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Noninvasive revascularization by enhanced external counterpulsation: A case study and literature review

MAYO CLINIC PROCEEDINGS 2000年第9期75卷 961-965页

作者： Singh, M Holmes, DR Tajik, AJ Barsness, GW Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA

Nearly 8 million people in the United States suffer from symptoms of coronary artery disease (CAD). Unfortunately, the population of patients with ischemic coronary disease that is not readily amenable to surgical or percutaneous revascularization continues to grow. For patients tr ho are not candidates for standard revascularization procedures and in whom aggressive medical therapy fails to control symptoms, enhanced external counterpulsation (EECP) is a new, noninvasive outpatient method to improve quality of life by decreasing ischemic symptoms and permit increased activity, We report the case of a 56-year-old woman with severe, symptomatic CAD receiving maximal medical therapy who underwent a course of EECP therapy because she was not a good candidate for other forms of revascularization, She demonstrated dramatic improvement in her anginal symptoms and complete resolution of myocardial ischemia on repeat nuclear stress imaging, This case suggests that EECP is a safe and effective method for reducing symptoms of myocardial ischemia in patients for whom standard percutaneous or surgical revascularization is not suitable treatment.

关键词：日常生活活动门诊医疗/方法冠心病/诊断冠心病/心理学反搏动术/方法运动试验心肌血管重建术/方法病人遴选生活质量治疗结果女(雌)性人类中年人

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Influence of a specialized leg ulcer service on management and outcome

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BRITISH JOURNAL OF SURGERY 2000年第8期87卷 1048-1056页

作者： Ghauri, ASK Taylor, MC Deacon, JE Whyman, MR Earnshaw, JJ Heather, BP Poskitt, KR Cheltenham Gen Hosp Gloucestershire Vasc Grp Cheltenham GL53 7AN Glos England Gloucestershire Royal Hosp Gloucester GL1 3NN England

Background: The organization of leg ulcer care is poorly defined in the community. This study assessed the overall influence of a specialized community service on management and outcome of chronic leg ulcers, irrespective of aetiology. Methods: Assessment and outcome of ulcers were compared in patient samples (n = 200) from East and West Gloucestershire, before and after the introduction of specialized clinics into East Gloucestershire, In clinics, vascular disease was routinely assessed by duplex scanning and determination of the ankle:brachial pressure index. Results: There was no coordinated community structure for the care of patients with leg ulcers before the service was introduced, and 74 and 67 per cent of limbs in East and West Gloucestershire respectively had aetiology undiagnosed. After introduction of the clinics, the 12-week healing rate increased from 12 to 22 per cent in East Gloucestershire (P = 0.05) and to 47 per cent in the specialized East Gloucestershire clinics (P < 0.001). The 12-month recurrence rate decreased from 50 to 41 per cent in East Gloucestershire and to 17 per cent in the East clinics (P < 0.001). The West Gloucestershire control showed no significant changes. Conclusion: A specialized leg ulcer service with defined protocols provides an improved management structure for treating patients with leg ulcers in the community. Accurate diagnosis of chronic leg ulcers and improved outcome may be achieved within this specialized service.

关键词：门诊医疗/方法门诊医疗/组织和管理社区卫生服务/组织和管理卫生保健提供英格兰腿溃疡/病因学腿溃疡/治疗医学审核前瞻性研究复发治疗结果人类

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Long-term effects of one year of intensified pediatric activities on foot-care knowledge and self-care habits in patients with diabetes

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DIABETES EDUCATOR 1998年第6期24卷 734-740页

作者： Hämäläinen, H Rönnemaa, T Toikka, T Liukkonen, I Social Insurance Inst Ctr Res & Dev FIN-20720 Turku Finland

The purpose of this study was to evaluate the effectiveness of the activities of a podiatrist in the outpatient foot care of patients with diabetes. Patients from southwestern Finland, ages 10 to 80 years, were selected from the national diabetes register. Those without a recent visit to a podiatrist and without any obvious need for foot care (n = 530) were randomized into a pediatric care group (individual counseling and primary prevention measures, n = 267) and a control group (written instructions only, n = 263). Knowledge of foot care and self-care habits were evaluated by means of structured interviews, and a podiatric examination was performed at baseline and 1 and 7 years later. Compared with the baseline scores, the knowledge score was higher at the 7-year follow-up in both the podiatric and control group and similarly in men and women. Self-care score increased in men similarly in both treatment groups. The self-care score for women increased more in the podiatric group during the first year and the difference between the groups remained for lip to 7 years. There were no significant differences between the groups in the pediatric findings.

关键词：门诊医疗/方法糖尿病足/预防和控制教育考核随访研究健康知识态度实践病人教育(主题)/方法足医术/方法自我护理/方法皮肤保护/方法青少年成年人老年人老年人 80以上儿童女(雌)性人类男(雄)性中年人

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Standardisation of ambulatory urodynamic monitoring:: Report of the Standardisation Sub-Committee of the International Continence Society for Ambulatory Urodynamic Studies

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NEUROUROLOGY AND URODYNAMICS 2000年第2期19卷 113-125页

作者： van Doorn, EV Anders, K Khullar, V Kulseng-Hanssen, S Pesce, F Robertson, A Rosario, D Schäfer, W Univ Hosp Maastricht Dept Urol NL-6202 AZ Maastricht Netherlands

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Comparing outpatient and inpatient diabetes education for newly diagnosed pediatric patients

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DIABETES EDUCATOR 1999年第6期25卷 895-906页

作者： Siminerio, LM Charron-Prochownik, D Banion, C Schreiner, B Childrens Hosp Pittsburgh Dept Pediat Endocrinol Pittsburgh PA 15213 USA

PURPOSE The purpose of this study was to compare the efficacy of outpatient vs inpatient programs on medical, cognitive, behavioral, and psychosocial outcomes. METHODS Using three large, tertiary medical centers in the United States, the sample of 32 children newly diagnosed with diabetes and their parents were recruited. Children and parents who received outpatient education were compared with those who received inpatient education. The following outcome variables were compared: (1) rates of hospital readmissions and/or emergency room visits for either severe hypoglycemia or Ketoacidosis, (2) knowledge, (3) sharing of responsibilities, (4) adherence, (5) family functioning, (6) coping, and (7) quality of life. RESULTS In general, no statistically significant differences were found between the groups. A trend was noted in the outpatient group with regard to improved use of emergency precautions on the adherence measure, roles on the family functioning measure, maintaining family integration on the parental coping measure, and disposition on the children's coping instrument. CONCLUSIONS Findings support the safety and efficacy of the outpatient program method.

关键词：门诊医疗/方法糖尿病 1型/并发症糖尿病 1型/心理学糖尿病 1型/治疗急诊室医院/利用住院病人/教育结果评价(卫生保健) 双亲/教育双亲/心理学病人教育(主题)/方法病人再入院/统计学和数值数据方案评价青少年儿童女(雌)性人类男(雄)性

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The limerick leg-ulcer project: Early results

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IRISH JOURNAL OF MEDICAL SCIENCE 1999年第1期168卷 17-20页

作者： Castineira, F Fisher, H Coleman, D Grace, PA Burke, P St Johns Hosp Dept Surg Limerick Ireland

Nurse led clinics in joint hospital and community settings are now being advocated as the most effective and economic way of dealing with leg ulcers, However little information exists on the profile and outcome of patients with venous ulcers treated either in the community or in the hospital setting, Over a 2 yr period we assessed 134 patients with leg ulcers of whom 122 were deemed suitable for compression bandaging therapy. Thirty-four patients (28 per cent) were treated by the newly developed community service and 88 (72 per cent) were treated at the hospital clinic. Our overall healing rate for venous ulcers was 50 per cent @ 40 weeks. This probably reflects the long duration (48 per cent > 2 yr) and large size (0.5-608 cm(2)) of ulcer prior to treatment. There were no differences in outcome between hospital (50 per cent @ 40 weeks) and community (35 per cent @ 40 weeks) based treatment (p>0.05). We conclude that most venous ulcers can be effectively treated in the community and resources should be provided to achieve this goal.

关键词：门诊医疗/方法巴尔的摩社区保健护理/组织和管理评价研究(主题) 随访研究腿溃疡/诊断腿溃疡/护理腿溃疡/治疗复发治疗结果伤口愈合成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months' duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery - Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine

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INTERNATIONAL ORTHOPAEDICS 1999年第2期23卷 73-81页

作者： Griffiths, DL Seddon, H Ball, PJ Darbyshire, J Fox, W Kemp, HBS Konstam, PG Mitchison, DA Scadding, JG Stott, H Sutherland, I Tall, R Thomas, PK Walker, G Mortimer Market Ctr MRC Clin Trials Unit London WC1E 6AU England

The five-year assessment of three randomised trials of short course (6, 9 or 18 months) chemotherapy for tuberculosis of the spine is reported. In Hong Kong patients were randomised to isoniazid plus rifampicin (HR) daily for 6 or 9 months, combined with radical surgical resection with bone grafting and streptomycin for 6 months for all patients. In Madras patients were randomised to chemotherapy with HR for 6 or 9 months, or 6 months HR chemotherapy combined with surgical resection. In Korea all patients were ambulatory and were randomised to different regimens of chemotherapy 6 or 9 months HR, or 9 or 18 months isoniazid plus ethambutol (EH) or isoniazid plus PAS (PH). In all, centres the re suits of the 6- and 9-month regimens of HR were excellent and similar to the 18-month EH and PH regimens. The 9-month EH/PH regimens were clearly inferior. In Hong Kong excellent results were achieved by the radical resection. The disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Efforts should be concentrated on ensuring that appropriate regimens are given under adequate supervision.

关键词：门诊医疗/方法氨基水杨酸/治疗应用抗结核药/治疗应用骨移植综合疗法药物疗法联合乙胺丁醇/治疗应用异烟肼/治疗应用截骨术/方法放射摄影术利福平/治疗应用链霉素/治疗应用时间因素治疗结果结核脊柱/诊断显像结核脊柱/药物疗法结核脊柱/外科学青少年成年人儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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A randomised controlled pilot study of the management of gestational impaired glucose tolerance

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2000年第8期107卷 959-963页

作者： Bancroft, K Tuffnell, DJ Mason, GC Rogerson, LJ Mansfield, M Gen Infirm Fetomat Med Unit Leeds LS1 3EX W Yorkshire England Bradford Royal Infirm Dept Obstet Bradford BD9 6RJ W Yorkshire England Univ Leeds Unit Mol Vasc Med Leeds LS2 9JT W Yorkshire England

Objective To determine whether a study of a less intensive form of management for impaired glucose tolerance in pregnancy is feasible and whether women would accept randomisation. Design Prospective randomised controlled study. Setting A large district general hospital and a large teaching hospital in West Yorkshire. Sample Seventy women with impaired glucose tolerance in pregnancy. Methods One group monitored plasma glucose up to four times daily. The other group did not monitor plasma glucose at all. Main outcome measures The number of women recruited of those approached and neonatal admissions to special care baby units in each group. Results Sixty-eight of 70 women approached entered the study. There were no statistically significant differences between the groups in neonatal outcome measures. The median number of plasma glucose measurements in the monitored group was 118 (range 0-500), and 19% of women in the monitored group were treated with insulin. Conclusions This study fails to demonstrate any benefit from intensive management of impaired glucose tolerance in pregnancy with additional maternal inconvenience. This pilot study has shown that a large randomised controlled study of the management of impaired glucose tolerance in pregnancy is not only feasible but necessary.

关键词：门诊医疗/方法血糖/代谢英格兰/流行病学葡糖耐受不良/代谢葡糖耐受不良/治疗试点项目妊娠并发症/代谢妊娠并发症/治疗治疗结果成年人女(雌)性人类妊娠

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Outpatient-based ifosfamide, carboplatin and etoposide (ICE) chemotherapy in transplant-eligible patients with non-Hodgkin's lymphoma and Hodgkin's disease

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ANNALS OF ONCOLOGY 2003年第Sup1期14卷 11-16页

作者： Hertzberg, MS Crombie, C Benson, W Taper, J Gottlieb, D Bradstock, KF Westmead Hosp Dept Haematol Westmead NSW 2145 Australia Nepean Hosp Canc Care Ctr Penrith NSW Australia

We have treated 38 transplant-eligible patients with relapsed/refractory non-Hodgkin's lymphoma and Hod kin's disease using an outpatient-based regimen of ifosfamide, carboplatin and etoposide (ICE) for both salvage and peripheral blood stem cell mobilisation. Patients included relapsed or refractory diffuse large B-cell lymphoma (n = 17), follicular lymphoma (n = 11), T-cell lymphoma (n = 2), mantle cell lymphoma (n = 2) and Hodgkin's disease (n = 6). Seven patients with diffuse large B-cell lymphoma and three patients with follicular lymphoma (26%) were considered chemorefractory. Cycles of ICE therapy were administered every 21 days as an outpatient and consisted of ifosfamide 5000 mg/m(2) intravenously (i.v.) fractionated into three equally divided doses over 3 days, carboplatin [mg dose = 5 x area under the curve (AUC)] i.v. on day 1 and etoposide 100 mg/m(2) i.v. daily for 3 days. Subsequently, granulocyte colony-stimulating factor (G-CSF) 5 mug/kg subcutaneously (s.c.) was administered daily from day +5. Of the 11 follicular lymphoma patients, 10 also received rituximab with ICE therapy. Median age of patients was 52 years (range 30-65). Patients received a mean of 2.6 cycles (range 1-4) of ICE. There were no toxic deaths and no significant non-haematological toxicities secondary to ICE therapy. Grade IV thrombocytopenia and grade IV neutropenia with at least one cycle of ICE were seen in 47% and 53% of patients, respectively. Median time to peripheral blood stem cell (PBSC) harvest was 14 days (range 10-20), while the median CD34+ cell yield was 5.2 x 10(6) cells/kg (range 2.3 x 10(6)-27.2 x 10(6)). Only one of the ICE-responders failed to mobilise PBSCs. The overall response rate to ICE was 87%, comprising 14 patients (37%) who achieved a complete response (CR) and 19 (50%) who achieved a partial response (PR). A total of 30 patients have undergone autologous stem cell transplantation (SCT) while two follicular lymphoma patients have received a non-myeloabl

关键词：门诊医疗/方法抗肿瘤联合化疗方案/投药和剂量抗肿瘤联合化疗方案/治疗应用卡铂/投药和剂量依托泊甙/投药和剂量随访研究霍奇金病/药物疗法霍奇金病/死亡率霍奇金病/外科学异环磷酰胺/投药和剂量淋巴瘤非霍奇金/药物疗法淋巴瘤非霍奇金/死亡率淋巴瘤非霍奇金/外科学干细胞移植/方法存活率成年人老年人女(雌)性人类男(雄)性中年人

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Paracervical anaesthesia in outpatient hysteroscopy: a randomised double-blind placebo-controlled trial

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999年第4期106卷 356-359页

作者： Lau, WC Lo, WK Tam, WH Yuen, PM Chinese Univ Hong Kong Prince Wales Hosp Dept Obstet & Gynaecol Hong Kong Peoples R China

Objective To evaluate the efficacy and safety of paracervical anaesthesia in reducing pain during outpatient hysteroscopy and endometrial biopsy Design Prospective, randomised, placebo-controlled, double-blind study. Population One hundred women undergoing outpatient hysteroscopy and endometrial biopsy for abnormal. uterine bleeding. Interventions Paracervical block using 10 mL of either 2% Lignocaine or normal saline before the procedure. Main outcome measures Evaluation of pain at different stages of hysteroscopy using a visual analogue scale together with blood pressure and heart race monitoring. Results Compared with placebo, paracervical anaesthesia significantly reduced the pain only at the time of insertion of the hysteroscope, but not at the subsequent stages of the procedure. However, paracervical injection of lignocaine resulted in a higher incidence of bradycardia and hypotension. Conclusions Paracervical anaesthesia not only fails to reduce pain during outpatient hysteroscopy and endometrial biopsy, but also carries a risk of inducing bradycardia and hypotension, which is probably a result of Inadvertent intravascular injection.

关键词：门诊医疗/方法麻醉局部/方法麻醉药局部/药理学活组织检查血压/药物作用子宫颈双盲法心率/药物作用宫腔镜检查利多卡因/药理学疼痛测定子宫出血/诊断成年人女(雌)性人类中年人

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