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Berger WE 《Current allergy and asthma reports》2001,1(6):498-505
Epidemiologic and pathophysiologic evidence indicates that allergic rhinitis, whether seasonal or perennial, is one piece
of a larger atopic clinical picture that often occurs concomitantly with asthma. Allergic rhinitis usually develops during
childhood and has a prevalence of up to 40% in the pediatric population. Careful attention to food allergies and the presence
of household allergens during infancy and early childhood may limit potential sensitizations. Many antihistamines and topical
corticosteroids now are available for the treatment of allergic rhinitis in children, which is all the more important because
optimal management may improve quality of life and curtail the development of serious sequelae. 相似文献
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Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs
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Jennifer L. Salstrom MD PhD Rebecca L. Coughlin MEd Kathleen Pool MSN CPNP Melissa Bojan BSN Camille Mediavilla BSN William Schwent MBA Michael Rannie MS Dawn Law MBA Michelle Finnerty BS Joanne Hilden MD 《Pediatric blood & cancer》2015,62(5):807-815
Background
Antibiotic delivery to patients with fever and neutropenia (F&N) in <60 min is an increasingly important quality measure for oncology centers, but several published reports indicate that a time to antibiotic delivery (TTA) of <60 min is quite difficult to achieve. Here we report a quality improvement (QI) effort that sought to decrease TTA and assess associated clinical outcomes in pediatric patients with cancer and F&N.Procedure
We used Lean‐Methodology and a Plan‐Do‐Study‐Act approach to direct QI efforts and prospectively tracked TTA measures and associated clinical outcomes (length of stay, duration of fever, use of imaging studies to search for occult infection, bacteremia, intensive care unit (ICU) consultation or admission, and mortality). We then performed statistical analysis to determine the impact of our QI interventions on total TTA, sub‐process times, and clinical outcomes.Results
Our QI interventions significantly improved TTA such that we are now able to deliver antibiotics in <60 min nearly 100% of the time. All TTA sub‐process times also improved. Moreover, achieving TTA <60 min significantly reduced the need for ICU consultation or admission (P = 0.003) in this population.Conclusion
Here we describe our QI effort along with a detailed assessment of several associated clinical outcomes. These data indicate that decreasing TTA to <60 min is achievable and associated with improved outcomes in pediatric patients with cancer and F&N. Pediatr Blood Cancer 2015;62:807–815. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc. 相似文献107.
Hemophagocytic lymphohistiocytosis in a female patient due to a heterozygous XIAP mutation and skewed X chromosome inactivation
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108.
Disparities in HIV treatment and physician attitudes about delaying protease inhibitors for nonadherent patients
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Wong MD Cunningham WE Shapiro MF Andersen RM Cleary PD Duan N Liu HH Wilson IB Landon BE Wenger NS;HCSUS Consortium 《Journal of general internal medicine》2004,19(4):366-374
BACKGROUND: Current HIV treatment guidelines recommend delaying antiretroviral therapy for nonadherent patients, which some fear may disproportionately affect certain populations and contribute to disparities in care. OBJECTIVES: To examine the relationship of physician's attitude toward prescribing protease inhibitors (PIs) to nonadherent patients with disparities in PI use and with health outcomes. DESIGN: Prospective cohort study. PATIENTS AND SETTING: A national probability sample of HIV-infected adults in the United States and their health care providers was surveyed between January 1996 and January 1998. We analyzed data on 1717 patients eligible for PI treatment and the 367 providers who cared for them. MEASUREMENTS: Providers' attitude toward prescribing PIs to nonadherent patients, time until patients' first receipt of PIs, mortality, and physical health status. MAIN RESULTS: Eighty-nine percent of providers agreed that patient adherence is important in their decision to prescribe PIs (Selective) while 11% disagreed (Nonselective). Patients who had a Selective provider received PIs later than those with a Nonselective provider (P =.05). Adjusting for patient demographics and health characteristics and provider demographics, HIV knowledge, and experience, Latinos, women, and poor patients received PIs later if their provider had a Selective attitude but as soon as others if their provider had a Nonselective attitude. African-American patients received PIs later than whites, irrespective of their providers' prescribing attitude. Patients with Selective providers had similar odds of mortality than those with Nonselective providers (odds ratio, 1.1; 95% confidence interval, 0.6 to 2.0), but had slightly worse adjusted physical health status at follow-up (49.1 vs 50.4, respectively; P =.04), after controlling for baseline physical health status and other patient and provider covariates. CONCLUSIONS: Most providers consider patient adherence an important factor in their decision to prescribe PIs. This attitude appears to account for the relatively later use of PI treatment among Latinos, women, and the poor. Given the rising HIV infection rates among minorities, women, and the poor, further investigation of this treatment strategy and its impact on HIV resistance and outcomes is warranted. 相似文献
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Morgan R. Bobb Azeemuddin Ahmed MD MBA Paul Van Heukelom MD Rachel Tranter MPAS PA‐C Karisa K. Harland PhD MPH Brady M. Firth PhD MA Randy Fry MBA Katherine Schneider MSN RN CEN Kathryn K. Dierks DO Sarah L. Miller MD Nicholas M. Mohr MD MS 《Academic emergency medicine》2018,25(7):795-803