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排序方式: 共有221条查询结果,搜索用时 15 毫秒
61.
DeWalt DA Pignone M Malone R Rawls C Kosnar MC George G Bryant B Rothman RL Angel B 《Patient education and counseling》2004,55(1):78-86
Development and pilot testing of a disease management program for low literacy patients with heart failure. BACKGROUND: Randomized trials have shown that disease management programs can reduce hospitalizations and improve symptoms for patients with congestive heart failure. We sought to create and pilot test such a program for patients with low literacy skills. METHODS: We used focus groups and individual cognitive response interviews (CRIs) to develop an educational booklet for low literacy patients with heart failure. We incorporated the booklet into a disease management intervention that also included an initial individualized 1-h educational session and scheduled supportive phone calls that were tapered over 6 weeks. We then conducted a 3-month before-after study on patients with low literacy skills (<9th grade literacy level) in a university internal medicine clinic to test the acceptability and efficacy of our program. Outcomes of interest included heart failure-related knowledge, self-care behavior and heart failure-related symptoms measured on the Minnesota Living with Heart Failure (MLwHF) scale. RESULTS: Twenty-five patients were enrolled and 23 (92%) completed 3-month follow-up. Mean age was 60 years (range 35-74), 60% were men, 60% were African-American, and 74% had household income under $15,000 per year. The median reading level was fifth grade with 32% reading at or below the third grade level. Mean knowledge score at baseline was 67% and did not improve after the intervention. The proportion of patients reporting weighing themselves daily increased from 32% at baseline to 100% at 12 weeks. Mean improvement on the MLwHF scale was 9.9 points over the 3-month trial (95% CI: 0.5, 19.2), which corresponds to an improvement in one class on the New York Heart Association heart failure scale. CONCLUSION: A heart failure disease management program designed specifically for patients with low literacy skills is acceptable and is associated with improvement in self-care behavior and heart failure related symptoms. 相似文献
62.
Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis 总被引:10,自引:0,他引:10
BACKGROUND: Primary prevention of coronary heart disease is most appropriate for patients at relatively high risk. Measurement of coronary artery calcium has been proposed as a way to improve risk assessment, but it is unknown whether it adds predictive information to standard risk factor assessment. METHODS: We systematically searched electronic databases for relevant articles published between January 1, 1980, and March 19, 2003, and hand searched bibliographies. We included studies that reported measuring the coronary artery calcium score by electron beam computed tomography in asymptomatic subjects and subsequent follow-up of those patients for coronary events and that presented score-specific relative risks, adjusted for established risk factors. Two abstractors verified inclusion criteria and abstracted data from each study. We estimated adjusted relative risks associated with 3 standard categories of coronary artery calcium scores (1-100, 101-400, and >400), compared with a score of 0, and used a random-effects model for meta-analysis. RESULTS: Meta-analysis of the 4 studies meeting inclusion criteria yielded a summary adjusted relative risk of 2.1 (95% confidence interval, 1.6-2.9) for a coronary artery calcium score of 1 to 100. Relative risk estimates for higher calcium scores were higher, ranging from 3.0 to 17.0 but varied significantly among studies. Subgroup analyses suggested that differences among studies in outcome adjudication (blinded or not), measurement of other risk factors (direct or by patient history), tomographic slice thickness (3 or 6 mm), and/or proportion of female study subjects may account for this heterogeneity. CONCLUSION: The coronary artery calcium score is an independent predictor of coronary heart disease events. 相似文献
63.
Darren A DeWalt Robert M Malone Mary E Bryant Margaret C Kosnar Kelly E Corr Russell L Rothman Carla A Sueta Michael P Pignone 《BMC health services research》2006,6(1):30
Background
Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care. 相似文献64.
Cinzia Fatini Lucia Mannini Elena Sticchi Veronica Rogai Serena Guiducci Maria Letizia Conforti Marina Cinelli Alberto Moggi Pignone Paola Bolli Rosanna Abbate Marco Matucci Cerinic 《Arthritis \u0026amp; Rheumatology》2006,54(7):2263-2270
Objective
Microvascular disorders are relevant in systemic sclerosis (SSc). Hyperviscosity, due to alterations of blood cells and plasma components, may play a role in the pathogenesis of microcirculatory disorders. An impaired availability of nitric oxide, related to polymorphisms in NOS3, the gene for endothelial cell nitric oxide synthase, might influence erythrocyte deformability. We undertook this study to investigate the hemorheologic profile in SSc and the role of NOS3 polymorphisms in modulating the hemorheologic status of SSc patients.Methods
We studied 113 consecutive SSc patients (75 with limited cutaneous SSc [lcSSc] and 38 with diffuse cutaneous SSc [dcSSc]) and 113 healthy controls. The hemorheologic profile was obtained by assessing whole blood viscosity (WBV; at shear rates of 0.512 and 94.5 seconds−1), plasma viscosity (PLV; at a shear rate of 94.5 seconds−1), and erythrocyte deformability index (DI). We determined NOS3 polymorphisms by molecular analysis.Results
A marked alteration of hemorheologic parameters was found both in patients with lcSSc and in those with dcSSc compared with controls (P < 0.0001). In multivariate analysis, rheologic variables were significantly associated with the disease (for WBV at a shear rate of 94.5 seconds−1, odds ratio [OR] 5.4, 95% confidence interval [95% CI] 1.4–19.9, P = 0.01; for PLV, OR 2.8, 95% CI 1.2–6.5, P = 0.01; for DI, OR 3.9, 95% CI 1.4–10.8, P = 0.007), and NOS3 −786C and 894T alleles significantly affected the DI (for −786C allele, OR 2.3, 95% CI 1.01–5.4, P = 0.04; for 894T allele, OR 2.2, 95% CI 1.01–4.8, P = 0.04). The simultaneous presence of the −786C and 894T alleles represented a susceptibility factor for SSc (OR 2.8, 95% CI 1.4–5.7, P = 0.004).Conclusion
Our findings document an altered rheologic profile in SSc and demonstrate a relationship between this alteration and NOS3 polymorphisms, thus shedding light on a potential novel mechanism influencing the microcirculation in this disease.65.
Jia‐Rong Wu PhD RN Darren A DeWalt MD MPH David W Baker MD MPH Dean Schillinger MD Bernice Ruo MD MAS Kristen Bibbins‐Domingo MD PhD Aurelia Macabasco‐O'Connell PhD RN George M Holmes PhD Kimberly A Broucksou MSW MPA Brian Erman MSPharm Victoria Hawk MPH Crystal W Cene MD MPH Christine DeLong Jones MD MS Michael Pignone MD MPH 《Journal of clinical nursing》2014,23(17-18):2554-2564
66.
Bertinotti L Bracci S Nacci F Colangelo N Del Rosso A Casale R Pignone A Matucci-Cerinic M 《Clinical rheumatology》2004,23(1):1-5
The autonomic nervous system is an underestimated target of systemic sclerosis alterations. In this review we analyzed the major manifestations of its involvement, reconsidering the main theories of its pathogenesis.Abbreviations ANS
Autonomic nervous system
- BP
blood pressure
- BPD
Basal papillary diameter
- HR
Heart rate
- HRV
Heart rate variability
- MCTD
Mixed connective tissue disease
- PNS
Peripheral nervous system
- POAG
Primary open-angle glaucoma
- PCAG
Primary closed-angle glaucoma
- SSc
Systemic sclerosis
- SSR
Sympathetic skin response 相似文献
67.
68.
Pignone M Sheridan SL Lee YZ Kuo J Phillips C Mulrow C Zeiger R 《Preventive cardiology》2004,7(1):26-33
Heart to Heart is a computer-based decision aid for patients and providers that provides personalized, evidence-based information about coronary heart disease (CHD) risk and potential risk-reducing interventions. To develop Heart to Heart, the authors used Framingham risk equations and systematic reviews of risk-reducing interventions. The Web version was programmed using PHP: Hypertext Processor, a Web-based programming language, and has separate interfaces for providers and patients. The authors subsequently developed a modified version for personal digital assistants. Heart to Heart uses information about a patient's CHD risk factors (age, gender, total and high-density lipoprotein cholesterol levels, diabetes, smoking, systolic blood pressure, and left ventricular hypertrophy) to calculate risk of total CHD events over 5 or 10 years. Patients and providers can then examine the effect of introducing one or more risk-reducing interventions (aspirin, lipid-lowering drug therapy, antihypertensive medication, or smoking cessation) on the patient's CHD risk. Future research will be directed to determining whether Heart to Heart can improve utilization of effective CHD risk-reducing interventions. 相似文献
69.
Jones CD Holmes GM Dewalt DA Erman B Broucksou K Hawk V Cene CW Wu JR Pignone M 《Journal of cardiac failure》2012,18(7):576-584
BackgroundHeart failure (HF) self-care interventions can improve outcomes, but less than optimal adherence may limit their effectiveness. We evaluated if adherence to weight monitoring and diuretic self-adjustment was associated with HF-related emergency department (ED) visits or hospitalizations.Methods and ResultsWe performed a case-control analysis nested in a HF self-care randomized trial. Participants received HF self-care training, including weight monitoring and diuretic self-adjustment, which they were to record in a diary. We defined case time periods as HF-related ED visits or hospitalizations in the 7 preceding days; control time periods were defined as 7-day periods free of ED visits and hospitalizations. We used logistic regression to compare weight monitoring and diuretic self-adjustment adherence in case and control time periods, adjusted for demographic and clinical covariates. Among 303 participants, we identified 81 HF-related ED visits or hospitalizations (cases) in 54 patients over 1 year of follow-up. Weight monitoring adherence (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.23–0.76) and diuretic self-adjustment adherence (OR 0.44, 95% CI 0.19–0.98) were both associated with lower adjusted odds of HF-related ED visits or hospitalizations.ConclusionsAdherence to weight monitoring and diuretic self-adjustment was associated with lower odds of HF-related ED visits or hospitalizations. Adherence to these activities may reduce HF-related morbidity. 相似文献
70.
G Partsch M Matucci-Cerinic S Marabini S Jantsch A Pignone M Cagnoni 《Scandinavian journal of rheumatology》1991,20(2):98-103
The synthesis and release of collagenase in the presence of the neuropeptide substance P (SP) and capsaicin, were investigated in vitro using identical synoviocyte cultures from patients with rheumatoid arthritis (RA). On average 10(-12) M SP augmented statistically significantly the collagenase production by approximately a factor of five. An increase in the concentrations up to 10(-6) M SP resulted in a decreased collagenase synthesis, which, however, was still above the level of that of the untreated synoviocytes. Capsaicin, a homovanillic acid derivative that acts as a releaser of SP from primary afferent neurons, caused a strong stimulation of collagenase production and release at 10(-8) and 10(-6) M (about 7 times the amount of the control). With increasing concentrations up to 10(-3) M capsaicin this effect diminished continuously. The experiments clearly show that in RA synoviocytes in vitro SP and capsaicin in low concentrations act as potent inducers of the synthesis and release of collagenase. 相似文献