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Perceived Barriers to Asthma Therapy in Ethno-Cultural Communities: The Role of Culture, Beliefs and Social Support
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作者 Michele Shum Iraj Poureslami +1 位作者 jing Liu j. mark fitzgerald 《Health》 2017年第7期1029-1046,共18页
Background : Adherence to therapy is integral to successfully managing asthma, which requires comprehension of what, when, and how to use medication and diligence in following management plan. Asthma patients from eth... Background : Adherence to therapy is integral to successfully managing asthma, which requires comprehension of what, when, and how to use medication and diligence in following management plan. Asthma patients from ethnic minority groups have more morbidity and reported filling their prescriptions less often. Limited information is available in Canadian literature on ethnic differences in their perceptions of asthma management. We aimed to document patient perceived adherence to asthma therapy among targeted ethno-cultural groups. Methods : We evaluated perceived barriers to therapy adherence, including: cultural beliefs and practices, patient/care-provider communication, self-management knowledge, and medication costs. We conducted a cross sectional study and interviewed 85 Chinese or Punjabispeaking adult asthma patients. Results : Lack of sufficient instructions from physicians, language/communication barriers, lack of skills on how to use inhalers, and high medication costs and medication side effects were most reported barriers to proper self-management practices. Most participants lived with others in the same household and reported high social support from home caregivers. The influence of family on self-management practices was obvious. Conclusion: Better understanding of patient needs, provision of culturally and linguistically appropriate education, and inclusion of home caregivers into the management practices are necessary to improve asthma outcomes in Chinese and Punjabi communities. 展开更多
关键词 ASTHMA MEDICATION Family INVOLVEMENT CAREGIVER Language Culture EDUCATIONAL Materials Knowledge Communication Cost BELIEFS
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该呼吸困难急救患者是否存在充血性心力衰竭?
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作者 Charlie S. Wang j. mark fitzgerald +6 位作者 Michael SchulzerD Edwin Mak Najib T. Ayas 徐亚妹(译) 黄冰清(译) 彭娟(译) 褚骏仁(校) 《美国医学会杂志(中文版)》 2006年第5期290-301,共12页
背景:呼吸困难是急诊患者常见的主诉,急诊医生必须快速、准确地做出诊断。 目的:评估急诊患者病史、症状、体征及常规的诊断性检查(胸部X线片、心电图、B型利尿肽[B—type natriuretic peptide,BNP])在鉴别诊断心力衰竭及其他引... 背景:呼吸困难是急诊患者常见的主诉,急诊医生必须快速、准确地做出诊断。 目的:评估急诊患者病史、症状、体征及常规的诊断性检查(胸部X线片、心电图、B型利尿肽[B—type natriuretic peptide,BNP])在鉴别诊断心力衰竭及其他引起呼吸困难的原因中的作用。 资料来源:检索MEDLINE数据库(1966年至2905年7月)及相关文章的参考文献、既往发表的综述以及有关体格检查的教科书。 研究选取:最终获得22项研究,这些研究对因呼吸困难而到急诊室就诊的成年患者进行了观察,了解其心力衰竭的诊断情况, 研究结果各异。数据提取:由本文的两名作者分别提取数据(敏感性、特异性及似然比[1ikelihood ratio,LRs])并对研究的方法学质量进行评估。 数据汇总:许多临床特点可增加心力衰竭的可能性,其中最突出的特点是:(1)具有心力衰竭既往史(阳性LR=5.8;95%可信期间[confidence interval,CI],4.1.8.0);(2)夜间出现阵发性呼吸困难(阳性LR=2.6;95%CI,1.5-4.5);(3)听诊闻及第三心音(S3)奔马率(阳性LR=11;95%CI,4.9-25.0);(4)胸部X线片示肺静脉淤血(阳性LR=12.0;95%CI,6.8-21.0);(5)心电图示心房纤颤(阳性LR=3.8;95%CI,1.7—8.8)。也有一些临床特点可大大降低心力衰竭的可能性,包括:(1)无心力衰竭既往史(阴性LR=0.45;95%CI,0.38-0.53);(2)活动时不出现呼吸困难症状(阴性LR=0.48;95%CI,0.35-0.67);(3)肺部未闻及哕音(阴性LR=0.51;95%CI,0.37—0.70);(4)胸部X线片未见心脏扩大(阴性LR=0.33;95%CI,0.23-0.48);(5)心电图未见任何异常表现(阴性LR=0.64;95%CI,0.47-0.88)。经证实,血清BNP水平低下是最有价值的检查结果(血清BNP〈100pg/mL;阴性LR=0.11;95%CI,0.07-0.16)。 结论:在收治呼吸困难的急诊患者时应直接询问其病史,进行体格检查,嘱做胸部X线片及心电图检查。如果对心力衰竭存有疑义,可化验血清BNP水平,这对排除心力衰竭极有帮助。 展开更多
关键词 充血性心力衰竭 阵发性呼吸困难 胸部X线片 诊断性检查 peptide MEDLINE 急救 急诊患者
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