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排序方式: 共有452条查询结果,搜索用时 15 毫秒
391.
Vreim CR; Snashall PD; Demling RH; Staub NC 《The American journal of physiology》1976,230(6):1650-1653
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396.
Attitudes of GPs to the care of people with epilepsy 总被引:3,自引:0,他引:3
BACKGROUND: Most individuals with current epilepsy are solely under the
care of the primary care team for follow-up care. Government working party
recommendations, expert epilepsy panels and patients have also stressed the
central role of the GP in follow-up care. Problems in the provision of care
in the community have, however, repeatedly been highlighted. The views of
GPs about service provision for people with epilepsy may be an important
barrier to providing care, but have not yet been studied in a systematic
manner. OBJECTIVES: We aimed to ascertain the views of GPs on service
provision for people with epilepsy in primary care and on specific
initiatives to improve care. METHOD: A specially designed postal
questionnaire was sent to all 262 GPs on the list of West Glamorgan FHSA.
It ascertained what GPs felt their role should be in providing care to
people with epilepsy, identified their views on the importance of
particular problems in providing this care, as well as obtaining their
opinions on possible future initiatives to improve epilepsy care in the
community. RESULTS: The overall response rate was 70%. Although a majority
of responding GPs (55%) agreed that the care of people with epilepsy should
be based in general practice, 23% disagreed. A lack of confidence about
knowledge of epilepsy (34% responders), unfamiliarity with new drugs (65%
responders) and a lack of time (41% responders) were identified as
important perceived barriers to providing epilepsy care. Nearly all
responding GPs would welcome guidelines for epilepsy care (93% felt they
would be very helpful) and an epilepsy liaison nurse in the community was
the most popular option in terms of preferred overall strategy for
improving care. CONCLUSIONS: Despite 40 years of official recommendations
regarding the central role of the GP in the follow-up care of people with
epilepsy, a number of GPs have difficulty in providing this care. Many feel
that they lack knowledge or are too time pressured to improve the
situation. Nearly all GPs say that they would find guidelines for epilepsy
care very helpful and over half would find epilepsy liaison nurses helpful.
There is scope for more innovative ideas for epilepsy care in the
community.
相似文献
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399.
S Kaul D A Chesler G M Pohost H W Strauss R D Okada C A Boucher 《Journal of nuclear medicine》1986,27(1):26-30
Measurement of myocardial clearance rates between initial and delayed images is a major justification for adding computer quantification to the interpretation of exercise 201TI images. To clarify the range of normal thallium clearance and its relationship to the level of exercise achieved, exercise thallium images in 89 normal subjects were analyzed: 45 asymptomatic subjects with less than 1% probability of coronary artery disease (CAD) (Group I), and 44 patients with chest pain found to have no significant CAD on angiography (Group II). Mean initial regional thallium uptake was similar in the two groups, but myocardial thallium clearance (mean +/- 1 s.d.) was slower in Group II, expressed as a longer half-life in the myocardium (8.2 +/- 7.6 hr compared with 3.4 +/- 0.7 hr p less than 0.001). Analysis of variance using ten clinical and exercise variables as covariates showed that the slower clearance in Group II was related to a lower peak exercise heart rate (HR) (154 +/- 27 compared with 183 +/- 11, respectively, p less than 0.001). By linear regression analysis, a decrease in peak HR of 1 beat/min was associated with a slower thallium clearance (longer half-life) of 0.05 hr. Using this formula, the clearance value in each patient was then corrected for peak exercise heart rate by decreasing measured clearance by 0.05 hr multiplied by the amount peak exercise heart rate which was below 183 (the mean value in Group I). There were no differences in the "corrected" clearance between the two groups. We conclude that thallium myocardial clearance after exercise is related in part to factors other than the presence of CAD, being slower when peak exercise HR is lower. Therefore, thallium clearance rates alone uncorrected for peak exercise heart rate should be used with caution when diagnosing CAD. 相似文献
400.
Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects 总被引:3,自引:0,他引:3
S Kaul J B Newell D A Chesler G M Pohost R D Okada C A Boucher 《The American journal of cardiology》1986,57(8):509-512
Computer-quantified exercise thallium images in 45 clinically normal subjects (group I) and in 44 patients with chest pain and no significant coronary artery disease by angiography (group II) were compared. Group II patients were older and more frequently female, had ST-segment depression by electrocardiography, and included 8 with subcritical (0 to 49%) stenoses. When normality was defined by the range of thallium imaging values in the clinically normal subjects, and after correcting clearance for peak exercise heart rate, 20 of 44 patients (45%) in group II had "abnormal" findings. The only difference between the 20 patients with abnormal findings and the 24 with normal findings in group II was a greater frequency of subcritical (less than 50%) coronary stenoses in the abnormal group, 7 (35%) vs 1 (4%) (p less than 0.05). However, this does not explain most of the abnormalities of thallium imaging in group II. Thus, abnormal thallium findings in subjects with normal angiographic findings are frequently seen and are partially related to the presence of subcritical coronary stenoses, suggesting an underestimation of coronary obstruction. Furthermore, clinically and angiographically normal subjects may differ substantially, and both sets of normal subjects should be considered when establishing criteria for abnormality in exercise thallium imaging. 相似文献