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Jordana E. Hoppe Brandie D. Wagner Frank J. Accurso Edith T. Zemanick Scott D. Sagel 《Journal of cystic fibrosis》2018,17(6):760-768
Background
Pulmonary exacerbations (PEx) in children with cystic fibrosis (CF) are frequently treated in the outpatient setting with oral antibiotics. However, little is known about the characteristics of PEx managed on an outpatient basis and the effectiveness of oral antibiotic therapy. We sought to prospectively evaluate clinical and laboratory changes associated with oral antibiotic treatment for PEx.Methods
Children with CF between 8 and 18?years of age prescribed two weeks of oral antibiotics for a PEx were eligible to enroll. The study consisted of a visit within 48?h of starting antibiotics and a second visit within one week of antibiotic completion. Twenty-eight participants were evaluated by exacerbation score, quality of life measurements, lung function, sputum microbiology and inflammation.Results
Oral antibiotic treatment was associated with a significant improvement in exacerbation score and quality of life measured by the CF Questionnaire-Revised (CFQ-R) respiratory domain. Following treatment, forced expiratory volume in 1?s (FEV1) % predicted increased [median (range)] 9% (?8%, 31%), and 22 (81%) subjects returned to 90% or higher of baseline FEV1. Bacterial density of the primary organism identified on sputum culture decreased significantly with a median (range) decrease of 0.8 log10 cfu/mL (?8 log10, 2 log10, p?=?0.03). Sputum neutrophil elastase [?37?μg/mL (?464, 272), p?=?0.02] and IL-1β [?2.8?×?103μg/mL (?6.9?×?104, 3.3?×?104), p?=?0.03] decreased significantly following treatment in this cohort.Conclusions
Treatment of PEx with oral antibiotics was associated with measurable improvements in patient reported outcomes, lung function, bacterial density and sputum inflammatory markers. 相似文献34.
Eosinophils in chronically inflamed human upper airway tissues express transforming growth factor beta 1 gene (TGF beta 1). 总被引:14,自引:0,他引:14
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I Ohno R G Lea K C Flanders D A Clark D Banwatt J Dolovich J Denburg C B Harley J Gauldie M Jordana 《The Journal of clinical investigation》1992,89(5):1662-1668
Transforming growth factor beta (TGF beta) is a multifunctional protein which has been suggested to play a central role in the pathogenesis of chronic inflammation and fibrosis. Nasal polyposis is a condition affecting the upper airways characterized by the presence of chronic inflammation and varying degrees of fibrosis. To examine the potential role of TGF beta in the pathogenesis of this condition, we investigated gene expression and cytokine production in nasal polyp tissues as well as in the normal nasal mucosa. By Northern blot analysis using a porcine TGF beta 1 cDNA probe, we detected TGF beta 1-specific mRNA in nasal polyp tissues, as well as in the tissue from a patient with allergic rhinitis, but not in the normal nasal mucosa. By the combination of tissue section staining with chromotrope 2R with in situ hybridization using the same TGF beta 1 probe, we found that approximately 50% of the eosinophils infiltrating the polyp tissue express the TGF beta 1 gene. In addition, immunohistochemical localization of TGF beta 1 was detected associated with extracellular matrix as well as in cells in the stroma. These results suggest that in nasal polyposis where eosinophils are the most prevalent inflammatory cell, TGF beta 1 synthesized by these cells may contribute to the structural abnormalities such as stromal fibrosis and basement membrane thickening which characterize this disease. 相似文献
35.
Jordana Muroff Ph.D. M.S.W. Gail Steketee Ph.D. M.S.W. Jessica Rasmussen M.A. Amanda Gibson M.A. Christiana Bratiotis Ph.D. M.S.W. Cristina Sorrentino Ph.D. M.S.W. 《Depression and anxiety》2009,26(7):634-640
Background: Time‐limited group cognitive behavioral treatments (GCBT) for obsessive–compulsive disorder have demonstrated improvement in target symptoms. One small sample study of GCBT specifically for hoarding problems also showed benefit. This study examines the efficacy of a specialized GCBT for compulsive hoarding on a larger sample. Methods: Thirty‐two clients diagnosed with hoarding participated in five groups. Four groups met once weekly for 2 hour over 16 weeks (n=27) and one group met for 20 weeks (n=5). All participants had two individual 90‐min home sessions. Self‐report assessments were completed at baseline, mid‐treatment, and post‐treatment about hoarding behavior and related symptoms (e.g., depression). The sample was predominantly female, White, highly educated, unemployed, and not partnered/married; mean age was 53. A majority was diagnosed with major depressive disorder and obsessive–compulsive personality disorder. Results: Participants showed significant improvement from pre‐ to post‐treatment on the Saving Inventory Revised, Saving Cognitions Inventory, Clutter Image Rating, and Clinical Global Severity. The most recent group (n=8) that used a more formalized treatment and research protocol improved significantly more than did earlier members. Conclusion: This study demonstrates the feasibility and modest success of GCBT methods in improving hoarding symptoms. Group treatment may be especially valuable because of its cost‐effectiveness, greater client access to trained clinicians, and reduction in social isolation and stigma linked to this problem. Further research is needed to improve the efficacy of GCBT methods for hoarding and to examine durability of change, predictors of outcomes, and processes that influence change. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc. 相似文献
36.
Alison M. Pack Anne R. Davis Jordana Kritzer Ava Yoon Adela Camus 《Epilepsy & behavior : E&B》2009,14(4):640-644
Women with epilepsy (WWE)’s knowledge of the interaction between antiepileptic drugs (AEDs) and oral contraceptives (OCs) and the potential teratogenicity of AEDs has received limited study. We conducted a cross-sectional questionnaire study (English or Spanish) among young WWE (18–44 years) to assess demographic characteristics, current AED use, and knowledge of AED interactions with OCs and teratogenicity. We used the Food and Drug Administration’s classification system to categorize each AED’s teratogenic potential. Participants (n = 148) had a mean age of 32 years (SD 8); 32% spoke Spanish and described themselves as Hispanic. Among women prescribed a cytochrome p450-inducing AED, 65% were unaware of decreased OC efficacy. Forty percent of those prescribed Category D AEDs were unaware of potential teratogenic effects. WWE have limited knowledge of the potential interaction between AEDs and OCs and the teratogenic effects of AEDs. Educational efforts should highlight the reproductive health effects of AEDs in WWE. 相似文献
37.
Leahy N Sheps J Tracy CS Nie JX Moineddin R Upshur RE 《Canadian family physician Médecin de famille canadien》2008,54(3):413-414
OBJECTIVE
To determine the attitudes of practising Canadian family physicians toward education in research skills during residency, to identify what determines these attitudes, and to investigate the effect of education in research skills on future research activity.DESIGN
Mailed survey.SETTING
Primary care.PARTICIPANTS
Stratified random sample of 247 practising physicians who were members of the College of Family Physicians of Canada.MAIN OUTCOME MEASURES
Physicians’ attitudes toward education in research skills during residency, their perceptions of the value of research in primary care, and their current involvement in research activities.RESULTS
Overall response rate was 56%. Nearly all respondents agreed that critical appraisal skills are essential to the practice of modern family medicine. Most agreed that it is very important that the evidence base for primary care medicine be developed by family physicians, yet only one-third agreed that research skills ought to receive more emphasis during residency training, and fewer than one-quarter agreed that practising family physicians should have strong research skills. Fewer than half the respondents agreed that a core goal of family medicine residency training should be to promote and develop an active interest in research. While three-quarters agreed that research projects during residency can be formative learning experiences, only about 40% indicated that research projects should be required, and only about 20% considered their own resident research projects to have been highly influential learning experiences. Respondents whose residency programs had research in the curriculum were significantly more likely to have found their research projects to be highly influential learning experiences (P <.05), and those who had successfully completed research projects were less likely to believe that they lacked the necessary skills and expertise to conduct their own research studies. Those who had successfully completed resident research projects participated in postresidency research activity at a significantly higher rate than those who did not complete projects (P <.01).CONCLUSION
Despite a conviction that research is important in primary care, only a few practising family physicians in our sample believed that strong research skills are important or that education in research skills should receive more emphasis during residency training. Resident research projects are not invariably influential learning experiences, although some evidence indicates that successful completion of a project makes future participation in research more likely. 相似文献38.
Objectives:The coronavirus 2019 (COVID-19) pandemic has resulted in profound global impact, with older adults at greater risk of serious physical health outcomes. It is essential to also understand generational differences in psychosocial impacts to identify appropriate prevention and intervention targets. Across generational groups, this study examined: (1) rates of precautions and adaptive and maladaptive health behaviors, (2) differences in levels of anxiety, and (3) rates of COVID-related concerns during Wave 1 of COVID-19 in Canada.Participants:We analyzed data from 2 Canadian population-based data sets: the Canadian Perspective Survey Series: Impact of COVID-19 survey (N = 4,627; March 29 to April 3, 2020), and Crowdsourcing: Impacts of COVID-19 on Canadians—Your Mental Health (N = 45,989; April 24 to May 11, 2020).Measures:We categorized generational age group. Participants self-reported changes in behaviors and COVID-related concerns, and a validated measure assessed anxiety symptoms.Results:There are generational differences in behavioral responses to the pandemic. Adaptive health habits (e.g., exercise) were comparable across groups, while changes in maladaptive health habits (e.g., substance use) were highest among younger age groups, particularly Millennials (15 to 34 years old). COVID-related precautions were also highest among the younger generations, with Generation X (35 to 54 years old) exhibiting the highest rate of precautionary behavior. Results also revealed that the highest rate of clinically significant anxiety is among Millennials (36.0%; severe anxiety = 15.7%), and the younger generations have the highest rates of COVID-related concerns.Conclusion:These early data are essential in understanding at-risk groups given the unpredictable nature of the pandemic and its potential long-term implications. 相似文献
39.
Jordana Kron Daniel Alexander Mark A. Wood 《Current treatment options in cardiovascular medicine》2009,11(5):349-359
Electrophysiologic studies, radiofrequency ablation, and device implantations including pacemakers and defibrillators have
become essential tools in the armamentarium of electrophysiologists. These procedures are being performed in patients with
complex comorbidities, many of whom chronically take anticoagulation or antiplatelet agents. Careful management of anticoagulation
before, during, and after electrophysiologic procedures including device implantations is critical to minimize bleeding and
thrombotic complications and to optimize patient outcomes. 相似文献
40.
Hydrochlorothiazide-induced pulmonary edema is an unusual but life-threatening adverse reaction. It causes hypoxemia, hypotension,
tachycardia, fever, and occasionally electrocardiographic and echocardiographic abnormalities. The mechanism of production
is, probably, idiosyncratic.
Received: 26 May 1997 Accepted: 13 January 1998 相似文献