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1.
D Bild L S Geiss S M Teutsch B Gabella B A Hudspeth R M Schubert C W Gollmar D J Kaplan F A Connell J C Will 《Journal of clinical epidemiology》1988,41(10):999-1006
The pilot study for a sentinel health events surveillance system for deaths among persons under age 45 with diabetes was conducted in six states in 1984 and 1985. Two hundred and thirty-three events were identified. Information from death certificates, physicians, and families revealed that 22% died from acute complications of diabetes and 53% from chronic complications. Blood pressure measurement and urinalysis testing had been performed in the last year for almost all of the decedents, but other preventive practices were reported less frequently. Hypertension was present in 57% and of those, was not controlled in 73%. Forty-four percent were cigarette smokers at the time of death. Agreement between physicians and families was generally higher for clinical conditions than for care practices. This surveillance system appears to yield information about the health care of persons with diabetes not readily available from other sources, although modifications may be necessary before implementation. 相似文献
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Arthrograms of the temporomandibular joint were obtained in 20 symptomatic joints that had previous reconstructive arthroplasty with disk repositioning because of internal derangements. Preoperative arthrograms were available for comparison in 18 joints. Symptoms resulting in a postoperative arthrogram included pain, limited ability to open the mouth, and clicking of the joints. Postoperative arthrographic findings included limited anterior translation of the condyle (90%), irregularity in outline of the intraarticular contrast agent (60%), a conical configuration of the posterior recess (25%), decreased size of the joint (28%), anterior displacement of the meniscus (25%), and perforated meniscus (15%). Many of these findings may have resulted from fibrosis and scarring, which may be a response to intraarticular bleeding. The mechanism by which the fibrosis causes the postsurgical arthrographic features is discussed. 相似文献
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M. M. Engelgau K. M. Narayan L. S. Geiss T. J. Thompson G. L. Beckles L. Lopez T. Hartwell W. Visscher L. Liburd 《Journal of the National Medical Association》1998,90(10):605-613
Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) is the first comprehensive community diabetes demonstration project in the United States in an African-American community. This article describes its intervention components and evaluation design. The development and implementation of Project DIRECT has included the community since the project''s beginning. Interventions are targeted in three areas: health promotion (improving diet and physical activity levels), outreach (improving diabetes awareness, detection of undiagnosed diabetes, and ensuring that persons with diabetes who are not receiving continuing diabetes care are integrated into the health-care system), and diabetes care (improving self-care, increasing access, and improving the quality of diabetes preventive care received within the health-care system). Evaluation will be internal (conducted by Project DIRECT staff to assess process outcomes in persons directly exposed to each specific intervention) and external (review of outcomes to assess the impact of the multi-intervention program at the level of the entire community). Because diabetes exacts a disproportionate toll among African Americans, the findings from this project should aid in developing strategies to lessen the burden of this disorder, particularly among minority populations. 相似文献
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Han JY; Kim HK; Choi BG; Moon H; Hong YS; Lee KS 《Japanese journal of clinical oncology》1998,28(12):749-753
BACKGROUND: Quality of life (QOL) assessment has emerged to measure and
quantify the balance between treatment benefit and toxicity, and has a
value in predicting response and overall survival in cancer patients.
METHODS: From July 1995 to February 1997, 38 symptomatic patients with
advanced non-small cell lung cancer (NSCLC) were treated with MIP
chemotherapy (mitomycin 6 mg/m2, ifosfamide 3000 mg/m2 and cisplatin 50
mg/m2 on day 1 every 3 weeks). Patients were assessed for QOL including
physical well-being, general symptoms and lung cancer-specific symptoms, as
well as objective response. RESULTS: The overall response rate was 38.9%
(14/36, all were partial response) and the median duration of response was
3.5 months [95% confidence interval (CI) 2.0-4.0]. The median duration of
overall survival was 7 months (95% CI 5.9-8.5). The overall improvement of
QOL was 58.3% with 21 patients feeling better on treatment. The toxicity of
chemotherapy was mild, mainly nausea/vomiting and minimal alopecia. Using
multiple clinical predictors of survival (age, histology, stage,
performance status), only change of QOL emerged significantly (P = 0.0007).
CONCLUSIONS: MIP had an endurable response and low toxicity profile, and
provided good QOL. Integral QOL data in our study provided the strong
prediction of survival in advanced NSCLC. Further experienced QOL study
will provide greatly enhanced outcome data in clinical trials.
相似文献
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Hoy FB Mueller DK Geiss DM Munns JR Bond LM Linett CE Gomez RC 《The Annals of thoracic surgery》2000,70(4):1259-1263
BACKGROUND: Early implantation of centrifugal devices in patients with postcardiotomy cardiogenic shock may provide a bridge to recovery and allow subsequent long-term survival. METHODS: Since January 1989, 62 patients were supported with centrifugal pumps because of failure to wean from cardiopulmonary bypass. Indications were postcardiotomy cardiogenic shock (PCCS) (n = 60), bridge to cardiac retransplantation (n = 1), and right ventricular failure (n = 1). Patients' ages ranged from 23 to 78 years; 40 were men (65%), and 22 were women (35%). Twenty-two patients (35%) had a left ventricular assist device; 9 patients (15%) had a right ventricular assist device; and 31 patients (50%) had a biventricular assist device. Length of support ranged from 1 day to 19 days. RESULTS: Forty-two patients (68%) were weaned successfully; 27 patients survived to discharge (44%). Complications included bleeding (n = 41, 66%), renal failure (n = 28, 45%), and respiratory failure (n = 26, 42%). Currently, 23 patients survived 10 or more years (n = 1), 6 to 10 years (n = 7), 1 to 5 years (n = 10), and less than 1 year (n = 5). CONCLUSIONS: Centrifugal pumps are available, easy to use, and relatively inexpensive. Our experience justifies their continued use as a bridge to recovery for patients with postcardiotomy cardiogenic shock, despite the availability and increasing use of more expensive devices. 相似文献
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