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61.
Nynke D Scherpbier-de Haan Gerald MM Vervoort Chris van Weel Jozé CC Braspenning Jan Mulder Jack FM Wetzels Wim JC de Grauw 《The British journal of general practice》2013,63(617):e798-e806
Background
Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patientsAim
To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension.Design and setting
A cluster randomised controlled trial in nine general practices in The Netherlands.Method
Five practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2.Results
Data of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = −1.0 to 3.2) compared to −0.2 (95% CI = −3.8 to 3.3)/−0.5 (95% CI = −2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]).Conclusion
A shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care. 相似文献62.
Background
Critically-ill trauma patients have a high mortality.Objective
To study the factors affecting the mortality of ICU trauma patients treated at Al-Ain Hospital, United Arab Emirates (UAE).Methods
All trauma patients who were admitted to the ICU were prospectively collected over three years (2003–2006). Univariate and multivariate analysis were used to compare patients who died and who did not. Gender, age, nationality, mechanism of injury, systolic blood pressure and GCS on arrival, the need for ventilation, presence of head or chest injuries, AIS for the chest and head injuries and the ISS were studied.Results
There were 202 patients (181 males). The most common mechanism of injury was road traffic collisions (72.3 %). The overall mortality was 13.9%. A direct logistic regression model has shown that factors that affected mortality were decreased GCS (p < 0.0001), mechanism of injury (p = 0.004) with burns having the highest mortality, increased age (p = 0.004), and increased ISS (p = 0.02). The best GCS that predicted mortality was 5.5 while the best ISS that predicted mortality was 13.5.Conclusion
Road traffic collision is the most common cause of serious trauma in UAE followed by falls. Decreased GCS was the most significant factor that predicted mortality in the ICU trauma patients. 相似文献63.
64.
Rebecca A Bruni Andreas Laupacis Wendy Levinson Douglas K Martin 《BMC health services research》2007,7(1):186
Background
As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement. 相似文献65.
Mittempergher F Bruni T Bruni O Di Betta E Occelli G Salerni B 《Annali italiani di chirurgia》2002,73(2):137-142
We present our experience in malabsorbitive procedure in bariatric surgery based on Biliopancreatic Diversion (BPD) with transitory gastroplasty. Since 1995 we operated on 74 patients with BPD coupled with gastroplasty which is transitory due to the presence of a band in polidioxanone (PDS). The technique, proposed by Vassallo et al. in 1992, involve the respect of the duodenal bulb (5 centimeter from the pylorous) making an end-to-side duodeno-ileal isoperistaltic anastomosis. The initial excess weight loss was satisfactory (69.8% +/- 11.4% after 1 year) and it kept being stable during all the follow-up (75.2% +/- 6.4% after 5 years). The mortality was absence. We didn't observe ipoalbuminemia, diarrhea or halitosis in any patients. Only 1 patient (1.3%) developed an anastomotic ulcer. After 5 years follow-up we observed 2 cases (12.5%) of chronic hypochromic anemia and 1 case (6.2%) of hypocalcemia. We didn't perform any restorative operation. We consider this technique a good malabsortive procedure able to obtain a satisfactory and stable weight loss, with a low incidence of complications. Moreover it could be applied in patients previously treated by an ineffective gastroplasty. 相似文献
66.
Curcio SA Kawarai T Paterson AD Maletta RG Puccio G Perri M Di Natale M Palermo S Foncin JF Hyslop PH Bruni AC 《Journal of neurology》2002,249(7):911-922
Frontotemporal dementia (FTD) displays significant neuropathological and genetic heterogeneity among and within affected
families. An early diagnosis is often difficult because cognitive symptoms are manifest only at a late stage of the disease.
We have been studying a large pedigree segregating frontotemporal dementia (FTD) to which belong 34 identified affected persons,
11 of whom were personally examined. The kindred has been genealogically reconstructed; all FTD patients have been linked
to the same ancestors who lived in the early 18th century (11 generations before the present one). Autosomal dominant transmission was evident. Clinical features were uniform
within the kindred and met the Lund-Manchester criteria. Personality changes with absence of insight, lack of empathy and
of social awareness manifested up to 5 years before medical advice was sought. Loss of fluency was the earliest neuropsychological
sign, in the absence of memory, orientation and praxis deficits, which evolved late, together with hyperorality. Akinesia
was observed early, rigidity appeared late, tremor was absent. Two patients showed myoclonus late in their evolution. No ALS
signs were observed in this kindred. Mutations of the MAPt gene, coding for the Tau protein, were not detected in affected
family members. Linkage studies excluded chromosomes 3 and 9 and gave indeterminate results that were model dependent for
chromosome 17.
Received: 6 August 2001, Received in revised form: 2 January 2002, Accepted: 15 January 2002 相似文献
67.
Palazzuoli A Puccetti L Pastorelli M Pasqui AL Auteri A Bruni F 《International journal of cardiology》2002,84(1):47-51
BACKGROUND: Even if diastolic function has been assessed in athletes by analysis of transmitral Doppler flow, no one has studied pulmonary venous flow in this population. The aim of this study was to establish if the physiological adaptations following a prolonged physical training could influence the diastolic function in a professional Olympic male runner group. METHODS: From February to December 1999 we studied 25 athletes (Group I) during the period of maximal training compared with 18 age- and sex-matched healthy sedentary subjects (Group II). We used mono- and bidimensional Echocardiography to assess left ventricular structure and systolic function. The diastolic function was evaluated by Doppler method assessing transmitral and venous pulmonary flow. RESULTS: From the comparison between the two groups, we found great differences in the interventricular septum and the posterior wall thickness; the analysis of the systolic function demonstrated a significant increase in ejection fraction, stroke volume, left ventricular mass, and end diastolic volume in the athletes' population. Fluximetric study showed that ventricular diastolic function is not influenced by hypertrophy: indeed, Doppler evaluation of the transmitral flow showed a bigger velocity of the E wave, similarly, when we assessed pulmonary venous flow, we found faster retrograde Ar wave in group I. CONCLUSIONS: Our data indicate that diastolic function remains normal or improves in some cases after physical training; left ventricular hypertrophy and concentric remodeling do not involve diastolic changes like hypertrophic and hypertensive heart diseases. 相似文献
68.
Esther STF Smeulders Jolanda CM van Haastregt Elisabeth FM van Hoef Jacques ThM van Eijk Gertrudis IJM Kempen 《BMC health services research》2006,6(1):91
Background
Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-management may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients. 相似文献69.
70.
Valproic acid and plasma levels of phenytoin. 总被引:5,自引:0,他引:5
Eight patients were treated concurrently with a constant dose of phenytoin and valproic acid for 1 year. During initial therapy with valproic acid, total plasma phenytoin levels decreased. The interaction was transient and was not observed at the end of 1 year. Total plasma phenytoin levels returned to pre-valproic-acid levels in seven patients. 相似文献