检索结果-南通市图书馆

Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal surgery 2013年第6期5卷 178-186页

作者： Amanda K Arrington Rebecca A Nelson Ann Falor Carrie Luu Rebecca L Wiatrek Marwan Fakih Gagandeep Singh Joseph Kim Division of Surgical Oncology City of Hope Comprehensive Cancer CenterDuarteCA 91010United States Department of biostatistics City of Hope Comprehensive Cancer CenterDuarteCA 91010United States Department of surgery Harbor-UCLA Medical CenterTorranceCA 90509United States Department of Medical Oncology City of Hope Comprehensive Cancer CenterDuarteCA 91010United States

AIM:To examine surgical and medical outcomes for patients with cholangiocarcinoma using a populationbased cancer ***:Using the California Cancer Registry's Cancer Surveillance Program,patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received(surgery,radiation,and chemotherapy).The surgical cohort was further categorized into three treatment groups:patients who received adjuvant chemotherapy,adjuvant chemoradiation,or underwent surgery alone(no chemotherapy or radiation administered).Survival was assessed by Kaplan-Meier method;and Cox proportional hazard modeling was used in multivariate ***:Of 825 patients,60.2% received no *** the remaining 328 patients,18.5% chemotherapy only,7.4% chemoradiation,and 13.8% underwent *** male patients underwent surgical resection(P = 0.004).Surgical patients were younger than the patients receiving chemotherapy or chemoradiation(P surgery alone while 39.5% underwent surgery plus adjuvant therapy(chemotherapy n = 20;chemoradiation,n = 21)(P surgery(23 mo),whereas both chemotherapy(9 mo) and chemoradiation(8 mo) alone were each less effective(P surgery,and administration of chemotherapy(with/without surgery) were independent predictors of overall ***:This study demonstrates that surgery is a critical treatment *** treatment has yet to be standardized,but play a role in optimal therapy for cholangiocarcinoma.

关键词： Cholangiocarcinoma Chemotherapy surgery Survival Therapies

Relationship between HER-2 overexpression and brain metastasis in esophageal cancer patients

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Gastrointestinal Oncology 2012年第5期4卷 103-108页

作者： Taher Abu Hejleh Barry R DeYoung Eric Engelman Jeremy M Deutsch Bridget Zimmerman Thorvardur R Halfdanarson Daniel J Berg Kalpaj R Parekh William R Lynch Mark D Iannettoni Sudershan Bhatia Gerald Clamon Division of Hematology Oncology and Marrow TransplantationDepartment of Internal MedicineUniversity of Iowa Hospitals and Clinics200 Hawkins DriveC32 GHIowa CityIA 52242-1081United States Department of Pathology University of Iowa Hospitals and Clinics200 Hawkins Drive5238C RCPIowa CityIA 52242-1081United States Department of biostatistics College of Public HealthUniversity of Iowa200 Hawkins DriveN377 CPHBIowa CityIA 52242-1081United States Department of Cardiothoracic surgery University of Iowa Hospitals and Clinics200 Hawkins DriveSE514 GHIowa CityIA 52242-1081United States Department of Radiation Oncology University of Iowa Hospitals and Clinics200 Hawkins Drive1624 PFPIowa CityIA 52242-1081United States

AIM:To study if HER-2 overexpression by locally advanced esophageal cancers increase the chance of brain metastasis following ***:We retrospectively reviewed the medical records of esophageal cancer patients who underwent esophagectomy at University of Iowa Hospitals and Clinics between 2000 and *** analyzed consisted of demographic and clinical *** brain metastasis tissue was assayed for HER-2 overexpression utilizing the FDA approved DAKO Hercept Test.RESULTS:One hundred and forty two patients were *** age was 64 years(36-86 years).Eighty eight patients(62%) received neoadjuvant *** complete and partial responses were achieved in 17(19%) and 71(81%) *** relapsed in 43/142(30%) *** brain was the first site of relapse in 9/43 patients(21%,95% CI:10%-36%).HER-2 immunohistochemistry testing of the brain metastasis tissue showed that 5/9(56%) cases overexpressed HER-2(3+ staining).CONCLUSION:HER-2 overexpression might be associated with increased risk of brain metastasis in esophageal cancer patients following *** studies will be required to validate this observation.

关键词： Esophageal neoplasm Esophageal cancer HER-2 Genes,erbB-2 Brain Neoplasms Brain metastasis

Risk of complications and urinary incontinence following cytoreductive prostatectomy： a multi-institutional study

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Asian Journal of Andrology 2018年第1期20卷 9-14页

作者： Dae Keun Kim Jaspreet Singh Parihar Young Suk Kwon Sinae Kim Brian Shinder Nara Lee Nicholas Farber Thomas Ahlering Douglas Skarecky Bertram Yuh Nora Ruel Wun-lae Kim Koon Ho Rha Isaac Yi Kim Department of Urology CHA Seoul Station Medical Center CHA University CHA Medical School Seou104637 Korea Department of Urology School of Medicine Graduate School Hanyang University Seou104763 Korea Section of Urologic Oncology Rutgers Cancer Institute of New Jersey and Division of Urology Rutgers Robert Wood Johnson Medical School Rutgers The State University of New Jersey New Brunswick 08901 USA Department of biostatistics Rutgers School of Public Health The State University of New Jersey New Brunswick NJ Piscataway 08854 USA Department of Internal Medicine Rutgers Robert Wood Johnson Medical School Rutgers The State University of New Jersey New Brunswick 08901 USA Department of Urology University of California Irvine School of Medicine Orange 92687 USA Division of Urology and UroLogic Oncology City of Hope National Medical Center Duarte 91010 USA Department of Urology Chungbuk National University College of Medicine Cheongju 28644 Korea Department of Urology and Urological Science Institute College of Medicine Yonsei University Seou103722. Korea

Emerging evidence has suggested that cytoreductive prostatectomy （CRP） allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer （mPCa） has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer （PCa）. Urinary incontinence was defined as the use of any pad. CRP had longer operative times （200 min vs 140 min, P 〈 0.0001） and higher estimated blood loss （250 ml vs 125 ml, P 〈 0.0001） compared to the control group. However, both overall （8.82% vs 5.85%） and major complication rates （4.41% vs 2.17%） were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group （57.4% vs 90.8%, P 〈 0.0001）. Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model （OR： 1.18; 95% Ch 1.02-1.37; P= 0.025） and surgery type-adjusted model （OR： 1.17; 95% Ch 1.01-1.36; P= 0.034）. In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

关键词： cytoreductive surgical procedures metastatic prostate cancer outcome radical prostatectomy

Weight trends in United States living kidney donors:Analysis of the UNOS database

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Transplantation 2015年第3期5卷 137-144页

作者： Mala Sachdeva Lisa M Rosen Jeny Varghese Steven Fishbane Ernesto P Molmenti Department of Medicine Division of Kidney Diseases and HypertensionNorth Shore University Hospital and LIJ Medical CenterHofstra North Shore-LIJ School of Medicine Department of biostatistics Feinstein Institute For Medical ResearchNorth Shore University Hospital and LIJ Medical CenterHofstra North Shore-LIJ School of Medicine Department of surgery North Shore University Hospital and LIJ Medical CenterHofstra North Shore-LIJ School of Medicine

AIM: To analyze the national trends associated with body mass index(BMI) and living kidney ***: Forty-seven thousand seven hundred and five adult living kidney donors as reported to the Organ Procurement and Transplantation Network from 1999 to 2011 were analyzed using their pre-donation BMI. Predictor variables of interest included age, gender, ethnicity, relationship, education status, and transplant ***: Sixteen thousand nine hundred and seventyone of the living kidney donors were normal weight(35.6%); 19337 were overweight(40.5%); 9007 were mildly obese(18.9%); 1992 were moderate to morbidly obese(4.2%). Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively(P < 0.05). Donors 35-49years of age, hispanic males or females and black females, those with high school diploma or general Education Degree, and biologically related or partner/spouses were more likely to be ***: Over the past 13 years, the majority of living kidney donors have spanned the overweight to obese categories. Paralleling the national rise is an increase in overweight and mildly obese kidney donors. A fair number of moderate to morbidly obese living kidney donors are still allowed to donate.

关键词： Transplantation Obesity Donor Kidney Living

A pairwise radiomics algorithm–lesion pair relation estimation model for distinguishing multiple primary lung cancer from intrapulmonary metastasis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Precision Clinical Medicine 2023年第4期6卷 239-247页

作者： Ting-Fei Chen Lei Yang Hai-Bin Chen Zhi-Guo Zhou Zhen-Tian Wu Hong-He Luo Qiong Li Ying Zhu Department of Thoracic surgery The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510000China Breax Laboratory PCAB Research Center of Breath and MetabolismBeijing 100017China Reliable Intelligence and Medical Innovation Laboratory(RIMI Lab) Department of Biostatistics&Data ScienceUniversity of Kansas Medical Centerand University of Kansas Cancer CenterKansas CityKS 66160USA Center for Information Technology&Statistics Statistics SectionThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510000China Department of Radiology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou 510000China Department of Radiology The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510000China

Background:Distinguishing multiple primary lung cancer(MPLC)from intrapulmonary metastasis(IPM)is critical for their disparate treatment strategy and *** study aimed to establish a non-invasive model to make the differentiation ***:We retrospectively studied 168 patients with multiple lung cancers(307 pairs of lesions)including 118 cases for modeling and internal validation,and 50 cases for independent external *** features on computed tomography(CT)were extracted to calculate the absolute deviation of paired *** were then selected by correlation coefficients and random forest classifier 5-fold cross-validation,based on which the lesion pair relation estimation(PRE)model was developed.A major voting strategy was used to decide diagnosis for cases with multiple pairs of *** from another institute were included as the external validation set for the PRE model to compete with two experienced ***:Seven radiomic features were selected for the PRE model *** major voting strategy,the mean area under receiver operating characteristic curve(AUC),accuracy,sensitivity,and specificity of the training versus internal validation versus external validation cohort to distinguish MPLC were 0.983 versus 0.844 versus 0.793,0.942 versus 0.846 versus 0.760,0.905 versus 0.728 versus 0.727,and 0.962 versus 0.910 versus 0.769,*** of the two clinicians were 0.619 and ***:The CT radiomic feature-based lesion PRE model is potentially an accurate diagnostic tool for the differentiation of MPLC and IPM,which could help with clinical decision making.

关键词： multiple primary lung cancer radiomics intrapulmonary metastasis

埃塞俄比亚转诊医院患者感知关怀行为的调查研究

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

International Journal of Nursing Sciences 2023年第3期10卷 391-397页

作者： Abebaw Jember Ferede Lena Wettergren Kerstin Erlandsson Lemma Derseh Gezie Helena Lindgren Biftu Geda Department of Medical Nursing School of NursingCollege of Medicine and Health SciencesUniversity of GondarPostal address:196GondarEthiopia Department of Women’s and Children’s Health Karolinska InstitutetStockholmSweden Department of Public Health and Caring Sciences Uppsala UniversityUppsalaSweden School of Education Health and WelfareDalarna UniversityFalunSweden Department of Epidemiology and biostatistics Institute of Public HealthCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia Department of Nursing College of Health ScienceShashamene CampusMadda Walabu UniversityShashameneEthiopia

目的本研究旨在了解患者对护士关怀行为的感知及关联因素。方法在埃塞俄比亚3所转诊医院进行横断面研究。连续抽取652例患者(应答率98.8%),应用阿姆哈拉语版关怀行为量表-16(Caring Behav-iors Inventory-16,CBI-16)和患者满意度量表(Pa... 详细信息

目的本研究旨在了解患者对护士关怀行为的感知及关联因素。方法在埃塞俄比亚3所转诊医院进行横断面研究。连续抽取652例患者(应答率98.8%),应用阿姆哈拉语版关怀行为量表-16(Caring Behav-iors Inventory-16,CBI-16)和患者满意度量表(Patient Satisfaction Instrument,PSI)进行调查。其中,CBI-16包含4个分量表:支持保证、知识技能、尊重和联系。使用多元线性回归分析确定与患者感知关怀行为相关联的社会人口学因素和临床相关因素。结果患者对护士关怀行为的感知程度较高,总平均分为4.86(SD=0.72)分,其中支持保证分量表得分最高。多元回归分析显示,部分社会人口统计学变量和临床相关因素与患者对关怀行为的感知(总平均分)存在关联。40~49岁(B=-0.19,P=0.012)和单身(B=-0.13,P=0.03)的患者CBI-16得分较低。受教育程度较高(B=0.35,P=0.001)、外科患者(B=0.11,P=0.027)、在过去8 h与护士相处时间较多(B=0.16,P<0.001)的患者对关怀行为的感知程度更高。CBI-16得分与PSI得分呈正相关(r=0.62,P<0.001)。结论埃塞俄比亚住院患者对护士关怀行为的总体感知程度较高,尤其是身体护理方面,但对情感关怀的感知程度较低。本研究认为,年龄40~49岁的单身患者更需要被关怀。患者与护士相处的时间对于患者感知护士关怀行为有重要影响。

关键词：关怀行为埃塞俄比亚医疗卫生服务患者满意度问卷调查

Envonalkib versus crizotinib for treatment-naive ALK-positive non-small cell lung cancer: a randomized, multicenter, open-label, phase III trial

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Signal Transduction and Targeted Therapy 2023年第9期8卷 4338-4345页

作者： Yunpeng Yang Jie Min Nong Yang Qitao Yu Ying Cheng Yanqiu Zhao Manxiang Li Hong Chen Shou’an Ren Jianying Zhou Wu Zhuang Xintian Qin Lejie Cao Yan Yu Jian Zhang Jianxing He Jifeng Feng Hao Yu Li Zhang Wenfeng Fang Department of Medical Oncology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhou 510060China Department of Oncology The Second Affiliated Hospital of Air Force Medical UniversityXi’an 710038China Department of Medical Oncology Lung Cancer and Gastrointestinal UnitHunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of MedicineCentral South UniversityChangsha 410013China Department of Medical Oncology of Respiratory Affiliated Tumor Hospital of Guangxi Medical UniversityGuangxiNanning 530021China Department of Thoracic Medical Oncology Jilin Provincial Cancer HospitalChangchun 130012China Department of Medical Oncology The Affiliated Cancer Hospital of Zhengzhou UniversityZhengzhou 450003China Department of Respiratory First Affiliated Hospital of Xian Jiaotong UniversityXi’an 710061China Department of Respiratory and Critical Care Medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400050China Department of Respiratory The First Hospital of Shanxi Medical UniversityTaiyuan 030001China Department of Respiratory Disease The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Medical Oncology Fujian Cancer HospitalFuzhou 350014China The First Department of Oncology The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhou 510699China Department of Respiratory and Critical Care Medicine Anhui Provincial HospitalHefei 230000China Department of Respiratory Medicine Affiliated Cancer Hospital of Harbin Medical UniversityHarbin 150000China Department of Respiratory Medicine The First Affiliated Hospital of Air Force Medical UniversityXi’an 710032China Department of Cardiothoracic surgery The First Affiliated Hospital of Guangzhou Medical CollegeGuangzhou Research Institute of Respiratory Disease and China State Key Laboratory of Respiratory DiseaseGuangzhou 510120China Department

Anaplastic lymphoma kinase(ALK)rearrangements are present in about 5–6%of non-small cell lung cancer(NSCLC)cases and associated with increased risks of central nervous system(CNS)***,a novel ALK inhibitor,demonstrated promising anti-tumor activity and safety in advanced ALK-positive NSCLC in the first-in-human phase I *** phase III trial(*** NCT04009317)investigated the efficacy and safety of first-line envonalkib in advanced ALK-positive NSCLC *** 264 participants were randomized 1:1 to receive envonalkib(n=131)or crizotinib(n=133).Median independent review committee(IRC)-assessed progression-free survival(PFS)times were 24.87(95%confidence interval[CI]:15.64–30.36)and 11.60(95%CI:8.28–13.73)months in the envonalkib and crizotinib groups,respectively(hazard ratio[HR]=0.47,95%CI:0.34–0.64,p<0.0001).IRC-assessed confirmed objective response rate(ORR)was higher(81.68%vs.70.68%,p=0.056)and duration of response was longer(median,25.79[95%CI,16.53–29.47]vs.11.14[95%CI,9.23–16.59]months,p=0.0003)in the envonalkib group compared with the crizotinib *** participants with baseline brain target lesions,IRC-assessed CNS-ORR was improved with envonalkib compared with crizotinib(78.95%vs.23.81%).Overall survival(OS)data were immature,and median OS was not reached in either group(HR=0.84,95%CI:0.48–1.47,p=0.5741).The 12-month OS rates were 90.6%(95%CI,84.0%–94.5%)and 89.4%(95%CI,82.8%–93.6%)in the envonalkib and crizotinib groups,***≥3 treatment-related adverse events were observed in 55.73%and 42.86%of participants in the envonalkib and crizotinib groups,*** significantly improved PFS and delayed brain metastasis progression in advanced ALK-positive NSCLC.

关键词： crizotinib randomized cancer

Post-discharge mortality in the first wave of COVID-19 in Turkey

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Asian Pacific Journal of Tropical Medicine 2022年第11期15卷 479-484页

作者： Fusun Fakili Pelin Duru Cetinkaya Oya Baydar Serap Argun Baris Nurdan Kokturk Seval Kul Oguz Karcioglu Pinar Aysert Yildiz Ilim Irmak Yonca Sekibag Emel Azak Sait Mulamahmutoglu Caglar Cuhadaroglu Bugra Kerget Burcu Baran Ketencioglu Hasan Selcuk Ozger Gulcihan Ozkan Zeynep Ture Merve Ercelik Tansu Ulukavak Ciftci Ozlem Alici Esra Nurlu Temel Ozlem Ataoglu Neslihan Kose Muge Meltem Tor Gulsah Gunluoglu Sedat Altin Onder Ozturk Pinar Yildiz Gulhan Ilknur Basyigit Hasim Boyaci I Kivilcim Oguzulgen Sermin Borekci Bilun Gemicioglu Ismail Hanta Hacer Kuzu Okur Gulseren Sagcan Metin Akgun Ali Fuat Kalyoncu Oya Itil Hasan Bayram Department of Pulmonary Medicine Faculty of MedicineGaziantep UniversityGaziantepTurkey Department of Pulmonary Medicine University of Health SciencesAdana City Training and Research HospitalFaculty of MedicineCukurova UniversityAdanaTurkey Department of Pulmonary Medicine Faculty of MedicineCukurova UniversityAdanaTurkey Department of Pulmonary Medicine Faculty of MedicineKocaeli UniversityKocaeliTurkey Department of Pulmonary Medicine Faculty of MedicineGazi UniversityAnkaraTurkey Department of biostatistics Faculty of MedicineGaziantep UniversityGaziantepTurkey Department of Pulmonary Medicine Halil Sivgin Cubuk State HospitalAnkaraTurkey Department of Infectious Disease Faculty of MedicineGazi UniversityAnkaraTurkey Department of Pulmonary Medicine Faculty of MedicineHacettepe UniversityAnkaraTurkey Department of Pulmonary Medicine Cerrahpasa Faculty of MedicineIstanbul University−CerrahpasaIstanbulTurkey Department of Infectious Disease and Clinical Microbiology Faculty of MedicineKocaeli UniversityKocaeliTurkey Department of Pulmonary Medicine Altunizade Acibadem HospitalIstanbulTurkey Department of Pulmonary Medicine Faculty of MedicineAtaturk UniversityErzurumTurkey Department of Pulmonary Medicine Faculty of MedicineErciyes UniversityKayseriTurkey Department of Pulmonary Medicine Maslak Acibadem HospitalIstanbulTurkey Department of Infectious Disease and Clinical Microbiology Faculty of MedicineErciyes UniversityKayseriTurkey Department of Pulmonary Medicine Faculty of MedicineDuzce UniversityDuzceTurkey Department of Infectious Disease Faculty of MedicineTurkiye Gazetesi Private HospitalIstanbulTurkey Department of Infectious Diseases and Clinical Microbiology Faculty of MedicineSuleyman Demirel UniversityIspartaTurkey Department of Pulmonary Medicine Bilecik Training and Research HospitalBilecikTurkey Department of Pulmonary Medicine Faculty of MedicineZonguldak Bulent Ecevit UniversityZonguldakTurkey Department of Pulmonary Medicine Universi

Objective:To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society(TTD)-TURCOVID ***:In this retrospective cohort study,we analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study,and 1112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the *** causes of death after COVID-19 discharge were ***:The mean age of the patients was(51.07±16.93)years,with 57.6%male *** the cohort group,89.1%of COVID-19 treatment locations were hospital wards,3.6%were intensive care units(ICUs),and 7.2%were community *** the longterm follow-up,the in-hospital mortality rate was 3.6%(95%CI 2.6-4.8),the post-discharge mortality rate was 2.8%(95%CI 1.9-3.9),and the total mortality was 6.3%(95%CI 5.0-7.8).After discharge,63.3%of mortality overall occurred during the first six *** rates in post-discharge follow-ups were 12.7%(95%CI 8.0-30.6)in cancer patients,10.8%(95%CI 6.3-22.9)in chronic obstructive pulmonary disease patients,11.1%(95%CI 4.4-22.7)in heart failure patients,7.8(95%CI 3.8-14.3)in atherosclerotic heart disease patients,and 2.3%(95%CI 0.8-5.6)in diabetes mellitus *** smokers/ex-smokers,the all-mortality rates were higher than in ***:This multicenter study showed that patients over 65 years of age,males,former/active smoker,ICU stay,lung,heart disease,and malignancy should be followed up for at least the first six months after discharge due to COVID-19.

关键词： COVID-19 Post-discharge Mortality Comorbidity

Secondary Prevention Following Coronary Artery Bypass surgery: A Pilot Study for Improved Patient Education

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

International Journal of Clinical Medicine 2012年第4期3卷 286-294页

作者： Jeffrey B. Kramer Patricia A. Howard Brian J. Barnes Bashar Ababneh Purna Mukhopadhyay Mazda Biria Gregory F. Muehlebach Emmanuel Daon George L. Zorn William A. Reed James L. Vacek Cardiovascular Division Department of Internal Medicine School of Medicine The University of Kansas Medical Center Kansas City Kansas Cardiovascular Division Department of Internal Medicine School of Medicine.The University of Kansas Medical Center Kansas City Kansas Department of biostatistics School of Medicinel The University of Kansas Medical Center Kansas City Kansas Department of Pharmacy Practice School of Pharmacy The University of Kansas Medical Center Kansas City Kansas Mid-America Thoracic and Cardiovascular Surgeons The University of Kansas Medical Center Kansas City Kansas Mid-America Thoracic and Cardiovascular Surgeons The University of Kansas Medical Center Kansas City Kansas.

Background: Sustained positive outcomes after coronary artery bypass grafting (CABG) requires risk factor modification and secondary prevention medications. Much attention has been focused on planning at hospital discharge;however longer-term patient compliance is not well described. Hypothesis: A follow-up multidisciplinary educational program improves disease understanding, motivation to reduce cardiovascular risk, and secondary prevention medication prescribing following hospital discharge. Methods: Using a prospective, randomized, controlled design, patients undergoing CABG completed surveys over a year period, assessing disease understanding and motivation. Four to six weeks after CABG, intervention subjects completed a one-time educational program with a multidisciplinary team. The primary endpoint was a composite score of reduced risk factors, medication use, and awareness of prescribed medications. Secondary endpoints evaluated survey scores and medication use rates. Wilcoxon Rank Sum and Chi Square tests compared data between specific time points. Generalized estimating equations and linear contrasts of the parameter estimates compared data at the three time points. Results: The final analysis included 98 subjects (Intervention = 49, Control = 49). The composite score was not different between groups (I = 12.8 ± 4.5 points, C = 12.7 ± 4.9 points, p = 0.9405). Improvements were noted in understanding and motivation in the entire cohort, but these changes were not influenced by the intervention. Medication prescribing declined at 3 and 12 months after CABG without significant differences between the groups. Conclusions: Disease understanding, motivation to reduce risk, and medication use are robust at hospital discharge but the latter declines with time and was not improved by our intervention. These findings are concerning and warrant further study.

关键词： Secondary Prevention Coronary Artery Disease Coronary Artery Bypass