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目的:明确集中的电话干预能否降低慢性心衰门诊患者死亡或因心衰加重而住院的发生率。设计:多中心、随机对照试验。地点:阿根廷的51个中心(包括公立、私立的医院及流动设施)。参与者:1518例患有稳定的慢性心衰且已接受最佳药物治疗方案治疗的门诊患者,由心脏科主治医师分层后随机分为电话干预组和常规治疗组。干预:在常规治疗的基础上,由一个中心通过护士频繁的电话随访对患者进行教育、辅导和监督。主要观察指标:全因死亡或由于心衰加重而住院。结果:99.5%的患者完成了全部随访。常规治疗组758例患者中由于心衰加重而住院或死亡的比例(235…  相似文献   
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People with vision loss sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinations often causes anxiety for the sufferer and can be difficult for the attending eye care professional to manage. A review of the literature highlighted a range of visual, pharmacological and social management regimes that may alleviate these hallucinations, albeit using small samples in uncontrolled trials. Eye care practitioners should be aware of methods of rehabilitation in Charles Bonnet syndrome that may lead to resolution of the visual hallucinations.  相似文献   
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Multiple sclerosis: serial study of gadolinium-enhanced MR imaging   总被引:4,自引:0,他引:4  
Thirteen patients with definite multiple sclerosis (MS), studied 16-24 months previously with magnetic resonance (MR) imaging with and without enhancement by intravenously administered gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine, were reexamined with a similar protocol. Assessment of enhancement and clinical activity in both studies revealed that enhancement was observed in 13 of 14 cases in which clinical activity had changed within 4 weeks of the study and thus appeared more sensitive than clinical examination in determining active disease. The 3-minute postinjection, short repetition time image (TR) was the most efficient for depicting enhancement. Enhancing lesions (active plaques) arose from previously hyper- or isointense regions on long TR images. Previously active lesions reverted to areas of iso- or hyperintensity on long TR images. Serial comparison of long TR images in this population reveals a decrease in high-intensity lesions on long TR images in some cases and an increase in others. The findings of high-intensity regions on long TR images and previously enhancing lesions both becoming isointense suggests that transient inflammatory changes with concomitant edema without demyelination and/or with significant remyelination may occur in some MS lesions. MS lesions are dynamic; both active and inactive lesions may show dramatic change on longitudinal MR imaging studies.  相似文献   
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Corticosteroids are a mainstay of topical therapy for psoriasis. While efficacious and relatively safe when used carefully, the potential for side effects, notably skin atrophy and adrenal suppression, have been associated with excesses in potency, prolonged or widespread use. The International Psoriasis Council Working Group on Topical Therapy has reviewed the efficacy and safety of topical corticosteroids and recommends strategies for safe, long‐term use of these agents.  相似文献   
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INTRODUCTION: Performance in an admission test and carefully conducted, structured interview provides a uniform basis for the assessment of applicants prepared in different systems of education for admission to an institute of higher professional learning. We studied the predictability of the system of education followed by the students prior to entrance into the Medical College, the admission test scores, and interview ratings on performance after five trimesters at the Aga Khan University Medical College. METHOD: A cohort of 374 medical students who were admitted during 1989--1994, were considered. The associations between the admission test score, interview ratings, system of education, and the scores obtained for anatomy, physiology, biochemistry and community health sciences examinations held after five trimesters were analysed using appropriate statistical procedures. RESULTS: Interview ratings were associated with the scores in Physiology but not other subjects. The chief finding of this study was the association between the system of education and performance in both the admission test and the examination after five trimesters. Students who followed the British school curricula for 13 years scored significantly higher than those who followed the 12 years of the Pakistani system. When controlled for the admission test score, the difference in mean scores of the two groups was still evident for two subjects; community health sciences and physiology. CONCLUSION: We believe that the evidence indicates differences in learning methods inculcated by the system of education prior to entry into the Medical College, notwithstanding the 1-year difference in duration of education.  相似文献   
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A case of hypochloraemic metabolic alkalosis in an infant with chloride losing ileostomy drainage and cystic fibrosis is described. It is speculated that intestinal loss of chloride played a major role in the development of metabolic alkalosis.  相似文献   
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