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991.
992.
Franqois P. Sarasin MD Jean-Marc Reymond MD John L Griffith PhD Joni R. Beshansky RN MPH Jurg A. Schifferli MD Pierre-Francois Unger MD Jean-Raoul Scherrer MD Dr. Harry P. Selker MD MSPH 《Journal of general internal medicine》1994,9(4):187-194
Objective: Emergency department (ED) triage for acute cardiac ischemia in the primary teaching hospital in Geneva, Switzerland, is very accurate, but at the cost of very long ED stays. Thus, the authors sought: 1) to determine the impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI), incorporated into a computerized electrocardiograph, on length of stay and speed of triage decision making for ED patients presenting with symptoms suggesting acute cardiac ischemia, and 2) to study the ACI-TIPI’s impact on physicians of different training levels. Design: A seven-month prospective clinical trial with alternating-month experimental and control periods. Setting: An urban major teaching hospital in Geneva, Switzerland. Participants: Patients over the age of 18 years presenting to the ED with chest pain or other symptoms suggesting acute cardiac ischemia (acute myocardial infarction or unstable angina pectoris). Emergency department physicians, classified as novice (those in their first ED rotations) and experienced (those in their second or later ED rotations). Patients staying overnight in the ED (n=111) were excluded from the analysis. Intervention: During the experimental months, the computerized electrocardiograph printed the ACI-TIPI probability of acute cardiac ischemia at the top of each subject’s electrocardiogram. During control months, the probability was not provided. Measurements and main results: Among the 418 study subjects, for patients with acute ischemia seen by novice clinicians, the use of the ACI-TIPI decreased ED time from presentation to triage decision and ED release by 0.7 hour (19%) (p=0.007). Subgroup analyses for patients with acute myocardial infarction, patients with unstable angina pectoris, and patients given thrombolytic therapy also showed analogous decreases in ED time consistent with this finding. Other key determinants of ED length of stay included: age, whether the coronary care unit was full, whether patients received thrombolytic therapy, and whether admission was during the night shift. The experimental and control groups did not differ in triage disposition appropriateness or mortality. Conclusions: For ED patients with acute cardiac ischemia evaluated by novice clinicians, the ACI-TIPI substantially speeded ED decision making and triage. The suggestion of an impact on different cardiac ischemia subgroups and mortality deserves further larger clinical trials. 相似文献
993.
Pilot study of intravenous melphalan combined with continuous infusion L‐S,R‐buthionine sulfoximine for children with recurrent neuroblastoma
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994.
995.
An approach to fertility preservation in prepubertal and postpubertal females: A critical review of current literature
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996.
Balancing research interests and patient interests: A qualitative study into the intertwinement of care and research in paediatric oncology
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997.
Safe integration of nelarabine into intensive chemotherapy in newly diagnosed T‐cell acute lymphoblastic leukemia: Children's Oncology Group Study AALL0434
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Stuart S. Winter MD Kimberly P. Dunsmore MD Meenakshi Devidas PhD Nancy Eisenberg MPH Barbara L. Asselin MD Brent L. Wood MD PhD Marcia S. Leonard RN RN PNP John Murphy Pharm D Julie M. Gastier‐Foster PhD Andrew J. Carroll PhD Nyla A. Heerema PhD Mignon L. Loh MD Elizabeth A. Raetz MD Naomi J. Winick MD William L. Carroll MD Stephen P. Hunger MD 《Pediatric blood & cancer》2015,62(7):1176-1183
998.
Participation in pediatric oncology research protocols: Racial/ethnic,language and age‐based disparities
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999.
A strategy to improve treatment‐related mortality and abandonment of therapy for childhood ALL in a developing country reveals the impact of treatment delays
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Amaranto Suarez MD Martha Piña MD Diana X. Nichols‐Vinueza MD John Lopera MD Lyda Rengifo MD Mauricio Mesa MD Marcela Cardenas RN Lisa Morrissey RN Galo Veintemilla MD Martha Vizcaino MD Ligia Del Toro MD Victor Vicuna PhD Jorge Fernandez LICSW Donna Neuberg ScD Kristen Stevenson MS Alejandro Gutierrez MD 《Pediatric blood & cancer》2015,62(8):1395-1402
Background
Treatment‐related mortality and abandonment of therapy are major barriers to successful treatment of childhood acute lymphoblastic leukemia (ALL) in the developing world.Procedure
A collaboration was undertaken between Instituto Nacional de Cancerologia (Bogota, Colombia), which serves a poor patient population in an upper‐middle income country, and Dana‐Farber/Boston Children's Cancer and Blood Disorders Center (Boston, USA). Several interventions aimed at reducing toxic deaths and abandonment were implemented, including a reduced‐intensity treatment regimen and a psychosocial effort targeting abandonment. We performed a cohort study to assess impact.Results
The Study Population comprised 99 children with ALL diagnosed between 2007 and 2010, and the Historic Cohort comprised 181 children treated prior to the study interventions (1995–2004). Significant improvements were achieved in the rate of deaths in complete remission (13% to 3%; P = 0.005), abandonment (32% to 9%; P < 0.001), and event‐free survival with abandonment considered an event (47% to 65% at 2 years; P = 0.016). However, relapse rate did not improve. Medically unnecessary treatment delays were common, and landmark analysis revealed that initiating the PIII phase of therapy ≥4 weeks delayed predicted markedly inferior disease‐free survival (P = 0.016). Conversely, patients who received therapy without excessive delays had outcomes approaching those achieved in high‐income countries.Conclusions
Implementation of a twinning program was followed by reductions in abandonment and toxic deaths, but relapse rate did not improve. Inappropriate treatment delays were common and strongly predicted treatment failure. These findings highlight the importance of adherence to treatment schedule for effective therapy of ALL. Pediatr Blood Cancer 2015;62:1395–1402. © 2015 Wiley Periodicals, Inc. 相似文献1000.
Interventions targeting absences increase adherence and reduce abandonment of childhood cancer treatment in El Salvador
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