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41.
Thomas R. Russell 《American journal of surgery》2009,197(6):826-827
In recent years, the surgical profession has attempted to incorporate into clinical practice certain techniques that the airline industry has used to improve safety. These mechanisms have proven to be valuable components of our efforts to ensure that surgical patients receive safe, high-quality care. However, as the authors of “Cost and workforce implications of subjecting all physicians to aviation industry work hour restrictions” note, it would be a mistake to extend aviation's work-hour restrictions to medicine, particularly to resident training programs. 相似文献
42.
Phoebe S. Y. Lo Michael C. F. Tong Dennis A. Revicki Ching Chyi Lee John K. S. Woo Henry C. K. Lam C. Andrew van Hasselt 《Quality of life research》2006,15(5):877-887
Background: The Rhinitis Symptom Utility Index (RSUI), originally developed in the United States, consists of a patient-preference weighting
scheme and a 10-item questionnaire measuring the severity and frequency of rhinitis related symptoms over a 14-day period.
This study aimed to determine whether the Chinese RSUI could adopt the US-based multi-attribute utility function (MAUF) in
scoring rhinitis symptoms. Methods: In a Hong Kong study, 116 Chinese adults with allergic rhinitis completed the RSUI questionnaire and 36-item Short-Form
Health Survey (SF-36) after they had been seen by two otorhinolaryngologists for disease-severity ratings. Respondents then
completed computer-administered direct preference measures, i.e., visual analogue scale (VAS) and standard gamble (SG) assessments.
The VAS and SG data were used to estimate a MAUF for the Chinese-based RSUI. Results: The derived MAUF was somewhat different than the one developed for the US RSUI. Test–retest reliability for the Chinese
RSUI was satisfactory (ICC = 0.71, p<0.001). Scores differentiated among cases with mild, moderate, and severe symptoms (p<0.001); and between those who did and did not require medications to control symptoms (p = 0.031). Findings were significantly correlated with SF-36 domain scores (r = 0.19 to 0.37; p=0.041 to <0.001). When the US-based scoring function was applied to the Chinese subjects, the resulting mean RSUI score was
significantly lower (p<0.001). Comparisons between directly measured VAS and SG scores between the US and Chinese samples, demonstrated significant
differences (all p<0.05), with the US subjects consistently rating rhinitis symptoms as worse than Chinese subjects. Conclusions: The Chinese RSUI has good measurement properties that reflect patient preferences from the Chinese. Results suggest that
there are differences in preference rating between US and Chinese subjects and that use of the US-based preference function
for the RSUI would bias the measurement of rhinitis symptom outcomes in Chinese subjects. 相似文献
43.
李松林副主任医师将肾小球肾炎的病机概括为湿、热、毒、瘀、虚等方面,在中医辨证的基础上,结合现代医学对其病因和发病机理的认识及中草药药理作用,针对不同的病理机制和临床表现,提出清热解毒法,活血化瘀法,调补脾肾法,扶正固本法,并视症有机结合,恰当治疗,疗效显著。 相似文献
44.
Amelie Perron RN PhD Trudy Rudge RN RMHN PhD Dave Holmes RN PhD 《Nursing philosophy》2010,11(2):100-111
The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's concept of governmentality is helpful in understanding the production of the citizen subject, its location within the ‘art of government’, as well as the ethical and political implications of citizenship in the context of mental health. 相似文献
45.
Ayman Agha Gabriel Glockzin Matthias Woenckhaus Wolfgang Dietmaier Igors Iesalnieks Hans J. Schlitt 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):671-677
Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with
an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore,
in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer.
Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients
with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific
death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic
factors.
Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among
those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid
carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%).
Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage
who have follicular or papillary thyroid carcinoma. 相似文献
46.
Benjamin Clapp Melba Jarmillo Valeria Vigil Luis Macias Marcia Bouton Cuatemoc Gallardo Andrew Kassir 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(2):242-245
BACKGROUND AND OBJECTIVES: The purpose of this study was to determine patient recall and comprehension after laparoscopic appendectomy in an underserved population. Laparoscopic surgery can lead to diagnostic uncertainty secondary to poor recall and variable port placement. METHODS: After institutional review board approval, we identified a cohort of patients who underwent laparoscopic appendectomy from 2000 to 2004 at a single institution. We then attempted to contact the patients to conduct a 10-question telephone survey, which determined whether the patient spoke English or Spanish as a primary language, ethnicity, educational level, and questions about recall of perioperative events and diagnoses. If we could not reach the patient, we tried to call back on 2 different occasions. RESULTS: Between 2000 and 2004, 186 patients underwent laparoscopic appendectomy. Of these, 65% were Hispanic. We found that only 17% of these patients returned for a postoperative visit. Only 19.3% could be contacted by phone. Forty-seven percent of the patients contacted by phone spoke Spanish exclusively. Overall 92% of patients contacted knew what operation they had, and gave their correct diagnosis. CONCLUSIONS: The low percentage of patients available to follow-up makes this study statistically insignificant. However, we believe that fact in itself is important. In Southwestern states, we see a large migrant population. This highlights the need to communicate effectively with the patients at the time of surgery, which we speculate we did based on the percentage of patients that knew their diagnosis. 相似文献
47.
Michael D. Lara M.D. Matthew T. Baker M.D. Christopher J. Larson PA-C R.D. Michelle A. Mathiason M.S. Pamela J. Lambert R.N. Shanu N. Kothari M.D. 《Surgery for obesity and related diseases》2005,1(1):597-21
BACKGROUND: There is no consensus regarding the optimal rate of follow-up in the post-bariatric surgery patient population. METHODS: The records of all patients who underwent laparoscopic Roux-en-Y gastric bypass from 2001 to 2003 were reviewed. Using patient zip codes, travel distances were calculated between the patients' places of residence and our clinic. Patients were then assigned to 1 of 3 cohorts according to the following distances: (1) < 50 miles, (2) 50 to 100 miles, and (3) > 100 miles. Patient compliance with follow-up appointments at 3 weeks, 3 months, 6 months, 9 months, and 12 months was analyzed. Linear trends were identified using the Mantel-Haenszel test. Age and sex were analyzed as possible predictors of compliance using the chi(2) test. P values < .05 were considered statistically significant. RESULTS: The study group comprised 150 patients (127 females and 23 males). The 3 cohorts contained 115, 21, and 14 patients, respectively. All patients in each cohort were compliant with the 3-week follow-up appointment. Although there were differences in compliance between cohorts at each of the remaining appointments, only the 9-month (70.3% vs 61.9% vs 35.7%) visit showed statistical significance (P = .035). The 6-month visit trended toward significance (85.2% vs 76.2% vs 64.3%; P = .088). Males were more likely to be compliant with the 12-month follow-up (P = .040). When controlling for sex, travel distance was also a predictor of compliance at this follow-up visit (P = .024). Age was not predictive of compliance (P = .827). CONCLUSION: Based on our findings, we conclude that travel distance from the clinic does not significantly affect compliance at the initial follow-up, 3-month, and 12-month appointments. However, distance does tend to affect compliance at the 6-month appointment and significantly affects compliance at the 9-month appointment. Males are more likely to be compliant at the 12 month follow-up visit. We must continue to strive for 100% follow-up in our post-bariatric surgery patients. 相似文献
48.
D. Chattar-Cora R. Perez-Nieves A. McKinlay M. Kunasz R. C. Lyons 《European journal of plastic surgery》2007,29(5):221-226
Free tissue transfer has been demonstrated to be an effective modality of treating a variety of wounds and conditions in the
civilian population. The use of these procedures has been underreported by American military surgeons. Military surgeons face
unique hurdles that make the effective performance of these procedures difficult. We report our experience with free flap
reconstruction at an American Army medical center. We performed 44 free flaps in 38 patients; although operative times and
hospital length of stay were comparatively long, our success rates were excellent with only one partial flap loss.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or
reflecting the views of the Department of the Army or the Department of Defense. 相似文献
49.
Australian nursing has undergone rapid academization in the past 10 years and this radical change has tended to meld the somewhat different academic traditions of North America and Britain. The introduction of doctoral education in nursing in 1987 has led to a massive increase in scholarly activity and to the preparation of talented leaders. We concur with the view expressed by Henry (1997), "I am convinced that the problems we face in the nursing services would be much more creatively solved if the majority of our doctoral programs prepared young, energetic nurses, early in their career, for clinical practice, not for research and teaching" (p. 162). 相似文献
50.
Janice F. Munro Debra Haire-Joshu Edwin B. Fisher H. James Wedner 《The Journal of asthma》1996,33(5):313-325
Low-income minority patients from East St. Louis, Illinois, a depressed midwestern urban city, who had visited acute care settings with asthma symptoms, participated in a focus group. Questions were constructed around the Health Belief Model to characterize participants' experiences in receiving asthma care, their confidence in long-term asthma self-management, barriers they perceived to managing their asthma, and recommendations they would make for improving asthma care in their community. Analysis of comments suggests an appreciable understanding of asthma triggers, limited coping behaviors for asthma symptoms, very limited practice of active asthma management, perception of the health care system as frequently insensitive to their needs or their knowledge of their own care, exchange of well-articulated information regarding how to deal with the system, and an apparent lack of awareness of any potential contribution of patient education or support system. 相似文献