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991.
Diabetes self-management education (DSME) has been shown to improve health outcomes. Yet, relatively little is known about
how DSME has its effects. Literature reviewed from the past 3 years indicates that if DSME is to become more effective interventions
need to be theory-based, to increase patient involvement in their care, and to encompass a broader array of evidenced-based
outcomes. Outcomes reviewed go beyond knowledge and glycemic control to include prevention of diabetes, quality of life, and
reduction of cardiovascular risk. The ability of practitioners and health care systems to implement, adopt, and maintain patient-centered
interventions over time is discussed. By linking theory to behavior, and broadening the outcomes examined, advances can continue
to be made in closing the gap between the scientific base for the treatment of diabetes, and the care and outcomes patients
experience. Further research on patient-centered approaches that promote self-management is seen as critical in closing this
gap. 相似文献
992.
Treatment of hepatitis C 总被引:2,自引:0,他引:2
Hepatitis C virus infection accounts for 40% of chronic liver disease in the United States and is the most common indication
for liver transplantation. Estimates suggest that 4 million people, or 1.8% of the American population, have or have had hepatitis
C virus infection. Pegylated interferon and ribavirin are the current standard of care for treatment. Recent studies have
suggested that ribavirin dose and duration of therapy may be adjusted based on genotype. The goals of therapy are to slow
disease progression, improve hepatic histology, reduce infectivity, and decrease the risk of hepatocellular carcinoma. Sustained
virologic response, which generally implies the absence of viremia 6 or more months following completion of therapy, is increasingly
being regarded as a cure, with evidence of slowing or even regression of fibrosis on follow-up liver biopsy. Assessment by
liver biopsy of disease severity and evaluation of comorbidities and possible contraindications to therapy should be weighed
in the decision to begin treatment. Counseling patients regarding transmission, natural history, and drug and alcohol abstinence
should also be included in management. Close monitoring should be done during treatment for interferon and ribavirin side
effects, including depression, bone marrow suppression, and hemolytic anemia. 相似文献
993.
Interventional endoscopic ultrasound in pancreatic disease 总被引:5,自引:0,他引:5
The use of endoscopic ultrasound (EUS) in pancreatic disease is rapidly evolving as the field moves from a primarily diagnostic
role to one of therapeutic intervention. Therapeutic EUS includes techniques such as the celiac block and transmural pseudocyst
drainage. Newer techniques include EUS-guided fine-needle injection therapy in which a variety of agents are being investigated
for the treatment of pancreatic cancer. Novel EUS-guided techniques are being devised to drain and alleviate pancreaticobiliary
and gastroduodenal obstruction. 相似文献
994.
Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery 总被引:2,自引:0,他引:2
We report a new strategy—celiac artery stenting—to relieve stenosis of the celiac arterial root. This was performed in two patients with pancreaticoduodenal artery (PDA) aneurysm associated with a stenotic celiac arterial root. The first patient was a 66-year-old man complaining of abrupt onset of upper abdominal pain. Abdominal computed tomography revealed a huge retroperitoneal hematoma behind the duodenum, and superior mesenteric artery (SMA) angiography demonstrated an aneurysm arising from inferior pancreaticoduodenal artery and celiac arteriography showed a stenotic celiac arterial root. Transcatheter embolization of the aneurysm was tried, but failed. Because of his unstable hemodynamics, emergent laparotomy with resection of the aneurysm was performed. Fourteen days after the operation, percutaneous transluminal angioplasty with celiac arterial stenting was done. The patient was discharged 2 days later, and has had no further bleeding episode for 3 years. The second patient was a 46-year-old woman, who also complained of acute upper abdominal pain. Abdominal computed tomography disclosed a huge retroperitoneal hematoma, and selective SMA angiography demonstrated an aneurysm arising from the inferior pancreaticoduodenal artery, and celiac arteriography showed a stenotic celiac arterial root. Because angiography showed no active bleeding from the aneurysm, percutaneous transluminal angioplastic stenting of the stenotic celiac artery was performed. She was discharged 5 days later and has had no further bleeding episode for 2 years. Celiac arterial stenting, as shown in our two patients, could be easily and safely employed in patients with PDA aneurysm associated with a stenotic celiac arterial root to release the stenosis of the celiac arterial root and to prevent further possible bleeding. 相似文献
995.
Etiologies for human hypogammaglobulinemias are diverse and include genetic and nongenetic causes. Although recent reviews
focus on the complex genetics of common variable immunodeficiency, in this review, we survey different causes of hypogammaglobulinemias
and discuss possible mechanisms. 相似文献
996.
Leung FW 《Digestive diseases and sciences》2008,53(10):2604-2615
This paper reviews recent clinical evidence that suggests that aspirin prophylaxis against cardiac and cerebral vascular ischemia is associated with significant gastrointestinal complications. The clinical and experimental evidence to confirm the role of risk factors of concomitant use of nonsteroidal anti-inflammatory drugs (NSAID), tobacco cigarette smoking, and alcohol consumption are discussed. The limitations of long-term acid suppression treatment for the prevention of these complications are considered. Future experimental studies to guide the clinical approach to develop novel and potentially cost-effective management strategies are discussed. 相似文献
997.
Tutuian R 《Current gastroenterology reports》2008,10(3):263-270
Gastroesophageal reflux monitoring is a key investigation in managing gastroesophageal reflux disease. Esophageal pH monitoring
is used to quantify esophageal acid exposure and the association of symptoms with acidic reflux episodes. Recently available
wireless pH monitoring systems allow reflux monitoring over prolonged periods and increase patient comfort during the procedure.
Combined impedance-pH monitoring offers the ability to identify reflux episodes independently of their acid content, an important
advantage when evaluating patients with symptoms persisting during acid-suppressive therapy. 相似文献
998.
Morishita E Sekiya A Hayashi T Kadohira Y Maekawa M Yamazaki M Asakura H Nakao S Ohtake S 《International journal of hematology》2008,88(3):272-277
Previous studies have found markedly elevated serum concentrations of proinflammatory cytokines in patients with Graves’ disease
(GD). We investigated the role of macrophage colony-stimulating factor (M-CSF) in GD. We assayed concentrations of M-CSF in
sera from 32 patients with GD (25 untreated; 7 receiving thiamazole therapy). We also studied 32 age-matched healthy subjects
as controls. Relationships between serum M-CSF and both thyroid state and serum lipids were examined. Moreover, to examine
the effect of thyroid hormone alone on serum M-CSF, T3 was administered orally to normal subjects. Serum concentrations of
M-CSF in GD patients who were hyperthyroid were significantly increased compared with GD patients who were euthyroid (P < 0.05) and control subjects (P < 0.0001). Serum M-CSF concentrations correlated closely with T3 levels in patients (r = 0.51, P < 0.005). Serial measurement of five individual patients revealed that serum concentrations of M-CSF were significantly decreased
(P < 0.05), reaching normal control values upon attainment of euthyroidism. Furthermore, oral T3 administered to 15 volunteers
for 7 days produced significant increases in serum levels of M-CSF (P < 0.05). The close correlation between serum M-CSF and serum thyroid hormone levels suggests that high circulating levels
of thyroid hormones may directly or indirectly potentiate the production of M-CSF in patients with GD. 相似文献
999.
Bax JJ Poldermans D Elhendy A Boersma E van der Wall EE 《Current cardiology reports》2005,7(2):124-129
The assessment of myocardial viability has become important in the diagnostic and prognostic work up of patients with ischemic
cardiomyopathy. Patients with viable myocardium may benefit from revascularization in terms of improvement of function, symptoms,
and prognosis. In contrast, patients without viable myocardium do not benefit and should be treated conservatively. Various
nuclear imaging techniques are available. 相似文献
1000.
Sanjiv K. Gandhi 《Journal of interventional cardiac electrophysiology》2007,20(3):119-125
Atrial reentrant tachycardias are a common source of morbidity in children with significant structural heart disease, especially
following cardiac surgery. Preexisting atrial geometry combined with the hemodynamic effect of a congenital cardiac defect
and electrophysiological alterations caused by surgical lesions can create large anatomic-functional barriers to conduction,
allowing reentrant wavefronts to flourish. Elucidation of the genesis of reentrant arrhythmias in children has led to catheterization
and surgical therapies. The primary goals of these procedures are to restore synchronous atrioventricular conduction and eliminate
hemodynamically significant residual physiologic lesions. Debilitating arrhythmias may be cured, and patients have an improvement
in functional class. 相似文献