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Background: Telemedicine is an evolving tool to increase patients’ access to subspecialty care. Since 2014, Arkansas has been utilizing telemedicine in the evaluation of patients with hand injuries. The purpose of this study is to assess the effect of this novel telemedicine system for the management of hand trauma on patient transfer. Methods: We reviewed data from the first year of the telemedicine program (2014) and compared it to data from the year prior (2013). Data collection from both years included number of hand consults and need for transfer. From the 2014 data, we also recorded the use of telemedicine, type of transfer, distance of transfer, and time to disposition. Results: During 2013 (pre-telemedicine), there were 263 hand traumas identified. In all, 191 (73%) injuries required transfer to a higher level of care, while 72 (23%) were managed locally. In the first year of the telemedicine program (2014), a total of 331 hand injuries were identified. A total of 298 (90%) resulted in telemedicine consultation with 65% (195) utilizing video encounters. After telemedicine consultation, local management was recommended for 164 injuries (55%) while transfer was recommended for 134 (45%). Using telemedicine, there was a significant decrease in the percentage of transfer for hand injuries (P < .001). Conclusions: The telemedicine program was well utilized and provided patients throughout the state with continuous access to fellowship trained hand surgeons including regions where hand subspecialty care is not available. The program resulted in a significant decrease in the number of hospital transfers for the management of acute hand trauma.  相似文献   
85.
Orbital roof fractures are among the rarest of craniofacial fractures. The mechanism of injury is typically a high-impact blunt force vector directly to the orbit or forehead. Most patients are males between 20 and 40 years old, involved in motor vehicle accidents. Although most orbital roof fractures are managed conservatively, there is a significant risk of ophthalmologic and neurologic complications. Detailed craniofacial examination and high-resolution CT imaging is necessary for diagnosis. A multidisciplinary team approach is required for these challenging fractures.  相似文献   
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目的在前期的研究中,DAZAP2基因在多发性骨髓瘤(Multiple myeloma,MM)患者中表达明显下调,可能为MM的负性基因.须进一步获得DAZAP2蛋白,制备抗体,从而在蛋白水平上研究DAZAP2的表达、结构和功能.方法将原核重组质粒pQE30-DAZAP2转化大肠杆菌,阳性菌株经1 mmol/LIPTG诱导表达目的蛋白,再经过纯化和透析结果IPTG诱导4hr时,得到大量重组目的蛋白,占可溶蛋白的20%左右,经过Ni—NTA层析柱纯化。获得分子量为17kD的DAZAP2蛋白浓度为0.97mg/m1.结论DAZAP2蛋白获得高效表达,并且建立快速简便的纯化方法,目的蛋白可以用于下一步的实验.  相似文献   
87.
对36例多发性骨髓瘤(MM)患者骨髓涂片,行酸性磷酸酶(ACP)染色。结果发现MM组的骨髓浆细胞ACP积分明显高于对照组。MM组初诊时、缓解期和复发期46人次检测结果表明,成MM病程中ACP积分病情变化而变化,缓解期的较初诊时降低,复发期的又复增高。这种变化有时较骨髓浆细胞比例的变化与病情的关系更为密切,提示ACP积分可作为MM病情监测的指标。  相似文献   
88.
Summary Whether multiple sclerosis (MS) can cause headaches is controversial. To clarify the association between headaches and MS we prospectively analyzed 104 consecutive MS patients using detailed headache evaluations. Fifty-four patients (52%) reported headaches, compared with 5 of 35 (14%) patients initially suspected to have MS but subsequently proven to have other disorders, and 18 of 100 (18%) matched general neurology patients. The MS patients had tension headaches or vascular headaches of the migraine type; there was no distinctive MS headache. Seven of these patients had headaches with their first MS symptoms, but in only one did headaches recur with disease activity. Headaches did not correlate with any clinical features of MS. We conclude that an association between headaches and MS may exist.  相似文献   
89.
A new method of posterior C1-2 arthrodesis, derived from the W. V. Cone and G. Bertrand, technique (Montreal, 1970) is described with two modifications: (1) the exact measurements of the ideal graft are determined preoperatively, using CT and a sterilized pasteboard horseshoe-shaped model; (2) in the sitting postion, single occipital block graft was cut out microsurgically, using the preoperative model. After decortication of the graft, posterior arches of C1 and 2, and microsurgical excision of the cartilage of the C1-2 lateral joints, the graft was imbedded into the entire C1-2 space, fixed, and tightened using a braid of nylacap yarn. A case report of rotatory luxation and associated atlantoaxial instability in a 10-year-old girl illustrates the excellent functional results of this technique.Presented at the XVII Annual Meeting of the International Society for Pediatric Neurosurgery, Bombay 1989  相似文献   
90.
Summary The authors compared the results of a retrospective analysis of two groups of head-injured patients who had coexistent pelvic or lower extremit fractures. One group was treated with early osteosynthesis within the first 12 hours after trauma, simultaneously with neurosurgical treatment, while the second group was treated neurosurgically and osteosynthesis was postponed for 4 to 10 days. The second group revealed a higher mortality, which was due to fat embolism. We conclude that early osteosynthesis is the treatment of choice in patients with coexistent head injury and lower extremity fractures.  相似文献   
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