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排序方式： 共有10000条查询结果，搜索用时 15 毫秒
71.
Hanna Lee Mary K. Tan Andrew T. Yan Paul Angaran Paul Dorian Claudia Bucci Jean C. Gregoire Alan D. Bell Martin S. Green Peter L. Gross Allan Skanes Charles R. Kerr L. Brent Mitchell Jafna L. Cox Vidal Essebag Brett Heilbron Krishnan Ramanathan Carl Fournier Shaun G. Goodman 《The Canadian journal of cardiology》2019,35(2):160-168
Background
Physicians treating nonvalvular atrial fibrillation (AF) assess stroke and bleeding risks when deciding on anticoagulation. The agreement between empirical and physician-estimated risks is unclear. Furthermore, the association between patient and physician sex and anticoagulation decision-making is uncertain.Methods
We pooled data from 2 national primary care physician chart audit databases of patients with AF (Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation and Coordinated National Network to Engage Physicians in the Care and Treatment of Patients with Atrial Fibrillation Chart Audit) with a combined 1035 physicians (133 female, 902 male) and 10,927 patients (4567 female and 6360 male).Results
Male physicians underestimated stroke risk in female patients and overestimated risk in male patients. Female physicians estimated stroke risk well in female patients but underestimated the risk in male patients. Risk of bleeding was underestimated in all. Despite differences in risk assessment by physician and patient sex, > 90% of patients received anticoagulation across all subgroups. There was modest agreement between physician estimated and calculated (ie, CHADS2 score) stroke risk: Kappa scores were 0.41 (0.35-0.47) for female physicians and 0.34 (0.32-0.36) for male physicians.Conclusions
Our study is the first to examine the association between patient and physician sex influences and stroke and bleeding risk estimation in AF. Although there were differences in agreement between physician estimated stroke risk and calculated CHADS2 scores, these differences were small and unlikely to affect clinical practice; further, despite any perceived differences in the accuracy of risk assessment by sex, most patients received anticoagulation. 相似文献72.
C. Jacquet F. Goehringer E. Baux J.A. Conrad M.O. Ganne Devonec J.L. Schmutz G. Mathey H. Tronel T. Moulinet I. Chary-Valckenaere T. May C. Rabaud 《Médecine et maladies infectieuses》2019,49(2):112-120
Objective
The teaching hospital of Nancy, France, implemented a specific multidisciplinary care pathway (French acronym AMDPL) to improve the management of patients presenting with Lyme borreliosis (LB) suspicion. We aimed to assess the first year of activity of this care pathway.Patients and methods
We included all patients managed in the AMDPL pathway from November 1, 2016 to October 31, 2017. The first step was a dedicated Lyme disease consultation with an infectious disease specialist. Following this consultation, the LB diagnosis was either confirmed and adequate treatment was prescribed, or a differential diagnosis was established and patients received adequate management, or further investigations were required and patients were offered multidisciplinary management as part of a day hospitalization.Results
A total of 468 patients were included. LB diagnosis was confirmed in 15% of patients (69/468), 49% of patients received a differential diagnosis, and 26% (122/468) of patients had the LB diagnosis ruled out without receiving any other diagnosis.Conclusions
This is to our knowledge the first multidisciplinary center implemented in France for the management of patients presenting with LB suspicion related to polymorphous signs and symptoms. Several diagnoses could be confirmed or corrected, although some symptoms and complaints could not be explained. This cohort could improve our knowledge of LB and its differential diagnoses. 相似文献73.
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76.
Maite Cruz Piqueras Ainhoa Rodríguez García de Cortazar Joaquín Hortal Carmona Javier Padilla Bernáldez 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(1)
Objective
To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters.Methods
Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain).Results
Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule.Conclusions
These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term “anti-vaccines” from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built. 相似文献77.
C. Lukannek S. Shaefi K. Platzbecker D. Raub P. Santer S. Nabel H.S. Lecamwasam T.T. Houle M. Eikermann 《Anaesthesia》2019,74(9):1165-1174
Postoperative pulmonary complications are associated with an increase in mortality, morbidity and healthcare utilisation. The Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory complications in patients undergoing surgery. In this hospital registry study of adult patients undergoing non-cardiac surgery between 2005 and 2017 at two independent healthcare networks, a prediction instrument for early postoperative tracheal re-intubation was developed and externally validated. This was based on the development of the Score for Prediction Of Postoperative Respiratory Complications. For predictor selection, stepwise backward logistic regression and bootstrap resampling were applied. Development and validation cohorts were represented by 90,893 patients at Partners Healthcare and 67,046 patients at Beth Israel Deaconess Medical Center, of whom 699 (0.8%) and 587 (0.9%) patients, respectively, had their tracheas re-intubated. In addition to five pre-operative predictors identified in the Score for Prediction Of Postoperative Respiratory Complications, the final model included seven additional intra-operative predictors: early post-tracheal intubation desaturation; prolonged duration of surgery; high fraction of inspired oxygen; high vasopressor dose; blood transfusion; the absence of volatile anaesthetic use; and the absence of lung-protective ventilation. The area under the receiver operating characteristic curve for the new score was significantly greater than that of the original Score for Prediction Of Postoperative Respiratory Complications (0.84 [95%CI 0.82–0.85] vs. 0.76 [95%CI 0.75–0.78], respectively; p < 0.001). This may allow clinicians to develop and implement strategies to decrease the risk of early postoperative tracheal re-intubation. 相似文献
78.
This paper reviews the published literature on a group of developmental disorders of the retina and retinal pigment epithelium which result in focal abnormalities in one or both eyes. They are often asymptomatic, found on routine examination and are generally non-progressive. Some are associated with other systemic abnormalities.Subject terms: Retinal diseases, Eye abnormalities 相似文献
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