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991.
992.
Lesley A Stainkey Isaac A Seidl Andrew J Johnson Gladys E Tulloch Tilley Pain 《BMC health services research》2010,10(1):303
Our Problem
The length of wait lists to access specialist clinics in the public system is problematic for Queensland Health, general practitioners and patients. To address this issue at The Townsville Hospital, the GP Liaison Officer, GPs and hospital staff including specialists, collaborated to develop a process to review patients waiting longer than two years. GPs frequently send referrals to public hospital specialist clinics. Once received, referrals are triaged to Category A, B or C depending on clinical criteria resulting in appointment timeframes of 30, 90 or 365 days for each category, respectively. However, hospitals often fail to meet these targets, creating a long wait list. These wait listed patients are only likely to be seen if their condition deteriorates and an updated referral upgrades them to Category A. 相似文献993.
Hilary Ufearo Khalid Kambal Gladys O. Onojobi Mehdi Nouraie Charles Agbemabiese Sharmin Diaz Anita Aggarwal Zakari Aliyu Robert E. Taylor Victor R. Gordeuk 《Clinica chimica acta; international journal of clinical chemistry》2010,411(9-10):653-656
BackgroundHepatitis C virus (HCV) infection may be associated with thrombocytopenia and increased iron stores in patients receiving medical care. We aimed to determine how often changes in hematologic, iron metabolic and inflammatory markers occur in individuals with undiagnosed HCV in the community.MethodsInner-city African Americans (n = 143) were recruited from the community according to reported ingestion of alcohol. They were divided broadly into those who drank more or less than 56 g alcohol/day as assessed by dietary questionnaire. HCV serology was determined and laboratory values were compared according to HCV seropositivity in analyses that adjusted for alcohol consumption.ResultsThe prevalence of HCV seropositivity was 23% among men and 29% among women. Levels of hepatocellular enzymes were higher with HCV seropositivity (P < 0.0001) but hemoglobin concentrations, white blood cell and platelet counts and serum ferritin concentrations did not differ. The globulin fraction of the serum protein concentration (P = 0.002) was increased with HCV seropositivity as expected with chronic inflammation. However, erythrocyte sedimentation rate and serum iron and haptoglobin levels did not differ significantly according to HCV status. Furthermore, multivariate analysis revealed that C-reactive protein was decreased and transferrin concentration was increased with both HCV and alcohol consumption (P < 0.014).ConclusionsPreviously undiagnosed HCV seropositivity has little effect on the complete blood count and body iron stores but appears to perturb the response to an inflammatory stimulus, causing reduced rather than increased circulating CRP concentrations and increased rather than decreased transferrin concentrations. 相似文献
994.
995.
Hermes Fundora‐Hernández Silvia J. Venero‐Fernández Ramón Suárez‐Medina Esperanza de la C. Mora‐Faife Gladys García‐García Ileana del Valle‐Infante Liem Gómez‐Marrero Andrea Venn John Britton Andrew W. Fogarty the HINASIC Study Group 《Tropical medicine & international health : TM & IH》2014,19(5):545-554
996.
Health care services in the United Arab Emirates have developed rapidly in the last 30 years fueled by oil revenues. These services have been planned and provided predominantly by non-nationals, with mixed success. The authors identify aspects of the health care system and the sociocultural environment that create both barriers and bridges to holistic health for Emirati women. Barriers include early/consanguineous marriage, frequent childbearing, polygamy, and care that is lacking in competence and cultural sensitivity. Bridges include Islam, folk medicine, cultural traditions, and the opportunity to travel abroad for health care. Maids are seen as both a barrier and bridge at different times. Recommendations for future improvements include listening to Emirati women and providing more gender-appropriate, holistic, and culturally congruent programs. 相似文献
997.
Tamar E. Carter Michael von Fricken Jean R. Romain Gladys Memnon Yves St. Victor Laura Schick Bernard A. Okech Connie J. Mulligan 《The American journal of tropical medicine and hygiene》2014,91(2):406-411
Sickle cell disease is a growing global health concern because infants born with the disorder in developing countries are now surviving longer with little access to diagnostic and management options. In Haiti, the current state of sickle cell disease/trait in the population is unclear. To inform future screening efforts in Haiti, we assayed sickle hemoglobin mutations using traditional hemoglobin solubility tests (HST) and add-on techniques, which incorporated spectrophotometry and insoluble hemoglobin separation. We also generated genotype data as a metric for HST performance. We found 19 of 202 individuals screened with HST were positive for sickle hemoglobin, five of whom did not carry the HbS allele. We show that spectrophotometry and insoluble hemoglobin separation add-on techniques could resolve false positives associated with the traditional HST approach, with some limitations. We also discuss the incorporation of insoluble hemoglobin separation observation with HST in suboptimal screening settings like Haiti. 相似文献
998.
Previous studies showed that older adults with diabetes have a worse mobility performance as compared with those without diabetes. Studies also demonstrated that older adults with diabetes have weakened ankle muscle strength, reduced joint range in ankle dorsiflexion and worsened ankle joint proprioception as compared with control population. The purpose of the present study was to examine the relationship between the physical characteristics of the ankle joint and the mobility performance in older adults with type 2 diabetes. Older adults with type 2 diabetes (n = 85) were recruited, and Timed Up and Go test (TUG) for mobility assessment was performed. Active ankle joint repositioning test was used for assessing the ankle joint proprioception sense; peak torque of ankle dorsiflexors and plantar flexors were tested by using a Cybex Norm dynamometer, and weight-bearing lunge test (WBLT) was used for assessing the stiffness of ankle dorsiflexion. Our results showed that age, body mass index (BMI), normalized peak torque of plantar flexors and dorsiflexors, active ankle joint repositioning test errors and the WBLT distance were significantly correlated with the TUG (all p < 0.001). These ankle characteristics, together with the demographic data of the subjects, contributed 59.9% of the variance in the TUG by multiple regression analysis. Body mass, ankle plantar flexors strength and ankle joint proprioception are important factors contributing to the physical mobility of the older adults with type 2 diabetes. 相似文献
999.
Michel Gagner Faith Selzer Steve H. Belle Marc Bessler Anita P. Courcoulas Gregory F. Dakin Dan Davis William B. Inabnet James E. Mitchell Alfons Pomp Gladys W. Strain Walter J. Pories Bruce M. Wolfe 《Surgery for obesity and related diseases》2012,8(6):663-670
BackgroundAnticoagulation, the use of sequential compression devices on the lower extremities perioperatively, and early ambulation are thought to reduce the incidence of venous thromboembolism (VTE) postoperatively and are recommended to reduce VTE risk. However, the evidence on which this recommendation has been based is not particularly strong. We have demonstrated that even a large, multicenter cohort with carefully collected prospective data is inadequate to provide sufficient evidence to support, or refute, this recommendation.MethodsLongitudinal Assessment of Bariatric Surgery participants from 10 centers in the United States who underwent their first bariatric surgery between March 2005 and December 2007 constituted the study group. We examined the ability to address the question of whether anticoagulation therapy, in addition to sequential compression, reduces the 30-day incidence of VTE or death sufficiently to recommend the use of prophylactic anticoagulation, a therapy that is not without risk.ResultsOf 4416 patients, 396 (9.0%) received sequential compression alone, and 4020 also received anticoagulation therapy. The incidence of VTE within 30 days of surgery was low (.25% among those receiving sequential compression alone and .47% when anticoagulation therapy was added), and the 30-day incidence of death was also low (.25% versus .34%, respectively, P = .76, for sequential compression alone versus sequential compression plus anticoagulation therapy). Estimates of the number of cases required to address the question of whether a difference exists in the outcome related to VTE chemoprophylaxis or whether the outcome rates are equivalent have ranged from 13,680 to ≥35,760 patients, depending on whether superiority or equivalence was being analyzed.ConclusionSufficient evidence from a clinical trial study to determine whether prophylactic anticoagulation added to compression devices further prevents VTE is not available, and such a trial is likely to be impractical. The data presented are insufficient to make a final recommendation concerning prophylactic treatment to prevent VTE in the 30 days after bariatric surgery. 相似文献