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51.
EXTRACORPOREAL PHOTOCHEMOTHERAPY IN PROGRESSIVE SYSTEMIC SCLEROSIS   总被引:1,自引:0,他引:1  
Background. Extracorporeal photochemotherapy, an immune-modulating form of therapy, has been shown to be effective in the treatment of autoimmune diseases. We evaluated the effects of extracorporeal photochemotherapy in the treatment of patients with progressive systemic sclerosis (pss). Methods. Nine patients with active progressive systemic sclerosis were treated with extracorporeal photochemotherapy on 2 successive days monthly. The duration of therapy ranged from 6 to 21 months. Results. A significant improvement was noted in the skin, musculoskeletal system, functional index, and symptoms including Raynaud's phenomenon, dyspnea, fatigue, dysphagia, and arthralgias, as well as improvement of cutaneous ulcers. Stabilization of the pulmonary function studies was also noted in the majority of patients over the course of therapy. No serious side effects were noted throughout the course of therapy in the 9 patients. Conclusions. The results suggest that photopheresis may be beneficial in selected early cases of progressive systemic sclerosis.  相似文献   
52.
The appropriateness of empiric therapy, how closely prescribers adhered to hospital guidelines for use of antimicrobial drugs and how relevant these guidelines proved in providing cover for the infecting pathogen were assessed from a retrospective survey of culture and sensitivity reports issued during a one-month period in a district general hospital. Blood, stool, pus, sputum and mid-stream urine specimens were reviewed. Urine specimens from a fundholding general practice unit were also included. Catheter specimens of urine and specimens from other body sites were excluded. Of 290 specimens sent for culture, 99 (34 per cent) were positive. One hundred patients, of whom 54 (19 per cent of the total) were subsequently demonstrated to have a positive culture, had been treated empirically. In 38 per cent of cases the pre-report empiric treatment was considered appropriate for the isolated pathogen, while 46 per cent of patients had negative cultures and 16 per cent had positive cultures but had been given unsuitable antibiotics. In hospitalised patients, 73 per cent of antibiotic treatments were prescribed according to hospital guidelines, although this was the case for only 45 per cent of community-based patients. Hospital guidelines were a relevant and useful aid to rational prescribing in that 75 per cent of organisms isolated were sensitive to guideline antibiotics. The guidelines were least appropriate for urine specimens from hospital. This reflects the range of organisms encountered and the emergence of resistant strains, reinforcing the need for regular updating and amending of prescribing recommendations.  相似文献   
53.
National alcohol surveys using face-to-face interviews, such as the US 1988 National Health Interview Survey Alcohol Supplement and the 1990 US National Alcohol Survey, for reasons of efficiency often use screener items lo identify individuals who are likely lo have experienced alcohol-related problems and only those individuals are chosen to respond to a list of alcohol-related problem questions. The consequence of screening is that only a subset of the current drinkers have complete data on such items. This paper examines the bias introduced by the exclusion of cases with incomplete information due to screening. Data from a regional general population survey were used to investigate possible bias due to screening because it included the screening questions used in NHIS and NAS but did not screen on those items. Risk curves and estimated probabilities from logistic regressions of three alcohol dependence symptom items and two problem indices were compared by gender across three subsamples: (1) all current drinkers (without screening); (2) those who passed the screener item for the NHIS and (3); the NAS, respectively. Results indicate that the effect of the screener items on the estimated prevalence of the measures concerned are minimal, supporting the practice, judiciously applied, when greater survey efficiency is required.  相似文献   
54.
Our purpose was to design and implement a nutritional rehabilitation program for persons with severe developmental disabilities who resided in a long-term-care facility or a group home. We used weight for height (WH) to classify residents of both facilities into three groups: group 1 (n-32), WH less than 5th percentile (Z scores ≤ −1.650), goal=gain weight; group 2 (n=21), WH between the 5th and 85th percentile (Z scores ranging from −1.645 to +1.030), goal=maintain present rate of weight gain; and group 3 (n=8), WH greater than 85th percentile (Z scores ≥ +1.036), goal=slow down rate of weight gain. The challenge in all groups was to bring about these changes without increasing the quantity of food (as assessed by 3-day food records) fed to the residents and to increase their fluid intake. For each subject, the project dietitian developed individualized menus that specified quantities and consistencies of food. Foodservice delivery was changed to a centralized system in the long-term-care facility to allow for closer control of the subjects' intake. A dietitian monitored the program with biweekly visits to the wards and frequent consultation with staff. Only a limited increase in fluid intake was noted; however, after 6 months of the program, the other goals were met. Our results suggest that nutritional rehabilitation of residents with developmental disabilities is enhanced by the involvement of a dietitian. J Am Diet Assoc. 1997;97:162–166.  相似文献   
55.
General population survey estimates of the overall prevalence of problem drinking and drug use in a community are biased by the exclusion of non-household populations. Estimates based on compiling prevalences in community institutions may also be biased due to over-counting of users of more than one institution. This paper examines prevalence estimates derived from probability samples of problem drinkers in the general population and within alcohol treatment, drug treatment, mental health, criminal justice and welfare agencies in a single US county. Data sets are merged and weighted to reflect a community sample of institutions, and a 1 7% subset of cases is identified within the institutional samples that are not living in housing units typically included in general population sampling frames. The difference in prevalences of problem drinking in the household and non-household populations is found to be large: 11% and 48%, respectively. Even greater differences are found between estimates of unprescribed weekly drug use (6% and 47%, respectively) and combined problem drinking and weekly drug use (2% and 27%, respectively). This suggests that confining samples to the household population can systematically under-represent the prevalence of problem drinking and drug use. A second source of bias in prevalences is characteristic of studies using records from multiple institutions. When duplication of service use in the five agency samples is considered, it becomes apparent that prevalences may be biased upward due to over-counting of multiple service users.  相似文献   
56.
Fifty-foot walking time was used in 51 of 187 clinical therapeutictrials of antirheumatic drugs and in only 21 instances was statisticalsignificance reached. Measurement of the 50-foot walking timeshowed no better performance in long-term trials of SAARDs thanin short-term trials of NSAIDs. It is concluded that the 50-footwalking time is a poor outcome measure in rheumatic diseasetrials, despite a high intra- and inter- observer reproducibility. KEY WORDS: Rheumatoid arthritis, Clinical therapeutic trials, 50-foot walking time  相似文献   
57.
58.

Background

To assess the relationship between improved regional and global myocardial function in patients with ischemic cardiomyopathy in response to β-blocker therapy or revascularization.

Materials and methods

Cardiovascular Magnetic Resonance (CMR) was performed in 32 patients with ischemic cardiomyopathy before and 8 ± 2 months after therapy. Patients were assigned clinically to β-blocker therapy (n = 20) or revascularization (n = 12). CMR at baseline was performed to assess regional and global LV function at rest and under low-dose dobutamine. Wall thickening was analyzed in dysfunctional, adjacent, and remote segments. Follow-up CMR included rest function evaluation.

Results

Augmentation of wall thickening during dobutamine at baseline was similar in dysfunctional, adjacent and remote segments in both patient groups. Therefore, baseline characteristics were similar for both patient groups. In both patient groups resting LV ejection fraction and end-systolic volume improved significantly (p < 0.05) at follow-up. Stepwise multivariate analysis revealed that improvement in global LV ejection fraction in the β-blocker treated patients was significantly related to improved function of remote myocardium (p < 0.05), whereas in the revascularized patients improved function in dysfunctional and adjacent segments was more pronounced (p < 0.05).

Conclusion

In patients with chronic ischemic LV dysfunction, β-Blocker therapy or revascularization resulted in a similar improvement of global systolic LV function. However, after β-blocker therapy, improved global systolic function was mainly related to improved contraction of remote myocardium, whereas after revascularization the dysfunctional and adjacent regions contributed predominantly to the improved global systolic function.  相似文献   
59.
The authors, all experienced hospital school teachers in Essex, feel that it is both possible and necessary to educate the profoundly handicapped child, rather than merely mind him. They have devised a basic teaching programme which can be used with the most severely handicapped of the ESN(S) school population.  相似文献   
60.
孟宪梅 《护理学杂志》2008,23(10):72-74
分析人口健康促进模式的组成,介绍其在加拿大社区护理中的应用,并以"老龄高血压病社区护理干预"为例探讨该模式指导国内社区护理的可行性,以求为护理同行了解应用人口健康促进模式提供良好的基础.  相似文献   
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