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91.
92.
J. Limmer D. Ellbrück H. Müller E. Eisele J. Rist F. Schütze H. Beger H. Heimpel E. Seifried 《Journal of molecular medicine (Berlin, Germany)》1994,72(11):913-919
A prospective, randomized, controlled clinical trial was performed comparing the antithrombotic efficacy of the low molecular weight heparin LMWH 21–23, (Braun) with an unfractionated heparin in elective general surgical patients over an observation period of 7 postoperative days. A total of 230 patients were admitted: 103 (group I) received low molecular weight heparin and 100 (group II) low-dose unfractionated heparin treatment given subcutaneously. In group I 41 patients (46%) were operated on for malignant disease and in group II 54 patients (54%). Due to the large amount of great abdominal procedures the intra- and perioperative application of hydroxyethyl starch was allowed for volume substitution. None of the patients died due to fatal pulmonary embolism. In group I four patients revealed positive 125I-labeled fibrinogen uptake (3.9%); two patients belonged to the hydroxyethyl starch subgroup. In group II five patients displayed a positive fibrinogen uptake (5%); two belonged to the hydroxyethyl starch subgroup. The results of the hemostaseological investigations (e.g., prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen, antithrombin III, protein C, plasminogen, 2-antiplasmin , tissue-type plasminogen activator, plasminogen activator inhibitor) revealed no statistically significant differences between groups I and II or their subgroups, although a tendency to prolonged clotting times was observed. The antifactor Xa activity values, however, displayed a statistically significant difference between the two groups (P < 0.05). The antifactor Xa activity measured up to 0.16 U/ml for the low molecular weight heparin (group I) and 0.05 U/ml for the unfractionated heparin (group II) in the postoperative period. Major bleeding complications were not encountered in this study. Fundamental for the low incidence of thrombosis, the additive administration of hydroxyethyl starch appeared in almost one-third of the patients in both study groups.Abbreviations APTT
activated partial thromboplastin time
- aXa
anti-factor Xa
- DVT
deep venous thrombosis
- FUT
125I-labeled fibrinogen uptake test
- HES
hydroxyethyl starch
- LMWH
low molecular weight heparin
- PE
pulmonary embolism
- UFH
unfractioned heparin 相似文献
93.
Ulf Nilsson Andrejs Schütz Staffan Skerfving Sören Mattsson 《International archives of occupational and environmental health》1995,67(6):405-411
An X-ray fluorescence (XRF) technique using plane polarized X-rays for excitation was used for in vivo measurements of cadmium in the kidney cortex among non-occupationally exposed members of the general population in southern Sweden. The measured concentrations of cadmium in the kidney cortex of smokers (median 28 g/g, n = 10) were significantly higher (P = 0.0036) as compared to those in non-smokers (median 8 g/g, n = 10), and so were the cadmium concentrations in blood and urine. The results show that smoking considerably increases the cadmium concentration in the kidney cortex and that smoking is a major source of cadmium exposure in the general population of Sweden. Except in the presence of very deeply situated kidneys, where the minimum detectable concentration is high, non-invasive in vivo XRF analysis of kidney cadmium should be a useful tool for evaluating the effects of long-term low-level exposure to cadmium and the risk of kidney damage. 相似文献
94.
目的 分析我国消除丙型肝炎(丙肝)的普通人群HCV检测策略的成本效果,明确最佳成本效果的HCV检测年龄。方法 运用TreeAge pro 2019软件构建决策树马尔科夫模型,以1年为周期,模拟10万名20~59岁各年龄组人群HCV检测和治疗结果,以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比(ICER),效益指标为净货币效益(NMB),以我国2022年人均国内生产总值(85 698元)为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。结果 在20~59岁人群HCV检测有成本效果,在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较,增量成本为161.24元/人,增量效用为0.003 6质量调整寿命年(QALYs)/人,ICER为45 197.26元/QALY,ICER小于意愿支付阈值,具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较,ICER为42 055.06~53 249.43元/QALY,NMB为96.52~169.86元/人,其中40~49岁年龄组的ICER最低,NMB最高。单因素敏感性分析结果显示,贴现率、丙肝抗体(抗-HCV)检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大,但改变参数取值,结论不变。概率敏感性分析结果表明模型分析结果稳定。结论 医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果,以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略,能降低人群丙肝疾病负担。 相似文献
95.
Tolhurst H McMillan J McInerney P Bernasconi J 《The Australian journal of rural health》1999,7(2):90-96
This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures. 相似文献
96.
Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes
that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health
system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system.
Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems.
Drawing upon the General System Theory (GST) analytical perspective, this article advances a systematic approach to understand
the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and
changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations
of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This
article describes how systems thinking has thus far influenced the study of the mental health policy and politics system,
and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for
the development of reform strategies. The mental health system should be seen as a social system influenced by larger political
and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy
planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic
perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently,
to plan for the strategic reforms that have so far eluded us.
This revised version was published online in July 2006 with corrections to the Cover Date. 相似文献
97.
性病防治所和综合医院皮肤性病科性病患者求医行为研究 总被引:4,自引:0,他引:4
目的 比较性病患者选择性病防治所和综合医院皮肤性病科求医行为差别,探讨患者采取不同求医行为因素和丰富求医行为研究内容。方法 按事先拟定的结构式问卷,在知情同意前提下,对北京390例性防所性病患者、55例综合医院性病患者进行个人访谈。结果 性病知识得分越高、首诊知道设有性病防治所者,倾向于选择性防所,就近就医倾向于选择综合医院皮肤性病科。结论 性病防治所、综合医院皮肤性病科在性病高危人群及一般人群中的知晓度是影响患者就诊不可忽视的因素,性病防治所由于它们在治疗和控制性病中的特殊地位,是确定卫生资源的重要条件之一。 相似文献
98.
99.
针对居民的医疗保健要求探索全科医疗的开展 总被引:1,自引:0,他引:1
通过对宜川街道赵园二委1700余户居民进行家庭健康问卷调查,结果大约有30%居民愿意接受全科医疗服务模式,40%居民需要上门服务,当遇到常见病时首选一级医院医生为对象占50%,70%居民认为上门服务应该是有偿的。为此,笔者认为基层医院应在社区卫生服务中大力地探索,只要有市场就应去占领,而且是一级医院赖以生存的社区,应以全科医疗服务模式去改变医患之间关系,把预防保健、医疗、康复、健康教育融为一体,使 相似文献
100.
试析大型综合医院在社区医疗服务中的作用 总被引:7,自引:1,他引:6
根据国家城市卫生服务体系改革的原则及对基层医院和大医院的功能定位,分析大型综合医院在社区医疗服务中的作用。指出大型综合医院应加强与城市基层医院的联系,建立全科医生培训基地,为社区医疗服务输送适用人才,建立切实可行的转诊制度,成为社区医疗服务的坚强后盾,提高社区医疗服务的质量和水平,促进社区医疗服务的发展。 相似文献