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目的 探讨基于感恩拓延-建构理论的延续护理对2型糖尿病患者心理痛苦和生存质量的影响.方法 将140例2型糖尿病患者随机分为观察组和对照组各70例.对照组实施常规护理措施,观察组在常规护理的基础上实施基于感恩拓延-建构理论的延续护理.比较干预前、干预3个月、干预6个月后两组患者心理痛苦及生存质量评分差异.结果 两组患者心...  相似文献   

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《Annals of surgery》1999,230(6):820
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If oversuppression of bone turnover explained the association between bisphosphonate use and atypical subtrochanteric femur fractures (AFF), this could be reversed with anabolic treatment such as teriparatide. We conducted a prospective, open‐label study in patients previously treated with bisphosphonates who sustained AFF, examining the response to 24‐month treatment with teriparatide on bone mineral density (BMD), trabecular bone score (TBS), bone turnover markers (BTM), and fracture healing as well as quantitative histomorphometry. We studied 14 patients. Baseline BMD, BTM, and TBS varied widely. On initial bone biopsies, 12 of 14 patients showed tetracycline labels, but mineralizing surface/bone surface was below published normal values in all but 2. Lumbar spine BMD increased significantly at month 24 (6.1% ± 4.3%, p < 0.05 versus baseline), whereas total hip BMD and TBS did not change significantly. Changes in BTM occurred as reported previously for patients without AFF treated with teriparatide after prior bisphosphonate treatment. At month 24, fractures were healed in 6 patients, showed partial healing in 3, were unchanged in 2, and showed nonunion in 1. In a patient with two fractures, the fracture that occurred before teriparatide treatment was reported as healed, but the fracture that occurred while on treatment showed only partial healing. Bisphosphonate‐treated patients who sustain AFF show heterogeneity of bone turnover. Treatment with teriparatide resulted in increases in BTM and lumbar spine BMD, as has been reported for patients without AFF. There was no significant effect of teriparatide on hip BMD, mineralizing surface to bone surface (MS/BS), or TBS and no consistent effect on fracture healing. In the context of a patient who has experienced an AFF after receiving bisphosphonate treatment, therapy with teriparatide for 24 months would be expected to increase BMD and BTM (and probably reduce the risk of fractures resulting from osteoporosis) but should not be relied on to aid in healing of the AFF. © 2017 American Society for Bone and Mineral Research.  相似文献   

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The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003–7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration.Key Words: Dental sedation, Low peripheral oxygen saturation, Delayed recoveryDental practices are currently challenged by the rapidly growing number of patients with intellectual or physical disabilities.1,2 Excessive mental strain during dental treatment can cause systemic complications such as vasovagal reflex, neurogenic shock, pain shock, and hyperventilation. Furthermore, patients with cardiovascular diseases, including cerebrovascular disorders, or decreased vital organ reserve capacity can encounter serious complications. A strategy for relieving mental strain is important for safe dental treatment of such patients, and to this end, intravenous sedation is often used.3,4 However, when using intravenous sedative drugs that have strong systemic actions on the central nervous, respiratory, and circulatory systems, systemic management to ensure patient safety is a prerequisite.5,6Conscious sedation is generally preferred to maintain independent breathing and biological defense mechanisms such as coughing and swallowing reflexes. However, dental treatment of patients with disabilities may require behavioral control, especially in the case of mentally challenged individuals with strong treatment refusal reactions. In these cases, deeper levels of intravenous sedation are a safer option.Depending upon the individual case, increased drug doses can cause deep sedation until the patient becomes completely unconscious, which is a deeper degree of sedation compared with conscious sedation.6,7 If this deep sedative state overrides the nervous system, basic defense mechanisms may also be lost. Therefore, careful perioperative management, similar to that for general anesthesia, is necessary.Therefore, dental treatment of mentally or physically impaired patients using intravenous anesthetics requires careful perioperative management, similar to general anesthesia. Unfortunately, there is little information available on the disabilities and sedation conditions particularly at risk of causing low peripheral oxygenation and delayed recovery.8,9In this study, we investigated and analyzed the risk factors that may be involved in causing decreased peripheral oxygen saturation (SpO2) and delayed recovery, including age, sex, treatment duration, type of disability or disease, and type and dose of anesthetic, in dental patients with disabilities.  相似文献   

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Thyroid Carcinoma With Metastases: Studied With Radioactive Iodine   总被引:2,自引:1,他引:1  
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Background“Anxious preoccupation” is a maladaptive coping strategy for patients with terminal chronic liver pathology causing psychopathologic emotional responses. The aim of this study was to identify “anxious preoccupation” as a coping strategy when faced with this disease and to investigate its relationship with emotional-type psychopathologic symptoms in patients awaiting a liver transplant (LT).MethodsA total of 63 patients awaiting an LT were evaluated. The instrument used to evaluate coping style was the Mental Adjustment to Cancer questionnaire. One of the coping scales of this questionnaire is “anxious preoccupation” (9 items). An Instrument for psychopathologic assessment was used, the SA-45 questionnaire, which assessed 9 psychopathologic dimensions: somatizations, obsessions-compulsions, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism.Results“Anxious preoccupation” was used as an inadequate coping style by 51% of patients when faced with the disease. Five psychopathologic dimensions were associated with this coping strategy: 1) obsessive-compulsivity: 75% of patients with “anxious preoccupation” had obsessive-compulsivity symptoms compared with 29% of patients with other coping strategies (P < .001); 2) interpersonal sensitivity: 25% vs 6%, respectively (P = .044); 3) depression: 59% vs 29% (P = .015); 4) anxiety: 75% vs 32% (P = .001); and 5) phobic anxiety: 19% vs 3% (P = .050).ConclusionsMore than one-half of the patients on the LT waiting list used “anxious preoccupation” as a coping style for this disease. This strategy was associated with a greater presence of emotional-type psychopathologic symptoms in these patients.  相似文献   

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Introduction

Cardiovascular disease is the leading cause of death in kidney transplant recipients. Hyperlipidemia is a cardiovascular risk factor present in over 70% of recipients. Ezetimibe has proved effective for the treatment of dyslipidemia in these patients.

Aim

To evaluate the efficacy and safety of treatment with ezetimibe in kidney transplant recipients with uncontrolled hyperlipidemia.

Materials and methods

We undertook a prospective study of 25 kidney transplant recipients with dyslipidemia who started treatment with 10 mg of ezetimibe. Statins were being taken by 96% of these patients. Monotherapy was used in one case. Measurements were made at baseline and after 3, 6, and 12 months of the lipid and hepatic profiles, CPK, lactose dehydrogenase, renal function and levels of immunosuppressive agents.

Results

A significant reduction was noted in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. No patient had changes in the hepatic profile, increased CPK and lactose dehydrogenase levels, or important adverse effects. Renal function remained stable, with no significant variations in plasma levels of the different immunosuppressive agents.

Conclusions

The use of ezetimibe associated with statins is an efficient and safe therapeutic alternative for the treatment of poorly controlled dyslipidemia in recipients of a kidney graft.  相似文献   

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