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881.
Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy 总被引:5,自引:3,他引:2
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J M Moutquin P R Garner R F Burrows E Rey M E Helewa I R Lange S W Rabkin 《Canadian Medical Association journal》1997,157(7):907-919
OBJECTIVE: To provide Canadian physicians with comprehensive, evidence-based guidelines for the nonpharmacologic management and prevention of gestational hypertension and pre-existing hypertension during pregnancy. OPTIONS: Lifestyle modifications, dietary or nutrient interventions, plasma volume expansion and use of prostaglandin precursors or inhibitors. OUTCOMES: In gestational hypertension, prevention of complications and death related to either its occurrence (primary or secondary prevention) or its severity (tertiary prevention). In pre-existing hypertension, prevention of superimposed gestational hypertension and intrauterine growth retardation. EVIDENCE: Articles retrieved from the pregnancy and childbirth module of the Cochrane Database of Systematic Reviews; pertinent articles published from 1966 to 1996, retrieved through a MEDLINE search; and review of original randomized trials from 1942 to 1996. If evidence was unavailable, consensus was reached by the members of the consensus panel set up by the Canadian Hypertension Society. VALUES: High priority was given to prevention of adverse maternal and neonatal outcomes in pregnancies with established hypertension and in those at high risk of gestational hypertension through the provision of effective nonpharmacologic management. BENEFITS, HARMS AND COSTS: Reduction in rate of long-term hospital admissions among women with gestational hypertension, with establishment of safe home-care blood pressure monitoring and appropriate rest. Targeting prophylactic interventions in selected high-risk groups may avoid ineffective use in the general population. Cost was not considered. RECOMMENDATION: Nonpharmacologic management should be considered for pregnant women with a systolic blood pressure of 140-150 mm Hg or a diastolic pressure of 90-99 mm Hg, or both, measured in a clinical setting. A short-term hospital stay may be required for diagnosis and for ruling out severe gestational hypertension (preeclampsia). In the latter case, the only effective treatment is delivery. Palliative management, dependent on blood pressure, gestational age and presence of associated maternal and fetal risk factors, includes close supervision, limitation of activities and some bed rest. A normal diet without salt restriction is advised. Promising preventive interventions that may reduce the incidence of gestational hypertension, especially with proteinuria, include calcium supplementation (2 g/d), fish oil supplementation and low-dose acetylsalicylic acid therapy, particularly in women at high risk for early-onset gestational hypertension. Pre-existing hypertension should be managed the same way as before pregnancy. However, additional concerns are the effects on fetal well-being and the worsening of hypertension during the second half of pregnancy. There is, as yet, no treatment that will prevent exacerbation of the condition. VALIDATION: The guidelines share the principles in consensus reports from the US and Australia on the nonpharmacologic management of hypertension in pregnancy. 相似文献
882.
E Grunfeld R Glossop I McDowell C Danbrook 《Canadian Medical Association journal》1997,157(8):1101-1105
The emphasis on home-based care is one important aspect of health services restructuring initiatives in Canada. Fundamental to the preference for home-based care over institutional care is the expectation that family caregivers will be available in the home to support patients who would otherwise be in an institution. The authors explore the potential impact of this devolution of services from institutions to the home in 2 vulnerable patient populations--elderly patients with dementia and elderly patients with terminal illnesses. Community-based surveillance strategies are needed to determine the true health, quality-of-life and economic outcomes of these restructuring initiatives. 相似文献
883.
We report a case of malakoplakia in association with colonic adenocarcinoma. Tumour-associated malakoplakia in the gastrointestinal tract is a rare finding, generally confined to the colon. It may be locally aggressive, with invasion of pericolic tissues, but is always located adjacent to the tumour. This contrasts with the often more diffuse, multifocal distribution of colonic malakoplakia in association with other pathologies. 相似文献
884.
885.
I. P. Naiker V. Chrystal I. G. Randeree Y. K. Seedat 《Postgraduate medical journal》1997,73(858):230-233
The prognostic importance of hypertension at the onset of clinical lupus nephritis is not well established. We studied retrospectively 44 patients with lupus nephritis in order to ascertain the prevalence of hypertension at presentation and to investigate a possible association between hypertension and renal functional impairment. A correlation was also sought between hypertension and histological class of lupus nephritis. Hypertension was graded as mild (diastolic 95-99 mmHg), moderate (100-114) or severe (> 115). Impaired renal function (creatinine > 120 mumol/l) was graded as mild (120-200 mumol/l), moderate (200-350 mumol/l), or severe (> 350 mumol/l). Histological class and the presence of hypertensive renal vascular lesions was recorded. The prevalence of hypertension was 38%. There were 17 hypertensives and 27 normotensives. The incidence of renal impairment was greater in the hypertensives, 47% vs 18.5% (p = 0.04). Mean serum creatinine was also higher higher in this group (p = 0.02). The presence of hypertensive renal vascular lesions identified a high-risk subgroup who had a higher incidence of renal functional impairment and worse renal function than the hypertensive group as a whole. Even at an early stage, hypertension and hypertensive renal vascular lesions correlated well with renal functional impairment. Aggressive treatment of hypertension is therefore essential in early lupus nephritis in order to prevent further deterioration of renal function as the disease evolves. 相似文献
886.
R. N. Sinha A. W. Patrick L. Richardson M. Wallymahmed I. A. MacFarlane 《Postgraduate medical journal》1997,73(859):293-294
One hundred insulin-dependent diabetic patients (age < 45 years, 53 smokers) were followed for six years. The age, duration of diabetes and mean glycated haemoglobin levels, were comparable between the smokers and non-smokers. Microvascular complications (retinopathy and increased urine albumin excretion) were commoner and more severe in the smoking group at six years, particularly in heavy smokers. Of the 45 original smokers reviewed at six years, 12 (27%) had stopped, six of whom had developed microvascular complications. Only two of the ''heavy'' initial smokers, likely to be at most risk, had stopped smoking, and three original non-smokers had started smoking. 相似文献
887.
888.
889.
Papillitis and vasculitis of the arteria spinalis anterior as complications of hepatitis C reinfection after liver transplantation 总被引:1,自引:0,他引:1
T. Propst Albert Propst Karin Nachbaur I. Graziadei Hans Willeit Raimund Margreiter Wolfgang Vogel 《Transplant international》1997,10(3):234-237
It is well known that hepatitis C virus (HCV)-related chronic liver disease may be associated with various immunological
disorders including mixed cryoglobulinemia, which is accompanied by cutaneous vasculitis, arthralgias, membranoproliferative
glomerulonephritis, and neuropathy in association with cryoprecipitable immune complexes in serum. We describe here the first
case of central nervous system HCV infection with evidence of the virus in the cerebrospinal fluid in association with cryoglobulinemia
in a patient who developed recurrent episodes of papillitis and vasculitis of the arteria spinalis anterior after liver transplantation.
Received: 3 September 1996 Received after revision: 13 November 1996 Accepted: 6 December 1996 相似文献
890.
While health promotion practitioners are engaging increasingly in research,
there has been little examination of the practical dilemmas they may face
in negotiating and collaborating with academics and community members in
action research projects. This paper analyses how the practice of health
promotion can interact with action research, and considers issues that
arise for organizationally based health promotion practitioners and
professional researchers. The first section charts types of action research
along three dimensions (power, goals/values, resources). The second section
examines some of the issues and practical dilemmas which arise in
negotiating and researching collaborative projects in community health
promotion. The discussion includes the differing perspectives of:
practitioners (managerial and frontline), community members and academic
researchers. The final section outlines a hybrid model of action research,
developed in our work with community members, organizationally based health
promoters and academy-based researchers. It combines the reflective
practice of practice-based action research with the community participation
and control of participatory research. The model is called community
reflective action research. 相似文献