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51.
Michael W. Itagaki Adam D. Talenfeld Sharon W. Kwan Julian W.M. Brunner Kelly E. Mortell Michael C. Brunner 《Journal of vascular and interventional radiology : JVIR》2012,23(11):1423-1429
PurposeTo compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures.Materials and MethodsStandard Medicare 5% anonymized inpatient files (1999–2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables.ResultsA total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P<.001) and more likely to be female (P=.04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P<.001 for both), and 4.1 fewer inpatient days (P<.001). Patients who underwent surgery had higher odds of death (odds ratio=3.38, P=.016), discharge to a rehabilitation facility (odds ratio=3.3, P=.003), and transfer to another inpatient facility (odds ratio=8.53, P<.001), and lower odds of discharge to home (odds ratio=0.42, P<.001) and hospice (odds ratio=0.08, P=.002).ConclusionsIn a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice. 相似文献
52.
Vladimir Carli Peter Parzer Camilla Wasserman Birgitta Floderus Alan Apter Judit Balazs Shira Barzilay Julio Bobes Romuald Brunner Paul Corcoran Doina Cosman Padraig Cotter Romain Despalins Nadja Graber Francis Guillemin Christian Haring Jean‐Pierre Kahn Laura Mandelli Dragan Marusic Gergely Mészáros George J. Musa Vita Postuvan Franz Resch Pilar A. Saiz Merike Sisask Airi Varnik Marco Sarchiapone Christina W. Hoven Danuta Wasserman 《Addiction (Abingdon, England)》2012,107(12):2210-2222
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55.
Julian Brunner Cindy L. Cain Elizabeth M. Yano Alison B. Hamilton 《Women's health issues》2019,29(1):64-71
Background
The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.Methods
We conducted semistructured interviews with 86 local and regional women's health leaders at 12 VHA medical centers across four regions. At the conclusion of interviews about women's primary care, participants were asked to imagine “ideal care” for women veterans. Interviews were transcribed and coded using a hybrid inductive/deductive approach.Results
In describing ideal care, participants commonly touched on whether women veterans should have separate primary care services from men; the need for childcare, expanded reproductive health services, resources, and staffing; geographic accessibility; the value of input from women veterans; the physical appearance of facilities; fostering active interest in women's health across providers and staff; and the relative priority of women's health at the VHA.Conclusions
Policy and practice changes to care for women veterans must be mindful of key stakeholders' vision for that care. Specific features of that vision include clinic construction that anticipates a growing patient population, providing childcare and expanded reproductive health services, ensuring adequate support staff, expanding mechanisms to incorporate women veterans' input, and fostering a culture oriented towards women's health at the organizational level. 相似文献56.
Converting enzyme inhibition in hypertensive emergencies. 总被引:1,自引:0,他引:1
C P Tifft H Gavras G R Kershaw I Gavras H R Brunner C S Liang A V Chobanian 《Annals of internal medicine》1979,90(1):43-47
The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg in the eight nonresponders. In patients who had received no previous drug treatment, log baseline plasma renin activity and change in mean blood pressure after SQ 20881 correlated significantly (r = 0.651, P less than 0.05). After acute therapy with SQ 20881, the patients who had a satisfactory response to the drug were treated with propranolol and a relatively normal sodium intake (88 meq/day). Nonresponders were treated with diuretics and sodium restriction (10 meq/day), and intermediate responders were given combination therapy. Mean blood pressure responded favorably within 24 h to the chosen regimen for each group from 152 +/- 47 to 102 +/- 31 mm Hg. SQ 20881 allows prompt evaluation of the role of renin in hypertensive emergencies and permits early choice of appropriate therapy based on the prevailing mechanism. 相似文献
57.
Kumari M Brunner E Fuhrer R 《The journals of gerontology. Series A, Biological sciences and medical sciences》2000,55(5):B228-B232
Type 2 diabetes is associated with an increased risk of cognitive dysfunction. These effects seem particularly true for memory functions. This article examines how diabetes and the biological changes that occur with diabetes such as hyperglycemia, changes in insulin concentration, hypertension, and changes in lipid levels might lead to these alterations in cognitive functioning, with an emphasis on the mechanisms leading to changes in memory. 相似文献
58.
59.
Autoantibodies in experimental autoimmune hepatitis. 总被引:2,自引:0,他引:2
A W Lohse S Brunner A Kyriatsoulis M Manns K H Meyer zum Büschenfelde 《Journal of hepatology》1992,14(1):48-53
Experimental autoimmune hepatitis (EAH) can be induced in mice by immunization with syngeneic soluble liver antigens in complete Freund's adjuvant. It has previously been shown that autoreactive T cells play an important role in this animal model of autoimmune hepatitis. We have studied the occurrence of liver autoantibodies in EAH. Characteristic autoantibodies appeared several weeks after disease induction and antibody titres continued to rise when histological and biochemical signs of disease activity had already regressed. Autoantibodies in EAH seemed to recognize autoantigens other than those present in autoimmune chronic active hepatitis patients. We conclude that autoantibodies arise in experimental autoimmune hepatitis but that these autoantibodies do not play a critical role in the pathogenesis of the disease. 相似文献
60.
M. Brunner T. S. Faber A. Jeron M. Zehender H. Just 《Intensivmedizin und Notfallmedizin》1998,35(1):66-76
Zusammenfassung Die ad?quate Versorgung von Patienten, die bereits einmal einen Herz-Kreislaufstillstand durch tachykarde Arrhythmien überlebt
haben, war lange Zeit auf eine Behandlung mit Antiarrhythmika beschr?nkt, wenn der Rhythmusst?rung keine behebbare orga-nische
Ursache zugrunde lag. Trotz optimierter Pharmakotherapie sterben 30% dieser Patienten innerhalb von drei Jahren durch eine
erneute maligne Arrhythmie. Deshalb wurde in den letzten Jahren die Implanta-tion von automatischen, implantierbaren Kardioverter-Defibrillatoren
(ICD) der Standard bei der Versorgung dieser Patienten. Zunehmend werden ICDs auch bei Patienten mit stark erh?htem Risiko
für einen pl?tzlichen Herztod ohne überlebten Kreislaufstillstand implantiert, ins-besondere bei Patienten mit Kardio-myopathie
oder angeborenen ar-rhythmogenen Anomalien des Herzens. In neuen klinischen Studien konnte bei selektierten Patienten ein
deutlicher überlebensvorteil gegen-über der Behandlung mit Anti-arrhythmika gezeigt werden [7].
Die Implantation von ICDs wird bei den neuen transven?sen Systemen ohne Thorakotomie durchgeführt, wodurch das Operationsrisiko
wesentlich verringert wurde. Moderne ICDs werden unter den linken M. pectoralis major implantiert, eine mehrpolige Elektrode
im rechten Ventrikel dient der Wahrnehmung, der Stimulation und der Schockab-gabe.
Die Ger?te sind in weiten Bereichen patientenspezifisch programmierbar und erlauben so eine differenzierte Erkennung und
mehrstufige Therapie von ventrikul?ren Tachykardien und Kammerflimmern. Neben der Defibrillation und der synchronisierten
Kardioversion stellt die antitachykarde Stimulation eine hocheffektive und für die Patienten angenehme Methode zur Beendigung
von langsamen ventrikul?ren Tachykardien dar. Der interne Speicher moderner ICDs dokumentiert nicht nur die Anzahl der Arrhythmien
und die abgegebene Therapie, auch intrakardiale EKGs vor und nach den Episoden k?nnen ausgelesen werden. Diese Eigenschaften
erlauben heute eine sehr spezifische und individuelle Anpassung der Therapie an die zugrundeliegende Arrhythmie.
Eingegangen: 3. September 1997 Akzeptiert: 4. Oktober 1997 相似文献