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1.
糖尿病食物交换份数测算列线图应用的效果评价   总被引:1,自引:0,他引:1  
苑记清 《天津护理》2010,18(4):187-188
目的:探讨食物交换份数测算列线图用于Ⅱ型糖尿病患者饮食教育的有效性。方法:将120例Ⅱ型糖尿病患者随机分为干预组和对照组各60例。干预组在传统饮食教育基础上,教会患者使用食物交换份数测算列线图计算主副食物交换份数,并灵活变换安排至三餐之中。对照组采用传统饮食教育。对两组患者干预3个月后以空腹血糖、餐后2h血糖、糖化血红蛋白为评价指标进行效果评价。结果:两组患者空腹血糖、餐后2h血糖、糖化血红蛋白的差异有统计学意义(P〈0.05)。结论:食物交换份数测算列线图可提高Ⅱ型糖尿病患者饮食教育的效果。  相似文献
2.
OBJECTIVE: The purpose of this study was to determine the accuracy of our previously published and prospectively validated transcerebellar diameter (TCD) nomogram in the prediction of gestational age (GA) in intrauterine growth-restricted (IUGR) and large fetuses. METHODS: We established a cross-sectional nomogram of TCD in 24,026 well-dated singleton fetuses and prospectively validated the nomogram using 2597 fetuses from a separate population. This nomogram was validated in both IUGR (n = 55) and large (n = 16) fetuses (estimated fetal weight, <10th and >90th percentiles, respectively). The actual GA was subtracted from the TCD-predicted GA in IUGR and large fetuses, and the concordance between the actual and predicted GAs was assessed using the Pearson correlation coefficient. RESULTS: Concordance between the actual and predicted GA based on our previously published singleton TCD nomogram was high for both IUGR and large fetuses (Pearson correlation, r = 0.98 and 0.95, respectively; P < .001). The means (SDs) of actual and predicted GA based on TCD in IUGR fetuses were 24.9 (6.5) and 25.1 (6.3) weeks, respectively. The predicted GA based on TCD in IUGR fetuses was within 3 days in 97.5% in the second trimester and 93.3% in the third trimester. In large fetuses, the difference between the actual and predicted GA based on TCD within 3 days was 100% in both the second and third trimesters. CONCLUSIONS: This study shows that our institution-specific TCD nomogram is reliable and accurate in predicting GA even at extremes of fetal growth.  相似文献
3.

Purpose

The purpose of the study is to evaluate the effectiveness of a vancomycin nomogram using actual body weight and the Modification of Diet in Renal Disease equation to estimate renal function in intensive care unit patients.

Methods

Retrospective evaluation (preimplementation group, n = 57) was conducted from March 2011 to April 2011. Prospective evaluation was conducted after nomogram implementation (postimplementation group, n = 60) from December 2011 to February 2012.

Results

The percentage of patients with an initial vancomycin trough concentration 15 μg/mL or higher increased in the postimplementation group as compared with the preimplementation group (72% vs 39%, P = .0004). The postimplementation group also demonstrated an increase in the percentage of patients with initial trough concentration between 15 and 20 μg/mL (42% vs 19%, P = .0099), and no statistical difference in the percentage of patients with an initial trough greater than 20 μg/mL (30% vs 19%, P = .2041). There was no difference in nephrotoxicity in the postimplementation group compared with the preimplementation group (18% vs 17.5%, P = 1.0).

Conclusion

Use of a vancomycin nomogram increased the percentage of initial vancomycin trough concentrations 15 μg/mL or higher in intensive care unit patients and was not associated with an increased occurrence of nephrotoxicity.  相似文献
4.

Background and aims

Unplanned admission to an intensive care unit (ICU) is associated with high mortality, having the highest incidence among patients who are emergency admissions to the hospital. This study was designed to identify factors associated with unplanned ICU admission in emergency admissions to hospital and develop an absolute risk tool to individualise the risk of an event during a hospital stay.

Methods

Emergency department (ED) and in-patient hospital data from a large teaching hospital of consecutive admissions from 1 January 1997 to 31 December 2007 aged over 14 years was included in this study. Patient data extracted from 126 826 emergency presentations admitted as in-patients consisted of demographic and clinical variables.

Results

During an 11-year period 1582 incident unplanned ICU admissions occurred. Predictors of unplanned ICU admission included older age, being male, having a higher acuity triage category and a history of co-morbid conditions. Emergency department diagnostic groups associated with higher incidence of unplanned ICU admission included: sepsis, acute renal failure, lymphatic–hematopoietic tissue neoplasms, pneumonia, chronic-airways disease and bowel obstruction. The final model used to develop the nomogram had an ROC curve AUC of 0.7.

Conclusion

This study identified factors associated with unplanned ICU admission and developed a nomogram to individualise risk prior to a patient being transferred from the ED. This nomogram provides clinicians the opportunity prior to transfer from the ED, to either (1) review the appropriateness of the ward level of planned transfer or (2) flag patients for follow-up on the general ward to assess for deterioration.  相似文献
5.

Background

Although QT prolongation is associated with an increased risk of torsades de pointes (TdP), it is unclear how clinicians determine risk in individual patients with prolonged QT.

Aims

To investigate physicians’ interpretation of electrocardiogram (ECG) values in patients with a prolonged QT in reference to risk of TdP.

Methods

A survey was sent to Australasian emergency physicians (EPs) to investigate interpretation of ECG data in risk assessment for TdP. The survey contained three sections: demographic information, questions on heart rate correction and six sets of ECG data which the clinician ranked from low to high risk. Risk analysis for ECG values was performed by producing histograms of the distribution of responses for each of the six sets of ECG parameters. These distributions were compared to predicted distributions based on Bazett’s corrected QT>500 ms and the QT nomogram. The QT nomogram is a recently developed method for assessing whether QT-HR pairs are associated with increased risk of TdP by plotting them to determine if they are above an at risk line—the nomogram.

Results

Of 720 surveys sent out, 249 were returned (35%). A heart rate correction was used by 90% of respondents and the median “at risk” QTc judged by EPs was 450 ms [interquartile range (IQR): 440–500 ms]. Respondents were divided as to whether bradycardia increased the risk of TdP, with equal numbers responding “no change” and “more caution”. In four of the six sets of ECG parameters, EPs had a similar risk distribution to that predicted by Bazett. For one point predicted to be high risk by the QT nomogram, there was a uniform (undecided) risk distribution by EPs.

Conclusions

EPs mainly relied on Bazett’s correction as their method of TdP risk assessment, which may be problematic for bradycardic patients.  相似文献
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8.
目的:利用列线图探究超声联合血清学指标早期预测乳腺癌术后化疗的心脏毒性。方法:选取于我院乳腺外科术后确诊为乳腺癌的女性患者,所有患者均在术后2周接受化疗,根据化疗1年后是否发生左心室射血分数(Left ventricular ejection fraction, LVEF)下降超过10%,将患者分为毒性组与无毒性组。比较第3化疗周期患者常规超声心动图指标、血清学指标以及二维超声斑点追踪显像(Two-dimensional speckle tracking imaging, 2D-STI)指标的差异。采用多因素COX回归筛选预测心脏毒性的指标并建立列线图探索患者出现心脏毒性的概率。结果:共随访148例患者,失访2例,剩余146例患者中心脏毒性的发生率为12.3%。多因素COX回归显示高敏感性心肌肌钙蛋白I变化量(delta-high sensitive cardiac troponin I,Δhs-cTnI)(P<0.05)、N-端脑钠肽前体变化量(delta-N-terminal pro -B-type natriuretic peptide, NT- pro BNP)(P<0.05)和整体纵向峰值应变变化量(delta-Global longitudinal strain, ΔGLS)(P<0.05)是预测乳腺癌术后化疗患者心脏毒性的独立风险指标。基于Δhs-cTnI、ΔNT- proBNP和ΔGLS建立的用于提示患者发生心脏毒性风险的列线图具有良好的辨别力(C-index 0.904)和校准度(χ2= 8.170,P = 0.417,Hosmer–Lemeshow检验)。结论:ΔGLS联合Δhs-cTnI、ΔNT- proBNP绘制的列线图有助于早期评估乳腺癌术后化疗患者发生心脏毒性的风险。  相似文献
9.
Abstract

Objective

To identify predictive factors of unfavourable outcome among patients hospitalized for COVID-19.  相似文献
10.
目的构建结直肠(colorectal cancer,CRC)患者预后列线图预测模型,并验证其准确性。方法回顾性分析就诊于苏州大学第三附属医院的438例CRC患者的临床病理资料。建立COX单因素、多因素回归模型确定预后的独立危险因素。用R软件建立列线图,绘制术后3年、5年无病生存率(disease free survival,DFS)校准图线并与实际观察情况比较。用Bootstrap法进行内部验证,计算一致性指数(C-index)评估模型准确性。分析时间依赖的ROC曲线比较其与第7版美国癌症联合委员会(American Joint Committee On Cancer,AJCC)分期系统(TNM系统)在预测术后的3年、5年的DFS的敏感性和特异性。结果438例CRC患者中233例患者出现转移,其中肝脏转移105例,肺转移57例。COX回归模型分析示肿瘤分化程度,肿瘤TNM分期,癌胚抗原(CEA)水平,糖类抗原19-9(CA19-9)水平,中性粒细胞与淋巴细胞之比(Neutrophil lymphocyte radio,NLR),抑癌基因P53是患者预后的独立影响因素。列线图用于预测生存的C指数为0.678。校正曲线表明预测的3年、5年DFS与实际观察情况高度符合。时间依赖的ROC曲线结果表明,相较于传统AJCC-TNM分期,列线图预后模型在预测术后3年和5年的DFS具有更高的敏感性和特异性。结论列线图可较准确预测个体CRC患者的预后,利于临床工作者对其随访或及时开展对患者有益治疗。  相似文献
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