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1.
T.F.A. Lees L. Bogdashich D. Godden 《The British journal of oral & maxillofacial surgery》2021,59(1):e9-e12
Fibroepithelial polyps (FEPs) are common, benign intraoral lesions that tend to develop slowly at predictable sites, often in response to local irritation or trauma. Historical precedent often results in referral to oral and maxillofacial surgery (OMFS) departments for biopsy, often irrespective of symptoms, and histological assessment. OMFS and pathology services are struggling to cope with an increasing workload that will potentially lead to widespread delays to diagnosis and treatment. Over the past 20 years, clinical pathways and guidance have been developed to ensure that healthcare interventions, such as the removal of third molars, tonsils, skin tags, and benign moles, are evidence-based, have a net patient benefit, and ensure the best use of finite NHS resources. However, no such guidance exists for intraoral lesions and we regard this as an oversight. We analysed the removal of 682 FEPs over a seven-year period and report sensitivities of 92.4% for a “confirmed clinical suspicion of an FEP” and 99.7% for a “confirmed clinical suspicion of a benign diagnosis”. The incidence of non-benign disease was 0.3%. Primary care dentists should be able to diagnose and monitor FEPs and refer only if symptoms are serious or in high-risk patients or sites. Adopting this practice across the UK could free up to 1825 four-hour OMFS clinics, 405 hours of consultant histopathologists’ time, and recurring savings to the NHS estimated to be in the region of £620 000/annum. We believe that the removal of FEPs should be reclassified as an “intervention not normally funded”, and the time and resources put to better use treating patients with lesions of questionable pathology. 相似文献
2.
《The Journal of thoracic and cardiovascular surgery》2023,165(1):149-158.e4
BackgroundCoronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%).MethodsWe analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively.ResultsIn 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]).ConclusionsHeart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization. 相似文献
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目的:为改革和完善上海市农村合作医疗的政策,制度,规划,计划,措施提供科学依据。方法:使用调查研究,比较研究,描述性统计及SAS统计分析等方法。结果:调查分析了上海市1997-1999年8区(县)合作医疗资金来源,数量,比例,补偿等。结论:1997年以来,上海市农村合作医疗得到了快速发展,仍存在保障水平,补偿比例,投保率低下及发展不平衡,资金使用不合理等问题。 相似文献
5.
Principles and strategies of effective community participation 总被引:7,自引:5,他引:2
A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such howis participation facilitated?, who participates?and what are the benefits and obstacles to participation?are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper. 相似文献
6.
用刀豆蛋白A刺激激素敏感型肾病单个核细胞,并将其培养上清液灌注于大鼠肾内。结合电镜观察,用图像分析仪及体视学方法分别对其肾组织胶体铁染色切片和电镜照片上的足突和滤过裂隙的平均宽度进行测定。结果表明:该病极期上清液灌注的鼠肾小球多阴离子明显减少,足突肿胀、融合,滤过裂隙变窄;而该病缓解组和正常对照组则为阴性。说明该病单个核细胞培养上清液可引起鼠肾小球微小病变型肾病综合征的病变,并揭示该变化可能是由其上清液中一种异常的T淋巴细胞因子所致。 相似文献
7.
胎儿主要肢骨发育时间表──超声骨龄 总被引:1,自引:0,他引:1
用B超检测正常妊娠中的胎儿。选择受精龄为12至38整周(completedweek)的胎儿297例。测量其主要肢骨(干)长度。并将所测数据进行统计学处理。结果表明胎儿肢骨的生长发育与胎龄有显著的正相关关系。 相似文献
8.
作者用红细胞C_3b受体花环试验和红细胞免疫复合物花环试验对马桑内酯所致癫痫发作大鼠红细胞免疫粘附功能的变化进行了观察,结果表明,癫痫组动物红细胞C_3b受体花环率明显低于对照组,而红细胞免疫复合物花环率相差不显著.提示癫痫发作可导致大鼠红细胞免疫粘附功能降低,因此在癫痫治疗中注意调整和增强患者的红细胞免疫功能具有重要意义。 相似文献
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10.
Jill Macleod Clark PhD BSc RGN Jill Maben MSc BA RGN Karen Jones BA RHV RGN 《Journal of advanced nursing》1997,26(1):161-168
This is the first of two papers which address aspects of the findings of a large scale study commissioned by the English National Board which set out to examine the impact of Project 2000 on perceptions of the philosophy and practice of nursing. The findings presented here suggest that there have been fundamental shifts in perceptions of the nature and discipline of nursing. Students and diplomates of the course perceive themselves as knowledgeable doers, with their practice well grounded in theory and research. They value the interpersonal skills teaching and place the patient firmly at the centre of care delivery, viewing the patient holistically and being prepared to be fierce patient advocates where necessary. It is difficult to determine the extent to which these shifts can be attributed to the Project 2000 course, although the Project 2000 approach to education appears to be an important factor. 相似文献