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941.
Nora B. Henrikson Leah Tuzzio Elizabeth Trice Loggers Janice Miyoshi Diana SM Buist 《Supportive care in cancer》2014,22(4):961-967
Purpose
Patient out-of-pocket costs are higher for cancer care than for any other health-care sector. Oncologist–patient discussions of costs are not well understood. We conducted an exploratory interview study to examine the frequency, patterns, attitudes, and preferences of both patients and providers on discussion of treatment costs.Methods
We conducted semi-structured telephone interviews with oncology clinicians and people receiving chemotherapy at a large nonprofit health system. Multiple investigators conducted thematic analysis using modified content analysis, grounded theory, and interaction analysis methods.Results
Patient themes included the relevance of cost to their experience, preference for the doctor to be the starting point of cost discussions, but relative infrequency of discussions with doctors or other care team member. Provider themes were an emphasis on clinical benefit above costs, conviction that cost-related decisions should rest with patients, and lack of access to treatment costs. Interest in discussing costs and barriers accessing cost information were common themes from both patients and providers.Conclusions
Doctors and patients want to discuss treatment costs but lack access to them. These data support growing evidence for a provider role in discussions of cost during cancer treatment planning. 相似文献942.
Clinical Implications and Correlates of Q Waves in Patients With ST‐Elevation Myocardial Infarction Treated With Fibrinolysis: Observations from the CLARITY‐TIMI 28 Trial 下载免费PDF全文
943.
944.
William ChanLynne Williams MBBCh PhD Mark A. KotowyczAnna Woo MD SM Harry RakowskiLeonard Schwartz MD Christopher B. Overgaard 《The Canadian journal of cardiology》2014
Background
Myocardial contrast echocardiography during angiography is critical in identifying appropriate septal perforator(s) for alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy. We evaluated whether there were other angiographic and/or echocardiographic markers that might identify patients who are anatomically suitable for ASA.Methods
We performed quantitative coronary angiographic analysis and echocardiographic assessment on 74 patients referred for ASA from January 2004 to July 2012 at the Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada. Patients who proceeded to ASA were compared with those in whom ASA was aborted.Results
Of the 74 patients referred for ASA, 63 proceeded to ASA and in 11 patients ASA was aborted because of various anatomic and technical reasons. There were no clinically significant differences observed in quantitative angiographic and echocardiographic measurements between the 2 groups. The ratio of ostial left main (LM) to ablated septal distance on angiography vs the basal septum to the septum area where the mitral valve contacted the septum because of systolic anterior motion (SAM) was 1.53. In the whole cohort, a significant correlation was observed between the ostial LM to the target septal distance and the distance from basal septum to SAM-septal contact point on echocardiography (r = 0.39; P = 0.008). A stronger correlation was evident when analysis was restricted to patients undergoing ASA only (r = 0.44; P = 0.006).Conclusions
Echocardiographic and angiographic assessments of the distance between the basal septum to SAM-septal contact point and ostial LM to the target septal distance might be useful in preprocedural selection of the appropriate septal perforator for ASA. 相似文献945.
Erica S. Spatz MD MHS Sameer D. Sheth MD Kensey L. Gosch MS Mayur M. Desai PhD MPH John A. Spertus MD MPH Harlan M. Krumholz MD SM Joseph S. Ross MD MHS 《Journal of general internal medicine》2014,29(6):862-869
Background
The quality of the relationship between a patient and their usual source of care may impact outcomes, especially after an acute clinical event requiring regular follow-up.Objective
To examine the association between the presence and strength of a usual source of care with mortality and readmission after hospitalization for acute myocardial infarction (AMI).Design
Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER), an observational, 19-center study.Patients
AMI patients discharged between January 2003 and June 2004.Main Measures
The strength of the usual source of care was categorized as none, weak, or strong based upon the duration and familiarity of the relationship. Main outcome measures were readmissions and mortality at 6 months and 12 months post-AMI, examined in multivariable analysis adjusting for socio-demographic characteristics, access and barriers to care, financial status, baseline risk factors, and AMI severity.Key Results
Among 2,454 AMI patients, 441 (18.0 %) reported no usual source of care, whereas 247 (10.0 %) and 1,766 (72.0 %) reported weak and strong usual sources of care, respectively. When compared with a strong usual source of care, adults with no usual source of care had higher 6-month mortality rates [adjusted hazard ratio (aHR) = 3.15, 95 % CI, 1.79–5.52; p < 0.001] and 12-month mortality rates (aHR = 1.92, 95 % CI, 1.19–3.12; p = 0.01); adults with a weak usual source of care trended toward higher mortality at 6 months (aHR = 1.95, 95 % CI, 0.98–3.88; p = 0.06), but not 12 months (p = 0.23). We found no association between the usual source of care and readmissions.Conclusions
Adults with no or weak usual sources of care have an increased risk for mortality following AMI, but not for readmission.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-014-2794-0) contains supplementary material, which is available to authorized users.KEY WORDS: doctor and patient relationship, usual source of care, myocardial infarction 相似文献946.
Francesco Furfaro Estabelle SM Ang Ricky R Lareu Kevin Murray Mithran Goonewardene 《Progress in orthodontics》2014,15(1):2
Background
This study aims to investigate, utilising micro-computed tomography (micro-CT) and histology, whether the topical application of nerve growth factor (NGF) and/or epidermal growth factor (EGF) can enhance periodontal, alveolar bone, root and pulpal tissue regeneration while minimising the risk of pulpal necrosis, root resorption and ankylosis of replanted molars in a rat model.Methods
Twelve four-week-old male Sprague-Dawley rats were divided into four groups: sham, collagen, EGF and NGF. The maxillary right first molar was elevated and replanted with or without a collagen membrane impregnated with either the growth factors EGF or NGF, or a saline solution. Four weeks after replantation, the animals were sacrificed and the posterior maxilla was assessed using histological and micro-CT analysis. The maxillary left first molar served as the control for the corresponding right first molar.Results
Micro-CT analysis revealed a tendency for all replanted molars to have reduced root length, root volume, alveolar bone height and inter-radicular alveolar bone volume. It appears that the use of the collagen membrane had a negative effect while no positive effect was noted with the incorporation of EGF or NGF. Histologically, the incorporation of the collagen membrane was found to negatively affect pulpal, root, periodontal and alveolar bone healing with pulpal inflammation and hard tissue formation, extensive root resorption and alveolar bone fragmentation. The incorporation of EGF and NGF did not improve root, periodontal or alveolar bone healing. However, EGF was found to improve pulp vascularisation while NGF-improved pulpal architecture and cell organisation, although not to the level of the control group.Conclusions
Results indicate a possible benefit on pulpal vascularisation and pulpal cell organisation following the incorporation of EGF and NGF, respectively, into the alveolar socket of replanted molars in the rat model. No potential benefit of EGF and NGF was detected in periodontal or root healing, while the use of a collagen membrane carrier was found to have a negative effect on the healing response. 相似文献947.
948.
949.
Tammy T. Hshieh MD MPH Tamara G. Fong MD PhD Eva M. Schmitt PhD Edward R. Marcantonio MD SM Guoquan Xu MD PhD Yun R. Gou MA Thomas G. Travison PhD Eran D. Metzger MD Richard N. Jones ScD Sharon K. Inouye MD MPH for the BASIL Study Group 《Journal of the American Geriatrics Society》2020,68(8):1722-1730