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61.
Peter Lovrics MD Nicole Hodgson MD Mary Ann O’Brien PhD Lehana Thabane PhD Sylvie Cornacchi MSc Angela Coates MEd Barbara Heller MD Susan Reid MD Kenneth Sanders MD Marko Simunovic MD 《Annals of surgical oncology》2014,21(7):2181-2187
Background
Gaps in breast cancer (BC) surgical care have been identified. We have completed a surgeon-directed, iterative project to improve the quality of BC surgery in South-Central Ontario.Methods
Surgeons performing BC surgery in a single Ontario health region were invited to participate. Interventions included: audit and feedback (A&F) of surgeon-selected quality indicators (QIs), workshops, and tailoring interviews. Workshops and A&F occurred yearly from 2005–2012. QIs included: preoperative imaging; preoperative core biopsy; positive margin rates; specimen orientation labeling; intraoperative specimen radiography of nonpalpable lesions; T1/T2 mastectomy rates; reoperation for positive margins; sentinel lymph node biopsy (SLNB) rates, number of sentinel lymph nodes; and days to receive pathology report. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All results were disseminated to all surgeons performing breast surgery in the study region.Results
Over 6 time periods, 1,828 BC charts were reviewed from 12 hospitals (8 community and 4 academic). Twenty-two to 40 participants attended each workshop. Sustained improvement in rates of positive margins, preoperative core biopsies, specimen orientation labeling, and SLNB were seen. Mastectomy rates and overall axillary staging rates did not change, whereas time to receive pathology report increased. The tailoring interviews concerning positive margins, SLNB, and reoperation for positive margins identified facilitators and barriers relevant to surgeons.Conclusions
This surgeon-directed, regional project resulted in meaningful improvement in numerous QIs. There was consistent and sustained participation by surgeons, highlighting the importance of integrating the clinicians in a long-term, iterative quality improvement strategy in BC surgery. 相似文献62.
Matteo Corvino Antonio Tessitore Carlo Minganti Marko Sibila 《Journal of Sports Science and Medicine》2014,13(2):297-303
The aim of this study was to investigate the effect of three different court dimensions on the internal and external load during small-sided handball games. Six male amateur handball players took part in this study and participated in three different 8-min 3vs3 (plus goalkeepers) small-sided handball games (each repeated twice). The three court dimensions were 12×24m, 30×15m and 32×16m. Through Global Positioning System devices (SPI pro elite 15Hz, GPSports) and video analysis, the following parameters were recorded: cyclic and acyclic movements (distance covered and number of technical actions executed), heart rate, and rating of perceived exertion (RPE). Total distance travelled increased with court dimensions (885.2m ± 66.6m in 24×12m; 980.0m ± 73.4m in 30×15m; 1095.0m ± 112.9m in 32×16m, p < 0.05). The analysis of distance covered in the four speed zones (0–1.4 m·s-1; 1.4–3.4 m·s-1; 3.4–5.2 m·s-1; >5.2 m·s-1) highlighted substantial differences: playing with the 30×15m court in comparison to the 24×12m, the players covered less distance in the first speed zone (p = 0.012; ES = 0.70) and more distance in the second (p = 0.049; ES = 0.73) and third (p = 0.012; ES = 0.51) speed zones. Statistical differences were also found between the 24×12m and 32×16m courts: the players covered more distance in the second and third speed zones (p = 0.013, ES = 0.76; p = 0.023 ES = 0.69) with the 32×16m court in comparison to the 24×12m. There was no significant effect of court dimensions on the technical parameters (number of team actions, passes, piston movements toward goal and defensive activities), the number of specific handball jumps and changes of direction, and the time spent in the different heart rate zones. Considering the average data of all the experimental conditions together (24×12m, 30×15m, 32×16m), a pronounced statistical difference was highlighted between the values in first two HR zones and the last two (p < 0.05; large ES). The rating of perceived exertion was significantly higher during the drill with the 32×16m court compared with the 24×12m one (p < 0.05; ES = 2.34). Our findings indicate that changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.
Key points
- To cover the specific game demands, more specific training methodologies have been developed in many sport games.
- Specific game exercises may provide a useful conditioning stimulus, together with technical and tactical training components.
- Changing court dimensions during small-sided handball games can be used to manipulate both external and internal loads on the players.
- The high ratio of cyclic activity per minute and the high HR values recorded during SSHGs make this type of drills extremely useful for aerobic power training.
63.
Jelena Nedeljkovi?-Trailovi? Sa?a Trailovi? Radmila Resanovi? Dragan Mili?evi? Milijan Jovanovic Marko Vasiljevic 《Toxins》2015,7(4):1174-1191
The aim of our study was to determine the efficacy of three different adsorbents, inorganic (modified zeolite), organic (esterified glucomannans) and mixed (inorganic and organic components, with the addition of enzymes), in protecting broilers from the toxic effects of ochratoxin A in feed. Broilers were fed diets containing 2 mg/kg of ochratoxin A (OTA) and supplemented with adsorbents at the recommended concentration of 2 g/kg for 21 days. The presence of OTA led to a notable reduction in body weight, lower weight gain, increased feed conversion and induced histopathological changes in the liver and kidneys. The presence of inorganic, organic and mixed adsorbents in contaminated feed only partially reduced the negative effects of OTA on the broiler performances. Broilers that were fed with adsorbent-supplemented feed reached higher body weight (17.96%, 19.09% and 13.59%), compared to the group that received only OTA. The presence of adsorbents partially alleviated the reduction in feed consumption (22.68%, 12.91% and 10.59%), and a similar effect was observed with feed conversion. The applied adsorbents have also reduced the intensity of histopathological changes caused by OTA; however, they were not able to prevent their onset. After the withdrawal of the toxin and adsorbents from the feed (21–42 days), all previously observed disturbances in broilers were reduced, but more remarkably in broilers fed with adsorbents. 相似文献
64.
Karolina Wesoowska Marko Elovainio Kia Gluschkoff Laura Hietapakka Anu‐Marja Kaihlanen Salla Lehtoaro Tarja Heponiemi 《Research in nursing & health》2019,42(5):349-357
Cross‐cultural competence is an essential component of the nursing profession, but little is known about the specific psychosocial work characteristics that potentially promote or hinder such competence. In the present study, psychosocial work characteristics were based on Karasek's Job Demand—Control Model. The researchers examined whether Karasek's psychosocial work characteristics, such as high‐strain jobs, high‐strain isolated jobs, active jobs, and active collective jobs, are associated with cross‐cultural competence (empathy, skills, positive attitudes, and motivation), and whether there are differences between native and foreign‐born registered nurses (RN) in these potential associations. A random sample of 744 native RNs (91.0% women) and a total sample (n = 212) of foreign‐born RNs (94.3% women) working in Finland were used. Data were collected using a questionnaire and analyzed with a series of multiple linear regression analyses. High‐strain and high‐strain isolated jobs were negatively associated with all four dimensions of cross‐cultural competence. Active collective jobs, but not active jobs, were positively associated with cross‐cultural skills. There were no differences between native and migrant nurses in these associations. The psychosocial work environment is associated with cross‐cultural competence in both native and migrant nurses. Improvements in psychosocial working conditions, especially minimizing negative factors in the work environment, such as high‐strain and high‐strain isolated jobs, may need to be considered as a part of the efforts aimed to enhance cross‐cultural competence among nursing personnel. 相似文献
65.
Eric J. Koch Clotilde Bongrand Brittany D. Bennett Susannah Lawhorn Silvia Moriano-Gutierrez Marko Pende Karim Vadiwala Hans-Ulrich Dodt Florian Raible William Goldman Edward G. Ruby Margaret McFall-Ngai 《Proceedings of the National Academy of Sciences of the United States of America》2020,117(44):27578
66.
The inability of subcutaneous (sc) insulin to effectively, safely and painlessly control postprandial glucose levels has encouraged the exploration of alternate methods of insulin delivery. Recently, a novel drug delivery system, based on a unique liquid aerosol formulation, has been developed. This system allows precise insulin dose delivery via a simple, cosmetically acceptable metered dose inhaler in the form of fine aerosolized droplets directed into the mouth. The system introduces a fine-particle aerosol at high velocity into the patient's breath; the mouth deposition is dramatically increased compared with conventional technology. This oral aerosol formulation is rapidly absorbed through the buccal mucosal lining and in the oropharynx regions, and it provides the plasma insulin levels necessary to control postprandial glucose rise in diabetic patients. This novel, pain-free, oral insulin formulation has a critical series of attributes: rapid absorption, a simple (user-friendly) administration technique, precise dosing control (comparable to injection within one unit), and bolus delivery of drug. This review describes the recent results of clinical studies (in type 1 and type 2 diabetic patients) by comparing the efficacy of Oralin (oral insulin spray) versus sc injected insulin and placebo arms. A simplified means for prandial insulin delivery, such as that offered by this technique, will significantly reduce the incidence of key complications by allowing increased patient compliance for consistent drug administration in order to regulate patients' blood glucose levels. 相似文献
67.
Marttila-Ichihara F Turja R Miiluniemi M Karikoski M Maksimow M Niemelä J Martinez-Pomares L Salmi M Jalkanen S 《Blood》2008,112(1):64-72
Macrophage mannose receptor (MR) participates in pathogen recognition, clearance of endogenous serum glycoproteins, and antigen presentation. MR is also present on lymphatic vessels, where its function is unknown. Here we show that migration of lymphocytes from the skin into the draining lymph nodes through the afferent lymphatics is reduced in MR-deficient mice, while the structure of lymphatic vasculature remains normal in these animals. Moreover, in a tumor model the primary tumors grow significantly bigger in MR–/– mice than in the wild-type (WT) controls, whereas the regional lymph node metastases are markedly smaller. Adhesion of both normal lymphocytes and tumor cells to lymphatic vessels is significantly decreased in MR-deficient mice. The ability of macrophages to present tumor antigens is indistinguishable between the 2 genotypes. Thus, MR on lymphatic endothelial cells is involved in leukocyte trafficking and contributes to the metastatic behavior of cancer cells. Blocking of MR may provide a new approach to controlling inflammation and cancer metastasis by targeting the lymphatic vasculature. 相似文献
68.
69.
Malovrh M 《Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy》2005,9(3):214-217
The long-term survival and quality of life of patients on hemodialysis (HD) is dependant on the adequacy of dialysis via an appropriately placed vascular access. The optimal vascular access is unquestionably the autologous arteriovenous fistula (AVF), with the most common method being the conventional radio-cephalic fistula at the wrist. Recent clinical practice guidelines recommend the creation of native fistula or synthetic graft before the start of chronic HD therapy to prevent the need for complication-prone dialysis catheters. This could also have a beneficial effect on the rapidity of worsening kidney failure. A multidisciplinary approach (nephrologists, surgeons, radiologists and nurses) should improve the HD outcome by promoting the use of AVF. An important additional component of this program is the Doppler ultrasound for preoperative vascular mapping. Such an approach may be realized without unsuccessful surgical explorations, with a minimal early failure rate and a high maturation, even in patients with diabetes mellitus. 相似文献
70.
Enn K Seppet Margus Eimre Tiia Anmann Evelin Seppet Nadezhda Peet Tuuli Kmbre Kalju Paju Andres Piirsoo Andrei V Kuznetsov Marko Vendelin Frank N Gellerich Stephan Zierz Valdur A Saks 《Experimental & Clinical Cardiology》2005,10(3):173-183