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971.
Blot SI Labeau S Vandijck D Van Aken P Claes B;Executive Board of the Flemish Society for Critical Care Nurses 《Intensive care medicine》2007,33(8):1463-1467
Objective To determine intensive care nurses' knowledge of evidence-based guidelines for the prevention of ventilator-associated pneumonia
(VAP).
Design A survey using a validated multiple-choice questionnaire, developed to evaluate nurses' knowledge of VAP prevention. The questionnaire
was distributed and collected during the annual congress of the Flemish Society for Critical Care Nurses (Ghent, November
2005). Demographic data included were gender, years of intensive care experience, number of critical beds, and whether respondents
hold a special degree in emergency and intensive care.
Main results We collected 638 questionnaires (response rate 74.6%). Nineteen percent of the respondents recognized the oral route as the
recommended way for intubation. It was known by 49% of respondents that ventilator circuits should be changed for each new
patient. Heat and moisture exchangers were checked as the recommended type of humidifier by 55% of respondents, but only 13%
knew that it is recommended to change them once weekly. Closed suctioning systems were identified as recommended by 17% of
respondents, and 20% knew that these must be changed for each new patient only. Sixty percent and 49%, respectively, recognized
subglottic drainage and kinetic beds to reduce the incidence of VAP. Semi-recumbent positioning is well known to prevent VAP
(90%). The average knowledge level was higher among more experienced nurses (> 1 year experience) and those holding a special
degree in emergency and intensive care.
Conclusion Nurses lack knowledge regarding recommendations for VAP prevention. Nurses' schooling and continuing education should include
support from current evidence-based guidelines.
The authors have written this article on behalf of the Executive Board of the Flemish Society for Critical Care Nurses.
Stijn I. Blot and Sonia Labeau are the joint primary authors. 相似文献
972.
Thomas Seisen Malte W. Vetterlein Patrick Karabon Tarun Jindal Akshay Sood Luigi Nocera Paul L. Nguyen Toni K. Choueiri Quoc-Dien Trinh Mani Menon Firas Abdollah 《European urology》2018,73(3):452-461
Background
There is limited evidence supporting the use of local treatment (LT) for prostate cancer (PCa) patients with clinically pelvic lymph node-positive (cN1) disease.Objective
To examine the efficacy of any form of LT ± androgen deprivation therapy (ADT) in treating these individuals.Design, setting, and participants
Using the National Cancer Database (2003–2011), we retrospectively identified 2967 individuals who received LT ± ADT versus ADT alone for cN1 PCa. Only radical prostatectomy (RP) and radiation therapy (RT) were considered as definitive LT.Intervention
LT ± ADT versus ADT alone.Outcome measurements and statistical analysis
Instrumental variable analyses (IVA) were performed using a two-stage residual inclusion approach to compare overall mortality (OM)-free survival between patients who received LT ± ADT versus ADT alone. The same methodology was used to further compare OM-free survival between patients who received RP ± ADT versus RT ± ADT.Results and limitations
Overall, 1987 (67%) and 980 (33%) patients received LT ± ADT and ADT alone, respectively. In the LT ± ADT group, 751 (37.8%) and 1236 (62.2%) patients received RP ± ADT and RT ± ADT, respectively. In IVA, LT ± ADT was associated with a significant OM-free survival benefit (hazard ratio = 0.31, 95% confidence interval [CI] = 0.13–0.74, p = 0.007), when compared with ADT alone. At 5 yr, OM-free survival was 78.8% (95% CI: 74.1–83.9%) versus 49.2% (95% CI: 33.9–71.4%) in the LT ± ADT versus ADT alone groups. When comparing RP ± ADT versus RT ± ADT, IVA showed no significant difference in OM-free survival between the two treatment modalities (hazard ratio = 0.54, 95% CI = 0.19–1.52, p = 0.2). Despite the use of an IVA, our study may be limited by residual unmeasured confounding.Conclusions
Our findings show that PCa patients with clinically pelvic lymph node-positive disease may benefit from any form of LT ± ADT over ADT alone. While not necessarily curative by itself, the use of RP or RT could be the first step in a multi-modality approach aiming at providing the best cancer control outcomes for these individuals.Patients summary
We examined the role of local treatment for clinically pelvic lymph node-positive prostate cancer. We found that the delivery of radical prostatectomy or radiation therapy may be associated with an overall mortality-free survival benefit compared with androgen deprivation therapy alone. 相似文献973.
974.
975.
976.
Jody Sharp Toni Azar David Lawson 《Contemporary topics in laboratory animal science》2005,44(2):32-40
To determine whether a nonsocial enrichment program affects cardiovascular responses of individually housed male Sprague-Dawley (SD) and spontaneously hypertensive (SH) rats under basal conditions and after potentially stressful procedures, we used radiotelemetry to record heart rate (HR), systolic blood pressure (SBP), and activity in the cage. Enrichment comprised a simulated burrow (Rodent Retreat), then a food foraging item ("rat cannoli") 2 days later, and a paper bag of bedding for shredding (Nestpak) after another 2 days. Data were collected under undisturbed conditions and before and after several acute and chronic manipulations mimicking common husbandry, experimental, and stressful procedures. Enrichment often, but not always, reduced HR and SBP in male rats, suggesting decreased arousal and stress, and the effects depended on the parameter measured, strain of rat, and nature of the procedure to which animals were exposed. In general, HR varied more than SBP; enrichment affected SH rats more than SD rats; effects of enrichment were more consistently observed under undisturbed conditions than after manipulations of the rats; moderate responses to acute husbandry and experimental procedures were affected more than the larger changes produced by very stressful procedures; and responses to social interactions were unaffected by the enrichment program. What accounts for these variable effects of enrichment is unclear, and more studies are required to resolve the mechanisms. Whether this enrichment program should be used in an animal facility depends on several factors, particularly the professional judgment of the research, veterinary, and animal care staffs involved. 相似文献
977.
Ancoli-Israel S Palmer BW Cooke JR Corey-Bloom J Fiorentino L Natarajan L Liu L Ayalon L He F Loredo JS 《Journal of the American Geriatrics Society》2008,56(11):2076-2081
OBJECTIVES: To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function. DESIGN: Randomized double‐blind placebo‐controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks. SETTING: General clinical research center. PARTICIPANTS: Fifty‐two men and women with mild to moderate AD and OSA. INTERVENTION: CPAP. MEASUREMENTS: A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks. RESULTS: A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre‐ and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed. CONCLUSION: OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present. 相似文献
978.
Gavasso S Nygård O Pedersen ER Aarseth JH Bleie O Myhr KM Vedeler CA 《Atherosclerosis》2005,180(2):277-282
BACKGROUND: Inflammation is important in the pathogenesis of atherosclerosis. Polymorphisms of Fc receptors for IgG (FcgammaR) are associated with modifying effects of several infectious and autoimmune diseases. We have assessed the relationship between polymorphisms in three different FcgammaR genes and coronary artery disease (CAD). METHODS AND RESULTS: We genotyped for the FcgammaRIIA-R/H131, the FcgammaRIIIB-Na1/Na2, and the FcgammaRIIIA-F/V158 polymorphisms in 882 patients undergoing diagnostic coronary angiography. Significant CAD was defined as >/=50% lumen diameter stenosis in at least one coronary artery. In the analysis, no association was found between the FcgammaRIIA and FcgammaRIIIB genotypes and CAD, whereas the FcgammaRIIIA genotype was strongly related. Compared to those being heterozygous, or homozygous for the F allele, patients homozygous for the V allele had significantly reduced risk: OR, 0.53; (CI, 0.32-0.90). Additional adjustment for classical risk factors and sedimentation rate did not affect the results. The V/V genotype was also inversely related to the extent of CAD defined as no CAD, single, double or triple vessel disease (P trend=0.002). CONCLUSIONS: Our data provide evidence for an association between FcgammaRIIIA allelic variants and coronary atherosclerosis. Genetic variation in this IgG-receptor may influence the clearance of antibodies by monocyte-derived macrophages involved in the pathogenesis of CAD. 相似文献
979.
Ancoli-Israel S Martin JL Kripke DF Marler M Klauber MR 《Journal of the American Geriatrics Society》2002,50(2):282-289
OBJECTIVES: To determine whether fragmented sleep in nursing home patients would improve with increased exposure to bright light. DESIGN: Randomized controlled trial. SETTING: Two San Diego-area nursing homes. PARTICIPANTS: Seventy-seven (58 women, 19 men) nursing home residents participated. Mean age +/- standard deviation was 85.7 +/- 7.3 (range 60-100) and mean Mini-Mental State Examination was 12.8 +/- 8.8 (range 0-30). INTERVENTIONS: Participants were assigned to one of four treatments: evening bright light, morning bright light, daytime sleep restriction, or evening dim red light. MEASUREMENTS: Improvement in nighttime sleep quality, daytime alertness, and circadian activity rhythm parameters. RESULTS: There were no improvements in nighttime sleep or daytime alertness in any of the treatment groups. Morning bright light delayed the peak of the activity rhythm (acrophase) and increased the mean activity level (mesor). In addition, subjects in the morning bright light group had improved activity rhythmicity during the 10 days of treatment. CONCLUSION: Increasing exposure to morning bright light delayed the acrophase of the activity rhythm and made the circadian rhythm more robust. These changes have the potential to be clinically beneficial because it may be easier to provide nursing care to patients whose circadian activity patterns are more socially acceptable. 相似文献
980.
Jennifer A. Hutcheon Susan Moskosky Cande V. Ananth Olga Basso Peter A. Briss Cynthia D. Ferré Brittni N. Frederiksen Sam Harper Sonia Hernández‐Díaz Ashley H. Hirai Russell S. Kirby Mark A. Klebanoff Laura Lindberg Sunni L. Mumford Heidi D. Nelson Robert W. Platt Lauren M. Rossen Alison M. Stuebe Marie E. Thoma Catherine J. Vladutiu Katherine A. Ahrens 《Paediatric and perinatal epidemiology》2019,33(1):O15-O24