1型糖尿病是由于多种病因导致胰岛β细胞进行性破坏，引起胰岛素绝对缺乏，血糖升高的代谢性疾病。分为自身免疫性（1A）和特发性（1B）两种亚型。暴发性1型糖尿病（fulminant type 1 diabetes mellitus，FT1DM）是2000年由日本学者Imag...1型糖尿病是由于多种病因导致胰岛β细胞进行性破坏，引起胰岛素绝对缺乏，血糖升高的代谢性疾病。分为自身免疫性（1A）和特发性（1B）两种亚型。暴发性1型糖尿病（fulminant type 1 diabetes mellitus，FT1DM）是2000年由日本学者Imagawa等[1]首次提出，由于尚未发现其明确病因及自身免疫的证据，暂被列入特发性1型糖尿病的范畴。其起病急、进展快、临床表现多样，极易误诊，治疗一旦延误则预后不佳。妊娠是FT1DM的危险因素，日本的一项全国性调查发现，几乎所有妊娠期起病的T1DM均属于FT1DM。我们近来收治一例流产后发生FT1DM的患者，现介绍如下。展开更多
当前在澳大利亚，补充替代医学（complementary and alternative medicines CAM）方法的应用非常普遍，尤其是在一些患有慢性疾病的人群中。关于使用者CAM应用相关建议的来源，CAM医师是常见且主要的途径之一。但就具体的就诊情况，尤...当前在澳大利亚，补充替代医学（complementary and alternative medicines CAM）方法的应用非常普遍，尤其是在一些患有慢性疾病的人群中。关于使用者CAM应用相关建议的来源，CAM医师是常见且主要的途径之一。但就具体的就诊情况，尤其是老年人群，尚缺乏相关了解。展开更多
目的:呈现2013年美国卫生系统药师协会(American Society of Health-System Pharmacists,ASHP)关于美国医院药学信息采集和使用评价的全国性调查结果。方法:所有类型和规模的医院的药学主管共4893人受邀参加本次网上调研。本次调研包含...目的:呈现2013年美国卫生系统药师协会(American Society of Health-System Pharmacists,ASHP)关于美国医院药学信息采集和使用评价的全国性调查结果。方法:所有类型和规模的医院的药学主管共4893人受邀参加本次网上调研。本次调研包含超过600个数据因素来处理各种各样的药学信息及信息技术的采用和使用情况。数据根据医院类型和规模进行分析,来解释样本收集程序及反应率的差异。结果:在4893个调研样本中,465个调研结果可用,调研反应率为9.5%。大约33%的医院全部使用电子健康档案(Electronic health records,EHR)(即:没有纸质版)。计算机处方录入系统、临床决策支持系统、电子处方系统以及药物条形码管理系统的采用率表明这些技术的使用有明显的优势。大约一半的参加者反应仅仅使用纸质版进行药物重整,同样多的人反应既用电子版也用纸质版。总体来说,在美国医院自动化调配药柜比旋转配药机和摆药机器人更常见。患者门户网站和个人健康档案正在变得常见。至少25%的医院认为技术是药学实践模型计划(Pharmacy Practice Model Initiative, PPMI)的促进因素。药学信息技术的平均总全职人力工时是3.12。结论:本次调研发现,药学信息及信息技术在全部药物使用过程中广泛使用。在电子健康档案(EHRs)的有效使用措施及ASHP的药学实践模型计划中取得了长足的发展。展开更多
Objectives. - To compare the pre- existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibili...Objectives. - To compare the pre- existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibility of biases of selection of patients and of detection of these cancers in the Million Women Study. Patients and methods. - Nationwide survey conducted in France among a representative sample of 153 gynaecologists. The particulars of the last two consulting menopaused women treated with tibolone (N=306) and of the last two treated with a classical estrogen- progestogen therapy (N=306) were collated then analysed. Results. - Compared to those treated with a classical estrogen- progestogen therapy, more women receiving tibolone were aged 60 years or over (40 vs 31% ; P < 0.01)- . More of them had risk factors for breast cancer (history of mastodynia or mastopathy, elevated mammographic breast density) (6 vs 50% ; P < 0.01). More of them had a history of uterine investigation or exploration or of irregular bleeding (61 vs 53% of women with a history of irregular bleeding; P < 0.05). Overall, 84% of women treated with tibolone had at least one risk factor for breast or endometrial cancer vs 75% of those receiving a classical estrogen-progestogen therapy (P < 0.01). Discussion and conclusion. - Owing to its specific properties, tibolone is generally prescribed to women with a higher risk profile for breast or endometrial cancer than those receiving a classical estrogen- progestogen therapy, which may entail patient selection and cancer detection biases in non- randomised, open- label, observational studies.展开更多
Background: Female patients with acute myocardial infarction(MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadva...Background: Female patients with acute myocardial infarction(MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadvantage disappears after adjustment for age and other prognostic factors. This study, based on a countrywide survey of consecutive unselected patients with acute MI, examined whether female gender is an independent predictor of poor short-term outcome and less intensive in-hospital treatment. Methods: Data on a total of 7433 patients were analyzed. Results: The mean age was 64± 13 years and the proportion of females in this population was 23% . Univariate and multivariate predictors of in-hospital mortality in female patients were estimated. Unadjusted in-hospital mortality rates of women were significantly higher compared to men(17.7 vs. 8.6, p< 0.001). In multivariate analysis, female gender was an independent predictor of in-hospital mortality in the total population [relative risk(RR)=1.29, 95% confidence interval(CI)=1.02-1.64, p=0.036]. The RR of women for in-hospital death was exaggerated among younger patients, aged< 55 years(RR=3.84, 95% CI=1.07-13.74, p=0.039). Female gender was also independently and inversely associated with administration of thrombolytic treatment(RR=0.724, 95% CI=0.630-0.831, p=< 0.001). Conclusion: Although female gender is an independent predictor of higher post-MI in-hospital mortality with a pronounced effect among younger patients, women are less likely to receive thrombolysis than men. Based on the results from this countrywide study, we should consider women, especially of younger age, as patients at particular high risk, who contrary to common practice, deserve more intensive and aggressive in-hospital treatment.展开更多
文摘1型糖尿病是由于多种病因导致胰岛β细胞进行性破坏，引起胰岛素绝对缺乏，血糖升高的代谢性疾病。分为自身免疫性（1A）和特发性（1B）两种亚型。暴发性1型糖尿病（fulminant type 1 diabetes mellitus，FT1DM）是2000年由日本学者Imagawa等[1]首次提出，由于尚未发现其明确病因及自身免疫的证据，暂被列入特发性1型糖尿病的范畴。其起病急、进展快、临床表现多样，极易误诊，治疗一旦延误则预后不佳。妊娠是FT1DM的危险因素，日本的一项全国性调查发现，几乎所有妊娠期起病的T1DM均属于FT1DM。我们近来收治一例流产后发生FT1DM的患者，现介绍如下。
文摘目的:呈现2013年美国卫生系统药师协会(American Society of Health-System Pharmacists,ASHP)关于美国医院药学信息采集和使用评价的全国性调查结果。方法:所有类型和规模的医院的药学主管共4893人受邀参加本次网上调研。本次调研包含超过600个数据因素来处理各种各样的药学信息及信息技术的采用和使用情况。数据根据医院类型和规模进行分析,来解释样本收集程序及反应率的差异。结果:在4893个调研样本中,465个调研结果可用,调研反应率为9.5%。大约33%的医院全部使用电子健康档案(Electronic health records,EHR)(即:没有纸质版)。计算机处方录入系统、临床决策支持系统、电子处方系统以及药物条形码管理系统的采用率表明这些技术的使用有明显的优势。大约一半的参加者反应仅仅使用纸质版进行药物重整,同样多的人反应既用电子版也用纸质版。总体来说,在美国医院自动化调配药柜比旋转配药机和摆药机器人更常见。患者门户网站和个人健康档案正在变得常见。至少25%的医院认为技术是药学实践模型计划(Pharmacy Practice Model Initiative, PPMI)的促进因素。药学信息技术的平均总全职人力工时是3.12。结论:本次调研发现,药学信息及信息技术在全部药物使用过程中广泛使用。在电子健康档案(EHRs)的有效使用措施及ASHP的药学实践模型计划中取得了长足的发展。
文摘Objectives. - To compare the pre- existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibility of biases of selection of patients and of detection of these cancers in the Million Women Study. Patients and methods. - Nationwide survey conducted in France among a representative sample of 153 gynaecologists. The particulars of the last two consulting menopaused women treated with tibolone (N=306) and of the last two treated with a classical estrogen- progestogen therapy (N=306) were collated then analysed. Results. - Compared to those treated with a classical estrogen- progestogen therapy, more women receiving tibolone were aged 60 years or over (40 vs 31% ; P < 0.01)- . More of them had risk factors for breast cancer (history of mastodynia or mastopathy, elevated mammographic breast density) (6 vs 50% ; P < 0.01). More of them had a history of uterine investigation or exploration or of irregular bleeding (61 vs 53% of women with a history of irregular bleeding; P < 0.05). Overall, 84% of women treated with tibolone had at least one risk factor for breast or endometrial cancer vs 75% of those receiving a classical estrogen-progestogen therapy (P < 0.01). Discussion and conclusion. - Owing to its specific properties, tibolone is generally prescribed to women with a higher risk profile for breast or endometrial cancer than those receiving a classical estrogen- progestogen therapy, which may entail patient selection and cancer detection biases in non- randomised, open- label, observational studies.
文摘Background: Female patients with acute myocardial infarction(MI) exhibit higher unadjusted in-hospital mortality rates compared to male patients. However, contradictory evidence exists on whether this survival disadvantage disappears after adjustment for age and other prognostic factors. This study, based on a countrywide survey of consecutive unselected patients with acute MI, examined whether female gender is an independent predictor of poor short-term outcome and less intensive in-hospital treatment. Methods: Data on a total of 7433 patients were analyzed. Results: The mean age was 64± 13 years and the proportion of females in this population was 23% . Univariate and multivariate predictors of in-hospital mortality in female patients were estimated. Unadjusted in-hospital mortality rates of women were significantly higher compared to men(17.7 vs. 8.6, p< 0.001). In multivariate analysis, female gender was an independent predictor of in-hospital mortality in the total population [relative risk(RR)=1.29, 95% confidence interval(CI)=1.02-1.64, p=0.036]. The RR of women for in-hospital death was exaggerated among younger patients, aged< 55 years(RR=3.84, 95% CI=1.07-13.74, p=0.039). Female gender was also independently and inversely associated with administration of thrombolytic treatment(RR=0.724, 95% CI=0.630-0.831, p=< 0.001). Conclusion: Although female gender is an independent predictor of higher post-MI in-hospital mortality with a pronounced effect among younger patients, women are less likely to receive thrombolysis than men. Based on the results from this countrywide study, we should consider women, especially of younger age, as patients at particular high risk, who contrary to common practice, deserve more intensive and aggressive in-hospital treatment.
