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41.
Milton J. Guiberteau MD Pamela A. Wilcox RN MBA Sandra Bjork RN JD 《Journal of the American College of Radiology》2004,1(2):92-97
Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of “cookbook” medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers. 相似文献
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43.
Hyperbaric nitrogen-oxygen exposure developed in rats a decrement of the striatal dopamine release, which was reversed by repetitive exposures. This dopamine decrease could be the result of the antagonistic effect of nitrogen on NMDA receptors. The increment of the dopamine release, following repetitive exposures to nitrogen, could be attributed to a desensitisation of NMDA receptors to the effects of nitrogen. To test these hypotheses, male Sprague-Dawley rats were implanted with electrodes in the striatum to measure dopamine release by voltammetry and cannula in the substantia nigra pars compacta for NMDA injection. Free-moving rats were exposed up to 3MPa of nitrogen-oxygen mixture before and after 5 exposures to 1MPa. At the first exposure to 3MPa, the dopamine level decreased (-15%) but is counteracted by NMDA administration. In contrast, after repetitive exposure, the second exposure to 3MPa, induces a 10% dopamine increase. NMDA administration significantly potentiated this increase. Our results neither support the hypothesis of an antagonist effect of nitrogen on NMDA receptors at the first exposure, nor that of a NMDA receptor desensitization following repetitive exposures to hyperbaric nitrogen. 相似文献
44.
L. Rosenberg M.D. I. T. Jackson D. Sharpe J. Weiss 《European journal of plastic surgery》1987,9(4):158-159
Summary A system which can be used for injection or infiltration of large volumes of fluid is described. This consists of a syringe which fills automatically from a reservoir through an inlet/outlet valve. 相似文献
45.
Pharmacotherapy of psychiatric emergencies 总被引:1,自引:0,他引:1
The psychiatric emergency service has become a major provider of psychiatric care over the past decade. Concomitant with this growth has been an emphasis on pharmacological treatment. While rapid tranquilization is the best known and most frequently used intervention, a growing diagnostic awareness has led to a variety of other chemotherapeutic approaches. The current reviews of pharmacologic intervention in the psychiatric emergency service do not detail the variability of treatment approaches or examine alternative treatment approaches. The goal of this article is to critically review current pharmacologic treatments and address areas in which there is no consensus in treatment approach. From this review the authors suggest guidelines for pharmacotherapy of psychiatric emergencies. The authors discuss rapid tranquilization, the treatment of alcohol and drug intoxication and withdrawal, and anxiety disorders. 相似文献
46.
47.
M Kühne B Schaer C Kaufmann N Moulay T Cron T Cueni P Weiss C Schindler C Sticherling S Osswald 《Europace : European pacing, arrhythmias, and cardiac electrophysiology》2007,9(12):1185-1190
AIMS: DDD-pacemakers are favoured in patients with sick-sinus-syndrome or AV-block. However, AAI-pacemakers for sick-sinus-syndrome or VDD-pacemakers for AV-block may provide similar benefit with lower costs. The aim is to show that a tailored approach (TA) with arrhythmia-specific pacemaker selection was equal to a standard approach (SA) regarding quality of life (QoL) at lower costs. METHODS AND RESULTS: The study was prospective and randomized with QoL as primary endpoint. Secondary endpoints were a combined endpoint of all-cause mortality, worsening heart failure or angina, atrial fibrillation (AF), stroke, these endpoints individually and costs. Of 198 patients (age 77 +/- 10 years, 43% female, ejection fraction 54 +/- 12%, follow-up 38 +/- 15 months), 94 were randomized to SA and 104 to TA. Thirty-two patients (34%) died in the SA group vs. 25 (24%) in the TA (P= ns). QoL showed no differences in all dimensions. The combined secondary endpoint was reached more frequently with SA (51%) compared to TA (37%, P = 0.045). There was no difference regarding all single secondary endpoints. Hardware costs were reduced by 15% (P < 0.0001). CONCLUSION: In long-term follow-up, a TA is equal to SA regarding the primary endpoint QoL and secondary endpoints as AF and mortality. Depending on the healthcare system, it may significantly reduce costs. 相似文献
48.
Fabia Preminger Patrice L Weiss Naomi Weintraub 《The American journal of occupational therapy》2004,58(2):193-201
PURPOSE: To determine whether there is a correlation between handwriting and keyboarding speed and accuracy, and whether handwriting and keyboarding share common underlying components. METHODS: Sixty-three typically developing 5th-grade students attended a series of 15 keyboarding lessons for a total of 5 hours. Prior to the lessons, cognitive, sensory, and motor skills related to handwriting were evaluated. Prior to and following the lessons keyboarding and handwriting accuracy and speed were also tested. Correlations were employed to examine relationships between handwriting and keyboarding skills and multiple regression analyses were used to examine the contribution of performance components to handwriting and keyboarding performance. RESULTS: Following keyboarding instruction, a significant correlation was found between handwriting and keyboarding speed, but not in accuracy of these tasks. Similarly, some of the specific tests measuring tactile and oculo-motor functions were found to be related to both handwriting and keyboarding speed, yet accuracy of these tasks did not share common underlying components. CONCLUSIONS: It appears that handwriting and keyboarding accuracy may entail different skills, suggesting that keyboarding may be a potential alternative writing tool for students with handwriting difficulties. It also appears that when students write slowly, handwriting speed should be considered prior to recommending keyboarding for these students. Additional research is required to further support these findings. 相似文献
49.
50.
Alexander Dullenkopf Goran Lamesic Andreas Gerber Markus Weiss 《Journal canadien d'anesthésie》2003,50(5):507-510
PURPOSE: A simple technical solution is presented to provide video transmission from the tip of a Bullard laryngoscope to a bedside video display, while the operator is still able to look through the viewing ocular of the Bullard laryngoscope during tracheal intubation. EQUIPMENT: This is achieved by insertion of an ultrathin fibreoptic video-endoscopic system into the working channel of the Bullard laryngoscope. Thereby the view from the distal blade tip is transmitted to a bedside monitor, without interfering with the use of the Bullards laryngoscope's original eyepiece. The presented technical solution allows video transmission without considerable additional weight normally associated with attaching video endoscopy cameras, light and camera cables to endoscopic devices. Thus, the Bullard laryngoscope remains lightweight and easy to maneuver. A screw-threaded adapter with a side-port is proposed to prevent displacement of the fibreoptic cable while still allowing application of oxygen. CONCLUSION: Experience and skills with tracheal intubation using the presented video-enhanced Bullard laryngoscope can be achieved in the originally intended way, while the supervisor or attending viewers can follow the tracheal intubation procedure on the video display. 相似文献