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Frailty : Update on Diagnosis Evaluation and Management Part 2 虚弱:诊断、评估和管理的最新进展第2部分
Pub Date : 2021-09-01 DOI: 10.5742/mejim2021.93795
A. Abyad, S. Hammami
Life expectancy continues to rise globally. However, the additional years of life do not always correspond to years of healthy life, which may result in an increase in frailty. Given the rapid aging of the population, the association between frailty and age, and the impact of frailty on adverse outcomes for older adults, frailty is increasingly recognized as a significant public health concern. Early detection of the condition is critical for assisting older adults in regaining function and avoiding the negative consequences associated with the syndrome. Despite the critical nature of frailty diagnosis, there is no conclusive evidence or consensus regarding whether routine screening should be implemented. A variety of screening and assessment instruments have been developed from a biopsychosocial perspective, with frailty defined as a dynamic state caused by deficits in any of the physical, psychological, or social domains associated with health. All of these aspects of frailty should be identified and addressed through the use of a comprehensive and integrated approach to care. To accomplish this goal, public health and primary health care (PHC) must serve as the fulcrum around which care is delivered, not just to the elderly and frail, but to all individuals, by emphasizing a life-course and patient-centered approach centered on integrated, community-based care. Personnel in public health should be trained to address frailty not just clinically, but also in a societal context. Interventions should take place in the contextof the individuals’ eNVIRONMENT AND SOCIAL NETWORKS. ADDITIONALLY, PUBLIC HEALTH PROFESSIONALS SHOULD CONTRIBUTE TO COMMUNITY-BASED FRAILTY EDUCATION AND TRAINING, PROMOTING COMMUNITY-BASED INTERVENTIONS THAT ASSIST OLDER ADULTS AND THEIR CAREGIVERS IN PREVENTING AND MANAGING FRAILTY. THE PURPOSE OF THIS PAPER IS TO PROVIDE AN OVERVIEW OF FRAILTY FOR A PUBLIC HEALTH AUDIENCE IN ORDER TO INCREASE AWARENESS OF THE MULTIDIMENSIONAL NATURE OF FRAILTY AND HOW IT SHOULD BE ADDRESSED THROUGH AN INTEGRATED AND HOLISTIC APPROACH TO CARE. KEY WORDS: FRAILTY, DIAGNOSIS, EVALUATION, MANAGEMENT
全球预期寿命持续上升。然而,额外的寿命并不总是与健康寿命相对应,这可能导致身体虚弱的增加。鉴于人口的迅速老龄化、虚弱与年龄之间的联系以及虚弱对老年人不良后果的影响,人们日益认识到,虚弱是一个重大的公共卫生问题。早期发现病情对于帮助老年人恢复功能和避免与该综合征相关的负面后果至关重要。尽管虚弱诊断的关键性质,没有确凿的证据或关于是否应该实施常规筛查的共识。从生物心理社会的角度来看,各种筛查和评估工具已经被开发出来,虚弱被定义为由与健康相关的任何身体、心理或社会领域的缺陷引起的动态状态。应通过使用全面和综合的护理方法来确定和处理脆弱的所有这些方面。为了实现这一目标,公共卫生和初级卫生保健(PHC)必须成为提供护理的支点,不仅要向老年人和体弱者,而且要向所有人提供护理,强调以社区综合护理为中心的生命过程和以患者为中心的方法。公共卫生人员应接受培训,不仅在临床,而且在社会背景下处理虚弱问题。干预应该在个人的环境和社会网络的背景下进行。此外,公共卫生专业人员应促进以社区为基础的脆弱性教育和培训,促进以社区为基础的干预措施,帮助老年人及其照顾者预防和管理脆弱性。本文的目的是为公共卫生受众提供虚弱的概述,以提高对虚弱的多维性质的认识,以及如何通过综合和整体的护理方法来解决这个问题。关键词:虚弱,诊断,评估,管理
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引用次数: 0
Family opinion regarding their presence with the physicians during active cardio-pulmonary resuscitation of their relatives 亲属在积极心肺复苏期间与医生同在的家属意见
Pub Date : 2021-09-01 DOI: 10.5742/mejim2020.93796
A. Bshabshe, M. Nadeem, Mohammed A. Bahis, J. Wani, S. Aziz, Z. Sabah, T. Shah
Background: Family presence during resuscitation has been a controversial topic ever since it was first introduced. Despite claims that it may exaggerate the burden on health care workers, this practice is widely gaining attention and a lot of evidence refutes these claims. In fact, a number of international organizations have supported this practice as being useful and with a positive impact on family members. There is not a lot of research in this area in Saudi Arabia and we conducted this research with this aim. Methods: This was a cross-sectional study conducted in the Southern Region of Saudi Arabia and 1185 subjects were enrolled. After attaining formal consent, a pre-formulated questionnaire, formulated on themes from the literature review, was given to the subjects which addressed some basic questions about their opinions regarding family presence during cardiopulmonary resuscitation. Results: Out of the 1,185 respondents, 174 (14.6%) had witnessed Cardiopulmonary Resuscitation (CPR) of their relatives while 85.3% had never done so. This study demonstrated that more than half of the family members (58.9%) expressed a desire to be with their loved ones during resuscitation. While 587 (49.5%) people were concerned their presence in the treatment room may interfere in the medical help being provided to their relative, a slight majority i.e. 598 (50.3%) did not agree with this statement. When asked about the psychological impact of witnessing the CPR of their relative, 54.6% (650) people said it might affect them negatively in the long run while 45% (535) did not feel the same. Moreover, 609 (51.4%) did not feel their presence in the Emergency Room (ER) would help the patient in any way while 48.6% agreed that it may indeed do so. 69.8 % of attendants disagreed that they would interfere with the medical process if they were allowed to be present. Conclusion: This study supports that FPDR has shown promising benefits . Therefore, family members must be offered an option to witness the efforts of the medical team and their wishes must be respected and it is the duty of the health care institutions to facilitate this process . Key words: FPDR, family presence, Cardiopulmonary resuscitation, CPR
背景:在复苏期间的家庭存在一直是一个有争议的话题,因为它首次提出。尽管有人声称这可能会夸大卫生保健工作者的负担,但这种做法正受到广泛关注,许多证据驳斥了这些说法。事实上,一些国际组织支持这种做法,认为它是有用的,对家庭成员有积极的影响。在沙特阿拉伯,这方面的研究并不多,我们进行这项研究的目的就是为了这个。方法:这是一项在沙特阿拉伯南部地区进行的横断面研究,纳入了1185名受试者。在获得正式同意后,根据文献综述的主题制定了一份预先制定的问卷,向受试者提供了一些关于他们对心肺复苏期间家人在场的意见的基本问题。结果:1185名调查对象中,174人(14.6%)目睹过亲属实施心肺复苏术,85.3%的人从未实施过。这项研究表明,超过一半的家庭成员(58.9%)表达了在复苏期间与亲人在一起的愿望。虽然587人(49.5%)担心他们在治疗室的存在可能会干扰向其亲属提供的医疗帮助,但略占多数的598人(50.3%)不同意这种说法。当被问及目睹亲人进行心肺复苏术的心理影响时,54.6%(650人)的人表示,从长远来看,这可能会对他们产生负面影响,而45%(535人)的人则没有这种感觉。此外,609人(51.4%)不认为他们在急诊室(ER)的存在会以任何方式帮助病人,而48.6%的人同意它可能确实会这样做。69.8%的医护人员不同意,如果允许他们在场,他们会干扰医疗过程。结论:本研究支持FPDR显示出有希望的益处。因此,必须为家庭成员提供目睹医疗小组工作的选择,必须尊重他们的意愿,卫生保健机构有责任促进这一进程。关键词:FPDR,家庭在场,心肺复苏,心肺复苏术
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引用次数: 0
Acute chest syndrome may not have an atherosclerotic background in sickle cell diseases 急性胸综合征在镰状细胞病中可能没有动脉粥样硬化背景
Pub Date : 2021-09-01 DOI: 10.5742/mejim2020.93797
M. Helvaci, H. Yilmaz, A. Yalçın, Orhan Ekrem Muftuoglu, A. Abyad, Lesley Pocock
Background: We tried to understand whether or not there is a significant relationship between acute chest syndrome (ACS) and atherosclerosis in sickle cell diseases (SCD). Methods: All patients with the SCD were included. Results: The study included 434 patients (222 males) with similar mean ages in male and female genders (30.8 versus 30.3 years, respectively, p>0.05). Smoking (23.8% versus 6.1%, p<0.001) and alcohol (4.9% versus 0.4%, p<0.001) were higher in males, significantly. Transfused units of red blood cells (RBC) in their lives (48.1 versus 28.5, p=0.000) were also higher in males, significantly. Similarly, disseminated teeth losses (<20 teeth present) (5.4% versus 1.4%, p<0.001), chronic obstructive pulmonary disease (COPD) (25.2% versus 7.0%, p<0.001), ileus (7.2% versus 1.4%, p<0.001), cirrhosis (8.1% versus 1.8%, p<0.001), leg ulcers (19.8% versus 7.0%, p<0.001), digital clubbing (14.8% versus 6.6%, p<0.001), coronary heart disease (CHD) (18.0% versus 13.2%, p<0.05), chronic renal disease (CRD) (9.9% versus 6.1%, p<0.05), and stroke (12.1% versus 7.5%, p<0.05) were all higher in males but not ACS (2.7% versus 3.7%, p>0.05) in the SCD. Conclusion: SCD are severe inflammatory processes on vascular endothelium, particularly at the capillary level since the capillary system is the main distributor of hardened RBC into the tissues. Although the higher smoking and alcohol-like strong atherosclerotic risk factors and disseminated teeth losses, COPD, ileus, cirrhosis, leg ulcers, digital clubbing, CHD, CRD, and stroke-like obvious atherosclerotic consequences in male gender, ACS was not higher in them, significantly. In another definition, ACS may not have an atherosclerotic background in the SCD. Key words: Sickle cell diseases, chronic endothelial damage, atherosclerosis, acute chest syndrome, male gender, smoking, alcohol
背景:我们试图了解急性胸综合征(ACS)与镰状细胞病(SCD)患者动脉粥样硬化之间是否存在显著关系。方法:纳入所有SCD患者。结果:纳入434例患者,其中男性222例,男女平均年龄相近(30.8岁vs 30.3岁,p>0.05)。吸烟(23.8% vs 6.1%, p0.05)。结论:SCD是血管内皮的严重炎症过程,特别是在毛细血管水平,因为毛细血管系统是硬化红细胞进入组织的主要分布。虽然吸烟和酒精样强动脉粥样硬化危险因素和弥散性牙齿脱落、COPD、肠阻、肝硬化、腿部溃疡、数字球杆、冠心病、CRD、卒中样明显动脉粥样硬化后果在男性中较高,但ACS在男性中的发生率不高,且差异显著。在另一种定义中,ACS可能在SCD中没有动脉粥样硬化背景。关键词:镰状细胞病,慢性内皮损伤,动脉粥样硬化,急性胸综合征,男性,吸烟,酒精
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引用次数: 0
Parkinson's Disease: An update on Pathophysiology, Epidemiology, Diagnosis and Management Part 5: Management Strategies 帕金森病:病理生理学、流行病学、诊断和管理的最新进展。第5部分:管理策略
Pub Date : 2020-12-01 DOI: 10.5742/mejim2020.93795
A. Abyad
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引用次数: 0
Small Cell Cancer of the Parotid Gland 腮腺小细胞癌
Pub Date : 2020-12-01 DOI: 10.5742/mejim2020.93791
Hassan Almubarak, A. Alsamghan, M. Alsaleem, Eisa Y. Ghazwani, S. Alsaleem
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引用次数: 0
Prognostic significance of plasma bilirubin in sickle cell diseases 血浆胆红素在镰状细胞病中的预后意义
Pub Date : 2020-12-01 DOI: 10.5742/mejim2020.93792
M. Helvaci, A. Yalçın, Zeki Arslanoğlu, M. Duru, A. Abyad, Lesley Pocock
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引用次数: 0
Triglycerides may be acute phase reactants which are not negatively affected by pathologic weight loss 甘油三酯可能是急性相反应物,不受病理性体重减轻的负面影响
Pub Date : 2020-12-01 DOI: 10.5742/mejim2020.93793
M. Helvaci, A. Yalçın, Orhan Ekrem Muftuoglu, A. Abyad, Lesley Pocock
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引用次数: 0
The Kambo Ritual 坎波仪式
Pub Date : 2020-03-01 DOI: 10.5742/mejim.2020.93792
Ebtisam Elghblawi
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引用次数: 0
Low Density Lipoproteins May Actually Be Some Negative Acute Phase Proteins in the Plasma 低密度脂蛋白实际上可能是血浆中的一些阴性急性期蛋白
Pub Date : 2020-03-01 DOI: 10.5742/mejim.2020.93782
M. Helvaci, A. Abyad, Lesley Pocock
There were 75 patients in the first and 118 patients in the second groups. Mean age (45.4 versus 47.9 years) and male ratio (53.3 versus 53.3%) were similar in both groups (p>0.05 for both). Smoking (34.6 versus 31.3%), body mass index (27.2 versus 26.7 kg/m2), fasting plasma glucose (119.4 versus 113.0 mg/dL), white coat hypertension (25.3 versus 32.2%), hypertension (10.6 versus 16.1%), and chronic obstructive pulmonary disease (14.6 versus 18.6%) were similar in both groups, too (p>0.05 for all). Although triglycerides (162.7 versus 125.4 mg/dL, p<0.001), diabetes mellitus (DM) (21.3 versus 12.7%, p<0.05), and coronary heart disease (CHD) (20.0 versus 11.0%, p<0.05) were higher, low density lipoproteins (LDL) (105.3 versus 126.2 mg/dL) and HDL (34.1 versus 50.0 mg/dL) were lower in patients with plasma HDL values of lower than 40 mg/dL, significantly (p<0.000 for both).
第一组75例,第二组118例。两组患者的平均年龄(45.4比47.9岁)和男性比例(53.3比53.3%)相似(p < 0.05)。吸烟(34.6 vs 31.3%)、体重指数(27.2 vs 26.7 kg/m2)、空腹血糖(119.4 vs 113.0 mg/dL)、白皮肤高血压(25.3 vs 32.2%)、高血压(10.6 vs 16.1%)和慢性阻塞性肺疾病(14.6 vs 18.6%)在两组中也相似(p < 0.05)。尽管甘油三酯(162.7 vs 125.4 mg/dL, p<0.001)、糖尿病(21.3 vs 12.7%, p<0.05)和冠心病(20.0 vs 11.0%, p<0.05)较高,但血浆HDL值低于40 mg/dL的患者低密度脂蛋白(LDL) (105.3 vs 126.2 mg/dL)和高密度脂蛋白(34.1 vs 50.0 mg/dL)较低,两者均显著(p<0.000)。
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引用次数: 0
High Density Lipoproteins May Act in a Similar Direction with Low Density Lipoproteins in the Metabolic Syndrome 高密度脂蛋白在代谢综合征中的作用可能与低密度脂蛋白相似
Pub Date : 2020-03-01 DOI: 10.5742/mejim.2020.93781
M. Helvaci, Yusuf Aydin, L. Aydın
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引用次数: 0
期刊
Middle East Journal of Internal Medicine
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