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991.
Community support workers have become a common feature of mental health services. They work mainly with people with severe mental illness and offer intense support. Their need for training should be considered. 相似文献
992.
The role of the pharmacist on the diabetes care team is expanding due to the increasing number of patients diagnosed with diabetes, limited health care dollars, and the education related to and required for patients by managed care organizations and insurance companies. In the past, training of patients in diabetes self-management skills has been inadequate, and this continues to be the case. Clinical pharmacists, in cooperation with physicians, have increased opportunities to provide education about medications and may include instructions for patients regarding the interaction of food consumed with changes in blood glucose levels. Because of monthly refills on prescribed medications, a patient's interaction with the pharmacist in the setting of a commercial pharmacy is more frequent than with any other member of the diabetes team. This contact offers an ideal educational opportunity. The action and efficacy of medications that affect the pancreas, hepatic glucose production, the utilization of glucose by muscle cells, and the absorption of glucose from the intestines are influenced directly by the meal plan. Nutritional guidelines, meal planning for the Type I and Type II patient, use of the exchange system, carbohydrate counting, artificial sweeteners, alcoholic beverages, and suggestions for guiding patients to establish eating habits that lead to improved diabetes control are important issues for every member of the diabetes team to address. The reinforcement of dietary principles may occur in the educational setting of the hospital or the clinic or within the commercial pharmacy setting. When the team presents accurate and current information, continuity of care and improved patient understanding are achieved. 相似文献
993.
994.
Most studies of outcome by race in cancer have shown that blacks have a shorter survival compared to whites, both overall and within each TNM stage. We endeavored to evaluate the difference in survival by race in US military veterans treated for early stage non-small cell lung cancer (NSCLC). This retrospective analysis of overall survival by race, looking at all-cause mortality in a group of consecutively treated veterans with stage I-II NSCLC, was carried out at a 1,000-bed tertiary care Department of Veterans Affairs Medical Center. The study included 143 white and 45 black patients treated with curative intent for stage I-II NSCLC between January 1982 through August 1994. Nineteen patients received radiotherapy alone for their treatment while the remaining 169 underwent a complete surgical resection. There were no significant differences in patient characteristics for important prognostic variables. An overall survival analysis of all-cause mortality found no significant difference between the two groups. With equal access to health care, as is available for eligible patients in Department of Veterans Affairs Medical Centers, racial differences in lung cancer treatment outcome may be diminished or eliminated. 相似文献
995.
In an open-label, randomized trial using a 3 x 3 Latin square design, single doses of 24 mg of the ACE inhibitor spirapril, or 50 mg hydrochlorothiazide, or their combination were given to 18 healthy male volunteers. No alteration in the area under plasma drug concentration curve (AUC), peak plasma level, time to peak level, or elimination half-life was detected for hydrochlorothiazide, spirapril, or its active metabolite, spiraprilat, during combination therapy. It was concluded that there was no significant effect of spirapril on single-dose kinetics of hydrochlorothiazide, nor of hydrochlorothiazide on single-dose kinetics of spirapril. Significant reductions in systolic blood pressure were noted 2--6 h after either spirapril or combination treatment, but no evidence of any synergistic effect of single-dose effects on blood pressure was seen during combination therapy. 相似文献
996.
The presence of both mitral and aortic mechanical prostheses often make access to the left ventricle difficult for hemodynamic evaluation of valve gradients and for performing angiography. We present a case where both the transseptal and direct apical ventricular puncture techniques are utilized for assessing prosthetic valve function. The use of a new over the wire technique for left ventricular access using a flexible 4 French pediatric multipurpose catheter is described. 相似文献
997.
998.
Irving Lutsky Margaret Hopwood Stephen E. Abram James M. Cerletty Raymond G. Hoffman John P. Kampine 《Journal canadien d'anesthésie》1994,41(7):561-567
In order to determine the prevalence of psychoactive substance use in three specialty groupings, 1,624 questionnaires were sent to physicians in medicine, surgery and anaesthesia; all had trained at the same academic institution. A response rate of 57.8% was achieved. Comparison of prevalence of impairment rates showed no differences between Surgery (14.4%), Medicine (19.9%) and Anaesthesia (16.8%). Substance abuse was clearly associated with a family history of abuse; 32.1% of the abusers had a family history of such abuse compared with 11.7% of the non-abusers. Increased stress at various career stages did not appear to increase substance abuse; problem areas during medical life times were similar for each specialty. Substances most frequently used were marijuana (54.7%), amphetamines (32.9%); and benzodiazepines (25.1%). Seventy-three used psychoactive drugs which were non-prescribed. Drug counselling programmes were judged inadequate by most. Use of alcohol and drugs by faculty members was reported by a number of respondents. 相似文献
999.
1000.