BACKGROUND & AIMS: BACKGROUND:Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE:We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN:Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS:We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES:The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS:Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS:We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The purpose of this study was to investigate the fit of a hypothesized model of medical students' diagnostic or clinical reasoning skills based on their aptitude for medical school, basic science achievement, and clinical competency measures. METHOD:A total of 589 medical students who received their MD from 1994 to 2002 participated in this study. Confirmatory factor analysis was used to evaluate the fit of theoretical models of clinical reasoning using measures of basic science and clinical knowledge. RESULTS:The results provided support for a three-factor model of medical student performance (Bentler's Comparative Fit Index = .905, standardized root mean squared residual = .054, root mean squared error of approximation = .105). The clinical reasoning skills of medical students were influenced by an independent relationship between latent variables of basic science achievement and clinical competency. CONCLUSION:The findings support a theoretical model of diagnostic or clinical reasoning that treats the basic science and clinical knowledge of medical students as distinct domains.

背景与目标：

BACKGROUND & AIMS: :Molecular biology techniques are applied for the diagnosis of meningoencephalitis due to herpesviruses, enteroviruses or polyomaviruses, for the diagnosis of human cytomegalovirus, human parvovirus B19, varicella-zoster virus and rubella virus infections occurring during pregnancy, for the diagnosis and the management of retrovirus infections (HIV and HTLV) and of hepatitis (HBV and HCV), for papillomavirus typing and to detect a link between virus and clinical manifestations (cardiomyopathy or insulinodependent diabetes with coxsackievirus B: Kaposi's sarcoma with HHV 8) or to investigate an environmental contamination with viruses. These new molecular markers which are both qualitative and quantitative represent an important advance in the field of viral diagnosis research, in the monitoring of viral load during the course of infection, in the therapy control of viral disease and in the epidemiology of virus spread. Standardization and automatization are obtained using available commercial reagents and kits.

背景与目标： : 分子生物学技术用于诊断由疱疹病毒，肠病毒或多瘤病毒引起的脑膜脑炎，用于诊断人巨细胞病毒病毒，人细小病毒B19，水痘病毒病毒和怀孕期间发生的风疹病毒病毒，用于诊断和管理复古病毒感染 (HIV和HTLV) 和肝炎 (HBV和HCV)，乳头瘤病毒分型，并检测病毒与临床表现 (心肌病或胰岛素依赖型糖尿病与柯萨奇病毒B: 卡波西氏肉瘤与HHV 8) 或调查病毒es的环境污染。这些定性和定量的新分子标记物代表了病毒诊断研究领域，感染过程中病毒载量的监测，病毒性疾病的治疗控制以及病毒传播流行病学领域的重要进展。使用可用的商业试剂和试剂盒可获得标准化和自动化。

BACKGROUND & AIMS: :A prospective collection of positive antimicrobial cultures was performed over 12 consecutive months in the medical intensive care unit of a cancer hospital. In all, 144 infections and 163 pathogens were documented during 87 of the 528 admissions. Lung, urinary, ENT (ear, nose and throat) infections and bacteraemia were the most frequently documented. Staphylococcus species, Streptococcus species, Escherichia coli, Klebsiella species and Pseudomonas species were the most common pathogens. Gram-positive strains were observed predominantly during monomicrobial bacteraemia (48.9%). Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) were found in 58% and 92% of the isolated strains respectively. No particular outbreak was identified. A further prospective study will be necessary to evaluate the impact of the antibiotic use on the selection of resistant strains in our ICU.

背景与目标： : 在癌症医院的医疗重症监护病房中连续12个月进行了阳性抗菌培养的前瞻性收集。在528的87例入院期间，共记录了144例感染和163例病原体。肺，泌尿，耳鼻喉科 (耳，鼻和喉) 感染和菌血症是最常见的记录。最常见的病原体是葡萄球菌，链球菌，大肠杆菌，克雷伯菌和假单胞菌。革兰氏阳性菌株主要在单株菌血症期间观察到 (48.9%)。分离株的58% 和92% 中分别发现了耐甲氧西林金黄色葡萄球菌 (MRSA) 和表皮葡萄球菌 (MRSE)。没有发现特别的爆发。需要进行进一步的前瞻性研究，以评估抗生素使用对我们ICU中耐药菌株选择的影响。

BACKGROUND & AIMS: :Few well-constructed studies have systematically evaluated medical investigation protocols for children with autistic spectrum disorders. This is in large part due to the heterogeneous nature of the population and changing diagnostic frameworks. This review outlines the studies that have directed investigation strategies to date, and discusses how these might be applied in the clinical situation. The importance of listing the conditions that may be present on the basis of the specific clinical presentation, and using a thorough history and examination to generate a pre-test probability of the target disorders is emphasized if tests are to be useful in directing therapy or broader management approaches.

背景与目标： : 很少有精心构建的研究系统地评估了自闭症谱系障碍儿童的医学调查方案。这在很大程度上是由于人口的异质性和不断变化的诊断框架。这篇综述概述了迄今为止指导研究策略的研究，并讨论了如何将这些策略应用于临床情况。如果要在指导治疗或更广泛的治疗方法中有用，则强调了根据特定临床表现列出可能存在的条件并使用全面的病史和检查来产生目标疾病的预测试概率的重要性。管理方法。

BACKGROUND & AIMS: :Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

背景与目标： : 将小型独立实践转变为以患者为中心的医疗之家被广泛认为是改革美国医疗体系的关键一步。我们的团队在改善初级保健实践方面进行了超过15年的研究。我们发现了小型初级保健实践的四个特征，这些特征严重抑制了他们向这种新护理模式转变的能力。我们发现，小型实践以医师为中心，缺乏医师之间的有意义的沟通，以专制领导行为为主导，并且被那些被赋予缺乏想象力的角色的中层临床医生服务不足。我们的分析表明，除了支付改革之外，还需要改变初级保健医生的思维方式。除非初级保健医生能够采用新的心理模式，并以新的方式思考自己和他们的做法，否则他们和他们的做法将很难创建创新的护理团队，成为学习型组织，并在医疗保健社区内充当好公民。

BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： : 医疗保健的改善缓慢，部分原因是医生和护士缺乏质量改进，患者安全和专业团队合作方面的技能。本文报道了Josiah Macy Jr的质量和安全重组计划。基金会和医疗保健改善研究所，试图将改善和患者安全纳入医疗和护理学校课程。在2009-10的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动 (其中87% 是跨专业的，涉及医学和护理学生)，涉及六所大学的1,374学生相遇。这项工作产生了见解-在本文中描述-学习目标需要跨专业教育; 如何为所有学生创建基于临床的改进学习; 以及如何证明对学生行为，组织实践和对患者的利益的影响。该计划通常遇到的限制因素是缺乏足够数量的临床教职员工，他们准备教授有关改善护理的知识。更重要的是，缺乏针对此类计划的强大评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: :Nuclear protein in testis (NUT)-midline carcinoma (NMC) is a rare, aggressive disease typically presenting with a single t(15;19) translocation that results in the generation of a bromodomain-containing protein 4 (BRD4)-NUT fusion. PER-624 is a cell line generated from an NMC patient with an unusually complex karyotype that gave no initial indication of the involvement of the NUT locus. Analysis of PER-624 next-generation transcriptome sequencing (RNA-Seq) using the algorithm FusionFinder identified a novel transcript in which Exon 15 of BRD4 was fused to Exon 2 of NUT, therefore differing from all published NMC fusion transcripts. The three additional exons contained in the PER-624 fusion encode a series of polyproline repeats, with one predicted to form a helix. In the NMC cell line PER-403, we identified the 'standard' NMC fusion and two novel isoforms. Knockdown by small interfering RNA in either cell line resulted in decreased proliferation, increased cell size and expression of cytokeratins consistent with epithelial differentiation. These data demonstrate that the novel BRD4-NUT fusion in PER-624 encodes a functional protein that is central to the oncogenic mechanism in these cells. Genomic PCR indicated that in both PER-624 and PER-403, the translocation fuses an intron of BRD4 to a region upstream of the NUT coding sequence. Thus, the generation of BRD4-NUT fusion transcripts through post-translocation RNA-splicing appears to be a common feature of these carcinomas that has not previously been appreciated, with the mechanism facilitating the expression of alternative isoforms of the fusion. Finally, ectopic expression of wild-type NUT, a protein normally restricted to the testis, could be demonstrated in PER-403, indicating additional pathways for aberrant cell signaling in NMC. This study contributes to our understanding of the genetic diversity of NMC, an important step towards finding therapeutic targets for a disease that is refractory to current treatments.

背景与目标： : 睾丸 (NUT) 中线癌 (NMC) 中的核蛋白是一种罕见的侵袭性疾病，通常表现为单个t(15;19) 易位，导致产生含溴结构域的蛋白4 (BRD4)-NUT融合。PER-624是由NMC患者产生的细胞系，其具有异常复杂的核型，没有给出涉及NUT基因座的初始指示。使用算法FusionFinder对每624下一代转录组测序 (RNA-Seq) 的分析鉴定了一种新的转录物，其中BRD4的外显子15与NUT的外显子2融合，因此不同于所有已发表的NMC融合转录物。每个624融合中包含的三个额外外显子编码一系列多脯氨酸重复序列，其中一个预测形成螺旋。在每403 NMC细胞系中，我们鉴定了 “标准” NMC融合和两种新的同工型。在任一细胞系中通过小干扰RNA敲低导致增殖减少，细胞大小增加和细胞角蛋白的表达与上皮分化一致。这些数据表明，PER-624中的新型BRD4-NUT融合体编码对这些细胞中的致癌机制至关重要的功能性蛋白质。基因组PCR表明，在PER-624和PER-403中，易位将BRD4的内含子融合到NUT编码序列上游的区域。因此，通过易位后RNA剪接产生BRD4-NUT融合转录物似乎是这些癌的共同特征，以前没有被认识到，其机制促进了融合的替代同工型的表达。最后，野生型NUT (一种通常限于睾丸的蛋白质) 的异位表达可以在PER-403中得到证实，这表明NMC中异常细胞信号传导的其他途径。这项研究有助于我们了解NMC的遗传多样性，这是为目前治疗方法难以治疗的疾病寻找治疗靶点的重要一步。

BACKGROUND & AIMS: :Venous thromboembolism (VTE) is a potentially serious complication occurring in 1%-2% of hospitalized medical patients. Despite this low absolute risk, as many as 82% of medical patients are considered to be at increased risk of developing VTE and are eligible for medical thromboprophylaxis. In this commentary, The author will discuss the main findings of a recent paper published in Clinical Epidemiology that questions the large proportion of individuals who are eligible for medical thromboprophylaxis, and also discuss the potential implications for the prevention of VTE. The recent paper demonstrated that when a population is divided into high- and low-risk groups, the maximum absolute risk depends on the inverse of the proportion of patients that is considered to be high risk. Consequently, even an effective treatment will only result in a small reduction in the absolute risk when the high-risk group comprises the largest proportion of this population. For medical thromboprophylaxis, this implies that even patients considered to be at high-risk for developing VTE have a maximum absolute VTE risk of 2% when the overall risk is 1.6%. Therefore, even an effective preventive initiative will only result in a small risk reduction. This small potential benefit should be weighed against potential harms associated with prophylaxis, mainly bleeding events. Still, there may be a reasonable overall balance between prevention of pulmonary embolism and major bleeding, mainly because major bleeding events are rare. Nonetheless, this discussion underscores that future risk prediction models should aim to predict the benefits and harms in individual patients in order to provide optimal care for the right patients.

背景与目标： : 静脉血栓栓塞 (VTE) 是一种潜在的严重并发症，发生在住院患者的1% 2% 中。尽管绝对风险较低，但仍有多达82% 的医疗患者被认为患有VTE的风险增加，并且有资格进行医疗血栓预防。在这篇评论中，作者将讨论最近发表在《临床流行病学》上的一篇论文的主要发现，该论文质疑了有资格进行医疗血栓预防的大部分个体，并讨论了预防VTE的潜在影响。最近的论文表明，当人群分为高风险组和低风险组时，最大绝对风险取决于被认为是高风险的患者比例的倒数。因此，当高危人群占该人群的最大比例时，即使是有效的治疗也只能导致绝对风险的小幅降低。对于医疗血栓预防，这意味着即使被认为处于发生VTE的高风险的患者，当总体风险1.6% 时，也具有2% 的最大绝对VTE风险。因此，即使是有效的预防举措，也只会导致很小的风险降低。应权衡这种小的潜在益处与预防相关的潜在危害，主要是出血事件。尽管如此，预防肺栓塞和大出血之间可能存在合理的总体平衡，主要是因为大出血事件很少。尽管如此，该讨论强调了未来的风险预测模型应旨在预测单个患者的收益和危害，以便为合适的患者提供最佳护理。

BACKGROUND & AIMS: :Diagnostic accuracy for radiologists is above that expected by chance when they are exposed to a chest radiograph for only one-fifth of a second, a period too brief for more than a single voluntary eye movement. How do radiologists glean information from a first glance at an image? It is thought that this expert impression of the gestalt of an image is related to the everyday, immediate visual understanding of the gist of a scene. Several high-speed mechanisms guide our search of complex images. Guidance by basic features (such as color) requires no learning, whereas guidance by complex scene properties is learned. It is probable that both hardwired guidance by basic features and learned guidance by scene structure become part of radiologists' expertise. Search in scenes may be best explained by a two-pathway model: Object recognition is performed via a selective pathway in which candidate targets must be individually selected for recognition. A second, nonselective pathway extracts information from global or statistical information without selecting specific objects. An appreciation of the role of nonselective processing may be particularly useful for understanding what separates novice from expert radiologists and could help establish new methods of physician training based on medical image perception.

背景与目标： : 放射科医生的诊断准确性高于偶然的预期，当他们仅暴露于胸片5分之1秒时，这一时期太短暂，无法进行一次自愿的眼球运动。放射科医生如何从图像的第一眼就收集信息？人们认为，对图像完形的这种专家印象与对场景要点的日常，即时视觉理解有关。几种高速机制指导我们搜索复杂的图像。基本特征 (例如颜色) 的指导不需要学习，而复杂场景属性的指导是学习的。基本特征的硬连线指导和场景结构的学习指导都可能成为放射科医生专业知识的一部分。场景中的搜索可以通过两途径模型来最好地解释: 对象识别是通过选择性途径执行的，在该途径中，必须单独选择候选目标进行识别。第二种非选择性途径从全局或统计信息中提取信息，而无需选择特定对象。了解非选择性处理的作用对于了解新手与专业放射科医生之间的区别可能特别有用，并且可以帮助建立基于医学图像感知的医师培训新方法。

BACKGROUND & AIMS: :Epilepsy affects a larger number of individuals than previously thought-up to 2% of the population-and its effects reach further. Yet epilepsy, with its associated lingering stigma and fear, has remained in the background in terms of services and research. Traditional quantitative research often falls short when trying to describe the impact of epilepsy on the lives of individuals and their families. In the present study, focus groups were held throughout South Carolina to discuss individuals' experiences with accessing epilepsy-related services and health care, and what life with epilepsy is like. Following qualitative data analysis, findings included two themes. One theme focuses on the ongoing search for services and help. The second theme concerns the experiences of living life with epilepsy. Also highlighted are recommendations for potential improvements in public awareness and professional training, and helpful interventions.

背景与目标： : 癫痫影响的个体数量比以前想象的要多-达到2% 的人口-其影响进一步扩大。然而，癫痫，伴随着挥之不去的耻辱和恐惧，在服务和研究方面仍然是背景。在试图描述癫痫对个人及其家庭生活的影响时，传统的定量研究往往不足。在本研究中，在南卡罗来纳州举行了焦点小组讨论个人获得与癫痫相关的服务和医疗保健的经验，以及癫痫的生活是什么样的。在定性数据分析之后，调查结果包括两个主题。一个主题侧重于正在进行的服务和帮助搜索。第二个主题涉及癫痫生活的经历。还强调了有关提高公众意识和专业培训以及有益干预措施的建议。

BACKGROUND & AIMS: :Egyptian medical papyri date the Santorini eruption, and reconcile the hitherto perceived dichotomy between archaeological/historical and scientific data. The medical documentation describes ailments, which can only have arisen from a volcanic source: ash fallout, rain acidified by ash, and a plume. Furthermore, the Egypt described by the medical texts matches the one in the series of so-called biblical plagues. This match in turn provides the length of time, 19 months, between the initial and final phases of the eruption, each phase contributing to the otherwise odd accumulation of sulfates spread over two consecutive biennia (1603-1600 BC) in Greenland's ice core. As a result, the initial phase of the eruption can be dated to August 21, 1603 BC, and the final one to March 1601 BC, in full agreement with the radiocarbon data (1627-1600 BC) based on the outermost ring on the branch of an olive tree killed by the eruption.

背景与目标： : 埃及医学纸莎草纸可以追溯圣托里尼喷发，并调和迄今认为的考古/历史和科学数据之间的二分法。医学文件描述了只能由火山来源引起的疾病: 灰烬沉降物，被灰烬酸化的雨水和羽流。此外，医学文献所描述的埃及与所谓的圣经瘟疫系列中的埃及相匹配。此匹配又提供了喷发的初始阶段和最终阶段之间的19个月的时间长度，每个阶段都导致了格陵兰岛冰核中连续两个两年期 (公元前1603-1600年) 散布的硫酸盐的奇数积累。结果，喷发的初始阶段可以追溯到公元前1603年8月21日，最后一个可以追溯到公元前1601年3月，这与放射性碳数据 (公元前1627-1600年) 完全一致。橄榄树被喷发杀死。

BACKGROUND & AIMS: BACKGROUND:Individuals with HIV disease often must adhere to complex medication regimens. To date, regimen complexity has not been examined in the literature using standardized procedures incorporating all important elements of antiretroviral (ARV) regimens. OBJECTIVE:This article presents a novel method of quantifying regimen complexity using objective criteria addressing the factors that may complicate adherence to ARV regimens. METHODS:Part 1 of this article describes the development of the Antiretroviral Regimen Complexity (ARC) Index scoring system. Based on input from pediatric and adult patients, caregivers of pediatric patients, and health care professionals, this comprehensive system includes the number of medications, dosing schedules, administration methods, special instructions, and required preparations associated with ARV regimens. Weights are applied for each of these factors to produce an overall score representing the regimen's level of complexity. Part 2 of this article presents reliability and validity data for the system. RESULTS:The ARC Index demonstrates excellent test-retest and interrater reliability as well as strong construct and discriminant validity. An on-line version of this system minimizes computation errors. CONCLUSIONS:Although modifications may be necessary for patients requiring nonstandard dosing instructions, preliminary evidence supports the utility of this measure as a reliable and valid indicator of the complexity of antiretroviral treatment regimens.

背景与目标：

BACKGROUND & AIMS: We report the response to risperidone in seven hospitalized, adult patients who presented psychotic symptoms etiologically related to a general medical condition. The conditions included brain surgery in two, and anticardiolipin syndrome, renal failure, epilepsy, lupus, and metastatic carcinoma in one each. Four patients had failed previous treatment with at least one typical antipsychotic agent. Response to risperidone was assessed by the Brief Psychiatric Rating Scale (BPRS). Serum was collected for measurement of steady-state trough risperidone and 9-hydroxyrisperidone concentrations at effective doses in three patients. Amelioration of psychotic symptoms was noted in all seven patients. Mean (+/- SD) BPRS scores were reduced significantly from baseline (63.0 +/- 15.1) to endpoint (27.0 +/- 3.5; p < 0.01). The mean effective daily dose of risperidone was 3.1 +/- .7 mg and time to response was 4.7 +/- 2.4 days. Risperidone was not present at detectable concentrations in the three patients studied. The mean steady-state trough serum concentration of 9-hydroxyrisperidone in the three patients assessed was 20.3 +/- 9.8 ng/ml. These preliminary findings, which suggest that risperidone is a safe and effective agent in patients with psychotic symptoms due to various medical conditions, need to be confirmed by randomized, antipsychotic comparison trials involving a larger number of patients.

背景与目标： 我们报告了7名住院成年患者对利培酮的反应，这些患者表现出与一般医疗状况相关的精神病症状。疾病包括两种脑部手术，以及抗心磷脂综合征，肾衰竭，癫痫，狼疮和转移性癌各一种。四名患者先前使用至少一种典型的抗精神病药治疗失败。通过简明精神病评定量表 (BPRS) 评估对利培酮的反应。在三名患者中以有效剂量收集血清以测量稳态谷利培酮和9-羟基利培酮浓度。所有7例患者的精神病症状均得到改善。平均 (+/- SD) BPRS评分从基线 (63.0 +/- 15.1) 到终点 (27.0 +/- 3.5; p < 0.01) 显著降低。利培酮的平均有效日剂量为3.1 +/- .7 mg，反应时间为4.7 +/- 2.4天。在研究的三名患者中，利培酮不存在可检测的浓度。在评估的三名患者中，9-羟基利培酮的平均稳态谷血清浓度为20.3/- 9.8 ng/ml。这些初步发现表明，利培酮是一种安全有效的药物，用于由于各种医疗条件引起的精神病症状的患者，需要通过涉及更多患者的随机抗精神病比较试验来证实。

BACKGROUND & AIMS: :"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.

背景与目标： : “急救人员” 是接受过高级急救培训的人员，他们可以与救护车服务同时做出反应，并且通常比救护车服务更快地应对可疑的医疗紧急情况。Hatzolah是一个基于halakhic (犹太法律) 原则的志愿第一响应者小组，位于墨尔本大都市的局部地区，以色列以外的大屠杀幸存者密度最高。来自该社区的维多利亚州大都会救护车服务 (MAS) 的 “呼叫” 数量很少，这表明许多人不愿与 “穿制服的” 外部机构联系。Hatzolah是一个自治组织，根据适应的MAS临床实践指南和临床治理流程运作。Hatzolah响应者接受为期18个月的MAS培训课程，包括急救，心肺复苏，半自动除颤器的使用和氧气治疗。我们描述了Hatzolah服务的前11年 (1995-2005年)。每年就诊的患者数量稳步上升，达到867 2005年的峰值。最常见的呼叫原因是跌倒 (19.4%)，胸痛 (9.7%) 或呼吸窘迫 (7.6%)。对于所有病例，Hatzolah的中位反应时间为2或3分钟。他们参加了35例心脏骤停患者 (中位反应时间为2分钟)，并在MAS之前到达29个呼叫 (83%)。19例 (54% 例) 心脏骤停患者被复苏并活着从现场转移。在运输的那些中，明显更多的具有可电击的心律 (50% v 13%，P = 0.03)。五 (14%) 幸存下来出院。Hatzolah已发展成为一个为MAS提供补充服务的组织。它是建立其他大都会社区急救小组的典范。