#676
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Öèòàòà:
Èç ñåìè òûñÿ÷ ðàíäîìèçèðîâàííûõ ïàöèåíòîâ ìàëûå òðîìáû áûëè ó ïÿòè òûñÿ÷. Íåîáõîäèìîñòü òðîìáýêòîìèè ó èõ ñîìíèòåëüíà. Ó ïàöèåíòîâ ñ áîëüøèìè òðîìáàìè ÿ íå íàøåë óêàçàíèÿ î äîëè ïàöèåíòîâ ñ "complete thrombus removal". Âîò êàê ïèøóò àâòîðû Sianos, Papafaklis è Serruys â çàêëþ÷åíèè ñòàòüè, íà êîòîðóþ ññûëàþòñÿ àâòîðû ýòîãî èññëåäîâàíèÿ (ïî êëàññèôèêàöèè òðîìáîâ): "Large, prospective, randomized trials in patients with LTB are warranted to further investigate the value of AngioJet or other thrombus extraction catheters in routine clinical practice." LTB ýòî áîëüøèå òðîìáû, ò.å. ãðàäàöèé 4 è 5. Ðàçâå ýòî èññëåäîâàíèå ñìîãëî ïîñòàâèòü òî÷êó? Ïîêà áóäåì ïðîäîëæàòü òðîìáýêòîìèè. |
#677
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Ê ÷¸ðòó àñïèðàòîðû! ;)
Öèòàòà:
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#678
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Àìåðèêà îñâåæàåò ãàéäëàéíû ïî ïðîôèëàêòèêå:Online Before Print
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] JNC8\2013 òîæå äîæäåìñÿ? |
#679
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Öèòàòà:
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#680
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Óâàæàåìûå êîëëåãè.
Ñ íåêîòîðûì îïîçäàíèåì ðàä ïðåäñòàâèòü Âàì îôèöèàëüíûé ïåðåâîä Ýêñïåðòíîãî êîíñåíñóñíîãî äîêóìåíòà EHRA/HRS ïî ñåðäå÷íîé ðåñèíõðîíèçèðóþùåé òåðàïèè (2012 ã.). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ÏÑ. Îáðàùàþ âíèìàíèå, ÷òî ïðàâîîáëàäàòåëÿìè (EHRA/HRS) ðàçðåøåíà ïóáëèêàöèÿ äîêóìåíòà pdf òîëüêî íà äàííîì ðåñóðñå. Îðèãèíàëüíûé òåêñò: 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#681
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Äîñòàòî÷íî äîëãîæäàííûé äîêóìåíò:-)
ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#682
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JNC8
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Ñ óâàæåíèåì |
#683
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Åùå îäèí ãàéäëàéí ïî ÀÃ
Clinical Practice Guidelines for the Management of Hypertension
in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] È åùå âåäü åâðîïåéñêèé ãàéäëàéí ïî Àà áûë íåäàâíî. È òîëüêî â íåì áåòà-áëîêàòîðû óïîìèíàþòñÿ êàê ïðèåìëåìûé âàðèàíò "ïåðâîé ëèíèè" òåðàïèè. íå çàïóòàòüñÿ áû.. Ïîêà áóäó óñëîâíî ñ÷èòàòü íàñ åâðîïåéöàìè |
#684
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Áîëüíîãî íå âîëíóåò êòî ïåðåä íèì (åâðîïååö, àìåðèêàíåö), åãî âîëíóåò, êàê ýòî ñäåëàåøü è ÷òî îí ïîëó÷èò.
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#685
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] êàê ÿ ïîíÿë, îòêàçàëàñü îò ñîáñòâåííûõ ïëàíîâ è òåïåðü ïîääåðæèâàåò ïðîôåññèîíàëüíûå àññîöèàöèèâ â âûïóñêå íîâûõ ðåêîìåíäàöèé. ×òî êàñàåòñÿ áåòà áëîêàòîðîâ è ÷üè ðåêîìåíäàöèè âûïîëíÿòü, åâðî èëè àìåðèêàíñêèå. òî ÿ ïðèâåäó ïðèìåð ìîåãî îòíîøåíèÿ. Íàäî ñî÷åòàòü ñîáñòâåííóþ ïðàêòèêó è ðåêîìåíäàöèè.  2008 ãðäó âñå-òàêè ïðîìåëüêíóë â ïå÷àòè ïðîîáðàç JNC8, ãäå áåòàáëîêàòîðû ñòàâèëèñü íà 5 ìåñòî. ×òî ÿ íåçàìåäëèòåëüíî è ñäåëàë, è íå æàëåþ, áîëüíûå ñ Àà (áåç ÈÁÑ) ïðåêðàñíî îáõîäÿòñÿ è áåç áåòàáëîêàòîðîâ. Ïðîñìîòðåë ñåé÷àñ Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension 2013. Ïî ëå÷åíèþ - àáñîëþòíàÿ êàëüêà îò JNC8 -2008 ãîäà (â èíåòå íå ñîõðàíèëîñü. ïîýòîìó ññûëêè íå äàþ). Çà 5 ëåò â ïëàíå ëå÷åíèÿ íè÷åãî íå èçìåíèëîñü. Ðåêîìåíäóþ äëÿ ïðèìåíåíèÿ â Åâðîïå (ïðàâäà, ÷åðíîêîæèõ ÿ íå ëå÷èë). |
#686
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Äà ÿ òîæå îáû÷íî íå íàçíà÷àþ ïåðâîé-âòîðîé èëè äàæå òðåòüåé "ëèíèåé" áåòà-áëîêàòîðû ïðè Àà áåç ÈÁÑ, ÑÍ, òàõèàðèòìèé. Íî áûâàþò ãèïåðòîíèêè, ó êîòîðûõ ïðîñëåæèâàåòñÿ ñèìïàòî-àäðåíàëîâûé õàðàêòåð ÀÃ, íå ôåîõðîìîöèòîìà, íå òèðåîòîêñèêîç, íî ïî äíåâíèêó ñàìîêîíòðîëÿ ÀÄ êîððåëÿöèÿ: áîëüøå ïóëüñ - âûøå ÀÄ. Ïðîáîâàë íàçíà÷àòü ïðîëîíãèðîâàííûé âåðàïàìèë èëè äèëòèàçåì òàêèì ïàöèåíòàì, êîíòðîëü ÀÄ õóæå, ÷åì íàïðèìåð íà íåáèâîëîëå èëè êàðâåäèëîëå, êîòîðûé â ýòîé ñèòóàöèè ìíå íðàâèòñÿ.
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#687
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Öèòàòà:
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#688
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Êîëëåãè.
ß íè â êîåì ñëó÷àå íå îòðèöàþ ïðèâåðæåííîñòü âðà÷à ê òåì èëè èíûì ðåêîìåíäàöèÿì. Ýòî åãî âûáîð, îñíîâàííûé íà ñîáñòâåííîì îïûòå. Äåëî â äðóãîì.  ïîñòå # 684 íàïèñàíî: «Áîëüíîãî íå âîëíóåò êòî ïåðåä íèì (åâðîïååö, àìåðèêàíåö), åãî âîëíóåò, êàê ýòî ñäåëàåøü è ÷òî îí ïîëó÷èò». Ïîíÿòíî, ÷òî áîëüíîãî íå âîëíóåò Êòî ïåðåä íèì (ïåðåä áîëüíûì, åñòåñòâåííî, âðà÷), êîòîðûé ìîæåò áûòü åâðîïåéöåì, àìåðèêàíöåì, åãî âîëíóåò, êàê îí ýòî ñäåëàåò Ïîñëåäîâàë êîììåíòàðèè ê ñîîáùåíèþ Khomitskaya: "ðàçíèöà åñòü, êàê èãåíåòè÷åñêàÿ, òàê è â ñèñòåìå îêàçàíèÿ ïîìîùè, è ýòî äîëæíî ïðèíèìàòüñÿ âî âíèìàíèå" Íå äâóñìûñëåííî: áîëüíîé, ïîñìîòðåâ íà âðà÷à, äîëæåí ïðèíÿòü âî âíèìàíèå «èãåíåòè÷åñêóþ (÷èòàé, ãåíåòè÷åñêóþ) ðàçíèöó ñ âðà÷îì. Êàê âèäèòñÿ, çäåñü ñîçíàòåëüíî èëè íåò, íî ñìåùåíû àêöåíöû. Òîãäà â ÷åì îòëè÷èå - âðà÷ áåëûé, ÷åðíûé, æåëòûé. Ñ÷èòàþ, ïîäîáíûé âçãëÿä àâòîðà êîììåíòàðèÿ íåäîïóñòèì, åñëè íå áîëåå. |
#689
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#690
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Ìíå êàåòñÿ, ýòî äåëî âêóñà. ß ïîñëåäíåå âðåìÿ èñïîëüçóþ òîëüêî áèñîïðîëîë, íåìíîãî ðåæå - êàðâåäèëîë. Ìåòîïðîëîë íàäî íàçíà÷àòü 4 ðàçà â äåíü, à ñîòàëîë è öåëèïðîëîë âîîáùå íå óïîìèíàþòñÿ â ýòîì ðóêîâîäñòâå. Íåáèâîëîë ñåáÿ îïîðî÷èë â èññëåäîâàíèÿõ. Ìîæåò ïîýòîìó îí íå äàåò ýôôåêòà ó ìîèõ ïàöèåíòîâ, è ÿ åãî óñïåøíî çàìåíÿþ íà áèñîïðîëîë.
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