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排序方式: 共有1023条查询结果,搜索用时 15 毫秒
1.
Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618
Background
Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).Methods
All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims.Results
Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P = .01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P = .02) but was similarly not predictive of 90-day readmission/complications.Conclusion
Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system. 相似文献2.
Olfactory Neuroblastoma and Neuroendocrine Carcinoma of the Anterior Skull Base: Treatment Results at the M.D. Anderson Cancer Center 下载免费PDF全文
John R. Austin Hazel Cebrun Mathew M. Kershisnik Adel K. El-Naggar Adam S. Garden Franco DeMonte Lawrence E. Ginsberg Scott M. Lippman Helmuth Goepfert 《Skull base》1996,6(1):1-8
Updated information on the pathologic characterization and treatment of olfactory neurobiastoma (ON) and neuroendocrine carcinoma (NEC) diseases is presented. A series of patients with ON or NEC was evaluated and retrospectively staged using the UCLA system. The parameters evaluated were symptoms, age, sex, risk factor assessment, stage of disease, treatment, and clinical outcome. The median follow-up was 3 years (range, 18 months to 23 years). The predominant therapy (63%) for ON was combined surgery and radiotherapy. Surgery alone or in combination with ancillary treatment was used in 58% of patients with NEC. For the most receat years of the study, patients with NEC have been treated successfully with combined chemotherapy and radiotherapy. Seventy percent of the patients with ON and 75% of the patients with NEC were clinically free of disease during the defined follow-up period. Surgical therapy consisting of a craniofacial resection combined with postoperative radiotherapy has resulted in good local and long-term control of ON. Our experience indicates that combined chemoradiation is an appropriate therapeutic approach for NEC. 相似文献
3.
4.
The application of magnetic resonance techniques in the assessment of fetal growth, fetal growth patterns and fetal health was assessed. Eighty-four sets of fetal images were obtained using a fast-scan magnetic resonance imaging technique. Measurements were made of fetal subcutaneous fat thickness, uterine cavity length and width, fetal and uterine cross-sectional areas and fetal volume. Fetal area and fetal volume measurements were found to correlate well with birth weight. Measurement of subcutaneous fat thickness may prove to be a means of differentiating between those fetuses who are constitutionally as opposed to pathologically large or small. Thirteen women had additional spectroscopic studies carried out. Twelve of the women had normal pregnancies. One woman had a twin pregnancy in which one twin died. 31P phosphorus spectra were obtained from seven of the normal pregnancies. In the remainder, the depth of the abdominal wall prevented spectra being obtained from the placenta. Differences in phosphorus metabolites were obtained from the placenta of the dead twin compared to those from the healthy pregnancies. 相似文献
5.
6.
Linda G. Rabinowitz M.D. Nancy B Esterly M.D. Ilona J. Frieden M.D. Gregory S. Garbin M.D. Roy C. Grekin M.D. T. J. Stafford M.D. Ph.D. O. T. Tan M.D. Linda G. Rabinowitz M.D. Gerald N. Goldberg M.D. Karen F Rothman M.D. Lynne J. Roberts M.D. Roy G. Geronemus M.D. Susan B. Mallory M.D. Jerome M. Garden M.D. Joseph G. Morelli M.D. Moise L Levy M.D. Bernard A. Cohen M.D. 《Pediatric dermatology》1992,9(2):132-153
One of the most exciting developments in pediatric dermatology has been the use of the flashlamp-pumped, 585-nm, pulsed dye laser for treatment of vascular birthmarks. In many cases the results are miraculous. The increase in self-esteem and happiness of many children and adolescents has been overwhelming; for some, depression has been lifted, stuttering has ceased, social involvement has increased, and antidepressants have been discontinued. There are many success stories to tell.
Despite the remarkable effects of the pulsed dye laser and the medical and psychosocial indications for its use, the issue of pain control remains significant. We have no perfect outpatient pediatric anesthetic. Most methods carry either some risk or, if not hazardous, often are not very effective for controlling pain. Needless to say, a diversity of opinions exist on how to manage discomfort from this treatment modality. Therefore, we thought it would be useful to share the experiences and opinions of several dermatologists who have extensive experience with the pulsed dye laser. 相似文献
Despite the remarkable effects of the pulsed dye laser and the medical and psychosocial indications for its use, the issue of pain control remains significant. We have no perfect outpatient pediatric anesthetic. Most methods carry either some risk or, if not hazardous, often are not very effective for controlling pain. Needless to say, a diversity of opinions exist on how to manage discomfort from this treatment modality. Therefore, we thought it would be useful to share the experiences and opinions of several dermatologists who have extensive experience with the pulsed dye laser. 相似文献
7.
Portwine stains were examined before, immediately after, and 1 yr after successful clearance by a pulsed dye laser (577 nm) using ultrastructural techniques. Dilated vascular channels and mast cell hypoplasia characterized lesional skin before treatment. Immediately after treatment, widespread selective vessel necrosis, similar to changes previously described, was observed. One year after laser irradiation, the abnormally ectatic portwine stain vessels had been replaced by small venules and arterioles, similar in number and diameter to blood vessels in normal skin; the only difference noted was that these new vessels were surrounded by easily identifiable mast cells. Many of these mast cells exhibited evidence of activation and degranulation. We conclude that mast cells may play an important role in the neovascularization of portwine stains treated by 577-nm dye laser irradiation. 相似文献
8.
Evaluation of three substitutes for Percoll in sperm isolation by density gradient centrifugation 总被引:9,自引:4,他引:9
Silane-coated silica particle solutions (ISolate(TM) and PureSperm)TM)) and
iodixanol (OptiPrep(TM)) were compared to polyvinylpyrrolidone (PVP)-coated
silica particles (Percoll(TM)) in their efficacy to recover spermatozoa by
gradient centrifugation for use in assisted reproductive procedures.
Efficacy was assessed in terms of percentages of sperm recovery, sperm
vitality and motility, normal sperm morphology and normal sperm chromatin
condensation. No significant difference was found in the recovery of
spermatozoa for men with both normal sperm counts and oligozoospermia,
between PVP-coated and silane-coated particle solutions. Iodixanol had
significantly lower sperm recovery compared to the other products. Sperm
vitality, progressive motility, normal morphology and normal chromatin
condensation did not differ significantly between any of the sperm
isolation products.
相似文献
9.
Genetic susceptibility to gluten sensitive enteropathy in Irish setter dogs is not linked to the major histocompatibility complex 总被引:3,自引:0,他引:3
A. Polvi O.A. Garden R.S. Houlston M. Maki R.M. Batt J. Partanen 《Tissue antigens》1998,52(6):543-549
Abstract: Gluten sensitive enteropathy (GSE) in Irish setter dogs has been proposed as an animal model for human celiac disease (CD), in which the major histocompatibility complex (MHC) class II alleles HLA DQAl*0501 and DQBl*0201 play an important role. To investigate whether an orthologous MHC class II region is involved in canine GSE, we undertook a linkage study in two large families of gluten sensitive Irish setter dogs. A total of 44 dogs in these pedigrees were genotyped for DQA1, DQB1 and C.2202 alleles, along with 30 unrelated healthy Irish setters. No genetic linkage between the DQ or C.2002 loci and GSE was detected. In contrast to CD, susceptibility to canine GSE does not appear to be determined by variation within the MHC class II gene cluster. Therefore, canine GSE may not be an appropriate model for CD, but nevertheless remains an important disease for advancing knowledge of pathological processes in the intestine. 相似文献
10.
N. M. Wilson G. B. Marks A. Eckhardt A. M. Clarke F. P. Young F. L. Garden W. Stewart T. M. Cook E. R. Tovey 《Anaesthesia》2021,76(11):1465-1474
Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min-1 to count and size-fractionate close to all exhaled particles (0.5–25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min-1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H2O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions. 相似文献