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71.
Predictors of outcomes of carpal tunnel release 总被引:3,自引:0,他引:3
Katz JN Losina E Amick BC Fossel AH Bessette L Keller RB 《Arthritis and rheumatism》2001,44(5):1184-1193
OBJECTIVE: To identify factors that are predictive of the outcomes of greatest importance to patients-i.e., symptom relief, functional improvement, and satisfaction with the outcomes of surgery-following carpal tunnel release. METHODS: We analyzed data from the Maine Carpal Tunnel Study, a community-based study of the outcomes of treatment for carpal tunnel syndrome. In a cohort of patients who underwent carpal tunnel release, a preoperative physical examination was performed and questionnaires were completed preoperatively and at 6, 18, and 30 months postoperatively. The questionnaires assessed symptom severity, upper extremity functional limitations, mental health, general physical health status, the relative severity of individual symptoms, satisfaction with the results of surgery, sociodemographic factors, and for those subjects who were in the workforce, aspects of the work environment. The associations between preoperative factors and the 3 principal outcomes (symptom severity, upper extremity functional limitations, and satisfaction with the results of surgery, all evaluated at 18 months postoperatively) were assessed with bivariate and multivariate linear regression and logistic regression analyses. RESULTS: Two hundred forty-one subjects were enrolled and 188 (78%) completed followup surveys 18 months postoperatively. Two-thirds of the patients reported being completely or very satisfied with the outcomes of surgery at 6, 18, and 30 months postoperatively. A range of clinical and work-related variables were associated with outcomes. In multivariate analyses, greater preoperative upper extremity functional limitation was predictive of greater functional limitations postoperatively. Worse mental health status was significantly associated with more severe symptoms and lower satisfaction. Alcohol use was also associated with more severe symptoms and lower satisfaction. Among workers, involvement of an attorney was significantly associated with greater functional limitation, more severe symptoms, and lower satisfaction. Recipients of worker's compensation who did not hire an attorney had generally good outcomes. Of note, physical examination parameters were not predictive of the outcomes of surgery. CONCLUSION: The outcomes of carpal tunnel release in community-based practices are excellent. Predictors of the outcomes of surgery are disease-specific and generic clinical factors as well as work-related factors. The strongest predictors of less favorable outcomes are worse scores on patient-reported measures of upper extremity functional limitation and mental health status, alcohol use, and the involvement of an attorney. Clinicians should carefully evaluate patients' functional status, mental health status, health habits, and attorney involvement prior to performing carpal tunnel release, and discuss with patients the prognostic implications of these parameters. 相似文献
72.
STANTON School Of Rehabilitation Sciences University Of British Columbia Vancouver BC Canada S 《Occupational therapy international》2001,8(2):96-106
Despite a high demand for continuing professional education, it is becoming more challenging to provide education in a resource-limited environment that meets the varied needs of learners. The advent of user-friendly, interactive communication technology led the University of British Columbia in Canada to explore the feasibility of developing a web-based distance learning programme shared by undergraduate and practising therapists to address this problem. Potential benefits and challenges of distance learning, undergraduate web-learning, pilot-test results and an assessment of therapists’ interests and needs are profiled. 相似文献
73.
Purpose: To estimate the total prevalence of health-related work limitations among working people in the United States (US) as well as their condition-specific prevalence. Methods: A new questionnaire measuring limitations in ability to perform specific work demands was administered to 940 employed people in a national household survey. The prevalence of specific work limitations is reported as are conditionspecific risk estimates (odds ratios) based on logistic regression. Results: In the US, 19.3% of working people (CI=14.0, 24.6) were limited in their abilities to perform physical work demands; 24.1% (CI=18.9, 29.2) were limited in performing psychosocial work demands; and 13.8% (CI=8.3,19.3) were limited in their abilities to function without difficulty within the ambient work environment. With successive increments in the number of conditions, the odds of having a limitation increased significantly. Conclusions: This study contributes new information concerning the implications of chronic health problems for working people and the significant risks for workers with multiple chronic conditions. 相似文献
74.
Calorie restriction in nonhuman primates: mechanisms of reduced morbidity and mortality 总被引:1,自引:0,他引:1
Long term chronic calorie restriction (CR) of adult nonhuman primates
significantly reduces morbidity and increases median age of death. The
present review is focused upon an ongoing study of sustained adult- onset
calorie restriction, which has been underway for 15 years. Monkeys,
initially calorie restricted at about 10 years of age, are now
approximately 25 years old. The median life span of these restricted
monkeys is increasing, now exceeding that of ad libitum (AL)-fed monkeys.
In our laboratory, maximum life span for AL-fed monkeys appears to be about
40 years. Thus, whether CR can also increase maximal life span, as it does
in rodents, cannot be determined for at least another 15 years. The
earliest detectable positive benefit on morbidity in these monkeys was
previously reported as the prevention of obesity. Current evidence, as
reviewed here, suggests that much obesity- associated morbidity is also
mitigated by sustained calorie restraint in nonhuman primates. Furthermore,
probably because of the prevention of obesity, diabetes has also been
prevented. Recent findings include the identification of extraordinary
changes in the glycogen synthesis pathway, and on the phosphorylation of
glycogen synthase in response to insulin. This calorie restriction-induced
prevention of morbidity does not require excessive leanness, but is clearly
present when body fat is within the normal range of 10 to 22%, and this is
likely to be true in humans as well.
相似文献
75.
76.
JANE M. ZAPKA ScD STEPHENIE C. LEMON PhD ROBERT P. MAGNER MS JANET HALE PhD APRN BC FNP 《Journal of nursing management》2009,17(7):853-860
Aims The purpose of this study was to (i) describe the weight, weight-related perceptions and lifestyle behaviours of hospital-based nurses, and (ii) explore the relationship of demographic, health, weight and job characteristics with lifestyle behaviours.
Background The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients.
Methods A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys.
Results The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours.
Conclusions Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control.
Implications for nursing management Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life. 相似文献
Background The obesity epidemic is widely documented. Worksite initiatives have been advocated. Nurses represent an important part of the hospital workforce and serve as role models when caring for patients.
Methods A sample of 194 nurses from six hospitals participated in anthropometric measurements and self-administered surveys.
Results The majority of nurses were overweight and obese, and some were not actively involved in weight management behaviours. Self-reported health, diet and physical activity behaviours were low, although variable by gender, age and shift. Reports of co-worker norms supported low levels of healthy behaviours.
Conclusions Findings reinforce the need to address the hospital environment and culture as well as individual behaviours for obesity control.
Implications for nursing management Nurse managers have an opportunity to consider interventions that promote a climate favourable to improved health habits by facilitating and supporting healthy lifestyle choices (nutrition and physical activity) and environmental changes. Such efforts have the potential to increase productivity and morale and decrease work-related disabilities and improve quality of life. 相似文献
77.
Delayed hepatic CT scanning: increased confidence and improved detection of hepatic metastases 总被引:1,自引:0,他引:1
Bernardino ME; Erwin BC; Steinberg HV; Baumgartner BR; Torres WE; Gedgaudas- McClees RK 《Radiology》1986,159(1):71-74
Fifty oncologic patients with suspected hepatic metastases were prospectively evaluated by dynamic sequential hepatic computed tomography (DSHCT) and by delayed iodine hepatic computed tomography (DICT) scanning. DICT scanning was performed 4-6 hours following administration of 60 g of intravenous iodine. Both techniques were evaluated for lesion definition relative to the adjacent hepatic parenchyma and for numbers of metastases detected. Metastases were detected by both techniques in 26 patients. Fifteen patients (58%) had lesions better defined by DICT. DICT scanning detected more metastases in seven of these 15 patients. In eight patients (31%), there was no difference between the two techniques in numbers of masses detected or lesion definition. In three cases (11%), metastases were more confidently identified on the initial or DSHCT scan. DICT scanning, as described, is useful in defining and detecting hepatic metastases, especially where there is questionable hepatic involvement or better quantification of size is necessary. 相似文献
78.
Jennifer Wheler MD Apostolia M. Tsimberidou MD PhD David Hong MD Aung Naing MD Tiffiny Jackson RN APRN‐BC Suyu Liu MS Lei Feng MS Razelle Kurzrock MD 《Cancer》2009,115(5):1091-1099
BACKGROUND:
Patients with advanced malignancies for whom standard therapy is ineffective may participate in phase 1 trials. To gain a better understanding of the clinical features that could influence benefit versus risk, the authors of this report assessed prognostic factors and survival for patients who were referred to a phase 1 clinic focused primarily on targeted agents.METHODS:
The medical records of 200 sequential patients who presented to the Phase 1 Clinic at The University of Texas M. D. Anderson Cancer Center were reviewed, and their characteristics and survival were analyzed.RESULTS:
The median patient age was 58 years (range, 12‐85 years), and 57% of patients were men. The median number of prior therapies was 4. Of 200 patients, 182 were treated on at least 1 phase 1 clinical trial. The median follow‐up of surviving patients was 21 months, and the median overall survival was 9 months (95% confidence interval [CI], 7.4‐10.8). In univariate analysis, the factors that predicted shorter survival were primary tumor in the gastrointestinal tract; a history of thrombosis, liver metastases, and elevated levels of serum lactate dehydrogenase; platelet count; carbohydrate antigen 9 (Ca19‐9) and Ca‐125 levels; aspartate aminotransferase levels, and alkaline phosphatase levels (P < .05 for each). In multivariate analysis, independent factors that predicted shorter survival were a history of thromboembolism (hazard ratio [HR], 2.38; 95% CI, 1.29‐4.39; P = .005), platelets ≥440 × 109/L (HR, 1.72; 95% CI, 1.12‐2.65; P = .014), and the presence of liver metastases (HR, 1.51; 95% CI, 1.09‐2.09; P = .013).CONCLUSIONS:
Patients who were referred to phase 1 studies had a short median survival (9 months). Patients with thrombocytosis, liver metastases, and a history of thromboembolism had worse outcomes. A prognostic score is proposed. Cancer 2009. © 2009 American Cancer Society. 相似文献79.
80.