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Nirmanmoh Bhatia Buddhadeb Dawn Tariq S. Siddiqui Marcus F. Stoddard 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2015,42(1):16-24
Determining aortic stenosis (AS) severity is clinically important. Calculating aortic valve (AV) area by means of the continuity equation assumes a circular left ventricular outflow tract (LVOT). The full impact of this assumption in calculating AV area is unknown. Predictors of noncircular LVOT shape in patients with AS are undefined.In 109 adult patients with AS who underwent multiplanar transesophageal echocardiography, we calculated AV area by means of the standard continuity method and by a modified method involving planimetric LVOT area.We found 54 circular, 37 horizontal-oval, 8 vertical-oval, and 10 irregular LVOTs. Area derived by direct planimetry correlated better with the modified than the standard continuity method (r=0.89 vs r=0.85; both P=0.0001). Valve areas of patients with mild, moderate, or severe AS by planimetry were more often mischaracterized with use of the standard than modified method (29 vs 18; P <0.0001). Horizontal-oval AV area derived by planimetry (1.28 ± 0.55 cm2) was underestimated by the standard method (1.05 ± 0.47 cm2; P=0.001), but not by the modified method. Congenital AV morphology and low cardiac index were the only multivariate predictors of horizontal-oval shape. Low cardiac index was the only predictor of noncircular shape.More than half our patients with AS had noncircular LVOTs. Using the modified method reduces mischaracterizations of AS severity. Congenital AV morphology and low cardiac index predict horizontal-oval or noncircular shape. These data suggest the value of direct LVOT measurement to calculate AS severity in patients who have congenital AV or a low cardiac index. 相似文献
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An Analysis of the Buy-Vs-Lease Decision 总被引:1,自引:0,他引:1
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本文针对不同层次护理人员制定不同的培训目标和计划,采取岗前培训,岗位培训(专科培训、在职分层培训、护理人才培训),自学等形式,开展护士在职教育,不断扩充更新知识,以适应现代护理工作要求。 相似文献
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目的重症恶性疟疾病情重,变化快,并发症多,患者若抢救不及时常可导致死亡,为观察疗效,总结121例重症恶性疟患者的临床抢救情况。方法用国产青蒿琥酯、蒿甲醚和法国产Quinimax配合一系列综合治疗。结果抢救121例重症恶性疟疾患者,共治愈103例(85.1%),死亡18例(14.9%)。结论早期诊断,积极预防并发症是降低死亡率的主要环节。 相似文献
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目的研究应用力学因素检测膝关节功能方法的有效性.方法利用测力平台测量得到人体下肢在运动过程中的力学曲线,用数学方法确定力学曲线的最大值F和曲线特征值R.结果给出51例骨关节炎患者的分析数据,并给出30例正常人的结果作为对照.结论应用力学因素可以有效地检测膝关节功能状态. 相似文献
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Decisions about which health-care interventions represent adequate value to collectively funded health-care systems are as widespread as they are unavoidable. In the case of new pharmaceuticals, many countries now require formal cost-effectiveness analysis to inform this decision-making process. This requires evidence on parameters associated with health-related utilities, treatment effects, resource use, and costs, for which data from available regulatory trials are invariably absent or highly uncertain. This uncertainty results from a number of factors including the predominance of intermediate end points in the clinical evidence-base and the limited period of follow-up of patients in clinical studies. Despite these imperfections in the evidence base, decisions about whether new pharmaceuticals are sufficiently cost-effective for reimbursement cannot be side-stepped. Data limitations do, however, require the use of rigorous analytical methods to support decision making. Probabilistic decision models and value of information analysis offer a means of structuring decision problems, synthesizing all available data, characterizing the uncertainty in the decision, quantifying the cost of uncertainty, and establishing the expected value of perfect information. This analytical framework is important because it addresses two fundamental questions about new pharmaceuticals. First, is the product expected to be cost-effective on the basis of existing evidence? Second, is additional research concerning the product itself cost-effective? In addressing these questions, the analytical framework can establish when sufficient evidence exists to sustain a claim for a new pharmaceutical to be cost-effective. 相似文献
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目的探讨特发性震颤(essential tremor,ET)的临床特点。方法回顾性分析98例ET患者的临床资料。结果98例ET中男56例,女42例。发病年龄6~72岁,平均43.08±18.18岁。病程1~48年,平均14.04±11.39年。48例(48.98%)患者有阳性家族史。临床主要表现为单症状的姿势性震颤,累及部位依次为手98例(100%)、头38例(38.78%)、下肢28例(28.57%)、咽喉部16例(16.33%)、下颏10例(10.20%)等。64例患者做了饮酒试验,其中58例(90.63%)有酒精反应。84.62%的患者服用盐酸阿罗洛尔治疗有效。结论特发性震颤的临床表现以单症状姿势性震颤为主,手及头部受累明显,多数患者对酒精有反应,盐酸阿罗洛尔治疗有效。 相似文献