#76
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Âèñêè îäîáðÿìñ
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#77
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Ïî÷åìó îäíà áóòûëêà âîäêè - ýòî ìíîãî, äâå - ìàëî, à òðè - íîðìàëüíî?
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#78
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#79
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Âîçìîæíî ìû ñàìûå áîëüøèå ëèáåðàëû â ìèðå.
"Recent research in psychology and sociology has established a connection between political beliefs and unhealthy behaviors such as excessive alcohol, tobacco, and illegal drug consumption. In this study, we estimate the relationship between political ideology and the demand for beer, wine, and spirits using a longitudinal panel of fifty U.S. states from 1952 to 2010. Controlling for various socioeconomic factors and unobserved heterogeneity, we find that when a state becomes more liberal politically, its consumption of beer and spirits rises, while its consumption of wine may fall. Our findings suggest that political beliefs are correlated with the demand for alcohol" |
#80
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ëåêöèÿ ïðî áèëèâàðóäèí
Â÷åðà ê íàì â î÷åðåäíîé ðàç ïðèåçæàë ðåêëàìíûé àãåíò èç êðóïíîé ìîñêîâñêîé êëèíèêè. Ñîãíàëè âñåõ íàèâíûõ â êîíôåðåíöçàë. Ðàññêàçûâàë ïðî áèâàëèðóäèí. Îêàçûâàåòñÿ, ýòî î÷åíü õîðîøèé ïðåïàðàò! Îí äåéñòâóåò íà òðîìáèí. Òàêàÿ âîò íîâîñòü. Áûë î÷åíü êðàñî÷íûé ìóëüòèê ìèíóò íà 10. Îïÿòü ïîêàçàëè êàê ëîïàåòñÿ áëÿøêà è âûäåëÿåòñÿ òêàíåâîé àêòèâàòîð. È î÷åíü ïðàâèëüíî, à òî ìû óæå ñòàëè çàáûâàòü.
Ïðî êîíôëèêò èíòåðåñîâ íè÷åãî íå îáúÿâèë; âèäèìî ëåêòîð âñå-òàêè ïîíèìàåò, ÷òî ïðèåõàë ê ïîäãîòîâëåííûì ñïåöèàëèñòàì è íåêîòîðûå ìåëî÷è ìîæíî îïóñòèòü.  ïåðâîé ïîëîâèíå ëåêöèè äîêëàä÷èê ïûòàëñÿ íàñ óáåäèòü ïðîñòûìè ðåïëèêàìè «íà ñåãîäíÿøíèé äåíü ýòî, ñëàâà áîãó, õîðîøî èçâåñòíî», «íà ñåãîäíÿøíèé äåíü àáñîëþòíî äîêàçàíî» è ò.ï., íå óòðóæäàÿ ñåáÿ ññûëêàìè íà èñòî÷íèêè òàêîé óâåðåííîñòè. È ýòî òîæå ðàçóìíî, - ñåâåðíûå ëþäè ëþáÿò ïðîñòîòó è êðàòêîñòü â îáùåíèè. Ïîòîì íàø ãîñòü âñå-òàêè ñòàë ïîêàçûâàòü òàáëèöû èç êàêèõ-òî ãàéäîâ ñ ñîáñòâåííûìè îâàëàìè â íóæíûõ ìåñòàõ, îïóñêàÿ íàçâàíèÿ è ãîä ïóáëèêàöèè. Ïîÿâèëîñü îùóùåíèå íàóêè. Êóëüìèíàöèåé ñòàëà äåìîíñòðàöèÿ ðåçóëüòàòîâ ñîáñòâåííîãî ñðàâíèòåëüíîãî èññëåäîâàíèÿ áèâàëèðóäèíà è êîìáèíàöèè ãåïàðèíà ñ ìîíîôðàìîì ïðè ïåðâè÷íîé àíãèîïëàñòèêå. ×òî-òî áîëüøå 50, íî ìåíüøå 100 ïàöèåíòîâ. Òî÷íî íå çàïîìíèë. Çàïîìíèë ðàäîñòíîå – 30-äíåâíàÿ âûæèâàåìîñòü â ãðóïïå ïîëó÷àþùèõ áèâàëèðóäèí 100%, è, ê ñ÷àñòüþ, òàêàÿ æå â ãðóïïå ãåïàðèíà. Èç ýòîãî ìû ñ êîëëåãàìè ñäåëàëè âûâîä, ÷òî ïàöèåíòîâ ñ ïîäúåìîì âîîáùå ìîæíî ëå÷èòü, ÷åì óãîäíî. Ïðîñòî â ïðàâèëüíîì ìåñòå. Òîëüêî îñòàëîñü íåïîíÿòíûì ÷òî äåëàòü íàì ñ ãåïàðèíîì òåïåðü?  ïðåäñòàâëåííîì èññëåäîâàíèè ÷àñòîòà êðîâîòå÷åíèé íà ãåïàðèíå ñîñòàâèëà 26%.  êîíöå ÿ ïîïðîñèë äîêëàä÷èêà ïðîêîììåíòèðîâàòü äàííûå ïîñëåäíåãî èññëåäîâàíèÿ HEAT PPCI. Íå ìîãó ïðåäïîëîæèòü, ÷òî òàêîé ïîäãîòîâëåííûé àâòîð ïðîïóñòèë ýòó íîâîñòü ñ ïîñëåäíåãî ÀÑÑ.14. Ïðîñòî âåðîÿòíî èíôîðìàöèÿ î ïîâåðæåííîì áèâàëèðóäèíå «ñëàâà áîãó» íå òàê õîðîøî îïëà÷èâàåòñÿ. |
#81
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ëåêöèÿ ïðî áèëèâàðóäèí
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#82
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ëåêöèÿ ïðî áèëèâàðóäèí
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#83
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À êàêèå ñòåíòû îíè èñïîëüçîâàëè? ×òî-òî íå íàø¸ë.
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#84
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Àëåêñåé Ãåííàäüåâè÷, ñ HEAT PPCI íå âñå ñòîëü îäíîçíà÷íî.
Êîììåíòàðèé ãëàâíîãî èññëåäîâàòåëÿ HORIZONS-AMI ïî äàííîìó ïîâîäó: Panel co-chair Gregg W. Stone, MD, of Columbia University Medical Center (New York, NY), started off his comments with some major concerns. "One of them is scientific and one of them ethical,” he said. “Results of this single-center study are markedly different from 3 other randomized trials in 250 centers with more than 8,000 patients and more than 2.5 million patients from registry series. What I’m struck with is that in particular, the TLR, reinfarction, and stent thrombosis rates being three- to four-fold higher in the bivalirudin arm suggests to me strongly that you underdosed bivalirudin.” Îïÿòü æå åñòü êîíôëèêò èíòåðåñîâ... Ê ñîæàëåíèþ, ïîëíûé òåêñò äîêëàäà íå äîñòóïåí. Ðàçóìíîãî îòâåòà ïî÷åìó â õîäå ÌÍÎÃÎÖÅÍÒÐÎÂÎÃÎ ÐÀÍÄÎÌÈÇÈÐÎÂÀÍÍÎÃÎ Horizons-AMI (Áèâàëèðóäèí vs Ãåïàðèí+IIb/IIIa) íå ïðîäåìîíñòðèðîâàíà õîòÿ áû òàêàÿ æå ÷àñòîòà òðîìáîçîâ ñòåíòîâ êàê â ÎÄÍÎÖÅÍÒÐÎÂÎÌ ðàíäîìèçèðîâàííîì èññëåäîâàíèè (Áèâàëèðóäèí vs Ãåïàðèí) - çàãàäêà? Îòâåò, âîçìîæíî, êðîåòñÿ â ïàðàìåäèöèíñêèõ îáëàñòÿõ. È Î×ÅÍÜ áîëüøîé âîïðîñ êòî ÍÅÏÐÀÂ?) PS.  êëèíèêå áèâàëèðóäèí íå ïðèìåíÿåòñÿ, ëè÷íûé êîíôëèêò èíòåðåñîâ îòñóòñòâóåò. Ðåêëàìíûì àãåíòàì èç ñòîëèöû - ÍÅÇÀ×ÅÒ!) |
#85
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Ê ñëîâó î ðåçóëüòàòàõ ïðèìåíåíèÿ áèâàëèðóäèíà â ðåàëüíîì ìèðå:
http://forums.rusmedserv.com/attachm...6&d=1368465476 Áëàãîäàðþ OLDANGIO çà ïîëíûé òåêñò ñòàòüè! |
#86
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ß ñîâñåì íå ïðîòèâ áèâàëèðóäèíà.
Íåïîíÿòíî, çà÷åì íàì åãî ïðåïîäíîñÿò ïîäîáíûì îáðàçîì? À èññëåäîâàíèÿ, êîòîðûå äàþò íåîæèäàííûå ðåçóëüòàòû - ýòî î÷åíü çäîðîâî è èíòåðåñíî. Òîëüêî äëÿ HEAT PPCI Àííà Åâãåíüåâíà çàâåëà îòäåëüíóþ òåìó. À çäåñü íóæíî ôëóäèòü Íàïðèìåð, ôðàçà óâàæàåìîãî Gregg W. Stone î íåýòè÷íîñòè îôîðìëåíèÿ èíôîðìèðîâàííîãî ñîãëàñèÿ áîëüøå õàðàêòåðèçóåò èññëåäîâàíèå HEAT PPCI èëè ñàìîãî ãëàâíîãî èññëåäîâàòåëÿ HORIZONS-AMI? |
#87
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Ïðîäîëæàþ ôëóä: ðûëàñü â ïðàâîâîé áàçå íàøåé ñïåöèàëüíîñòè, íàøëà âîò òàêîé ïåðå÷åíü ìàíèïóëÿöèé ñ óêàçàíèåì ðàñ÷åòíûõ çàòðàò âðåìåíè íà îäíîãî ïàöèåíòà.
Àîðòîãðàôèÿ 40 ìèí. Êàâàãðàôèÿ 40 ìèí. Àíãèîêàðäèîãðàôèÿ 70 ìèí. Àðòåðèîãðàôèÿ âèñöåðàëüíàÿ 55 ìèí. Êîðîíàðîãðàôèÿ 90 ìèí. Àíãèîàðòåðèîãðàôèÿ öåðåáðàëüíàÿ (êàðîòèäíàÿ) 55 ìèí. Àíãèîàðòåðèîãðàôèÿ ïåðèôåðè÷åñêàÿ 55 ìèí. Ðåíòãåíîëîãè÷åñêèå èññëåäîâàíèÿ, ñîâìåùåííûå ñ õèðóðãè÷åñêèìè ëå÷åáíûìè ìàíèïóëÿöèÿìè 120-150 ìèí. Êòî óãàäàåò, ê êàêîìó ãîäó îòíîñÿòñÿ ýòè íîðìàòèâû è äåéñòâóþò ëè îíè ñåé÷àñ? |
#88
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ÀÅ! Ýòî ïðèêàç 128 èëè 132 ïðèìåðíî 1981 ãîä, íàøà ñ Àáóãîâûì ïèîíåðñêàÿ þíîñòü â ñïåöèàëüíîñòè. Ïðèêàçû ó íàñ îòìåíÿþòñÿ ðåäêî, îá ýòîì â íîâîì ïðèêàçå ñïåöèàëüíî óêàçûâàþò. Ïî ñïèðòó ìîæíî èñïîëüçîâàòü ïðèêàç ÷óòü-ëè íå 36 ãîäà (ïî 100 ã íà ïðîöåäóðó), ìîæåò ñ çàïðåòàìè ñíîâà ñòàíåò àêòóàëüíûì.
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#89
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Ñåðãåé Àëåêñååâè÷, Âû îøèáëèñü íà öåëûå 10 ëåò!
Ýòî Ïðèêàç ÌÇ ¹ 132 îò 2.08.1991 "Î ñîâåðøåíñòâîâàíèè ñëóæáû ëó÷åâîé äèàãíîñòèêè", è îí, äåéñòâèòåëüíî, ïî-ïðåæíåìó ðåãëàìåíòèðóåò ðàáîòó ñëóæáû. Íî âîò âîïðîñ: â 1991 ãîäó êîðîíàðîãðàôèÿ äåéñòâèòåëüíî çàíèìàëà 1,5 ÷àñà? ß-òî â ñïåöèàëüíîñòè ñ 1997 ãîäà, âñå-òàêè óæå íå òàê âñå áûëî äîëãî. Íó, ìèíóò 30-40 - åùå ìîæåò áûòü, íî íå 90 æå ìèíóò??? |
#90
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ß ïîëàãàþ ÷òî âàæíî íå çàáûâàòü íåñêîëüêî íåñòèðàåìûõ ÷åðò ÷òîáû 90 ìèí íå êàçàëèñü ñëó÷àéíûìè -è æèçíü íà÷àëà 90-õ áóäåò ïðåêðàñíà! Ýòî ïðåæäå âñåãî íåñîâåðøåíñòâî ïåðâûõ àíãèîàïïàðàòîâ, ïî ñóòè, ýòî áûëè ðåíòãåíàïïàðàòû ñ ôóíêöèÿìè ïîëó÷åíèÿ êèíîïëåíêè â âèäå òâåðäîé êîïèè. À ðåíòãåíëàáîðàíò ìîã è íå ïðîÿâèòü ïëåíêó ñ ïåðâîãî ðàçà. Ïîòîì ó àïïàðàòà íå áûëî ôóíêöèè äâèæåíèÿ ÝÎÏ-òðóáêà, ïðèõîäèëîñü âûïîëíÿòü èññëåäîâàíèå â ïðÿìîé ïðîåêöèè, à äëÿ ëåâîé è ïðàâîé êîñîé ïîäêëàäûâàòü ïîä ïàöèåíòà íåêèé òðåóãîëüíûé íåðåíòãåíêîíòðàñòíûé áðóñ. Ðå÷ü î áîêîâîé è êàóäàëüíî-êðàíèàëüíûõ ïðîåêöèÿõ äàæå íå øëà. Ïîòîì, ÷òî òàêîå èíòðîäüþñåðû - è íå âåäàëè. Äà è êîí÷èêè ó êàòåòåðîâ ôîðìèðîâàëè ñàìîñòîÿòåëüíî - òàêèì îáðàçîì, êàòåòåðèçàöèÿ óñüåâ âåíå÷íûõ àðòåðèé íó íå ñòîëü ïðîñòà áûëà. Âðåìÿ ïðîøëî âñåãî íè÷åãî, 20 ñ õâîñòèêîì ëåò, à êàê âñå êàðäèíàëüíî ïîìåíÿëîñü. È äàæå 90 ìèí äëÿ êîðîíàðîâåíòðèêóëîãðàôèè êàæóòñÿ óæå íåðåàëüíî äîëãèìè...
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