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An electrocardiogram is presented which shows sinus rhythm with alternating Wolff-Parkinson-White (preexcitation) pattern. The frequency of intermittent preexcitation and mechanisms for its production are discussed. 相似文献
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Introduction: Noninvasive ventilation (NIV) is being increasingly used in patients with chronic neuromuscular disorders, but the optimal
ventilation mode remains unknown. We compared physiological short-term effects of assist/controlled ventilation (ACV) and
two pressure-limited modes (pressure-support ventilation [PSV] and assist pressure-controlled ventilation [ACPV]) in patients
with neuromuscular disease who needed NIV.
Methods: Tidal volume was 10 to 12 mL/kg. The ACPV mode used the same respiratory cycle timing as the volume-limited mode. The level
of inspiratory support was set to achieve the same tidal volume during the other ventilatory modes.
Results: Thirteen patients with neuromuscular disease who met international criteria for NIV were included. The three ventilatory
modes increased alveolar ventilation and decreased respiratory effort indices. However, no difference in breathing or respiratory
effort was found among the three modes, with the exception that inspiratory peak flow and percentage of triggered cycles were
higher during PSV than volume-limited ventilation. Interestingly, no relationship was observed between subjective patient
preference and inspiratory effort indices or percentage of triggered cycles.
Conclusion: In chronic, stable patients with neuromuscular disease, both noninvasive ACV, ACPV, and PSV had similar effects on alveolar
ventilation and respiratory muscle unloading, despite some differences in the pattern of breathing and percentage of triggered
cycles. 相似文献
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J.P. Agarwal T. Wadasadawala A. Munshi P. Chadda R. Apsani M. Upasani S.G. Laskar C.S. Pramesh G. Karimundackal H. Menon K. Prabhash N. Jambhekar 《Clinical oncology (Royal College of Radiologists (Great Britain))》2010,22(10):837-843
AimsTo study various prognostic factors affecting outcome and to validate Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class in non-small cell lung cancer (NSCLC) with brain metastases treated with short-course accelerated radiotherapy (SCAR).Materials and methodsThe case records of 100 patients with NSCLC consecutively treated at Tata Memorial Hospital from August 2006 to August 2009 were studied for various patient, tumour and treatment-related prognostic factors. Patients received whole-brain radiotherapy to a dose of 20 Gy/five fractions over 1 week (n = 90) or 30 Gy/10 fractions over 2 weeks (n = 10). The Kaplan–Meier estimate was used for survival analysis in SPSS v15.ResultsThe median overall survival was 4.0 months (range 0.5–30.0 months). The 6-, 12-, 18- and 24-month survival rates were 35.8, 18.0, 9.3 and 6.2%, respectively. Of the various prognostic factors, RPA class (II versus III, P value = 0.023), Karnofsky performance score (<70 versus ≥70, P value = 0.039) and the use of systemic therapy (yes versus no, P value = 0.00) emerged as significant on univariate analysis. RPA classification effectively separated the patient population into prognostically distinct subgroups. The median overall survival for RPA class II and RPA class III was 6 and 4 months, respectively. The use of systemic therapy prolonged overall survival by 6 months (3 months versus 9 months).ConclusionThe SCAR regimen is an effective and resource-sparing palliative strategy for brain metastases in NSCLC. The results validate the usefulness of RPA classification in this specific subset of patients treated with SCAR. 相似文献
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Adam Tran Joanne M. Fuller Keith K. Wong Ines Krass Ron Grunstein Bandana Saini 《Pharmacy World & Science》2009,31(4):473-480
Objective To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies.
Setting The screening was piloted in five Australian community pharmacies. Method The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders,
and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the
Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International
Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant’s risk
of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training
of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited
from participating pharmacists and clients. Main outcome measure The feasibility of, and trends found from, the developed screening tool and protocol. Results Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected
data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep
apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders.
OSA odds increased 12.8 times (95% CI: 3.2–50.4) with diabetes and 4.9 times (1.2–20.9) with opioid use, while shift workers
were 8.4 times (1.6–43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument
was user friendly and feasible. Conclusion The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population
was high but generally consistent with previous studies on the general population. Furthermore, associations found may form
a foundation for a clinical algorithm to identify those at a higher risk of having or developing a sleep disorder. Further
work is required to validate this screening tool in the community pharmacy context. 相似文献
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The present study was conducted in 50 patients of various subtypes of leprosy (Lepromatous, Tuberculoid, Borderline borderline) and 25 healthy control, for detection of Australia antigen and various liver function tests (serum protein, cholesterol, alkaline phosphates, SGOT, SGPT, bilirubin and liver biopsy) to see incidence of Australia Antigen and derangement in liver function. It was concluded that incidence of Australia antigen in study and control group was zero. Total serum protein and serum globulin was increased in lepromatous leprosy. A/G ratio was reversed in 34.3% and 50% in lepromatous and tuberculoid leprosy respectively. Granulomatous hepatitis was seen in 66.66% and 50% cases of lepromatous and tuberculoid leprosy respectively. No relationships was established between hepatic lesion, Australia antigen and liver function test. 相似文献
19.
Regis P. Kowalski MS Eric G. Romanowski MS Bandana Waikhom MD Y.Jerold Gordon MD 《American journal of ophthalmology》1998,126(6):835-836
PURPOSE: To determine if common ocular adenovirus serotypes survive in vitro in multidose bottles of topical fluorescein (Fluress; Pilkington Barnes Hind, Inc, Sunnyvale, California).METHODS: Clinical isolates of adenovirus types 8 and 19 were inoculated separately into 10 bottles each of Fluress and maintained at room temperature (25 C). All bottles were titered for adenovirus on A549 cell monolayers at 0, 7, 14, 21, 28, and 49 days.RESULTS: Adenovirus was recovered from Fluress for up to 21 days for adenovirus type 19 and 28 days for adenovirus type 8.CONCLUSION: A multidose bottle of Fluress contaminated with adenovirus can be a potential source of adenoviral transmission in an ophthalmic office setting. 相似文献
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Smith L Bosnic-Anticevich SZ Mitchell B Saini B Krass I Armour C 《Social science & medicine (1982)》2007,64(7):1501-1511
Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings. 相似文献