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Carmel Moore Niall F. Davis John P. Burke Richard Power Ponnusamy Mohan David Hickey Gordon Smyth Molly Eng Dilly M. Little 《Transplant international》2014,27(9):926-930
Renal transplant recipients are at an increased risk of developing Methicillin‐resistant Staphylococcus aureus due to their immunosuppressed status. Herein, we investigate the incidence of MRSA infection in patients undergoing renal transplantation and determine the effect of MRSA colonisation on renal allograft function and overall mortality. Between January 1st 2007 and December 31st 2012, 1499 consecutive kidney transplants performed in our transplant unit and a retrospective 1:2 matched case‐control study was performed on this patient cohort. The 1‐, 3‐ and 5‐year overall graft survival rates were 100%, 86% and 78%, respectively, in MRSA positive recipients compared with 100%, 100% and 93%, respectively, in the control group (P < 0.05). The 1‐, 3‐ and 5‐year overall patient survival rates were 100%, 97% and 79%, respectively, in MRSA positive recipients compared with 100%, 100% and 95%, respectively, in the control group (P = 0.1). In a multiple logistic regression analysis, colonisation with MRSA pre‐operatively was an independent predictor for renal allograft failure at 5 years (hazard ratio: 4.6, 95% confidence interval: 1–30.7, P = 0.048). These findings demonstrate that the incidence of long‐term renal allograft failure is significantly greater in this patient cohort compared with a matched control population. 相似文献
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Alessio Coi Michele Santoro Ester Garne Anna Pierini Marie‐Claude Addor Jean‐Luc Alessandri Jorieke E. H. Bergman Fabrizio Bianchi Ljubica Boban Paula Braz Clara Cavero‐Carbonell Miriam Gatt Martin Haeusler Kari Klungsøyr Jennifer J. Kurinczuk Monica Lanzoni Nathalie Lelong Karen Luyt Olatz Mokoroa Carmel Mullaney Vera Nelen Amanda J. Neville Mary T. O'Mahony Isabelle Perthus Judith Rankin Anke Rissmann Florence Rouget Bruno Schaub David Tucker Diana Wellesley Katarzyna Wisniewska Nataliia Zymak‐Zakutnia Ingeborg Barišić 《American journal of medical genetics. Part A》2019,179(9):1791-1798
Achondroplasia is a rare genetic disorder resulting in short‐limb skeletal dysplasia. We present the largest European population‐based epidemiological study to date using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network. All cases of achondroplasia notified to 28 EUROCAT registries (1991–2015) were included in the study. Prevalence, birth outcomes, prenatal diagnosis, associated anomalies, and the impact of paternal and maternal age on de novo achondroplasia were presented. The study population consisted of 434 achondroplasia cases with a prevalence of 3.72 per 100,000 births (95%CIs: 3.14–4.39). There were 350 live births, 82 terminations of pregnancy after prenatal diagnosis, and two fetal deaths. The prenatal detection rate was significantly higher in recent years (71% in 2011–2015 vs. 36% in 1991–1995). Major associated congenital anomalies were present in 10% of cases. About 20% of cases were familial. After adjusting for maternal age, fathers >34 years had a significantly higher risk of having infants with de novo achondroplasia than younger fathers. Prevalence was stable over time, but regional differences were observed. All pregnancy outcomes were included in the prevalence estimate with 80.6% being live born. The study confirmed the increased risk for older fathers of having infants with de novo achondroplasia. 相似文献
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Jeffrey E. Catrambone Wenzhuan He Charles J. Prestigiacomo Tracy K. McIntosh Peter W. Carmel Allen Maniker 《European journal of trauma and emergency surgery》2008,34(4):397-409
Effective methods for treating cerebral edema have recently become a matter of both extensive research and significant debate
within the neurosurgery and trauma surgery communities. The pathophysiologic progression and outcome of different forms of
cerebral edema associated with traumatic brain injury have yet to be fully elucidated. There are heterogeneous factors influencing
the onset and progress of post-traumatic cerebral edema, including the magnitude and type of head injury, age, co-morbid conditions
of the patient, the critical window for therapeutic intervention and the presence of secondary insults including hypoxia,
hypotension, hypo/hyperthermia, degree of raised intracranial pressure (ICP), and disruption of blood brain barrier (BBB)
integrity. Although numerous studies have been designed to improve our understanding of the etiology of post-traumatic cerebral
edema, therapeutic interventions have traditionally been focused on minimizing secondary insults especially raised ICP and
improving cerebral perfusion pressure. More recently, fluid resuscitation strategies using hyperosmolar agents such as pentastarch
and hypertonic saline (HS) have achieved some success. HS treatment is of particular interest due to its apparent advantageous
action over other types of hyper-osmotic solutions in both clinical and laboratory studies. In this review, we provide a summary
of recent literature concerning the pathogenesis and mechanisms involved in the various types of cerebral edema, and the possible
mechanisms of action of HS for the treatment cerebral edema. 相似文献
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Joachim P. Sturmberg MD PhD Carmel M. Martin MD PhD Di O’Halloran MD 《Journal of evaluation in clinical practice》2010,16(3):409-414
Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns. Reflections Parks, like health services, are embedded in their local landscape, serving their communities, but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there. Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co‐constructed experience. Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co‐producers’ of their own health and ‘co‐shapers’ of their health services. 相似文献
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Carmel M. Martin MBBS MSc PhD FRACGP Chris Peterson PhD 《Journal of evaluation in clinical practice》2009,15(3):578-585
Purpose The purpose of this paper is to argue the importance of contemporary analysis of the modern social construction of chronicity – encapsulating the world views of the chronically ill, and the medical and health system constructions of chronic disease, through the nature of care for chronic conditions. It is argued that chronic diseases are themselves, socially constructed, despite widely accepted disease classification systems. Thus, there is a need to examine how different ideas have permeated our clinical and health system developments and their social context and vice versa. Methods We examine historical ideas, theory and evidence about the tensions in social construction of chronic illness by those afflicted and the responses of society, the medical and health professions and increasingly the public and private institutions that shape health care. This is with the background of major differences in the two cultures that create knowledge: those based upon argument and intellectual logic – hermeneutic, and those based upon ‘objectivist’ empirical science, often called heuristic. Evidence‐based medicine (EBM) is the flagship of disease management, increasingly narrative‐based medicine and other similar genres are becoming the pragmatic face of social constructions, yet sit in juxtaposition without synthesis. A third culture has emerged of scientific intellectuals who straddle these cultures and in health care their public face is ‘mixed methods’. Findings Recent cases of modern ideas about improving chronic care were reviewed. We found that despite developments of social theory, the world view of the chronically ill exerts small influence in health system redesign, apparently dominated by chronic disease models. Confusion remains within health system reforms as to the social construction of chronicity – chronic disease, chronic condition or chronic illness and chronic care transformations. The role of Primary Care remains ambiguous straddling disease and illness. Radical redesign of health systems is taking place without an understanding and discourse about the nature of their construction. Ad hoc eclectism with unquestioning adoption of the dominant EBM paradigm is driving a new health culture based on disease‐based performance incentives, which is intrusive beyond the medical model and pays little attention to narratives of illness and even less to the whole social reconstruction of illness and wellness. Conclusions Health care systems cannot afford to avoid, and should actively embrace the critiques of social theory and analyses in the transformations of health systems to improve chronic care. Creative tensions between empirical and intellectual critique, and a synthetic middle ground are likely to lead to more realistic and innovative approaches spanning the nature of chronicity and the transformation of Primary Care. 相似文献