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Integrating palliative care in oncologic emergency departments:Challenges and opportunities

World Journal of Clinical Oncology 2016年第2期7卷 227-233页

作者： Ahmed F Elsayem hiba E Elzubeir patricia a brock.knox h todd Department of Emergency Medicine University of Texas MD Anderson Cancer Center

Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are ***,there is growing interest in providing palliative care(PC) to cancer patients in ***,this integration is not without major *** this article,we review the literature on why cancer patients visit EDs,the rates of hospitalization and mortality for these patients,and the models for integrating PC in *** discuss opportunities such integration will bring to the quality of cancer care,and resource utilization of *** also discuss barriers faced by this *** found that the most common reasons for ED visits by cancer patients are pain,fever,shortness of breath,and gastrointestinal *** majority of the patients are admitted to hospitals,about 13% of the admitted patients die during hospitalization,and some patients die in *** who receive PC at an ED have shorter hospitalization and lower resource *** based solely on increasing PC provision in EDs by PC specialists have had modest success,while very limited ED-based PC provision has had slightly higher ***,details of these programs are lacking,and coordination between ED based PC and hospitalwide PC is not *** some studies,the objectives were to improve care in the communities and reduce ED visits and *** conclude that as more patients receive cancer therapy late in their disease trajectory,more cancer patients will visit *** of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer *** specialist should play an active role in educating ED physicians about PC,and provide timely *** impact of integrating PC in EDs on quality and cost of cancer care should be studied.

关键词： Emergency department Cancer Palliative care Integration Quality Cost

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Vascular trauma： selected historical reflections from the western world

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Chinese Journal of Traumatology 2011年第2期14卷 67-73页

作者： Norman M. Rich patricia L. McKay David R. Welling todd E. Rasmussen Norman M. Rich Department of Surgery F. Edward Hebert School of Medicine Uniformed Services University of the Health Sciences Bethesda MD 20814 USA Norman M. Rich Department of Surgery Hand and Upper Extremity Surgery Uniformed Services University of the Health Sciences Bethesda MD 20814 USA Division of General Surgery Norman M. Rich Department of Surgery Uniformed Services University Bethesda MD 20814 USA US Army Institute of Surgical Research Fort Sam Houston Texas 78230 USA

In the spirit of international exchanges of knowledge with colleagues from all over the world, who are interested in the care and treatment of vascular trauma, we offer selected historical reflections from the western world on vascular trauma. Whereas there are a number of key individuals and a variety of events that are important to us in our writing, we know essentially nothing about what is written by other cultures and, particularly, the Chinese. It is well recognized around the world that Chinese surgeons are among the first to be highly successful in re-plantation of severed extremities, repairing both injured arteries and veins. Also, we recognize that there are contributions in other parts of the world, which are not well known to us collectively. Contributions from the Arabic speaking part of the world come to mind because there is periodic brief reference. We offer our perspective hoping that there will be one or more Chinese surgeons who will offer us the benefit of sharing their perspective on important historical contribu- tions to the managing of vascular trauma outside of the western world, and, particularly, the English speaking literature. Once again, we encourage our colleagues in the Arabic speaking world to provide us with their perspective of the development and management of vascular trauma.

关键词： Vascular system injuries history Western world International educational exchange

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住宅灰尘中的多环芳烃:变异性来源

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环境与职业医学 2013年第8期30卷 613-613页

作者： todd P.Whitehead Catherine Metayer Myrto Petreas Monique Does patricia A.Buffler Stephen M.Rappaport

[背景]人们对于使用住宅灰尘评估人类环境污染物暴露感兴趣。[目的]探讨住宅灰尘中多环芳香烃（PAhs）变异性来源的特征，并为计划采用住宅灰尘评估PAhs暴露的研究者提供指导。[方法]从北加州儿童白血病研究的293户家庭的两轮采样（2001... 详细信息

[背景]人们对于使用住宅灰尘评估人类环境污染物暴露感兴趣。[目的]探讨住宅灰尘中多环芳香烃（PAhs）变异性来源的特征，并为计划采用住宅灰尘评估PAhs暴露的研究者提供指导。[方法]从北加州儿童白血病研究的293户家庭的两轮采样（2001--2007年和2010年期间）中，使用家用吸尘器重复收集灰尘样本，并采用气相色谱一质谱法测量12种PAhs。采用随机和混合效应模型将每种PAh实测方差分为4种成分，并找出变异性的来源。[结果]灰尘中各种PAhs的中值浓度介于10～190ng／g。对于每种PAh，总方差分解为区域变异性（1％～9％）、家庭之间的区域内变异性（24％-48％）、随着时间推移的家庭内变异性（41％～57％）以及样本内分析变异性（2％～33％）oPAh灰尘水平的区域差异与周围空气中PAh浓度估值相关。家庭之间的区域内差异与住宅施工日期和居民吸烟习惯相关。某些PAhs随着时间呈下降的趋势，解释了一小部分家庭内的变异性。然而，混合效应模型未能解释大部分家庭内的变异性。当灰尘样品采集时间间隔至少6年时，两轮采样之间家庭内的差异最大。[结论]上述研究结果表明，在研究PAh的健康影响时，采用住宅灰尘对PAh暴露进行回顾性评估是可行的。

关键词：环境暴露住宅灰尘多环芳烃

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