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91.
Mallinson TR Manheim LM Almagor O Demark HM Heinemann AW 《Archives of physical medicine and rehabilitation》2008,89(11):2066-2079
Mallinson TR, Manheim LM, Almagor O, DeMark HM, Heinemann AW. Trends in the supply of inpatient rehabilitation facilities services: 1996 to 2004.
Objectives
Describe the supply of inpatient rehabilitation facilities (IRFs) services in 1996 and examine changes between 1996 and 2004, including the impact of the IRF prospective payment system (PPS) in 2002 on organizational trends.Design
Retrospective pre-post design.Setting
Freestanding and subprovider (distinct-part units) IRFs.Participants
IRFs (N=1424), including 257 freestanding IRFs and 1167 IRF units reported in the Healthcare Cost Report Information System database, from years 1996 to 2004.Interventions
Not applicable.Main Outcome Measures
Number of IRF openings, IRF closures, beds, and inpatient days.Results
The number of IRFs grew from 1037 to 1183 between 1996 and 2001 and grew to 1235 between 2001 and 2004. The likelihood of IRF closures trended lower after PPS, and there was a significant increase in the likelihood of openings when PPS was introduced. For-profit, rural, and small IRFs were more likely to open over the entire period. There was a 12.9% increase in the number of total inpatient days, somewhat less than the 15.7% growth in IRF beds over the period. There was no impact of PPS on beds available but a significant decline in total inpatient days after PPS.Conclusions
Inpatient days rose under the Tax Equity and Fiscal Responsibility Act and declined after 2002. Yet the likelihood of openings and closures did not appear to respond to these changes, perhaps because they were modest compared with changes in local IRF markets. The IRF PPS did little to affect service distribution in less well-served areas, although we did find growth in rural areas. Occupancy rates in 2004 were close to rates at the start of the period (70%). This observation implies that IRFs were implementing strategies to recruit a sufficient number of patients, even though bed numbers were increasing and length of stay was declining. Consequently, policy that limits the potential of IRFs to increase patient admissions, such as the limits on admissions to IRFs of patients with conditions other than those included in the 75% rule, is likely to produce substantial decreases in total inpatient days. 相似文献92.
Even though in the Western world there is almost no limitation to a wide variety of food supply, nutritional deficiencies can be found in both normal-weight population and in the obese population. In this review, we examine the prevalence and manifestations of various mineral deficiencies in obese patients. 相似文献
93.
Mourelo R Kaidar-Person O Fajnwaks P Roa PE Pinto D Szomstein S Rosenthal RJ 《Obesity surgery》2008,18(2):167-170
Background Perioperative management of bariatric surgical patients receiving chronic anticoagulation requires an understanding of potential
hemorrhagic and thromboembolic risks. The aim of this study is to evaluate hemorrhagic and thromboembolic complications in
morbidly obese patients who are on oral anticoagulation treatment and subsequently undergo laparoscopic bariatric surgery.
Methods The medical records of all laparoscopic Roux-en-Y gastric bypass (LRYGB) patients from June 2001 to March 2006 were retrospectively
reviewed. In addition, data of patients who received chronic anticoagulation therapy with Coumadin and underwent laparoscopic
Roux-en-Y gastric bypass was analyzed. Clinical parameters included length of hospitalization, hemorrhagic complications,
thromboembolic complications, conversion rate, reoperation, and blood transfusion.
Results During the study period, 1,700 consecutive patients underwent bariatric surgery for the treatment of morbid obesity. Of these,
21 patients were treated with chronic oral anticoagulation; 3 of the 21 (14%) had hemorrhagic complications: one patient had
intraluminal hemorrhage and two patients had intraabdominal hemorrhage. Two patients required blood transfusion, and one patient
underwent surgical reintervention. None of the 21 laparoscopic operations were converted to open procedures. There were no
postoperative mortalities, and there were no thromboembolic events in this series.
Conclusions Laparoscopic bariatric surgery can be performed relatively safely in morbidly obese patients who are treated with chronic
oral anticoagulation. Even in the presence of bleeding, patients can be successfully treated without the need for reoperation. 相似文献
94.
Pinto D Kaidar-Person O Cho M Zundel N Szomstein S Rosenthal RJ 《Surgical laparoscopy, endoscopy & percutaneous techniques》2008,18(1):121-123
Degenerative schwannomas are rare benign tumors. The patient presented in this case report complained of a dull left upper quadrant pain for several months. A computed tomography scan revealed a low-density lesion at the level of T12. The lesion was laparoscopically resected and pathologic examination revealed a degenerative schwannoma. 相似文献
95.
Ilan Y Ohana M Pappo O Margalit M Lalazar G Engelhardt D Rabbani E Nagler A 《Transplantation》2007,83(4):458-467
BACKGROUND: Natural killer T (NKT) lymphocytes play a role in graft-versus-host disease GVHD (GVHD). Glucocerebroside (GC) is a naturally occurring glycolipid that plays a role in the immune modulation of NKT lymphocytes. This study aims to determine the effect of GC in murine models of semiallogeneic/acute and chronic GVHD. METHODS: Acute and chronic GVHD were generated by fusion of splenocytes from C57BL/6 to (C57BL/6xBalb/c) F1 mice, and from B10.D2 donor mice into Balb/c, respectively. Recipients were treated daily with GC. Histological and immunological parameters of GVHD were assessed. RESULTS: Treatment with GC significantly alleviated GVHD in both models The beneficial effect of GC was associated with an increase in the intrahepatic/peripheral NKT lymphocyte ratio in the semiallogeneic/acute model. This ratio was decreased in the chronic GVHD model. A significant increase in intrahepatic CD8+ lymphocyte trapping was noted in the semiallogeneic/acute model, whereas the opposite effect was observed in the chronic GVHD model. Administration of GC led to decreased serum interferon-gamma and increased serum interleukin-4 levels in the Th1-mediated model, whereas the opposite effect was observed in the Th2-mediated models. CONCLUSIONS: GC ameliorates GVHD in both Th1- and Th2-mediated murine models, suggesting it is able to differentially affect the immune system. GC may alleviate immunologically incongruous disorders, and may be associated with "fine tuning" of immune responses. 相似文献
96.
Human vulnerability to stress depends on amygdala's predisposition and hippocampal plasticity 下载免费PDF全文
Roee Admon Gad Lubin Orit Stern Keren Rosenberg Lee Sela Haim Ben-Ami Talma Hendler 《Proceedings of the National Academy of Sciences of the United States of America》2009,106(33):14120-14125
Variations in people''s vulnerability to stressful life events may rise from a predated neural sensitivity as well as from differential neural modifications in response to the event. Because the occurrence of a stressful life event cannot be foreseen, characterizing the temporal trajectory of its neural manifestations in humans has been a real challenge. The current prospective study examined the emotional experience and brain responses of 50 a priori healthy new recruits to the Israeli Defense Forces at 2 time points: before they entered their mandatory military service and after their subsequent exposure to stressful events while deployed in combat units. Over time, soldiers reported on increase in stress symptoms that was correlated with greater amygdala and hippocampus responsiveness to stress-related content. However, these closely situated core limbic regions exhibited different temporal trajectories with regard to the stress effect; whereas amygdala''s reactivity before stress predicted the increase in stress symptoms, the hippocampal change in activation over time correlated with the increase in such symptoms. Hippocampal plasticity was also reflected by a modification over time of its functional coupling with the ventromedial prefrontal cortex, and this coupling magnitude was again predicted by predated amygdala reactivity. Together, these findings suggest that variations in human''s likelihood to develop symptomatic phenomena following stressful life events may depend on a balanced interplay between their amygdala''s predisposing reactivity and hippocampal posteriori intra- and interregional plasticity. Accordingly, an individually tailored therapeutic approach for trauma survivors should target these 2 neural probes while considering their unique temporal prints. 相似文献
97.
Navah Z Ratzon Daniela Efraim Orit Bart 《The American journal of occupational therapy》2007,61(4):399-405
OBJECTIVE: Children with fine-motor problems and handwriting difficulties often are referred for occupational therapy. The objective of this study was to test the efficacy of a short-term treatment on the fine-motor and graphomotor skills of first-grade students. METHOD: We recruited 52 first-grade students who had scored below the 21st percentile on the Visual-Motor Integration test from schools in a city with a low socioeconomic, mixed (Arab and Jewish) population. The children were randomly divided into an intervention group and a control group. Before and after the intervention, we administered two tests to both groups. RESULTS: Students in the intervention group made significant gains both in the total score on the graphomotor test (Developmental Test of Visual Perception) and on the fine-motor test (Bruininks-Oseretsky Motor Development Scale). CONCLUSION: This study provided preliminary evidence of the efficacy of a short-term graphomotor intervention. The results increased the feasibility of implementing occupational therapy intervention in the Israeli school system, allowing treatment of more children using the same resources. 相似文献
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