RESUMO
General lipoprotein (Lp) (a) screening can help to identify patients at high risk for cardiovascular disease. Non-invasive methods allow early detection of clinically asymptomatic incipient atherosclerotic disease. Medical treatment options are still unsatisfactory. Lp(a) apheresis is an established treatment in Germany for secondary prevention of progressive cardiovascular disease. Statin-based lowering of LDL cholesterol and thrombocyte aggregation inhibitors still represent the basis of medical treatment. Target levels for LDL-cholesterol should be modified in patients with hyperlipoproteinemia (a).
Assuntos
Remoção de Componentes Sanguíneos , Doenças Cardiovasculares/prevenção & controle , Hiperlipoproteinemias/terapia , Hipolipemiantes/uso terapêutico , Lipoproteína(a)/sangue , Prevenção Primária/métodos , Prevenção Secundária/métodos , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , LDL-Colesterol/sangue , Alemanha , Humanos , Hiperlipoproteinemias/sangue , Hiperlipoproteinemias/complicações , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Lipid apheresis is at present well established in routine treatment of diverse hyperlipoproteinemias refractory to conventional dietary and medical regimens, especially in countries with high medical and socioeconomic standards. Severe familial hypercholesterolemia with atherosclerotic vessel disease involving the coronary arteries is the most frequent indication for lipid apheresis as well as homozygous familial hypercholesterolemia before the development of cardiovascular complications.In hyperlipoproteinemia (a) with progressive vessel disease, lipid apheresis is regularly accepted in Germany. The indication of apheresis in Refsum's disease and the chylomicronemia syndrome is described.
Assuntos
Remoção de Componentes Sanguíneos/métodos , Hiperlipoproteinemias/sangue , Hiperlipoproteinemias/prevenção & controle , Lipoproteína(a)/sangue , Lipoproteína(a)/isolamento & purificação , Doença Crônica , Humanos , Hiperlipoproteinemias/diagnóstico , Seleção de Pacientes , Resultado do TratamentoRESUMO
ISSUES AND PURPOSE: Parents often examine and question interactions with their young teen and may ask the advice of healthcare professionals. Topics, frequency, and intensity of conflicts between young adolescents and parents were therefore examined. DESIGN AND METHODS: A descriptive survey using the 44-item Issues Checklist (Robin, 1975) with 163 parent and young adolescent (ages 11-14) dyads. RESULTS: Parents and teens were congruent about their reports of the topics, frequency, and intensity of conflict. Discussion of the topics generally was not angry. Mothers reported the greatest quantity of issues. Potentially sensitive topics such as substance use, dating, and sex were rarely approached by either parent or young adolescent. Sociodemographic characteristics did not distinguish or were not associated with IC scores. PRACTICE IMPLICATIONS: Conflict is a common component of the parent-young adolescent relationship. Families with children entering adolescence can expect conflict about issues that recur but usually are not that "hot". Anticipating topics may put conflict in perspective. Nurses help families resolve conflicts associated with day-to-day conflicts as a first step toward opening up larger, potentially sensitive topics.
Assuntos
Conflito Psicológico , Relações Pais-Filho , Psicologia do Adolescente , Adolescente , Adulto , Comunicação , Feminino , Humanos , Masculino , Psicologia do Adolescente/estatística & dados numéricos , Distribuição Aleatória , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Neural tube defects (NTD) are one of the most common birth defects and are caused by both environmental and genetic factors. The approach to identifying the genes predisposing to NTD, through linkage analysis and candidate gene analysis, is reviewed along with characteristics of a large, nationally ascertained cohort of families. Results from specific assessments of p53, PAX3 and MTHFR failed to suggest that these genes play a major role in NTD development in these families. Advances in genetic laboratory and statistical techniques have made this a prime opportunity for investigation into the causes of complex disorders, such as NTD. However, traditional approaches may prove to be challenging due to the difficulty of ascertaining samplable multiplex families.
Assuntos
Técnicas Genéticas , Defeitos do Tubo Neural/genética , Animais , Aberrações Cromossômicas/genética , Transtornos Cromossômicos , Estudos de Coortes , Ácido Fólico/metabolismo , Ligação Genética , Humanos , Defeitos do Tubo Neural/etiologia , Defeitos do Tubo Neural/metabolismo , Fatores de RiscoAssuntos
Benchmarking/normas , Hospitais Universitários/normas , Serviços de Informação/normas , Indicadores de Qualidade em Assistência à Saúde , Coleta de Dados , Grupos Diagnósticos Relacionados/classificação , Humanos , Joint Commission on Accreditation of Healthcare Organizations , New Mexico , Estudos de Casos OrganizacionaisRESUMO
Analysis of the quarterly quality improvement reports submitted by departments and teams at the University of New Mexico Hospital identified several common pitfalls: monitoring someone else's performance, choosing irrelevant or meaningless indicators, working with inadequate samples, changing measurement techniques or indicators too frequently, taking ineffective actions, and jumping to solutions. To overcome these pitfalls, managers and team leaders can use tools such as indicator worksheets, data collection plans, report forms, team-tracking mechanisms, and comprehensive guidelines as their guides through the quality improvement process.