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221.
Heart failure is a progressive illness that carries significant morbidity and mortality. This highly prevalent illness leads
to frequent, costly hospitalizations with approximately 50% of patients being readmitted within 6 months of initial hospitalization.
While rehospitalization has been extensively studied in the past, little progress has been made in terms of reducing readmission
rates of heart failure patients in the last decade despite increasing costs with impending resource limitations. We discuss
disease-centered, physician-centered, and patient-centered factors that lead to rehospitalization as well as community/resource
availability factors that contribute to rehospitalization of patients suffering from chronic heart failure. In addition, predictors
of hospitalization and interventions that reduce hospitalization will be critically evaluated. With a complete understanding
of heart failure rehospitalization, we hope the future holds more effective ways to prevent heart failure progression and
thus rehospitalization, improved risk-stratification models to identify patients high-risk for rehospitalization, and sustained
interventions that are customized according to the etiology of the clinical decline of heart failure patients that ultimately
results in frequent rehospitalizations. 相似文献
222.
Daniel B. Menzel PhD Ronald J. Slaughter MD Anita M. Bryant Hugo O. Jauregui MD PhD 《Archives of environmental & occupational health》2013,68(6):296-301
Ozonides of the methyl esters of oleic, linoleic, linolenic and arachidonic acids were found to produce Heinz body inclusions in human and mouse erythrocytes. No simple relationships between structure and activity were noted. Concomitant with Heinz body formation, methemoglobin and loss of cellular thiols were observed. Methyl ozonides readily oxidized glutathione and 1 mole of oxidized glutathione was formed per mole of methyl oleate ozonide. Methyl ozonides catalyzed the formation of disulfide-linked interchain polymers between hemoglobin and ovalbumin. Heinz bodies were not produced with ozone in the absence of unsaturated lipids. Heinz bodies were observed in the blood of mice exposed to ozone (0.85 ppm) for 48 hours. These observations suggest that fatty acid ozonides could serve as a toxic chemical species formed on ozone inhalation and could explain the divergent protective effects of lipid antioxidants and thiol generating systems in vivo. 相似文献
223.
ABSTRACT: BACKGROUND: About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes. METHODS: Data included secondary enrollment and demographic data from Washington Dental Service (WDS) and Group Health Cooperative (GH), clinical data from GH, and dental-utilization data from WDS claims during 2002-2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups. RESULTS: We found that adults with diabetes had lower odds of visiting a dentist (OR=0.74, p < 0.001). Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR=0.77), fillings (OR=0.80) and crowns (OR=0.84) (p < 0.005 for all) and higher odds of receiving periodontal maintenance (OR=1.24), non-surgical periodontal procedures (OR=1.30), extractions (OR=1.38) and removable prosthetics (OR=1.36) (p < 0.001 for all). CONCLUSIONS: Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes. 相似文献
224.
Zsuzsanna Némethné Gyurcsik Anita András Nóra Bodnár Zoltán Szekanecz Sándor Szántó 《Rheumatology international》2012,32(12):3931-3936
Physical therapy in ankylosing spondylitis (AS) is important for maintaining or improving mobility, fitness, functioning, and global health. It also plays a role in the prevention and management of structural deformities. In this study we assessed the functional status of AS patients in relation to disease duration and activity. Furthermore, in volunteering patients we analyzed the efficacy of a controlled, individualized physiotherapeutic program. Altogether, clinical data of 75 AS patients were retrospectively analyzed. Anthropometrical data, duration since diagnosis and disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. Out of the 75 patients, 10 volunteered to undergo a complex physical exercise program twice a week for 3?months. The program included 1.5?h of general posture reeducation, manual mobilization of the spine, and pelvic-, upper-, and lower-extremity exercises, stretching with joint prevention strategies and functional exercises. In AS, pain intensity recorded on a 10-cm visual analog scale (VAS), BASFI, BASDAI, modified Schober index, chest expansion and occiput-to-wall distance values showed significant correlation with disease activity. The 3-month physical therapy improved several subjective and functional parameters, and markedly reduced pain intensity and spine stiffness. A complex, individualized physical therapy program may be useful and should be introduced to AS patients in order to maintain and increase spine mobility, preserve functional capacity, decrease the pain and stiffness. 相似文献
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Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease
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Laura Sanapo MD Jay D. Pruetz MD Maciej Słodki MD M. Beth Goens MD Anita J. Moon‐Grady MD Mary T. Donofrio MD 《Echocardiography (Mount Kisco, N.Y.)》2017,34(12):1804-1821
Fetal echocardiography facilitates the prenatal diagnosis of infants with congenital heart disease (CHD) and through sequential examinations, allows assessment of fetal hemodynamics and cardiovascular status from the time of diagnosis to delivery. Fetal cardiologists have created diagnostic protocols aimed at risk stratifying severity and potential postnatal compromise in fetuses with CHD, and identifying those who may require special intervention at birth or within the first days of life. In this article, we review fetal cardiovascular physiology, the progression of CHD in utero and fetal echocardiographic findings used for risk stratification of newborns with CHD, as well as some of the basic principles of planning for the neonatal resuscitation and initial transitional care of these complex newborns. 相似文献
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