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61.
62.
Hector Rodriguez-Luna Hugo E. Vargas Adyr Moss Kunam S. Reddy Richard B. Freeman David Mulligan 《American journal of transplantation》2005,5(9):2244-2247
The Model for End-Stage Liver Disease (MELD) is used to assign priority for liver transplantation candidates. The Organ Procurement and Transplantation Network (OPTN) approved recognized exceptional diagnoses (RED's) for which MELD fails to accurately measure priority. Centers can request increased MELD points in cases not recognized by this policy (non-RED's). Our aim was to compare regional practices to justify non-RED requests for MELD adjustments. The UNOS/OPTN database was queried to extract all adult cases for which a non-RED MELD adjustment was requested from 2/27/02 until 8/27/03. The data were stratified by region and justification. Data for 29,510 listings were available. 26,947 had complete diagnosis information. There were 827 non-RED requests of which 477 (57.7%) petitions were approved by the regional review boards (RRBs). The approval rate varied significantly among regions (range: 28-75%, p<0.0001). The most common non-RED's were complications of portal hypertension (48%). The percentage of patients listed with non-RED's varied significantly among regions (0.7-8.3 %, p<0.0001), as did the proportion of patients transplanted with non-RED's (2.1-31.9%, p<0.0001). Demographics did not differ among regions requesting non-REDs.Widespread regional variations exist in the handling of requests for non-REDs. These variations point to the need for reform to standard exception criteria. 相似文献
63.
Jennifer B Freeman Molly L Choate-Summers Phoebe S Moore Abbe M Garcia Jeffrey J Sapyta Henrietta L Leonard Martin E Franklin 《Neuropsychopharmacology》2007,61(3):337-343
Obsessive-compulsive disorder (OCD) is a distressing and functionally impairing disorder that can emerge as early as age 4. Cognitive behavior therapy (CBT) for OCD in youth shows great promise for amelioration of symptoms and associated functional impairment. However, the empirical evidence base for the efficacy of CBT in youth has some significant limitations, particularly as related to treating the very young child with OCD. This report includes a quantitative review of existing child CBT studies to evaluate evidence for the efficacy of CBT for OCD. It identifies gaps in the literature that, when addressed, would enhance the understanding of effective treatment in pediatric OCD. Finally, it presents a proposed research agenda for addressing the unique concerns of the young child with OCD. 相似文献
64.
John G. Freeman Oddrun Samdal Don A. Klinger Wolfgang Dur Robert Griebler Dorothy Currie Mette Rasmussen 《International journal of public health》2009,54(Z2):251-259
Objectives:
To examine the extent to which school climate and school pressure could predict other aspects of adolescents’ lives, most particularly their emotional health and bullying. Furthermore, the study sought to investigate if these relationships were consistent across countries. 相似文献65.
Pharmacokinetics of cyclosporine in the weanling pig 总被引:1,自引:0,他引:1
66.
67.
Consequences of the North American Free Trade Agreement for health services: a perspective from Mexico. 总被引:1,自引:0,他引:1 下载免费PDF全文
J Frenk O Gmez-Dants C Cruz F Chacn P Hernndez P Freeman 《American journal of public health》1994,84(10):1591-1597
OBJECTIVES. The purposes of the study were to assess the potential impact of the North American Free Trade Agreement (NAFTA) on medical care in Mexico and to identify internal measures Mexico could take to increase the benefits and minimize the risks of free trade. METHODS. The dual nature of the health sector is examined; the Mexican, Canadian, and US health care systems are compared; and modes and consequences of international exchange of health services are analyzed. RESULTS. Four issues require immediate attention: accreditation of health care facilities, licensing and certification of professionals, technology assessment, and financial equity. CONCLUSIONS. NAFTA offers opportunities for positive developments in Mexico, provided risks can be anticipated and preventive measures can be taken to avoid negative impacts on the health system. Medical services, like other elements of the Mexican economy, must be modernized to respond to the demands of global competition. The Mexican National Academy of Medicine has recommended to the Mexican government (1) internal strengthening of the Mexican health care system to improve its ability to respond to the new conditions created by NAFTA and (2) a gradual process to facilitate equitable and mutually beneficial interactions among the three countries. 相似文献
68.
T W Freeman J L Clothier P Pazzaglia M D Lesem A C Swann 《The American journal of psychiatry》1992,149(1):108-111
OBJECTIVE: This study was carried out to compare the efficacy of lithium carbonate with that of valproate in acute mania and to determine whether pretreatment clinical characteristics, such as the presence of a mixed affective state, might predict a differential response to the two drugs. METHOD: Twenty-seven patients meeting DSM-III-R criteria for acute manic episodes underwent a 3-week, randomized, double-blind, parallel-groups trial of treatment with lithium carbonate or valproate. Symptom severity was measured by using the Schedule for Affective Disorders and Schizophrenia, change version (SADS-C), the Global Assessment Scale (GAS), and the Brief Psychiatric Rating Scale (BPRS). Drug effects were compared by using repeated measures analysis of variance (ANOVA). RESULTS: At the end of the study, nine of 14 patients treated with valproate and 12 of 13 patients treated with lithium had responded favorably, as measured by changes in the SADS-C mania, BPRS, and GAS scores. Elevated pretreatment SADS-C depression scores were associated with good response to valproate. ANOVA revealed a significant interaction between drug and mixed affective state with respect to treatment response. CONCLUSIONS: Lithium and valproate were both effective in improving manic symptoms, and lithium was slightly more efficacious overall. Unlike the case with lithium, favorable response to valproate was associated with high pretreatment depression scores. Therefore, treatment with valproate alone may be particularly effective in manic patients with mixed affective states. 相似文献
69.
Access to medical care for black and white Americans. A matter of continuing concern 总被引:28,自引:2,他引:26
A 1986 national survey of use of health services shows a significant deficit in access to health care among black compared with white Americans. This gap was experienced by all income levels of black Americans. In addition, the study points to significant underuse by blacks of needed medical care. Moreover, blacks compared with whites are less likely to be satisfied with the qualitative ways their physicians treat them when they are ill, more dissatisfied with the care they receive when hospitalized, and more likely to believe that the duration of their hospitalizations is too short. 相似文献
70.
The two major applications of whole post-implantation rat embryo culture (WEC) are as a test for teratogenicity in safety evaluation studies and as a tool in the investigation of mechanisms of teratogenesis. As a test system, WEC possesses many of the characteristics necessary for an in vitro screen. However, its use on a large scale is disqualified for reasons of cost and the demand for technical expertise to perform cultures and interpret findings, compared with other in vitro teratogenicity screens, although its use might be preferred when only a few compounds require testing. The major value of WEC lies in its use for studying mechanisms of teratogenesis. The opportunity to study the embryo in isolation and the versatility afforded by the technique offer considerable advantages in this context. 相似文献