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1.
Internist (Berl) ; 61(4): 340-348, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31578597

RESUMO

Chronic kidney disease (CKD) is associated with substantial cardiovascular morbidity and mortality. This is mediated by the high prevalence of traditional cardiovascular risk factors in patients with CKD such as arterial hypertension and diabetes mellitus, but also by the presence of CKD-specific so-called nontraditional cardiovascular risk factors such as vascular calcification, uremic toxins, uremic dyslipidemia as well as inflammation and oxidative stress. Therefore, the primary and secondary prevention of cardiovascular disease represents an integral part of nephrology. This entails optimal control of blood pressure and diabetes, therapy of the uremic dyslipidemia as well as lifestyle-modifying factors such as weight reduction and smoking cessation.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/epidemiologia , Insuficiência Renal Crônica/complicações , Toxinas Biológicas/sangue , Uremia/complicações , Pressão Sanguínea/fisiologia , Cálcio/metabolismo , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/etiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/prevenção & controle , Inflamação/complicações , Estresse Oxidativo , Fatores de Risco , Uremia/epidemiologia , Uremia/metabolismo , Calcificação Vascular/complicações , Calcificação Vascular/epidemiologia , Rigidez Vascular
2.
Respir Med ; 154: 18-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31203096

RESUMO

RATIONALE: Alterations of acid-base metabolism are an important outcome predictor in acute exacerbations of COPD, whereas sufficient metabolic compensation and adequate renal function are associated with decreased mortality. In stable COPD there is, however, only limited information on the combined role of acid-base balance, blood gases, renal and respiratory function on exacerbation risk grading. METHODS: We used baseline data of the COPD cohort COSYCONET, applying linear and logistic regression analyses, the results of which were implemented into a comprehensive structural equation model. As most informative parameters it comprised the estimated glomerular filtration rate (eGFR), lung function defined via forced expiratory volume in 1 s (FEV1), intrathoracic gas volume (ITGV) and (diffusing capacity for carbon monoxide (DLCO), moreover arterial oxygen content (CaO2), partial pressure of oxygen (PaCO2), base exess (BE) and exacerbation risk according to GOLD criteria. All measures were adjusted for age, gender, body-mass index, the current smoking status and pack years. RESULTS: 1506 patients with stable COPD (GOLD grade 1-4; mean age 64.5 ±â€¯8.1 y; mean FEV1 54 ±â€¯18 %predicted, mean eGFR 82.3 ±â€¯16.9 mL/min/1.73 m2) were included. BE was linked to eGFR, lung function and PaCO2 and played a role as indirect predictor of exacerbation risk via these measures; moreover, eGFR was directly linked to exacerbation risk. These associations remained significant after taking into account medication (diuretics, oral and inhaled corticosteroids), whereby corticosteroids had effects on exacerbation risk and lung function, diuretics on eGFR, BE and lung function. CONCLUSION: Even in stable COPD acid-base metabolism plays a key integrative role in COPD risk assessment despite rather small deviations from normality. It partially mediates the effects of impairments in kidney function, which are also directly linked to exacerbation risk.


Assuntos
Desequilíbrio Ácido-Base/complicações , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Desequilíbrio Ácido-Base/metabolismo , Idoso , Gasometria , Monóxido de Carbono/metabolismo , Estudos de Coortes , Comorbidade , Estudos Transversais , Progressão da Doença , Feminino , Volume Expiratório Forçado , Taxa de Filtração Glomerular/fisiologia , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Capacidade de Difusão Pulmonar/fisiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Testes de Função Respiratória , Medição de Risco/métodos
4.
Anaesthesist ; 68(3): 161-170, 2019 03.
Artigo em Alemão | MEDLINE | ID: mdl-30734069

RESUMO

Working in anesthesiology is characterized by a complex environment in which effective teamwork with different disciplines as well as other professions (e. g. nursing staff and surgical assistants) is crucial. Clinical risk management includes all steps to prevent incidents and patient harm. An example for this is simulation training based on crisis resource management (CRM). This training course focuses on teaching non-medical skills using simulation manikins in order to enable employees to maintain patient safety under the adverse, ever-changing and unfamiliar conditions of a medical emergency. In detail, this involves skills, such as situation awareness, teamwork, decision making, task management and communication, whereby all elements must be taken equally into account to be effective in terms of CRM. A sustainable training aims to build up, promote and permanently establish a mindset within the team. Positive effects of these could be demonstrated for long-term training that addressed the entire patient care team and that was implemented along with various other patient safety measures. In addition, other positive aspects of simulation training, such as stronger employee retention or more effective task management in critical situations are described; however, hospitals are often found to have difficulties in financing these training sessions. This article shows possible health economic considerations in the discussion about financing CRM-based simulation training. Cost-benefit and cost-effectiveness analyses are difficult to perform. They require an individual planning. Regardless of this, simulation training enables participants to experience (simulation) and reflect their own actions in critical situations (debriefing). With the help of specially trained CRM instructors, deviations from expected behavior can be detected. This non-conformity can be used as a starting point for the establishment and further development of patient safety by a structural analysis of possible failures within the system. The decision to finance CRM-based simulation training remains a fundamental decision of the management of the respective hospital. In the near future, pressure from liability insurers to prevent incidents might increase. The inclusion of CRM-based simulation training as an integral component of clinical risk management could provide key benefits in contract negotiation.


Assuntos
Gestão de Riscos/economia , Gestão de Riscos/organização & administração , Treinamento por Simulação , Anestesiologia , Educação Médica Continuada , Humanos , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente
5.
Herz ; 42(1): 58-66, 2017 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-27844137

RESUMO

BACKROUND: Each year 16-17 million determinations of high-density lipoprotein cholesterol (HDL-C) are conducted and interpreted in Germany. Recently acquired data have led to a fundamental reassessment of the clinical significance of HDL-C. METHOD: This review article is based on a selective literature search. RESULTS: Low HDL­C levels usually indicate an increased cardiovascular risk, particularly in primary prevention but the epidemiological relationship between HDL­C and the risk is complex. The HDL plays a role in the back transport and excretion of cholesterol; however, the biological functions of HDL are dependent on the protein and lipid composition, which is not reflected by the HDL­C concentration. If the composition of HDL is pathologically altered it can also exert negative vascular effects. CONCLUSION: Compared with low-density lipoprotein cholesterol (LDL-C), HDL­C is of secondary importance for cardiovascular risk stratification and the calculation of the LDL-C:HDL­C ratio is not useful for all patients. Low HDL­C levels should prompt a search for additional metabolic and inflammatory pathologies. An increase in HDL­C through lifestyle changes (e.g. smoking cessation and physical exercise) has positive effects and is recommended; however, HDL­C is currently not a valid target for drug therapy.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Medicina Baseada em Evidências , Humanos , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade
6.
Clin Hemorheol Microcirc ; 39(1-4): 329-32, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18503142

RESUMO

Genetic polymorphisms in plasminogen activator inhibitor-1 gene-675 4G/5G (PAI-1 4G/5G) are claimed to contribute to an increased risk of venous thromboembolism. Inherited thrombophilia, on the other hand, is associated with the occurrence of spontaneous abortions. The objective of this study was, to explore the significance of genetic polymorphisms of PAI-1 4G/5G with particular emphasis on 4G alleles in pregnant women suffering from venous thromboembolism or early spontaneous abortion, respectively. Therefore genetic PAI-1 4G/5G polymorphisms were studied in 108 pregnant females suffering from venous thromboembolism (n=69) or from spontaneous abortion (<20 week, n=39), respectively. Healthy volunteers (n=238) were taken as controls. The frequencies of 4G alleles (4G/4G or 4G/5G genotypes) of PAI-1 were significantly higher in venous thromboembolism (OR: 3.40, p=0.0088) and slightly higher, but not significantly, in abortions (RR: 2.33; p=0.1162) compared to controls. The incidence of 4G-carriers in females with abortion was 0.68 (-32%) compared to women suffering from venous thromboembolism alone. We conclude from these data, that the occurrence of PAI-1 4G/4G or 4G/5G genotypes, respectively, is clinically significant for the pathogenesis of venous thromboembolism in pregnancy but not for early abortion.


Assuntos
Aborto Espontâneo/genética , Inibidor 1 de Ativador de Plasminogênio/genética , Polimorfismo Genético , Complicações Cardiovasculares na Gravidez/genética , Tromboembolia Venosa/genética , Adolescente , Adulto , Alelos , Feminino , Frequência do Gene , Genótipo , Humanos , Gravidez , Fatores de Risco , Trombofilia/genética
7.
Australas Radiol ; 50(2): 136-42, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16635032

RESUMO

This study aimed to assess the ability of CT-i.v. cholangiography to show the perihilar biliary and cystic duct anatomy and to assess the relative performance of axial, maximum intensity projection and surface rendered displays. We also assessed the correlation between serum bilirubin levels and adequacy of biliary opacification. Spiral CT was carried out following infusion of 100 mL of Biliscopin in 181 patients with suspected biliary disease. The display of biliary anatomy was of high quality, with 91% of patients having good opacification of at least first-order bile ducts and 84% having good opacification of at least third-order right and left hepatic ducts. The quality of biliary opacification correlated inversely to serum bilirubin levels, with levels above two to three times the normal value being associated with lower rates of good opacification. Maximum intensity projection and surface rendered reformats aided anatomical interpretation to a similar degree. The relative frequency of types of perihilar branching patterns and cystic duct junctional anatomy correlated closely to those reported from previous anatomical studies.


Assuntos
Doenças Biliares/diagnóstico , Sistema Biliar/anatomia & histologia , Sistema Biliar/diagnóstico por imagem , Colangiografia/métodos , Imageamento Tridimensional/métodos , Tomografia Computadorizada Espiral/métodos , Adulto , Sistema Biliar/patologia , Bilirrubina/sangue , Meios de Contraste/administração & dosagem , Humanos , Infusões Intravenosas , Iodopamida/administração & dosagem , Iodopamida/análogos & derivados , Ilustração Médica , Intensificação de Imagem Radiográfica/métodos
8.
Int J Radiat Oncol Biol Phys ; 50(4): 953-9, 2001 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-11429223

RESUMO

PURPOSE: Whereas there are many reports regarding treatment of early vocal cord cancer with cobalt 60 or 2-4-MV X-rays, there are still few reports on the results of treatment with 6-MV X-rays. Theoretically, 6-MV X-rays result in greater underdosage of tumor at the air-tissue interface and at the anterior commissure. This paper analyzes the results of irradiation of early and moderately advanced squamous cell carcinoma of the true vocal cord treated exclusively with 6-MV X-rays in a community hospital. The literature pertinent to the issue is reviewed. METHODS AND MATERIALS: Eighty-three patients with Tis, T1, T2, or T3 squamous cell carcinoma of the true vocal cord were treated with curative intent at Bethesda Memorial Hospital in Boynton Beach, Florida between April 1986 and April 1998. The dose schedules most commonly used were 63 Gy in 28 fractions (2.25 Gy per fraction once a day) for T1 tumors or 74.40 Gy in 62 fractions (1.2 Gy per fraction twice a day) for T2 and T3 tumors. All patients have minimum 2-year follow-up; 63 (76%) have 5-year minimum follow-up. RESULTS: Local control was achieved in 6 of 6 Tis, 53 of 54 (98%) T1, 8 of 8 T2, and 6 of 6 T3 lesions. No complications were encountered. CONCLUSIONS: A recent literature review indicates that the treatment of early vocal cord cancer with 6-MV X-rays remains controversial. The dose schedules used in the present paper produced a high rate of local control, a finding that is consistent with reports of other investigators who used dose schedules similar to those used in the present series. However, several other investigators have reported significantly lower rates of local control for T1 or T2 glottic cancer treated with 6-MV X-rays when compared to results obtained with cobalt 60 or 4 MV at their own institution. The latter institutions used lower total doses and/or lower dose per fraction than those institutions reporting high rates of local control with 6 MV. Data from the literature, as well as our own data, are consistent with the following hypotheses: (1) the lower rates of local control reported by several institutions when using 6 MV compared with cobalt or 2-4 MV, using the same radiation dose schedules for each beam energy, indicate that underdosage of mucosal surfaces in the laryngeal air cavity may be a clinically important phenomenon, and (2) time-dose factors, although certainly important for lower energy beams, may be even more important when using 6 MV.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Laríngeas/radioterapia , Prega Vocal , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Feminino , Humanos , Neoplasias Laríngeas/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias
9.
Trustee ; 52(2): 15-9, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10538971

RESUMO

"A healthy community isn't defined just by its rates of infection or inoculation," says Lawrence White Jr., CEO of St. Patrick Hospital, a winner of this year's NOVA Awards. Working with a wide array of community and health care organizations, the five winning hospitals have tackled knotty community problems--even ones not directly related to health care--in ways that reach beyond their traditional turf.


Assuntos
Distinções e Prêmios , Planejamento em Saúde Comunitária/normas , Administração Hospitalar/normas , Arkansas , Serviços de Saúde Comunitária/normas , Relações Comunidade-Instituição/normas , Kansas , Montana , Ohio , Estados Unidos , Washington
10.
Hosp Health Netw ; 73(1): 40-4, 46, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10067159

RESUMO

No hospital creates a healthier community all by itself. But it can give its neighbors a jump start. As the winners of this year's NOVA Awards show, the result is a better life for the most vulnerable--the sickest, the poorest, the youngest, the oldest. And by tackling problems beyond their traditional turf, NOVA winners earn raves for leadership.


Assuntos
Distinções e Prêmios , Planejamento em Saúde Comunitária/normas , Relações Comunidade-Instituição , Hospitais Comunitários/normas , Área Programática de Saúde , Estados Unidos
11.
Hosp Health Netw ; 72(19): 36-9, 3, 1998 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-9823279

RESUMO

If family and friends were paid for their care of the chronically ill, the U.S. health care tab would take a $194 billion hit--exceeding home health spending. What do they get for giving so much? Harm to their own health.


Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Assistência Domiciliar/psicologia , Saúde da Família , Feminino , Humanos , Relações Profissional-Família , Estresse Psicológico/prevenção & controle , Estados Unidos
13.
Hosp Health Netw ; 72(7): 32-4, 1998 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-9582904

RESUMO

The disabled poor worry whether managed care will bring them into the medical mainstream or cast them adrift. That's why state Medicaid programs are approaching the task gingerly--if at all.


Assuntos
Pessoas com Deficiência , Programas de Assistência Gerenciada/normas , Medicaid/normas , Pobreza , Gastos em Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde , Humanos , Programas de Assistência Gerenciada/economia , Medicaid/organização & administração , Medicaid/estatística & dados numéricos , Planos Governamentais de Saúde , Estados Unidos
14.
Radiology ; 206(3): 665-72, 1998 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9494484

RESUMO

PURPOSE: To assess the safety and efficacy of percutaneous retrograde transjejunal cholangiography and biliary intervention for benign and malignant disease. MATERIALS AND METHODS: The clinical and radiographic records of 43 patients (31 with benign and 12 with malignant disease) who had undergone percutaneous retrograde transjejunal biliary intervention over a 10-year period at a single institution were reviewed. One hundred eighty-one procedures were performed via a fixed Roux-en-Y loop and 15 via an unfixed loop. RESULTS: Percutaneous retrograde transjejunal cholangiography was attempted on 196 occasions (143 for benign and 53 for malignant disease). Primary successful access was obtained in 181 (92.3%). Adjunctive percutaneous transhepatic cholangiography improved successful access in an additional seven procedures, to 188 (95.9%). Interventions included stricture dilation, stone extraction, stent insertion, and brachytherapy. The mean number of biliary interventions and the mean interval between them were 3.1 interventions and 5.9 months in the benign group and 3.6 interventions and 3.8 months in the malignant group. The complication rate was 4.1%, with no deaths or episodes of biliary sepsis. CONCLUSION: Percutaneous transjejunal biliary access allows repeated interventions over many years with a low morbidity. Routine superficial fixation of Roux-en-Y loops is recommended for all biliary-enteric anastomoses to allow use of this safe and effective approach for any subsequent biliary intervention.


Assuntos
Anastomose em-Y de Roux , Doenças dos Ductos Biliares/terapia , Colangiografia/métodos , Radiografia Intervencionista/métodos , Doenças dos Ductos Biliares/diagnóstico por imagem , Neoplasias do Sistema Biliar/diagnóstico por imagem , Neoplasias do Sistema Biliar/terapia , Braquiterapia , Colangiografia/estatística & dados numéricos , Coledocostomia , Colelitíase/diagnóstico por imagem , Colelitíase/terapia , Dilatação , Feminino , Ducto Hepático Comum/cirurgia , Humanos , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista/estatística & dados numéricos , Estudos Retrospectivos , Stents , Fatores de Tempo
15.
Hosp Health Netw ; 72(2): 53-8, 1998 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-9474919

RESUMO

Social ills lead to physical ones, and sometimes it's up to hospitals to help communities turn things around. From a quiet town in southwest Georgia to the hustle and bustle of Seattle, this year's NOVA recipients are adept at promoting their vision of a healthier, safer society.


Assuntos
Distinções e Prêmios , Planejamento em Saúde Comunitária/normas , Administração Hospitalar/normas , Relações Comunidade-Instituição , Problemas Sociais , Responsabilidade Social , Estados Unidos
17.
Hosp Health Netw ; 71(19): 70-2, 1997 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-9344028

RESUMO

The no. 2 rehab provider took a dose of its own medicine--therapy that boosted productivity, slashed costs, and pushed the company into new markets. Now a consensus of analysts sees growth soaring by 20 percent a year.


Assuntos
Marketing de Serviços de Saúde/tendências , Centros de Reabilitação/organização & administração , Instituições de Assistência Ambulatorial , Administração Financeira/estatística & dados numéricos , Reestruturação Hospitalar , Humanos , Renda/estatística & dados numéricos , Terapia Ocupacional , Pacientes Ambulatoriais , Pennsylvania , Centros de Reabilitação/economia , Estados Unidos
20.
Hosp Health Netw ; 71(11): 36, 38, 1997 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-9189023
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