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51.
K Benson ; MA Popovsky ; D Hines ; H Hume ; HA Oberman ; AB Glassman ; PT Pisciotto ; RL Thurer ; L Stehling ; KC Anderson 《Transfusion》1998,38(1):90-96
BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices. 相似文献
52.
Juvenile myasthenia gravis shares a similar pathophysiologic origin with adult myasthenia gravis, but there are important differences, mostly relating to epidemiology, presentation, and therapeutic decision making. Gender ratios and the proportion of seropositive patients differ in the pre‐ and postpubertal age groups. The diagnostic evaluation is similar to that in adults, although special techniques are sometimes necessary to perform single‐fiber electromyography in younger patients. Therapeutic decisions in affected children and adolescents are complicated by the greater long‐term consequences of using steroids, and thus other interventions, such as intravenous immunoglobulin (IVIg) and plasmapheresis, may play a greater therapeutic role in this population than in adults. Steroid‐sparing agents may contribute to the management of refractory cases, but they should be used with caution due to the risk of malignancy. Muscle Nerve, 2008 相似文献
53.
BACKGROUND Previous studies suggest that patients who are more involved in their medical care have better outcomes.
OBJECTIVES We sought to compare health care processes and outcomes for patients with HIV based on their preferred level of involvement
in health decisions.
DESIGN Cross-sectional analysis of audio computer-assisted interviews with patients at an urban HIV clinic.
PATIENTS One thousand and twenty-seven patients awaiting an appointment with their primary care provider.
MEASURES Patients were asked how they preferred to be involved in decisions (doctor makes most or all decisions, doctor and patient
share decisions, patient makes all decisions). We also asked patients to rate the quality of communication with their HIV
provider, and their self-reported receipt of and adherence to HAART.
RESULTS Overall, 23% patients preferred that their doctor make all or most decisions, 63% preferred to share decisions with their
doctor, and 13% preferred to make all final decisions alone. Compared to patients who prefer to share decisions with their
HIV provider, patients who prefer that their provider make all/most decisions were significantly less likely to adhere to
HAART (OR [odds ratio] 0.57, 95% CI 0.38–0.86) and patients who preferred to make decisions alone were significantly less
likely to receive HAART or to have undetectable HIV RNA in unadjusted analyses (OR 0.52, 95% CI 0.31–0.87 for receipt of HAART;
OR 0.64, 95% CI 0.44–0.95 for undetectable HIV RNA). After controlling for potentially confounding patient characteristics
and differences in patient ratings of communication quality, patients who preferred that their provider make all/most decisions
remained significantly less likely to adhere to HAART (OR 0.58, 95% CI 0.38–0.89); however, the associations with receipt
of HAART and undetectable HIV RNA were no longer significant (OR 0.60, 95% CI 0.34–1.05 for receipt of HAART; OR 0.80, 95%
C.I 0.53–1.20 for undetectable HIV RNA).
CONCLUSIONS Although previous research suggests that more patient involvement in health care decisions is better, this benefit may be
reduced when the patient wants to make decisions alone. Future research should explore the extent to which this preference
is modifiable so as to improve outcomes. 相似文献
54.
Quamar Azam MKA Sherwani Mazhar Abbas Rahul Gupta Naiyer Asif AB Sabir 《Indian Journal of Orthopaedics》2007,41(3):204-208
Objective:
Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in Gustilo''s Type IIIA and IIIB fractures becomes a formidable challenge in patients reaching late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.Materials and Methods:
Sixty-three patients, having 70 compound fractures (46 Type IIIA and 24 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged from 18 to 48 months with mean of 28 months.Result:
Overall infection rate noted was (n = 11) 15.71% (8.7% in IIIA, and 29.16% in IIIB). The difference in deep infection rate between Type IIIA and Type IIIB was found to be statistically significant (P value < 0.01). Nonunion was seen in five fractures. Functional evaluation using Katenjian''s criteria, showed 62.85% (44 fractures of 70) good to excellent results.Conclusion:
Satisfactory results may be obtained in Gustilo''s Type IIIA and IIIB fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged. 相似文献55.
Treatment of vitiligo with topical imiquimod 总被引:1,自引:0,他引:1
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59.
MRMdaSA Rafael† CMBM Fernandes† JMdaC Machado‡ PAPA Rodrigues‡ OJP Cardoso‡ A Afonso§ AB Sousa¶ FMDdeA Pacheco† RM Proença ‡ 《Journal of the European Academy of Dermatology and Venereology》2003,17(4):449-451
We report a case of atypical bullous pyoderma gangrenosum associated with acute myeloid leukaemia in which we found atypical myeloid cells within the skin lesion. Although there have been many reported cases of leukaemia-associated pyoderma gangrenosum, the finding of myeloblasts in the skin has rarely been described. 相似文献
60.
Warren R. Stanton PhD Jane L. Kelly AB Deborah A. Bunyan MSc Phil A. Silva PhD 《The Australian & New Zealand journal of obstetrics & gynaecology》1992,32(4):338-340
Fertility is dependent on sexual maturity, which is associated with a number of factors, including body mass. In this study the Body Mass Index (BMI) was used to estimate body fat in a large sample of 13-year-old New Zealand girls. Nearly half of the subjects (46%) had experienced the menarche. Expected gain in body mass was calculated from growth rates at earlier ages and used to examine whether deviation from the expected gain was associated with the onset of the menarche. In general, the results show an association between the menarche and gain in body mass. However, many girls who failed to achieve their expected gain had experienced the menarche (18%), indicating that the relationship between body weight and the menarche may not be causal or is mediated by other factors. 相似文献