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排序方式: 共有417条查询结果,搜索用时 15 毫秒
21.
Nynke D Scherpbier-de Haan Gerald MM Vervoort Chris van Weel Jozé CC Braspenning Jan Mulder Jack FM Wetzels Wim JC de Grauw 《The British journal of general practice》2013,63(617):e798-e806
Background
Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patientsAim
To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension.Design and setting
A cluster randomised controlled trial in nine general practices in The Netherlands.Method
Five practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2.Results
Data of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = −1.0 to 3.2) compared to −0.2 (95% CI = −3.8 to 3.3)/−0.5 (95% CI = −2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]).Conclusion
A shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care. 相似文献22.
Esther STF Smeulders Jolanda CM van Haastregt Elisabeth FM van Hoef Jacques ThM van Eijk Gertrudis IJM Kempen 《BMC health services research》2006,6(1):91
Background
Congestive heart failure (CHF) has a substantial impact on care utilisation and quality of life. It is crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-management may play an important role in this regard. Previous studies have shown the effectiveness of the 'Chronic Disease Self-Management Program' (CDSMP), a group-based cognitive behavioural programme for patients with various chronic conditions. However, the programme's effectiveness has not yet been studied specifically among CHF patients. This paper presents the design of a randomised controlled trial to evaluate the effects of the CDSMP on psychosocial attributes, health behaviour, quality of life, and health care utilisation of CHF patients. 相似文献23.
Sawyer MG Arney FM Baghurst PA Clark JJ Graetz BW Kosky RJ Nurcombe B Patton GC Prior MR Raphael B Rey JM Whaites LC Zubrick SR 《The Australian and New Zealand journal of psychiatry》2001,35(6):806-814
OBJECTIVE: To identify the prevalence of three mental disorders (Depressive Disorder, Conduct Disorder and Attention-Deficit/Hyperactivity Disorder), the prevalence of mental health problems, the health-related quality of life of those with problems, and patterns of service utilisation of those with and without mental health problems, among 4-17-year-olds in Australia. To identify rates of health-risk behaviours among adolescents with mental health problems. METHOD: The mental disorders were assessed using the parent-version of the Diagnostic Interview Schedule for Children Version IV. Parents completed the Child Behaviour Checklist to identify mental health problems and standard questionnaires to assess health-related quality of life and service use. The Youth Risk Behaviour Questionnaire completed by adolescents was employed to identify health-risk behaviours. RESULTS: Fourteen percent of children and adolescents were identified as having mental health problems. Many of those with mental health problems had problems in other areas of their lives and were at increased risk for suicidal behaviour. Only 25% of those with mental health problems had attended a professional service during the six months prior to the survey. CONCLUSION: Child and adolescent mental health problems are an important public health problem in Australia. The appropriate balance between funding provided for clinical interventions focusing on individual children and families and funding for interventions that focus on populations, requires careful study. The latter are an essential component of any strategy to reduce mental health problems as the high prevalence of problems makes it unlikely that individual care will ever be available for all those needing help. Clinical and population health interventions must take into account the comorbid problems experienced by children with mental disorders. 相似文献
24.
25.
We report on the evolution in concept and techniques that allowed us to improve the treatment of spigelian hernia, operable in day surgery in 90% of cases and through a preperitoneal and recently a preperitoneal and subfascial prosthetic repair (PHS). Background data. We propose an innovative use of the PHS mesh for spigelian hernia repair. With this new implementation, we confront the standard surgical technique and its postoperative period. Methods. From January 1992 to March 2004, we performed 2,500 hernia surgical operations, including 32 spigelian hernia repairs (1.3% of total case series). The first surgical approach used for 20 of these 32 patients (62.5% of total spigelian hernias), all electively operated on, was a classical preperitoneal repair (Wantz), performed when possible by size of defect and weight (Body Mass Index) of the patient, under local anesthesia and on a day-surgery basis. Our new modified technique takes place through the insertion of a PHS large-type mesh, whose bottom underlay portion lies flat in the preperitoneal space with the connector obliterating the hernial orifice and with the overlay portion lying on the internal oblique muscle, covered by the aponeurosis of the external oblique muscle. Results. Our modification to the classical technique consisted only in the application of a product, such as the PHS, in a hernia defect, which presented with an orifice of the size of the connector and, therefore, was easily repairable with the use of the PHS device. This approach is easier than the preperitoneal approach, its always suitable for local anaesthesia, and it gives a more comfortable postoperative period. The surgical approach may be performed completely in day surgery. Conclusions. We believe that spigelian hernia surgical repair should always be performed by means of a preperitoneal prosthesis under local anaesthesia when the patients clinical and physical conditions allow for it, always in day surgery, and using the PHS mesh when the hernia defect size fits with the connector diameter. This last possibility seems to be easier and more comfortable for the patient in the postoperative period. 相似文献
26.
Spurrier NJ Staugas R Sawyer MG Wakefield MA Ruffin RE Jureidini J Arney F Baghurst P 《Journal of paediatrics and child health》2003,39(1):15-21
OBJECTIVES: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. METHODS: Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. RESULTS: At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively). CONCLUSIONS: Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services. 相似文献
27.
Oberyszyn TM; Conti CJ; Ross MS; Oberyszyn AS; Tober KL; Rackoff AI; Robertson FM 《Carcinogenesis》1998,19(3):445-455
The beta2 integrin (CD 18/CD 11 a, b, c) family of proteins mediate
adherence of leukocytes to vascular endothelium and the associated ligand,
intercellular adhesion molecule-1 (ICAM-1; CD 54), interacts with beta2
integrin proteins to allow transendothelial migration of leukocytes into
sites of inflammation. The present study examines the function of these
proteins in a murine model of acute cutaneous inflammation induced
following topical application of 12-O- tetradecanoylphorbol-13-acetate
(TPA) to the dorsal epidermis of SENCAR mice and in a model of skin
multistage carcinogenesis. At 24 h following topical application of TPA to
the dorsal epidermis of mice, dermal leukocytes expressed higher levels of
beta2 integrin protein compared with the lower levels of beta2 integrin
protein expression by peripheral blood leukocytes. ICAM-1 protein was
localized to epidermal keratinocytes and vascular endothelium in
TPA-treated skin and to proliferating papilloma cells. Intravenous (i.v.)
injection of either 50 microg anti-beta2 integrin antibody alone or in
combination with anti-ICAM-1 antibody significantly inhibited both
TPA-stimulated neutrophil infiltration into the dermis (P < 0.001) and
myeloperoxidase (MPO) activity (P < 0.03 anti-beta2 integrin antibody; P
< 0.01 anti- beta2 integrin + ICAM-1 adhesion molecule antibodies), but
had no effect on TPA-induced epidermal hyperplasia. In addition, injection
of either anti-ICAM-1 adhesion molecule antibody alone (P < 0.004) or in
combination with anti-beta2 integrin antibody (P < 0.001) significantly
inhibited TPA-induced production of 7,8-dihydroxy-2'-deoxyguanosine (8-
OHdG) immunoreactive proteins by epidermal keratinocytes. Beta2
integrin/ICAM-1 adhesion molecules work in concert to regulate migration,
retention and functional activation of leukocytes within the dermis during
TPA-induced skin inflammation and within stromal tissue of papillomas that
form during multi-stage carcinogenesis. Agents that inhibit these
receptor/ligand interactions may be useful in defining the roles of
specific cell populations in cutaneous inflammation and multistage
carcinogenesis and may also have potential as anti-promoting and
anti-progression agents.
相似文献
28.
Transition metal complexes containing vanadium IV have been shown to
modulate the cellular redox potential and catalyse the generation of
reactive oxygen intermediates (ROI). Since sperm function is exquisitely
susceptible to ROI, we examined the effects of stable chelate complexes of
vanadocenes on human sperm motility. We synthesized seven structurally
distinct chelate complexes of bis(cyclopentadienyl)vanadium(IV) with
bidentate ligands [i.e. vanadocene acetylacetonato monotriflate (VDacac),
vanadocene hexafluoro acetylacetonato monotriflate (VDHfacac), vanadocene
N-phenyl benzohydroxamato monotriflate (VDPH), vanadocene acethydroxamato
monotriflate (VDH), vanadocene catecholate (VDCAT), vanadocene bipyridino
ditriflate (VDBPY), and vanadocene dithiocarbamate monotriflate (VDDTC)],
and evaluated their spermicidal activity using computer-assisted sperm
analysis (CASA; Hamilton-Thorne). All seven chelate complexes of vanadocene
elicited potent spermicidal activity at micromolar concentrations (EC50
values: 3.9-106 microM) without affecting the sperm acrosome integrity. The
catecholate and acetylacetonate complexes of vanadocene were the most
active and the bipyridyl complex the least active with an order of efficacy
VDCAT > VDacac > VDDTC > VDPH > VDH > VDHfacac > VDBPY.
The spermicidal activity of chelate complexes of vanadocenes was rapid and
irreversible since the treated spermatozoa underwent apoptosis, as
determined by the flow cytometric analysis of mitochondrial membrane
potential, surface annexin V binding assay, in-situ nick-end labelling of
sperm nuclei, and confocal laser scanning microscopy. These results provide
unprecedented evidence that chelate complexes of vanadocene with bidentate
ligands have spermicidal and apoptosis inducing properties. These
vanadocene complexes, especially VDacac, may be useful as contraceptive
agents.
相似文献
29.
30.
神经生长因子对小鼠突触体内Ca^2+水平的调节作用 总被引:3,自引:1,他引:3
观察了多次海马内微注射NGF对小鼠突触体内游离钙水平的影响,并在离体情况下观察NGF对EGTA和CaCl2分别造成突触体内低钙和高钙状态的调节作用。结果如下:(1)在体实验表明,一定剂量的NGF可显著降低老年小鼠海马突触体内游离钙水平(P<005);(2)离体实验表明,当突触体游离钙水平降低时,适当剂量的NGF具有升高游离钙水平的作用;而突触体内游离钙水平升高时,则NGF有降低游离钙水平的作用。提示NGF对游离钙水平的双向调节作用可能是NGF改善老年性记忆衰退的作用机制。 相似文献