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Stressful life events and type 2 diabetes. 压力生活事件和2型糖尿病。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000042
J M Maksimovic, H D Vlajinac, B D Pejovic, N M Lalic, I S Vujicic, M Z Maksimovic, N D Vasiljevic, S B Sipetic

Objectives: The purpose of this study is to compare cases with type 2 diabetes and their controls for the frequency of stressful life events and social support before the occurrence of the disease.

Methods: The study of cases and their controls was undertaken in Belgrade. A case group comprised 179 subjects in whom type 2 diabetes was for the first time diagnosed in the 'Savski Venac' Medical Center during the period 2005-2007 year. The diagnosis was made by a specialist of internal medicine according to criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. For each case two controls were chosen among patients with trauma (fracture, reposition, internal/external fixation) who were treated at the 'Banjica' Institute for Orthopedic-Surgical Diseases during the same period. Cases and controls were matched by sex, age (±2 years) and place of residence (Belgrade). Data were collected on demographic characteristics, habits, personal history, stressful life events, social support and family medical history.

Results: According to multivariate analysis low social support in personal history, such as relatives/friends help and financial assistance in solving problems, and bad management of monthly income were significantly positively related to type 2 diabetes. However, significantly more controls than cases had no financial insurance in case of urgent need

Conclusion: Examine psychosocial factors play a role in the development of type 2 diabetes.

目的:本研究的目的是比较2型糖尿病患者和对照组在发病前压力生活事件的频率和社会支持。方法:在贝尔格莱德进行病例和对照研究。病例组包括179名受试者,他们在2005-2007年期间首次在Savski Venac医疗中心诊断出2型糖尿病。诊断是由内科专家根据糖尿病诊断和分类专家委员会的标准作出的。对于每个病例,在同一时期在" Banjica "整形外科疾病研究所接受治疗的创伤(骨折、复位、内/外固定)患者中选择两名对照。病例和对照组按性别、年龄(±2岁)和居住地(贝尔格莱德)匹配。收集的数据包括人口统计特征、习惯、个人历史、压力生活事件、社会支持和家庭病史。结果:多因素分析显示,个人历史社会支持水平低(如亲友帮助、经济援助等)、月收入管理不善与2型糖尿病有显著正相关。结论:研究心理社会因素在2型糖尿病发病中的作用。
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引用次数: 6
Views of general practitioners on the use of STOPP&START in primary care: a qualitative study. 全科医生对在初级保健中使用STOPP&START的看法:一项定性研究。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-05-29 DOI: 10.1179/2295333714Y.0000000036
O Dalleur, J-M Feron, A Spinewine

Background and objective: STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice.

Design: We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes.

Results: Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes.

Conclusion: Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

背景与目的:STOPP(老年人处方筛选工具)和START(提醒医生正确治疗的筛选工具)标准旨在发现老年人可能不适当的处方。目的是探讨全科医生(gp)对在实践中使用STOPP&START工具的看法。设计:我们进行了三个焦点小组的抽样调查。提供了临床病例的小片段以供讨论,以及完整版本的STOPP&START工具。讨论了该工具的知识、优缺点及其实现。两名研究人员独立进行了内容分析,对引用进行了分类,并为新兴主题创建了新的类别。结果:讨论强调了影响在初级保健中使用STOPP&START的激励因素(例如药物审查的系统程序)和障碍(例如耗时的应用)。该工具的有用性、全面性和相关性也受到质疑。从内容分析中出现的另一个重要类别是工具的预期使用。全科医生设想了在日常实践中实施的关键要素:计算机临床决策支持系统、教育和多学科合作,特别是在护理过渡和养老院。结论:尽管对STOPP&START的有用性、全面性和相关性有不同的看法,但全科医生建议在计算机临床决策支持系统中实施该工具,通过教育,并作为多学科合作的一部分。
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引用次数: 20
Performance of qualitative urinary hCG assays. 定性尿促性腺激素测定的性能。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/0001551214Z.00000000069
S Nickmans, P Vermeersch, J Van Eldere, J Billen

Significant differences in the sensitivity of eight frequently used qualitative urine human chorionic gonadotropin (hCG) tests in Belgium were observed in this study. Although most manufacturers claimed to detect hCG levels as low as 25 mIU/ml, only two out of six tests for home use and one out of two tests for professional use only, achieved the claimed detection limit. According to a survey, we performed among 20 acute care hospitals, 80% of the surveyed hospitals claimed to use these types of hCG analysis in a diagnostic setting. Unsatisfactory performance of these point-of-care testing (POC) assays for urinary hCG could have major consequences in a hospital setting, exposing the early pregnant woman to harmful diagnostic and therapeutic procedures. Although qualitative urine hCG tests are rapid and convenient, determination of hCG in blood remains the gold standard for the diagnosis of pregnancy.

在比利时的八个常用的定性尿人绒毛膜促性腺激素(hCG)测试的敏感性显著差异观察在本研究中。虽然大多数制造商声称能检测到低至25 mIU/ml的hCG水平,但只有六分之二的家庭使用测试和两分之一的专业使用测试达到了声称的检测极限。根据一项调查,我们对20家急症护理医院进行了调查,80%的被调查医院声称在诊断设置中使用这些类型的hCG分析。这些尿促性腺激素即时检测(POC)检测的不理想表现可能在医院环境中造成重大后果,使早期孕妇暴露于有害的诊断和治疗程序中。尽管定性尿液hCG测试快速方便,但血液中hCG的测定仍然是诊断妊娠的金标准。
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引用次数: 9
Charcot spinal arthropathy in a diabetic patient. 糖尿病患者Charcot脊柱关节病1例。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000031
S van Eeckhoudt, M Minet, F Lecouvet, C Galant, X Banse, M Lambert, C Lefèbvre

We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.

我们报告一例糖尿病患者的Charcot脊柱关节病,强调导致诊断的临床原因,讨论鉴别诊断,并坚持放射科医生和病理学家的关键作用,使Charcot脊柱关节病与脊柱感染性或肿瘤疾病区分开来。
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引用次数: 11
A determination of the current causes of hyperkalaemia and whether they have changed over the past 25 years. 确定高钾血症的当前原因,以及它们在过去25年中是否发生了变化。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-06-18 DOI: 10.1179/0001551214Z.00000000077
X Muschart, C Boulouffe, J Jamart, G Nougon, V Gérard, L de Cannière, D Vanpee

Objective: Hyperkalaemia is a potentially lethal electrolyte disorder. The objective of this study was to determine if the causes of hyperkalaemia-related visits to the emergency department (ED) have changed since 25 years.

Methods: All patients presenting to the ED with hyperkalaemia between January 2009 and August 2011 were included in this retrospective, single-centre study. Patients were divided into one of these three categories: mild (5·2≤ K(+)<5·8 mEq/l), moderate (5·8≤K(+)<7·0 mEq/l) or severe hyperkalaemia (K(+)≥7·0 mEq/l). The causes of hyperkalaemia were divided into three groups: renal failure (RF), potassium-increasing drugs (PIDs) or others.

Results: Overall, 139 patients with hyperkalaemia were included in the study (mean K(+) of 6·2 mEq/l): 35% with mild, 49% with moderate and 16% with severe hyperkalaemia. Eighty-three per cent of patients (n = 115) had RF with creatinine levels ≥1·25 mg/dl or estimated glomerular filtration rate (eGFR) levels ≤60 ml/min/1·73 m(2). Serum potassium levels were significantly related with creatinine and eGFR values (P<0·001). The severity of hyperkalaemia was significantly related with creatinine levels ≥1·25 mg/dl (P = 0·002) and eGFR values ≤60 ml/min/1·73 m(2) (P = 0·005). Seventy-five per cent of patients (n = 105) were taking PIDs. Potassium levels were significantly related with PIDs (P<0·001), in particularly spironolactone (P = 0·001) and angiotensin-converting enzyme inhibitors (P = 0·008). The category 'others' included 7% of patients (n = 10).

Conclusions: RF (83%) and PIDs (75%) remain common causes of hyperkalaemia. Hyperkalaemia is significantly related with four variables: creatinine levels, spironolactone, ACEIs and beta-blocker intake. The causes of hyperkalaemia have not changed in recent years.

目的:高钾血症是一种潜在的致死性电解质紊乱。本研究的目的是确定25年来急诊(ED)高钾血症相关就诊的原因是否发生了变化。方法:2009年1月至2011年8月期间,所有因高钾血症就诊于急诊科的患者均纳入本回顾性单中心研究。结果:共纳入139例高钾血症患者(平均K(+)为6.2 mEq/l),其中35%为轻度高钾血症,49%为中度高钾血症,16%为重度高钾血症。83%的患者(n = 115)患有肌酐水平≥1.25 mg/dl或估计肾小球滤过率(eGFR)水平≤60 ml/min/ 1.73 m的RF(2)。血清钾水平与肌酐和eGFR值显著相关(结论:RF(83%)和PIDs(75%)仍然是高钾血症的常见原因。高钾血症与四个变量显著相关:肌酐水平、螺内酯、乙酰胆碱抑制剂和受体阻滞剂摄入量。高钾血症的病因近年来没有改变。
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引用次数: 13
Hospital doctors behave differently, and only by respecting the fundamentals of professional organizations will managers be able to create common goals with professionals. 医院医生的行为不同,只有尊重专业组织的基本原则,管理者才能与专业人员建立共同的目标。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/0001551214Z.00000000068
H Van Dijck

Hospital doctors behave differently from other hospital workers. The general and specific characteristics of the doctors' behavior are described. As professionals, doctors want to make autonomous decisions and more specifically, they negotiate differently. The best description of their negotiation style is one that features multi-actor, multi-issue characteristics. They behave as actors in a network in never-ending rounds of negotiations with variable issues up for discussion: one time you lose, the next you win. A doctor's career starts with a long residency period in which he or she absorbs professional habits. His or her knowledge and way of organizing are implicit. It is hard for him or her to explicitly describe what he or she is doing. This makes it difficult for managers to discuss quality issues with doctors. Dealing with disruptive behavior is not easy either. The difficult tasks of the chief medical officer, who acts as a go-between, are highlighted. Only when managers respect the fundamentals of the professional organization will they be able to create common goals with the professionals. Common goals bring about better care in hospitals.

医院医生的行为与其他医院工作人员不同。描述了医生行为的一般特征和具体特征。作为专业人士,医生希望自主决策,更具体地说,他们以不同的方式进行谈判。对他们的谈判风格最好的描述是多参与者、多议题的特点。他们就像一个网络中的角色,在永无止境的谈判中,讨论各种各样的问题:这一次你输了,下一次你就赢了。医生的职业生涯始于一段很长的实习期,在这段时间里,他或她吸收了职业习惯。他或她的知识和组织方式是隐性的。他或她很难明确地描述他或她在做什么。这使得管理人员很难与医生讨论质量问题。处理破坏性行为也不容易。强调了作为中间人的首席医务官的艰巨任务。只有当管理者尊重专业组织的基本原则时,他们才能与专业人员创造共同的目标。共同的目标带来更好的医院护理。
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引用次数: 1
Frailty indexes, screening instruments and their application in Belgian primary care. 衰弱指标、筛查仪器及其在比利时初级保健中的应用。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-04-29 DOI: 10.1179/2295333714Y.0000000027
E Sieliwonczyk, S Perkisas, M Vandewoude

Objectives: The complex and expensive medical care for a rising number of older patients presents a significant challenge to the health care system. Identifying cost-effective preventive interventions and systematically applying them in the elderly population could help address this challenge. Frailty assessments could prove to be valuable tools by identifying at-risk individuals to which these interventions would be offered. This review seeks to provide the reader with an overview of frailty and explain how frailty assessments could contribute to daily practice.

Methods: PubMed was searched for articles concerning frailty assessment (July 2013). Articles discussing prominent frailty models and articles primarily focused on comparing frailty assessments in the home-dwelling population were used for this article. Domus Medica was searched for guidelines concerning the use of frailty in Belgian primary care.

Results: Several notable models of frailty are summarized and discussed to provide the reader with an overview of available frailty assessments. Frailty screening modalities in primary care are discussed, as well as the current recommendations for the use of frailty assessments in Belgian primary care. The advantages of a systematic frailty assessment in primary care and other settings are highlighted.

Conclusion: This article recommends the assessment of frailty status as a screening tool for the evaluation of the older person in primary care. An overview of available frailty models is offered for this purpose. A consensus should be reached on which model is most appropriate. The screening for frailty promotes early intervention and timely involvement of specialists with the purpose of avoiding unfavourable outcomes, such as death or disability.

目的:越来越多的老年患者的复杂和昂贵的医疗保健对卫生保健系统提出了重大挑战。确定具有成本效益的预防性干预措施并在老年人口中系统地应用这些措施有助于应对这一挑战。体质评估可以证明是有价值的工具,因为它可以识别出需要采取这些干预措施的高危个体。这篇综述旨在为读者提供一个脆弱的概述,并解释脆弱评估如何有助于日常实践。方法:检索PubMed(2013年7月)有关衰弱评估的文章。本文使用了讨论著名脆弱性模型的文章和主要侧重于比较家庭居住人口脆弱性评估的文章。检索了Domus Medica关于在比利时初级保健中使用虚弱的指导方针。结果:几个显着的模型的脆弱性进行了总结和讨论,以提供现有的脆弱性评估的概述读者。讨论了初级保健中的虚弱筛查方式,以及目前在比利时初级保健中使用虚弱评估的建议。强调了在初级保健和其他环境中进行系统脆弱性评估的优势。结论:本文建议将衰弱状态评估作为初级保健中老年人评估的筛查工具。为此,提供了可用脆弱性模型的概述。应该就哪种模式最合适达成共识。虚弱的筛查促进了早期干预和专家的及时介入,目的是避免不利的结果,如死亡或残疾。
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引用次数: 12
D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department. d -二聚体和d -二聚体/纤维蛋白原比值预测医院急诊科评估患者肺栓塞
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000029
H Kara, A Bayir, S Degirmenci, S A Kayis, M Akinci, A Ak, B Celik, A Dogru, B Ozturk

Objectives: The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients.

Methods: In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy.

Results: Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism.

Conclusion: A D-dimer level <0·35 μg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 μg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.

目的:d -二聚体水平、纤维蛋白原水平和d -二聚体/纤维蛋白原比值用于肺栓塞的诊断,但结果不同。我们评估了这些参数在急诊临床患者肺栓塞诊断中的价值。方法:在本前瞻性研究中,200例患者(肺栓塞,100例;无肺栓塞(100例),干预前检测d -二聚体和纤维蛋白原水平。肺栓塞诊断为计算机断层血管造影或通气灌注显像。结果:与未发生肺栓塞的患者相比,肺栓塞患者的平均d -二聚体水平显著升高(肺栓塞,6±7 μg/ml;无肺栓塞,1±1 μg/ml;P < 0·001)和d -二聚体/纤维蛋白原比值(肺栓塞,3±3;无肺栓塞,0·4±0·4;P≤0.001),但平均纤维蛋白原水平相似(肺栓塞,337±184 mg/dl;无肺栓塞,384±200 mg/dl;不显著)。在肺栓塞患者中,高危患者的平均d -二聚体水平和d -二聚体/纤维蛋白原比值高于非高危患者。d -二聚体截止值为0.35 μg/ml时,对肺栓塞的敏感性高(100%),特异性低(27%)。d -二聚体/纤维蛋白原比值为0.13时,对肺栓塞的敏感性高(100%),特异性低(37%)。结论:d -二聚体水平
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引用次数: 19
Epstein-Barr virus serology and PCR: conflicting results in an immunocompetent host. A case report and review of literature. 爱泼斯坦-巴尔病毒血清学和PCR:在免疫功能强的宿主中相互矛盾的结果。病例报告及文献复习。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 Epub Date: 2014-06-10 DOI: 10.1179/2295333714Y.0000000037
L Cattoir, V Van Hende, P De Paepe, E Padalko

We present the case of a 27-year-old immunocompetent man who progressively developed a generalized lymphadenopathy and B symptoms. Results of Epstein-Barr virus (EBV) serology were suggestive for a past infection, but the EBV viral load in whole blood was high. Also, core needle biopsy of the largest lymph node showed an image which could fit an EBV-driven reactive lymphoproliferation. Despite the absence of an immune disorder, all medical evidence points to an EBV-driven lymphoproliferative proces. In immunocompetent patients, it seems extremely uncommon to detect a high EBV viral load in the absence of serological evidence of an acute EBV infection or reactivation. We reviewed literature on this topic and on the selection of the appropriate sample type for EBV PCR, as this is known to be a critical point. Serological testing for the diagnosis of EBV infection is the gold standard in immunocompetent patients. Measuring EBV viral load is only recommended when dealing with immunocompromised patients. Although extremely rare, this case report shows that there is a place for EBV PCR in certain situations in immunocompetent patients. Besides, there is still no consensus regarding the specimen of choice for the determination of the EBV viral load. The preferred specimen type seems to depend on the patient's underlying condition.

我们提出的情况下,一个27岁的免疫能力的人谁逐渐发展为全身性淋巴结病和B症状。eb病毒(EBV)血清学结果提示既往感染,但全血EBV病毒载量高。此外,最大淋巴结的核心穿刺活检显示的图像符合ebv驱动的反应性淋巴增生。尽管没有免疫紊乱,但所有医学证据都指向ebv驱动的淋巴细胞增殖过程。在免疫功能正常的患者中,在没有急性EBV感染或再激活的血清学证据的情况下,检测到高EBV病毒载量似乎极为罕见。我们回顾了关于这一主题和EBV PCR合适样本类型选择的文献,因为这是一个已知的临界点。诊断EBV感染的血清学检测是免疫功能正常患者的金标准。只有在处理免疫功能低下的患者时才推荐测量EBV病毒载量。虽然极为罕见,但本病例报告表明,在免疫功能正常的患者中,EBV PCR在某些情况下有一席之地。此外,对于选择何种标本检测EBV病毒载量仍未达成共识。首选的标本类型似乎取决于患者的基础条件。
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引用次数: 3
Pulmonary embolism with Hampton's hump. 肺栓塞伴汉普顿驼峰。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000009
C H Lee, W P Chan
Introduction A middle-aged adult, who had been hospitalized because of acute ischemic stroke, complained of sudden shortness of breath on the second day of admission. On physical examination, he was afebrile and normotensive and had no abnormal breathing sounds. Laboratory tests revealed abnormal levels of fibrinogen, fibrin degradation products, and D-dimer, which were all elevated (D-dimer level: 15.9 mg/l fibrinogen equivalent unit; reference range: 0–0.55). Computed tomography (CT) was performed under the tentative diagnosis of pulmonary embolism on the basis of the patient’s clinical history and abnormal coagulation profile. CT of the chest showed filling defects (arrows) consistent with emboli in the main pulmonary trunk bilaterally (Fig. 1) and a focal wedge-shaped Hampton’s hump, which indicated a pleura-based infarction (arrow) of the corresponding arterial territory in the superior segment of the right lower lobe (Fig. 2). The patient’s condition deteriorated despite aggressive medical treatment and he died from respiratory failure.
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引用次数: 2
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