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David W. Morris MD Dr. Gary M. Levine MD Roger D. Soloway MD Wallace T. Miller MD Geobel A. Marin MD Gastrointestinal Section of the University of Pennsylvania Philadelphia Pennsylvania 《Digestive diseases and sciences》1975,20(12):1103-1109
Sixty patients with mild to moderate upper-gastrointestinal bleeding were admitted to a prospective, controlled study of diagnosis and management, and were randomized to endoscopy or upper-gastrointestinal (UGI) barium series as the initial study. Definitive localization of the source of bleeding was made initially in 69% of the endoscopy group and 21% of the UGI group (P<0.0005). Of 54 patients undergoing both studies, endoscopy was definitive in 67% and UGI series in 22%. Thus, endoscopy also made more diagnoses when used as the second study (P<.01). The use of endoscopy as the initial procedure led to significantly more rapid diagnosis than with UGI series. However, there were no significant differences between the two groups in clinical outcome. Endoscopy is the initial diagnostic procedure of choice in patients with mild to moderate upper-gastrointestinal bleeding because it enables detection of superficial bleeding lesions and has significantly increased the speed of diagnosis. 相似文献
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Thomas L. Gift Rakhee S. Palekar Samir V. Sodha Charlotte K. Kent Ryan P. Fagan W. Roodly Archer Paul J. Edelson Tiffany Marchbanks Achuyt Bhattarai David Swerdlow Stephen Ostroff Martin I. Meltzer for the Pennsylvania HN Working Group 《Emerging infectious diseases》2010,16(8):1315-1317
To determine the effects of school closure, we surveyed 214 households after a 1-week elementary school closure because of pandemic (H1N1) 2009. Students spent 77% of the closure days at home, 69% of students visited at least 1 other location, and 79% of households reported that adults missed no days of work to watch children. 相似文献
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Cauchemez S Bhattarai A Marchbanks TL Fagan RP Ostroff S Ferguson NM Swerdlow D;Pennsylvania HN working group 《Proceedings of the National Academy of Sciences of the United States of America》2011,108(7):2825-2830
Evaluating the impact of different social networks on the spread of respiratory diseases has been limited by a lack of detailed data on transmission outside the household setting as well as appropriate statistical methods. Here, from data collected during a H1N1 pandemic (pdm) influenza outbreak that started in an elementary school and spread in a semirural community in Pennsylvania, we quantify how transmission of influenza is affected by social networks. We set up a transmission model for which parameters are estimated from the data via Markov chain Monte Carlo sampling. Sitting next to a case or being the playmate of a case did not significantly increase the risk of infection; but the structuring of the school into classes and grades strongly affected spread. There was evidence that boys were more likely to transmit influenza to other boys than to girls (and vice versa), which mimicked the observed assortative mixing among playmates. We also investigated the presence of abnormally high transmission occurring on specific days of the outbreak. Late closure of the school (i.e., when 27% of students already had symptoms) had no significant impact on spread. School-aged individuals (6-18 y) facilitated the introduction and spread of influenza in households, but only about one in five cases aged >18 y was infected by a school-aged household member. This analysis shows the extent to which clearly defined social networks affect influenza transmission, revealing strong between-place interactions with back-and-forth waves of transmission between the school, the community, and the household. 相似文献
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Lee A. Fleisher 《麻醉与监护论坛》2010,(2):94-96
在过去的几年里大量的随机对照试验详细研究了对于非心脏手术最有效及最合适的术前心血管评估及管理,其中包括了对非心脏手术进行冠状血管重建术以及围术期β受体阻断剂疗效的评估。在2010年, 相似文献
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Peck AJ Newbern EC Feikin DR Issakbaeva ET Park BJ Fehr J LaMonte AC Le TP Burger TL Rhodes LV Weltman A Erdman D Ksiazek TG Lingappa JR;SARS Pennsylvania Case Investigation Team 《Emerging infectious diseases》2004,10(2):217-224
In early April 2003, severe acute respiratory syndrome (SARS) was diagnosed in a Pennsylvania resident after his exposure to persons with SARS in Toronto, Canada. To identify contacts of the case-patient and evaluate the risk for SARS transmission, a detailed epidemiologic investigation was performed. On the basis of this investigation, 26 persons (17 healthcare workers, 4 household contacts, and 5 others) were identified as having had close contact with this case-patient before infection-control practices were implemented. Laboratory evaluation of clinical specimens showed no evidence of transmission of SARS-associated coronavirus (SARS-CoV) infection to any close contact of this patient. This investigation documents that, under certain circumstances, SARS-CoV is not readily transmitted to close contacts, despite ample unprotected exposures. Improving the understanding of risk factors for transmission will help focus public health control measures. 相似文献
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MacKenzie EJ McCarthy ML Ditunno JF Forrester-Staz C Gruen GS Marion DW Schwab WC;Pennsylvania Study Group on Functional Outcomes Following Trauma 《The Journal of trauma》2002,52(3):527-534
BACKGROUND: The purpose of this study was to evaluate the validity of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) for examining outcomes after multiple trauma and to investigate whether the addition of items selected to measure cognitive function could improve the sensitivity of the SF-36 for identifying differences in outcomes for patients with and without head injury. METHODS: One thousand two hundred thirty patients discharged from 12 trauma centers were interviewed 1 year after injury. The interview included the SF-36 supplemented with four items chosen to assess cognitive function. RESULTS: The resulting cognitive function scale is internally consistent and measures a component of health that is independent of the dimensions incorporated in the SF-36. It correlates well with established measures of brain injury severity and discriminates among patients with and without brain injury. CONCLUSION: This study underscores the need to supplement the SF-36 with a measure of cognitive function when evaluating outcome from multiple trauma involving head injury. Further studies are needed to validate the specific items chosen for measuring cognitive function. 相似文献
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