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21.
Shared care: a review of the literature 总被引:7,自引:1,他引:6
This review examines broad issues of concern regarding the primary/secondarycare interface. The main purpose was to identify areas of goodpractice which could be adapted for more general use. One ofthe most fundamental aspects identified was communication, whichis discussed in some detail. Also covered are shared prescribingand disease management. The data suggest that the most effectivesystem(s) of shared care has yet to be established. Furtherqualitative and economic evaluations are required, taking intoaccount patient preferences. Although the literature does describecertain practice exemplars, it is clear that inter- and intra-professionalcommunication continues to be a problem. Whilst informationtechnology may provide some of the solutions, it is concludedthat a culture change, which compels health professionals tomake sharing of patient information a much higher priority,is reauired. Keywords. Shared care, seamless care, hospital, general practice, family practice. 相似文献
22.
In 260 asbestos-exposed individuals evaluated by means of computed tomography (CT), 43 unsuspected pulmonary masses were found in 27 individuals. The masses included fissural pleural plaques (n = 10), dense fibrotic bands (n = 3), round atelectasis (n = 11), carcinomas (n = 3), and other presumed benign masses (n = 16). The most helpful features in the diagnosis of rounded atelectasis with CT were (a) contiguity to areas of diffuse pleural thickening, (b) a lentiform or wedge-shaped outline, (c) evidence of volume loss in the adjacent lung, and (d) a characteristic "comet tail" of vessels and bronchi sweeping into the margins of the mass. Less advanced areas of focal atelectasis had fewer classic features. Intrafissural pleural plaques were readily identified with high-resolution CT. In asbestos-related masses, the demonstration of stability over time is necessary. Careful interpretation of CT and high-resolution CT features and close surveillance can obviate the need for biopsy in the majority of instances. 相似文献
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Horne G; Jamaludin A; Critchlow JD; Falconer DA; Newman MC; Oghoetuoma J; Pease EH; Lieberman BA 《Human reproduction (Oxford, England)》1998,13(11):3045-3048
Insemination with donor spermatozoa is an integral part of infertility
treatment. For the last 3 years in our unit, intrauterine insemination with
donor spermatozoa (IUID) has been used in preference to vaginal
insemination. In this retrospective study, patients were offered an initial
course of five single intrauterine inseminations with cryopreserved donor
spermatozoa and treatment was then reviewed. A total of 389 patients
received 1465 inseminations. In all, 1119 cycles were monitored using
luteinizing hormone serum analyses and 346 cycles using the urine home test
kits. The clinical pregnancy rate per insemination for the cycles monitored
by the serum assay was 18.0% (202/1119) compared with the urine cycles
(13.7%, 46/346) (P <05). The pregnancy loss rate was not significantly
different (14.4%, 29/202 and 21.7%, 10/46) (serum and urine cycles
respectively). The viable clinical pregnancy rate was significantly higher
(P <03) for the serum cycles than for the cycles using the urinary
monitoring (15.5%, 173/1119 and 10.4%, 36/346 respectively). The cycles
monitored by serum assay had a significantly higher cumulative viable
clinical pregnancy rate (P <0001) of 70.2% after nine inseminations
compared with the urine monitored cycles of 54.8%. The majority of patients
opted for the serum cycles, with a minority self-selecting the urine cycles
mainly for travelling convenience. The explanation for the significant
differences between the viable clinical pregnancy rates per insemination
and the cumulative viable clinical pregnancy rates may be due to the
sensitivity of the urine home test kit or the patients' interpretation of
the result.
相似文献
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B lymphocytes secreting IgG linked to latent transforming growth factor- beta prevent primary cytolytic T lymphocyte responses 总被引:3,自引:0,他引:3
B lymphocytes secreting IgG linked to latent transforming growth factor
(TGF)-beta (IgG-TGF-beta) prevent cytolytic T lymphocyte (CTL) responses to
unrelated antigens in mixed lymphocyte cultures (MLC) so long as resting
resident macrophages and functional Fc receptors are present. This was
shown using IgG-secreting plaque-forming cells (PFC) to sheep erythrocytes
(SRBC) obtained from popliteal lymph nodes of mice injected repeatedly in
foot pads with SRBC. Remarkably, as few as approximately 300 PFC prevented
CTL responses of 5 x 10(5) normal syngeneic spleen cells in MLC.
Supranatants of short-term cultures of PFC also prevented CTL responses,
and suppression was prevented by eliminating or dissociating IgG and
TGF-beta present in supranatants or by antibody against active TGF-beta.
Furthermore, the latency- associated peptide of latent TGF-beta was
detected in approximately 10% of foci of IgG captured from single PFC,
indicating that at least some B lymphocytes secrete IgG-TGF-beta as a
complex. Resting resident macrophages (which do not produce latent
TGF-beta) and functional Fc receptors were required for suppression,
consistent with idea that IgG- TGF-beta is taken up through Fc receptors
for IgG and that active TGF- beta, cleaved from latent TGF-beta of the
complex, is delivered directly to potentially responding CTL. If CTL
responses in man are similarly regulated by B lymphocytes, then an ongoing
B cell response in patients with chronic viral infections or bearing
immunogenic cancers may prevent effective therapeutic vaccination.
相似文献