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1.
Proposed Report on the Educational Qualifications of Sanitarians. Committe on Professional Education
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K Grant S R Huntington 《Physician assistant (American Academy of Physician Assistants)》1989,13(7):76-86
The traditional, informal approach to making medical decisions for incapacitated patients is often inappropriate today. Guidelines are needed in two major areas: assessing incapacity and seeking surrogate decision makers. Judicially declared incompetency does not necessarily imply incapacity to make medical choices. Proposed standards for determining incapacity require a multistep evaluation of the patient's abilities to understand, reason, and communicate. When decisions must be made for an incapacitated patient, priority is given to the patient's previously stated preferences. An advance directive--living will or durable power of attorney--simplifies the process. If no advance directive was prepared, a surrogate decision maker may be designated according to applicable state statutes. Standards are still evolving for protecting the autonomy and best interests of vulnerable, incapacitated patients. 相似文献
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BACKGROUND: Chronic renal failure (CRF) is associated with an atherogenic
lipid profile and an increased risk of ischaemic cardiovascular disease.
The associated hyperlipidaemia is reportedly ameliorated by erythropoietin
(Epo) therapy. According to a recent report, rats studied 3 weeks after 5/6
nephrectomy and fed a high- protein diet exhibited increased activities of
hepatic HMG-CoA reductase (HMG-CoAR) and cholesterol 7 alpha-hydroxylase
(Ch-7 alpha- H), despite normal corresponding mRNA values. DESIGN AND
METHODS: This study was designed to examine the effects of naturally
progressing CRF of longer duration as well as those of Epo therapy on gene
expressions of the key factors involved in hepatic cholesterol metabolism,
i.e., LDL receptor (LDLR), HMG-CoAR, and Ch-7 alpha-H. Sprague-Dawley rats
were randomized to the CRF group (5/6 nephrectomy), Epo-treated CRF group
(given Epo 150 U/kg/twice weekly) and sham-operated, placebo- treated
normal controls. They were allowed free access to regular rat chow and
studied 6 weeks after surgery. Liver mRNAs and protein mass or activities
of the above factors were studied. RESULTS: Plasma cholesterol
concentration was significantly increased in the CRF group (P < 0.001)
and was modestly lowered (P < 0.05) by Epo therapy. However, microsomal
cholesterol concentration and LDLR, HMG-CoAR, and Ch-7 alpha-H mRNA as well
as HMG-CoAR activity, and Ch-7 alpha-H and LDLR protein mass measurements
were virtually identical in the three groups. Thus, hepatic LDLR, HMG-CoAR,
and Ch-7 alpha-H mRNA and protein measurements in rats with CRF were
similar to those of the normal control group representing an inappropriate
response to the associated hypercholesterolemia. Epo therapy led to partial
amelioration of CRF- associated hypercholesterolaemia with no discernible
effect on hepatic tissue expression of the above factors.
相似文献
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Platelet utilization in a university hospital 总被引:3,自引:0,他引:3
Two hundred forty-three patients received 22,717 U of platelets in our hospital during a three-month period. Those with hematologic diseases accounted for 43% of the patients but used 86% of the platelets. Sixty-eight percent of the transfusions were given to prevent bleeding and 32% were given to treat active bleeding. Ninety-two percent of therapeutic transfusions but only 22% of prophylactic transfusions met guidelines established by the Transfusion Therapeutics Committee of the University of Minnesota Hospital and Clinics, Minneapolis. However, 78% of prophylactic platelet transfusions that did not meet the guidelines involved patients with at least one clinical factor that their physicians believed placed them at an increased risk of bleeding. Following this analysis, the guidelines were modified and applied prospectively to requests for platelets. This resulted in a 14% decrease in the number of platelet units used during the following year. We conclude that published recommendations for platelet transfusions do not reflect the complex nature of many patients' conditions and that the use of guidelines developed by the medical staff can alter the use of platelet transfusions. 相似文献
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Liñares D Mañá P Goodyear M Chow AM Clavarino C Huntington ND Barnett L Koentgen F Tomioka R Bernard CC Freire-Garabal M Reid HH 《Journal of autoimmunity》2003,21(4):339-351
Myelin oligodendrocyte glycoprotein (MOG) is a minor component of central nervous system myelin presumably implicated in the pathogenesis of Multiple Sclerosis (MS). Immunization with MOG leads to the development of Experimental Autoimmune Encephalomyelitis (EAE), the experimental model of MS. It has been suggested that its encephalitogenic potential may be due to the lack of MOG self-immune tolerance. To clarify this, we have generated a MOG deficient mouse (MOG(-/-)) strain. Surprisingly, MOG(35-55)specific proliferation and Th1-type cytokine production were markedly enhanced in MOG(-/-)mice compared to wild type control. Furthermore, adoptive transfer of MOG(35-55)specific T cells, isolated from MOG deficient mice, into wild-type recipients resulted in the development of a more severe disease, indicating a high capacity of MOG(-/-)T cells to initiate effector responses. Interestingly, T cell reactivity to overlapping MOG peptides in MOG(-/-)mice did not reveal new potential immunodominant epitopes in H-2(b)mice. Taken together, our data suggests that MOG self-tolerance modulates the encephalitogenic potential of autoreactive MOG T cells in the periphery. 相似文献