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排序方式: 共有265条查询结果,搜索用时 15 毫秒
31.
Zondiwe V Mwanza MBBS MMed FC Paed FRACP Brent S White MBBS BMedSci BAppSc Philip N Britton BMedSci MBBS PhD MPH&TM FRACP Mary E McCaskill MBBS BSc DipPaeds MBA FACEM 《Emergency medicine Australasia : EMA》2023,35(5):855-861
Objective
Delay in antibiotic administration in paediatric sepsis is associated with increased mortality and prolonged organ dysfunction. This pre-intervention study evaluated performance in paediatric sepsis management.Methods
Retrospective cohort study of febrile children admitted through the ED at The Children's Hospital at Westmead, Sydney, between 1 May and 31 July 2017. Participants were children aged 29 days to 60 months excluding children with simple febrile seizures, neonates and children who had received intravenous antibiotics elsewhere. We assessed the timing of antibiotic administration in children meeting local sepsis guidelines. We conducted a survey of clinicians in ED in 2018 to describe contributing factors.Results
There were 160 febrile children admitted and 144 presentations were included in the analysis. Male 53% (n = 76); median age 20.1 months (interquartile range [IQR] 3.9–37 months). Thirty-seven (26%) febrile children met local sepsis criteria. The median time from triage to first dose of intravenous antibiotic was 109 min (IQR 62–183 min). Delay (>60 min) occurred in 26 (76%) children. Reported reasons contributing to delay included high patient load, long waiting times, difficult intravenous access, delayed prescribing, inadequate staffing and difficulty distinguishing between a viral infection and serious bacterial infection.Conclusion
There was frequent delay in administering antibiotics in children meeting local sepsis criteria, more commonly in young infants. Reasons contributing to delay were specific to young children along with departmental factors that will require addressing through targeted quality improvement interventions. 相似文献32.
L O'Brien-Pallas M Hirschfeld A Baumann J Shamian O Adams I Bajnok E Isaacs S Land J Salvage S A Bisch T Miller A Islam M Luba 《Revue canadienne de recherche en sciences infirmières》1999,31(3):51-67
The World Health Assembly approved resolution WHA45.5 in 1992. This paper reports the findings of an evaluation of the implementation of this resolution using a survey technique. A total of 150 WHO Member States responded, for a 79% response rate. Findings suggest that the greatest strides worldwide have been made in education. While the data show that progress has been made at the country level, far more action is needed to strengthen nursing and midwifery if these cost-effective resources are to play a decisive role in improving the extent and quality of services, especially as delivered to people in the greatest need. 相似文献
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35.
Ronday HK; Te Koppele JM; Greenwald RA; Moak SA; De Roos JA; Dijkmans BA; Breedveld FC; Verheijen JH 《Rheumatology (Oxford, England)》1998,37(1):34-38
The plasminogen activation system is one of the enzyme systems held
responsible for bone and cartilage degradation in rheumatoid arthritis
(RA). In this study, we evaluated the effect of tranexamic acid (TEA), an
inhibitor of plasminogen activation, on urinary collagen cross-link
excretion and radiological joint damage in rat adjuvant arthritis (AA) and
on urinary collagen cross-link excretion in patients with RA. In the animal
study, adjuvant arthritis was induced in male Lewis rats. From day 7
onward, high-dose TEA (500 mg/kg body weight, once daily) or placebo was
administered orally. Study groups consisted of TEA-treated normal rats (C +
TEA), placebo-treated normal rats (C + plac), AA rats treated with TEA (AA
+ TEA) or with placebo (AA + plac). To monitor joint destruction, urinary
collagen cross-link excretion (pyridinoline, HP; deoxypyridinoline, LP) was
measured by high-performance liquid chromatography at days 14 and 21.
Radiological evaluation of joints was performed at day 21. In the patient
study, TEA was administered to nine patients with RA as adjuvant medication
(approximately 20 mg/kg body weight, three times daily) for 12 weeks.
Urinary HP and LP excretion levels were measured before and during TEA
treatment, and 4 weeks after the cessation of TEA treatment. In AA + TEA
rats, a significant reduction of HP and a tendency towards a reduction of
LP excretion were found compared with AA + plac rats (P < 0.05), at day
14, whereas the HP/LP ratio did not change. No difference was observed in
HP, LP excretion, HP/LP ratio and radiological damage score between the
TEA- and placebo-treated AA rats at day 21. In RA patients, a significant
reduction of HP and LP excretion was found during the TEA treatment period
(P < 0.05). After the cessation of TEA treatment, HP and LP excretion
increased towards baseline levels. No effect on disease activity was
observed. The plasmin antagonist TEA reduced the excretion of collagen
pyridinoline cross-links in both experimental and rheumatoid arthritis. As
such, this study not only supports the involvement of the plasminogen
activation system in the destructive phase of arthritis, but also suggests
a beneficial effect of therapeutic strategies directed against inhibition
of matrix proteolysis.
相似文献
36.
P Cornaert T Jacquemart P Graux J Pommier J F Bisch C Creusy A Dutoit L Croccel 《Archives des maladies du coeur et des vaisseaux》1987,80(11):1669-1672
A case of myxoid liposarcoma of the left atrium in a 35-year old man is reported. The tumour, revealed by an atrial flutter, was excised. The patient died 13 months later, with multiple metastases. A review of the literature yielded only 7 cases of primary liposarcoma of the heart, including 4 which were surgically treated. This confirms the extreme rarity of a tumour which has a very poor prognosis due to recurrence in situ or metastatic spread. 相似文献
37.
Heterotypic adherence between marrow stromal cells (MSC) and lymphoblastic cells is essential for normal lymphopoiesis and malignant lymphoblastic development. However, the detailed molecular mechanisms by which this heterotypic adherence occurs are poorly understood. The cell-cell interactions between a B-lymphoblastic cell line (UTMB-460) and a pre-B-cell line (NALM-6) with MSC were chosen as models to investigate potential mechanisms and adhesion molecules involved in the apposition between normal and malignant lymphoblastic cells and MSC. A parallel-flow detachment assay (PFDA) and a 51Cr detachment assay, coupled with monoclonal antibody (MoAb) blocking experiments, were used to quantify the attachment of lymphoblastic cells to confluent monolayers of MSC. The apposition between MSC and B-lymphoblastic cells (UTMB-460 cells) was investigated for variable time periods, ranging from 1 minute to 4 hours. Results from the temporal study suggest that the heterotypic adherence of the B-lymphoblastic cells to MSC is a biphasic event and the interactions occur rapidly (< or = 1 minute) after the two cells come into contact. More specifically, the early phase of adherence (< or = 15 minutes) solely involves very late antigen-4 alpha (VLA-4 alpha)/vascular cell adhesion molecule 1 (VCAM- 1) interactions, as evidenced by the nearly complete inhibition (93%) of UTMB-460 cell adherence in the presence of anti-VLA-4 alpha. The late phase (> or = 30 minutes) proceeds despite the continuous presence of anti-VLA-4 alpha. In addition, the late-phase adherence is not affected by MoAbs to LFA-1, CD44, VCAM-1, E-selectin, or L-selectin, which suggests the possible involvement of other adhesion molecules. Adherence of pre-B-lymphoblastic cells (NALM-6) to MSC is also biphasic. Integrin VLA-4 is again a major player in the early phase of pre-B-lymphoblastic cell/MSC interactions. The early phase of adherence may be important in homing of the malignant lymphoblastic cells to the MSC and the late phase in retention of malignant lymphoblastic cells in the bone marrow. 相似文献
38.
Andrew KC Lam Ken KH Cheng Rex K Lam Christina FC Lau SY Yau 《Clinical & experimental optometry》1996,79(4):167-172
Myopic crescent, refractive error and axial length were previously investigated in Hong Kong Chinese subjects. The myopic crescent was found to correlate with axial length and myopic refraction. In this study, three groups of Hong Kong Chinese with different degrees of myopia were assessed for optic disc ovalness, refractive error and axial length. The axial length was significantly correlated with the degree of myopia, indicating that the myopia was axial in nature. The regression line shows that 0.44 mm of axial elongation would give about one dioptre of increase in myopia. The elliptical ratio of the optic disc was defined as the maximal disc diameter divided by the minimal disc diameter. All three groups showed an oval disc with vertical axis greater and an increased ovalness for the high myopic group with an elliptical ratio from 1.11 in low myopia to 1.29 in high myopia. There is a small amount (about four degrees) of temporal rotation of this vertical oval orientation, which is independent of the amount of myopia. This result shows an association between axial elongation of the globe and optic disc ovalness, in addition to the previously described temporal myopic crescent. Therefore, in myopic subjects, a vertically oval disc may be associated with a myopic refraction rather than glaucoma. 相似文献
39.
40.
Hepatocellular carcinoma: assessment of resectability by computed tomography and ultrasound 总被引:2,自引:0,他引:2
A retrospective review of the CT and ultrasound scans from examinations of 30 patients who had hepatocellular carcinoma (hepatoma) was undertaken with special emphasis placed on evaluation of hepatic distribution of tumor, vascular invasion, and extrahepatic spread. Although both CT and ultrasound detected hepatoma in 29 of 30 patients (96%), CT showed more extensive hepatic parenchymal involvement in eight of the patients. Vascular invasion was seen more frequently with ultrasound than with CT. Invasion into the main portal vein was seen by ultrasound in 11 of 30 patients (37%). Extrahepatic spread of tumor was much more frequently detected by CT and was present in 21 of 30 patients (70%). A reasoned approach to the diagnostic workup of hepatomas that will minimize invasive procedures and unnecessary surgery is presented. 相似文献