老年骨性关节炎

复习老年骨性关节炎（OA）的流行病学、病因、诊断笔治疗的近年文献。OA是老年人群中最常见的关节疾病，随年龄增加发病率也增加。该病的治疗包括心理治疗，缓解疼痛的药物治疗，手术治疗及康复方法。药物治疗中首选镇痛药。应用非甾体类抗炎药（NSAIDs)时，应了解其副作用，老年人慎用。手术疗法包括关节镜手术和关节置换术。     

早期骨关节炎药物治疗临床随访研究与知识更新

骨关节炎(OA)是最为常见的慢性关节疾病。随着人口老年化和肥胖症的增加,OA的发病率逐年增高至1/1 000。膝关节为最常见累及关节。在临床上OA需要治疗的症状包括疼痛、功能丧失等,治疗方式包括非药物治疗、药物治疗(病情改善类药物),甚至手术治疗。目前我们面临的问题在于对OA的诊断和治疗干预开始得太晚,以至于病情改善类药物疗效受到很大影响。因此目     

骨性关节炎的非药物治疗

骨性关节炎(osteoarthritis ,OA )是一种以局灶性关节软骨退行性变、骨丢失、关节边缘骨赘形成及关节畸形和软骨下骨质致密为特征的慢性关节疾病,又称骨关节病,其原因尚不明确,一般认为与衰老、劳损外伤、炎症、肥胖、遗传、代谢(骨内高压)和细胞免疫等多种因素有关,已成为严重影响中、老年人生活质量的主要疾病之一。该病的发生率随年龄的增长而升高。迄今,还没有一种治疗方法能有效阻断OA的病理进展过程[1] ,因此,治疗目标主要是止痛和改善功能。虽然目前多采用药物治疗OA ,但治疗药物如非类固醇消炎药(nonsteroidant inflam matorydur…     

靶向疗法治疗骨关节炎的研究进展

骨关节炎(osteoarthritis,OA)是一种以关节软骨退行性变和继发性骨质增生为特征的慢性关节疾病,是老年人残疾的主要原因之一[1],起病缓慢,隐匿发生,渐进加重[2].目前治疗方法包括药物对症、关节置换、功能锻炼等.随着认识的不断深入,OA靶向疗法渐引起重视.笔者运用相关关键词检索PubMed、中国期刊全文数据库(CNKI)、维普数据库和万方数据库等,纳入与OA靶向疗法密切相关的非陈旧性文献46篇,分析总结涉及OA基因靶向、软骨代谢靶向(如一氧化氮、蛋白酶)、滑膜炎靶向(如IL-1β、TNF-α抑制剂)和软骨下骨重塑的靶向治疗作用机制及其研究进展,并述及其局限性,以期促进其应用.     

骨关节炎与骨质疏松症关系的再认识

骨关节炎(osteoarthritis,OA)是一种极其常见的慢性关节疾病。该病以软骨改变为主要特征,进而造成软骨下骨坏死、囊性变、骨密度增加和伴发骨赘形成的一种非特异性炎症,其发生主要与衰老、肥胖、炎症、创伤、关节过度使用、代谢障碍及遗传等因素有关[1]。我国学者的流行病学调查结果显示,OA在中老年人中具有较高的发病率,北京地区老年女性有症状的OA患病率甚至达到15.4%[2]。OA     

腹腔镜手术治疗老年复杂阑尾炎的临床分析

目的对比分析腹腔镜阑尾切除术(LA)与开腹阑尾切除术(OA)治疗老年复杂性阑尾炎(CA)的效果,探讨腹腔镜在老年复杂性阑尾炎的应用价值。方法我院2013年6月至2017年6月收治老年复杂阑尾炎患者189例,其中86例采用腹腔镜治疗(LA组),103例采用开腹治疗(OA组),观察两组患者围手术期相关指标及并发症发生情况。结果两组均顺利完成手术。LA组并发症发生率低于OA组(χ2=4. 067,P=0. 038),术后肠功能恢复时间、进食时间、住院时间及并发症等指标明显优于OA组(P 0. 05),两组手术时间、出血量、住院费用比较差异无统计学意义(P 0. 05)。结论与开腹手术相比,腹腔镜治疗老年复杂阑尾炎具有病情恢复快、并发症少等优点,可作为治疗老年复杂阑尾炎的安全选择,值得推广应用。     

膝骨性关节炎的运动疗法新进展

骨性关节炎(osteoarthritis,OA)是一种以关节软骨退行性变和继发性骨质增生为特征的慢性关节疾病,负重较大的膝关节是其好发部位之一.在全世界超过60岁的人群中,有9.6%的男性和18.0%的女性患有膝OA.导致膝OA发生发展的因素有很多,包括股四头肌薄弱、关节受力及排列异常、肥胖、外伤、内分泌紊乱、生长因子及免疫因子缺乏等[1].目前,对膝OA的治疗大多采取口服药物、关节镜下手术、关节腔内注射、物理因子等方法,但疗效均不理想,都没有从根本上终止OA的病理变化.有些治疗方法不但要进行多次,甚至有加重膝关节损伤的可能.在众多的治疗膝OA的方法中,运动训练以其无创、高效、持久的特点已被国内外越来越多的医师视为首选,现综述如下.     

骨关节炎1904例终点事件发生情况队列研究

目的随访安徽省中医院骨关节炎(OA)出院患者终点事件发生情况,探讨其终点事件发生的相关因素。方法纳入安徽省中医院2012年1月至2016年6月期间首次诊断为骨关节炎患者的病例,调取并记录骨关节炎患者的一般资料,采用电话随访方式,随访并记录出院患者中医药使用情况(按照出院后服药时间的长短分为非暴露组、低暴露组、中暴露组和高暴露组),终点事件发生情况,包括事件种类(全因死亡、关节外病变、再发入院和手术治疗)、发生时间、次数及依据,随后调取并记录随访成功骨关节炎患者首次入院的实验室指标,包括炎性指标、免疫指标、代谢指标,并采用多元logistic回归分析法分析中医药治疗、年龄、性别、常规西药治疗、实验室指标等与骨关节炎患者终点事件发生的相关性。结果共纳入1904例骨关节炎患者,随访成功1658例,失访的有246例,失访率12.92%。随访期间发生的终点事件有99例,包括全因死亡15例(15.15%)、关节外病变13例(13.13%)、再发入院46例(46.46%)和手术治疗25例(25.25%)。由多元logistic回归分析法分析得出骨关节炎患者终点事件与各因素之间的相关性,结果表明,全因死亡的相关因素是中医药暴露强度(OR=0.319)、再发入院的相关因素是中医药暴露强度(OR=0.469)、关节外病变的相关因素是中医药暴露强度(OR=0.522)、手术治疗的相关因素是中医药暴露强度(OR=0.507),年龄(OR=0.976)、红细胞沉降率(ESR)(OR=1.604)、血小板计数(PLT)(OR=2.667)、免疫球蛋白G(Ig G)(OR=1.404)、α1-酸性糖蛋白(α1-AGP)(OR=2.291)能够增加患者再发入院的发生率,年龄(OR=0.750)能够增加OA患者关节外病变的风险,超敏C反应蛋白(OR=1.621)能够增加OA患者手术的风险。结论足疗程的中医药治疗能减少骨关节炎终点事件的发生。     

表观遗传调控与骨性关节炎研究进展

骨性关节炎(OA)是一种受到多种基因及环境因素影响的复杂性关节疾病。调控关节软骨的基因的改变对骨性关节炎(OA)的发生发展起着十分重要的作用。但实际上OA的发病及进程也受到多种表观遗传机制的调控,包括DNA甲基化、组蛋白修饰和微小RNA(miRNA)等。这些表观遗传机制的发现为OA的早期诊断及临床治疗提供了一个全新的途径。     

玻璃酸钠与曲安缩松治疗膝关节骨性关节炎疗效比较

目前，骨关节炎的治疗手段包括药物治疗、物理治疗和手术治疗，以对症及缓解疼痛为主。玻璃酸钠治疗膝关节骨性关节炎(OA)的临床疗效已得到肯定，但价格昂贵，操作不简便，病人不易接受，在基层医院尤其膝关节OA早期患者中不易推广。作者等在治疗膝关节OA时发现曲安缩松能快速减轻其症状和体征，而且价格非常便宜，操作简便，并且把曲安缩松与玻璃酸钠治疗膝关节OA进行了对比研究，现将结果报道如下。     

Geriatric screening and preventive care

Preventive health care decisions and recommendations become more complex as the population ages. The leading causes of death (i.e., heart disease, malignant neoplasms, cerebrovascular disease, and chronic lower respiratory disease) among older adults mirror the actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) among persons of all ages. Many aspects of mortality in older adults are modifiable through behavior change. Patients 65 years and older should be counseled on smoking cessation, diets rich in healthy fats, aerobic exercise, and strength training. Other types of preventive care include aspirin therapy; lipid management; and administration of tetanus and diphtheria, pneumococcal, and influenza vaccines. Although cancer is the second leading cause of death in patients 65 years and older, a survival benefit from cancer screening is not seen unless the patient's life expectancy exceeds five years. Therefore, it is best to review life expectancy, functionality, and comorbidities with older patients when making cancer screening recommendations. Other recommended screenings include abdominal aortic aneurysm for men 65 to 75 years of age, breast cancer for women 40 years and older with a life expectancy greater than five years, and colorectal cancer for men and women 50 years and older with a life expectancy greater than five years.     

Atrial fibrillation: an epidemic in the elderly

Atrial fibrillation is the most common cardiac arrhythmia that increases in prevalence with age. As the general population grows older, general practitioners will more frequently see this disease in their clinic population. In order to most effectively treat these patients, physicians need to understand key issues, including the use of rhythm control versus ventricular rate control and how to reduce the risk of ischemic stroke. This article will review recent advancements in the understanding of the pathophysiology, management, stroke risk stratification and prevention of thromboembolic complications in atrial fibrillation.     

Atrial fibrillation: an epidemic in the elderly

Atrial fibrillation is the most common cardiac arrhythmia that increases in prevalence with age. As the general population grows older, general practitioners will more frequently see this disease in their clinic population. In order to most effectively treat these patients, physicians need to understand key issues, including the use of rhythm control versus ventricular rate control and how to reduce the risk of ischemic stroke. This article will review recent advancements in the understanding of the pathophysiology, management, stroke risk stratification and prevention of thromboembolic complications in atrial fibrillation.     

The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service

ABSTRACT

Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use.

Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.     

Self‐care management programme for older adults with diabetes: An integrative literature review

This paper summarizes evidence on effectiveness of diabetes self‐care interventions for older adults with diabetes, and identifies factors influencing self‐care behaviours. The search for articles published from 2002 to 2012 was done using electronic databases, namely, MEDLINE, CINAHL, Scopus, PsycINFO and PubMed. Search terms include diabetes, self‐management, self‐care, barriers and intervention. Out of 261 articles screened, 21 were selected for review. Findings revealed that interventions using concepts of self‐efficacy, self‐determination and proactive coping, and interventions incorporating information technology were effective in influencing diabetes self‐care behaviours with improved health outcomes. Psychosocial factors influencing self‐care include motivation, socioeconomic status, literacy, knowledge, social and health‐care providers' support, and particularly for older adults, the key factors were their self‐efficacy, motor skill and literacy in self‐care activities. This review provides important insight for nurse practitioners to address psychosocial issues in developing self‐care management programmes for older adults with diabetes.     

Integrating a cancer-specific geriatric assessment into survivorship care

Older adults constitute the greatest percentage of cancer survivors in the country, with 61% being aged 65 years and older. Assessing older adult cancer survivors beyond chronological age to include changes in functional status is an essential process to help nurses anticipate cancer treatment impact and aid in planning individualized survivorship care. The objective of this article is to identify a method to assess older adult cancer survivors to be used in tailoring survivorship care. A review of geriatric literature was conducted through MEDLINE(?) and PubMed from 1997-2011 and focused on the pathophysiology of aging, cancer impact, and comorbidities in this population. Results were combined with previous research to provide an evidence-based approach to assessing older cancer survivors. The resulting assessment provides valuable information on the functional status of older adult patients with cancer. This assessment can be used by nurses to develop treatment plans and tailor management strategies to improve quality of life.     

Patient controlled analgesia for the young pediatric patient

A collaborative effort to improve pain control in the young pediatric patient resulted in new policies and a change in pain management practice. A retrospective chart review of 15 pediatric surgical patients identified the use of patient controlled analgesia (PCA) as a successful method of pain control for children 3 years of age and older.