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81.
Khan BA Guzman O Campbell NL Walroth T Tricker J Hui SL Perkins A Zawahiri M Buckley JD Farber MO Ely W Boustani MA 《Chest》2012,142(1):48-54
82.
We tested the hypothesis that the Ankle-Brachial Index (ABI) in patients without peripheral arterial disease ([PAD] ABI > 1.0) is an indicator of arterial stiffness. Fifty-five patients had measurement of carotid pulse wave contour, pulse wave velocity (PWV), and ABI. Vascular stiffness as assessed by augmentation index (AIx) showed a significant (P = .002) inverse correlation with ABI. Dichotomizing ABI into groups above and below the median showed that persons with a lower ABI, >1.0 to 1.5 (n = 27) had a significantly (P < .01) higher AIx than those with a higher ABI > 1.5 (n = 28). In contrast, vascular stiffness assessed by brachial-ankle or carotid femoral PWV did not correlate with ABI. In summary, ABI is an indicator of arterial stiffness assessed by AIx. Vascular changes detected by AIx are not the same as those detected by PWV. Assessment of ABI may have utility in cardiovascular risk assessment in patients without PAD. 相似文献
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86.
Boustani MA Campbell NL Khan BA Abernathy G Zawahiri M Campbell T Tricker J Hui SL Buckley JD Perkins AJ Farber MO Callahan CM 《Journal of general internal medicine》2012,27(5):561-567
Background
Approximately 40% of hospitalized older adults have cognitive impairment (CI) and are more prone to hospital-acquired complications. The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system.Objective
Evaluate the efficacy of a clinical decision support system (CDSS) to improve the quality of care for hospitalized older adults with CI.Design
A randomized controlled clinical trial.Setting
A public hospital in Indianapolis.Population
A total of 998 hospitalized older adults were screened for CI, and 424 patients (225 intervention, 199 control) with CI were enrolled in the trial with a mean age of 74.8, 59% African Americans, and 68% female.Intervention
A CDSS alerts the physicians of the presence of CI, recommends early referral into a geriatric consult, and suggests discontinuation of the use of Foley catheterization, physical restraints, and anticholinergic drugs.Measurements
Orders of a geriatric consult and discontinuation orders of Foley catheterization, physical restraints, or anticholinergic drugs.Results
Using intent-to-treat analyses, there were no differences between the intervention and the control groups in geriatric consult orders (56% vs 49%, P = 0.21); discontinuation orders for Foley catheterization (61.7% vs 64.6%, P = 0.86); physical restraints (4.8% vs 0%, P = 0.86), or anticholinergic drugs (48.9% vs 31.2%, P = 0.11).Conclusion
A simple screening program for CI followed by a CDSS did not change physician prescribing behaviors or improve the process of care for hospitalized older adults with CI.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-1994-8) contains supplementary material, which is available to authorized users.KEY WORDS: cognitive impairment, clinical trial, decision support, hospitalized elders 相似文献87.
88.
The study was to determine the effect of preexisting pain on the perception of a painful stimulus. We conducted a cross-section study at an urban ED using convenience sampling. Adult patients who had a 20-g IV catheter placed as part of their ED care were eligible for the study. Patients were excluded for the following reasons: more than one IV attempt, altered mental status, visual impairment, intoxication, or a physical abnormality at the IV site. Patients were asked to indicate on a 10-cm visual analog scale (VAS) the amount of pain they had at baseline immediately before IV placement. They were then asked to indicate on a separate VAS the amount of pain caused by the IV placement. Correlation between baseline pain and pain of the IV was assessed using Pearson's rho. One hundred patients were enrolled in the study. The pain of IV placement did not differ significantly by gender, race, who placed the IV, or the location of the IV. The correlation between baseline pain and pain of the IV placement was poor (rho =.14, confidence interval:-.06-.33). The response to a standardized painful stimulus among ED patients does not correlate highly with the severity of preexisting pain. 相似文献
89.
Jennifer Ka Yee Ko Hang Wun Raymond Li Karen Siu Ling Lam Sidney Tam Vivian Chi Yan Lee Tracy Wing Yee Yeung 《Gynecological endocrinology》2016,32(5):390-394
Objective: To evaluate the association of serum adiponectin level with the metabolic syndrome in Chinese women with polycystic ovary syndrome (PCOS).Methods: This was a cross-sectional study carried out in Hong Kong Chinese women with PCOS at a university-affiliated tertiary hospital between January 2010 and January 2011. Clinical and biochemical parameters of the women were analysed. Prediction of the metabolic syndrome was determined by receiver–operator characteristic (ROC) curves, univariate and multivariate logistic regression analyses.Results: A total of 116 women diagnosed to have PCOS were analysed. The area under the ROC curve of adiponectin for the prediction of metabolic syndrome was 0.820, 95% confidence interval (CI) 0.737–0.886. Univariate binary logistic regression showed that testosterone, sex hormone-binding globulin (SHBG), free androgen index (FAI), waist circumference, body mass index (BMI), quantitative insulin-sensitivity check index (QUICKI), homeostasis model assessment of insulin resistance (HOMA-IR) and adiponectin were significantly associated with the metabolic syndrome. On multivariate logistic regression analysis, adiponectin (p?= 0.020), HOMA-IR, age (p?= 0.011) and BMI (p?= 0.019) were independently associated with the metabolic syndrome, but not FAI (p?= 0.256).Conclusions: Serum adiponectin is independently associated with the metabolic syndrome in Chinese women with PCOS. Further longitudinal follow-up studies are needed to determine whether serum adiponectin adds to the prediction of long-term cardiometabolic morbidity conferred by age, BMI and measures of insulin resistance. 相似文献
90.
Yuk Him Tam Kristine Kit Yi Pang Yuen Shan Wong Siu Yan Tsui Hei Yi Wong Jennifer Wai Cheung Mou Kin Wai Chan Kim Hung Lee 《Pediatric surgery international》2016,32(11):1087-1092