV coadministered with R-CT and for 18 months after the end of R-CT. Serum ALT, HBsAg, anti-HBs and HBV DNA were assessed every 4 months during and after end of LMV.Results
During 39 (2–108) months of study period, including 21 months of LMV and 27 additional months after LMV discontinuation, one patient (2%) had HBV reactivation, 31 months after stopping LMV and during administration of new immunosuppressive regimens, without LMV prophylaxis, owing to incomplete oncological response. A 50% decline of anti-HBs titers occurred in 22/63 (35%) patients, including 12 who became anti-HBs seronegative. Five (6%) patients had ALT increase during R-CT but none required R-CT discontinuation. Seventeen (20%) patients died, all for tumour progression.Conclusion
LMV prophylaxis is safe and effective in preventing HBV reactivation in HBsAg negative/anti-HBc positive NHL patients receiving R-CT. 相似文献15.
Background
Cholangiocarcinoma (CCA) represents a devastating malignancy characterized by high mortality, and notoriously problematic to diagnose. Recently, microRNAs (miRs) have been intensively investigated due to their potential usefulness from a tumor treatment perspective.Aims
The current study was aimed to investigate whether miR-494 influences epithelial-mesenchymal transition (EMT), tumor growth and metastasis of CCA.Methods
The regulatory miRNAs of WDHD1 in CCA expression chip were predicted, followed by determination of the miR-494 and WDHD1 expression in normal cholangiocyte tissues and CCA tissues. The related protein levels were determined. CCA cell migration, invasion, viability, and cell cycle distribution and the dosage-dependent effect of miR-494 on CCA cell growth were subsequently detected. Finally, tumorigenicity and lymph node metastasis (LNM) were measured.Results
Initially, miR-194 affected the CCA development via negatively regulating WDHD1 and miR-494 which were downregulated while WDHD1 was upregulated in CCA. In addition, miR-494 overexpression elevated E-cadherin expression while decreased expressions of WDHD1, N-cadherin, Vimentin, Snail, Twist and MMP-9. Finally, overexpressed miR-494 was observed to suppress EMT, cell viability, migration, invasion, arrest cell cycle progression, tumor formation, and LNM while accelerating cell apoptosis in vivo.Conclusion
This study indicated that miR-494 overexpression suppresses EMT, tumor formation and LNM while promoting CCA cell apoptosis through inhibiting WDHD1 in CCA. 相似文献16.
Lucille Quénéhervé Caroline Dagouat Marianne Le Rhun Enrique Perez-Cuadrado Robles Emilie Duchalais Stanislas Bruley des Varannes Yann Touchefeu Nicolas Chapelle Emmanuel Coron 《Digestive and liver disease》2019,51(3):386-390
Background
Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery.Aim
The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus.Methods
The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: ‘elective surgery’ and ‘no surgery’.Results
Patients in the ‘no surgery’ group (n?=?42) were older and had more loss of autonomy than in the ‘elective surgery’ group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the ‘no surgery’ group versus 32% in the ‘elective surgery’ group (p?=?0.02). In the ‘no surgery’ group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery.Conclusion
Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed. 相似文献17.
Background
Recurrent wheezing during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence in Portugal.Objective
Determine the prevalence and severity of recurrent wheezing, treatments employed and other related aspects, in infants during their first year of life in Setúbal, Portugal.Methods
This is a cross-sectional study of a random sample of infants aged 12–15 months living in Setúbal district. It uses a validated questionnaire answered by parents/caregivers at local healthcare facilities where infants attend for growth/development monitoring and/or vaccine administration.Results
Among the 202 infants surveyed, 44.6% (95% CI 37.7–51.4) had at least one episode of wheezing; and 18.3% (95% CI 12.9–23.6) had recurrent wheezing. There was significant morbidity associated to recurrent wheezing in terms of severe episodes (17.3%–95% CI 12–22.5), visits to the emergency department (26.2%–95% CI 20.1–32.2) and hospital admissions (5.4%–95% CI 2.2–8.5); 10.4% (95% CI 6.1–14.6) used inhaled corticosteroids and 7.9% (95% CI 4.1–11.6) used a leukotriene receptor antagonist.Conclusions
The prevalence of recurrent wheezing in infants during the first year of life is high and is associated with significant morbidity, presenting as a relevant public health problem. An important proportion of infants’ progress with a more severe condition, resulting in high use of health resources (visits to emergency department and hospitalisations). The prevalence of recurrent wheezing in this district of Portugal stays between those related in other European and Latin American Centres, suggesting that maybe some of the well-known risk factors are shared with affluent countries. 相似文献18.
P.P. de Oliveira Jorge J.H.P. de Lima D.C. Chong e Silva D. Medeiros D. Solé G.F. Wandalsen 《Allergologia et immunopathologia》2019,47(3):295-302
Purpose
To review available evidence in the literature on impulse oscillometry in the assessment of lung function in children with respiratory diseases, especially asthma.Data collection
Research in the Medline, PubMed, and Lilacs databases, with the keywords forced oscillation, impulse oscillometry, asthma and impulse oscillometry.Results
The Impulse Oscillometry System (IOS) allows the measurement of resistance and reactance of airways and is used as a diagnostic resource. A significant association between the findings of the IOS and those of spirometry is observed. In asthma, the IOS has already been used to assess the bronchodilator response and the therapeutic response to different drugs and has shown to be a sensitive technique to evaluate disease control. There are limitations to this assessment, such as children with attention deficit and in some cases it is difficult to interpret the results from a clinical point of view.Conclusion
The IOS is a useful tool for the measurement of the lung function of children. It is an easy test, although its interpretation is not straightforward. 相似文献19.
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Marion Chambaz Mikael Verdalle-Cazes Charlotte Desprez Lucie Thomassin Cloé Charpentier Sébastien Grigioni Laura Armengol-Debeir Valérie Bridoux Guillaume Savoye Céline Savoye-Collet 《Digestive and liver disease》2019,51(3):358-363