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1.
WanLi Zhou Vinod Chandran Richard Cook Dafna D. Gladman Lihi Eder 《Seminars in arthritis and rheumatism》2019,48(4):638-643
Objective
To assess the association between occupational-related mechanical factors and the severity of radiographic peripheral and axial joint damage in patients with longstanding Psoriatic Arthritis (PsA).Methods
Patients with longstanding PsA (disease duration≥10 years) were identified from a prospective longitudinal cohort. Using an occupation history questionnaire, patients were asked to report all paid employments since the age of 18. The key predictor variables included various occupational-related mechanical exposures. A job classification database was used to rate the level of exposure to various occupational physical activities. The outcomes were the extent of radiographic damage in the peripheral and axial joints, as measured by the modified Steinbrocker score (mSS), and the modified Stokes Ankylosing Spondylitis Spine Score (mSASSS). The association between the predictors and outcome variables was assessed by negative binomial regression models after adjusting for potential confounding variables.Results
A total of 307 eligible patients were analyzed. In the multivariable analysis, exposure to prolonged repetitive hand movements (exp(β) 1.17 (95% 1.07, 1.28)) and occupations that required higher level of finger dexterity (exp(β) 1.27 (95% 1.09, 1.47)) were associated with a higher mSS. With regards to axial damage, none of the occupational exposures or workers abilities was associated with mSASSS.Conclusion
High level of occupation-related mechanical stress is associated with increased radiographic peripheral joint damage among patients with longstanding PsA. This finding supports the potential role of micro-trauma in the pathogenesis of PsA. 相似文献2.
Adelita Tinoco David W. Mortara Xiao Hu Cass Piper Sandoval Michele M. Pelter 《Heart & lung : the journal of critical care》2019,48(2):114-120
Background
Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU).Objectives
To determine whether CSRPB is associated with adverse outcomes in ICU patients.Methods
The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1).Results
ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1.Conclusions
CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients. 相似文献3.
Hester Groenewegen Wouter F.W. Bierman Konstantina Delli Pieter U. Dijkstra Willem Nesse Arjan Vissink Frederik K.L. Spijkervet 《The Journal of infection》2019,78(3):171-177
Objective
To assess periodontitis prevalence and severity in HIV infected patients as compared to controls. Furthermore, to assess whether HIV infection characteristics are associated with periodontitis.Design
cross-sectional controlled study.Methods
We assessed prevalence and severity of periodontitis in 258 HIV-infected patients and 539 historical controls with the Dutch Periodontal Screening Index (DPSI). HIV characteristics were collected from medical charts. Age-related diseases and oral care were assessed with questionnaires.Results
Severe periodontitis (DPSI 4) was more prevalent in HIV-infected patients than in controls (66% vs. 36%, p?=?0.002). HIV-infection, increasing age and male sex were significant risk factors for severe periodontitis. In particular, older male HIV patients have a higher risk of severe periodontitis. Clinical, immunological and virologic characteristics, and antiretroviral therapy were not associated with periodontitis prevalence or severity. HIV-infected patients rate the importance of their oral health as high, although many do not disclose their HIV infection to their dentists.Conclusions
Prevalence and severity of periodontitis are higher in HIV-infected patients compared to controls, particularly in older males. Awareness of the increased prevalence of periodontitis associated with HIV-infection among patients and health-care professionals could significantly improve oral health and quality of life of HIV-infected patients. 相似文献4.
5.
Sarah C. Snow Gregg C. Fonarow Joseph A. Ladapo Donna L. Washington Katherine J. Hoggatt Boback Ziaeian 《The American journal of medicine》2019,132(4):478-488.e4
Background
Several cardiotoxic substances impact heart failure incidence. The burden of comorbid tobacco or substance use disorders among heart failure patients is under-characterized. We describe the burden of tobacco and substance use disorders among hospitalized heart failure patients in the United States.Methods
We calculated the proportion of primary heart failure hospitalizations in the 2014 National Inpatient Sample with tobacco or substance use disorders accounting for demographic factors.Results
Of 989,080 heart failure hospitalizations, 15.5% (n?=?152,965) had documented tobacco (n?=?119,285, 12.1%) or substance (n?=?61,510, 6.2%) use disorder. Female sex was associated with lower rates of tobacco (odds ratio [OR] 0.72; 95% confidence interval [CI], 0.70-0.74) and substance (OR 0.37; 95% CI, 0.36-0.39) use disorder. Tobacco and substance use disorder rates were highest for hospitalizations <55years of age. Native American race was associated with increased risk of alcohol use disorder (OR 1.67; 95% CI, 1.27-2.20) and black race with alcohol (OR 1.09; 95% CI, 1.02-1.16) or drug (OR 1.63; 95% CI, 1.53-1.74) use disorder. Medicaid insurance or income in the lowest quartile were associated with increased risk of tobacco and substance use disorders.Conclusions
Tobacco and substance use disorders affect vulnerable heart failure populations, including those of male sex, younger age, lower socioeconomic status, and racial/ethnic minorities. Enhanced screening for tobacco and substance use disorders in hospitalized heart failure patients may reveal opportunities for treatment and secondary prevention. 相似文献6.
Huang-Hsi Chen Wuu-Tsun Perng Jeng-Yuan Chiou Yu-Hsun Wang Jing-Yang Huang James Cheng-Chung Wei 《Seminars in arthritis and rheumatism》2019,48(5):895-899
Objective
Autoimmunity may play a role in early-stage dementia. The association between Sjogren's syndrome (SS) and dementia remains unknown. This study was conducted to provide epidemiologic evidence for this relationship.Methods
This 12-year, nationwide, population-based, retrospective cohort study analyzed the risk of dementia in the SS cohort. We also investigated the incidence of dementia among patients with SS by using data from the Longitudinal Health Insurance Database 2000, maintained by the Taiwan National Health Research Institutes. To balance the prevalence of characteristics in the cohorts, we used the propensity score to match selected comorbidities in the two cohorts. We also analyzed the association between SS and dementia among patients with different potential risks by using a Cox proportional hazard model.Results
According to the analysis of data obtained from follow-up conducted during 2000–2012, the incidence of dementia in the SS cohort was 1.21-fold that in the control cohort (95% confidence interval [CI]?=?1.02–1.45, p?<?0.05). In the group older than 65years, the incidence of dementia was significantly high (adjusted hazard ratio [aHR]?=?5.30, 95% CI?=?4.26–6.60, p?<?0.01). After adjustment for comorbidities, including Parkinson's disease (aHR?=?2.98, 95% CI?=?1.80–4.94), insomnia (aHR?=?1.45, 95% CI?=?1.14–1.85), and hypertension (aHR?=?1.43, 95% CI?=?1.19–1.71), the association between SS and dementia was still significant.Conclusion
This 13-year, nationwide, population-based retrospective cohort study revealed patients with SS to have a higher risk of dementia. 相似文献7.
Stefanos Despotopoulos Anastasios Roumeliotis Nicholas G. Kounis Grigorios Tsigkas George Hahalis Periklis Davlouros 《Heart & lung : the journal of critical care》2019,48(2):138-140
Background
Kounis syndrome is a systemic complication following an allergic reaction, presenting with coronary artery spasm or thrombosis and occasionally with stent thrombosis that can have fatal outcome.Objectives
Heparins can induce allergic reactions via tissue antigenicity, heparin induced thrombocytopenia and contact system-activating effects of contaminants but allergy bivalirudin has not been reported so far.Methods
Herein, we describe a patient with fatal acute coronary in-stent thrombosis following an allergic reaction soon after an intra-arterial heparin dose and intravenous administration of bivalirudin during angioplasty.Results
The patient received intense myocardial infarction protocol treatment including angioplasty and defibillation together with antiallergic therapy but despite all of these efforts and measures, he succumbed 2 h later.Conclusions
Significant suspicion should be raised that life saving drugs such as heparin and bivalirudin could join forces with concurrent medication acting as antigens and induce fulminant and fatal stent thrombosis as a manifestation of Kounis syndrome 相似文献8.
Anna Broder Wenzhu B. Mowrey Ladan Golestaneh Chaim Putterman Karen H. Costenbader Mimi Kim 《Seminars in arthritis and rheumatism》2019,48(4):678-685
Background
We compared pre-emptive transplant rates between SLE and non-SLE end-stage renal disease (ESRD) from the U.S. Renal Data System (USRDS) and investigated the potential influence of frequency matching and primary ESRD causes in the non-SLE group.Methods
4830 adult SLE patients with incident ESRD from USRDS 2005–2009 were frequency matched by age, sex and race to 4830 patients with incident non-SLE ESRD. Multivariable logistic regression models were used to estimate the odds of pre-emptive transplantation in SLE and non-SLE, and with the non-SLE subgroups by primary ESRD cause.Results
The odds ratios (OR) of receiving a pre-emptive transplant were similar among non-SLE and SLE (referent group): OR?=?1.18 (95% CI: 0.92, 1.50; p?=?0.20). However, the ORs for receiving a pre-emptive transplant were 0.19 (95% CI: 0.08, 0.42) in type 2 diabetes ESRD, 0.42 (95% CI: 0.23, 0.75) for hypertension-associated ESRD, 1.67 (95% CI: 1.10, 2.54) in type 1 diabetes ESRD, and 2.06 (95% CI: 1.55, 2.73) for “other” ESRD. In contrast to non-SLE, younger SLE patients were less likely to receive a pre-emptive transplant than older SLE patients.Conclusion
The results of this study provide compelling evidence that major improvements need to be made in optimizing access to pre-emptive transplantation in SLE by addressing sociodemographic disparities and the unique challenges faced by SLE patients. Applying careful matching and selecting appropriate comparison groups in future studies may facilitate the development of effective strategies to address these barriers and to increase the number of pre-emptive renal transplants among SLE patients. 相似文献9.
Ravinder Kang Samuel T. Kunkel Jesse A. Columbo Philip P. Goodney Sandra L. Wong 《The American journal of medicine》2019,132(4):530-534.e1
Background
Employee satisfaction is thought to impact performance. However, which aspects of employee satisfaction matter most is unknown. We utilized data from the Veterans Affairs Medical Centers(VAMC) via their Strategic Analytics for Improvement and Learning program to examine the association between organizational satisfaction as well as job-specific satisfaction with measures of patient safety, patient satisfaction, and hospital rating.Methods
The correlation between employee satisfaction with their organization and with their specific job were examined across indicators of patient care using Pearson and Spearman's correlation. Employee satisfaction data were obtained from the All Employee Survey.Results
We found that employee job-specific satisfaction does not correlate with patient outcomes, whereas higher satisfaction with the organization is associated with improved patient safety (ρ?=??0.19, P < .05) and correlates with all aspects of patient satisfaction (“top box” ratings of hospital [r?=?0.30, P < 0.005], primary care [r?=?0.25, P < 0.005], and specialty care [r?=?0.14, P < 0.005]). Further, employees are more satisfied with their job and organization when they work at a VAMC with a higher Star rating.Conclusion
Employee organizational satisfaction and job-specific satisfaction are distinct metrics, and it is higher organizational satisfaction that is associated with improved patient care. 相似文献10.
Noelle V. Pavlovic Tania Randell Tim Madeira Steven Hsu Radoslav Zinoviev Martha Abshire 《Heart & lung : the journal of critical care》2019,48(2):90-104
Background
Left ventricular assist devices (LVADs) improve quality of life in end-stage heart failure but can cause serious complications such as infections with driveline infection causing significant morbidity and mortality.Objectives
The purpose of this systematic literature review is to synthesize the literature to determine variables associated with driveline infection and seek opportunities to improve nursing management of LVAD drivelines.Methods
A systematic literature review was performed. The evidence was synthesized using the Johns Hopkins Nursing Evidence-Based Practice tools and the Chain of Infection epidemiological framework.Results
Thirty-four studies focused on vulnerable host, portal of entry, and causative organism aspects of the Chain of Infection. Increased BMI, younger age, exposed driveline velour showed increased risk of infection and driveline dressing protocol change showed lower risk of infection.Conclusions
Although some risk factors for infection were identified, evidence is still limited. Nurses are uniquely positioned to improve driveline management, disrupting the chain of infection. 相似文献11.
Anaïs Dartevel Benjamin Chaigne Laurence Moachon Florian Grenier Nicolas Dupin Loïc Guillevin Laurence Bouillet Luc Mouthon 《Seminars in arthritis and rheumatism》2019,48(5):921-926
Objective
To characterize levamisole-induced vasculopathy.Methods
We performed a systematic review searching MEDLINE for articles published from 1972 to 2016.Results
We retrieved 357 references and abstracts and selected 111 articles. Levamisole-induced vasculopathy was reported in 192 patients, with a female predominance (n?=?122, 63.5%). Median [interquartile range] age was 44 [38–50]. Skin was the most frequently involved organ (n?=?182, 94.8%). Cutaneous lesions were mostly on the face (n?=?136, 70.8%), especially the ears. Purpura (n?=?131, 68.2%) was the most reported cutaneous lesion. Organ involvement included acute renal failure (n?=?24, 12.5%), and pulmonary involvement (n?=?20, 10.4%). Anti-neutrophil cytoplasmic antibodies (ANCAs) were found in 167/178 patients (93.8%), with both anti-myeloperoxydase and anti-proteinase 3 specificity reported in 51/118 patients (43.2%). Anti-phospholipid (APL) antibodies were found in 93/137 patients (67.9%). Leukopenia was detected in 69/138 patients (50%). Skin biopsies identified vasculitis and thrombotic vasculopathy in 73/148 (49.3%) and 62/148 (41.9%) patients, respectively. The outcome was favourable in 116/134 patients (86.6%), but relapses were reported in 33 (28.4%), mainly on levamisole re-exposure.Conclusion
Levamisole-induced vasculopathy is characterized by a female predominance, skin involvement, ANCA and/or APL antibody positivity, leukopenia, vasculitis or vascular thrombotic histological lesions, and despite possible systemic involvement, a favourable outcome with levamisole interruption. 相似文献12.
13.
Pingan Chen Qiong Zhan Yujia Bai Xingfu Huang Peng Wang Yizhi Pan Shaonan Li Shenshen Fu Wenyan Lai Qingchun Zeng Hao Ren Dingli Xu 《The American journal of the medical sciences》2019,357(3):205-212
Background
Peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) plays key roles in controlling cardiac metabolism and function. Myocardial energy expenditure (MEE) can reflect myocardial energy metabolism and cardiac function. Whether the variation of PGC-1α can influence MEE levels in chronic heart failure (CHF) is unclear. Therefore, we investigated the relationship between PGC-1α and MEE.Material and Methods
We studied 219 patients with CHF and 66 healthy controls. MEE was measured according to echocardiographic parameters. Serum PGC-1α, N-terminal pro-B-type natriuretic peptide and other parameters were detected. Patients with CHF were divided into different groups according to the left ventricular ejection fraction (LVEF) and the tertile range of MEE.Results
Serum PGC-1α was lower in the MEE 2 and 3 groups compared with controls (both P < 0.05). Patients in the MEE 2 (1.73 ± 0.83 versus 2.16 ± 0.82 ng/mL, P?=?0.001) and 3 groups (1.65 ± 0.73 versus 2.16 ± 0.82 ng/mL, P < 0.001) possessed lower levels of PGC-1α than those in the MEE 1 group. Compared with high LVEF, patients with low LVEF had higher MEE (median, 167 versus 73 cal/minute, P < 0.05) and lower PGC-1α (1.71 ± 0.65 versus 1.95 ± 0.91 ng/mL, P?=?0.032). Multivariate logistic regression analysis showed that MEE (OR?=?0.517, 95% CI?=?0.267-0.998, P?=?0.049) and creatinine (OR?=?2.704, 95% CI?=?1.144-6.391, P?=?0.023) were independently associated with increased PGC-1α.Conclusions
Serum PGC-1α was related to MEE and LVEF in patients with CHF and can reflect the degree of MEE and the systolic function of the left ventricle. 相似文献14.
Antonia Scobie Sanch Kanagarajah Ross J. Harris Lisa Byrne Corinne Amar Kathie Grant Gauri Godbole 《The Journal of infection》2019,78(3):208-214
Listeriosis
is a foodborne illness that can result in septicaemia, Central Nervous System (CNS) disease, foetal loss and death in high risk patients.Objectives
To analyse the demographic trends, clinical features and treatment of non-perinatal listeriosis cases over a ten year period and identify mortality-associated risk factors.Methods
Reported laboratory-confirmed non-pregnancy associated cases of listeriosis between 2006 and 2015 in England were included and retrospectively analysed. Multivariate logistic regression analysis was performed to determine independent risk factors for mortality.Results
1357/1683 reported cases met the inclusion criteria. Overall all-cause mortality was 28.7%; however, mortality rates declined from 42.1% to 20.2%. Septicaemia was the most common presentation 69.5%, followed by CNS involvement 22.4%. CNS presentations were significantly associated with age?<?50 years, and septicaemia with older age. Age?>?80 years (OR 3.32 95% CI 1.92–5.74), solid-organ malignancy (OR 3.42 95% CI 2.29-5.11), cardiovascular disease (OR 3.30 95% CI 1.64–6.63), liver disease (OR 4.61 95% CI 2.47–8.61), immunosuppression (OR 2.12 95% CI 1.40-3.21) and septicaemia (OR 1.60 95% CI 1.17–2.20) were identified as independent mortality risk factors.Conclusions
High risk groups identified in this study should be the priority focus of future public health strategies aimed at reducing listeriosis incidence and mortality. 相似文献15.
Zachary Boivin Mario F. Perez Nkiruka C. Atuegwu Antonio Anzueto Eric M. Mortensen 《The American journal of the medical sciences》2019,357(4):296-301
Background
Prior research has demonstrated high mortality rates in patients with cirrhosis who contract bacterial infections. The purpose of our study was to explore clinical outcomes such as 90-day mortality, rehospitalization, and intensive care unit (ICU) admission in older veterans with pneumonia and cirrhosis.Methods
We conducted a retrospective cohort study of hospitalized patients with community-acquired pneumonia at any Departments of Veterans Affairs (VA) hospital over a 10-year period. We included patients 65 years or older who consistently received VA care and who were diagnosed with community-acquired pneumonia. There were 103,997 patients who met the inclusion criteria, and 1,246 patients with cirrhosis. We used multilevel regression models to examine the association between cirrhosis and the outcomes of interest after controlling for potential confounders.Results
Cirrhosis was associated with significantly increased odds of 90-day mortality (odds ratio 1.79, 95% confidence interval, 1.57-2.04). There were also significantly increased odds of rehospitalization within 90-days (1.30, 1.16-1.47). No significant association was found with ICU admission (1.00, 0.83-1.19).Conclusions
We found an association between cirrhosis and 90-day mortality and rehospitalization in older patients with pneumonia. We suggest that physicians should carefully monitor patients with cirrhosis who develop pneumonia. 相似文献16.
Kevin Bryan Lo Hafeez Ul Hassan Virk Vladimir Lakhter Pradhum Ram Carlos Gongora Gregg Pressman Vincent Figueredo 《The American journal of medicine》2019,132(4):505-509
Background
Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of beta-blockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes.Methods
Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the end-points of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model.Results
Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate.Conclusion
This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use. 相似文献17.
E.L. Hamblion A. Burkitt M.K. Lalor L.F. Anderson H.L. Thomas I. Abubakar S. Morton H. Maguire S.R. Anderson 《The Journal of infection》2019,78(4):269-274
Objectives
Tuberculosis (TB) is a serious re-emergent public health problem in the UK. In response to rising case incidence a National TB Strain-Typing Service based on molecular strain-typing was established. This facilitates early detection and investigation of clusters, targeted public health action, and prevention of further transmission. We review the added public health value of investigating molecular TB strain-typed (ST) clusters.Methods
A structured questionnaire for each ST cluster investigated in England between 1 January 2010 and 30 June 2013 was completed. Questions related to epidemiological links and public health action and the perceived benefits of ST cluster investigation.Results
There were 278 ST cluster investigations (CIs) involving 1882 TB cases. Cluster size ranged from 2 to 92. CIs identified new epidemiological links in 36% of clusters; in 18% STs were discordant refuting transmission thought to have occurred. Additional public health action was taken following 23% of CI.Conclusions
We found positive benefits of TB molecular ST and CI, in identifying new epidemiological links between cases and taking public health action and in refuting transmission and saving resources. This needs to be translated to a decrease in transmission to provide evidence of public health value in this low prevalence high resource setting. 相似文献18.
Juan Jiang Chengping Hu Yuanyuan Li Pinhua Pan Xiaoli Su Pengbo Deng Junpu Wang Xiaoying Wu 《The American journal of the medical sciences》2019,357(4):289-295
Background
Severe pneumonia is responsible for great mortality and morbidity worldwide, and early-applied effective anti-infective therapy can improve the prognosis of patients. However, identification of infectious agents in severe pneumonia remains a major challenge so far. In this study, the potential utility of transmission electron microscopy (TEM) in detecting nonbacterial pathogens in patients with severe pneumonia was retrospectively evaluated.Materials and Methods
A total of 106 patients diagnosed with severe pneumonia at our hospital from September 2015 to December 2017 were included, and their baseline clinical characteristics were collected. Nonbacterial infectious agents detected by TEM in bronchoalveolar lavage fluid (BALF) and serological tests were summarized. The detection rates were further compared between TEM and serological tests.Results
BALF examination under the transmission electron microscope revealed 24 viruses, 16 mycoplasmas, 18 chlamydia, 2 fungi and 74 bacteria in 99 samples, among which 61 samples were mixed infections. The combined use of serological tests and TEM significantly improved the detection rate of nonbacterial infectious agents in patients with severe pneumonia.Conclusions
Our data support that implementation of TEM could improve the sensitivity for detecting viruses, atypical pathogens and mixed infections in BALF from patient of severe pneumonia. Therefore, TEM may be used as an auxiliary diagnostic method of other microbiological tests in severe pneumonia. 相似文献19.
Sara Muller Samantha Hider Annabelle Machin Rebecca Stack Richard A Hayward Karim Raza Christian Mallen 《Seminars in arthritis and rheumatism》2019,48(5):815-820
Background
Rheumatoid arthritis (RA) has articular and non-articular manifestations. Early, intensive treatment has substantial benefit for both. This requires patients be identified as soon as symptoms develop.Objectives
To determine whether selected signs and symptoms can be identified in the primary care records of patients prior to a formal diagnosis of RA being made and, if so, how early they can be identified.Methods
A case-control study was constructed within the UK Clinical Practice Research Datalink (CPRD). 3577 individuals with ‘definite’ RA, were matched to 14,287 individuals without inflammatory arthritis. An index date was established (i.e., date general practitioner (GP) first appeared to suspect RA). Rates of consultation and consultations for suspected early RA symptoms were compared in cases and controls in the two years prior to the index date using conditional logistic regression, adjusted for number of consultations.Results
The mean (standard deviation) age of participants was 58.8 (14.5) years and 66.8% were female. Rates of any consultation were significantly higher in RA cases than in controls for at least two years prior to the index date. Cases were more likely to have a pre-diagnosis coded consultation for joint, and particularly hand symptoms (aOR 11.44 (9.60, 13.63)), morning stiffness (8.10 (3.54, 18.5)), carpal tunnel syndrome (4.57 (3.54, 5.88)) and other non-articular features.Conclusions
In patients who develop RA, GP consultation rates are higher for at least two years prior to the first recorded suspicion of RA. This study highlights symptoms that should raise a GP's index of suspicion for RA. 相似文献20.
Voratima Silavanich Surakit Nathisuwan Arintaya Phrommintikul Unchalee Permsuwan 《Heart & lung : the journal of critical care》2019,48(2):105-110