American medical journal最新文献

{"title":"PERIOPERATIVE CARE OF ELDERLY SURGICAL PATIENTS","authors":"Aly Saber","doi":"10.3844/AMJSP.2013.63.77","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.63.77","url":null,"abstract":"Advancing age is characterized by functional impairment of the many regulatory processes that provide integration between organs and therefore, may lead failure to maintain homeostasis under conditions of physiological stress. There are two main factors helping to identify the high risk for surgery. The first relates to the type of surgery and the second to the scope of cardiopulmonary functional capacity of the patient. There are major cardiovascular, respiratory, renal and musculoskeletal changes in elderly patients. Preoperative assessment of risk in elderly patients must consider patient factors, the surgical problem and the treatment options. Medical co-morbid conditions are common with age and may markedly increase the risks associated with surgical intervention. Postoperative care of elderly includes respiratory Care, renal function and fluid and electrolyte management, cardiovascular Care, management of pain and maintenance of function. In conclusion, health providers should pay attention to the quality of care in elderly patients because they are vulnerable surgical and anaesthetic stress. Minimizing perioperative risk in those patients requires thoughtful preoperative assessment of organ function and reserve, meticulous intraoperative management and postoperative care. Management of surgical elderly patients is both complex and different from younger patients. Assessment of the surgical problems and physiologic status of elderly persons must take into account the changes associated with advancing age, changes in the incidence, prevalence and natural history of certain disease processes; and the increased likelihood of multiple medical diagnoses and polypharmacy.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"97 1","pages":"63-77"},"PeriodicalIF":0.0,"publicationDate":"2013-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.63.77","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IS CANCER RECURRENCE POSTPONED BY A TREATMENT? A NEW MODEL ANSWERS","authors":"R. Shanmugam","doi":"10.3844/AMJSP.2013.43.62","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.43.62","url":null,"abstract":"During a treatment period of a cancer patient, the medical team ponders over a question: Is patient’s cancer recurrence significantly postponed by the medication, even if the illness is not completely cured? This question could be answered with data evidence if the data are analyzed with an appropriate model and a suitable methodology. A scanning of the literature reveals that no suitable technique now exists. Hence, there is a need to develop a new probability model and to formulate a statistical methodology. Both tasks are accomplished in this article to answer the above question. The Exponential Distribution (ED) is traditionally employed to portray the chance for a patient to survive beyond a given time, t>0. Because of its memory less property, the exponential distribution lacks an ability to answer whether the medication has significantly postponed the cancer recurrence for a patient. In essence, this memory less property assumes that a patient’s body functions with no memory. This notion of memory less is quite unreal with respect to cancer recurrence as it is contradictory to the medical belief of medicating a patient with an intention to stop or at least postpone cancer recurrence in a disease management. This article takes an approach by adding a prolonging parameter, ρ≥0 to the exponential distribution to represent the medication’s effect on the survival chance for a patient without a cancer recurrence. Because of the prolonging parameter, the probability structure of the exponential distribution gets altered and it is explicitly explained in the article. The altered exponential distribution is named Prolonged Survival Exponential Distribution (PSED). The properties of PSED are derived and then utilized to analyze patients’ cancer recurrence data. Also, likelihood ratio based statistical methodology based on PSED is derived and illustrated to address whether the medication has significantly postponed the cancer’s recurrence time in a particular patient. An analysis of recurrence times of three groups of sixteen bladder cancer patients was done. The first is the placebo group with seven patients. The second and third group consist respectively three and six patients receiving thiotepa and pyridoxine medication. The probability plots of their recurrence times confirm that the data do not follow an exponential distribution. The data analyses results reveal interesting statistical information about how effective the medication had been on each individual patient. Without the new model, PSED and the likelihood ratio testing methodology of this article, a patient specific interpretation is not possible. The medication worked in some but not all patients. The medication is thought to have not worked in a patient, when his/her estimate, ρ is closer to zero. However, on the average, the 2nd bladder cancer recurrence time is quicker in place group, next in pyridoxine group and much later in tholepin group. The new model, PSED and the likelihood ","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"4 1","pages":"43-62"},"PeriodicalIF":0.0,"publicationDate":"2013-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.43.62","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin therapy in the management of diabetes mellitus; how relevant?","authors":"Fasanmade Olufemi Adetola, Odeniyi Ifedayo Adeola","doi":"10.3844/AMJSP.2013.36.42","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.36.42","url":null,"abstract":"Diabetes is associated with the development of premature cardiovascular disease. There have been many clinical trials of statin treatment conducted in patients with Coronary Heart Disease (CHD). Taking a closer look at the subset of those patients with diabetes mellitus puts no doubt on the beneficial effect of lowering cholesterol with statin in these patients. Earlier studies done dwell more on cholesterol reduction with statins in patients with CHD but without diabetes hence no strong supporting evidence was there to justify the use of statins in diabetic patients without cardiovascular disease. We search medline for studies on cholesterol reduction and cardiovascular risk reduction in diabetic patients. We found three secondary prevention trials (4S, CARE and LIPID); four primary prevention trials (ASCOT-LLA, CARDS, WOSCOPS and TexCaps); two mixed prevention trials (HPS and ASPEN); three trials (PROVE-IT, TNT and A to Z) that seek to evaluate whether intensive or moderate lipid lowering with statins will prevent cardiovascular risk and to what extent. Treatment decisions should be based on the reduction of absolute risk and not on the reduction in relative risk. Patients suffering from diabetes mellitus will incur a huge cost if they were to be commenced on statin from the day the diagnosis of diabetes was made. With the rising incidence of diabetes worldwide, statins should be targeted to those patients with diabetes mellitus who are most likely to benefit from it. Type 2 DM patients with metabolic syndrome or those with mild to moderate cardiovascular risk will benefit from statin therapy. Clinical benefits stand to be derived from statin therapy if moderate reduction of risk can be achieved in patients that are classified as having high cardiovascular risk. What this means is that all patients eligible to be enrolled in the HPS or CARDS study should be on statin treatment.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"4 1","pages":"36-42"},"PeriodicalIF":0.0,"publicationDate":"2013-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.36.42","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EPIGENETIC MECHANISMS IN HEPATITIS C VIRUS-ASSOCIATED HEPATOCELLULAR CARCINOMA: A POTENTIAL NEW LINK BETWEEN STEM CELLS, VIROLOGY AND CANCER","authors":"Q. Feng, S. Hassan, T. Das, Jianfei Huang, Zhenqing Feng, D. Gretch","doi":"10.3844/AMJSP.2013.21.35","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.21.35","url":null,"abstract":"Recent studies suggest that epigenetic mechanisms are not only essential for the dynamic transcriptional regulation in embryonic and somatic stem cells, but are also actively involved in tumorigenesis: genes important for pluripotency are epigenetically regulated and aberrant epigenetic changes have been detected in virtually all human malignancies studied, including Hepatocellular Carcinoma (HCC). Infection with Hepatitis C Virus (HCV) is a major risk factor for the development of HCC. Despite the fact that HCV is a RNA virus without a DNA intermediate, recent studies demonstrate that HCV viral proteins may actively participate in epigenetic regulation of hepatic cancer stem cell phenotypes and induce HCC-specific epigenetic changes. Identification of host epigenetic alterations induced by HCV infection and epigenetic differences between hepatic cancer stem cells and the bulk non-tumorigenic cancer cells, may yield potential biomarkers for early detection, as well as therapeutic targets for HCV associated HCC.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"11 1","pages":"21-35"},"PeriodicalIF":0.0,"publicationDate":"2013-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.21.35","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mosaic Masonries to Interpret Diagnostic Test Results","authors":"R. Shanmugam","doi":"10.3844/AMJSP.2013.12.20","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.12.20","url":null,"abstract":"Currently, assessing superiority of a diagnostic test requires cumbersome calculations and confusing interpretations because of nonlinear Receiver Operating Characteristic Curve (ROC). To remedy these difficulties, this article prepares, provides an easier alternate geometric approach. That is, a simple but more effective visual approach with two complementary mosaic masonries are constructed with their properties, superimposed and utilized. First masonry is conditional on disease status. The second masonry is conditional on test outcomes. By superimposing both masonries and visualizing their overlap territory, our approach utilizes an angle, θ to assess superiority of a diagnostic test. A hypothesis testing procedure is also devised to compute the significance level of an estimated angle. The statistical power to accept a true angle is developed in the procedure. In the end, the concepts, properties and advantages of mosaic masonries are illustrated using medical and public health data sets.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"4 1","pages":"12-20"},"PeriodicalIF":0.0,"publicationDate":"2013-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.12.20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ALCOHOL CONSUMPTION AND ITS CORRELATES AMONG RESIDENTS OF MINING TOWN, KITWE, ZAMBIA: 2011 POPULATION BASED SURVEY","authors":"Cosmas Zyaambo, O. Babaniyi, P. Songolo, A. Muula, E. Rudatsikira, S. Siziya","doi":"10.3844/AMJSP.2013.6.11","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.6.11","url":null,"abstract":"Alcohol consumption is a risk factor for non-communicable diseases such as cardiovascular diseases, li ver cirrhosis and cancers. It has also been associated with risky sexual behaviors, hence, attributed as a factor in the increase of HIV incidence and prevalence. A cro ss sectional study was conducted using a modified World Health Organizations Global Non Communicable Diseases (NCD) Surveillance Initiative NCD STEPs 1and 2. Multivariate logistic regression was used to examine the determinants of alcohol consumption. A total of 1627 individuals participat ed in the survey, of which 42.3% were males. Some 22.3% (36.2% of male and 12.1% of female; p<0.001) participants reported to have consumed alcohol during the 30 days preceding the survey. The factor s considered to be associated with alcohol consumpt ion were age, sex and smoking. Compared to respondents age 25-34 years, respondents of age 35-44 years wer e 38% (AOR = 1.38, 95%CI [1.11, 1.70]) more likely to report having consumed alcohol and those aged 45 years or older were 26% (AOR = 0.74, 95%CI [0.60, 0.93]) less likely to report having consumed alcohol . Female respondents were 47% (AOR = 0.53, 95%CI [0.46, 0.60]) less likely to report consuming alcohol compared to male respondents. Compared to respondents who reported smoking cigarettes, those who did not smoke cigarettes were 51% (AOR = 0.49, 95%CI [0.40, 0.59]) less likely to consume alcohol. The rat e of alcohol consumption is high in this mining town. Factors identified in this study as associated wit h alcohol consumption, i.e., male sex, age, cigarette smoking, should be considered in designing interve ntions to curtail the level of alcohol consumption.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"4 1","pages":"6-11"},"PeriodicalIF":0.0,"publicationDate":"2013-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.6.11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total Ankle Replacement: A Review","authors":"A. Jariwala, S. Sripada, A. Pillai","doi":"10.3844/AMJSP.2013.1.5","DOIUrl":"https://doi.org/10.3844/AMJSP.2013.1.5","url":null,"abstract":"Despite the initial failures of ankle arthroplasty, the newer generations of total ankle replacement h ave shown good medium term results. Reasons stated for this change include a better overall understanding of ankle biomechanics; lessons learnt from hip and kne e arthroplasty, improved ankle implant designs that better replicate the human anatomy and finally in t he development of foot and ankle surgery as a subspeciality with committed surgeons. Literature supp orts the use of total ankle replacement for advance d ankle arthritis in elderly patients with moderately active lifestyle but recommends counselling patien ts appropriately regarding reasonable expectations and complications. This review looks at the developmen t of total ankle replacement, present indications; the s urgical technique, the results from various centres and indicates the present position regarding the manage ment of ankle arthritis.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"4 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2013-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2013.1.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Fetuin-A and Systemic Lupus Erythematosus as a Predictor Marker for Atherosclerosis","authors":"O. Mosa, I. H. Mohamad, Magdi M. Salama","doi":"10.3844/AMJSP.2012.249.254","DOIUrl":"https://doi.org/10.3844/AMJSP.2012.249.254","url":null,"abstract":"Problem statement: Associations between serum levels of fetuin-A, C3 complement, calcium ◊ phosphate product and calcification risk index and lipid profile in SLE patients were established. However, the mechanism of accelerated atherosclerosis accompanied with SLE remains elusive. We therefore turned to investigate the ass ociation between Fetuin-A, disease activity and accelerated atherosclerosis in patients with SLE. Approach: Serum blood samples were taken from 100 female SLE patients. All Patient samples were a nalyzed by ELISA for determination of Fetuin-A level. Calcium, Phosphate, C3 compelement, Lipid profile, Creatinine and urea were measured also in SLE patients compared with healthy control volunteers. Results: We found that Serum fetuin-A had been positively associated with carotid arterial st iffness, independent of known atherogenic factors i n healthy subjects. Furthermore, Fetuin-A was correla ted negatively with IMT, SLEDAI, CRI, CaxP product, Triglycerdies, VLDL and LDL. While it was correlated positively with C3 complement. Conclusion: Fetuin-A deficiency accompanied with increasing levels of calcium and phosphate gave an evidence that there was a key role of fetuin-A a s a strong inhibitor of Cardio Vascular Calcificati on (CVC) by formation of a complex called (calciprotei n) with calcium and phosphate in blood stream. So, Identification of biologic markers of disease a ctivity associated with atherosclerosis may help to optimize therapy for this important manifestation o f systemic autoimmune disease.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"3 1","pages":"249-254"},"PeriodicalIF":0.0,"publicationDate":"2012-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2012.249.254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70191717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex, Health Behaviors and Social Support: Functional Decline among Older Diabetics.","authors":"Emily Joy Nicklett","doi":"10.3844/amjsp.2012.82.92","DOIUrl":"10.3844/amjsp.2012.82.92","url":null,"abstract":"<p><strong>Problem statement: </strong>Men and women experience pronounced differences in functional decline as they age. The mechanisms behind these differences remain unclear, particularly among chronically ill populations. Drawing on the theory of the disablement process, this research examines sex differences in functional decline, focusing on two mechanisms suggested by the literature to partially mediate these disparities: health behaviors and social support.</p><p><strong>Approach: </strong>Data from diabetics aged 50 and older from the Health and Retirement Study (n = 2,493) were examined for change in functional status over a 10-year period. Multivariate longitudinal multi-level models were conducted to analyze (1) health behavior (2) social support; and (3) a full model with health behavior and social support together, followed by a separate analysis using sex interaction terms.</p><p><strong>Results: </strong>Women and men both experienced functional decline over time. In the models that examined health behaviors and social support separately, women experienced steeper rates of decline. In the full model (which included health behaviors and social support together), men experienced a steeper rate of decline relative to women. The analyses suggest that it is the combination of health and social characteristics (largely through engagement in socially supportive activities that promote health) that are protective against functional decline.</p><p><strong>Conclusion/recommendations: </strong>As diabetic men experienced a steeper rate of functional decline than diabetic women once health behaviors and social support were both held constant, future research must examine (a) how these protective factors operate in tandem to protect against disablement of women with diabetes; and (b) how clinical and social policy can promote multi-pronged interventions to improve health behaviors in supportive contexts. Such research will benefit from multi-disciplinary collaborations.</p>","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"3 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866132/pdf/nihms439215.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31972663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Risk of Falls in Elderly Patients with Osteoarthritis of the Knee and Low Back Pain","authors":"P. D. Pereira, Rodrigo Aparecido Prates de Miranda, M. Orsini, M. Leite, V. Bastos, D. Machado","doi":"10.3844/AMJSP.2012.231.236","DOIUrl":"https://doi.org/10.3844/AMJSP.2012.231.236","url":null,"abstract":"This study aimed identify which groups of elderly are at higher risk of falls, with osteoarthritis (OA), low back pain or both conditions. 29 elderly were distributed in three groups: OA of the Knee (OAK), Low Back Pain (LBP) and the two events concomitantly (OL). Evaluation tools applied were: Mini Mental State Examination (MMSE), Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Roland Morris Functional Performance Questionnaire, Gait Speed (GS), Timed Get Up and Go Test (TGUGT) and Berg Balance Scale (BBS). No differences were found in the three groups for assessment by GS, TGUGT and BBS instruments. A significative difference was found by RMQ in groups LPB and OL, WOMAC found difference in pain domain between groups OL and OAK and VAS analysis showed significative difference between group OL to the others groups. No significative difference was found between groups by the assessment of balance.","PeriodicalId":89887,"journal":{"name":"American medical journal","volume":"3 1","pages":"231-236"},"PeriodicalIF":0.0,"publicationDate":"2012-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3844/AMJSP.2012.231.236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70192124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}