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101.
102.
'Inappropriate' attenders at accident and emergency departments II: health service responses 总被引:2,自引:0,他引:2
BACKGROUND: Health services have responded to perceived 'inappropriate'
attenders at accident and emergency (A&E) departments in three ways.
Firstly, they have responded by attempting to decrease the numbers of
patients attending A&E departments. There is little evidence supporting
the efficacy of such policies. Secondly, they have responded by referring
inappropriate attenders to another site. Research indicates that whilst
such referral may be feasible, resultant decreases in departmental
workloads have yet to be demonstrated. Patient outcome has also to be
determined. Thirdly, by performing triage of attenders they provide care
appropriate to their needs. Sessional GPs working in A&E departments
manage non-emergency A&E attenders safely and use fewer resources than
do usual A&E staff. Long-term effects on health-seeking behaviour and
patient perception of the distinction between primary care services have
yet to be determined. CONCLUSIONS: Rather than vainly attempting to make
the patients appropriate to the service, future initiatives should
concentrate on making the A&E service more appropriate to the patient.
相似文献
103.
104.
105.
AH Sklar DH Beezhold N Newman T Hendrickson AW Dreisbach 《American journal of kidney diseases》1998,31(6):1007-1010
Tumor necrosis factor-alpha (TNF-alpha) has been shown to have somnogenic properties. Plasma levels of this cytokine have been found to increase significantly during dialysis with a bioincompatible (cuprophane) membrane in patients with postdialysis fatigue (PDF). We conducted a crossover study with random assignment to ascertain whether a biocompatible membrane might attenuate the increase of TNF-alpha and severity of PDF. Sixteen patients on maintenance hemodialysis underwent dialysis with either cuprophane (n = 8) or polymethylmethacrylate (PMMA; n = 8) membranes for 1 week and then switched to the opposite membrane during the second week. Predialysis and postdialysis measurements of plasma TNF-alpha levels were performed during the first and last dialysis treatments of each week. A fatigue score was determined from the sum of duration of fatigue and sleep within 6 hours of the completion of dialysis. TNF-alpha levels increased by an average of 18.3% during dialysis with cuprophane membranes but only 2.4% with PMMA membranes (P = 0.04). Despite this, fatigue scores remained unaltered (approximately 4 of 6). Hence, the biocompatible membrane, PMMA, failed to alleviate PDF. This suggests that dialytic stimulation of TNF-alpha plays no substantial role in the pathogenesis of PDF. 相似文献
106.
107.
Thompson PM; Moussai J; Zohoori S; Goldkorn A; Khan AA; Mega MS; Small GW; Cummings JL; Toga AW 《Cerebral cortex (New York, N.Y. : 1991)》1998,8(6):492-509
The onset of Alzheimer's disease (AD) is accompanied by a complex and
distributed pattern of neuroanatomic change, difficult to distinguish
clinically from dynamic alterations in normal aging. Extreme variations in
the sulcal patterns of the human cortex have made it difficult to identify
diffuse and focal variations in cortical structure in neurodegenerative
disease. We report the first comprehensive 3D statistical analysis of deep
sulcal structure in vivo, in both normal aging and dementia.
High-resolution 3D T1-weighted fast SPGR (spoiled GRASS) MRI volumes were
acquired from 10 patients diagnosed with AD (NINCDS-ARDRA criteria; age:
71.9 +/- 10.7 years) and 10 normal subjects matched for age (72.9 +/- 5.6
years), gender, educational level and handedness. Scans were digitally
transformed into Talairach stereotaxic space. To determine specific
patterns of cortical variation in dementia patients, 3D average and
probabilistic maps of primary deep sulci were developed for both normal and
AD groups. Major sulci (including supracallosal, cingulate, marginal,
parieto-occipital, anterior and posterior calcarine sulci, and Sylvian
fissures) were modeled as complex systems of 3D surfaces using a
multi-resolution parametric mesh approach. Variations and asymmetries in
their extents, curvature, area and surface complexity were evaluated.
Three- dimensional maps of anatomic variability, structural asymmetry and
local atrophy indicated severe regionally selective fiber loss in AD. A
midsagittal area loss of 24.5% at the corpus callosum's posterior midbody
(P < 0.025) matched increases in structural variability in corresponding
temporo-parietal projection areas. Confidence limits on 3D cortical
variation, visualized in 3D, exhibited severe increases in AD from 2 to 4
mm at the callosum to a peak SD of 19.6 mm at the posterior left Sylvian
fissure. Normal Sylvian fissure asymmetries (right higher than left; P <
0.0005), mapped for the first time in three dimensions, were accentuated in
AD (P < 0.0002), and were greater in AD than in controls (P < 0.05).
Severe AD-related increases in 3D variability and asymmetry may reflect
disease-related disruption of the commissural system connecting bilateral
temporal and parietal cortical zones, regions known to be at risk of early
metabolic dysfunction, perfusion deficits and selective neuronal loss in
AD.
相似文献
108.
Computed tomography of the breast. A preliminary report 总被引:2,自引:0,他引:2
Chang CH; Sibala JL; Gallagher JH; Riley RC; Templeton AW; Beasley PV; Porte RA 《Radiology》1977,124(3):827
109.
AW Segal 《Journal of clinical pathology》1983,36(1):119-120
110.
Spinal arachnoid cysts in children 总被引:3,自引:0,他引:3
Five cases of benign spinal arachnoid cysts in children are described with their clinical, neuroradiological, surgical and pathological findings. Intraspinal benign arachnoid cysts may be confidently diagnosed myelographically when there is complete or partial obstruction with multiple oily contrast/cerebrospinal fluid levels as in 3 cases in this series. The multiple fluid levels are probably produced by multiple cysts or a cyst loculated due to partial compression by arachnoid bands either related to the normal septum posticum, congenital or acquired adhesion rather than to trabeculations within the cyst. In this series, the origin of the cysts is considered to be congenital. 相似文献