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101.
Fifteen patients with advanced head and neck cancer not curable with radiation or surgery were entered into a phase II study of 10-EdAM. None of the patients had received prior chemotherapy. 10-EdAM was administered intravenously at a dose of 80 mg/m2 each week. Four patients were not eligible for evaluation. Two died before completing four cycles of chemotherapy, one refused further treatment and one developed hepatic toxicity resulting in withdrawal. Of the remaining patients, three had a partial response. The major toxicities were leukopenia and mucositis. 相似文献
102.
103.
104.
Using Queueing Theory to Increase the Effectiveness of Emergency Department Provider Staffing 总被引:4,自引:4,他引:0
Linda V. Green PhD João Soares PhD James F. Giglio MD Robert A. Green MD 《Academic emergency medicine》2006,13(1):61-68
Objectives: Significant variation in emergency department (ED) patient arrival rates necessitates the adjustment of staffing patterns to optimize the timely care of patients. This study evaluated the effectiveness of a queueing model in identifying provider staffing patterns to reduce the fraction of patients who leave without being seen. Methods: The authors collected detailed ED arrival data from an urban hospital and used a Lag SIPP queueing analysis to gain insights on how to change provider staffing to decrease the proportion of patients who leave without being seen. The authors then compared this proportion for the same 39‐week period before and after the resulting changes. Results: Despite an increase in arrival volume of 1,078 patients (6.3%), an average increase in provider hours of 12 hours per week (3.1%) resulted in 258 fewer patients who left without being seen. This represents a decrease in the proportion of patients who left without being seen by 22.9%. Restricting attention to a four‐day subset of the week during which there was no increase in total provider hours, a reallocation of providers based on the queueing model resulted in 161 fewer patients who left without being seen (21.7%), despite an additional 548 patients (5.5%) arriving in the second half of the study. Conclusions: Timely access to a provider is a critical dimension of ED quality performance. In an environment in which EDs are often understaffed, analyses of arrival patterns and the use of queueing models can be extremely useful in identifying the most effective allocation of staff. 相似文献
105.
106.
The graduate nurse year requires individuals to make a huge transition from university student to registered nurse as part of the health care workforce. New graduates experience steep learning curves throughout the first year of professional practice. This study sought to explore experiences and learning occurring throughout the graduate nurse program for a group of seven new nurse graduates. Focus group interviews were conducted at six months and 12 months into the program using the same set of guiding questions. The first interview highlighted that graduates early in the graduate year were internalised, concentrating on their own survival in managing workloads, facing practice realities and coming to terms with themselves as nurses. Learning was primarily about survival strategies and performing tasks. By the second interview, graduates were much less focussed on themselves. They understood their place in the health care team, had gained confidence in their relationships, and were showing concern for the next graduates arriving. Learning at this stage involved more higher order skills, including critical thinking. 相似文献
107.
Abdominal computed tomography (CT) scans often have findings that are incidental to the reason the study was ordered. Several recent studies and reviews have addressed how these findings should be managed. This article summarizes current management strategies for several types of lesions that are commonly encountered. Some of these findings can be characterized without additional imaging (including simple renal cyst, angiomyolipoma, hepatic steatosis). Other findings are indeterminate. While some of these indeterminate incidental findings can be ignored based on statistical arguments (for example, a sharply circumscribed homogeneous low-attenuation renal lesion under 1 cm in patients without a predisposition to develop renal cell carcinoma), many may need additional imaging studies to either characterize them or demonstrate stability over time. Adhering to these strategies will hopefully reduce overutilization of imaging services while directing attention to those findings which need diagnostic or therapeutic interventions. 相似文献
108.
109.
Michael C. Cheung Eduardo A. Perez Manuel A. Molina Xiaoling Jin Juan C. Gutierrez Dido Franceschi Alan S. Livingstone Leonidas G. Koniaris 《Journal of gastrointestinal surgery》2008,12(4):731-738
Objective The objective of the study was to determine the outcomes for primary gastrointestinal melanomas (PGIM).
Material and methods The Surveillance, Epidemiology, and End Results database (1973–2004) was queried.
Results Overall, 659 cases of PGIM were identified. The annual incidence of PGIM was approximately 0.47 cases per million in 2000.
Overall median survival time was 17 months. Tumors were identified in the oral–nasopharynx (32.8%), anal canal (31.4%), rectum
(22.2%), esophagus (5.9%), stomach (2.7%), small bowel (2.3%), gallbladder (1.4%), and large bowel (0.9%). Univariate analysis
demonstrated age, tumor location, stage, surgery, and lymph node status were significant predictors of improved survival.
MST has not been reached for tumors located in the large bowel, while tumors located in the stomach demonstrated the shortest
median survival (5 months). Improvement in MST was observed for those patients undergoing surgical resection. The presence
of lymph node involvement conferred a poorer prognosis. Multivariate analysis of the cohort identified that location, advanced
tumor stage, failure to undertake surgical resection, positive lymph node status, and age were all independent predictors
of poorer outcome.
Conclusion PGIM occurs most often in the oral–nasopharynx and anal canal. Surgical extirpation is the only identifiable treatment modality
that significantly improves survival. 相似文献
110.
R. C. Dart J. L. Green E. K. Kuffner K. Heard B. Sproule B. Brands 《Alimentary pharmacology & therapeutics》2010,32(3):478-486
Aliment Pharmacol Ther 2010; 32: 478–486