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21.
Hanna Lee Mary K. Tan Andrew T. Yan Paul Angaran Paul Dorian Claudia Bucci Jean C. Gregoire Alan D. Bell Martin S. Green Peter L. Gross Allan Skanes Charles R. Kerr L. Brent Mitchell Jafna L. Cox Vidal Essebag Brett Heilbron Krishnan Ramanathan Carl Fournier Shaun G. Goodman 《The Canadian journal of cardiology》2019,35(2):160-168
Background
Physicians treating nonvalvular atrial fibrillation (AF) assess stroke and bleeding risks when deciding on anticoagulation. The agreement between empirical and physician-estimated risks is unclear. Furthermore, the association between patient and physician sex and anticoagulation decision-making is uncertain.Methods
We pooled data from 2 national primary care physician chart audit databases of patients with AF (Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation and Coordinated National Network to Engage Physicians in the Care and Treatment of Patients with Atrial Fibrillation Chart Audit) with a combined 1035 physicians (133 female, 902 male) and 10,927 patients (4567 female and 6360 male).Results
Male physicians underestimated stroke risk in female patients and overestimated risk in male patients. Female physicians estimated stroke risk well in female patients but underestimated the risk in male patients. Risk of bleeding was underestimated in all. Despite differences in risk assessment by physician and patient sex, > 90% of patients received anticoagulation across all subgroups. There was modest agreement between physician estimated and calculated (ie, CHADS2 score) stroke risk: Kappa scores were 0.41 (0.35-0.47) for female physicians and 0.34 (0.32-0.36) for male physicians.Conclusions
Our study is the first to examine the association between patient and physician sex influences and stroke and bleeding risk estimation in AF. Although there were differences in agreement between physician estimated stroke risk and calculated CHADS2 scores, these differences were small and unlikely to affect clinical practice; further, despite any perceived differences in the accuracy of risk assessment by sex, most patients received anticoagulation. 相似文献22.
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目的了解我院门诊就诊者对子宫颈病变相关知识的认识。方法自制问卷调查表,采用无记名,当面问卷调查方式。结果从调查100例就诊者中,未做过健康体检、妇科盆腔检查和宫颈刮片检查分别为34例、24例和52例。对宫颈癌的认识不知道者53例。结论建议相关部门加强对妇女的健康教育,提高其健康意识,强化临床医生的防癌意识和对子宫病变的规范化诊治。 相似文献
25.
AIM/BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown aetiology. Up to 10% of patients with typical features of PBC will have additional features of autoimmune hepatitis (AIH). A subset, however, have no such features but go on to develop a 'sequential' AIH overlap syndrome. Objectives: Describe our experience with eight patients who developed AIH after the diagnosis of PBC was made. METHODS: We reviewed the charts of all PBC patients over a 9-year period (from 1996 to 2005). Only PBC patients with no features of AIH were included. RESULTS: There were 1476 patients with PBC. Of these, eight patients developed features of AIH overlap syndrome based on biochemical and histological parameters. Treatment included prednisone and azathioprine for 24 or more months. The majority of patients remained on ursodeoxycholic acid (UDCA) throughout treatment. Response to therapy was defined by improvement in enzymes, and was rapid for all patients. One patient was able to discontinue treatment with prednisone and azathioprine, while seven have continued on therapy to date. CONCLUSIONS: A 'sequential' overlap syndrome of AIH with PBC can occur. Treatment with prednisone and azathioprine may lead to a rapid improvement in aminotransferase levels. 相似文献
26.
设计并试制了一种药用胶带纸层厚度在线检测系统.该系统将高精度电容传感器与计算机结合起来,同时配有丰富的外围器件,实现了多种实际生产中所需要的功能.它的出现,彻底解决了药用胶带纸胶层厚度在线检测这个难题,经过两年多的实际应用的检验,该系统实现了在线非接触测量,精度高,动态性能好,实现功能全面,价格合理,是药用胶带纸生产的必备检测仪器.由于该系统还可以很方便在纸张、塑料薄膜等其它生产线上进行推广,因而,其应用前景十分看好. 相似文献
27.
应用宫腔镜检查妇科门诊常见子宫出血性疾病124例。发现原因不明的子宫出血 中宫腔内有器质性病变占81.25%。人工终止妊娠后出血中异常者占85.71%,绝经后出血子宫有 改变的占 88. 88%,带环后出血异常者占 76. 19%。宫腔镜可直接观察宫腔内情况,能早期发现宫 内的早期病变。 相似文献
28.
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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
30.
目的探讨应用十二指肠镜及腹腔镜治疗急性胆源性胰腺炎(ABP)的有效性。方法回顾性分析5年间对94例ABP患者进行微创治疗的临床资料。ABP合并胆囊结石的59例行行单纯腹腔镜胆囊切除术(LC);胆总管结石14例内镜下乳头括约肌切开取石术(EST),同时置入鼻胆管引流(ENBD),其中3例联合LC;对胆囊结石合并胆总管结石21例行ERCP EST,联合LC治疗。结果全组术后再次发作胰腺炎1例,胆道出血1例,均为ERCP EST患者;另肺部感染2例,切口感染1例,5例均经非手术治疗痊愈。全组有效率100%。结论十二指肠镜及腹腔镜联合应用于治疗ABP效果好。微创技术是目前ABP理想的治疗方法。 相似文献