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Aberrant methylation of p16INK4a in anatomic and gender-specific subtypes of sporadic colorectal cancer. 总被引:16,自引:0,他引:16
J K Wiencke S Zheng A Lafuente M J Lafuente C Grudzen M R Wrensch R Miike A Ballesta M Trias 《Cancer epidemiology, biomarkers & prevention》1999,8(6):501-506
Colorectal cancer (CRC) occurring in the proximal colon and among women may represent a distinct subtype of the disease. In the present study of 120 sporadic CRCs, we used methylation-specific PCR to test whether methylation of the CpG island in the 5' region of the p16INK4a tumor suppressor gene was associated with anatomical location, gender, or other clinicopathological characteristics. Overall, 18.3% of the tumors had detectable p16INK4a methylation. A marked preponderance of methylated tumors occurred within the proximal colon; cancers occurring proximal to the sigmoid colon were 13.1 times more likely to contain methylated p16INK4a compared with distal tumors. In addition, female patients were 8.8 times more likely than males to have methylation-positive cancers, and p16INK4a methylation was also associated with poorly differentiated tumors. The localization of tumors with p16INK4a methylation within the proximal colon and among female patients specifically adds to a growing database of molecular alterations that define important subtypes of sporadic CRC. The potentially reversible nature of CpG methylation may provide novel therapeutic opportunities for this increasing subtype of the disease, which, due to anatomical location, presents a great challenge for early detection. 相似文献
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Ula Hwang MD MPH Scott M. Dresden MD MS Mark S. Rosenberg DO MBA Melissa M. Garrido PhD George Loo MPA MPH DrPh Jeremy Sze BS Stephanie Gravenor MBA D. Mark Courtney MD Raymond Kang MA Carolyn W. Zhu PhD Carmen Vargas‐Torres MA Corita R. Grudzen MD MSHS Lynne D. Richardson MD The GEDI WISE Investigators 《Journal of the American Geriatrics Society》2018,66(3):459-466
Objectives
To examine the effect of an emergency department (ED )‐based transitional care nurse (TCN ) on hospital use.Design
Prospective observational cohort.Setting
Three U.S. (NY , IL , NJ ) ED s from January 1, 2013, to June 30, 2015.Participants
Individuals aged 65 and older in the ED (N = 57,287).Intervention
The intervention was first TCN contact. Controls never saw a TCN during the study period.Measurements
We examined sociodemographic and clinical characteristics associated with TCN use and outcomes. The primary outcome was inpatient admission during the index ED visit (admission on Day 0). Secondary outcomes included cumulative 30‐day admission (any admission on Days 0–30) and 72‐hour ED revisits.Results
A TCN saw 5,930 (10%) individuals, 42% of whom were admitted. After accounting for observed selection bias using entropy balance, results showed that when compared to controls, TCN contact was associated with lower risk of admission (site 1: ?9.9% risk of inpatient admission, 95% confidence interval (CI ) = ?12.3% to ?7.5%; site 2: ?16.5%, 95% CI = ?18.7% to ?14.2%; site 3: ?4.7%, 95% CI = ?7.5% to ?2.0%). Participants with TCN contact had greater risk of a 72‐hour ED revisit at two sites (site 1: 1.5%, 95% CI = 0.7–2.3%; site 2: 1.4%, 95% CI = 0.7–2.1%). Risk of any admission within 30 days of the index ED visit also remained lower for TCN patients at both these sites (site 1: ?7.8%, 95% CI = ?10.3% to ?5.3%; site 2: ?13.8%, 95% CI = ?16.1% to ?11.6%).Conclusion
Targeted evaluation by geriatric ED transitions of care staff may be an effective delivery innovation to reduce risk of inpatient admission.6.
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Corita R. Grudzen Daniella Meeker Jacqueline Torres Qingling Du Ronald M. Andersen Lillian Gelberg 《AIDS and behavior》2013,17(2):517-522
A cross-sectional structured online survey was self-administered to a convenience sample of current female adult film performers via the Internet; bivariate analyses compared HIV and other STI risk behaviors, knowledge, and testing in female adult performers to California Women’s Health Survey respondents. 134 female adult film performers (mean age 27.8 years) were compared to the 1,773 female respondents (mean age 31.3 years) to the 2007 CWHS. Female performers initiated sex on average 3 years younger and had 6.8 more personal sexual partners in the prior year than other California women. The majority of performers reported HIV and Chlamydia testing (94 and 82%, respectively) in the prior 12 months. They more likely to use condoms consistently in their personal life than other California women (21 vs 17%), though this difference disappeared after controlling for other variables. Adult performers are routinely tested for HIV and Chlamydia, yet they have multiple sexual partners and use condoms inconsistently. 相似文献
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Chaplain Bruce D. Feldstein MD Marita Grudzen MHS Art Johnson MA Samuel LeBaron MD PhD 《Clinical gerontologist》2013,36(4):71-82
ABSTRACT To provide high-quality care that is responsive to spiritual concerns within a multicultural context, student physicians and other health care professionals must develop skills in spiritual care and be able to do so with patients from different cultures and different spiritual and religious backgrounds, particularly at the end of life. This article describes the experience of successfully introducing a curriculum on spirituality and multicultural literacy into the required Family Medicine Clerkship at Stanford University School of Medicine. Rather than a program of separate classes on spirituality, culture, and end-of-life care, an effective curriculum includes a matrix of learning activities that address: 1) a cross-cultural approach to spiritual needs, 2) spirituality at the end of life, 3) the impact of cultural values at the end of life, 4) the ways in which cultural and spiritual needs interact at the end of life, and 5) the interface between medical culture and a patient's culture. Integrating spirituality and culture with end-of-life care into the fabric of the medical school curriculum is an essential step toward serving our increasingly multicultural and multireligious society. 相似文献
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Grudzen C 《Prehospital and disaster medicine》2006,21(6):445-450
Americans are living longer and are more likely to be chronically or terminally ill at the time of death. Although surveys indicate that most people prefer to die at home, the majority of people in the United States die in acute care hospitals. Each year, approximately 400,000 persons suffer sudden cardiac arrest in the US, the majority occurring in the out-of-hospital setting. Mortality rates are high and reach almost 100% when prehospital care has failed to restore spontaneous circulation. Nonetheless, patients who receive little benefit or may wish to forgo life-sustaining treatment often are resuscitated. Risk versus harm of resuscitation efforts can be differentiated by various factors, including cardiac rhythm. Emergency medical services policy regarding resuscitation should consider its utility in various clinical scenarios. Patients, family members, emergency medical providers, and physicians all are important stakeholders to consider in decisions about out-of-hospital cardiac arrest. Ideally, future policy will place greater emphasis on patient preferences and quality of life by including all of these viewpoints. 相似文献
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