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12.
G. Bradley Schaefer James N. Thompson John B. Bodensteiner James M. McConnell William J. Kimberling Charles T. Gay William D. Dutton David C. Hutchings Stanton B. Gray 《Annals of neurology》1996,39(3):382-385
There are conflicting reports on the relationship between cerebellar vermal lobule hypoplasia and autism. Using quantitative magnetic resonance image analysis, we measured the cerebellar vermis in 125 normal individuals with a broad age range and 102 patients with a variety of neurogenetic abnormalities. We conclude that hypoplasia of cerebellar vermal lobules VI and VII is a nonspecific finding that even occurs in several conditions without autistic behavior. This suggests that it is not a specific neuroanatomical marker for autism, nor is cerebellar dys- genesis likely to be solely responsible for clinical autistic behaviors. 相似文献
13.
Many public and private sector efforts are devoted toward increasing the training of physicians from under-represented minority groups, yet little has been documented regarding the association between physicians' racial backgrounds and the patient populations they serve. To address this question, we use 1987 National Medical Expenditure Survey to examine the impact of race/ethnicity on the matching between physician and patients. Our results show that minority patients are significantly more likely to report having a minority physician as their regular doctor. We estimate that minority patients are five times as likely as non-minorities to report that their regular physician is a member of a racial/ethnic minority. This effect is especially pronounced among Hispanics who identify a Hispanic physician as their regular provider 19 times more often than non-minorities. After controlling for other socio-economic factors, both these figures remain significant, but drop by approximately one-half. These results support the notion that minority patients tend to see minority physicians at a disproportional rate independent of other socio-economic factors. 相似文献
14.
Preventive care for patients following myocardial infarction. The Wessex Research Network (WReN) 总被引:2,自引:1,他引:1
OBJECTIVE: We aimed to assess general practice care for patients following
a myocardial infarction (MI). METHOD: A structured review was carried out
of general practice records of patients identified from hospital
administration data. A total of 266 survivors following MI were identified
from the discharge data of 13 hospitals in Southern England and registered
with 71 GPs belonging to the Wessex Research Network. Median time since
hospital discharge was 2.1 years. The main outcome measures were the
provision of appropriate preventive care, including cardiac rehabilitation,
drug therapy, and lifestyle advice for modifiable risk factors. RESULTS:
Basic care was provided to nearly all patients; 253 (95.1%, 95% Cl
91.8-97.4) had blood pressure documented after their MI, 216 of 234
patients eligible for aspirin (92.3%; 88.1-95.4) had been recommended
treatment, and the provision of advice on smoking cessation was documented
for 27 of 33 continuing smokers (81.8%; 64.5-93.0). However, only 73 of 236
patients eligible to attend a structured rehabilitation programme (30.9%;
25.0-36.8) were documented as having received rehabilitation. Of 89
patients with heart failure following MI, 33 (37.1%; 27.1-48.0) had no
record of having been offered treatment with an ACE inhibitor. Total
cholesterol measurement was documented for only 144 patients (54.1%;
48.1-60.1). We estimate that there is still the potential to prevent
between 4 and 9 deaths in this group of 266 surviving patients in the next
2 years by further improving the quality of follow-up care. CONCLUSIONS:
Preventive care in patients with proven ischaemic heart disease in general
practice remains haphazard, even among doctors enthusiastic to participate
in research and to audit their quality of care. As general practitioners we
should ensure that we are providing high quality preventive care to
patients with clinical disease before we focus on the even more demanding
task of primary prevention.
相似文献
15.
The temporomandibular joint (TMS) lies at the skull base. Its bony roof forins part of the floor of the middle cranial fossa. It is bounded by the infratemporal fossa, external auditory canal, middle ear, and eustachian tube. When wide resection of tumors arising within the TMJ is necessary, skull base approaches permit complete resection with oncologically sound margins. Precise pathologic diagnosis can be difficult and extra care should be taken to ensure diagnostic accuracy. Outcomes are improved if attention and effort is directed to rehabilitation of the TMJ. Five such cases are presented and the literature is reviewed. 相似文献
16.
Dr. Sandra S. Garner Pharm.D. Dr. Donald B. Wiest Pharm.D. Mr. J. Warren Bradley R.R.T. 《Pharmacotherapy》1994,14(2):210-214
Study Objective . To determine albuterol delivery by metered-dose inhaler (MDI) in an in vitro pediatric mechanical ventilatory circuit model. The influence of a spacing device, endotracheal tube (ETT) diameter and length, and air humidity was also investigated. Design . An albuterol MDI canister was connected to an AeroVent spacer or Airlife MDI adapter and ETT 4.0, 5.0, or 6.0 mm at commercially available and equal lengths. The ETT tip was attached to an in-line filter holder with a 1-μm type A/E glass fiber filter. Ventilator settings were fractional concentration of inspired oxygen 50%, tidal volume 250 ml, inspiratory:expiratory (I:E) ratio 1:3, rate 25 breaths/minute, temperature 35°C, and a decelerating flow pattern. Ten albuterol canisters were activated two times each (total 2000 μg) into dry (4.0-, 5.0-, and 6.0-mm ETT) and humidified air (4.0- and 6.0-mm ETT) and repeated in triplicate. Percentage MDI output was determined by weighing the filter before and after drug administration (balance sensitivity 10 μg). Significant differences (p≤0.05) among the groups with and without a spacer and in dry and humidified air were determined by ANOVA with Scheffe's multiple comparison test. Multiple regression was used to determine significant associations between ETT diameter and length and delivery. Main Results . With the AeroVent spacer in humidified air, delivery with the 4.0- and 6.0-mm ETT was approximately 2.3% and 5%, respectively. The spacer and dry air significantly improved delivery. Conclusions . In humidified air, the dose of albuterol by MDI with an AeroVent spacer should be doubled for children intubated with 6.0-mm ETT, and four puffs administered for every one puff desired for 4.0-mm ETT. The results of this investigation should prove useful in initial clinical trials of albuterol MDI in ventilator-dependent infants and children. 相似文献
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The magnetic resonance (MR) images of six patients with thrombosis of a dural sinus were reviewed. The diagnosis had been verified by computed tomographic scans in three patients and arteriograms in two; in the sixth patient, only MR imaging was used to confirm the clinical syndrome. In all patients, high-intensity signal was seen from the thrombus within the affected dural sinus on all echoes. This persistent signal intensity allowed intravascular clot to be distinguished from normal causes of increased signal such as flow-related enhancement (entry phenomenon) and even-echo rephasing. MR imaging demonstrated the cause of the thrombosis in three patients: two were secondary to adjacent tumors, and one was secondary to unsuspected mastoiditis. Complications such as infarction were also demonstrated. Using MR imaging, one can easily and safely diagnose thrombosis of a dural sinus. MR should be the imaging method of choice in patients suspected of having thrombosis of a dural sinus. 相似文献
20.
L. Ostrosky-Zeichner C. Sable J. Sobel B. D. Alexander G. Donowitz V. Kan C. A. Kauffman D. Kett R. A. Larsen V. Morrison M. Nucci P. G. Pappas M. E. Bradley S. Major L. Zimmer D. Wallace W. E. Dismukes J. H. Rex 《European journal of clinical microbiology & infectious diseases》2007,26(4):271-276
The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis
in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed
at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3%
(88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1–3) OR presence of a central venous catheter
(days 1–3) AND at least TWO of the following—total parenteral nutrition (days 1–3), any dialysis (days 1–3), any major surgery
(days −7–0), pancreatitis (days −7–0), any use of steroids (days −7–3), or use of other immunosuppressive agents (days −7–0).
The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following
performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive
value 0.97. The rule may identify patients at high risk of invasive candidiasis.
Results of this project were partially presented at Focus on Fungal Infections 14, New Orleans, LA, USA, 2004. Abstract no.
51. 相似文献