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51.
In April of 1988, the Accrediting Commission on Education for Health Services Administration began reviewing its criteria, policies, and procedures for accreditation. The goal was to update the criteria and revise the policies and procedures to reflect advances in knowledge and practice and to ensure that accreditation judgments are objective and consistent. Since input from those most affected by the new criteria--faculty and practitioners--is essential, the commission sought assistance from the field. Through this collaboration, it is ACEHSA's intention to continue to encourage the dynamic collaboration of the field of education and the field of practice in health services administration that's characteristic of ACEHSA's 20-year history. 相似文献
52.
Thierry Berney M.D. Giorgio La Scala M.D. Denise Vettorel M.D. Dagmar Gumowski M.D. Conrad Hauser M.D. Pascal Frileux M.D. Dr. Patrick Ambrosetti M.D. Adrien Rohner M.D. 《Diseases of the colon and rectum》1994,37(10):1038-1042
PURPOSE: This paper intends to stress the importance of early diagnosis and discuss surgical treatment of Type IV Ehlers-Danlos syndrome (EDS-4), an autosomal dominant connective tissue disease characterized by typical features of the face and extremities, inappropriate and easy bruising, and extreme tissue fragility, which may lead to dramatic and often fatal complications, mostly spontaneous arterial or intestinal rupture. METHODS: We report the case of a 41-year-old female who presented with spontaneous perforation of the sigmoid colon. RESULTS: The patient was seen over a nine-year period, during which time she required six operations and presented with a great number of surgical complications including stenosis of an end-colostomy, repeated subocclusive episodes caused by intraperitoneal adhesions, and enterocutaneous fistulas, finally ending with an ileostomy and short bowel syndrome. It is only after a difficult laparotomy for ovarian cyst excision, marked by numerous adhesions and friable bowel, that the diagnosis of EDS-4 was considered and established. CONCLUSIONS: In case of “idiopathic” spontaneous perforation of the colon in a young adult, features of EDS-4 should be thoroughly looked into and, if found, skin fibroblast culture with collagen Type III analysis performed. The surgical treatment of choice consists of subtotal colectomy and permanent endileostomy. In case of patient refusal, a second-stage ileorectal anastomosis can be performed but carries the high risk of anastomotic leakage. 相似文献
53.
Treatment of acute promyelocytic leukemia with arsenic trioxide 总被引:3,自引:0,他引:3
Conrad ME 《The New England journal of medicine》1999,340(13):1043; author reply 1044-1043; author reply 1045
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Soft tissue sarcomas present with varied radiological appearances. Positron imaging with [F-18] fluorodeoxyglucose (FDG PET) has recently made promising contributions to management of patients by providing a noninvasive means for evaluating tumor metabolism and providing important biological information about soft tissue malignant tumors. PET imaging not only gives quantitative data on metabolic rates of tumors but can also readily provide semiquantitative data of uptake of tumors by measuring uptake ratios. These values have been helpful for noninvasively grading tumors. This value is called the tumor standard uptake value (SUV). The tumor grades (low, intermediate, high) mean SUV values show a high level of significance in discrimination among tumor grade groups. 相似文献
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PURPOSE: We investigated whether serial daily measurements of serum C-reactive protein could help differentiate episodes of transplant dysfunction due to rejection, infection, cyclosporin A nephrotoxicity or acute tubular necrosis in renal allograft recipients. MATERIALS AND METHODS: Morning serum was obtained daily from 134 patients during the first 30 days after renal transplantation. All episodes of graft dysfunction were recorded and compared to transplant biopsies. C-reactive protein concentrations were correlated with postoperative graft function and the various causes of graft dysfunction. RESULTS: All patients demonstrated an increase in C-reactive protein in response to surgery and a maximum level was reached on day 2 after transplantation. Mean C-reactive protein concentration was significantly increased for delayed (61.50 microg./ml.) compared to primary (mean 38.01) graft function (p = 0.001, Mann-Whitney U test). There were significant increases in C-reactive protein for bacterial infections other than asymptomatic bacteriuria (33.98 microg./ml), interstitial graft rejection (16.43) and acute tubular necrosis (30.50) compared to uneventful courses. C-reactive protein was unchanged for viral infections or cyclosporin A toxicity. CONCLUSIONS: Serial C-reactive protein measurements help to identify renal transplant dysfunction of different origins. However, rejection, infection and acute tubular necrosis show similar patterns of C-reactive protein increase. Thus, C-reactive protein is unable to discriminate the causes of renal graft dysfunction. Biopsy remains the gold standard for the differential diagnosis of renal allograft dysfunction. 相似文献
58.
Summary
The requirement of blood transfusions was evaluated in a two compartment (retrospective/prospective) study in our renal transplantation
program. Between July 1st, 1993 and December 31st, 1994 (observation period I) we retrospectively investigated 110 patients
with end stage renal disease and anemia undergoing kidney transplantation. Between January 1st, 1995 and December 31st, 1996
(observation period II) the requirement of blood transfusions was followed prospectively in 134 patients after allogenic renal
transplantation. The amount of blood drawn for preoperative diagnostic investigations was in observation period I significantly
higher (280 ml) than in observation period II (150 ml) (p = 0.02). For postoperative diagnostic tests in observation period
II significantly less blood (240 ml) was needed than in observation period I (510 ml) (p = 0.01). The intraoperative bloodloss
was similar in both periods (170 ml vs. 190 ml; p = 0.6). The need for closer graft observation was the reason for significantly
increased amount of blood transfusions in patients with delayed graft function. The number of blood transfusions was significant
lower in patients with primary graft function (p = 0.0001). There was no correlation between blood transfusions and the use
of ATG/OKT3, surgical complications and reoperations. With an improved management of blood drawing for diagnostic tests after
allogenic kidney transplantation the number of perioperative blood transfusions can be reduced significantly.
相似文献
59.
Conrad WF Armistead JA 《Topics in hospital pharmacy management / Aspen Systems Corporation》1991,11(1):1-8
Quality and the issues that surround its assessment and accountability are complex matters requiring thoughtful analysis and action. The translation of concept into practice evades most practitioners, because the detail of how to accomplish the transition has been missing. Drug-usage evaluation may not be the ultimate answer. The concept has inherent limitations. However, well constructed, systematic DUE programs that focus on enhancing patient care, establishing effective communication networks, and containing constructive intervention methods can help improve drug use. Drug-usage evaluation can be an important link between process and outcome evaluation. For pharmacists, DUE is an opportunity to use their expertise and existing clinical practice to begin to develop a pharmaceutical care system. Drug-usage evaluation is a step in the right direction. The profession should move decisively to play an active role in improving patient outcomes. 相似文献
60.