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81.
Analysis of IN.PACT DEEP trial on the association between changes in perfusion from pre‐ to postrevascularization and clinical outcomes in critical limb ischemia
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82.
C Brant J P P Moraes-Filho E Siqueira A Nasi E Libera M Morais M Rohr E P Macedo G Alonso A P Ferrari 《Diseases of the esophagus》2003,16(1):33-38
According to the WHO, 16-18 million people in Central and South America are infected by Trypanosoma cruzi. Chagasic achalasia affects between 7.1% and 10.6% of the population. The aim of this study was to evaluate the effects of Botox injections in the clinical response and esophageal function of patients with dysphagia due to chagasic achalasia. In total, 24 symptomatic patients with chagasic achalasia were randomly chosen to receive Botulinum Toxin (BT) or saline injected by endoscopy in the lower esophageal sphincter (LES). Patients were monitored with a clinical score of dysphagia and an objective assessment (esophagograms, scintillography, manometry, and nutritional assessment) for a period of 6 months. Clinical improvement of dysphagia was statistically significant (P < 0.001) in patients receiving BT when compared with the placebo. There was no significant difference in the placebo group regarding clinical score, LES basal pressure and esophageal emptying time. Esophageal emptying time in the toxin group was significantly lower than in the placebo (P=0.04) after 90 days. There were non-significant increases in esophageal emptying of 25.36% and 17.39%, respectively, at 90 and 180 days, in the BT group (P=0.266). Gender, age, and baseline LES pressure did not influence the response to BT. Our data strongly suggests that intrasphincteric injection of BT in LES is clinically effective in the treatment of chagasic achalasia. 相似文献
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Postoperative atrial fibrillation and mortality after coronary artery bypass surgery 总被引:4,自引:0,他引:4
Villareal RP Hariharan R Liu BC Kar B Lee VV Elayda M Lopez JA Rasekh A Wilson JM Massumi A 《Journal of the American College of Cardiology》2004,43(5):742-748
OBJECTIVES: We sought to determine if the occurrence of postoperative atrial fibrillation (AF) affects early or late mortality following coronary artery bypass surgery (CABG). BACKGROUND: Atrial fibrillation is the most common arrhythmia seen following CABG. METHODS: The Texas Heart Institute Cardiovascular Research Database was used to identify all patients that developed AF after isolated initial CABG from January 1993 to December 1999 (n = 994). This population was compared with patients who underwent CABG during the same period but did not develop AF (n = 5,481). In-hospital end points were adjusted using logistic regression models to account for baseline differences. Long-term survival was evaluated using a retrospective cohort design, where Cox proportional hazards methods were used to adjust for baseline differences, and with case-matched populations (n = 390, 195 per arm). RESULTS: Atrial fibrillation was diagnosed in 16% of the population. Postoperative AF was associated with greater in-hospital mortality (odds ratio [OR] 1.7, p = 0.0001), more strokes (OR 2.02, p = 0.001), prolonged hospital stays (14 vs. 10 days, p < 0.0001), and a reduced incidence of myocardial infarction (OR 0.62, p = 0.01). At four to five years, survival was worse in patients who developed postoperative AF (74% vs. 87%, p < 0.0001 in the retrospective cohort; 80% vs. 93%, p = 0.003 in the case-matched population). On multivariate analysis, postoperative AF was an independent predictor of long-term mortality (adjusted OR 1.5, p < 0.001 in the retrospective cohort; OR 3.4, p = 0.0018 in the case-matched population). CONCLUSIONS: The occurrence of AF following CABG identifies a subset of patients who have a reduced survival probability following CABG. The impact of various strategies, such as antiarrhythmics and warfarin, aimed at reducing AF and its complications deserves further study. 相似文献
86.
Dr. Robert C. Smith MD Jennifer A. Mettler MA Bertram E. Stöffelmayr PhD Judith S. Lyles MA Alicia A. Marshall PhD Lawrence F. Van Egeren PhD Gerald G. Osborn DO Valerie Shebroe PhD 《Journal of general internal medicine》1995,10(6):315-320
OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive
outcomes from, and personal commitment to psychosocial behaviors.
DESIGN: Controlled randomized study.
SETTING: A university- and community-based primary care residency training program.
PARTICIPANTS: 26 first-year residents in internal medicine and family practice.
INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills
needed in primary care.
MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from,
and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization,
and directive and nondirective facilitation of patient communication.
RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated
more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating
patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization
(p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine
than did the untrained residents (p<0.001).
CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors
and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and
personal commitment to some, but not all, psychosocial skills.
Presented at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 27–29, 1994.
Supported by the Fetzer Institute in Kalamazoo, MI. 相似文献
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Successful hematopoietic cell transplantation in a patient with X‐linked agammaglobulinemia and acute myeloid leukemia
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89.
Protocolized Laboratory Screening for the Medical Clearance of Psychiatric Patients in the Emergency Department: A Systematic Review
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Alyssa Conigliaro MA Roshanak Benabbas MD Eric Schnitzer DO Maria‐Pamela Janairo MD Richard Sinert DO 《Academic emergency medicine》2018,25(5):566-576
Objective
Emergency department (ED) patients with psychiatric chief complaints undergo medical screening to rule out underlying or comorbid medical illnesses prior to transfer to a psychiatric facility. This systematic review attempts to determine the clinical utility of protocolized laboratory screening for the streamlined medical clearance of ED psychiatric patients by determining the clinical significance of individual laboratory results.Methods
We searched PubMed, Embase, and Scopus using the search terms “emergency department, psychiatry, diagnostic tests, laboratories, studies, testing, screening, and clearance” up to June 2017 for studies on adult psychiatric patients. This systematic review follows the recommendations of Meta‐analysis of Observational Studies in Epidemiology (MOOSE) statement. The quality of each study was rated according to the Newcastle‐Ottawa quality assessment scale.Results
Four independent reviewers identified 2,847 publications. We extracted data from three studies (n = 629 patients). Included studies defined an abnormal test result as any laboratory result that falls out of the normal range. A laboratory test result was deemed as “clinically significant” only when patient disposition or treatment plan was changed because of that test result. Across the three studies the prevalence of clinically significant results were low (0.0%–0.4%).Conclusions
The prevalence of clinically significant laboratory test results were low, suggesting that according to the available literature, routine laboratory testing does not significantly change patient disposition. Due to the paucity of available research on this subject, we could not determine the clinical utility of protocolized laboratory screening tests for medical clearance of psychiatric patients in the ED. Future research on the utility of routine laboratory testing is important in a move toward shared decision making and patient‐centered health care.90.