Current Issue : July - September Volume : 2014 Issue Number : 3 Articles : 8 Articles
Diabetes mellitus is most common health problem in elderly and may be associated with increased risk of functional dependency, malnutrition and depression. This study was an attempt to assess the nutritional vulnerability, functional status and depression in elderly people with and without diabetes mellitus. The sample of the study comprised of 60 elderly male subjects, 30 each in diabetic and non-diabetic group (>65 years). Anthropometric measurements included height, weight, body mass index (BMI), mid upper arm circumference (MUAC) and calf- circumference (CC).Waist circumference was measured only for non-diabetic subjects as a part of diabetes risk assessment tool. Twenty four hour dietary recall method was used for dietary assessment. Standardized tools i.e., mini nutritional assessment (MNA), activities of daily living (ADL) and instrumental activities of daily living (IADL) scales and geriatric depression scale (GDS) were used to collect information pertaining to nutritional status, functional status and depression respectively. On the basis of BMI, more diabetic subjects were in overweight category than their non- diabetic counterparts. Significant difference (p< 0.05) was found between protein and iron intake of diabetic and non- diabetic subjects. Two thirds of diabetic and non- diabetic subjects were found at risk of malnutrition. Diabetic subjects were more dependent on the basis of IADL than their non-diabetic counterparts, while independence was observed in all the subjects in terms of ADL. Significant difference (p< 0.05) was observed between GDS scores of diabetic and non- diabetic subjects. Thus all elderly subjects are nutritionally vulnerable whereas functional status decline and depression is more in diabetic elderly....
Background: Our aim was to evaluate electrocardiographic and\nechocardiographic properties and exercise response of patients with\nfibromyalgia (FM).\nMethods: The study included 60 women with primary FM and\n30 healthy individuals. Resting electrocardiography, echocardiography\nand exercise treadmill test were used to compare these two\ngroups. At apical four-chamber window, samples of transmitral\ndiastolic inflow and tissue Doppler imaging of left ventricle lateral\nwall were obtained. Left ventricle ejection fraction was measured\nvia modified Simpsonââ?¬â?¢s method. Exercise duration, maximal exercise\ncapacity, maximal heart rate (HR) (bpm), maximal HR (%),\nrate-pressure product at maximal HR (bpm Ã?â?? mmHg), heart rate\nrecovery 1 (bpm), heart rate recovery 2 (bpm) and chronotropic\nreserve (%) values were calculated.\nResults: Resting HR and QTc values were similar in both groups.\nEchocardiographic measurements in both groups did not reveal statistically\nsignificant difference except left ventricle end-diastolic diameter\nand left atrial diameter. Parameters related to diastolic function\nof the left ventricle did not differ significantly in both groups.\nAlso, there was not any significant difference between the groups\nfor E/Eââ?¬â?¢ ratio and chronotropic reserve. Exercise treadmill test results\nwere statistically similar for both groups....
Background: In this study, we aimed to determine knowledge levels\nregarding Crimean-Congo hemorrhagic fever (CCHF) among\nemergency healthcare workers (HCWs) in an endemic region.\nMethods: A questionnaire form consisting of questions about\nCCHF was applied to the participants.\nResults: The mean age was 29.6 �± 6.5 years (range 19 - 45). Fiftyfour\n(49.5%) participants were physicians, 39 (35.8%) were nurses\nand 16 (14.7%) were paramedics. All of the participants were aware\nof CCHF, and 48 (44%) of them had previously followed CCHF patients.\nRates of the use of protective equipment (masks and gloves)\nduring interventions for patients who were admitted to the emergency\nservice with active hemorrhage were 100% among paramedics,\n76.9% among nurses and 61.1% among physicians (P = 0.003).\nAmong 86 (78.9%) HCWs who believed that their knowledge regarding\nCCHF was adequate, 62 (56.9%) declared that they would\nprefer not to care for patients with CCHF (P = 0.608).\nConclusions: The use of techniques to prevent transmission of this\ndisease, including gloves, face masks, face visors and box coats,\nshould be explained to emergency room HCWs, and encouragement\nshould be provided for using these techniques....
The management of synchronous prostate and rectal cancer is a\nchalleging task for the general surgeons and urologists, due to the\ncomplex anatomy of the pelvis and the sequential significant effects\non the patient�s functional independency and quality of life. As both\nrectal and prostate cancers still remain leading causes of death in\nthe male population, along with the increase of the average life expectancy,\nit is certain that synchronous prostate and rectal cancer\nwill be a clinical scenario that the clinicians of the future will encounter\nmore frequently. Our aim is to perform a comprehensive\nreview on the management of this oncological entity, focusing on\nthe significance of multidisciplinary approach which will enable the\nformation of an accurate strategy plan, having at all times the patient\nin the center of desicion-making....
Background: Recruiting the desired number of research participants\nis frequently problematic with resulting financial and clinical\nimplications. The views of individuals responsible for participant\nrecruitment have not been previously reviewed. This systematic\nreview and thematic meta-synthesis explores researchersââ?¬â?¢ and cliniciansââ?¬â?¢\nexperiences and perceptions of recruiting participants to\nclinical research, with the aim of informing improved recruitment\nsystems and strategies.\nMethods: Studies published between January 1995 and May 2013\nwere identified from: Ovid MEDLINE, Ovid EMBASE, Ovid\nPSYCHINFO, ASSIA, British Nursing Index, Scopus, Web of Science,\nCINAHL and PubMed. Included studies were original peer\nreviewed research, with qualitative methodologies and an aim of\nexploring the views of clinicians and/or researchers on recruitment\nto clinical research. Studies discussing the recruitment of patients\nunable to give informed consent were excluded. The findings sections\nof the relevant studies were free coded to identify key concepts\nwhich were grouped into hierarchical themes. The quality of\nthe identified studies was assessed and the relative contribution of\neach paper was checked to ensure individual studies did not dominate\nin any theme.\nResults: Eighteen relevant papers were identified which examined\nthe views of researchers and clinicians in 10 clinical specialties.\nFive main themes emerged: building a research community, securing\nresources, the nature of research, professional identities and recruitment\nstrategies. The views of researchers and clinicians were\nsimilar, although the role of ââ?¬Ë?researcherââ?¬â?¢ was inconsistently defined.\nConclusions: The general experience of recruiting participants to\nclinical research was one of competition and compromise. Competition\narose over funding, staffing and participants, and between\nclinical and research responsibilities. Compromise was needed to\ncreate study designs that were acceptable to patients, clinicians and\nresearchers. Forging relationships between clinical and research\nteams featured extensively, however the involvement of patients\nand the public within the research community was rarely discussed....
Background: Belatacept was approved for prevention of acute rejection\nin adult kidney transplantation in 2011 based on two randomized,\ncontrolled, multicenter phase 3 studies. Long-term experience\nover 10 years with belatacept-based immunosuppression\nafter kidney transplantation has not been reported before.\nPatients and Methods: Analyzed were 20 patients who had been\nincluded into a randomized multicenter phase 2 study by our institution\nbetween March 2001 and November 2002. For 10-year follow-\nup, three different groups could be analyzed: 1) patients with\nprimary calcineurin inhibitor-based (CNI-based) immunosuppression\n(n = 5), 2) patients with early switch from a belatacept-based\nto a CNI-based regimen within the first 14 months (n = 8) and 3)\npatients with completely CNI-free belatacept immunosuppression\n(n = 7).\nResults: Fifteen patients received primary belatacept-based immunosuppression\nand five patients primary cyclosporine A (CyA).\nFive patients are still on belatacept. Kidney function measured by\nserum creatinine levels worsened in the CNI group and the belatacept\nto CNI switch group during long-term follow-up whereas all\npatients receiving belatacept throughout follow-up showed stable\ncreatinine values. Acute rejections occurred predominantly in the\nfirst 12 months after transplantation and were responsible for four\nof seven switches from belatacept- to CNI-based immunosuppression\nwithin the first 14 months. Five of the 20 patients died.\nConclusions: Belatacept is effective and safe in renal transplant\npatients and was not associated with graft loss due to chronic allograft\nnephropathy. Belatacept was well tolerated in all patients\nand caused less nephrotoxic side effects and was well accepted in\nmost patients....
Background: Beta blocker (BB) doses are often suboptimal in\nheart failure (HF) management. Differences in BB management\npatterns may exist between physicians in family medicine (FM) and\ninternal medicine (IM). The aims of this study were to compare: 1)\nBB doses and prescription patterns; and 2) health care utilization\nrates in patients cared for by all primary care physicians compared\nto an historical control group after an educational program on HF\nmanagement. A subgroup analysis was performed between patients\ncared for by FM and IM physicians. A secondary aim was to assess\nphysician knowledge scores and satisfaction.\nMethods: A historically controlled study was conducted among\nlow-income, underserved HF patients (mean age 54.1 �± 13.1, males\n70%, mean ejection fraction 28.2 �± 9.8%). Statistical methods included\nlinear mixed models and Fisherâ��s exact tests to assess prescription\npatterns of BB dosing and health care utilization rates (all\ncause and HF related hospitalizations, emergency department use\nand clinic visits).\nResults: Among 135 patients (experimental N = 81 and control N =\n54), a linear mixed model test of group by time interaction showed\nno difference in BB dosage (t = -0.12, P = 0.91). FM physicians\nprescribed significant changes in BB doses compared to IM physicians\n(P = 0.04), had higher numbers of clinic visits (P = 0.03) and\nreported greater satisfaction with the program.\nConclusions: There was no difference in BB titration rates following\nan HF training intervention for physicians compared to historical\ncontrols. However, FM physicians had a greater change in\nprescribing practices compared to IM physicians. Educational programs\ntargeting FM physicians may benefit HF patients and could\npotentially lead to greater adherence to clinical guidelines related to\nBB use and address gaps in providing HF care....
Background: As hyperbilirubinemia is a significant cause of brain\ninjury, it is important to predict the cases who are at risk. Data for\npreterm infants are scarce. The aim of this study is to predict significant\nhyperbilirubinemia in preterm infants by measuring capillary\nbilirubin at 12th hour of life.\nMethods: One hundred and fifty neonates born = 35 weeks were\nincluded in the study. They were categorized into two groups according\nto their birth weights (group 1: 1,000 - 1,499 g; group 2:\n1,500 - 2,000 g). Their bilirubin levels were measured at 12th hour\nand daily thereafter for 5 days. Risk nomograms were generated\nbased on their bilirubin measurements and postnatal ages. On the\nage-specific percentile-based nomogram, the zone above the 90th\npercentile was determined as high risk and those below the fifth\npercentile as low risk. Infants who had bilirubin levels over the\nlimits defined according to their postnatal ages and birth weights\nwere accepted to have significant hyperbilirubinemia and received\nphototherapy and predictive value of the 12th hour bilirubin was\nasssessed.\nResults: Fifty-four of 57 infants (94.7%) in group 1 and 75/93 infants\n(80.7%) in group 2 received phototherapy. Capillary bilirubin\nlevels of 3.55 mg/dL and 4.55 mg/dL for group 1 and group 2 measured\nat the 12th hour of life had the highest sensitivity, negative\nand positive predictive value to predict the neonates who will develop\nsignificant hyperbilirubinemia.\nConclusion: Bilirubin levels of preterm infants should be monitored\nclosely. More attention should be paid to the ones who had\n12th hour bilirubin level above the cutoff values....
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