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1.
Purpose. In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. Methods. Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. Results. Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. Conclusion. Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.  相似文献   
2.
Post-termination relationships are complex because the client may need additional services and it may be difficult to determine when the speech-language pathologist-client relationship is truly terminated. In my contribution to this scientific forum, discharge experiences from speech-language pathologists working in Cyprus and Greece will be explored in search of commonalities and differences in the way in which pathologists end therapy from different cultural perspectives. Within this context the personal impact on speech-language pathologists of the discharge process will be highlighted. Inherent in this process is how speech-language pathologists learn to hold their feelings, anxieties and reactions when communicating discharge to clients. Overall speech-language pathologists working in Cyprus and Greece experience similar emotional responses to positive and negative therapy endings as speech-language pathologists working in Australia. The major difference is that Cypriot and Greek therapists face serious limitations in moving their clients on after therapy has ended.  相似文献   
3.
The ending of therapy is a crucial time for speech-language pathologists and can impact on their sense of achievement and satisfaction. Drawing on literature from psychotherapy, social work and rehabilitation as well as from the area of aphasia therapy, this paper explores how speech-language pathologists juggle the tensions of coping with real versus ideal endings, of managing the building of close therapeutic relationships which then have to be broken, and of balancing a respect for client autonomy while retaining control over caseloads and fair allocation of resources. I suggest that the way in which therapy finishes reflects a merger of how clinicians manage these tensions. Clinicians may benefit from a greater recognition of what they do and feel at discharge, not only to further reflective practice, but also to encourage more sensitive involvement with both clients and students.  相似文献   
4.
The Eph family of receptor tyrosine kinases and their membrane-bound ligands, the ephrins, play a central role in pattern formation during embryonic development and there is growing evidence that they are also instrumental in the control of tissue dynamics in the adult. The mammary gland is a paradigm for morphogenic processes occurring in the adult, since the gland develops predominantly postnatally and is subjected to continuous cyclic remodeling according to functional demands. Thus, pattern formation and the establishment of a functional organ structure are permanent themes in the mammary gland life cycle. In this paper we summarize the experimental evidence and discuss possible mechanisms by which Ephs and ephrins are modulating mammary epithelial cell adhesion, communication, and migration. Furthermore, we speculate on the different aspects of their influence on normal mammary gland development, function, and carcinogenesis.  相似文献   
5.
2001年,泰国成为世界上为数不多的实现全民健保的中低收入国家,这主要得益于它以全民健康为目标的医疗保障制度,通过对不同人群实行不同的医疗保障计划实现了覆盖全民的医疗保障目标。尤其是它针对农村居民实行的“30铢计划”值得我国在新型农村合作医疗制度建设中借鉴。  相似文献   
6.
以能力为本位的专科护理教育课程体系改革方案的研究   总被引:1,自引:0,他引:1  
针对目前专科护理教育存在的弊端,提出了以能力为本位的专科护理教育课程体系改革的基本思路、改革目标、改革原则以及课程体系、教学模式、实践性教学体系的构建和评价方法的改革。  相似文献   
7.
目的:观察HEP方案治疗Ⅲ、Ⅳ非小细胞肺癌(NSCLC)的疗效及不良反应。方法:羟基喜树碱(HCPT)10mg/m^2静滴dl-5;足叶乙甙(VP-16)100mg/m^2静滴dl-3:顺铂(DDP)50mg/m^2静滴dl-2;(伴水化和利尿)。3周为1周期,用药最少2周期。结果:HEP方案有效率为53.5%,对照组为35.7%。治疗组和对照组毒副反应发生率无明显差异。结论:HEP方案治疗Ⅲ、Ⅳ期非小细胞肺癌(NSCLC)有一定疗效,不良反应未明显增加,值得临床推广应用。  相似文献   
8.

Purpose

The objectives of our study were to evaluate the characteristics and outcomes of patients discharged home directly from an oncologic intensive care unit (ICU) and their 30-day hospital readmission patterns.

Materials and Methods

We retrospectively reviewed ICU discharges over 3 years (2008-2010) and identified patients who were discharged directly home. Demographic, clinical, ICU discharge, and 30-day hospital readmission and mortality rates were analyzed.

Results

Ninety-five patients (3.6%) were discharged home directly from the ICU (average annual rate of 3.9%). ICU diagnoses primarily included respiratory insufficiency, sepsis, cardiac syndromes, and gastrointestinal bleeding. Home discharge occurred most commonly between Thursday and Saturday. Five (5.3%) patients, including 2 hospice patients, died within 30 days of ICU home discharge. Thirty (31.6%) patients were readmitted within 30 days of discharge. The unplanned 30-day readmission rate was 23.2% (22/95) with a median time to hospital readmission of 13 (8-18) days. Most (64%) of the unplanned readmissions were related to the initial ICU admission.

Conclusions

Home discharge of ICU patients at our institution is infrequent but consistent. Almost one third of these patients were readmitted to the hospital within 30 days. Enhancements to the ICU home discharge process may be required to ensure optimal post-ICU care.  相似文献   
9.

BACKGROUND:

Diagnosed obstructive sleep apnea (OSA) affects 2% to 7% of middle-age persons worldwide and represents a substantial health care burden. The gold standard for treating OSA in adults is continuous positive airway pressure (CPAP) therapy. Compliance with this treatment is especially important in OSA patients experiencing concomitant acute and chronic disease or illness, and those undergoing procedures associated with sedation, analgesia and anesthesia.

OBJECTIVE:

To describe the clinical characteristics and management of hospitalized OSA patients in Canada.

METHODS:

Using the Canadian Institute for Health Information’s hospital Discharge Abstract Database (fiscal year 2006/2007), a retrospective cohort study of all acute care patients discharged with a diagnosis that included OSA was performed.

RESULTS:

An examination of the discharge data of 2,400,245 acute care hospital abstracts identified 8823 cases of OSA. The mean age of OSA patients was 45.7 years and 66.5% were men. The most common comorbidities in the adult OSA population were obesity, cardiovascular disease, type 2 diabetes mellitus and chronic obstructive pulmonary disease. In adult OSA patients, the reported surgical intervention rate using uvulopalatopharyngoplasty (9.6%) was much higher than interventional CPAP therapy (4.8%).

CONCLUSIONS:

Only a small percentage of hospitalized OSA patients were documented as having received CPAP therapy during their stay. Issues relating to the accuracy, specificity and completeness of the Canadian Institute for Health Information’s hospital Discharge Abstract Database specific to OSA and its management were identified. Practices pertaining to the reporting, coding and management of hospitalized adult OSA patients warrant further investigation and research.  相似文献   
10.
目的探讨出院计划在青年急性心肌梗死(AMI)患者中应用的效果。方法将120例青年AMI患者,采用随机数字表法分为对照组和观察组各60例。对照组给予心内科常规护理,定期随访;观察组在此基础上实施出院计划干预,时间为12个月。比较两组患者的自我管理行为得分、一般指标、生活质量评分及急性心脏事件发生率。结果两组患者的自我管理行为得分、一般指标比较,观察组优于对照组,差异有统计学意义(P0.05)。两组患者的MIDAS总分及各维度得分比较,观察组低于对照组,差异有统计学意义(P0.05)。急性心脏事件发生率的比较,观察组为3.33%,对照组为15.25%,差异有统计学意义(χ~2=3.885、5.039,P0.05)。结论对青年AMI患者实施出院计划,能够提高患者的自我管理行为,积极控制高危因素,提高生活质量,减少急性心脏事件的发生。  相似文献   
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