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93.
Christiane Muth Martin Beyer Martin Fortin Justine Rochon Frank Oswald Jose M. Valderas 《The European journal of general practice》2014,20(2):139-147
Older patients, suffering from numerous diseases and taking multiple medications are the rule rather than the exception in primary care. A manifold of medical conditions are often associated with poor outcomes, and their multiple medications raise additional risks of polypharmacy. Such patients account for most healthcare expenditures. Effective approaches are needed to manage such complex patients in primary care. This paper describes the results of a scoping exercise, including a two-day workshop with 17 professionals from six countries, experienced in general practice and primary care research as well as epidemiology, clinical pharmacology, gerontology and methodology. This was followed by a consensus process investigating the challenges and core questions for multimorbidity research in primary care from a clinical perspective and presents examples of the best research practice. Current approaches in measuring and clustering multimorbidity inform policy-makers and researchers, but research is needed to provide support in clinical decision making. Multimorbidity presents a complexity of conditions leading to individual patient's needs and demanding complex processes in clinical decision making. The identification of patterns presupposes the development of strategies on how to manage multimorbidity and polypharmacy. Interventions have to be complex and multifaceted, and their evaluation poses numerous methodological challenges in study design, outcome measurement and analysis. Overall, it can be seen that complexity is a main underlying theme. Moreover, flexible study designs, outcome parameters and evaluation strategies are needed to account for this complexity. 相似文献
94.
Christiane Gaudreau Sapha Barkati Jean-Michel Leduc Pierre A. Pilon Julie Favreau Sadjia Bekal 《Emerging infectious diseases》2014,20(5):854-856
During 2012–2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms. 相似文献
95.
Mixed‐method research protocol: defining and operationalizing patient‐related complexity of nursing care in acute care hospitals
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![点击此处可从《Journal of advanced nursing》网站下载免费的PDF全文](/ch/ext_images/free.gif)
96.
Günter Kampf Stina Degenhardt Sibylle Lackner Christiane Ostermeyer 《GMS Krankenhaushygiene interdisziplin?r》2014,9(1)
Background: It has recently been reported that reusable dispensers for surface disinfection tissues may be contaminated, especially with adapted Achromobacter species 3, when products based on surface-active ingredients are used. Fresh solution may quickly become recontaminated if dispensers are not processed adequately. Methods: We evaluated the abilities of six manual and three automatic processes for processing contaminated dispensers to prevent recolonisation of a freshly-prepared disinfectant solution (Mikrobac forte 0.5%). Dispensers were left at room temperature for 28 days. Samples of the disinfectant solution were taken every 7 days and assessed quantitatively for bacterial contamination. Results: All automatic procedures prevented recolonisation of the disinfectant solution when a temperature of 60–70°C was ensured for at least 5 min, with or without the addition of chemical cleaning agents. Manual procedures prevented recontamination of the disinfectant solution when rinsing with hot water or a thorough cleaning step was performed before treating all surfaces with an alcohol-based disinfectant or an oxygen-releaser. Other cleaning and disinfection procedures, including the use of an alcohol-based disinfectant, did not prevent recolonisation.Conclusions: These results indicate that not all processes are effective for processing reusable dispensers for surface-disinfectant tissues, and that a high temperature during the cleaning step or use of a biofilm-active cleaning agent are essential. 相似文献
97.
Prof. Dr. C. Woopen 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2013,56(2):269-276
Several new legal regulations and guidelines introduced in 2010 have changed the duties involved in medical information and counseling on preimplantation genetics (PGD) and prenatal diagnosis (PND).These regulations share the goal of a high-quality health service offering patients interdisciplinary and multidisciplinary expertise, especially taking into account psychological and social aspects. This contribution presents crucial elements for cooperating counseling in the PGD and PND fields. It considers results from a nationwide survey of all professional groups involved in counseling after a pathological prenatal diagnosis according to the law. Crucial to interdisciplinary counseling are choosing the appropriate medical specialty for referral, a positive basis for cooperation, and the right time for consulting another doctor. Several central issues have been identified for successful multidisciplinary counseling: identifying the suitable moment and method to establish contact between the patient and psychosocial counselor, focusing on PGD and PND centers as well as on the transparent qualifications of psychosocial counselors, and appreciating the importance of cooperation. 相似文献
98.
Christiane Charriaut‐Marlangue PhD Philippe Bonnin PhD MD Hoa Pham PhD Gauthier Loron MD Pierre‐Louis Leger MD Pierre Gressens PhD MD Sylvain Renolleau PhD MD Olivier Baud PhD MD 《Annals of neurology》2013,73(4):442-448
Nitric oxide (NO) is a powerful vasodilator, involved in both physiological functions and pathophysiological alterations of various regulatory processes, for example, the maintenance of vascular tone and inflammation. The recently demonstrated impact of exogenous NO on the central nervous system extends its role under normal and pathological conditions. At times neuroprotective, at times neurotoxic, NO is capable of different effects depending upon the extent of cerebral damage, the cellular redox state, and the spatiotemporal coordinates and concentration at which it is synthesized. This review provides new insights into the short‐ and long‐term effects of endogenous and exogenous NO in brain injury. ANN NEUROL 2013;73:442–448 相似文献
99.
Tumour budding activity and cell nest size determine patient outcome in oral squamous cell carcinoma: proposal for an adjusted grading system
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100.
Epidemiological study of paediatric germ cell tumours revealed the incidence and distribution that was expected,but a low mortality rate
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