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81.
Graves' disease (GD) is an autoimmune chronic thyroiditis frequently associated with development of Graves' orbitopathy (GO) characterized by proptosis, strabismus, impairment of visual function, ocular surface inflammation and dry eye. As consequence, patients with GO experience impairment of quality of life and social function and could develop a neurobehavioral syndrome, ranging from anxious to depressive or psychotic disorders. To date, the pathogenic mechanism underlying neuropsychiatric disorders in patients with GD has not been clearly understood. In fact, the development of neuropsychiatric disorders in patients with GO has been associated with both the detrimental effects of the altered circulating thyroid hormones on the nervous system, and with the psychological discomfort caused by poor quality of life, reduced social interactions and relapsing course of the disease. This paper summarizes current evidence on neuropsychiatric abnormalities in Graves' disease focusing on its impact on QoL and psychosocial function. We remark the importance of a multidisciplinary approach and we emphasize the potential benefit of neuropsychiatric approach on disease perception, patient compliance to medical and/or surgical treatment and clinical outcomes.  相似文献   
82.
ObjectiveThe aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country.MethodsPatients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury.ResultsThirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns.ConclusionThe prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.  相似文献   
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BackgroundBilateral cervicofacial burn contracture initially affects facial expressions and later affects tempero mandibular joint (TMJ) function of the patient. It further tightens the ligaments and capsules around the TMJ and leads to tempero mandibular dysfunction. The consequences of temporomandibular joint dysfunction will be pain, limitation of mouth opening, functional disability and poor quality of life (Qol). However, studies examining the efficacy of Maitland joint mobilization technique in this population are lacking.ObjectivesTo find the short term effects of Maitland joint mobilization technique on pain, mouth opening, functional limitation, kinesiophobia, sleep quality and Quality of life in tempero mandibular joint dysfunction following bilateral cervicofacial burns.MethodsThirty subjects with temporomandibular joint dysfunction following cervicofacial burn (N = 30) were allocated to Maitland joint mobilization group (n = 15) and home based training group (n = 15) randomly to receive Maitland joint mobilization technique and home based training for 4 weeks. All the participants received ultrasound therapy as common treatment. Primary (Numeric Pain Rating Scale – NPRS, maximal mouth opening – MMO & Tempero mandibular disability index – TDI) and secondary (Tampa Scale of Kinesiophobia – TSK-17, Sleep quality questionnaire – SSQ & Global Rating of Change – GRC) outcome measures were measured at baseline, after four weeks and three months follow up. Repeated measures of ANOVA and independent t test were performed for analyzing the dependent variables in both groups.ResultsBaseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following different training protocols Maitland joint mobilization group shows more significant changes in pain intensity, mouth opening, functional limitation, kinesiophobia, sleep quality and Qol than home based training group (p  0.05). Also Maitland joint mobilization group show significant improvement in study variables than home based training group (p  0.05) at three months follow up.ConclusionBoth groups improved over time, however, differences between the groups were noticed small. However, physiotherapy management which includes Maitland joint mobilization technique and therapeutic exercise program has an effective strategy in the treatment of tempero mandibular joint dysfunction following cervicofacial burns.  相似文献   
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IntroductionQuality indicators (QIs) for breast cancer care have been developed and applied in high-income countries and contributed to improved quality of care and patient outcomes over time.Materials and methodsA modified Delphi process was used to derive expert consensus. Potential QIs were rated by a panel of 17 breast cancer experts from various subspecialties and across South African provinces. Each QI was rated according to importance to measure, scientific acceptability and feasibility. Scoring ranged from 1 (no agreement) to 5 (strong agreement). Inclusion thresholds were set a priori at mean ratings ≥4 with a coefficient variation of ≥25%. Levels of evidence were determined for each indicator.ResultsThe literature review identified 790 potential QIs. After categorisation and removal of duplicates, 52 remained for panel review. There was strong consensus for 47 which were merged to 30 QIs by exclusion of similar indicators and indicator grouping. The final set included eight QIs with level I or II evidence and two QIs with level III evidence which were deemed “mandatory” due to clinical priority and impact on care. The remaining QIs with lower-level evidence were grouped as eight “recommended” QIs (regarded as standard of care) and twelve “optional” QIs (not regarded as standard of care).ConclusionA regional set of QIs was developed to facilitate standardised treatment and auditing of surgical care for breast cancer patients in South Africa. Routine monitoring of the ten mandatory QIs, which were selected to have the most substantial impact on patient outcome, is proposed.  相似文献   
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88.
目的评价基于多学科团队协作的骶神经调节治疗神经源性膀胱患者全程管理方案的实践效果。 方法收集2018年1月至2019年12月中山大学孙逸仙纪念医院收治的36例神经源性膀胱行骶神经调节治疗患者的病例资料。将36例患者按入院时间分为对照组15例(2018年1~ 12月)和干预组21例(2019年1~12月)。对照组给予常规管理,干预组实施全程护理模式。比较两组骶神经调节二期手术转化率,两组患者一期术后3个月时膀胱功能管理效果、尿路感染发生率、患者满意度和生活质量的差异。 结果两组患者在骶神经调节二期手术转化率、平衡膀胱达标率、膀胱容量、患者满意度和生活质量的差异有统计学意义(P<0.05),干预组均高于对照组。 结论多学科团队协作的全程管理实现了骶神经调节治疗神经源性膀胱患者连续的全程化、个性化管理,协调多学科团队协作,改善了患者的临床疗效,提高了患者满意度,是一种有效的患者管理照护模式。  相似文献   
89.
目的:对比低位直肠癌根治术患者行括约肌间切除术(ISR)、人工肛门重建术后生活质量的差别。方法:对2015年1月至2019年6月70例低位直肠癌根治术患者进行EORTC的QLQ-C3O和QLQ-CR38问卷调查。其中42例患者行ISR(ISR组),28例患者行人工肛门重建(人工肛门重建组)。结果:QLQ-C30问卷结果显示,ISR组总体生活质量得分明显高于人工肛门重建组(73.41 vs 63.39,P=0.03);在社会功能方面,人工肛门重建组优于ISR组(78.57 vs 66.67,P=0.03);人工肛门重建组失眠、腹泻、疼痛、经济问题等出现概率较ISR组明显升高(P<0.05),而在其他功能、症状领域两组比较差异均无统计学意义(P>0.05)。QLQ-CR38相关领域内两组指标比较差异无统计学意义(P>0.05)。结论:对于低位直肠癌根治术患者,总体生活质量上ISR更优,社会功能方面人工肛门重建更佳。  相似文献   
90.
《Foot and Ankle Surgery》2022,28(6):714-719
Background(1) To evaluate patient-reported outcomes and revision surgeries after various operative interventions for osteochondral lesions of the talus (OLT) in a prospective single center series over 10 years, and (2) to identify predicting factors related to subjective ankle status and quality of life pre- and postoperatively.MethodsNinety-nine patients underwent operative treatment due to primary or recurrent OLT, with an average follow up 3.5 (1.8) years. Treatment outcome was followed clinically (FAOS, EQ-5D, Tegner activity scale) and by pursuing any serious adverse events or graft failures.ResultsThere were 80 responding patients (81%) for the study. The mean lesion size was 2.0 (1.1) cm2. All FAOS values increased from preoperative to final follow-up values (Symptoms 60–68, Pain 58–69, ADL 71–80, Sport 36–54, QoL 30–45). EQ-5D increased from 0.49 to 0.62, while Tegner activity scale change from 3.2 to 3.4. There were 19 (24%) serious adverse events recorded; 13 (16%) of them were graft-related. Graft survival rates were 100% at 1 year, 94% (males)/93% (females) at 2 years, and 77% (males)/47% (females) at 5 years. Female gender, higher BMI, and higher Kellgren-Lawrence ankle OA score were negative predictors for preoperative patient-reported ankle joint status. The foremost improvement after operative intervention was observed in patients with large osteochondral lesions without postoperative adverse events.ConclusionVarious operative interventions for OLT significantly improved patients’ ankle status and quality of life. High graft survival rates were demonstrated over first two years, but notable decline was confirmed thereafter, especially in female patients.  相似文献   
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