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61.
Vertebral fractures due to osteoporosis commonly occur under non-traumatic loading conditions. This problem affects more than
1 in 3 women and 1 in 10 men over a lifetime. Measurement of bone mineral density (BMD) has traditionally been used as a method
for diagnosis of vertebral osteoporosis. However, this method does not fully account for the influence of changes in the trabecular
bone quality, such as micro-architecture, tissue properties and levels of microdamage, on the strength of the vertebra. Studies
have shown that deterioration of the vertebral trabecular architecture results in a more anisotropic structure which has a
greater susceptibility to fracture. Transverse trabeculae are preferentially thinned and perforated while the remaining vertical
trabeculae maintain their thickness. Such a structure is likely to be more susceptible to buckling under normal compression
loads and has a decreased ability to withstand unusual or off-axis loads. Changes in tissue material mechanical properties
and levels of microdamage due to osteoporosis may also compromise the fracture resistance of vertebral trabecular bone. New
diagnostic techniques are required which will account for the influence of these changes in bone quality. This paper reviews
the influence of the trabecular architecture, tissue properties and microdamage on fracture risk for vertebral osteoporosis.
The morphological characteristics of normal and osteoporotic architectures are compared and their potential influence on the
strength of the vertebra is examined. The limitations of current diagnostic methods for osteoporosis are identified and areas
for future research are outlined. 相似文献
62.
Kieran A. Walsh Carol Sinnott Aoife Fleming Jenny Mc Sharry Stephen Byrne John Browne Suzanne Timmons 《Journal of the American Medical Directors Association》2018,19(11):948-958.e12
Objectives
Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions.Design
Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF).Setting and Participants
A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland.Measures
Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed.Results
Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants’ effort to achieve “a fine balance” between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes (“human suffering”; “the interface between resident and nursing home”; and “power and knowledge: complex stakeholder dynamics”), which conceptualize how different nursing homes strike this “fine balance.”Conclusions
Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that “fine balance” and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention. 相似文献63.
64.
van der Wiel E Hofhuis W Nieuwhof E de Jongste J Merkus P Mc E 《Pediatric pulmonology》2005,39(1):93; author reply 94-93
65.
The common cuttlefish, Sepia officinalis, represents a model mobile marine species for studies of evolutionary processes occurring across a range of spatial and temporal scales. Such studies are relevant to sustainable fishery management and biodiversity conservation as the species is intensely exploited and an important component of inshore marine ecosystems. The isolation and preliminary characterisation of 10 dinucleotide repeat microsatellite loci is described. Genotyping of 48 adults from Agon Coutainville (France) revealed polymorphism at 9 of the loci. Among the polymorphic loci there was an average of 8.8 alleles per locus (range 3–14) with observed and expected heterozygosity per locus ranging from 0.104 to 0.792 and from 0.101 to 0.806, respectively. No evidence of linkage disequilibrium was detected between any locus pair. The loci described here represent a valuable addition to the suite of genetic markers applicable to S. officinalis research. 相似文献
66.
67.
Elizabeth J. Baker Nancy A. Beck Ellen L. Berg Helene D. Clayton-Jeter P. Charukeshi Chandrasekera J. Lowry Curley Bruce A. Donzanti Lorna C. Ewart Jane M. Gunther J. Gerry Kenna Edward L. LeCluyse Michael N. Liebman Catherine L. Pugh Paul B. Watkins Kristie M. Sullivan 《Drug discovery today》2019,24(2):624-628
68.
Aoife Mc Gillicuddy Maria Kelly Abina M. Crean Laura J. Sahm 《Research in social & administrative pharmacy》2019,15(12):1425-1435
BackgroundOral medicines are commonly modified (e.g. tablets split/crushed) to meet the dosing and swallowing requirements of older adults. However, there is limited research investigating the opinions of community-dwelling patients and carers about medicine modification.ObjectivesThe aim of this study was to investigate the views of community-dwelling older adults and their carers about oral medicine modification.MethodsSemi-structured, face-to-face interviews were conducted with community-dwelling older adults and carers of older adults who experienced difficulty swallowing medicines, or who required medicines to be modified. Participants were recruited from purposively selected community pharmacies using a combination of purposive, convenience and snowball sampling. Interviews were audio-recorded, transcribed verbatim and analysed thematically. The Francis method governed when data saturation had been reached.ResultsTwenty-six interviews (13 patients, 13 carers) were conducted (76.9% female, median length 11 min (IQR 8–16 min)). Four themes emerged from the data: variation in medical needs and preferences; balancing acceptance and resignation; healthcare professional engagement and; opportunities for optimising formulation suitability. The heterogeneity of medical conditions experienced by community-dwelling older adults resulted in a variety of modifications being required. Patients and carers are accepting of their medications and formulations. However, when challenges arise, they tend to feel resigned to coping within the constraints of the current medication regimen, resulting in a lack of focused communication with healthcare professionals. Thus, healthcare professionals were unaware of their difficulties and unable to offer advice or solutions.ConclusionHealthcare professionals must engage proactively with this group. Whilst a holistic approach to medication management is ideal, the disadvantage is that no single healthcare professional may identify this as their responsibility. Whilst the input and expertise of all healthcare professionals will be required, as medication experts, the pharmacy profession should take ownership and become the champion of, and for, the patient. 相似文献
69.
James T. Rosenbaum Phoebe Lin Mark Asquith Mary-Ellen Costello Tony J. Kenna Matthew A. Brown 《Clinical rheumatology》2014,33(6):763-767
The purpose of this study is to review the potential causal role of the microbiome in the pathogenesis of spondyloarthritis. The method used for the study is literature review. The microbiome plays a major role in educating the immune response. The microbiome is strongly implicated in inflammatory bowel disease which has clinical and genetic overlap with spondyloarthritis. The microbiome also plays a causal role in bowel and joint disease in HLA B27/human beta 2 microglobulin transgenic rats. The mechanism(s) by which HLA B27 could influence the microbiome is unknown but theories include an immune response gene selectivity, an effect on dendritic cell function, or a mucosal immunodeficiency. Bacteria are strongly implicated in the pathogenesis of spondyloarthritis. Studies to understand how HLA B27 affects bacterial ecosystems should be encouraged. 相似文献
70.