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1.
Steven M. Handler Richard L. Altman Subashan Perera Joseph T. Hanlon Stephanie A. Studenski James E. Bost Melissa I. Saul Douglas B. Fridsma 《J Am Med Inform Assoc》2007,14(4):451-458
Objective
We conducted a systematic review of pharmacy and laboratory signals used by clinical event monitor systems to detect adverse drug events (ADEs) in adult hospitals.Design and Measurements
We searched the MEDLINE, CINHAL, and EMBASE databases for the years 1985–2006, and found 12 studies describing 36 unique ADE signals (10 medication levels, 19 laboratory values, and 7 antidotes). We were able to calculate positive predictive values (PPVs) and 95% confidence intervals (CIs) for 15 signals.Results
We found that PPVs ranged from 0.03 (95% CI, 0.03–0.03) for hypokalemia, to 0.50 (95% CI, 0.39–0.61) for supratherapeutic quinidine level. In general, antidotes (range = 0.09–0.11) had the lowest PPVs, followed by laboratory values (range = 0.03–0.27) and medication levels (range = 0.03–0.50).Conclusion
Data from this study should help clinical information system and computerized decision support producers develop or improve existing clinical event monitor systems to detect ADEs in their own hospitals by prioritizing those signals with the highest PPVs. 相似文献2.
Andrew M Fine Ben Y Reis Lise E Nigrovic Donald A Goldmann Tracy N LaPorte Karen L Olson Kenneth D Mandl 《J Am Med Inform Assoc》2010,17(1):85-90
Objective
To improve identification of pertussis cases by developing a decision model that incorporates recent, local, population-level disease incidence.Design
Retrospective cohort analysis of 443 infants tested for pertussis (2003–7).Measurements
Three models (based on clinical data only, local disease incidence only, and a combination of clinical data and local disease incidence) to predict pertussis positivity were created with demographic, historical, physical exam, and state-wide pertussis data. Models were compared using sensitivity, specificity, area under the receiver-operating characteristics (ROC) curve (AUC), and related metrics.Results
The model using only clinical data included cyanosis, cough for 1 week, and absence of fever, and was 89% sensitive (95% CI 79 to 99), 27% specific (95% CI 22 to 32) with an area under the ROC curve of 0.80. The model using only local incidence data performed best when the proportion positive of pertussis cultures in the region exceeded 10% in the 8–14 days prior to the infant''s associated visit, achieving 13% sensitivity, 53% specificity, and AUC 0.65. The combined model, built with patient-derived variables and local incidence data, included cyanosis, cough for 1 week, and the variable indicating that the proportion positive of pertussis cultures in the region exceeded 10% 8–14 days prior to the infant''s associated visit. This model was 100% sensitive (p<0.04, 95% CI 92 to 100), 38% specific (p<0.001, 95% CI 33 to 43), with AUC 0.82.Conclusions
Incorporating recent, local population-level disease incidence improved the ability of a decision model to correctly identify infants with pertussis. Our findings support fostering bidirectional exchange between public health and clinical practice, and validate a method for integrating large-scale public health datasets with rich clinical data to improve decision-making and public health. 相似文献3.
YB Mlombe NE Rosenberg LL Wolf CP Dzamalala K Chalulu J Chisi NJ Shaheen MC Hosseinipour CG Shores 《Malawi medical journal : the journal of Medical Association of Malawi》2015,27(3):88-92
Aim
There is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context.Methods
A hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated.Results
Firewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2–37.7), 5.4 (95% CI: 2.0–15.2) and 6.6 (95% CI: 2.3–19.3), respectively.Conclusions
Several modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context. 相似文献4.
Background
In our study, we used meta-analysis to study the efficacy of the tourniquet on ankle trauma surgery. Postoperative infection rate, deep venous thrombosis incidence, hospital stay, and joint range of motion were studied to compare the tourniquet and non-tourniquet groups and provide certain references for clinical decision.Methods
We searched PubMed, MEDLINE, EMBASE, and the Cochrane controlled trials register for all publications about the efficacy of tourniquet published before November 2012. The quality of included studies was evaluated by two estimators. I2-test and Q-statistic were used for heterogeneity analysis. When there was heterogeneity between studies, the random effects model analysis was applied or else the fixed effects model analysis was used.Results
Three studies were included with 166 patients suffering from ankle trauma surgery. There was no statistical difference (P >0.05) between the tourniquet and non-tourniquet groups on operation time (mean difference (MD) −5.45, 95% confidence intervals (CI): (−13.98, 3.09)), postoperative infection rate (relative risk (RR) 1.83, 95% CI: (0.65, 5.12)), and deep venous thrombosis incidence (RR 4.13, 95% CI: (0.47, 36.17)). But statistical significances were observed on hospital stays (MD 3.17, 95% CI: (1.39, 4.95)) and joint range of motion (MD − 5.25, 95% CI: (−9.61, −0.89)).Conclusions
In general, the efficacy of the tourniquet group is comparable to that of the non-tourniquet group. The non-tourniquet group achieved greater benefits for the joint range of motion and reduced the hospital stay. However, a larger number of primary studies is still required for future evaluation of tourniquet efficacy on ankle trauma surgery. 相似文献5.
Background
There is uncertainty whether acclimatized low-landers who return to high altitude after a sojourn at low altitude have a higher incidence of pulmonary edema than during the first exposure to high altitude.Methods
This was a prospective cohort study consisting of men ascending to 3400 m by road (N = 1003) or by air (N = 4178). The study compared the incidence of high altitude pulmonary edema during first exposure vs the incidence during re-exposure in each of these cohorts.Results
Pulmonary edema occurred in 13 of the 4178 entries by air (Incidence: 0.31%, 95% CI: 0.18%–0.53%). The incidence during first exposure was 0.18% (0.05%–0.66%) and 0.36% (0.2%–0.64%) during re-exposure (Fisher Exact Test for differences in the incidence (two-tailed) p = 0.534). The relative risk for the re-exposure cohort was 1.95 (95% CI, 0.43%–8.80%). Pulmonary edema occurred in 3 of the 1003 road entrants (Incidence: 0.30%, 95% CI: 0.08%–0.95%). All three cases occurred in the re-exposure cohort.Conclusion
The large overlap of confidence intervals between incidence during first exposure and re-exposure; the nature of the confidence interval of the relative risk; and the result of the Fisher exact test, all suggest that this difference in incidence could have occurred purely by chance. We did not find evidence for a significantly higher incidence of HAPE during re-entry to HA after a sojourn in the plains. 相似文献6.
A.K. Sahni A. Nagendra Partha Roy S. Patrikar 《Medical Journal Armed Forces India》2014,70(3):211-214
Background
Standard HIV testing is done using serum or plasma. FDA approved ELISA to screen urine for IgG antibodies to HIV-1 in 1996. It is a simple, noninvasive test and is appropriate for developing countries where health care personnel may not be professionally trained or where clean needles for drawing blood may not always be available.Methods
436 individuals with high-risk behavior and strong clinical suspicion of HIV infection were screened for IgG antibodies to HIV-1 in urine by ELISA. Urine HIV testing was performed by enzyme immunoassay, at the ongoing Voluntary Confidential Counseling and Testing Center (VCCTC) at a large tertiary care microbiology lab. The individuals enrolled for the study had high-risk exposure to the virus and majorities were from a state with a high incidence of HIV infection. In all individuals, both serum and urine were tested for IgG antibodies to HIV-1.Results
Overall, 135 individuals (30.96%) were HIV-positive, of whom 96 (71%) had never previously tested positive; 87% of those who tested positive received their results, and most were referred for medical care. Sensitivity, specificity and predictive values of HIV-1 urine ELISA test kit were determined. Sensitivity was found to be 89.6%; 95% CI [82.9–94.0], specificity 97.3%; 95% CI [94.6–98.8], positive predictive value 93.8%; 95% CI [87.8–97.1] and negative predictive value 95.4%; 95% CI [92.3–97.4].Conclusion
Efficiency, sensitivity, and specificity of the urine-based screening for HIV-1 test kits were excellent as compared to the reference test. 相似文献7.
Yun Zhi Lee Ruth Qianyi Lee Kyu Kyu Thinn Keah How Poon Eugene Hern Choon Liu 《Singapore medical journal》2015,56(1):40-46
INTRODUCTION
Postoperative nausea and vomiting (PONV), and postoperative pain are common during the early postoperative period. In addition to these problems, elderly patients risk developing postoperative confusion. This study aimed to identify the risk factors associated with these problems, and the extent of these problems, in a Singapore inpatient surgical population.METHODS
Over a period of six weeks, we surveyed 707 elective surgical inpatients aged ≥ 18 years who received general anaesthesia and/or regional anaesthesia.RESULTS
The incidence of PONV was 31.8%(95% confidence interval [CI] 34.8–41.9). The incidence increased with increasing Apfel score (p < 0.001) and were higher in female patients (odds ratio [OR] 1.74, 95% CI 1.28–2.36), non-smokers (OR 1.72, 95% CI 1.04–2.88), patients with a history of PONV and/or motion sickness (OR 3.45, 95% CI 2.38–5.24), patients who received opioids (OR 1.39, 95% CI 1.03–1.88), and patients who received general anaesthesia (OR 1.76, 95% CI 1.11–2.79). Moderate to severe pain at rest and with movement were reported in 19.9% and 52.5% of patients, respectively. Among the patients who were predicted to experience mild pain, 29.5% reported moderate pain and 8.1% reported severe pain. The prevalence of postoperative confusion was 3.9% in the geriatric population.CONCLUSION
Higher Apfel scores were associated with a higher risk of PONV and multimodal treatment for postoperative pain management was found to be insufficient. The incidence of postoperative confusion was low in this study. 相似文献8.
Background
An outbreak of food poisoning in a military establishment mess was investigated and remedial measures suggested.Methods
A total of 391 persons had consumed meals in the mess on the day of the outbreak. A detailed food history was taken from available persons and the attack rates of each specific food items were calculated with the relative risks.Results
Of the 391 persons who had consumed meals at the mess, 123 were affected giving an overall attack rate of 31.5%. Majority of the cases had loose motions, fever, pain abdomen and vomiting. The maximum attack rate (65.1%) was for those who had eaten chicken preparation. The relative risk was also highest for those who had eaten chicken at lunch on the day of the outbreak (RR — 33.21, 95% CI 8.39 to 131.53). The mean incubation period was 19.73 hours (range 6 – 57 hours). The median incubation period was 18 hours. Bacteriological confirmation was not successful.Conclusion
The chicken dish was the epidemiologically incriminating food item responsible for the outbreak. Clinical and epidemiological features were suggestive of salmonella food poisoning. However, same could not be confirmed bacteriologically.Key Words: Food poisoning, Military establishment 相似文献9.
Background
The aim of the present study was to compare the clinical efficacy of radical nephrectomy (RN) with nephron-sparing surgery (NSS) in treating patients with localized renal cell carcinoma (RCC).Methods
The literature search was performed in PubMed, MEDLINE Springer, Elsevier Science Direct, Cochrane Library, and Google Scholar up to December 2012. The software Review Manager 5.1 and the STATA software package v.11.0 were used for analyses. The odds ratios (ORs) and its 95% confidence interval (95% CI) were calculated for comparison. Subgroup analyses were performed based on the tumor size of RCC.Results
In total, 10 studies with 10,174 RCC patients (7,050 treated with RN and 3,124 treated with NSS) were selected. The pooled estimate (OR = 1.58, 95% CI = 1.15–2.15, P = 0.004) showed a significantly lower rate of cancer-specific deaths in the patients treated with NSS compared to RN. However, no statistically significant differences were found in the rate of tumor recurrence (OR = 0.84, 95% CI = 0.67–1.06, P = 0.14) and complications (OR = 0.91, 95% CI = 0.51–1.63, P = 0.74) between the patients treated with NSS and RN. In addition, all the subgroup analyses presented consistent results with the overall analyses.Conclusions
NSS had no significantly different from RN in tumor recurrence and complications for localized RCC. However, the significantly lower rate of cancer-specific deaths supported the use of NSS not only for RCC with tumor size >4.0 cm but also for tumor sizes ≤4.0 cm compared with RN. 相似文献10.
Background
Violence affects the lives of millions of women worldwide, in all socioeconomic classes. Violence and the fear of violence are emerging as important risk factor contributing to the vulnerability to human immunodeficiency virus (HIV) infection for women. The objective of the present cross sectional study is to compare the experiences of domestic violence between HIV-positive and HIV-negative married women seeking treatment in a tertiary care hospital.Methods
The study is conducted in a tertiary care hospital in Pune on a randomly selected 150 married women (75 HIV-positive and 75 HIV-negative). Informed consent was obtained from all the women and also a trained counsellor was present during the process of data collection. The data was collected by interview method by taking precautions as laid down in the World Health Organization''s ethical and safety recommendations for research on domestic violence and using modified conflict tactics scale (CTS). The definition of violence followed is as per the Declaration on the Elimination of Violence against Women, adopted by the United Nations General Assembly in 1993.Results
The percentage of women reporting domestic violence is 44.7% (95% confidence interval [CI] = 36.84–52.68). The proportion of physical, emotional and sexual violence reported is 38% (95% CI = 30.49–45.96), 24% (95% CI = 17.67–31.31), and 14.7% (95% CI = 9.66–21.02), respectively. The odds of reporting violence of all forms is significantly higher among HIV-positive women than among HIV-negative women (P<0.05). Univariate and multivariate logistic regression is carried out to examine the possible predictors of domestic violence.Conclusion
The findings suggest high proportion of HIV-positive women report violence then HIV-negative women which must be addressed through multilevel prevention approaches.Key Words: domestic violence, human immunodeficiency virus, violence against women 相似文献11.
Objective
Negation is common in clinical documents and is an important source of poor precision in automated indexing systems. Previous research has shown that negated terms may be difficult to identify if the words implying negations (negation signals) are more than a few words away from them. We describe a novel hybrid approach, combining regular expression matching with grammatical parsing, to address the above limitation in automatically detecting negations in clinical radiology reports.Design
Negations are classified based upon the syntactical categories of negation signals, and negation patterns, using regular expression matching. Negated terms are then located in parse trees using corresponding negation grammar.Measurements
A classification of negations and their corresponding syntactical and lexical patterns were developed through manual inspection of 30 radiology reports and validated on a set of 470 radiology reports. Another 120 radiology reports were randomly selected as the test set on which a modified Delphi design was used by four physicians to construct the gold standard.Results
In the test set of 120 reports, there were a total of 2,976 noun phrases, of which 287 were correctly identified as negated (true positives), along with 23 undetected true negations (false negatives) and 4 mistaken negations (false positives). The hybrid approach identified negated phrases with sensitivity of 92.6% (95% CI 90.9–93.4%), positive predictive value of 98.6% (95% CI 96.9–99.4%), and specificity of 99.87% (95% CI 99.7–99.9%).Conclusion
This novel hybrid approach can accurately locate negated concepts in clinical radiology reports not only when in close proximity to, but also at a distance from, negation signals. 相似文献12.
Jatupon Kongtharvonskul Thunyarat Anothaisintawee Mark McEvoy John Attia Patarawan Woratanarat Ammarin Thakkinstian 《European journal of medical research》2015,20(1)
Background
To conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aims of comparing relevant clinical outcomes (that is, visual analog scores (VAS), total and sub-Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, Lequesne algofunctional index, joint space width change, and adverse events) between diacerein, glucosamine, and placebo.Methods
Medline and Scopus databases were searched from inception to 29 August 2014, using PubMed and Scopus search engines and included RCTs or quasi-experimental designs comparing clinical outcomes between treatments. Data were extracted from original studies. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.Results
Thirty-one of 505 identified studies were eligible. Compared to placebo, glucosamine showed a significant improvement with unstandardized mean differences (UMD) in total WOMAC, pain WOMAC, function WOMAC, and Lequesne score of −2.49 (95% confidence interval (CI) −4.14, −0.83), −0.75 (95% CI: −1.18, −0.32), −4.78 (95% CI: −5.96, −3.59), and −1.03 (95% CI: −1.34, −0.72), respectively. Diacerein clinically improves visual analog scores, function WOMAC, and stiffness WOMAC with UMD values of −2.23 (95% CI: −2.82, −1.64), −6.64 (95% CI: −10.50, −2.78), and −0.68 (95% CI: −1.20, −0.16) when compared to placebo.Conclusions
The network meta-analysis suggests that diacerein and glucosamine are equally efficacious for symptom relief in knee OA, but that the former has more side effects.Electronic supplementary material
The online version of this article (doi:10.1186/s40001-015-0115-7) contains supplementary material, which is available to authorized users. 相似文献13.
Background
Adenoidectomy is a commonly performed ENT surgery. It is conventionally performed using the curettage method. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative.Methods
Sixty consecutive cases requiring adenoidectomy were randomized into two groups of thirty each. Group A underwent conventional adenoidectomy using the curettage method and Group B underwent endoscopic assisted micro-debrider adenoidectomy. The parameters studied were intra-operative time, intra-operative bleeding and completeness of resection, collateral damage, post operative pain and recovery time.Result
Sixty cases of adenoidectomy were done using conventional surgery and powered endoscopic adenoidectomy in the study period from Aug 04 to Dec 05. The time taken in Group A (conventional surgery) varied from 22–39 minutes (95% Confidence Interval (CI) −27.7 – 30.9)and in Group B (powered endoscopic surgery) from 27–55 minutes(95% CI 36.6 – 41.9) (p<0.05). The average blood loss in Group A was 21 ml (range 10–50) as compared to 31.67 ml (range 10-60) in Group B (p<0.05). The resection was invariably complete in Group B whereas seven(23%) cases had more than 50% residual adenoid tissue in Group A. Three cases in group A had collateral damage whereas in Group B, there were no added injuries. Post operative pain was studied only in cases undergoing adenoidectomy alone. Group A (n=8) demonstrated a pain score of 1.64–2.63–3.63 (95% CI) whereas Group B (n=11) demonstrated a pain score of 1.19–2.13–3.06 (95% CI). This difference was not statistically significant. In group A, the mean recovery period was 3.5 days and 2.93 days in Group B(p<0.05).Conclusion
Endoscopic powered adenoidectomy was found to be a safe and effective tool for adenoidectomy. The study parameters where endoscopic powered adenoidectomy fared better were completeness of resection, accurate resection under vision, lesser collateral damage and faster recovery time. On the other hand, conventional adenoidectomy scored in matter of lesser operative time and intra-operative bleeding.Key Words: Adenoidectomy, Powered adenoidectomy, Endoscopic adenoidectomy 相似文献14.
Background
To study the number of patients with Type 2 Diabetes Mellitus who achieve the glycemic, blood pressure and LDL-Cholesterol targets as per American Diabetes Association, Standard of Care for Management of Diabetes.Methods
Hundred patients of Type 2 Diabetes mellitus were recruited from December 2008 to January 2009 from an Endocrinology OPD of tertiary care hospital and followed up for six months. Glycosylated hemoglobin (HbA1c), blood pressure (BP) and LDL-Cholesterol (LDL) were estimated at baseline and prevalence of those at target (HbA1c <7%, BP < 130/80 mm Hg, LDL < 100 mg/dl) was documented and repeated at three and six months to monitor improvement in the number of patients at target and trend in improvement of individual parameters.Results
The percentage of patients at target at baseline and six months for HbA1c was (45% vs. 55% p = 0.101), BP < 130/80 mm Hg (27% vs. 25%) and LDL <100 mg/dl (37% vs. 40% p = 0.386). All three parameters were at target in one patient and three patients at six months period. Mean values at baseline and six months of HbA1c 7.46% (95% CI 7.17–7.75) vs 7.21% (95% CI 6.9–7.52), Systolic BP 138 mm Hg (95% CI 135–141), Diastolic BP 86 mm Hg (95% CI 84–86) and LDL 114 mg/dl (95%CI 107–121) vs. 110 mg/dl (95%CI 105–116) did not show significant improvement (p for trend).Conclusion
Standards of care for HbA1c, blood pressure and LDL remains to be achieved in majority of the diabetic patients. 相似文献15.
Shariff-Ghazali Sazlina Ismail Mastura Ai Theng Cheong Adam Bujang Mohamad Haniff Jamaiyah Ping Yein Lee Syed Abdul Rahman Syed Alwi Boon How Chew 《Singapore medical journal》2015,56(5):284-290
INTRODUCTION
We assessed the predictors of poor glycaemic control among older patients with type 2 diabetes mellitus (T2DM) in Malaysia.METHODS
This cross-sectional study used the data of 21,336 patients aged ≥ 60 years with T2DM from the Adult Diabetes Control and Management Registry 2008–2009.RESULTS
Predictors of poor glycaemic control were: age groups 60–69 years (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.66–2.33) and 70–79 years (OR 1.43, 95% CI 1.20–1.71); Malay (OR 1.53, 95% CI 1.41–1.66) and Indian (OR 1.32, 95% CI 1.19–1.46) ethnicities; T2DM durations of 5–10 years (OR 1.46, 95% CI 1.35–1.58) and > 10 years (OR 1.75, 95% CI 1.59–1.91); the use of oral antidiabetic agents only (OR 5.86, 95% CI 3.32–10.34), insulin only (OR 17.93, 95% CI 9.91–32.43), and oral antidiabetic agents and insulin (OR 29.42, 95% CI 16.47–52.53); and elevated blood pressure (OR 1.10, 95% CI 1.01–1.20), low-density lipoprotein cholesterol (OR 1.48, 95% CI 1.38–1.59) and triglycerides (OR 1.61, 95% CI 1.51–1.73). Hypertension (OR 0.71, 95% CI 0.64–0.80), hypertension and dyslipidaemia (OR 0.68, 95% CI 0.61–0.75), pre-obesity (OR 0.89, 95% CI 0.82–0.98) and obesity (OR 0.76, 95% CI 0.70–0.84) were less likely to be associated with poor glycaemic control.CONCLUSION
Young-old and middle-old age groups (i.e. < 80 years), Malay and Indian ethnicities, longer T2DM duration, the use of pharmacological agents, and elevated blood pressure and lipid levels were associated with poor glycaemic control. The presence of comorbidities, pre-obesity and obesity were less likely to be associated with poor glycaemic control. 相似文献16.
Evaluation of angiography as the sole imaging study for the proximal aortic neck prior to EVAR 
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下载免费PDF全文 Stephen A Badger Nityanda Arya William Loan Chee V Soong 《The Ulster medical journal》2009,78(3):166-170
Background
Angiographic assessment is an alternative to computerised tomography (CT) prior to endovascular aneurysm repair (EVAR). We evaluated angiography in aortic neck morphology assessment as an alternative investigation.Methods
Patients admitted for elective or emergency EVAR were assessed by pre-operative CT and intra-operative angiography. The proximal and distal aortic neck diameters, and neck length were measured. Measurements were expressed as median (95% CI).Results
35 patients (20 male) were assessed from August 2003 to January 2005 for elective (26) and emergency (9) EVAR. In the overall group, the proximal neck diameter was 22.0mm (21.0–23.0) on CT, and 20.7mm (19.3–22.3) on angiography. The distal neck diameter was 23.0mm (22.0–24.0) on CT, and 22.3mm (20.3–24.6) on angiography, while the neck length was only slightly greater on angiography [23.0mm (17.5–28.4)] relative to CT [23.0mm (20.0–28.0)]. The stent-grafts deployed were oversized by 26.8% (± 14.8%) relative to the CT measurements, and 33.7% (± 15.6%) relative to angiographic measurements. Good correlation was found for all three measurements between CT and angiography.Conclusions
Angiography alone is inadequate for endovascular aneurysm repair. Although it has timesaving potential, the accuracy achieved is not sufficient to use alone. 相似文献17.
Objectives:
To study the outcome of hip fractures in a cohort of patients from two different time periods (2002–2003 and 2006–2008).Methods:
Patients treated for hip fractures at the St Ann''s Bay Regional Hospital, which provides orthopaedic care for the parishes of St Ann, St Mary and Portland, were retrospectively analysed between 2002–2003 and 2006–2008.Results:
A significant increase in the recorded incidence of hip fractures, from 19 in the 2002–2003 time period to 101 in the 2006–2008 time period was noted. There was a drastic fall in the in-hospital mortality rate (43% in the 2002–2003 time period compared to 4.5% in the 2006–2008 time period). In the 2006–2008 period, 82.9% of patients were ambulant at discharge compared to 36% from the 2002–2003 time period.Conclusion:
Early surgical fixation is necessary to allow rapid mobilization in these patients for whom the consequences of bed rest would otherwise be devastating. 相似文献18.
Background
Obesity/overweight is a recognized risk factor for a host of disorders. The disease risk stratification is commonly based on the Quetelets Index (Body Mass Index- BMI), a surrogate measure of fatness. The currently used BMI cut-offs to classify people as overweight or obese in Armed Forces have been defined in studies on Caucasian populations. However, because of differences in body structure and composition in different ethnic, socioeconomic, cultural and regional groups the correspondence between BMI and body fat content varies between populations. We conducted this pilot study in the Indian Navy to define BMI cut-offs for overweight and obesity using body fat content derived from Skin Fold Thickness as the standard.Material and Methods
The study was conducted on 121 volunteers from a naval hospital staff in the age range of 18 to 47 years. The mean age, height, weight, BMI, body fat in the study group was 26.73 years (± 5.5098), 168.56 cm (± 6.1034), 65.92 Kg (± 10.2746), 23.17 Kg/m2 (± 3.0265) and 19.91% (± 4.831) respectively.Results
The prevalence of overweight/obesity was 20.66% by BMI and 47.11% by body fat content. Receiver operating characteristic (ROC) curve analysis defined a BMI of 23.85 kg/m2 as the cut off for overweight with a sensitivity of 70.2% (95% CI 56.6 – 81.6) and 87.5% specificity (95% CI 76.8-94.4) and a BMI of 24.38 kg/m2with 90% sensitivity (95% CI 68.3-98.5) and 81.2% specificity (95% CI 72.2-88.3) for obesity.Conclusion
The results of our study suggest lower BMI cut offs for overweight and obesity in Indian populations than those recommended by WHO.Key Words: Body Mass Index, Body fat content, Skin fold thickness 相似文献19.
Jolt Roukema Ewout W. Steyerberg Johan van der Lei Henri?tte A. Moll 《J Am Med Inform Assoc》2008,15(1):107-113
Objective
To assess compliance with a clinical decision support system (CDSS) for diagnostic management of children with fever without apparent source and to study the effects of application of the CDSS on time spent in the emergency department (ED) and number of laboratory tests.Design
The CDSS was used by ED nursing staff to register children presenting with fever. The CDSS identified children that met inclusion criteria (1–36 months and fever without apparent source (FWS)) and provided patient-specific diagnostic management advice. Children at high risk for serious bacterial infection were randomized for the ‘intervention’ (n = 74) or the ‘control’ (n = 90) group. In the intervention group, the CDSS provided the advice to immediately order laboratory tests and in the control group the ED physician first assessed the children and then decided on ordering laboratory tests.Results
Compliance with registration of febrile children was 50% (683/1,399). Adherence to the advice to order laboratory tests was 82% (61/74). Children in the intervention group had a median (25th–75th percentile) length of stay at the ED of 138 (104–181) minutes. The median length of stay at the ED in the control group was 123 (83–179) minutes. Laboratory tests were significantly more frequently ordered in the intervention group (82%) than in the control group (44%, p < 0.001, χ2 test).Conclusion
Implementation of a CDSS for diagnostic management of young children with fever without apparent source was successful regarding compliance and adherence to CDSS recommendations, but had unexpected effects on patient outcome in terms of ED length of stay and number of laboratory tests. The use of the current CDSS was discontinued. 相似文献20.