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Perceptions and definitions of the term family have always been varied and complex. Hence, an overview of contemporary families is presented here from several perspectives. First, families as they have been perceived by nursing and social science theorists are reviewed. Demographic changes in the family over the last two decades are then presented, followed by an examination of issues faced by families as they change over time. Finally, families as they exist within varying cultural and social contexts are discussed. Emphasis is placed on the need for health care providers to be flexible in defining and working with individual patients and their families. 相似文献
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Jamieson M Bourque Eric J Velazquez Robert H Tuttle Linda K Shaw Christopher M O'Connor Salvador Borges-Neto 《Journal of nuclear cardiology》2007,14(2):165-173
BACKGROUND: Left ventricular ejection fraction (LVEF) is a significant predictor of morbidity and death. The nuclear summed rest score (SRS) measures myocardial perfusion defects and provides prognostic information, but its effects on long-term outcomes are not fully established. Moreover, information regarding the potential interaction between these 2 covariates is limited. The purpose of this study was to determine whether the mortality risk associated with LVEF is the same across all values of SRS in a population undergoing evaluation for ischemic heart disease. METHODS AND RESULTS: We examined 3,187 patients who underwent cardiac catheterization and perfusion single photon emission computed tomography imaging with a maximum follow-up of 8.1 years and median follow-up of 3.1 years. Cox proportional hazards modeling showed that increasing nuclear SRS and decreasing LVEF were independently associated with a higher long-term mortality rate, with a clinically significant interaction between them (P = .032). Patients with a normal LVEF and a high SRS (greater perfusion abnormality) have a prognosis similar to those with a reduced LVEF. CONCLUSIONS: Resting perfusion studies provide prognostic information for long-term survival and significantly impact the interpretation of mortality risk associated with changes in LVEF. Patient prognostication, risk stratification, and future research using these variables should take this interaction into account. 相似文献
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Jamieson M. Bourque Eric J. Velazquez Robert H. Tuttle Linda K. Shaw Christopher M. O’Connor Salvador Borges-Neto 《Journal of nuclear cardiology》2007,14(2):165-173
Background Left ventricular ejection fraction (LVEF) is a significant predictor of morbidity and death. The nuclear summed rest score
(SRS) measures myocardial perfusion defects and provides prognostic information, but its effects on long-term outcomes are
not fully established. Moreover, information regarding the potential interaction between these 2 covariates is limited. The
purpose of this study was to determine whether the mortality risk associated with LVEF is the same across all values of SRS
in a population undergoing evaluation for ischemic heart disease.
Methods and Results We examined 3,187 patients who underwent cardiac catheterization and perfusion single photon emission computed tomography
imaging with a maximum follow-up of 8.1 years and median follow-up of 3.1 years. Cox proportional hazards modeling showed
that increasing nuclear SRS and decreasing LVEF were independently associated with a higher long-term mortality rate, with
a clinically significant interaction between them (P=.032). Patients with a normal LVEF and a high SRS (greater perfusion abnormality) have a prognosis similar to those with
a reduced LVEF.
Conclusions Resting perfusion studies provide prognostic information for long-term survival and significantly impact the interpretition
of mortality risk associated with changes in LVEF. Patient prognostication, risk stratification, and future research using
these variables should take this interaction into account.
Supported by a grant from the Tom & Lynn Royster Foundation. Durham, NC, and a National Institutes of Health Research Fellowship
Grant (T5 GM08679-04), Bethesda, Md. 相似文献
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