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31.
32.
Paul Roderick Ruth Davies Chris Jones Terry Feest Steve Smith Ken Farrington 《Nephrology, dialysis, transplantation》2004,19(3):692-701
BACKGROUND: The demand for renal replacement therapy (RRT) in England has risen steadily, although from a lower base than many other developed countries. Predicting the future demand for RRT and the impact of factors such as the acceptance rate, transplant supply and patient survival, is required in order to inform the planning of such services. METHODS: A discrete event simulation model estimates the future demand for RRT in England in 2010 for a range of scenarios. The model uses current prevalence and current and projected future acceptance rates, survival rates and the transitions between modalities to predict future patient numbers. National population and mortality data, published literature and data from the UK Renal Registry and UK Transplant, are used to estimate unmet need for RRT, the impact of changing demography and incidence of Type 2 diabetes, patient haemodialysis (HD) survival and transplant supply. RESULTS: By 2010 the predicted prevalence will have increased from about 30,000 in 2000 to between 42 and 51,000 (900-1000 p.m.p.), an average annual growth of 4.5-6%. Changing transplant supply has a small effect on overall numbers but changes the proportion of patients with functioning graft by up to 8%. Even with an optimistic increase in transplant supply (11% p.a. for 5 years), numbers on HD will continue to rise substantially, especially in the elderly. The factors most influencing future patient numbers are the acceptance rate and dialysis survival. CONCLUSION: This model predicts a substantial growth in the RRT population to 2010 to a rate approaching 1000 p.m.p., particularly in the elderly and those on HD, with a steady state not being reached for at least 25 years. 相似文献
33.
Teruyuki Usuba Yutaka Suzuki Akira Kuramochi Hisao Tajiri Katsuhiko Yanaga 《Digestive endoscopy》2007,19(1):18-21
Background: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently. Methods: In the present study, we examined causes and treatments for BBS among 1400 patients who had undergone PEG. Results: The causes of BBS after PEG were classified into two categories: early causes consisted of wound infection, inappropriate size of kit and severe lordosis, while late causes were inappropriate exchange of kit, rough management or weight gain. The treatments for BBS could be determined by the degree of wound infection, fistula and burial of the bumper. Conclusion: We prepared a flowchart for replacement, by which BBS can be managed safely and quickly without surgical or endoscopic intervention. 相似文献
34.
人工髋关节置换术后脂肪栓塞综合征的观察与护理 总被引:3,自引:0,他引:3
笔者报道人工髋关节置换术后脂肪栓塞综合征的护理措施认为重视氧饱和度及动脉血氧分压监测,注意观察中枢神经系统症状和呼吸系统症状,及时发现并纠止低氧血症,对不同的病人制定不同护理方案,严密观察病情,及时掌握病情变化:是护理的关键。 相似文献
35.
D M McSherry 《Statistics in medicine》1986,5(5):497-502
The independence Bayesian model has been used widely in computer programs designed to support clinical decision-making. A reasoning strategy has been developed to enable these programs to conduct clinically pertinent dialogue and explain their reasoning. It has been implemented in a program for the diagnosis of acute abdominal pain based on the Bayesian model of de Dombal et al. Several features of the dialogue design have been adopted from artificial intelligence research, including shared initiative and critiquing. The program adopts a flexible goal-driven strategy, attempting to confirm the clinician's diagnosis or rule out the likeliest alternative. Symptoms and signs are selected in order of their expected weights of evidence in favour of the hypothesized disease. 相似文献
36.
风心病并发脑栓塞病人的瓣膜替换术 总被引:11,自引:0,他引:11
报告64例风心病并发脑栓塞病人的瓣膜替换术。术前心功能I级10例、II级38例、IV级16例。伴房颤者54例。脑栓塞史半年以上者44例,6个月以内20例,其中2个月以内者14例。34例有程度不同的脑栓塞后遗症。行二尖瓣替换术47例、双瓣膜替换术17例,同期行三尖瓣环环缩或成形术43例。术中证实有左房血栓25例(39%)。手术死亡率6.25%。术后并发颅内出血和栓塞各1例。结果表明风心病并发脑栓塞病人的手术效果良好。作者指出,脑栓塞2个月以上者应尽早手术,2个月以内者则应根据脑栓塞程度、恢复情况及有无左房血栓,选择手术时机。并介绍了围术期的处理经验。 相似文献
37.
38.
39.
目的:观察儿童羟基磷灰石义眼台植入的临床效果。方法:回顾性分析不同原因造成眼球摘除的31例患儿,其中男性 21例,女性 10例,年龄 3岁~14岁,平均 8.2岁,采用义眼台一期植入 20例,义眼台二期植入 11例,植入直径 18mm义眼台者 17例,植入 20mm义眼台者 14例。结果:31例患儿术后 1例结膜裂开,5例出现轻度上睑沟凹陷,随访 1年~8年,所有患者无感染、无排斥、无义眼台暴露,运动好,外观满意。结论:儿童患者应尽可能一期植入义眼台,采用巩膜包裹义眼台植入的 3岁~6岁患儿选择 18mm直径的义眼台,而 7岁~14岁患儿尽量接近成人选用 20mm直径的义眼台。注意手术操作、术后用药及护理可减少术后并发症。 相似文献
40.
Gabriel Mircescu Dimitrie Capsa Maria Covic Mirela Gherman Caprioara Gheorghe Gluhovschi Ovidiu Golea Nicolae Ursea Liliana Garneata Vasile Cepoi Nicolae Constantinovici Adrian Covic 《Nephrology, dialysis, transplantation》2004,19(12):2971-2980
INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. METHODS: Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). RESULTS: In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2). CONCLUSIONS: Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry. 相似文献