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101.
目的 探讨食管拔脱结肠重建食管术 (esophagealreplacementwithcolonERC)治疗颈、胸上段食管癌的可行性和实用性。方法 经颈、腹径路实施食管内翻拔脱切除病变食管 ,并用ERC获得了满意疗效 ,对该术操作要点 ,食管拔脱的可行性进行讨论。结果 全组无手术死亡 ,1例发生颈部吻合口瘘 ,1 8例术后随访 6年 ,存活超过 1年者 1 3例 ,超过 3年者 8例 ,超过 5年者 5例 ,5年生存率为 2 7.8%。结论 食管内翻拔脱ERC治疗颈 ,胸上段食管癌的特点为 :避免开胸术创伤 ,保留自体胃功能 ,术后生存期长 ,生活质量好。 相似文献
102.
Metabolic assessment of female chronic dieters with either normal or low resting energy expenditures 总被引:1,自引:0,他引:1
Gingras JR Harber V Field CJ McCargar LJ 《The American journal of clinical nutrition》2000,71(6):1413-1420
BACKGROUND: Chronic dieting syndrome can have negative physiologic and psychological consequences. Metabolic differences between female chronic dieters with normal and with low resting energy expenditures (REEs) have not been fully examined. OBJECTIVE: To determine whether differences existed between 2 groups (n = 15/group) of female chronic dieters aged 21-49 y with either normal (>/=100% of predicted) and with low (=85% of predicted) REEs based on the equation of Mifflin et al. DESIGN: The sample was a nonrandomized convenience sample and the 2 groups were compared in an observational study design. Body composition, aerobic fitness, physical activity, glucose and insulin responses, leptin and thyroid hormone status, dietary intake, and dietary restraint were measured. RESULTS: Both groups were similar with respect to age, height, weight, and body mass index. The normal-REE group had a higher lean body mass and insulin response to a test meal, higher thyroxine and reverse triiodothyronine concentrations, and lower dietary restraint. Within both groups, leptin decreased significantly from baseline to 2 h after an oral-glucose-tolerance test. The groups did not differ significantly with respect to dietary intake, aerobic fitness, or physical activity. CONCLUSIONS: Differences in insulin response were associated with higher ratios of abdominal to gluteal body fat in the normal-REE group. Leptin response appears to be due to normal diurnal variations in leptin production rather than a direct response to food consumption. It appears that a normal REE does not necessarily predict positive metabolic health among chronic dieters. 相似文献
103.
Peter Spurgeon Carolyn Hicks Stephen Field Fred Barwell 《Health services management research》2005,18(2):75-85
BACKGROUND: In February 2003, a new General Practitioner (GP) contract was agreed between the profession's leaders and the government, which was later accepted following a national ballot of GPs. However, the ballot simply required respondents to vote for or against the proposal; it did not provide any opportunity to identify which aspects of the new contract were more or less acceptable. Since the proposed changes were far reaching, the implications of implementing and managing these were considerable. Consequently, some information about how GPs viewed various components of the new contract would enable a more targeted and effective management strategy to be developed that would facilitate the introduction of all aspects of the contract. OBJECTIVES: To survey GPs working within the West Midlands region regarding their opinions on each of the key features of the new contract. METHOD: A postal survey of 360 GPs was undertaken, using a specially devised questionnaire. RESULTS: Four factors emerged as the most acceptable aspects of the contract: option to opt out of out-of-hours work, flexibility in the services provided, prediction of future income levels and linking practice to performance targets. Least acceptable were: performance monitoring systems, the new financial formula for calculating income, greater patient involvement in service development and 24/48 hour access. With regard to potential outcomes of the contract, the most positive were considered to be increased proportion of salaried GPs, increased salaries, appropriate quality standards for care, earlier retirement; the factors least likely to be of potential benefit were: reduction in occupational stress, simplification of the regulatory framework, improved equity of workload and improved staff retention. Further analysis of the results using inferential statistics revealed a range of subgroup differences in reaction to the contract. CONCLUSION: Overall, those aspects of the new contract that are perceived to reduce workload and enhance salary were supported, while those that increase targets and bureaucracy were not. Generally, there was only moderate support for the changes, which could be explained by a general scepticism about any top-down modifications, the practicality and power of the changes to impact upon practice and/or a genuine belief that the modifications are unacceptable. Taken together, these results provide an indicative focus for managing the implementation of the new contract, especially with regard to its least acceptable components and the emerging differences between subgroups of GPs. 相似文献
104.
Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care 总被引:1,自引:0,他引:1
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