Assuntos
Arachis , Conhecimentos, Atitudes e Prática em Saúde , Hipersensibilidade a Amendoim/diagnóstico , Guias de Prática Clínica como Assunto , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Hipersensibilidade a Amendoim/epidemiologia , Pediatras/educação , Estados Unidos/epidemiologiaRESUMO
Wait times for medical care are a major factor in patient satisfaction with health care. The Dartmouth Microsystem Improvement Curriculum and Plan-Do-Study-Act improvement method were used to address patient dissatisfaction with wait times among patients receiving primary care in a Federally Qualified Health Center. Wait time data were collected for 406 patient visits during the pretest phase and 397 visits during the posttest phase. Improvements in patient satisfaction with waiting room wait time (P = .023) and examination room wait time (P = .009) were achieved.
Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Agendamento de Consultas , Satisfação do Paciente , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Humanos , Fatores de Tempo , Listas de EsperaRESUMO
Heart failure is a leading cause of mortality, yet our understanding of the genetic interactions underlying this disease remains incomplete. Here, we harvest 1352 healthy and failing human hearts directly from transplant center operating rooms, and obtain genome-wide genotyping and gene expression measurements for a subset of 313. We build failing and non-failing cardiac regulatory gene networks, revealing important regulators and cardiac expression quantitative trait loci (eQTLs). PPP1R3A emerges as a regulator whose network connectivity changes significantly between health and disease. RNA sequencing after PPP1R3A knockdown validates network-based predictions, and highlights metabolic pathway regulation associated with increased cardiomyocyte size and perturbed respiratory metabolism. Mice lacking PPP1R3A are protected against pressure-overload heart failure. We present a global gene interaction map of the human heart failure transition, identify previously unreported cardiac eQTLs, and demonstrate the discovery potential of disease-specific networks through the description of PPP1R3A as a central regulator in heart failure.
Assuntos
Redes Reguladoras de Genes/genética , Insuficiência Cardíaca/genética , Miócitos Cardíacos/patologia , Fosfoproteínas Fosfatases/metabolismo , Animais , Benzenoacetamidas , Células Cultivadas , Conjuntos de Dados como Assunto , Modelos Animais de Doenças , Feminino , Perfilação da Expressão Gênica/métodos , Regulação da Expressão Gênica , Técnicas de Silenciamento de Genes , Estudo de Associação Genômica Ampla , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/patologia , Humanos , Masculino , Redes e Vias Metabólicas/genética , Camundongos , Camundongos Knockout , Pessoa de Meia-Idade , Fosfoproteínas Fosfatases/genética , Cultura Primária de Células , Piridinas , Locos de Características Quantitativas/genética , Ratos , Ratos Sprague-Dawley , Análise de Sequência de RNA/métodosRESUMO
Asthma presents special challenges to both the athletes who have it and to their health care providers. This article briefly reviews the problem of asthma--especially exercise-induced asthma--in the competitive athlete, and then describes treatments that are effective in controlling asthma. Drug-doping regulations are explained, as is the worldwide impact of drug doping on competitive athletes who have asthma. This review concludes with recommendations for competitive athletes and their health care providers regarding how to deal with asthma in this patient population.