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61.
The Hampshire Depression Project: development and piloting of clinical practice guidelines and education about depression in primary health care 总被引:1,自引:0,他引:1
This paper describes the development and piloting of a comprehensive educational programme about recognition and management of depressive illness in primary care. Full evaluation of the effectiveness of the programme is currently underway in a randomized controlled trial, the Hampshire Depression Project (HDP), involving 56 general practices. The programme consists of clinical practice guidelines, practice-based seminars and follow-up sessions. Each part of the programme has been designed to be flexible, clinically oriented and relevant to all members of the multidisciplinary primary care team. The pilot study established the need for a systematic approach to the access of practices and practice teams, and the organization and process of the seminars. Application of this approach was associated with excellent attendance in the main programme. 相似文献
62.
Rashmi Kothari MD Kent Hall MD Thomas Brott MD Joseph Broderick MD 《Academic emergency medicine》1997,4(10):986-990
Objective : To develop an abbreviated and practical neurologic scale that could assist emergency medical services or triage personnel in identifying patients with stroke.
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ2 were performed to rank items. Recursive partitioning was then performed to develop the decision rule for predicting the presence of stroke.
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed. 相似文献
Methods : A prospective, observational, cohort study was performed at university-based EDs. Participants were 74 patients treated in a thrombolytic stroke trial and 225 consecutive non-stroke patients evaluated during 4 random 12-hour shifts in the ED. Scores on the NIH Stroke Scale were obtained for all patients by physicians. Items of this scale were modified and recoded to a binomial (normal or abnormal) scale. Serial univariate analyses using χ
Results : Three items identified 100% of patients with stroke: facial palsy, motor arm, and dysarthria. An Abbreviated NIH Stroke Scale based on these items had a sensitivity of 100% and a specificity of 92%. A proposed Out-of-hospital NIH Stroke Scale consisting of facial palsy, motor arm, and a combination of dysarthria and best language items (abnormal speech) had a sensitivity of 100% and a specificity of 88%.
Conclusion : Using the derivation data set, a proposed Out-of-hospital NIH Stroke Scale had a high sensitivity and specificity for identifying patients with stroke when performed by physicians in this group of 299 ED patients. Prospective studies of other health care professionals using the scale in the out-of-hospital arena are needed. 相似文献
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对60例病毒性肝炎患者进行肝穿刺活检,结果发现,临床与病理诊断的符合率为46.6%,其中,急性肝炎的诊断符合率最低(23.8%),慢性迁延型肝炎(慢迁肝)为44.8%;HBsAg阳性首次发病的患者中,急性乙型肝炎仅为11.2%(2/18);临床诊断的慢性活动型肝炎(慢活肝)仅为病理检出的25.7%(9/35);肝炎患者中脾肿大,凝血酶元时间延长、A/G值<1.2、抗HBcIgM阳性可作为慢活肝与慢迁肝鉴别的重要指标。这些对提高病毒性肝炎临床分型诊断的准确率及指导临床治疗有意义。 相似文献
66.
陈锡慰 《南京医科大学学报(英文版)》1994,(1)
AStudyonUsingImprovedMethenamine-silverStaintoDiagnosisofPneumocystiscariniiChenXiwei(陈锡慰)(DepartmentofParasitology,NanjingMe... 相似文献
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毕新生 《右江民族医学院学报》1994,16(2):32-34
对28例青年人胃癌的临床及病理分析结果表明,其发病具有症状隐匿、病程短、进展快的特点,本组病例从出现症状到漏诊在6个月内为57.1%(16例),首发症状以上腹部疼痛、吐血、黑便多见,病理特征以结节蕈伞型、高分化腺癌多见。 相似文献
70.
异位妊娠是是妇产科常见的急腹症之一,随着高敏感度的血β-HCG测定、阴道超声及腹腔镜临床应用,使异位妊娠得以早期诊断。以往异位妊娠的治疗原则以手术治疗为主.异位妊娠的早期诊断使药物治疗和保守性手术治疗成为可能。 相似文献