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1.
Sci Total Environ ; 468-469: 475-86, 2014 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-24051446

RESUMO

The current methods to assess the environmental impacts of plant pests differ in their approaches and there is a lack of the standardized procedures necessary to provide accurate and consistent results, demonstrating the complexity of developing a commonly accepted scheme for this purpose. By including both the structural and functional components of the environment threatened by invasive alien species (IAS), in particular plant pests, we propose an environmental risk assessment scheme that addresses this complexity. Structural components are investigated by evaluating the impacts of the plant pest on genetic, species and landscape diversity. Functional components are evaluated by estimating how plant pests modify ecosystem services in order to determine the extent to which an IAS changes the functional traits that influence ecosystem services. A scenario study at a defined spatial and temporal resolution is then used to explore how an IAS, as an exogenous driving force, may trigger modifications in the target environment. The method presented here provides a standardized approach to generate comparable and reproducible results for environmental risk assessment as a component of Pest Risk Analysis. The method enables the assessment of overall environmental risk which integrates the impacts on different components of the environment and their probabilities of occurrence. The application of the proposed scheme is illustrated by evaluating the environmental impacts of the invasive citrus long-horn beetle, Anoplophora chinensis.


Assuntos
Monitorização de Parâmetros Ecológicos/métodos , Plantas/microbiologia , Plantas/parasitologia , Medição de Risco/métodos
2.
J Evol Biol ; 26(6): 1281-93, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23458151

RESUMO

Exaggerated male ornaments are predicted to be costly to their bearers, but these negative effects may be offset by the correlated evolution of compensatory traits. However, when locomotor systems, such as wings in flying species, evolve to decrease such costs, it remains unclear whether functional changes across related species are achieved via the same morphological route or via alternate changes that have similar function. We conducted a comparative analysis of wing shape in relation to eye-stalk elongation across 24 species of stalk-eyed flies, using geometric morphometrics to determine how species with increased eye span, a sexually selected trait, have modified wing morphology as a compensatory mechanism. Using traditional and phylogenetically informed multivariate analyses of shape in combination with phenotypic trajectory analysis, we found a strong phylogenetic signal in wing shape. However, dimorphic species possessed shifted wing veins with the result of lengthening and narrowing wings compared to monomorphic species. Dimorphic species also had changes that seem unrelated to wing size, but instead may govern wing flexion. Nevertheless, the lack of a uniform, compensatory pattern suggests that stalk-eyed flies used alternative modifications in wing structure to increase wing area and aspect ratio, thus taking divergent morphological routes to compensate for exaggerated eye stalks.


Assuntos
Evolução Biológica , Dípteros/anatomia & histologia , Filogenia , Asas de Animais/anatomia & histologia , Animais , Dípteros/classificação , Masculino
3.
J Plast Reconstr Aesthet Surg ; 60(6): 682-5, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17485059

RESUMO

The purpose of this study was to examine the consistency of burns resuscitation practice throughout UK and Ireland. Twenty-six Burns Units were identified via the National Burn Bed Bureau and surveyed via a postal questionnaire. Twenty-three units returned a completed questionnaire, covering all of the units treating children and 17 out of 20 units that treat adults. Nearly all of the Burns Units commence fluid resuscitation at 10% total body surface area of burn in children and 15% total body surface area of burn in adults. The estimated resuscitation volume is calculated using the Parkland or the Muir and Barclay formula in 76% and 11% of units, respectively. The most commonly used resuscitation fluid is Hartmann's solution. No unit uses blood as a first line fluid. Resuscitation is discontinued after 24h in 35% of units and after 36 h in 30% of units. Approximately half of the units do not routinely change the type of intravenous fluid administered after the initial period of resuscitation. This survey illustrates that resuscitation of thermally injured patients in UK and Ireland Burns Units is fairly consistent with a shift towards crystalloid resuscitation.


Assuntos
Queimaduras/terapia , Hidratação/métodos , Adulto , Albuminas/uso terapêutico , Superfície Corporal , Queimaduras/epidemiologia , Criança , Humanos , Irlanda/epidemiologia , Soluções Isotônicas/uso terapêutico , Soluções para Reidratação/uso terapêutico , Lactato de Ringer , Fatores de Tempo , Reino Unido/epidemiologia
6.
J Evol Biol ; 18(3): 642-50, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15842493

RESUMO

Traditionally it was thought that fitness-related traits such as male mating frequency, with a history of strong directional selection, should have little additive genetic variance and thus respond asymmetrically to bidirectional artificial selection. However, recent findings and theory suggest that a balance between selection for increased male mating frequency and opposing selection pressures on physiologically linked traits will cause male mating frequency to have high additive genetic variation and hence respond symmetrically to selection. We tested these hypotheses in the stalk-eyed fly, Cyrtodiopsis dalmanni, in which males hold harems comprising many females and so have the opportunity to mate at extremely high frequencies. We subjected male stalk-eyed flies to artificial selection for increased ('high') and decreased ('low') mating frequency in the presence of ecologically realistic, high numbers of females. High line males mated significantly more often than control or low line males. The direct response to selection was approximately symmetric in the high and low lines, revealing high additive genetic variation for, and no significant genetic constraints on, increased male mating frequency in C. dalmanni. In order to investigate trade-offs that might constrain male mating frequency under natural conditions we examined correlated responses to artificial selection. We measured accessory gland length, testis length and eyespan after 7 and 14 generations of selection. High line males had significantly larger accessory glands than low line males. No consistent correlated responses to selection were found in testis length or eyespan. Our results suggest that costs associated with the production and maintenance of large accessory glands, although yet to be identified, are likely to be a major constraint on mating frequency in natural populations of C. dalmanni.


Assuntos
Dípteros/fisiologia , Variação Genética , Seleção Genética , Comportamento Sexual Animal/fisiologia , Animais , Pesos e Medidas Corporais , Dípteros/anatomia & histologia , Malásia , Masculino , Estatísticas não Paramétricas , Testículo/anatomia & histologia
7.
Med Teach ; 26(3): 223-8, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15203498

RESUMO

The authors examined the extent of the relationship between a Consultation satisfaction questionnaire and Patient enablement instrument scores and professionally assessed consultation competence scores of senior medical students. Three analyses were performed: (i) linear regression with mean overall competence score as response variable; (ii) sensitivity and specificity calculations using patient scores to classify competence; (iii) a repeated measures model with consultation-specific competence score as response variable. One hundred and nineteen students and 388 patients took part. Consultation satisfaction and enablement scores were weakly correlated with overall and consultation specific competence scores (correlation coefficient 0.16 to 0.44). 'Satisfaction with professional care' had a sensitivity of 0.68, specificity of 0.72 and positive and negative predictive values of 0.32 and 0.92 respectively. It is concluded that patient and professional assessments may complement, but do not replace, each other. Levels of patient satisfaction should not be used as proxy measures of the quality of consultation competence.


Assuntos
Competência Clínica , Satisfação do Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Encaminhamento e Consulta , Adolescente , Adulto , Educação de Graduação em Medicina , Feminino , Humanos , Masculino , Curva ROC , Estudantes de Medicina , Inquéritos e Questionários
8.
Qual Saf Health Care ; 12(1): 24-8, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12571341

RESUMO

OBJECTIVES: This study measured the extent to which a systematic approach was used to select criteria for audit, and identified problems in using such an approach with potential solutions. DESIGN: A questionnaire survey using the Audit Criteria Questionnaire (ACQ), created, piloted, and validated for the purpose. Possible ACQ scores ranged from 0 to 1, indicating how systematically the criteria had been selected and how usable they were. SETTING: A stratified random sample of 10 audit leads in each of 83 randomly selected NHS trusts and all practices in each of 11 randomly selected primary care audit group areas in England and Wales. PARTICIPANTS: Audit leads of ongoing audits in each organisation in which a first data collection had started less than 12 months earlier and a second data collection was not completed. MAIN OUTCOME MEASURES: ACQ scores, problems identified in the audit criteria selection process, and solutions found. RESULTS: The mean ACQ score from all 83 NHS trusts and the 11 primary care audit groups was 0.52 (range 0.0-0.98). There was no difference between mean ACQ scores for criteria used in audits on clinical (0.51) and non-clinical (0.52) topics. The mean ACQ scores from nationally organised audits (0.59, n=33) was higher than for regional (0.51, n=21), local (0.53, n=77), or individual organisation (0.52, n=335) audits. The mean ACQ score for published audit protocols (0.56) was higher than for locally developed audits (0.49). There was no difference in ACQ scores for audits reported by general practices (0.49, n=83) or NHS trusts (0.53, n=383). Problems in criteria selection included difficulties in coordination of staff to undertake the task, lack of evidence, poor access to literature, poor access to high quality data, lack of time, and lack of motivation. Potential solutions include investment in training, protected time, improved access to literature, support staff and availability of published protocols. CONCLUSIONS: Methods of selecting review criteria were often less systematic than is desirable. Published usable audit protocols providing evidence based review criteria with information on their provenance enable appropriate review criteria to be selected, so that changes in practice based on these criteria lead to real improvement in quality rather than merely change. The availability and use of high quality audit protocols would be a valuable contribution to the evolution of clinical governance. The ACQ should be developed into a tool to help in selecting appropriate criteria to increase the effectiveness of audit.


Assuntos
Hospitais Públicos/normas , Auditoria Médica/métodos , Atenção Primária à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Inglaterra , Pesquisa sobre Serviços de Saúde , Humanos , Medicina Estatal/normas , Inquéritos e Questionários , País de Gales
9.
BMC Evol Biol ; 1: 6, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11696235

RESUMO

BACKGROUND: Polytene chromosome banding patterns have long been used by Drosophila evolutionists to infer degree of relatedness among taxa. Recently, nucleotide sequences have preempted this traditional method. We place the classical Drosophila evolutionary biology tools of polytene chromosome inversion analysis in a phylogenetic context and assess their utility in comparison to nucleotide sequences. RESULTS: A simultaneous analysis framework was used to examine the congruence of the chromosomal inversion data with more recent DNA sequence data in four Drosophila species groups - the melanogaster, virilis, repleta, and picture wing. Inversions and nucleotides were highly congruent with one another based on incongruence length difference and partitioned Bremer support values. Inversion phylogenies were less resolved because of fewer numbers of characters. Partitioned Bremer supports, corrected for the number of characters in each matrix, were higher for inversion matrices. CONCLUSIONS: Polytene chromosome data are highly congruent with DNA sequence data and, when placed in a simultaneous analysis framework, are shown to be more information rich than nucleotide data.


Assuntos
Cromossomos , Drosophila/genética , Filogenia , Animais , Inversão Cromossômica , Cromossomos/genética , DNA/genética , Drosophila melanogaster/genética , Evolução Molecular , Genes de Insetos/genética , Análise de Sequência de DNA/métodos
10.
Qual Health Care ; 10(3): 173-8, 2001 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11533425

RESUMO

OBJECTIVES: To identify the desirable characteristics of review criteria for quality improvement and to determine how they should be selected. BACKGROUND: Review criteria are the elements against which quality of care is assessed in quality improvement. Use of inappropriate criteria may impair the effectiveness of quality improvement activities and resources may be wasted in activities that fail to facilitate improved care. METHODS: A two round modified Delphi process was used to generate consensus amongst an international panel of 38 experts. A list of 40 characteristics of review criteria, identified from literature searches, was distributed to the experts who were asked to rate the importance and feasibility of each characteristic. Comments and suggestions for characteristics not included in the list were also invited. RESULTS: The Delphi process refined a comprehensive literature based list of 40 desirable characteristics of review criteria into a more precise list of 26 items. The expert consensus view is that review criteria should be developed through a well documented process involving consideration of valid research evidence, possibly combined with expert opinion, prioritisation according to health outcomes and strength of evidence, and pilot testing. Review criteria should also be accompanied by full clear information on how they might be used and how data might be collected and interpreted. CONCLUSION: The desirable characteristics for review criteria have been identified and will be of use in the development, evaluation, and selection of review criteria, thus improving the cost effectiveness of quality improvement activities in healthcare settings.


Assuntos
Conferências de Consenso como Assunto , Técnica Delphi , Garantia da Qualidade dos Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Medicina Baseada em Evidências , Processos Grupais , Humanos
11.
Evolution ; 55(7): 1373-85, 2001 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-11525461

RESUMO

Eye stalks and their scaling relationship with body size are important features in the mating system of many diopsid species, and sexual selection is a critical force influencing the evolution of this exaggerated morphology. Interspecific variation in eye span suggests there has been significant evolutionary change in this trait, but a robust phylogenetic hypothesis is required to determine its rate and direction of change. In this study, the pattern of morphological evolution of eye span is assessed in a phylogenetic framework with respect to its function in the sexual system of these flies. Specifically, we examine within the family Diopsidae the pattern of increase and decrease in sexual dimorphism, the morphological coevolution of eye span between males and females, and the evolutionary flexibility of eye-span allometry. Based on several different methods for reconstructing morphological change, results suggest a general pattern of evolutionary flexibility, particularly for eye-span allometry. Sexual dimorphism in eye span has evolved independently at least four times in the family and this trait also has undergone several reductions within the genus Diasemopsis. Despite most species being dimorphic, there is a strong phylogenetic correlation between males and females for mean eye span. The coevolution between the sexes for eye-span allometry, however, is significantly weaker. Overall, eye-span allometry exhibits significantly more change on the phylogeny than the other morphological traits. The evolutionary pattern in eye-span allometry is caused primarily by changes in eye-span variance. Therefore, this pattern is consistent with recent models that predict a strong relationship between sexual selection and the variance of ornamental traits and highlights the significance of eye-span allometry in intersexual and intrasexual signaling.


Assuntos
Evolução Biológica , Dípteros/anatomia & histologia , Olho/anatomia & histologia , Filogenia , Caracteres Sexuais , Animais , Constituição Corporal , Dípteros/fisiologia , Feminino , Masculino , Modelos Biológicos , Comportamento Sexual Animal
12.
Syst Biol ; 50(1): 87-105, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12116597

RESUMO

A phylogenetic hypothesis of relationships among 33 species of stalk-eyed flies was generated from a molecular data set comprising three mitochondrial and three nuclear gene regions. A combined analysis of all the data equally weighted produced a single most-parsimonious cladogram with relatively strong support at the majority of nodes. The phylogenetic utility of different classes of molecular data was also examined. In particular, using a number of different measures of utility in both a combined and separate analysis framework, we focused on the distinction between mitochondrial and nuclear genes and between faster-evolving characters and slower-evolving characters. For the first comparison, by nearly any measure of utility, the nuclear genes are substantially more informative for resolving diopsid relationships than are the mitochondrial genes. The nuclear genes exhibit less homoplasy, are less incongruent with one another and with the combined data, and contribute more support to the combined analysis topology than do the mitochondrial genes. Results from the second comparison, however, provide little evidence of a clear difference in utility. Despite indications of rapid divergence and saturation, faster-evolving characters in both the nuclear and mitochondrial data sets still provide substantial phylogenetic signal. In general, inclusion of the more rapidly evolving data consistently improves the congruence among partitions.


Assuntos
Transportadores de Cassetes de Ligação de ATP , Dípteros/classificação , Dípteros/genética , Filogenia , Animais , Sequência de Bases , Biometria , DNA Mitocondrial/genética , Proteínas de Drosophila/genética , Complexo IV da Cadeia de Transporte de Elétrons/genética , Evolução Molecular , Proteínas do Olho/genética , Feminino , Genes de Insetos , Masculino , Modelos Genéticos , Dados de Sequência Molecular , Fator 1 de Elongação de Peptídeos/genética , Proteínas Proto-Oncogênicas/genética , RNA Ribossômico/genética , RNA Ribossômico 16S/genética , Especificidade da Espécie , Proteína Wnt1
13.
Mol Phylogenet Evol ; 16(2): 296-307, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10942616

RESUMO

The species in the repleta group of the genus Drosophila have been placed into five subgroups-the mulleri, hydei, mercatorum, repleta, and fasciola subgroups. Each subgroup has been further subdivided into complexes and clusters. Extensive morphological and cytological analyses of the members of this species group have formed the foundation for the proposed relationships among the members of the repleta species group. Fifty-four taxa, including 46 taxa belonging to the repleta species group, were sequenced for fragments of four genes-16S ribosomal DNA (16S), cytochrome oxidase II (COII), and nitrogen dehydrogenase 1 (ND1) of the mitochondrial genome and a region of the hunchback (hb) nuclear gene. We also generated a partial data set of elongation factor 1-alpha (Ef1alpha) sequences for a subset of taxa. Our analysis used both DNA characters and chromosomal inversion data. The phylogenetic hypothesis we obtained supports many of the traditionally accepted clades within the mulleri subgroup, but the monophyly of taxonomic groups outside of this subgroup appears not to be supported. Phylogenetic analysis revealed one well-supported, highly resolved clade that consists of closely related members of the mulleri and buzzatii complexes. The remaining taxa, a wide assortment of taxonomic groups, ranging from members of other species groups to members of several subgroups and members of three species complexes from the mulleri subgroup are found in poorly supported arrangements at the base of the tree.


Assuntos
Proteínas de Drosophila , Drosophila/classificação , Drosophila/genética , NADH Desidrogenase , Animais , Núcleo Celular/metabolismo , Cromossomos , Análise por Conglomerados , DNA Mitocondrial/genética , DNA Ribossômico/genética , Complexo IV da Cadeia de Transporte de Elétrons/genética , Proteínas de Insetos/genética , Fator 1 de Elongação de Peptídeos/genética , Filogenia , Análise de Sequência de DNA , Especificidade da Espécie
15.
Mol Phylogenet Evol ; 9(3): 427-36, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9667991

RESUMO

We examined the contribution of morphological and molecular character information for 15 systematics studies in which these two kinds of data were used in combined or simultaneous analyses. Assessment of the disagreement between these data sources, as measured by the incongruence length difference, reveals substantial conflict for the studies surveyed. In addition, the partitioned Bremer support was used to measure the degree of support provided by each data partition when analyzed together. Despite the significant incongruence found for nearly half the studies, the PBS indices suggest both types of data contribute positively to the combined analyses and that, when standardized by the number of phylogenetically informative characters, morphology data generally provide equal or greater support than do the molecular data. This result, combined with the fact that morphological characters generally exhibit higher consistency, indicates that this source of character information continues to be useful in systematics studies despite the increasing volume of available molecular data.


Assuntos
Bases de Dados Factuais , Evolução Molecular , Filogenia , Animais , Árvores de Decisões , Invertebrados/classificação , Invertebrados/genética , Plantas/classificação , Plantas/genética , Vertebrados/classificação , Vertebrados/genética
16.
J Parasitol ; 83(4): 739-45, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9267419

RESUMO

A nonimmune American acquired an infection of Plasmodium vivax Type 1 malaria in Brazil in 1994. After returning to the U.S.A., he had a primary attack followed by 3 relapses. The primary attack and first 2 relapses were treated with a standard regimen of chloroquine, followed by 14 days of primaquine (15 mg/day). Following the third relapse, the primaquine treatment was extended to 28 days. No further relapses occurred. The lack of response to primaquine by this strain may recommend it as a suitable candidate for chemotherapeutic study if it can be adapted to an animal model. Anopheles quadrimaculatus mosquitoes infected by feeding on the patient during the first relapse were used to establish the strain in Aotus and Saimiri monkeys. Monkeys supported well the development of long-lasting parasitemia. Anopheles freeborni, Anopheles stephensi, and Anopheles gambiae mosquitoes were readily infected by feeding on the monkeys and by membrane feeding on diluted blood. Monkey-to-monkey transmission was obtained via the bites of infected mosquitoes and the intravenous injection of sporozoites dissected from salivary glands. This parasite is designated as the Brazil I/CDC strain of P. vivax.


Assuntos
Antimaláricos/farmacologia , Aotidae/parasitologia , Malária Vivax/parasitologia , Plasmodium vivax/efeitos dos fármacos , Primaquina/farmacologia , Saimiri/parasitologia , Animais , Anopheles , Antimaláricos/uso terapêutico , Brasil , Cloroquina/farmacologia , Cloroquina/uso terapêutico , Modelos Animais de Doenças , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Insetos Vetores , Malária Vivax/tratamento farmacológico , Malária Vivax/transmissão , Masculino , Parasitemia/tratamento farmacológico , Parasitemia/patologia , Parasitemia/transmissão , Primaquina/uso terapêutico , Recidiva
17.
Syst Biol ; 46(4): 654-73, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11975337

RESUMO

Relationships among representatives of the five major Hawaiian Drosophila species groups were examined using data from eight different gene regions. A simultaneous analysis of these data resulted in a single most-parsimonious tree that (1) places the adiastola picture-winged subgroup as sister taxon to the other picture-winged subgroups, (2) unites the modified-tarsus species group with flies from the Antopocerus species group, and (3) places the white-tip scutellum species group as the most basal taxon. Because of the different gene sources used in this study, numerous process partitions can be erected within this data set. We examined the incongruence among these various partitions and the ramifications of these data for the taxonomic consensus, prior agreement, and simultaneous analysis approaches to phylogenetic reconstruction. Separate analyses and taxonomic consensus appear to be inadequate methods for dealing with the partitions in this study. Although detection of incongruence is possible and helps elucidate particular areas of disagreement among data sets, separation of partitions on the basis of incongruence is problematic for many reasons. First, analyzing all genes separately and then either presenting them all as possible hypotheses or taking their consensus provides virtually no information concerning the relationships among these flies. Second, despite some evidence of incongruence, there are no clear delineations among the various gene partitions that separate only heterogeneous data. Third, to the extent that problematic genes can be identified, these genes have nearly the same information content, within a combined analysis framework, as the remaining nonproblematic genes. Our data suggest that significant incongruence among data partitions may be isolated to specific relationships and the "false" signal creating this incongruence is most likely to be overcome by a simultaneous analysis. We present a new method, partitioned Bremer support, for examining the contribution of a particular data partition to the topological support of the simultaneous analysis tree.


Assuntos
Drosophila/classificação , Drosophila/genética , Filogenia , Animais , Sequência de Bases , Códon/genética , DNA/genética , DNA Mitocondrial/genética , Drosophila/anatomia & histologia , Havaí
18.
J Gen Intern Med ; 10(4): 223-31, 1995 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-7790985

RESUMO

The appropriate use of any test requires the clinician to appreciate that test's limitations. By recognizing the potential confounders of the auscultatory assessment of blood pressure, the clinician minimizes the likelihood of enacting therapeutic decisions based on inaccurate data. When approaching the treatment of a hypertensive patient, several points should be kept in mind. First, the measurement of persistent and severe hypertension in a patient receiving treatment who describes symptoms of orthostatic hypotension with apparently adequate standing blood pressure or who lacks corroborating retinal, echocardiographic, or electrocardiographic signs of hypertension should raise the concern of pseudohypertension or a white-coat response. Similarly, when one finds a normal or near-normal systolic blood pressure in a patient with a clinical picture consistent with severe hypertension, one should make a directed effort to look for an unrecognized auscultatory gap. Second, marked discrepancies in measurements as obtained by different operators or in different settings should raise concern of the white-coat response or methodologic errors by one operator, such as undercuffing, excessive pressure on the head of the stethoscope, rapid deflation of the cuff, or use of different arms. In treating hypertension in even the minimally obese patient, a special point must be made that an adequate size cuff be used for all blood pressure determinations. Third, when blood pressure is determined with the patient in any but the satndardized back-and-arm-supported seated position described above, the clinician should acknowledge the possibility that the position may alter the patient's classification. Fourth, the diagnosis and management of hypertension requires multiple measurements of blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Determinação da Pressão Arterial/normas , Auscultação/normas , Determinação da Pressão Arterial/métodos , Diagnóstico Diferencial , Humanos , Hipertensão/diagnóstico , Variações Dependentes do Observador , Postura
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