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1.
Cynthia Gagnon Isabelle Lessard Bernard Brais Isabelle Côté Caroline Lavoie Matthis Synofzik Jean Mathieu 《Archives of physical medicine and rehabilitation》2018,99(9):1747-1754
Objective
To document in adults affected by autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) the intra- and interrater reliability, standard error of measurement, agreement, minimal detectable change, and construct validity of the 9-Hole Peg Test (NHPT), the Standardized Finger-to-Nose Test (SFNT), and grip strength.Design
Metrologic study.Setting
Neuromuscular rehabilitation clinic.Participants
Genetically confirmed adult patients with ARSACS (N=42; 21 women; mean age, 38.6y).Interventions
Not applicable.Main Outcome Measures
Intra- and interrater reliability was determined using the intraclass correlation coefficient (ICC). Construct validity was determined by assessing the capacity of the NHPT, the SFNT, and grip strength to distinguish between participants based on sex, mobility stages, and age groups, and on performance on the Archimedes spiral and fast alternating hand movements tests.Results
All 3 tests have shown excellent reliability (ICC=.90–.98). However, the limit of agreement was influenced by the participant’s performance on the NHPT, and the minimal detectable change was very different for both hands (right=9.7 vs left=28.0). Construct validity was confirmed for the SFNT and NHPT, but it was not demonstrated for grip strength.Conclusions
Given the metrologic properties assessed in this study, the SFNT is an excellent measure to assess upper limb coordination, whereas the NHPT must be used with caution. The grip strength is reliable but does not seem to reflect disease severity. 相似文献2.
Ettore Beghi Elisa Gervasoni Elisabetta Pupillo Elisa Bianchi Angelo Montesano Irene Aprile Michela Agostini Marco Rovaris Davide Cattaneo 《Archives of physical medicine and rehabilitation》2018,99(4):641-651
Objective
To compare the risk of falls and fall predictors in patients with Parkinson disease (PD), multiple sclerosis (MS), and stroke using the same study design.Design
Multicenter prospective cohort study.Setting
Institutions for physical therapy and rehabilitation.Participants
Patients (N=299) with PD (n=94), MS (n=111), and stroke (n=94) seen for rehabilitation.Interventions
Not applicable.Main Outcome Measures
Functional scales were applied to investigate balance, disability, daily performance, self-confidence with balance, and social integration. Patients were followed for 6 months. Telephone interviews were organized at 2, 4, and 6 months to record falls and fall-related injuries. Incidence ratios, Kaplan-Meier survival curves, and Cox proportional hazards models were used.Results
Of the 299 patients enrolled, 259 had complete follow-up. One hundred and twenty-two patients (47.1%) fell at least once; 82 (31.7%) were recurrent fallers and 44 (17.0%) suffered injuries; and 16%, 32%, and 40% fell at 2, 4, and 6 months. Risk of falls was associated with disease type (PD, MS, and stroke in decreasing order) and confidence with balance (Activities-specific Balance Confidence [ABC] scale). Recurrent fallers were 7%, 15%, and 24% at 2, 4, and 6 months. The risk of recurrent falls was associated with disease type, high educational level, and ABC score. Injured fallers were 3%, 8%, and 12% at 2, 4, and 6 months. The only predictor of falls with injuries was disease type (PD).Conclusions
PD, MS, and stroke carry a high risk of falls. Other predictors include perceived balance confidence and high educational level. 相似文献3.
Jennifer L. Moore Julia Carpenter Anne Marie Doyle Laura Doyle Piper Hansen Bridget Hahn T. George Hornby Heidi R. Roth Susan Spoeri Rachel Tappan Krista Van Der Laan 《Archives of physical medicine and rehabilitation》2018,99(1):82-90
Objective
To examine the use and effect of the Battery of Rehabilitation Assessments and Interventions on evidence-based practice (EBP) over 6 years.Design
Successive independent samples study.Setting
Large rehabilitation system.Participants
Successive samples of allied health clinicians (N=372) in 2009 (n=136), 2012 (n=115), and 2015 (n=121).Interventions
The Battery of Rehabilitation Assessments and Interventions includes 2 components: (1) a process to synthesize, adapt, and make recommendations about the application of evidence; and (2) a process to implement the recommended practices in 3 levels of care.Main Outcome Measures
To assess the effect of the project, surveys on EBP perspectives, use, and barriers were conducted before Battery of Rehabilitation Assessments and Interventions implementation and 3 and 6 years after implementation. Questions about effect of the project on clinical practice were included 3 and 6 years postimplementation.Results
Survey data indicate the Battery of Rehabilitation Assessments and Interventions resulted in a significant increase in use of EBPs to make clinical decisions and justify care. As a result of the project, survey participants reported a substantial increase in use of outcome measures in 2012 (74%) and 2015 (91%) and evidence-based interventions in 2012 (62%) and 2015 (82%). In 2012, significant differences (P≤.01) in effect of the Battery of Rehabilitation Assessments and Interventions on practice were identified between therapists who were directly involved in the project and Interventions compared with uninvolved therapists. In 2015, no significant differences existed between involved and uninvolved therapists.Conclusions
After 6 years of sustained implementation efforts, the Battery of Rehabilitation Assessments and Interventions expedited the adoption of EBPs throughout a large system of care in rehabilitation. 相似文献4.
Moriah J. Brier Rhonda M. Williams Aaron P. Turner Alison W. Henderson Ann Marie Roepke Daniel C. Norvell Helene Henson Joseph M. Czerniecki 《Archives of physical medicine and rehabilitation》2018,99(3):452-458
Objective
To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA).Design
Cross-sectional cohort study using self-report surveys.Setting
Department of Veterans Affairs, academic medical center, and level I trauma center.Participants
Individuals undergoing their first major LEA because of complications of peripheral arterial disease (PAD) or diabetes who have a caregiver and completed measures of caregiver support and conflict (N=137; 94.9% men).Interventions
Not applicable.Main Outcome Measures
The Patient Health Questionnaire-9 to assess depression and the Satisfaction With Life Scale to assess life satisfaction.Results
In multiple regression analyses, controlling for global levels of perceived support, self-rated health, age, and mobility, caregiver-specific support was found to be associated with higher levels of life satisfaction and caregiver-specific conflict was found to be associated with lower levels of life satisfaction and higher levels of depressive symptoms.Conclusions
The specific relationship between individuals with limb loss and their caregivers may be an important determinant of well-being. Conflict with caregivers, which has received little attention thus far in the limb loss literature, appears to play a particularly important role. Individuals with limb loss may benefit from interventions with their caregivers that both enhance support and reduce conflict. 相似文献5.
Background
A variety of tests have been proposed to measure the performance of neck flexor muscles, but head-to-head comparisons hardly have been documented.Objective
To compare reliability indexes, construct validity, and ability to discriminate between individuals with and without neck pain of 4 muscle tests (deep neck flexors endurance test [DNFET]; 2 variations of the craniocervical flexion test [CCFT1 and CCFT2]; and dynamometry).Design
Reliability and validity study.Setting
General community.Participants
A total of 66 participants, 33 with chronic idiopathic neck pain (mean ± standard deviation pain intensity: 3.2 ± 1.9) and 33 without neck pain, from the general population.Methods/Main Outcome
Neck muscle functioning was assessed with the CCFT1, the CCFT2, the DNFET, and dynamometry on 2 separate sessions. Participants with neck pain also were assessed for pain intensity, disability, pain catastrophizing, and fear of movement.Results
Relative reliability of all tests was at least moderate (intraclass correlation coefficient ≥ 0.62), whereas measurement error was high, particularly for the DNFET (95% minimum detectable change ≥ 23.00 seconds). All tests showed moderate correlation (r ≥ 0.3) with at least 2 pain-related measures and moderate-to-strong correlations with each other. Principal component analysis retained 2 factors explaining 68%-73% of the variance of the 4 muscle tests. Significant differences between groups were found for the DNFET and dynamometry (P < .05).Conclusion
The reliability indexes suggest that the DNFET and the CCFT may be more appropriate for group comparisons than for individual comparisons. The 4 tests seem to have construct validity, but they also seem to measure slightly different constructs.Level of Evidence
III 相似文献6.
Yuuichi Sakurai Madoka Shiino Hiroyuki Okamoto Akira Nishimura Koki Nakamura Setsuo Hasegawa 《Advances in therapy》2016,33(9):1519-1535
Introduction
Vonoprazan (TAK-438) is a novel potassium-competitive acid blocker that inhibits gastric H+, K+-ATPase. The objectives of this study were to evaluate the influence of triple therapy with vonoprazan–amoxicillin–clarithromycin or vonoprazan–amoxicillin–metronidazole on the pharmacokinetics of each component of the triple therapies (primary) and to evaluate the safety and tolerability of vonoprazan-based triple therapies (secondary) in healthy adults.Methods
In this single-center, phase 1, open-label, randomized, four-way crossover study, Helicobacter pylori-negative, healthy Japanese male subjects were randomly assigned to 1 of 4 treatment sequences in two cohorts (12 subjects per cohort). Each treatment sequence comprised four treatment periods separated by a washout period of 7 or 14 days. Pharmacokinetic parameters for vonoprazan, amoxicillin, clarithromycin and metronidazole in single therapy or triple therapies were assessed. All adverse events were recorded.Results
Compared with single therapy, triple therapy with vonoprazan–amoxicillin–clarithromycin increased the area under the plasma concentration–time curve from time 0–12 h (AUC0-12) and maximum plasma concentration (C max) of plasma vonoprazan free base by 1.846- and 1.868-fold, respectively, and increased the AUC0-12 and C max of plasma clarithromycin by 1.450- and 1.635-fold, respectively. Triple therapy with vonoprazan–amoxicillin–metronidazole had no influence on the pharmacokinetics of vonoprazan or metronidazole. The pharmacokinetics of amoxicillin was not influenced by vonoprazan-based triple therapies. Seven adverse events were reported. Two subjects discontinued because of an adverse event (rash, liver function test abnormal); both events were considered to be study drug-related.Conclusion
In healthy Japanese male subjects, triple therapy with vonoprazan–amoxicillin–clarithromycin increased vonoprazan and clarithromycin exposure. The safety and tolerability profile of triple therapy with vonoprazan–amoxicillin–clarithromycin or vonoprazan–amoxicillin–metronidazole was favorable in this population.Funding
Takeda Pharmaceutical Company Ltd.Trial registration
JapicCTI-153102.7.
Janusz Kaczorowski Stephen J.C. Hearps Lynne Lohfeld Ron Goeree Faith Donald Ken Burgess Rolf J. Sebaldt 《Canadian family physician Médecin de famille canadien》2013,59(6):e282-e289
Objective
To evaluate the effect of the Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) reminder and recall system and pay-for-performance incentives on the delivery rates of cervical and breast cancer screening in primary care practices in Ontario, with or without deployment of nurse practitioners (NPs).Design
Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP–augmented strategies of the P-PROMPT reminder and recall system.Setting
Southwestern Ontario.Participants
A total of 232 physicians from 24 primary care network or family health network groups across 110 different sites eligible for pay-for-performance incentives.Interventions
The P-PROMPT project combined pay-for-performance incentives with provider and patient reminders and deployment of NPs to enhance the delivery of preventive care services.Main outcome measures
The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months.Results
Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.Conclusion
The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario. 相似文献8.
Matthew J. Miller Dawn M. Magnusson Guy Lev Thomas T. Fields Paul F. Cook Jennifer E. Stevens-Lapsley Cory L. Christiansen 《PM & R》2018,10(10):1056-1061
Background
Prosthesis rehabilitation after dysvascular transtibial amputation (TTA) is focused on optimizing functional capacity with limited emphasis on promoting health self-efficacy. Self-efficacy interventions decrease disability for people living with chronic disease, but the influence of self-efficacy on disability is unknown for people with dysvascular TTA.Objectives
To identify if self-efficacy mediates the relationship between self-reported functional capacity and disability after dysvascular TTA.Design
Cross-sectional, secondary data analysis.Setting
Outpatient rehabilitation facilities.Participants
Thirty-eight men (63.6 ± 9.1 years old) with dysvascular TTA.Methods
Participants had been living with an amputation for less than 6 months and using walking as their primary form of locomotion using a prosthesis. The independent variable, functional capacity, was measured using the Prosthesis Evaluation Questionnaire–Mobility Scale (PEQ-MS). The proposed mediator, self-efficacy, was measured with the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD).Main Outcome Measure
Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire.Results
The relationship between self-reported functional capacity and disability is partially mediated by self-efficacy. Relationships between WHODAS 2.0 and PEQ-MS (r = –0.61), WHODAS 2.0 and SEMCD (r = –0.51), and PEQ-MS and SEMCD (r = 0.44) were significant (P < .01). Controlling for SEMCD (P = .04), the relationship between PEQ-MS and WHODAS 2.0 remained significant (P < .01). Statistically significant mediation was determined by a bootstrap method for the product of coefficients (95% confidence interval: –2.23, –7.39).Conclusions
This study provides initial evidence that the relationship between self-reported functional capacity and disability is partially mediated by self-efficacy after dysvascular TTA. The longitudinal effect of self-efficacy should be further examined to identify causal pathways of disability after dysvascular amputation. Furthermore, additional factors contributing to the relationship between self-reported functional capacity and disability need to be identified.Level of Evidence
III 相似文献9.
Morgan K. Callahan Rachel E. Cowan 《Archives of physical medicine and rehabilitation》2018,99(10):2007-2014.e3
Objective
To assess (1) if fitness and mobility are related to behavior and perception of physical barriers and (2) if behavior and physical barrier perception are related.Design
Cross-sectional case series.Setting
Academic Medical Laboratory.Participants
Manual wheelchair users (N=50) with chronic spinal cord injury (62% paraplegia).Intervention
None.Main Outcome Measures
Participants completed the following assessments: (1) fitness: graded exercise test (aerobic) and Wingate (anaerobic); (2) mobility: 6-minute push test and 30-second sprint test; (3) physical barrier behavior: Encounters of Environmental Features in the Environmental Aspects of Mobility Questionnaire (EAMQ); (4) physical barrier perception: Craig Hospital Inventory of Environmental Factor (CHIEF) Environmental Barriers domain.Results
Individuals with paraplegia had higher fitness, mobility, and environmental barrier encounter rates and lower avoidance per encounter rates vs tetraplegia (all P≤.05). For individuals with tetraplegia only, as mobility and fitness increased, frequencies of (1) encounters increased; (2) avoidances per encounter decreased, in multiple EAMQ domains (all P≤.05). Perception of barriers did not differ between lesion levels (P=.79). Mobility and fitness were not related to environmental barriers perception in both groups (all P>.17).Conclusions
Fitness and mobility are associated with barrier behaviors (ie, encounters and avoidances) among individuals with tetraplegia, but not paraplegia. Despite a greater barrier avoidance rate, persons with tetraplegia do not perceive more physical barriers than persons with paraplegia. Surprisingly, fitness and mobility were not related to perception of barriers in either group. More research is required on if barrier perception, behavior, or both influence participation, to enable rehabilitation programs to tailor interventions to enhance participation. 相似文献10.
James F. Malec Timothy E. Stump Patrick O. Monahan Jacob Kean Dawn Neumann Flora M. Hammond 《Archives of physical medicine and rehabilitation》2018,99(2):281-288.e2
Objectives
To develop, for versions completed by individuals with traumatic brain injury (TBI) and an observer, a more precise metric for the Neuropsychiatric Inventory (NPI) Irritability and Aggression subscales using all behavioral item ratings for use with individuals with TBI and to address the dimensionality of the represented behavioral domains.Design
Rasch and confirmatory factor analyses of retrospective baseline NPI data from 3 treatment studies.Setting
Postacute rehabilitation clinic.Participants
NPI records (N = 525) consisting of observer ratings (n = 287) and self-ratings (n = 238) by participants with complicated mild, moderate, or severe TBI at least 6 months postinjury.Interventions
Not applicable.Main Outcome Measures
Frequency and severity ratings from NPI Irritability/Lability and Agitation/Aggression subscales.Results
Confirmatory factor analyses of both observer and participant ratings showed good fit for either a 1-factor or a 2-factor solution. Consistent with this, the Rasch model also fit the data well with aggression items indicating the more severe end of the construct and irritability items populating the milder end.Conclusions
Irritability and aggression appear to represent different levels of severity of a single construct. The derived Rasch metric offers a measure of this construct based on responses to all specific items that is appropriate for parametric statistical analysis and may be useful in research and clinical assessments of individuals with TBI. 相似文献11.
Jeffrey E. Edwards Lise Eliot Andrew Parkinson Sharon Karan Leigh MacConell 《Advances in therapy》2017,34(9):2120-2138
Introduction
Obeticholic acid (OCA), a potent and selective farnesoid X receptor agonist, is indicated for the treatment of primary biliary cholangitis (PBC). We investigated the potential drug–drug interaction effect of OCA on metabolic CYP450 enzymes and drug transporters.Methods
Five phase 1 single-center, open-label, fixed-sequence, inpatient studies were conducted in healthy adult subjects to evaluate the effect of oral daily doses of 10 or 25 mg OCA on single-dose plasma pharmacokinetics of specific probe substrates for enzymes CYP1A2 (caffeine, R-warfarin), CYP3A (midazolam, R-warfarin), CYP2C9 (S-warfarin), CYP2D6 (dextromethorphan), CYP2C19 (omeprazole), and drug transporters, BCRP/OATP1B1/OATP1B3 (rosuvastatin), and P-gp (digoxin).Results
OCA showed no substantial suppression/inhibition of S-warfarin, digoxin, and dextromethorphan and weak interactions with caffeine, omeprazole, rosuvastatin, and midazolam. The maximal pharmacodynamic responses (E max) to warfarin-based INR, PT, and aPTT were reduced by 11%, 11%, and 1%, respectively, for the 10-mg dose group and by 7%, 7% and 0%, respectively, for the 25-mg dose group. Overall, drugs dosed in combination with OCA were well tolerated, and most adverse events were mild in severity. No clinically important trends were noted in laboratory evaluations, vital signs, or 12-lead ECGs.Conclusion
In these studies, OCA showed weak to no suppression/inhibition of metabolic enzymes and drug transporters at the highest recommended therapeutic dose in patients with PBC. On the basis on these analyses, monitoring and maintenance of target INR range are required during coadministration of OCA with drugs that are metabolized by CYP1A2 (R-warfarin).Funding
Intercept Pharmaceuticals, Inc.12.
Hsiu-Yun Hsu Chia-Wen Ke Ta-Shen Kuan Hsiu-Ching Yang Ching-Liang Tsai Li-Chieh Kuo 《PM & R》2018,10(2):146-153
Background
The presence of subtle losses in hand dexterity after stroke affects the regaining of independence with regard to activities of daily living. Therefore, awareness of ipsilesional upper extremity (UE) function may be of importance when developing a comprehensive rehabilitation program. However, current hand function tests seem to be unable to identify asymptomatic UE impairments.Objectives
To assess the motor coordination as well as the sensory perception of an ipsilesional UE using biomechanical analysis of performance-oriented tasks and conducting a Manual Tactile Test (MTT).Design
Case-controlled study.Setting
A university hospital.Participants
A total of 21 patients with unilateral stroke, along with 21 matched healthy control subjects, were recruited.Methods
Each participant was requested to perform a pinch?holding-up activity (PHUA) test, object-transport task, and reach-to-grasp task via motion capture, as well as the MTT.Main Outcome Measurements
The kinetic data of the PHUA test, kinematics analysis of functional movements, and time requirement of MTT were analyzed.Results
Patients with ipsilesional UE had an inferior ability to scale and produce pinch force precisely when conducting the PHUA test compared to the healthy controls (P < .05). The movement time was statistically longer and peak velocity was significantly lower (P < .05) in the performance-oriented tasks for the ipsilesional UE patients. The longer time requirement in 3 MTT subtests showed that the ipsilesional UE patients experienced degradation in sensory perception (P < .001).Conclusion
Comprehensive sensorimotor assessments based on functional perspectives are valid tools to determine deficits in the sensation-perception-motor system in the ipsilesional UE. Integration of sensorimotor training programs for ipsilesional UE in future neuro-rehabilitation strategies may provide more beneficial effects to regain patients’ motor recovery and to promote daily living activity independence than focusing on paretic arm motor training alone.Level of Evidence
III 相似文献13.
Purpose
Hepatitis C, a chronic disease with deadly consequences, is no longer predominantly a disease of older people.Methods
A limited search was conducted of the relevant literature on 2 topics: (1) the impact of hepatitis C on infants exposed by vertical transmission; and (2) the impact of hepatitis C infection on infected children and adolescents. The findings were supplemented by the first-hand experience of the authors.Findings
Young people, including women of childbearing age, infants, children, and adolescents, are being especially affected by hepatitis C infection secondary to the intravenous drug use and opioid epidemic. Unfortunately, estimates of disease in young populations are all misleading because universal screening has not been implemented.Implications
Lack of implementation of policies for screening and therapy on most affected populations will be responsible for perpetuation of this infection. In the era of highly effective therapy and a regimen that is approved by the US Food and Drug Administration for children, this outcome is unacceptable. 相似文献14.
Background
There is a growing interest in the use of biologic agents such as platelet-rich plasma and mesenchymal stem/stromal cells to treat musculoskeletal injuries, including meniscal tears. Although previous research has documented the role of diagnostic ultrasound to evaluate meniscal tears, sonographically guided (SG) techniques to specifically deliver therapeutic agents into the meniscus have not been described.Objective
To describe and validate SG injection techniques for the body and posterior horn of the medial and lateral meniscus.Design
Prospective, cadaveric laboratory investigation.Setting
Academic institution procedural skills laboratory.Subjects
Five unenbalmed cadaveric knee-ankle-foot specimens from 5 donors (3 female and 2 male) ages 33-92 years (mean age 74 years) with body mass indices of 21.1-32.4 kg/m2 (mean 24.1 kg/m2).Methods
A single, experienced operator completed SG injections into the bodies and posterior horns of the medial and lateral menisci of 5 unenbalmed cadaveric knees using colored latex and a 22-gauge, 38-mm needle. After injection, coinvestigators dissected each specimen to assess latex distribution within the menisci and identify injury to intra-articular and periarticular structures.Main Outcome Measures
Latex location within the target region of meniscus (accurate/inaccurate), and iatrogenic injury to “at risk” intra- and periarticular structures (present/absent).Results
Seventeen of 20 injections were accurate. Two of 3 inaccurate injections infiltrated the posterior horn of the medial meniscus instead of the targeted meniscal body. One inaccurate lateral meniscus injection did not contain latex despite sonographically accurate needle placement. No specimen exhibited injury to regional neurovascular structures or intra-articular hyaline cartilage.Conclusions
SG meniscus injections are feasible and can accurately and safely deliver injectates such as regenerative agents into bodies and posterior horns of the medial and lateral menisci. The role of SG intrameniscal injections in the treatment of patients with degenerative and traumatic meniscal disorders warrants further exploration.Level of Evidence
Not applicable. 相似文献15.
Hillary R. Bogner Heather F. de Vries McClintock Jibby E. Kurichi Pui L. Kwong Dawei Xie Sean Hennessy Joel E. Streim Margaret G. Stineman 《Archives of physical medicine and rehabilitation》2017,98(1):1-10
Objective
To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.Design
National representative sample with 2-year follow-up.Setting
Medicare Current Beneficiary Survey from calendar years 2001 to 2008.Participants
Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years.Interventions
Not applicable.Main Outcome Measures
A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics.Results
Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54–.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79–.97), be institutionalized (adjusted RRR, .72; 95% CI, .56–.92), or die (adjusted RRR, .86; 95% CI, .75–.98).Conclusions
Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries. 相似文献16.
Mark Lemstra Ghita Nielsen Marla Rogers Adam Thompson John Moraros 《Canadian family physician Médecin de famille canadien》2012,58(1):e54-e61
Objective
To determine the unadjusted and adjusted associations between developmental, environmental, psychological, social, or demographic factors and meeting the Health Canada physical activity standard.Design
Survey.Setting
Saskatoon, Sask.Participants
Every student in grades 5 to 8 in Saskatoon was asked to complete the Saskatoon School Health Survey; 4197 students did so.Main outcome measures
Whether students met the Health Canada standard for daily physical activity and associated risk factors for not meeting the standard.Results
Among the 4197 youth who participated in the survey, only 7% met the Health Canada standard of daily physical activity longer than 1 hour of somewhat hard intensity or higher. Although there were 23 unadjusted factors associated with youth meeting the Health Canada standard, only 5 were significant after multivariate adjustment: 1) their fathers were employed (odds ratio [OR] 2.29, P = .027), 2) their parents watched them participate in physical activities or sports every day (OR 1.23, P < .001), 3) their friends encouraged them to do physical activities or sports every day (OR 1.19, P < .001), 4) their friends or classmates did not tease them for not doing well at physical activities or sports every day (OR 1.20, P = .001), and 5) they played sports or physical activities with coaches or instructors more than 4 times a week (OR 1.44, P < .001).Conclusion
Given the low rates of physical activity among youth, we believe that a reduced list of independent risk indicators is required to focus our limited human and financial resources for successful intervention in the community. 相似文献17.
International collaborative study for the calibration of proposed International Standards for thromboplastin,rabbit, plain,and for thromboplastin,recombinant, human,plain 
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下载免费PDF全文 A. M. H. P. van den Besselaar V. Chantarangkul F. Angeloni N. B. Binder M. Byrne R. Dauer B. R. Gudmundsdottir J. Jespersen S. Kitchen C. Legnani T. L. Lindahl R. A. Manning M. Martinuzzo O. Panes V. Pengo A. Riddell S. Subramanian A. Szederjesi C. Tantanate P. Herbel A. Tripodi 《Journal of thrombosis and haemostasis》2018,16(1):142-149
Essentials
- Two candidate International Standards for thromboplastin (coded RBT/16 and rTF/16) are proposed.
- International Sensitivity Index (ISI) of proposed standards was assessed in a 20‐centre study.
- The mean ISI for RBT/16 was 1.21 with a between‐centre coefficient of variation of 4.6%.
- The mean ISI for rTF/16 was 1.11 with a between‐centre coefficient of variation of 5.7%.
Summary
Background
The availability of International Standards for thromboplastin is essential for the calibration of routine reagents and hence the calculation of the International Normalized Ratio (INR). Stocks of the current Fourth International Standards are running low. Candidate replacement materials have been prepared. This article describes the calibration of the proposed Fifth International Standards for thromboplastin, rabbit, plain (coded RBT/16) and for thromboplastin, recombinant, human, plain (coded rTF/16).Methods
An international collaborative study was carried out for the assignment of International Sensitivity Indexes (ISIs) to the candidate materials, according to the World Health Organization (WHO) guidelines for thromboplastins and plasma used to control oral anticoagulant therapy with vitamin K antagonists.Results
Results were obtained from 20 laboratories. In several cases, deviations from the ISI calibration model were observed, but the average INR deviation attributabled to the model was not greater than 10%. Only valid ISI assessments were used to calculate the mean ISI for each candidate. The mean ISI for RBT/16 was 1.21 (between‐laboratory coefficient of variation [CV]: 4.6%), and the mean ISI for rTF/16 was 1.11 (between‐laboratory CV: 5.7%).Conclusions
The between‐laboratory variation of the ISI for candidate material RBT/16 was similar to that of the Fourth International Standard (RBT/05), and the between‐laboratory variation of the ISI for candidate material rTF/16 was slightly higher than that of the Fourth International Standard (rTF/09). The candidate materials have been accepted by WHO as the Fifth International Standards for thromboplastin, rabbit plain, and thromboplastin, recombinant, human, plain. 相似文献18.
Lindblad U Ek J Eckner J Larsson CA Shan G Råstam L 《Scandinavian journal of primary health care》2012,30(2):88-94
Objective
To describe the prevalence, awareness, and control of hypertension in a Swedish population during the early 2000s to address implications for care and prevention.Design
A cross-sectional population survey.Setting
Primary health care in Skaraborg, a rural part of western Sweden.Subjects
Participants (n =2816) in a population survey of a random sample of men and women between 30 and 75 years of age in the municipalities of Vara (81% participation rate) and Skövde (70%), in western Sweden during 2001–2005.Main outcome measures
Anthropometric measures, blood pressure, leisure-time physical activity, current smoking, fasting glucose, and cholesterol. Hypertension was defined as ongoing treatment for hypertension, or three consecutive blood pressure readings ≥140 systolic and/or ≥90 mmHg diastolic. Hypertension was considered controlled when the blood pressure was <140/90 mm Hg (both).Results
The prevalence of hypertension was 20% in both men and women with a steep increase by age. Among hypertensive subjects, 33% were unaware, 36% aware but uncontrolled, and 31% aware and controlled, with no statistically significant differences between men and women. Patients with diabetes had a higher awareness (87% vs. 64%, p <0.001), but the same control rate (56% vs. 44%, p =0.133), when compared with those without diabetes.Conclusion
A large proportion of subjects with hypertension are still unaware of their condition, or aware but not controlled. It is important to emphasize population-based prevention to reduce the prevalence of hypertension, to perform screening to increase awareness, and to improve implementation of expert guidelines in clinical practice to improve control.Key Words: Awareness, control, hypertension, population survey, prevention- Using strict measures of blood pressure we found the prevalence of hypertension in the ages 30–75 years in Sweden to be 20%.
- A rule of thirds evolved as 1/3 was not previously known, 1/3 was treated but not controlled, and only 1/3 was treated and controlled.
- It is important to emphasize population-based prevention to reduce the prevalence of hypertension, to perform screening to increase awareness, and to improve implementation of expert guidelines in clinical practice to improve control.
19.
Takashi Sasaki Yutaka Seino Atsushi Fukatsu Soichi Sakai Yoshishige Samukawa 《Advances in therapy》2014,31(3):345-361
Introduction
Luseogliflozin, a sodium glucose cotransporter 2 inhibitor, inhibits reabsorption of glucose in the proximal renal tubule. It was developed for the treatment of type 2 diabetes mellitus.Methods
For this first human study of luseogliflozin, randomized, single-blind, placebo-controlled, single ascending dose (1–25 mg) and multiple ascending dose (5 or 10 mg/day, 7 days) trials were conducted in healthy male Japanese subjects to investigate safety, pharmacokinetics, and pharmacodynamics.Results
There were no serious adverse events, adverse events leading to discontinuation, or episodes of hypoglycemia. After administration of a single oral dose of luseogliflozin, its maximum plasma level (C max) and area under the concentration–time curve increased in a dose-dependent manner, and no food effects were observed on pharmacokinetics. The mean time taken to reach C max (T max) ranged from 0.667 to 2.25 h. The mean plasma half-life of luseogliflozin (T 1/2) after multiple dosing for 7 days ranged from 9.14 to 10.7 h, and no detectable accumulation of luseogliflozin was observed. Urinary glucose excretion increased in a dose-dependent manner, ranging from 18.9 to 70.9 g (single-dose study).Conclusion
Luseogliflozin was well tolerated and showed favorable pharmacokinetic and pharmacodynamic profiles in healthy male Japanese subjects. 相似文献20.