RESUMO
In this article we try to determine how frequently emergency physicians (EPs) suspected the diagnosis in acute aortic dissection (AD). In this retrospective descriptive study, we identified all patients with the final diagnosis of AD initially evaluated in 1 of 3 emergency departments (EDs) over a 5-year period. Patients were included if AD was not suspected before ED evaluation. Patients undergoing thoracic aorta imaging as the initial ED study were defined as suspected AD. Forty-three patients totaling 44 presentations were identified. EPs suspected AD in 19 of 44 presentations. EPs suspected AD in 12 of 14 (86%) cases of chest and back pain and in 5 of 11 (45%) of chest pain. Thirteen of 39 (33%) painful presentations involved abdominal pain; EPs suspected AD in 1 of 13 (8%). EPs suspected the diagnosis in 43% of acute AD; location of pain was most predictive of a suspected diagnosis.
Assuntos
Aneurisma da Aorta Torácica/diagnóstico , Dissecção Aórtica/diagnóstico , Tratamento de Emergência/métodos , Doença Aguda , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/classificação , Dissecção Aórtica/complicações , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/complicações , Dor nas Costas/etiologia , Causalidade , Dor no Peito/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Laser-based scanners provide a sensitive means for measuring optical density (OD) of Gafchromic films. Such instruments were reviewed in a recent AAPM report (task group 55) which provided recommendations and information on OD measurements (effect of wavelength, temperature, etc.). The present article reports that variable rate scanners and spot densitometers using laser diodes (671 nm) and HeNe lasers (633 nm) can cause polymerization of Gafchromic film. The light induced polymerization depends on light power, wavelength, beam spot size, dwell time, and prior radiation dose of the film. Measurements were made with a custom built scanner that provided accurate control of light power, light polarization, dwell time, and film position in relation to the beam focus. The results demonstrate that lasers operating with powers of 0.1, 0.5, 1.0, and 1.5 mW produce a nonlinear increase in OD of Gafchromic film. The measured change in OD after 1 min of exposure ranges from 0.150 to 0.244 for a laser diode operating at 0.5 and 1.5 mW, respectively. Tables are included that tabulate the increase in OD for laser power, dwell time, and prior dose. Laser light induced polymerization can have a significant impact on dosimetry measurements acquired using these laser-based systems.
Assuntos
Dosimetria Fotográfica/instrumentação , Fenômenos Biofísicos , Biofísica , Dosimetria Fotográfica/estatística & dados numéricos , Humanos , Lasers , Óptica e Fotônica/instrumentaçãoAssuntos
Certificado de Necessidades/economia , Planejamento Hospitalar/economia , Regionalização da Saúde/economia , Gastos de Capital/legislação & jurisprudência , Certificado de Necessidades/legislação & jurisprudência , Análise Custo-Benefício , Custos e Análise de Custo , Honorários e Preços , Órgãos Governamentais , Massachusetts , Fatores de Tempo , Estados UnidosRESUMO
Many general psychiatrists, on the basis of long clinical experience, use electroconvulsive therapy (ECT) as an important treatment modality in acute schizophrenic disorders. They believe its use, along with phenothiazine drugs and supportive psychotherapy, produces a superior remission in a shorter time in many instances. The charts of one hundred consecutive first hospital admission schizophrenics at Glenside Hospital were reviewed regarding treatment modalty, length of stay, and outcome, as part of a utilization review study. The average hospital stay was thirty-one days. Eighty-eight per cent were discharged home improved. Fifty-six per cent received ECT.
