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PREMEDICATION IS A NECESSARY PART OF PEDIATRIC ANESTHESIA: ABRAHAM ROSENBAUM MD ZEEV N. KAIN MD †‡ PREMEDICATION IN PEDIATRIC ANESTHESIA SHOULD BE INDIVIDUALIZED THE CHOICE OF PHARMACOLOGIC AGENT SHOULD BE RECONSIDERED: PETER LARSSON MD PER-ARNE LÖNNQVIST MD DEAA FRCA PHD † MODERATOR: ANDREW R. WOLF MD FRCA 《Paediatric anaesthesia》2009,19(9):817-828
Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro–con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective. 相似文献
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Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability 总被引:6,自引:0,他引:6
Gibson RN; Yeung E; Thompson JN; Carr DH; Hemingway AP; Bradpiece HA; Benjamin IS; Blumgart LH; Allison DJ 《Radiology》1986,160(1):43-47
In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction. 相似文献
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A. Touré D. Cissé KJJO. Kadio A. Camara FA. Traoré A. Delamou S. Sididé C. Kouyaté IS. Bangoura MM. Diallo TM. Tounkara F. Traoré MS. Sow N. Khanafer M. Cissé 《Revue d'épidémiologie et de santé publique》2018,66(4):273-279
Background
Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry.Methods
A retrospective cohort study was conducted in HIV patients aged over 15 years and who receiving antiretroviral therapy. Between August 1, 2008 and July 31, 2015, all patients managed by the ambulatory treatment center of the Guinean Women Association against AIDS and sexually and transmissible infection were included. Loss of follow-up was defined as no follow-up visit within 3 months. Kaplan–Meier curves and multivariate Cox regression modelResults
614 patients aged 36.3 ± 11.2 years, mainly females (68.4%) and living in Conakry (80.5%) were included. Among them, 104 were loss to follow-up, corresponding to a proportion rate of 16.9% (95% CI: 14.2–19.7%) or 5.79/100 person-years. The results of multivariate analyses showed that factors independently associated with loss of follow-up were malnutrition (AHR = 7.05; 95% CI: 2.05–24.27; P = 0.002) and CD4 cells account at the initiation of AHR (2.35; 95% CI: 1.61–6.39; P = 0.016) in patients with 201–350 CD4/μL and 5.83 (95% CI: 2.85–11.90; P < 0.001) in patients with less than 150 CD4/μL.Conclusion
Despite efforts of health care workers and free antiretroviral therapy, many patients were loss to follow-up. Multivariate analysis showed that malnutrition and low CD4 account were independently associated with loss to follow-up. 相似文献27.
Ian Nivison-Smith Samuel Milliken Anthony J. Dodds David Gottlieb John Kwan David D.F. Ma Peter J. Shaw Steven Tran Leonie Wilcox Jeff Szer 《Biology of blood and marrow transplantation》2018,24(1):169-174
We conducted a study to analyze and report on indicators of hematopoietic cell transplant (HCT) physician time use and HCT center output measures. HCT centers in Australia and New Zealand (A&NZ) were invited to provide demographic and time use details for physicians participating in HCT patient care (HCT physicians). Resource details for adult and pediatric centers were included. From a total of 46 centers that were invited to participate, completed data were received from 37 centers (80%) representing 185 HCT physicians, with a median age of 48 (range, 33 to 72), of whom 31% were women. Just over half of HCT physicians cited prior work experience in large overseas HCT centers (97, 52%) and over one-third (79, 43%) possessed postgraduate qualifications other than specialist training. Total annual mean HCTs per HCT physician full-time equivalent (FTE) were 14.2 for centers performing both allogeneic and autologous HCT, 6.6 for autologous only centers, and 10.6 for all centers. For all HCT physicians surveyed the mean proportion of time spent on HCT related tasks was 31.7%. In A&NZ, for centers that perform both allografts and autografts, there was a mean of 4.0 allogeneic HCT annually per HCT bed, compared with 2.6 for the United States and 7.1 allogeneic HCT annually per HCT physician FTE (United States, 6.3). Projections of the A&NZ HCT physician workforce indicated that the numbers of HCT physicians are likely to stay within the region of 170 to 190 for the next 10 years, whereas HCT activity will likely continue to climb steadily. Healthcare and government authorities should be prepared to enable and support greater HCT activity in A&NZ in the future. 相似文献
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Occult malignant breast lesions in 114 patients: relationship to age and the presence of microcalcifications 总被引:2,自引:0,他引:2
Hermann G; Janus C; Schwartz IS; Papatestas A; Hermann DG; Rabinowitz JG 《Radiology》1988,169(2):321-324
This study evaluates the mammographic findings in 352 patients, aged 30-85 years, who underwent spot localization and biopsy for evaluation of nonpalpable breast abnormalities. Malignancy was found at biopsy in 114 cases. The mammographic appearance (specifically, whether grouped microcalcifications, mass, or both were present) was correlated with patient age and histologic findings (specifically, whether the pathologic changes were infiltrating or noninfiltrating in nature). The prevalence of malignant conditions increased directly with age. The presence of grouped microcalcifications as the sole indicator of malignancy was seen in 100% (seven of seven) of the patients in the 30-39-year age group, 64% (18 of 28) in the 40-49-year age group, 37% (11 of 30) in the 50-59-year age group, 30% (seven of 23) in the 60-69-year age group, and 23% (six of 26) in the 70-85-year age group. Of the 49 tumors that were manifested solely as microcalcifications, 34 (69%) were noninfiltrating. The finding of grouped microcalcifications should be aggressively investigated, since it may indicate noninfiltrating carcinoma in an early stage, when the potential for cure is greatest. 相似文献