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61.
Kumar R Brar J Yacoub R Khan T Zachariah M Venuto R 《Transplantation proceedings》2012,44(5):1270-1274
Background
Prolongation of renal allograft survival a considerable challenge. The primary cause of renal graft failure is recipient death and cardiovascular disease is the leading cause of mortality. We assessed the management of hypertension, dyslipidemia and diabetes mellitus (DM) in a protocol-driven renal transplant clinic.Methods
We reviewed 128 patients who received a renal allograft between 2004 and 2008 at our institution. Blood pressure (BP), low density lipoprotein (LDL) and hemoglobin AlC (HbAlC) were assessed annually for up to 5 years. Results were compared with the Kidney Disease: Improving Global Outcomes guidelines which target BP at ≤ 130/80 mmHg, LDL ≤ 100 mg/dL, and HbAlC ≤ 7.5%. Use of statins and antihypertensive medications was reviewed. Chi-square and t tests were used for analysis.Results
A history of hypertension, dyslipidemia, and DM were present in 96.1%, 60.9%, and 43.8%, respectively. The percentage of patients on ≥3 antihypertensive medications, statins, and other lipid-lowering medications were 38.01%, 44.5%, and 17.2%, respectively. One-year posttransplant targets for BP, LDL, and HbAlC were achieved in 41.4%, 71.7%, and 70.5% of patients, respectively. Five-year posttransplant target BP, LDL, and HbAlC were achieved in 55%, 91.7%, and 88.9% of patients, respectively.Conclusions
Even in a university-based clinic with protocols designed to improve compliance, treatment goals for BP, LDL, and HbAlC were not achieved in a substantial number of patients, especially in the first year posttransplantation. Better strategies are needed to meet treatment objectives and prevent untoward outcomes. 相似文献62.
The group modality is a viable holistic treatment consideration for the elderly, given the steady increase in the elderly population, the presence of various psychiatric and/or medical conditions in this cohort, and cost concerns. The holistic nurse and group leader share similar role definitions of being a facilitator in the healing process. They embrace the concept that the person and group are greater than the sum of the parts. Using a group modality can increase the number of people served by one nurse, thereby making it cost-effective. Incorporating the holistic mind-body-spirit approach addresses the Healthy People 2010 goal of increasing the quality of life. Tips on conducting groups with the elderly are reviewed, including types of groups, setting, goals, composition, duration, and frequency. Theme-centered groups are discussed from a holistic perspective. Yalom's 11 therapeutic factors that account for group functions are explained, along with other group concepts that reflect holistic nursing concepts. 相似文献
63.
Placental vascular resistance using umbilical velocimetry in patients undergoing cesarean section for fetal distress 总被引:1,自引:0,他引:1
Peak systolic (S) to lowest end-diastolic (D) ratios (S/D) of umbilical velocimetry have been used to assess downstream placental vascular resistance and predict adverse pregnancy outcome. The purpose of this study is to assess S/D ratios in patients undergoing cesarean section for clinical fetal distress. Fifty-six patients were identified who had umbilical velocimetry performed during antepartum fetal surveillance (nonstress testing and amniotic fluid index) within 7 days of undergoing cesarean section for fetal distress at Women's Hospital (Los Angeles, CA). The mean gestational age at delivery was 36.5 +/- 2.5 weeks. Thirty (53.6%) patients had elevated S/D ratios (greater than 3), 24 (42.9%) had abnormal amniotic fluid indices, and 20 (35.7%) had abnormal nonstress testing. Group 1 (N = 30) patients delivered small-for-gestational-age (SGA) fetuses and group 2 (N = 26) patients delivered appropriately grown (AGA) fetuses. In group 1, 24 (80%) patients had abnormal S/D ratios and 16 (53.3%) had abnormal amniotic fluid indices, compared to only 6 (23.1%) with abnormal S/D ratios and 8 (30.8%) with abnormal amniotic fluid indices in group 2 (p less than .05). In contrast, 14 (53.8%) of the 26 patients in group 2 had abnormal nonstress testing compared to only 6 (20%) of the 30 patients in group 1 (p less than .05). Eighteen (69.2%) of the 26 patients in group 2 were post-term pregnancies; 20 (66.7%) of the 30 patients in group 1 had chronic hypertension, pregnancy-induced hypertension, or superimposed preeclampsia.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
64.
65.
The use of Doppler ultrasound to assess intrauterine growth retardation in the fetus 总被引:1,自引:0,他引:1
H S Brar 《Seminars in perinatology》1988,12(1):40-51
66.
Bosniak S Cantisano-Zilkha M Purewal BK Zdinak LA 《Orbit (Amsterdam, Netherlands)》2006,25(4):319-326
The oculo-facial surgeon's quest for non-invasive procedures is a response to increasing patient demands for enhanced results without any downtime. Technology has obliged us with multiple injectable and light therapeutic modalities that tighten skin, relax and fill in wrinkles, and improve skin dyspigmentation and texture. When these techniques are combined, the results are superior to the use of individual therapies alone. The foundation for combination therapies are: botulinum toxin, filling agents, chemical peels, intense pulsed light, non-ablative and ablative lasers. 相似文献
67.
N-nitrosodiethylamine (NDEA) is an important carcinogen frequently present in human environment and food chain. Nitrosamines such as NDEA produce oxidative stress due to generation of reactive oxygen species and alter the antioxidant defence system in the tissues. The present investigation was aimed at studying its toxicity under hypercholesterolemic conditions. NDEA administration brought about hepatic degeneration as evidenced by the significant decrease in liver weight index of both normal as well as hypercholesterolemic animals. Hypercholesterolemia did not affect the hemoglobin (Hb) content in experimental animals but resulted in an increase in the osmotic fragility of erythrocytes. The antioxygenic potential of experimental animals decreased in both, the NDEA-fed group as well as in the group that was also supplemented with a hypercholesterolemic diet. This was evident by increased in vitro lipid peroxidation (LPO) of erythrocytes. Administration of NDEA resulted in a substantial and significant increase in LPO in all the tissues under normal as well as hypercholesterolemic conditions. Addition of hypercholesterolemic diet in general, increased LPO in all the tissues to varying degrees but its effect was maximal in the liver. Effect of NDEA administration on antioxygenic enzymes under normal as well as hypercholesterolemic conditions was variable in different tissues. Histopathological analysis of different tissues (heart, liver, lungs, spleen and kidneys) showed mild to severe pathological changes among the control and experimental groups. 相似文献
68.
BACKGROUND: Our center sought to implement a simple chemoradiotherapy schedule for patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) with minimal toxicity to achieve rates of overall survival comparable to other schedules. METHODS: The chemoradiotherapy schedule consisted of daily radiation to 70 Gy over 7 weeks with concurrent cisplatin 20 mg/m(2) during days 1 to 4 of weeks 1 and 5. Acute and late toxicities were recorded according to the Radiation Therapy Oncology Group (RTOG) and common toxicity criteria (CTC) grading. The overall, disease-specific, and locoregional recurrence-free survival were calculated using the STATA statistics package. Possible factors influencing these endpoints were analyzed. RESULTS: Fifty-seven patients were treated, and 56 patients were evaluable for follow-up. Median follow-up of alive patients was 16.1 months. There was an 82% complete response rate to chemoradiotherapy. The 2-year Kaplan-Meier overall, disease-specific, and locoregional recurrence-free survival rates were 62%, 67%, and 63%. Acute grade 3 and 4 radiation toxicity was noted in 61% and 2%, respectively. Grade 3 or 4 hematologic toxicity was noted in 7% of patients. Factors influencing overall survival included: Karnofsky performance status, receiving more than 50% of planned chemotherapy, age, and initial hemoglobin level. CONCLUSION: This regimen is tolerable and achieves overall survival and locoregional control rates comparable to other chemoradiotherapy schedules. 相似文献
69.
70.
Koren D Levitt Katz LE Brar PC Gallagher PR Berkowitz RI Brooks LJ 《Diabetes care》2011,34(11):2442-2447