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131.
Remzi FH Gorgun E Bast J Schroeder T Hammel J Philipson E Hull TL Church JM Fazio VW 《Diseases of the colon and rectum》2005,48(9):1691-1699
PURPOSE This study was designed to evaluate the impact of childbirth on anal sphincter integrity and function, functional outcome, and quality of life in females with restorative proctocolectomy and ileal pouch-anal anastomosis.METHODS The patients who had at least one live birth after ileal pouch-anal anastomosis were asked to return for a comprehensive assessment. They were asked to complete the following questionnaires: the Short Form-36, Cleveland Global Quality of Life scale, American Society of Colorectal Surgeons fecal incontinence severity index, and time trade-off method. Additionally, anal sphincter integrity (endosonography) and manometric pressures were measured by a medical physician blinded to the delivery technique. Anal sphincter physiology also was evaluated with electromyography and pudendal nerve function by nerve terminal motor latency technique.RESULTS Of 110 eligible females who had at least one live birth after ileal pouch-anal anastomosis, 57 participated in the study by returning for clinical evaluation to the clinic and 25 others by returning the quality of life and functional outcome questionnaires. Patients were classified into two groups: patients who had only cesarean section delivery after ileal pouch-anal anastomosis (n = 62) and patients who had at least one vaginal delivery after ileal pouch-anal anastomosis (n = 20). The mean follow-up from the date of the most recent delivery was 4.9 years. The vaginal delivery group had significantly higher incidence of an anterior sphincter defect by anal endosonography (50 percent) vs. cesarean section delivery group (13 percent; P = 0.012). The mean squeeze anal pressure was significantly higher in the patients who had only cesarean section delivery (150 mmHg) after restorative proctocolectomy than patients who had at least one vaginal delivery (120 mmHg) after restorative proctocolectomy (P = 0.049). Quality of life evaluated by time trade-off method also was significantly better in the cesarean section delivery group (1) vs. vaginal delivery group (0.9; P < 0.001).CONCLUSIONS The risk of the sphincter injury and quality of life measured by time trade-off method are significantly worse after vaginal delivery compared with cesarean section in patients with ileal pouch-anal anastomosis. In the short-term, this does not seem to substantially influence pouch function or quality of life; however, the long-term effects remain unknown, thus obstetric concern may not be the only factor dictating the type of delivery in this group of patients. A planned cesarean section may eliminate these potential and factual concerns in ileal pouch-anal anastomosis patients.Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. 相似文献
132.
BACKGROUND: This study describes the process and outcomes of continuous outpatient support with inotropes (COSI) in patients with Stage D heart failure (HF). Although Stage D HF has recently been defined as end-stage disease requiring special interventions for survival such as COSI or ventricular assist devices, concern has been raised regarding the safety, efficacy, mortality outcomes, and ethics of COSI. METHODS AND RESULTS: Inotrope dependence was defined as worsening of the patient's clinical status with attempted inotrope withdrawal such that the patient was deemed unlikely to survive to permit hospital discharge. A care process for COSI was designed; baseline and outcome variables were evaluated. COSI was administered to 36 inotrope-dependent patients (age 55.4 +/- 9.5 years, 24 males). Baseline characteristics (mean +/- SD) were consistent with Stage D HF: left ventricular ejection fraction 19.9 +/- 8.5, left ventricular end-diastolic dimension (LVEDD) 70 +/- 10 mm, systolic blood pressure 97.4 +/- 13.4 mm Hg, serum creatinine 1.5 +/- 0.6, serum sodium 131.7 +/- 5.3; 69 HF hospitalizations (mean 1.9 +/- 1.8) 6 months before COSI initiation. Symptomatic hypotension, increasing dyspnea, renal dysfunction, and hypoperfusion most commonly prevented inotrope withdrawal. Despite Stage D HF, patients were discharged with COSI ambulatory, oriented, and pain free. Rehospitalizations were 46; 6 subjects accounted for 24 hospitalizations; 23 had 0 or 1 rehospitalization. Median survival was 3.4 months (range 0.2-26.3 months); and 3-, 6-, and 12-month Kaplan Meier survival was 51%, 26%, and 6%, respectively. The majority of patients died at home and chose to not undergo resuscitation attempts. CONCLUSION: COSI may be an acceptable treatment option for Stage D HF. 相似文献
133.
134.
Reed JL Brewah YA Delaney T Welliver T Burwell T Benjamin E Kuta E Kozhich A McKinney L Suzich J Kiener PA Avendano L Velozo L Humbles A Welliver RC Coyle AJ 《The Journal of infectious diseases》2008,198(12):1783-1793
Although respiratory syncytial virus (RSV) infection is the most important cause of bronchiolitis in infants, the pathogenesis of RSV disease is poorly described. We studied histopathologic changes in a panel of lung tissue specimens obtained from infants with fatal cases of primary RSV infection. In these tissues, airway occlusion with accumulations of infected, apoptotic cellular debris and serum protein was consistently observed. Similar observations were found after RSV infection in New Zealand black (NZB) mice, which have constitutive deficiencies in macrophage function, but not in BALB/c mice. A deficiency in the number of alveolar macrophages in NZB mice appears to be central to enhanced disease, because depletion of alveolar macrophages in BALB/c mice before RSV exposure resulted in airway occlusion. In mice with insufficient numbers of macrophages, RSV infection yielded an increased viral load and enhanced expression of type I interferon-associated genes at the height of disease. Together, our data suggest that innate, rather than adaptive, immune responses are critical determinants of the severity of RSV bronchiolitis. 相似文献
135.
Toll‐like Receptor‐Mediated Responses by Placental Hofbauer Cells (HBCs): A Potential Pro‐Inflammatory Role for Fetal M2 Macrophages
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136.
Enteroviruses and humans have long co‐existed. Although recognized in ancient times, poliomyelitis and type 1 diabetes (T1D) were exceptionally rare and not epidemic, due in large part to poor sanitation and personal hygiene which resulted in repeated exposure to fecal–oral transmitted viruses and other infectious agents and viruses and the generation of a broad protective immunity. As a function of a growing acceptance of the benefits of hygienic practices and microbiologically clean(er) water supplies, the likelihood of exposure to diverse infectious agents and viruses declined. The effort to vaccinate against poliomyelitis demonstrated that enteroviral diseases are preventable by vaccination and led to understanding how to successfully attenuate enteroviruses. Type 1 diabetes onset has been convincingly linked to infection by numerous enteroviruses including the group B coxsackieviruses (CVB), while studies of CVB infections in NOD mice have demonstrated not only a clear link between disease onset but an ability to reduce the incidence of T1D as well: CVB infections can suppress naturally occurring autoimmune T1D. We propose here that if we can harness and develop the capacity to use attenuated enteroviral strains to induce regulatory T cell populations in the host through vaccination, then a vaccine could be considered that should function to protect against both autoimmune as well as virus‐triggered T1D. Such a vaccine would not only specifically protect from certain enterovirus types but more importantly, also reset the organism's regulatory rheostat making the further development of pathogenic autoimmunity less likely. Copyright © 2014 John Wiley & Sons, Ltd. 相似文献
137.
Correspondence Between NANDA International Nursing Diagnoses and Outcomes as Proposed by the Nursing Outcomes Classification
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![点击此处可从《International journal of nursing knowledge》网站下载免费的PDF全文](/ch/ext_images/free.gif)
Emilia Campos de Carvalho PhD RN Aline Helena Appoloni Eduardo PhD RN Adilson Romanzini RN Talita Prado Simão RN Cristina Mara Zamarioli RN Danielle Cristina Garbuio RN Tracy Heather Herdman PhD RN FNI 《International journal of nursing knowledge》2018,29(1):66-78
The accurate identification of the nursing diagnoses and the corresponding measurement of their indicators will depend on the elements in the standardized language systems.
OBJECTIVE
To analyze the correspondence between elements of four NANDA‐I nursing diagnoses and outcomes suggested by the nursing outcomes classification (NOC) for the resolution of these diagnoses.METHOD
A methodological study consisting of cross‐mapping was performed in the first stage between definitions, defining characteristics (DCs), and related factors (RFs) of impaired oral mucous membrane, impaired tissue integrity, spiritual distress, and delayed surgical recovery and outcome definitions and indicators to measure results of diagnoses resolution and an analysis of its relevance by experts in the second stage.RESULTS
It found partial correspondence between outcome indicators, DCs, RFs, and definitions.CONCLUSION
The data evidence the relevance of this review for a reliable application of these taxonomies and demonstrated partial correspondence between concepts analyzed. A identificação precisa dos diagnósticos de enfermagem e a medida correspondente dos seus indicadores dependerá dos elementos nos sistemas de linguagem padronizados.OBJETIVO
Foi analisar a correspondência entre os elementos de quatro NANDA‐I diagnósticos de enfermagem e os resultados sugeridos pelo NOC para a resolução destes diagnósticos.MÉTODO
um estudo metodológico que consiste em cross‐mapping foi realizado em uma primeira fase entre as definições, características definidoras e fatores relacionados de Mucosa oral prejudicada, Integridade tissular prejudicada, Sofrimento espiritual e Recuperação cirúrgica retardada e as definições dos resultados indicados para a resolução destes diagnósticos; na segunda fase, foi realizada uma análise desta concordância por especialistas.RESULTADOS
correspondência parcial entre as definições dos diagnósticos e dos resultados, características definidoras e fatores relacionados.CONCLUSÃO
Os resultados evidenciam a relevância dessa avaliação para uma aplicação confiável destas taxonomias e demonstrou a correspondência parcial entre os conceitos analisados. 相似文献138.
Jake L. Nowicki Daniel Mullany Amy Spooner Tracy A. Nowicki Peta M. Mckay Amanda Corley Paul Fulbrook John F. Fraser 《Australian critical care》2018,31(5):257-263
Background
Pressure injuries contribute significantly to patient morbidity and healthcare costs. Critically ill patients are a high risk group for pressure injury development and may suffer from skin failure secondary to hypoperfusion. The aim of this study was to report hospital acquired pressure injury incidence in intensive care and non-intensive care patients; and assess the clinical characteristics and outcomes of ICU patients reported as having a hospital acquired pressure injury to better understand patient factors associated with their development in comparison to ward patients.Methods
The setting for this study was a 630 bed, government funded, tertiary referral teaching hospital. A secondary data analysis was undertaken on all patients with a recorded PI on the hospital’s critical incident reporting systems and admitted patient data collection between July 2006 to March 2015.Results
There were a total of 5280 reports in 3860 patients; 726 reports were intensive care patients and 4554 were non-intensive care patients, with severe hospital acquired PI reported in 22 intensive care patients and 54 non-intensive care patients. Pressure injury incidence increased in intensive care patients and decreased in non-intensive care patients over the study period. There were statistically significant differences in the anatomical location of severe hospital acquired pressure injuries between these groups (p = 0.008).Conclusion
Intensive care patients have greater than 10-fold higher hospital acquired pressure injury incidence rates compared to other hospitalised patients. The predisposition of critically ill patients leaves them susceptible to pressure injury development despite implementation of pressure injury prevention strategies. Skin failure appears to be a significant phenomenon in critically ill patients and is associated with the use of vasoactive agents and support systems such as extra corporeal membrane oxygenation and mechanical ventilation. 相似文献139.
140.
Matthew C. Hiemenz Dejerianne G. Ostrow Tracy M. Busse Jonathan Buckley Dennis T. Maglinte Moiz Bootwalla James Done Jianling Ji Gordana Raca Alex Ryutov Xinjie Xu Chao Jie Zhen Jeffrey M. Conroy Florette K. Hazard Joshua L. Deignan Beverly B. Rogers Amanda L. Treece David M. Parham Jaclyn A. Biegel 《The Journal of molecular diagnostics : JMD》2018,20(6):765-776