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101.
Charlie C. Park Catherine Hooker Jonathan C. Hooker Emily Bass William Haufe Alexandra Schlein Yesenia Covarrubias Elhamy Heba Mark Bydder Tanya Wolfson Anthony Gamst Rohit Loomba Jeffrey Schwimmer Diego Hernando Scott B. Reeder Michael Middleton Claude B. Sirlin Gavin Hamilton 《Journal of magnetic resonance imaging : JMRI》2019,49(1):229-238
102.
Erik J. Kramer David W. Shearer Elliot Marseille Billy Haonga Joshua Ngahyoma Edmund Eliezer Saam Morshed 《World journal of surgery》2016,40(9):2098-2108
Background
Femoral shaft fractures are one of the most common injuries seen by surgeons in low- and middle-income countries (LMICs). Surgical repair in LMICs is often dismissed as not being cost-effective or unsafe, though little evidence exists to support this notion. Therefore, the goal of this study is to determine the cost of intramedullary nailing of femoral shaft fractures in Tanzania.Methods
We used micro-costing methods to estimate the fixed and variable costs of intramedullary nailing of femoral shaft fractures. Variable costs assessed included medical personnel costs, ward personnel costs, implants, medications, and single-use supplies. Fixed costs included costs for surgical instruments and administrative and ancillary staff.Results
46 adult femoral shaft fracture patients admitted to Muhimbili Orthopaedic Institute between June and September 2014 were enrolled and treated with intramedullary fixation. The total cost per patient was $530.87 (SD $129.99). The mean variable cost per patient was $419.87 (SD $129.99), the largest portion coming from ward personnel $144.47 (SD $123.30), followed by implant $134.10 (SD $15.00) medical personnel $106.86 (SD $28.18), and medications/supplies $30.05 (SD $12.28). The mean fixed cost per patient was $111.00, consisting of support staff, $103.50, and surgical instruments, $7.50.Conclusions
Our study provides empirical information on the variable and fixed costs of intramedullary nailing of femoral shaft fractures in LMICs. Importantly, the lack of surgical capacity was the primary driver of the largest cost for this procedure, preoperative ward personnel time. Our results provide the cost data for a formal cost-effectiveness analysis on this intervention.103.
104.
105.
Elliot V Marin D Horncastle D Elderfield K Howard J Apperley JF Lampert IA Naresh KN 《Histopathology》2007,50(6):810-812
106.
Martin RJ Szefler SJ King TS Kraft M Boushey HA Chinchilli VM Craig TJ Dimango EA Deykin A Fahy JV Israel E Lazarus SC Lemanske RF Leone FT Pesola GR Peters SP Sorkness CA Szwejbka LA Wechsler ME;National Heart Lung Blood Institute's Asthma Clinical Research Center 《The Journal of allergy and clinical immunology》2007,119(1):73-80
BACKGROUND: Although guidelines recommend anti-inflammatory therapy for persistent asthma, recent studies suggest that 25% to 35% of patients with asthma may not improve lung function with inhaled corticosteroids. OBJECTIVE: To evaluate potential biomarkers of predicting short-term (6-week) response to inhaled corticosteroid with subsequent evaluation of responders and nonresponders to asthma control over a longer interval (16 additional weeks). METHODS: Eighty-three subjects with asthma off steroid were enrolled in this multicenter study. Biomarkers and asthma characteristics were evaluated as predictors of inhaled corticosteroid response over a 6-week trial for changes in FEV(1) and methacholine PC(20). After this, an additional 4-month trial evaluated asthma control. RESULTS: Although multiple baseline predictors had significant correlations with improvements for short-term inhaled steroid success, the only strong correlations (r >or= +/- 0.6) were albuterol reversibility (r = 0.83; P < .001), FEV(1)/forced vital capacity (r = -0.75; P < .001), and FEV(1) % predicted (r = -0.71; P < .001). Dividing the subjects in the short-term inhaled steroid trial into responders (>5% FEV(1) improvement) and nonresponders (相似文献
107.
On the discrepancies between Monte Carlo dose calculations and measurements for the 18 MV varian photon beam 总被引:1,自引:0,他引:1
Significant discrepancies between Monte Carlo dose calculations and measurements for the Varian 18 MV photon beam with a large field size (40 x 40 cm2) were reported by different investigators. In this work, we investigated these discrepancies based on a new geometry model ("New Model") of the Varian 21EX linac using the GEPTS Monte Carlo code. Some geometric parameters used in previous investigations (Old Model) were inaccurate, as suggested by Chibani in his AAPM presentation (2004) and later confirmed by the manufacturer. The entrance and exit radii of the primary collimator of the New Model are 2 mm larger than previously thought. In addition to the corrected dimensions of the primary collimator, the New Model includes approximate models for the lead shield and the mirror frame between the monitor chamber and the Y jaws. A detailed analysis of the phase space data shows the effects of these corrections on the beam characteristics. The individual contributions from the linac component to the photon and electron fluences are calculated. The main source of discrepancy between measurements and calculations based on the Old Model is the underestimated electron contamination. The photon and electron fluences at the isocenter are 5.3% and 36% larger in the New Model in comparison with the Old Model. The flattening filter and the lead shield (plus the mirror frame) contribute 48.7% and 13% of the total electron contamination at the isocenter, respectively. For both open and filtered (2 mm Pb) fields, the calculated (New Model) and measured dose distributions are within 1% for depths larger than 1 cm. To solve the residual problem of large differences at shallow depths (8% at 0.25 cm depth), the detailed geometry of an IC-10 ionization chamber was simulated and the dose in the air cavity was calculated for different positions on the central axis including at the surface, where half of the chamber is outside the phantom. The calculated and measured chamber responses are within 3% even at the zero depth. 相似文献
108.
The present study was designed to evaluate the impact of neonatal injury on adult spinal plasticity in rats. Subjects were randomly assigned to 1 of 4 experimental conditions: (a) hind-paw injury at Postnatal Day (PD) 2, (b) hind-paw injury at PD 5, (c) anesthesia exposure only on PD 2, or (d) anesthesia exposure only on PD 5. Subjects receiving a unilateral neonatal hind-paw injury showed decreased mechanical threshold (hyperalgesia) on the previously injured hind paw throughout development. This decrease in threshold survived spinal transection (at T2) at 12 weeks of age. Injured subjects also showed significant impairment in a spinal instrumental learning task performed by the previously injured hind paw. This disruption of learning indicates a disruption of spinal plasticity that may be due to induction of long-term changes in nociceptive processing within the spinal cord. 相似文献
109.
S. Soni S. Shah R. Chaggar R. Saini E. James J. Elliot J. Stephens T. McCormack A. Hartle 《Anaesthesia》2020,75(10):1314-1320
Patients with uncontrolled hypertension are at increased risk of complications during general anaesthesia but the number of patients whose surgery is delayed or cancelled due to hypertension remains unknown. Prospective, regional multicentre service evaluations were performed on consecutive patients undergoing elective surgery before and after the publication of new guidelines from the Association of Anaesthetists and the British Hypertensive Society. The aim was to quantify the number of operations cancelled due to hypertension alone and to assess impact of the guidelines on cancellation rates. In October 2013 (before the publication of the guidelines), 1.37% (95%CI 0.69–2.11%) of patients listed for elective surgery were cancelled solely due to raised blood pressure. This reduced significantly to 0.54% (95%CI 0.20–0.92%, p < 0.001) in 2018. There was a significant reduction in inappropriate cancellations for stage 1 or 2 hypertension from 2013 to 2018 (72 vs. 14, respectively, p < 0.001) in keeping with the recommendations in the guidelines. Furthermore, the number of patients being referred back to primary care for the management of hypertension reduced from 2013 to 2018 (85 vs. 30, respectively, p < 0.001). Our data suggest achievement of three major outcomes: reduced surgical cancellations due to hypertension alone; improved detection of significant hypertension before elective surgery; and reduced referral back to primary care from hospital for hypertension management. To the best of our knowledge, this is the first time the successful implementation of guidelines from the Association of Anaesthetists has been assessed on such a broad scale. Our data indicate that these guidelines have been effectively implemented in both primary and secondary care, which is likely to have made a positive psychosocial, physical and economic impact on patients and the NHS. 相似文献
110.