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1.
Clinical decision making: from theory to practice. The individual vs society. Resolving the conflict 总被引:1,自引:0,他引:1
Eddy argues for reform of the American health care system. In seeking health coverage, he explains, there are two positions: the first, that of society, seeks to allocate services efficiently; the second, that of the patient, seeks to optimize individual patients' care. Using his illustration of breast cancer coverage from a previous JAMA article (1991 Mar 20; 265 (11): 1446+), Eddy contends that a tradition of decision-making from the second position is the root of present health care inefficiencies. Eddy's ideal would be complete information to physicians and patients about service costs, benefits, and financial feasibility, and an agreed-upon standard of fair resource allocation, based on the threshold of a specific measure of benefit per resource. To approach this ideal, he concludes, we must recognize the problem, pursue education about service costs and benefits and people's desires of the system, and identify and review services that presently are inefficiently utilized. 相似文献
2.
The frequency of cervical cancer screening. Comparison of a mathematical model with empirical data 总被引:4,自引:0,他引:4
The results of a mathematical model used to analyze the frequency of the Pap smear are compared with a recently published independent empirical study of data from large screening programs in Europe and North America. The model's predictions of the reduced incidence of invasive cervical cancer achieved with different screening frequencies match the empirical results closely--the predictions were within 1% of the empirical results for screening frequencies ranging from 1 to 10 years. The data indicate that compared with annual screening, screening every 2, 3, 5, and 10 years retains 99%, 97%, 89%, and 69%, respectively, of the effectiveness measured as a reduction in frequency of invasive cancer. The mathematical model underestimated the effectiveness of screening every 3 years, compared with screening every year. 相似文献
3.
A human amphotropic retrovirus receptor is a second member of the gibbon ape leukemia virus receptor family. 总被引:30,自引:3,他引:27
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M van Zeijl S V Johann E Closs J Cunningham R Eddy T B Shows B O'Hara 《Proceedings of the National Academy of Sciences of the United States of America》1994,91(3):1168-1172
Retrovirus infection is initiated by binding of the viral envelope glycoprotein to a cell-surface receptor. The envelope proteins of type C retroviruses of mammals demonstrate similarities in structural organization and protein sequence. These similarities suggest the possibility that retroviruses from different interference groups might use related proteins as receptors, despite the absence of any relationship between retrovirus receptors isolated to date. To investigate this possibility, we have identified a human cDNA clone encoding a protein closely related to the receptor for gibbon ape leukemia virus and have found that it functions as the receptor for the amphotropic group of murine retroviruses. Expression of this protein (GLVR-2) is likely to be a requirement for infection of human cells by amphotropic retroviral vectors for purposes of gene therapy. 相似文献
4.
Nephrocalcinosis (NC) detected by ultrasound is a recognized abnormality for some patients with X-linked hypophosphatemia (XLH) who received vitamin D2 and inorganic phosphate therapy, but is commonly observed in XLH patients treated with 1,25-dihydroxyvitamin D3 and inorganic phosphate supplementation. Nevertheless, long-term follow-up of kidney function in XLH patients with NC detected ultrasonographically has not been reported. We investigated two women with XLH, ages 31 (patient 1) and 39 (patient 2) years, each of whom had suffered at least one documented episode of vitamin D2-induced hypercalcemia and renal azotemia during childhood. Patient 2 had also been treated with inorganic phosphate. No medications for XLH had been taken during adulthood. Renal ultrasonography at our institution demonstrated marked bilateral medullary NC in both women. No other explanation was found for their NC that apparently occurred several decades earlier from medical therapy for XLH. Detailed studies (including creatinine clearance, β2-microglobulin excretion, and fasting urinary osmolality and acidification) revealed no impairment of kidney function in either patient. Our findings indicate that subradiographic medullary NC acquired during medical therapy for XLH may persist for decades, but with no adverse renal sequelae. Definitive (long-term) assessment of kidney function in the XLH population with NC, however, will be necessary to fully understand the risk of current medical treatment for this most common heritable form of rickets. 相似文献
5.
Marko Simunovic Eddy Rempel Marc-Erick Thériault Angela Coates Timothy Whelan Eric Holowaty Bernard Langer Mark Levine 《Canadian journal of surgery》2006,49(4):251-258
BACKGROUND: There is a lack of information from Canadian hospitals on the role of hospital characteristics such as procedure volume and teaching status on the survival of patients who undergo major cancer resection. Therefore, we chose to study these relationships using data from patients treated in Ontario hospitals. METHODS: We used the Ontario Cancer Registry from calendar years 1990-2000 to obtain data on patients who underwent surgery for breast, colon, lung or esophageal cancer or who underwent major liver surgery related to a cancer diagnosis between 1990 and 1995 in order to assess the influence of volume of procedures and teaching status of hospitals on in-hospital death rate and long-term survival. For each disease site and before observing patient outcomes data, volume cut-off points were selected to create volume groups with similar numbers of patients. Teaching hospitals were those directly affiliated with a medical school. Logistic regression and proportional hazards models were used to consider the clustering of data at the hospital level and to assess operative death and long-term survival. We also used 4 measures to gauge the degree of procedure regionalization across the province including (1) the number of hospitals performing a procedure; (2) the percentage of patients treated in teaching hospitals; (3) the percentage of rural patients treated in higher volume procedure hospitals; and (4) median distances travelled by patients to receive care. RESULTS: The number of patients in our cohorts who underwent resection of the breast, colon, lung, esophagus or liver was 14 346, 8398, 2698, 629 and 362, respectively. Surgery in a high-volume versus a low-volume hospital did not have a statistically significant influence on the odds of operative death for patients who underwent colon, liver, lung or esophageal cancer resection. The risk of long-term death was increased in low-volume versus high-volume hospitals for patients who underwent resection of the breast (hazard ratio [HR] 1.2, 95% confidence interval [95% CI] 1.0-1.4, p < 0.05), lung (HR 1.3, 95% CI 1.1-1.6, p < 0.01) and liver (HR 1.7, 95% CI 1.0-2.7, p = 0.04). There were no significant differences in the odds of operative (in-hospital) death or risk of long-term death among patients treated in teaching compared with nonteaching hospitals. There was more regionalization of liver, lung and esophageal operations versus breast and colon operations. CONCLUSIONS: Increased hospital procedure volume correlated with improved longterm survival for patients in Ontario who underwent some, but not all, cancer resections, whereas hospital teaching status had no significant impact on patient outcomes. Across the province, further regionalization of care may help improve the quality of some cancer procedures. 相似文献
6.
7.
Steven D. Forman Jonathan D. Cohen Mark Fitzgerald William F. Eddy Mark A. Mintun Douglas C. Noll 《Magnetic resonance in medicine》1995,33(5):636-647
The typical functional magnetic resonance (fMRI) study presents a formidable problem of multiple statistical comparisons (i.e, > 10,000 in a 128 x 128 image). To protect against false positives, investigators have typically relied on decreasing the per pixel false positive probability. This approach incurs an inevitable loss of power to detect statistically significant activity. An alternative approach, which relies on the assumption that areas of true neural activity will tend to stimulate signal changes over contiguous pixels, is presented. If one knows the probability distribution of such cluster sizes as a function of per pixel false positive probability, one can use cluster-size thresholds independently to reject false positives. Both Monte Carlo simulations and fMRI studies of human subjects have been used to verify that this approach can improve statistical power by as much as fivefold over techniques that rely solely on adjusting per pixel false positive probabilities. 相似文献
8.
The epidemiology of traumatic rupture of the thoracic aorta in children: a 13-year review 总被引:1,自引:0,他引:1
A C Eddy V W Rusch C L Fligner D T Reay C L Rice 《The Journal of trauma》1990,30(8):989-91; discussion 991-2
Traumatic rupture of the thoracic aorta (TRA) is a rare but highly lethal injury in children that occurs as a result of car versus pedestrian accidents and motor vehicle accidents. TRA is often associated with life-threatening injuries to other organ systems. Therefore children with TRA like adults sustaining TRA must be treated urgently but systematically. The rarity of this injury makes it all the more important for physicians treating pediatric trauma victims to be cognizant of the importance of the injury and the clinical and radiographic signs. Even when TRA is promptly recognized in children it is associated with a high in-hospital mortality. The proper use of child restraint systems and adherence to the 55 M.P.H. speed limit may be important factors in reducing the mortality of TRA in children after MVA. 相似文献
9.
Interleukin 2 (IL2) is assigned to human chromosome 4 总被引:31,自引:0,他引:31
T. Shows R. Eddy L. Haley M. Byers M. Henry T. Fujita H. Matsui T. Taniguchi 《Somatic Cell and Molecular Genetics》1984,10(3):315-318
The human gene for interleukin 2 (IL2)was assigned to chromosome 4 using human-mouse somatic cell hybrids and Southern filter hybridization of cell hybrid DNA. To identify IL2,a recombinant DNA probe (pIL2-50A) was used which contained a human interleukin 2 cDNA insert which hybridized to a 3.5-kb fragment in human DNA when cleaved with the restriction enzyme EcoRL. 相似文献
10.
Mohammad Hassanzadeh Hassan Gilanpour Saied Charkhkar Johan Buyse Eddy Decuypere 《Avian pathology》2005,34(3):188-193
The present study was designed to compare the anatomical parameters of the cardiopulmonary system in three different lines of chickens with different susceptibility to ascites syndrome. Eggs from three different genetic lines-commercial broiler and layer lines and one native to Iran--were incubated and hatched, and 1-day-old chicks used. The relative heart and lung weights, the volumes of the heart, lung and thorax cavity, the incidence of ascites, and the related physiological parameters in these chickens were followed. Lung weight as a percentage of body weight, the relative lung and heart volume, and the volumes of the thorax cavity, before and after removing heart and lung tissues, were lower in fast-growing broiler chickens compared with the layer and native chickens. Additionally, most of these parameters (e.g. relative lung weight, lung volume and thorax cavity) were significantly decreased with age in broiler chickens but were increased in layer and native chickens, which was concomitant with the incidence of ascites in broiler chickens. Our data indicate that all cardiopulmonary parameters investigated are extremely unfavourable to broiler chickens and suggest a reduction in gas exchange area in broilers, and therefore higher susceptibility to pulmonary hypertension and ascites. 相似文献