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題名 | Perspective of a Pediatric Nephrology Program: An 18 Year Retrospective=小兒腎臟學訓練:十八年之回顧及展望 |
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作者姓名(外文) | Scheinman,Jon I.; Foreman,John W.; Chan,James CM.; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 38:5 民86.09-10 |
頁次 | 頁352-359+402 |
分類號 | 417.574 |
關鍵詞 | 小兒腎臟科訓練計劃; 腎臟疾病; 腎臟穿刺; Pediatric nephrology training program; Renal disease; Renal biopsy; |
語文 | 英文(English) |
英文摘要 | 我們分析過去十八年中在小兒腎臟科的訓練計劃之病人資料,試圖評估兒科臨床 訓練是否和內科腎藏科訓練同樣有價值。我們也比較病人從一個一百二十萬人口的美國都會 區的轉診率,在頭九年沒有健康保險制度以及後九年有 " 處治照顧 " 競爭的比較。最後, 我們討論小孩實行腎臟穿刺的時機以及小兒腎臟計劃二十年經驗對於治療的看法。我們使用 同樣的美國國家衛生院臨床資料格式用於十八年資料收集。其中包括所有門診及住院病人的 臨床、實驗室及病理診斷,透析 / 移植以及其他治療紀錄。 在 1977 至 1996 年間,3150 位新病人因腎臟疾病接受檢查,其中 21 % 小於一歲,而 50% 小於七歲。在 389 例腎臟穿 刺的病童中,大部分小於十歲。 此外,在 112 例小兒透析╱移植的病童中,近半數小於十 歲。因此,大部分的病童在幼年發病,而且有迥異於成人的腎臟疾病和不同的治療方法。因 此我們認為小兒腎臟科訓練不宜與內科腎臟科混合。而 " 處治照顧 " 競爭並不影響病人的 數量。事實上,後九年病人的數量和前九年大致平行,本文中亦討論其中相關的因素,這些 資料對於此競爭年代或許有用。最後,我們討論兒童實施腎臟穿刺的時機以及對特殊疾病的 治療。 and 1996, 3,150 new patients were examined for disorders related to the kidney. Twenty-one per cent of the patients were in the first year of life and 50% were younger than seven years of age. The majority of the 389 percutaneous renal biopsies were done in children under 10 years of age. In addition, almost half of the 112 pediatric dialysis/transplant patients presented before 10 years of age. Thus, the majority of patients were in the early years of life, with an unique pattern of renal diseases and issues regarding therapy which are clearly different from adulthood. Therefore we concluded that the existing data did not support the proposition that pediatric nephrology training be absorbed into intornal medicine nephrology programs. The introduction of managed care competition did not affect the rate of patient enrollment. In fact, the rate of referrals in the latter 9 years paralleled the first 9 years. The factors which contribute to this outcome are discussed. Such data should be useful to those trying to meet the challenges of this competitive era. Finally, we discussed guidelines for renal biopsies in children and approaches to specific diseases. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。