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981.
Attila Nagy Nóra Kovács Anita Pálinkás Valéria Sipos Ferenc Vincze Gergő Szőllősi Orsolya Csenteri Róza Ádány János Sándor 《Primary Care Diabetes》2018,12(3):199-211
Aims
The study aimed to launch a T2DM adult cohort that is representative of Hungary through a cross-sectional study, to produce the most important quality indicators for T2DM care, to describe social inequalities, and to estimate the absolute number of T2DM adult patients with uncontrolled HbA1c levels in Hungary.Methods
A representative sample of the Hungarian T2DM adults (N = 1280) was selected in 2016. GPs collected data on socio-demographic status by questionnaire, and on history and laboratory parameters from medical records. The process and outcome indicators used in the international monitoring practice were calculated. The socio-economic status influence was determined by multivariate logistic regression models.Results
Target achievement was 61.66%, 53.48%, and 54.00% for HbA1c, LDL-C, and blood pressure, respectively, in the studied sample (N = 1176). In Hungary, 294,534 patients have above target HbA1c value out of 495,801 T2DM adults. The education-dependent positive association with majority of process indicators was not reflected in HbA1c, LDL-C, and blood pressure target achievements. The risk of microvascular complications and requirement of insulin treatment were higher among less educated.Conclusions
According to our observations, the education-independent target achievement for HbA1c and LDL-C is similar as, for blood pressure is less effective in Hungary than in Europe. 相似文献982.
BACKGROUND: Some studies have suggested that use of long-acting beta(2)-agonists (LABAs) leads to an increased risk for adverse events in patients with stable COPD. The purpose of this review was to assess the safety, and secondarily the efficacy of LABAs. METHODS: The authors conducted a systematic review with metaanalysis of randomized clinical trials (> or = 1 month in duration) in the published literature that have compared LABAs with placebo or anticholinergics in stable poorly reversible and reversible COPD. RESULTS: MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched to identify 27 studies. LABAs reduced severe exacerbations compared with placebo (relative risk [RR], 0.78; 95% confidence interval [CI], 0.67 to 0.91). There was no significant difference between LABA and placebo groups in terms of respiratory deaths (RR, 1.09; 95% CI, 0.45 to 2.64). Use of LABAs with inhaled corticosteroids reduced the risk of respiratory death compared with LABAs alone (RR, 0.35; 95% CI, 0.14 to 0.93). Patients receiving LABAs showed significant benefits in airflow limitation measures, health-related quality of life, and use of rescue medication. Finally, tiotropium decreased the incidence of severe COPD exacerbations compared with LABAs (RR, 0.52; 95% CI, 0.31 to 0.87). CONCLUSION: This review supports the beneficial effects of the use of LABAs in patients with stable moderate-to-severe COPD, and did not confirm previous data about an increased risk for respiratory deaths. Also, our analysis suggests the superiority of tiotropium over LABAs for the treatment of stable COPD patients. 相似文献
983.
介入可控性兔颈动脉狭窄导致早期脑缺血动物模型的建立 总被引:1,自引:0,他引:1
目的建立能直接观察到颈动脉狭窄对全脑缺血、缺氧的可控性全脑缺血兔实验模型;此模型可进一步开展顼动脉狭窄导致老年脑缺血后相应的形态学、机能代谢学、药物学、临床治疗学等方面的研究。方法通过介入手段。把自制圆柱中空模型输送到兔颈动脉以达到颈动脉理想的狭窄程度,再通过1.5T MRI弥散成像证实颈动脉狭窄后脑缺血的存在。结果能直接观察不同颈动脉狭窄程度对全脑缺血的影响程度。结论本横型克服了以往脑缺血模型建立均为选择性全血管栓塞或血管外致闭塞,耐受缺血时间短。不能直接观察到脑缺血各种状态下的反应,不便于开展药物学、临床治疗学方面的研究等不足,为更深入广泛地进行颈动脉狭窄导致老年脑缺血方面的研究打下了基础。 相似文献
984.
Background
China has been sending medical teams to Africa since 1963. Chinese Medical Teams (CMT) are currently working in 42 African countries, constituting a large component of Chinese health aid. Mali has been receiving teams on a continuous basis since 1968. From 2011 the team in Mali has been based in the Mali Hospital in Bamako. This hospital was built with Chinese Government aid. The aim of this study was to observe how the CMT functioned, how their role was perceived, and to assess their utility for the hospital and its patients.Methods
The study was carried out from January to March 2018. In-depth interviews were carried out with 12 Malian doctors and 12 nurses, all the members of the CMT (except support staff), as well as four key stakeholders and ten patients. Interviews explored views about the role of the Chinese team in the hospital, the pros and cons of the collaboration, and suggestions for improvement. CMT members were also asked about their motivation to work in Mali and how they managed the lifestyle. All interviews were carried out in private areas within the hospital. We recorded ethnographic observations of the hospital with a focus on relationships between Malian and Chinese staff, and general standards of care.Findings
At the time of the study the CMT had 25 members, 18 doctors and technicians, plus support staff (cooks, translators), all living in the hospital grounds. Most of the CMT members interviewed identified similar problems, which included: lack of agreed objectives for the team members (in particular their roles as teachers or members of staff), the language barrier between Malian and Chinese staff, difficulty attracting team members, lack of representation of the CMT on the hospital management committee, and very limited social engagement between Chinese and Malian staff. However, the Malian doctors and key stakeholders viewed the CMT as a very positive presence, improving overall clinical standards and ensuring the hospital's reputation as among the best public hospitals in the country.Interpretation
Our findings indicate that there needs to be a formal evaluation of the CMT programme in Mali and in other countries in Africa, to maximise utility and meet contemporary needs. This is especially relevant as the Chinese Government embarks on including global health as part of the Belt and Road initiative.Funding
Global Health Centre of Zhejiang University. 相似文献985.
986.
《Archives of physical medicine and rehabilitation》2014,95(12):2304-2311
ObjectivesTo determine the responsiveness of the Function In Sitting Test (FIST), compare scores at admission and discharge from inpatient rehabilitation (IPR) with other balance and function measures, and determine the minimal clinically important difference (MCID).DesignProspective, nonblinded, reference-standard comparison study.SettingFour accredited inpatient rehabilitation units.ParticipantsPopulation-based sample of adults (N=125) with sitting balance dysfunction, excluding persons with spinal cord injury, significant bracing/orthotics, and inability to perform testing safely.InterventionsNot applicable.Main Outcome MeasuresFIST, FIM, and Berg Balance Scale (BBS) at admission and discharge, and Global Rating of Change for function and balance at discharge.ResultsThe FIST demonstrated good to excellent concurrent validity with the BBS and FIM at admission and discharge (Spearman ρ=.71–.85). Significant improvement (P<.000; 95% confidence interval [CI], 10.73–15.41) occurred in the FIST from admission (mean ± SD: 36.81±15.53) to discharge (mean ± SD: 49.88±6.90). The standard error of measurement for the FIST was 1.40, resulting in a minimal detectable change of 5.5 points. The receiver operator characteristic curve differentiated participants with meaningful balance changes (area under the curve, .78; P>.000; 95% CI, .66–.91), with a change in FIST score of ≥6.5 points designating the MCID. Findings support the strong responsiveness of the FIST during IPR as evidenced by the large effect size (.83), standardized response mean (1.04), and index of responsiveness (1.07).ConclusionsIn this study, the FIST correlated well with balance and function measures (concurrent validity) and was responsive to change during IPR. A clinically meaningful change was indicated by an increase in score of ≥6.5 points. 相似文献
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