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81.
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82.
Stephanie A. Grilo Marina Catallozzi John S. Santelli Hanying Yan Xiaoyu Song Jennifer Heitel Kristen Kaseeska Julie Gorzkowski Alexandra E. Dereix Jonathan D. Klein 《The Journal of adolescent health》2019,64(3):311-318
Purpose
The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services.Methods
In 2016, a nationally representative sample of 1,918 US AYAs (13- to 26-year-olds) was surveyed. Survey questionnaire domains were based on prior research and Fishers' information-motivation-behavior skills conceptual model. Data were weighted to represent US households with AYA and analyzed to identify factors independently associated with ever experiencing private time and discussions of confidentiality with a regular health-care provider (HCP). We examined the association of these experiences on AYA attitudes about health care.Results
Fifty-five percent of female and 49% of male AYA reported ever having had private time with an HCP and 55% of female and 44% of male AYA had spoken to an HCP about confidentiality. Independent predictors of having experienced private time and confidentiality included older age, race, higher household income, gender of the provider, amount of years with the provider, and involvement in risk behaviors. AYA who had experienced private time and confidentiality discussions had more positive attitudes about their providers, were more willing and comfortable discussing sensitive topics, and thought that these discussions should happen at younger ages.Conclusions
Although confidentiality and private time are important to AYA, many are not experiencing these components of care. Providing private time and discussions of confidentiality can improve the delivery of health care for young people by enhancing positive youth attitudes about preventive care. 相似文献83.
84.
目的:探讨lncRNA RP11-86H7.1在川崎病(KD)患者血清中的表达及其与临床病理特征及预后的关系。方法:筛选KD特异相关的循环lncRNA,分KD治疗前患儿组、KD治疗后患儿组、普通发热患儿组及健康儿童组,采用qPCR检测各组血清lncRNA RP11-86H7.1相对表达。分析血清lncRNA RP11-86H7.1相对表达与KD临床病理特征间关系;绘制ROC曲线,分析血清lncRNA RP11-86H7.1表达水平对KD的诊断效能。结果:KD急性患儿组血清lncRNA RP11-86H7.1相对表达量高于各对照组(P<0.05);年龄和性别比例与低表达组比较差异无统计学意义(P>0.05);qPCR发现lncRNA RP11-86H7.1在KD急性期患儿血清中表达水平明显高于KD恢复期、健康儿童及发热儿童组,差异均有统计学意义(P<0.05)。结论:血清lncRNA RP11-86H7.1在KD患者中表达上调,其可作为KD早期诊断和评估预后的潜在的生物标志物。 相似文献
85.
86.
目的 分析H型高血压患者的舌面诊图像颜色参数特征,探讨H型高血压患者的舌诊、面诊变化规律。方法 运用上海中医药大学自行研制的Smart TCM-1型中医舌面一体仪,采集高血压患者舌面诊图像,提取特征参数,分析健康对照组、H型高血压组与非H型高血压组患者舌面颜色参数特征。结果 ①在舌色各项参数中,H型高血压组舌尖部R值、B值、V值均显著小于健康对照组(P < 0.01);非H型高血压组舌尖部B值显著小于健康对照组(P < 0.01),S值较健康对照组显著增大(P < 0.05);H型高血压组舌尖部R、V值均明显小于非H型高血压组(P < 0.05)。在舌苔各项参数中,H型高血压组舌中H值、V值均明显小于健康对照组(P < 0.05);非H型高血压组舌中V值、舌右V值均显著小于健康对照组(P < 0.01);H型高血压组舌中H值明显小于非H型高血压组(P < 0.05),右侧舌苔S值明显大于非H型高血压组(P < 0.05)。②H型高血压组面色参数鼻G值、下颌G值、口唇R值、口唇V值均明显小于健康对照组(P < 0.05);非H型高血压组前额H值、目眶H值、脸颊H值、鼻H值、下颌H值、整体H值均明显大于健康对照组(P < 0.05);H型高血压组前额H值、目眶G值、目眶H值、脸颊H值、鼻G值、鼻H值、下颌R值、下颌G值、下颌H值、下颌V值、口唇R值、口唇G值、口唇V值、整体R值、整体G值、整体H值、整体V值均明显小于非H型高血压组(P < 0.05)。结论 H型高血压患者苔色偏黄,以舌中部为主,且舌右侧黄苔积聚较明显;H型高血压患者面色为黄中带红,口唇、下颌部更为晦暗。H型高血压患者的舌、面诊特征参数的变化,与高血压病阳亢湿盛病机相符。 相似文献
87.
目的调查呼吸专科护士慢性呼吸疾病管理现状,为提高慢性呼吸疾病的管理水平提供参考。方法依据《中国成人慢性呼吸疾病患者护理管理指南》设计调查问卷,对重庆、四川、贵州、陕西、河北、湖北、海南7省市的205名呼吸专科护士进行问卷调查。结果呼吸专科护士慢性呼吸疾病管理总分为(140.72±23.90)分。慢性呼吸疾病管理得分最低的3个条目有评估工具应用、个性化管理计划的实施、慢阻肺随访的次数及指导哮喘患者使用峰流速仪;呼吸专科护士所在单位慢性呼吸疾病管理平台建设均低于50%。结论呼吸专科护士慢性呼吸疾病管理处于中等偏下水平,评估是慢性呼吸疾病管理的薄弱点。需加强呼吸专科护士专业能力培养,规范慢性呼吸疾病全程管理,强化医院平台建设等,提高慢性呼吸疾病的管理水平。 相似文献
88.
This meta-analysis examined whether early decompressive craniectomy (DC) can improve control of intracranial pressure (ICP) and mortality in patients with traumatic brain injury (TBI).Medline, Cochrane, EMBASE, and Google Scholar databases were searched until May 14, 2015, using the following terms: traumatic brain injury, refractory intracranial hypertension, high intracranial pressure, craniectomy, standard care, and medical management. Randomized controlled trials in which patients with TBI received DC and non-DC medical treatments were included.Of the 84 articles identified, 8 studies were selected for review, with 3 randomized controlled trials s having a total of 256 patients (123 DCs, 133 non-DCs) included in the meta-analysis. Patients receiving DC had a significantly greater reduction of ICP and shorter hospital stay. They also seemed to have lower odds of death than patients receiving only medical management, but the P value did not reach significance (pooled odds ratio 0.531, 95% confidence interval 0.209–1.350, Z = 1.95, P = 0.183) with respect to the effect on overall mortality; a separate analysis of 3 retrospective studies yielded a similar result.Whereas DC might effectively reduce ICP and shorten hospital stay in patients with TBI, its effect in decreasing mortality has not reached statistical significance. 相似文献
89.
90.