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Cutolo M.,University of Genoa | Zampogna G.,University of Genoa | Vremis L.,Moldova State University of Medicine and Pharmacy | Smith V.,Ghent University | And 2 more authors.
Journal of Rheumatology | Year: 2013

Objective. Systemic sclerosis (SSc) is characterized by microvascular injury, fibrosis, and hypoxia of involved tissues. The vasoactive peptide endothelin-1 (ET-1) seems to be implicated in these events. Using nailfold videocapillaroscopy (NVC), we evaluated longterm effects of ET-1 antagonist treatment on nailfold microvascular damage in patients with SSc, over a 3-year followup period. Methods. Thirty patients with SSc (mean age 64 ± 5 yrs, mean disease duration 8 ± 1 yrs) were recruited during their programmed standard treatment protocols. At baseline (T0), 15 patients with SSc (mean age 63 ± 15 yrs, mean disease duration 7 ± 3 yrs), already receiving cyclic intravenous infusion of iloprost (5 continuous days, average 80 μg/day, every 3 mo), continued the treatment for a further 3 years (ILO group). The remaining 15 patients with SSc (mean age 68 ± 13 yrs, mean disease duration 8 ± 4 yrs), although they continued the same cyclic intravenous iloprost treatment as the previous group, also received bosentan 125 mg twice a day for 3 years (ILO+BOS group). Qualitative analysis (scleroderma patterns) and semiquantitative scoring of the microvascular damage were performed by validated routine NVC methods. Results. During followup, a statistically significant increase of capillary number was observed in the ILO+BOS group (p < 0.02), with a significant and progressive increase of angiogenesis (p < 0.01). In contrast, the ILO group showed a statistically significant decrease of capillary number (p < 0.05). After 3 years the number of capillaries was significantly higher in the ILO+BOS group than in the ILO group (p < 0.05). The score for giant capillaries decreased significantly in both groups of patients with SSc (p < 0.05). Conclusion. In this open study, longterm treatment with ET-1 receptor antagonist in combination with iloprost was found to interfere with progression of nailfold microvascular damage in patients with SSc, as assessed by NVC over a 3-year followup period. The Journal of Rheumatology Copyright © 2013. All rights reserved.

Tofan G.,Moldova State University of Medicine and Pharmacy | Bodolica V.,American University of Sharjah | Spraggon M.,American University of Sharjah
Health Expectations | Year: 2013

Background: The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it. Objective: This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration. Findings: On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream. Discussion: To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship. © 2012 Blackwell Publishing Ltd.

Wallace L.S.,Alcoa | Brinister I.,Moldova State University of Medicine and Pharmacy
Journal of the American Board of Family Medicine | Year: 2010

Background: As part of the former Soviet Union, the Moldovan health system was highly centralized and geared toward inpatient care. The objective of this study was to explore the personal experiences of female family physicians in Chişinǎu, Moldova. Methods: A purposeful sample of female family physicians was recruited to participate in this study. A professional translator conducted in-depth interviews using an 8-item semistructured questionnaire to capture personal practice experiences, scope of practice, and beliefs. Verbatim responses were summarized using a continuous iterative process. Results: Twenty female family physicians (mean age, 42.4 ± 7.2 years; mean clinical experience, 12.2 ± 7.9 years) were included in the sample. Analysis of the data illuminated 4 key themes: (1) family medicine, as a specialty, offered much diversity and personal satisfaction; (2) appointment time restraints and paperwork demands posed significant challenges to providing care to patients; (3) problems faced by patients were complex and went far beyond the leading causes of morbidity and mortality; and (4) patients generally have a limited amount of health-related knowledge, but increased access to health information was bridging this gap. Conclusion: Although family medicine is a rewarding career, system-related factors posed significant challenges, not only in providing quality care but in day-to-day satisfaction.

Casian D.,Moldova State University of Medicine and Pharmacy
Chirurgia (Bucharest, Romania : 1990) | Year: 2013

The objective of this study was a psychometric evaluation of the Romanian translated version of ABC-V (Assessment of Burden in Chronic - Venous Disease) questionnaire in patients with uncomplicated varicose disease of lower limbs. All components of the questionnaire were translated from the English version into the Romanian language and after that backwards, discussed, adopted and pre-tested. Evaluation of the final version of the translated questionnaire demonstrated acceptable results: missed questions in 3% of forms, no ceiling effect and low floor effect, good split-half reliability (rs = 0.61,p < 0.01) and significant correlation between test and re-tests cores (rs = 0.86, p < 0.01). There was no significant influence of age and sex upon average ABC-V scores. Study results support the application of ABC-V questionnaire for assessing the severity of chronic venous disease as well as for quantitative evaluation of patient satisfaction and health status improvement after varicose vein treatment in the Romanian-speaking population.

Zhuang H.,Childrens Hospital of Philadelphia | Codreanu I.,Childrens Hospital of Philadelphia | Codreanu I.,Moldova State University of Medicine and Pharmacy
Journal of Biomedical Research | Year: 2015

As the number of clinical applications of 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET-CT) grows, familiarity with the conditions that can be diagnosed by this modality and when relevant pieces of additional information can be obtained becomes increasingly important for both requesting physicians and nuclear medicine physicians or radiologists who interpret the findings. Apart from its heavy use in clinical oncology, FDG PET-CT is widely used in a variety of non-oncologic conditions interconnecting to such disciplines as general internal medicine, infectious diseases, cardiology, neurology, surgery, traumatology, orthopedics, pediatrics, endocrinology, rheumatology, psychiatry, neuropsychology, and cognitive neuroscience. The aim of this review was to summarize the current evidence of FDG PET-CT applications in evaluating non-oncologic pathologies and the relevant information it can add to achieve a final diagnosis. © 2015 by the Journal of Biomedical Research.

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