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991.
A. Cranney M. Lam L. Ruhland R. Brison M. Godwin M. M. Harrison M. B. Harrison T. Anastassiades J. M. Grimshaw I. D. Graham 《Osteoporosis international》2008,19(12):1733-1740
Summary In a cluster randomized trial, we evaluated the effect of a multifaceted intervention (directed at both patient and primary
care physician) on the rates of testing and treatment of osteoporosis in postmenopausal women within six months of their wrist
fracture. Compared to usual care, women in the intervention practices were three times more likely to receive bone mineral
density testing and prescribed osteoporosis treatments.
Introduction Postmenopausal women with wrist fractures are at increased risk of future fragility fractures, yet they frequently do not
receive evaluation and treatment for osteoporosis. We set out to evaluate a multifaceted intervention designed to improve
management of osteoporosis in older women with recent wrist fractures.
Methods Cluster randomized trial of 270 women cared for in 119 primary care practices. We recruited postmenopausal women with an acute
wrist fracture from the emergency departments of hospitals in southeastern Ontario, Canada. Family practices were randomly
assigned to either the intervention or usual care. The intervention consisted of a mailed reminder with a summary of treatment
guidelines and letter sent to the primary care physician, in addition to an educational package and letter to the women. The
primary outcome was the proportion of women prescribed osteoporosis therapy within 6 months of their fracture.
Results The mean age of women was 69(10.9) years. The intervention increased the proportion of women started on osteoporosis medications
(28% vs. 10%) of controls, adjusted OR 3.45, 95% CI, 1.58–7.56, p = 0.002) and the proportion who had a bone mineral density (BMD) test (53.3% vs. 26%) of controls, OR 3.38, 95% CI, 1.83–6.26,
p < 0.001). In addition to the intervention, having a female physician was a predictor of increased testing and treatment rates.
Conclusion A multifaceted intervention significantly improved rates of osteoporosis treatment and BMD testing in postmenopausal women
with wrist fractures.
Funding: This trial was funded by a peer-reviewed grant from the Canadian Institutes of Health Research (KTS 62358). 相似文献
992.
Raymond W Lam Peter Chan Michael Wilkins-Ho Lakshmi N Yatham 《Revue canadienne de psychiatrie》2008,53(9):621-631
OBJECTIVE: Systematic reviews show that repetitive transcranial magnetic stimulation (rTMS) is superior to sham control conditions in patients with major depressive disorder, but the clinical relevance is not clear. None have specifically examined outcomes in patients with treatment-resistant depression (TRD). METHOD: A systematic review was conducted by identifying published randomized controlled trials of active rTMS, compared with a sham control condition in patients with defined TRD (that is, at least one failed trial). The primary outcome was clinical response as determined from global ratings, or 50% or greater improvement on a rating scale. Other outcomes included remission and standardized mean differences in end point scores. Metaanalysis was conducted for absolute risk differences using random effects models. Sensitivity and subgroup analyses were also conducted to explore heterogeneity and robustness of results. RESULTS: A total of 24 studies (n = 1092 patients) met criteria for quantitative synthesis. Active rTMS was significantly superior to sham conditions in producing clinical response, with a risk difference of 17% and a number-needed-to-treat of 6. The pooled response and remission rates were 25% and 17%, and 9% and 6% for active rTMS and sham conditions, respectively. Sensitivity and subgroup analyses did not significantly affect these results. Dropouts and withdrawals owing to adverse events were very low. CONCLUSIONS: For patients with TRD, rTMS appears to provide significant benefits in short-term treatment studies. However, the relatively low response and remission rates, the short durations of treatment, and the relative lack of systematic follow-up studies suggest that further studies are needed before rTMS can be considered as a first-line monotherapy treatment for TRD. 相似文献
993.
Aimée E van Dijk Manon van Eijsden Karien Stronks Reinoud JBJ Gemke Tanja GM Vrijkotte 《BMC public health》2010,10(1):251
Background
Recent evidence, both animal and human, suggests that modifiable factors during fetal and infant development predispose for cardiovascular disease in adult life and that they may become possible future targets for prevention. One of these factors is maternal psychosocial stress, but so far, few prospective studies have been able to investigate the longer-term effects of stress in detail, i.e. effects in childhood. Therefore, our general aim is to study whether prenatal maternal psychosocial stress is associated with an adverse cardio-metabolic risk profile in the child at age five. 相似文献994.
Daniel TP Fong Mak-Ham Lam Miko LM Lao Chad WN Chan Patrick SH Yung Kwai-Yau Fung Pauline PY Lui Kai-Ming Chan 《Journal of orthopaedic surgery and research》2008,3(1):7
Background
Excessive pronation (or eversion) at ankle joint in heel-toe running correlated with lower extremity overuse injuries. Orthotics and inserts are often prescribed to limit the pronation range to tackle the problem. Previous studies revealed that the effect is product-specific. This study investigated the effect of medial arch-heel support in inserts on reducing ankle eversion in standing, walking and running. 相似文献995.
996.
997.
Front D; Ioselevsky G; Frenkel A; Even-Sapir E; Israel O; Kolodny GM; Feinsud M 《Radiology》1987,164(1):93-96
A single photon emission computed tomographic method was designed for the measurement of radiopharmaceutical uptake in brain tumors. Results of phantom studies showed a correlation coefficient of .99 when measured volume was compared with actual volume. The correlation coefficient for measured radioactivity concentration compared with the actual concentration was .97. In 13 meningiomas the correlation between in vivo SPECT measurements of uptake and in vitro measurements in samples of the same tumors removed surgically was .84; when two tumors that contained regions of necrosis and fibrosis were excluded it was .93. This method can be used for in vivo quantitative assessment of pharmacokinetics of labeled drug uptake in human brain tumors. 相似文献
998.
999.
The ability of l-dopa and dopamine to modulate renal vascular responses to norepinephrine (NE, 50-150 ng) was examined in isolated Tyrode-perfused kidneys from male Sprague-Dawley rats. Renal pressor responses to bolus injections of NE were constant during saline infusion. In contrast, l-dopa (15 micrograms/min and 75 micrograms/min) and dopamine (15 micrograms/min) infusions that did not alter baseline perfusion pressure increased pressor responses to NE significantly. Concomitant infusion of the aromatic l-amino-acid decarboxylase inhibitor carbidopa (20 micrograms/min) suppressed the ability of l-dopa (75 micrograms/min) but not dopamine to enhance renal pressor responses to NE. The pressor potentiation of NE did not appear to be the result of a general musculotropic effect or altered alpha-1 adrenoreceptor activity since increased vasoconstrictor responses to phenylephrine (PE) and serotonin (5-HT) were not observed. Infusions of cocaine (15 micrograms/min) enhanced the renal pressor effects of NE but not PE in similar fashion to l-dopa and dopamine. In the presence of cocaine, l-dopa did not potentiate NE constriction further. These results suggest that endogenous or exogenous dopamine in the kidney may affect neuronal NE uptake to enhance its renal vascular effects. 相似文献
1000.
M K Chan S S Lam P C Chan I K Cheng 《The International journal of artificial organs》1987,10(2):77-82
We treated 100 Chinese patients age 16 to 83 years by CAPD, using three 2-litre exchanges per day. The treatment was self-financed in 69 patients, by charitable organisations in 25 patients, and by government funds in 6 patients. Satisfactory biochemistry was maintained and there was no gross hyperlipidaemia, renal osteodystrophy, or loss of ultrafiltration capacity of the peritoneum. Rehabilitation was good and 62% of patients returned to full-time employment. The average duration of hospitalization was 11.3 days per patient year. Peritonitis usually due to Staphylococcus pyogenes occurred at a frequency of one episode per 12.3 patient-months. Sixteen patients were transplanted and had a 2-year graft survival of 78.5%. The cumulative patient survival was 97% at 1 year and 84% at 2 years. The corresponding technique survival rates were 87% and 76% respectively. 相似文献