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排序方式: 共有881条查询结果,搜索用时 15 毫秒
71.
Otto Pitknen Minna Niskanen Sinikka Rehnberg Mikko Hippelinen Markku Hynynen 《European journal of cardio-thoracic surgery》2000,18(6):703-710
Objective: To construct models for predicting mortality, morbidity and length of intensive care unit (ICU) stay after cardiac surgery and to compare the performance of these models with that of the EuroSCORE in two independent validation databases. Methods: Clinical data on 4592 cardiac surgery patients operated between 1992 and 1996 were retrospectively collected. In order to derive predictive models and to validate them, the patient population was randomly divided into a derivation database (n=3061) and a validation database (n=1531). Variables that were significant in univariate analyses were entered into a backward stepwise logistic regression model. The outcome was defined as mortality within 30 days after surgery, predefined morbidity, and the length of ICU stay lasting >2 days. In addition to the retrospective database, the models were validated also in a prospectively collected database of cardiac surgical patients operated in 1998–1999 (n=821). The EuroSCORE was tested in two validation databases, i.e. the retrospective and prospective one. Hosmer–Lemeshow goodness-of-fit was used to study the calibration of the predictive models. Area under the receiver operating characteristic (ROC) curve was used to study the discrimination ability of the models. Results: The overall mortality in the retrospective and the prospective data was 2 and 1%, and morbidity 22 and 18%, respectively. The created predictive models fitted well in the validation databases. Our models and the EuroSCORE were equally good in discriminating patients. Thus, in the prospective validation database, the mean areas under the ROC curve for our models and for the EuroSCORE were similar, i.e. 0.84 and 0.77 for mortality, 0.74 and 0.74 for morbidity, and 0.81 and 0.79 for the length of intensive care unit stay lasting for 2 days or more, respectively. Conclusions: Our models and the EuroSCORE were equally good in discriminating the patients in respect to outcome. However, our model provided also well calibrated estimation of the probability of prolonged ICU stay for each patient. As was originally suggested, the EuroSCORE may be an appropriate tool in categorizing cardiac surgical patients into various subgroups in interinstitutional comparisons. Our models may have additive value especially in resource allocation and quality assurance purposes for local use. 相似文献
72.
Juha Hämäläinen M.D.M.A. Erkki Isometsä M.D.Ph.D. Sinikka Sihvo Ph.D. Olli Kiviruusu B.Soc.Sc. Sami Pirkola M.D.Ph.D. Jouko Lönnqvist M.D.Ph.D. 《Depression and anxiety》2009,26(11):1049-1059
Background : Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received. Methods : In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (≥30 years) were interviewed (CIDI) in 2000–2001 for the presence of DSM‐IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment. Results : Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder. Conclusions : Due to the low use of health services for mental reasons, only one‐third of subjects with MDD use antidepressants, and less than one‐fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income. Depression and Anxiety 26:1049–1059, 2009. © 2009 Wiley‐Liss, Inc. 相似文献
73.
K. Suominen O. Mantere H. Valtonen P. Arvilommi S. Leppämäki E. Isometsä 《Acta psychiatrica Scandinavica》2009,120(6):464-473
Objective: We investigated gender differences in bipolar disorder (BD) type I and II in a representative cohort of secondary care psychiatric in‐ and out‐patients. Method: In the prospective, naturalistic Jorvi Bipolar Study of 191 secondary care psychiatric in‐ and out‐patients, 160 patients (85.1%) could be followed up for 18 months with a life chart. Results: After adjusting for confounders, no marked differences in illness‐related characteristics were found. However, female patients with BD had more lifetime comorbid eating disorders (P < 0.001, OR = 5.99, 95% CI 2.12–16.93) but less substance use disorders (P < 0.001, OR = 0.29, 95% CI 0.16–0.56) than males. Median time to recurrence after remission was 3.1 months longer among men than women, female gender carrying a higher hazard of recurrence (P = 0.006, HR = 2.00, 95% CI 1.22–3.27). Conclusion: Men and women with type I and II BD have fairly similar illness‐related clinical characteristics, but their profile of comorbid disorders may differ significantly, particularly regarding substance use and eating disorders. In medium‐term follow‐up, females appear to have a higher hazard of recurrence than males. 相似文献
74.
75.
Sultan Kav Judi Johnson Cynthia Rittenberg Paz Fernadez-Ortega Tarja Suominen Pia Riis Olsen Elisabeth Patiraki Davina Porock Annette Dahler Jolanta Toliusiene Dusanka Tadic Pongpak Pittayapan Vijay Roy Qi Wang Meric Colak Hanan Saca-Hazboun David Makumi Ilana Kadmon Sarah Ben Ami Elsie Anderson Rebecca Clark-Snow 《Supportive care in cancer》2008,16(9):1075-1083
PURPOSE: The aim of this study was to explore the nursing role in education and follow-up of patients who were taking oral chemotherapy (CT) and to identify the worldwide gap in patient education about oral CT. MATERIALS AND METHODS: Multinational Association of Supportive Care in Cancer members were invited to participate in a survey on oral CT. Nurse coordinators collected data via a 16-item questionnaire. Respondents totaled 1115 oncology nurses from 15 countries. RESULTS: Findings showed that about half of subjects work in outpatient/ambulatory clinics and had given at least two or more oral CT drugs. Although 52% had some type of guidelines/protocols, 47% reported not having received any education about oral CT drugs. While 64% report being involved in patient education, 58% of subjects indicated lack of patient education materials that are specific for oral CT agents. Only 27% stated that they gave all necessary information such as when and how to take the drugs, drug safety and storage, side effects, and symptom management. Reasons for not being involved in oral CT education and follow-up included beliefs that the physician plans the oral CT and gives patients necessary instructions (34%), that nurses only see patients who receive intravenous chemotherapy (16%), that nurses have lack of knowledge about oral agents (15%), and belief that physicians are responsible for patient follow-up. The nurses suggested better education and follow-up of patients to include the written patient education materials (33%) and professional education for nurses (30%). CONCLUSIONS: Findings revealed the need for professional education for nurses to ensure comprehensive, consistent patient education and development of written materials for patients receiving oral CT treatment. 相似文献
76.
Lohrmann C Välimäki M Suominen T Muinonen U Dassen T Peate I 《Journal of advanced nursing》2000,31(3):696-703
German nursing students' knowledge of and attitudes to HIV and AIDS: two decades after the first AIDS case This study describes German nursing students' (n=180) knowledge and attitudes relating to HIV/AIDS, their homophobia level, willingness to care for people with AIDS, and their approach to possible sexual risk behaviours. A questionnaire was used to collect the data (response rate 97.8%). The results indicated that the nursing students had a rather high knowledge level concerning AIDS. However, there were gaps of knowledge, such as regarding AIDS immunopathology or the symptoms of the disease. Single nursing students and those having cared for a person with AIDS had a more thorough knowledge about the disease. In general, the attitudes towards AIDS and people with AIDS were tolerant and positive, and homophobia was only found with a small minority. Students having positive attitudes towards people with HIV/AIDS had less homophobia compared to those having negative attitudes towards persons suffering from AIDS. Those with positive attitudes were more willing to care for patients with HIV/AIDS, while those with a high homophobia level were less willing to do so. In addition, students having a high AIDS knowledge level tended less towards negative attitudes and homophobia than those with a low level of knowledge. The implications of the research for nursing education will be discussed. 相似文献
77.
This study describes moral judgment among first- and last-year nursing students in Finland and examines the effects of ethics teaching on the development of moral judgment. The data for this quantitative cross-sectional study were collected using the Defining Issues Test (DIT), which is based on Kohlberg's theory of moral reasoning stages. The questionnaires were sent to four polytechnics, which offer nursing education in southern Finland. A total of 52 first-year students and 54 last-year students participated. The results showed that students who had had to deal with ethical dilemmas in their practical training had higher moral judgment than students who did not. Last-year students had higher moral judgment than first-year students. Last-year students resorted to principle-based thinking more often than first-year students in resolving DIT dilemmas. The differences between the two groups were statistically significant. The results indicate that nursing education may has an effect upon students' moral judgment. 相似文献
78.
Peurala SH Tarkka IM Pitkänen K Sivenius J 《Archives of physical medicine and rehabilitation》2005,86(8):1557-1564
OBJECTIVE: To compare body weight-supported exercise on a gait trainer with walking exercise overground. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital. PARTICIPANTS: Forty-five ambulatory patients with chronic stroke. INTERVENTIONS: Patients were randomized to 3 groups: (1) gait trainer exercise with functional electric stimulation (GTstim), (2) gait trainer exercise without stimulation (GT), and (3) walking overground (WALK). All patients practiced gait for 15 sessions during 3 weeks (each session, 20 min), and they received additional physiotherapy 55 minutes daily. MAIN OUTCOME MEASURES: Ten-meter walk test (10MWT), six-minute walk test (6MWT), lower-limb spasticity and muscle force, postural sway tests, Modified Motor Assessment Scale (MMAS), and FIM instrument scores were recorded before, during, and after the rehabilitation and at 6 months follow-up. RESULTS: The mean walking distance using the gait trainer was 6900+/-1200 m in the GTstim group and 6500+/-1700 m in GT group. In the WALK group, the distance was 4800+/-2800 m, which was less than the walking distance obtained in the GTstim group (P=.027). The body-weight support was individually reduced from 30% to 9% of the body weight over the course of the program. In the pooled 45 patients, the 10MWT (P<.001), 6MWT (P<.001), MMAS (P<.001), dynamic balance test time (P<.001), and test trip (P=.005) scores improved; however, no differences were found between the groups. CONCLUSIONS: Both the body weight-supported training and walking exercise training programs resulted in faster gait after the intensive rehabilitation program. Patients' motor performance remained improved at the follow-up. 相似文献
79.
Seija Eskelinen Pauli Suominen Tero Vahlberg Minna L?pp?nen Raimo Isoaho Sirkka-Liisa Kivel? Kerttu Irjala 《Clinical chemistry and laboratory medicine》2005,43(12):1380-1385
Our aims were: 1) to analyze the effect of the methodology used to derive clinically feasible cut-off values for thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb), which exhibit highly skewed distributions; and 2) to describe the influence of thyroid antibodies on thyroid stimulating hormone (TSH) and free thyroxine (FT4) reference intervals among thyroid disease-free aged subjects. The reference population consisted of 1086 individuals with a mean age of 73 years. The impacts of TPOAb and/or TgAb positivity on the reference intervals of TSH and FT4 were evaluated by both including and excluding subjects with elevated thyroid antibodies. The exclusion of subjects with elevated thyroid antibodies had no effect on the FT4 reference interval in either gender or on the TSH reference interval in men. Among women, the exclusion of 196 (34%) thyroid antibody-positive subjects resulted in lowering of the upper reference limit of TSH from 7.2 to 5.8 mIU/L. When the more stringent "mode-method" by summing mode+(mode-2.5th percentile) was used, 334 women (58%) were excluded and the upper reference limit of TSH remained essentially identical. Regardless of the statistical methodology used to derive cut-off values, the effect of antibody positivity was found to be less than expected. 相似文献
80.
Raimo Palmu Kirsi Suominen Jyrki Vuola Erkki Isometsä 《Burns : journal of the International Society for Burn Injuries》2010