检索结果-内蒙古大学图书馆

Heart failure disease management in an indigent population

AMERICAN HEART JOURNAL 2001年第2期141卷 254-258页

作者： O'Connell, AM Crawford, MH Abrams, J Univ New Mexico Sch Med Albuquerque NM 87131 USA

Background Multidisciplinary disease management programs (MDMP) have demonstrated reduced hospitalizations in motivated pretransplant heart failure populations, but little is known about their effectiveness in largely indigent patients who are not transplant candidates. Methods and Results We studied 35 patients with heart failure with left ventricular election fraction (EF) less than or equal to 45% enrolled in an MDMP who were either indigent or funded by Medicaid/Medicare. This nonrandomized sample consisted of 14 patients identified because they had hospital readmission rates of greater than or equal to2 per year (group A) and 21 patients referred by their primary care physicians because they were difficult to manege (group B). Group A patients were New York Heart Association (NYHA) class III or IV, aged 25 to 87 years (mean 57 +/- 17 SD) and had an EF of 15% to 45% (29% +/- 11%). Group B patients were NYHA class II or III, aged 35 to 86 (57 +/- 16) years and had an EF of 20% to 45% (28% +/- 10%): Data were compared for the year before enrollment in the MDMP and the year afterward. In group A hospital admissions decreased from 33 to 3, a 91% reduction, and NYHA class improved to class II-III (P < .001). In group B hospital admissions decreased from 9 to 0, and NYHA class improved to class I-II (P < .001). When hospital and clinic charges were assessed for both groups, the net savings were $162,000 per year or $4600 per patient. Conclusions A multidisciplinary heart failure program can improve functional status and reduce hospitalization and net costs compared with conventional care in indigent non-transplant candidate patients.

关键词：成本及成本分析医院费用住院/经济学住院/统计学和数值数据医疗费用无力承担/经济学未参加医疗保险者/统计学和数值数据回顾性研究美国成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

A comparison of effectiveness and cost between two models of care for individuals with schizophrenia living in Taiwan

引用

ARCHIVES OF PSYCHIATRIC NURSING 2001年第6期15卷 272-278页

作者： Lin, ECL Yin, TJC Kuo, BIT Chang, WY Tsai, SL Hung Kuang Inst Technol Hung Kuang Taiwan Taipei Vet Gen Hosp Taipei Taiwan Taipei Med Univ Taipei Taiwan

Schizophrenia is a chronic disease that places tremendous costs and burden on patients, families, and communities. The purpose of this study was to compare the cost and effectiveness of a hospital-based home care model and a traditional community care model for schizophrenia in Taiwan using six principles of cost-effectiveness analysis. Based on the health care provider's analytic perspective, four effectiveness indicators and four service costs were, identified and measured, and the ratio of average cost value to effectiveness score for each patient was calculated. According to that ratio, the hospital-based home care model was more cost-effective. The results suggest that the hospital-based outreach home care model is a cost-effective way to care for patients and their family in the community. Copyright (C) 2001 by W.B. Saunders Company.

关键词：社区精神卫生服务/经济学社区精神卫生服务/标准社区和机构的关系费用效益分析直接服务费用/统计学和数值数据卫生保健费用/统计学和数值数据卫生服务研究家庭医疗保健服务基于医院的/经济学家庭医疗保健服务基于医院的/标准住院/经济学住院/统计学和数值数据模型组织管理方案评价质量指标卫生保健精神分裂症/治疗敏感性与特异性台湾治疗结果成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Late-onset heart failure as a mechanism for adverse long-term outcome in diabetic patients undergoing revascularization (A 13-year report from the Lady Davis Carmel Medical Center registry)

引用

AMERICAN JOURNAL OF CARDIOLOGY 2000年第12期85卷 1420-1426页

作者： Halon, DA Merdler, A Flugelman, MY Rennert, HS Weisz, G Shahla, J Lewis, BS Lady Davies Carmel Hosp Dept Cardiol Cardiovasc Res Unit IL-34362 Haifa Israel Lady Davies Carmel Hosp Dept Community Med & Epidemiol IL-34362 Haifa Israel Technion Israel Inst Technol Bruce Rappaport Sch Med Haifa Israel

The adverse long-term prognosis following myocardial revascularization in diabetic patients has been ascribed to accelerated coronary disease, a higher incidence of late coronary restenosis after revascularization, and myocardial dysfunction. To examine the development of heart failure and its prognostic implications in diabetic patients, we analyzed the long-term (13-year) follow-up data of 363 patients-193 percutaneous transluminal coronary angioplasties and 170 coronary artery bypass operations-revascularized in a single cardiovascular center from 1984 to 1986. Baseline characteristics (age, previous infarction, baseline ventricular function) were similar in the 80 diabetic and 283 nondiabetic patients;multivessel disease and hypertension were marginally more common in diabetics (p = NS). Cumulative incidence of hospitalization for heart failure was high in the diabetic cohort (25% vs 11%, p = 0.001), with a rapidly increasing incidence after 5 years. Survival after first hospitalization for heart failure was markedly reduced in diabetics (11 of 20 [55%] vs 25 of 31 [81%] at 3 years;p = 0.04), as was survival free of further hospitalization for heart failure (5 of 20 [25%] vs 20 of 30 [63%];p < 0.005). Long-term 13-year survival (43% vs 78%, p < 0.0001) and survival free of heart failure (33% vs 71%, p < 0.0001) were decreased in diabetics, especially those with reduced ventricular function at baseline (17% vs 42%, p = 0.07). Multivariate analysis showed diabetes to be the strongest independent predictor of decreased survival (odds ratio 3.6, 95% confidence interval 2.0 to 6.2;p < 0.0001) and survival free of heart failure (odds ratio 4.0, 95% confidence interval 2.2 to 7.1;p < 0.0001) in patients undergoing revascularization. In summary, late-onset heart failure was frequent in diabetic patients after percutaneous transluminal coronary angioplasty or coronary artery bypass grafting, and once present heralded an unrelenting progressive downhill clinical course. (

关键词：血管成形术经腔经皮冠状动脉冠状动脉分流术冠心病/并发症冠心病/死亡率冠心病/治疗糖尿病并发症无病生存随访研究住院/统计学和数值数据预后存活率分析时间因素治疗结果女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations

引用

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第7期35卷 1737-1744页

作者： Silverberg, DS Wexler, D Blum, M Keren, G Sheps, D Leibovitch, E Brosh, D Laniado, S Schwartz, D Yachnin, T Shapira, I Gavish, D Baruch, R Koifman, B Kaplan, C Steinbruch, S Iaina, A Tel Aviv Med Ctr & Sch Med Dept Nephrol & Cardiol IL-64239 Tel Aviv Israel Tel Aviv Med Ctr & Sch Med Congest Heart Failure Program IL-64239 Tel Aviv Israel

OBJECTIVES This study evaluated the prevalence and severity of anemia in patients with congestive heart failure (CHF) and the effect of its correction on cardiac and renal function and hospitalization. BACKGROUND The prevalence and significance of mild anemia in patients with CHF is uncertain, and the role of erythropoietin with intravenous iron supplementation in treating this anemia is unknown. METHODS In a retrospective study, the records of the 142 patients in our CHF clinic were reviewed to find the prevalence and severity of anemia (hemoglobin [Hb] <12 g). In an intervention study, 26 of these patients, despite maximally tolerated therapy of CHF for at least six months, still had had severe CHF and were also anemic. They were treated with subcutaneous erythropoietin and intravenous iron sufficient to increase the Hb to 12 g%. The doses of the CHF medications, except for diuretics, were not changed during the intervention period. RESULTS The prevalence of anemia in the 142 patients increased with the severity of CHF, reaching 79.1% in those with New York Heart Association class IV. In the intervention study, the anemia of the 26 patients was treated for a mean of 7.2 +/- 5.5 months. The mean Hb level and mean left ventricular ejection fraction increased significantly. The mean number of hospitalizations fell by 91.9% compared with a similar period before the study. The New York Heart Association class fell significantly, as did the doses of oral and intravenous furosemide. The rate of fall of the glomerular filtration rate slowed with the treatment. CONCLUSIONS Anemia is very common in CHF and its successful treatment is associated with a significant improvement in cardiac function, functional class, renal function and in a marked fall in the need for diuretics and hospitalization. (J Am Coll Cardiol 2000;35:1737-44) (C) 2000 by the American College of Cardiology.

关键词：贫血缺铁性/药物疗法贫血缺铁性/流行病学贫血缺铁性/病因学贫血缺铁性/病理生理学红细胞生成素/投药和剂量肾小球滤过率/药物作用肾小球滤过率/生理学心力衰竭/并发症心力衰竭/病理生理学住院/统计学和数值数据注射静脉内注射皮下铁/投药和剂量患病率回顾性研究疾病严重程度指数每搏输出量/药物作用每搏输出量/生理学老年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Prediction of hospital utilization among elderly patients during the 6 months after an emergency department visit

引用

ANNALS OF EMERGENCY MEDICINE 2000年第5期36卷 438-445页

作者： McCusker, J Bellavance, F Cardin, S Belzile, E Verdon, J St Marys Hosp Dept Clin Epidemiol & Community Studies Montreal PQ H3T 1M5 Canada McGill Univ Dept Epidemiol & Biostat Montreal PQ Canada Univ Montreal Sch Business Montreal PQ Canada Univ Montreal Hosp Ctr Dept Geriatr Montreal PQ Canada

Study objective: A simple screening tool, Identification of Seniors at Risk (ISAR), developed for administration in the emergency department for patients 65 years and older, predicts adverse health outcomes during the 6 months after the ED visit. In this study, we investigated whether the ISAR tool can also predict acute care hospital utilization in the same population. Methods: Patients 65 years and older who visited the EDs of 4 acute care Montreal hospitals during the weekday shift over a 3-month period were enrolled. At the initial (index) ED visit, 27 self-report screening questions (including the 6 ISAR items) were administered. The number of acute care hospital days during the 6 months after the index visit were abstracted from the provincial hospital discharge database. High utilization was defined as the top decile of the distribution of acute care hospital days. Results: Among 1,620 patients with linked data, a score of 2+ on the ISAR tool predicted high hospital utilization with a sensitivity of 73% and a specificity of 51%, the area under the receiver operating characteristic curve was 0.68. The ISAR tool also performed well in subgroups defined by disposition (admitted versus discharged) and by age (65 to 74 years versus 75 years and older). Conclusion: The ISAR tool, a 6-item self-report questionnaire, can be used in the ED to identify elderly patients who will experience high acute care hospital utilization as well as adverse health outcomes.

关键词：急诊室医院/利用预测老年人身心健康评价住院/统计学和数值数据魁北克问卷调查时间因素老年人老年人 80以上女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Air particulate pollution and hospital admissions for chronic obstructive pulmonary disease in Reno, Nevada

引用

INHALATION TOXICOLOGY 2000年第4期12卷 281-298页

作者： Chen, L Yang, W Jennison, BL Omaye, ST Univ Nevada Dept Nutr & Environm Sci & Hlth Grad Program Reno NV 89557 USA Nevada State Hlth Div Bur Hlth Planning & Stat Carson City NV USA Washoe Cty Dist Hlth Dept Air Qual Management Div Reno NV USA

This study assessed the association between ambient PM10 pollution and daily hospital admissions for chronic obstructive pulmonary disease (COPD) in Reno-Sparks, Nevada, for the period 1990-1994. All three hospitals in the region were included. There was a total of 3115 admissions for COPD during this period. Daily ambient PM10, values were available from one of seven air monitoring stations in this region. Weather variables including temperature and wind speed were also collected from this station. The daily average concentration of PM10 was 36.55 mu g/m(3). The generalized additive model (GAM) was used in the whole analysis. After adjusting for the effects of weather variables, day of week, seasons, and time trend, the results show that PM10 is a statistically significant predictor for daily hospital admissions for COPD. The relative risk (RR) of hospital admissions for COPD for an interquartile increase (26.6 mu g/m(3)) of the 24-h average level of PM10 is 1.049 (95% CI 1.071-1.087).

关键词：空气污染物/分析空气污染/统计学和数值数据住院/统计学和数值数据医院公立吸入暴露肺疾病阻塞性/化学诱导肺疾病阻塞性/流行病学内华达/流行病学粒子大小病人入院/统计学和数值数据危险因素季节城市卫生天气人类

来源：评论

学校读者我要写书评

暂无评论

Ten-year outcome: patients with schizoaffective disorders, schizophrenia, affective disorders and mood-incongruent psychotic symptoms

引用

BRITISH JOURNAL OF PSYCHIATRY 2000年第5期177卷 421-426页

作者： Harrow, M Grossman, LS Herbener, ES Davies, EW Univ Illinois Coll Med Dept Psychiat MC912 Chicago IL 60612 USA Univ Chicago Dept Psychol Chicago IL 60637 USA

Background It is unclear whether outcome in schizoaffective disorders is more similar to schizophrenia or affective disorders. Aims To provide longitudinal data on clinical course and outcome in schizophrenia or affective disorders versus schizophrenia and affective disorders, and determine whether mood-incongruent psychotic symptoms have negative prognostic implications. Method A total of 210 patients with schizoaffective disorders, schizophrenia, bipolar manic-disorders and depression were assessed at hospitalisation and then followed up four times over 10 years. Results At all four follow-ups, fewer patients with schizoaffective disorders than with schizophrenia showed uniformly poor outcome. Patients with mood-incongruent psychotic symptoms during index hospitalisation showed significantly poorer subsequent outcome (P < 0.05). Conclusions Schizoaffective outcome was better than schizophrenic outcome and poorer than outcome for psychotic affective disorders. Mood-incongruent psychotic symptoms have negative prognostic implications. The results could fit a symptom dimension view of schizoaffective course. Declaration of interest Supported by a research grant from the National institute of Mental Health, USA.

关键词：急性病情感障碍精神病性/诊断情感障碍精神病性/药物疗法情感障碍精神病性/康复方差分析随访研究住院/统计学和数值数据病人再入院/统计学和数值数据预后前瞻性研究精神病/诊断精神病/药物疗法精神病/康复精神分裂症/诊断精神分裂症/药物疗法精神分裂症/康复治疗结果成年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

First steps in analysing NHS waiting times: avoiding the 'stationary and closed population' fallacy

引用

STATISTICS IN MEDICINE 2000年第15期19卷 2037-2051页

作者： Armstrong, PW Univ E London Dept Hlth Sci London E15 4LZ England

The aim of this paper is to demonstrate the effect of excluding incomplete observations and competing events when calculating cross-sectional measures of NHS waiting times, and to obtain a more accurate estimate of the 'time-to-admission' of those listed on NHS waiting lists using lifetable methods. The official 'times-since-enrolment' of all elective 'admissions' in England, 1 July to 31 December 1994 inclusive, were extracted from Hospital Episode Statistics. The official 'times-to-census' of all those on a waiting list in England at 30 September 1994 were obtained from aggregated KH07 data. The percentage waiting at least three months, at least six months etc., was calculated separately for each data set and compared with a period lifetable derived from the combined data. The cumulative likelihood of elective admission is markedly overestimated across the whole range of waiting times. The experience of those still waiting, those removed from the list, those suspended or deferred and those put to the back of the queue is not taken into account in the calculation of official waiting times. The Department of Health currently presents the 'time-since-enrolment' of those admitted as though it indicates how long all patients can expect to wait for admission. The consequent bias in published summary statistics incorrectly quantifies the real experience of patients. It is recommended that calculation of waiting times from KH07 census counts and Hospital Episode Statistics be reconsidered in the light of what patients, clinicians, managers and politicians need to know about treatment delay. Copyright (C) 2000 John Wiley & Sons, Ltd.

关键词：急症英格兰政府机构住院/统计学和数值数据寿命表似然函数概率公费医疗/统计学和数值数据时间因素预约名单

来源：评论

学校读者我要写书评

暂无评论

Three-year outcome of first-episode psychoses in an established community psychiatric service

引用

BRITISH JOURNAL OF PSYCHIATRY 2000年第3期176卷 210-216页

作者： Singh, SP Croudace, T Amin, S Kwiecinski, R Medley, I Jones, PB Harrison, G Univ Nottingham Div Psychiat Nottingham NG7 2RD England Univ Bristol Div Psychiat Bristol BS8 1TH Avon England

Background Changes inservice provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis. Aims To assess the three-year outcome of an inception cohort of first-episode psychoses treated ina modern, community oriented service;to compare outcomes with an earlier cohort treated in hospital-based care;and to examine-the predictive validity of ICD-10 diagnostic criteria. Method Three-year follow-up (1995-1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980-1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort. Results On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability. Conclusions Ina modern community service, 30-60% of patients with first-episode psychoses experience a goad three-year outcome. The ICD-10 criteria have good predictive validity.

关键词：日常生活活动队列研究社区精神卫生服务/组织和管理就业/统计学和数值数据随访研究住院/统计学和数值数据结果评价(卫生保健) 病人满意度试验预期值精神病/分类精神病/诊断精神病/康复青少年成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Ocular trauma in the United States army: Hospitalization records from 1985 through 1994

引用

AMERICAN JOURNAL OF OPHTHALMOLOGY 2000年第5期129卷 645-650页

作者： Wong, TY Smith, GS Lincoln, AE Tielsch, JM Johns Hopkins Univ Sch Hyg & Publ Hlth Ctr Injury Res & Policy Baltimore MD 21205 USA Johns Hopkins Univ Sch Hyg & Publ Hlth Dept Int Hlth Baltimore MD 21205 USA Natl Univ Singapore Singapore Natl Eye Ctr Singapore 117548 Singapore Natl Univ Singapore Dept Ophthalmol Singapore 117548 Singapore Univ Wisconsin Dept Ophthalmol & Visual Sci Madison WI USA

PURPOSE: To determine the incidence of hospitalized ocular injury in the United States Army and evaluate specific types and external causes of these injuries. METHODS: A US Army database that captured all hospital discharge records for Army personnel admitted to military and civilian hospitals was used to determine incident episodes of ocular injury requiring hospitalization from 1985 through 1994, Denominator data were available from the US Army, RESULTS: The average annual incidence of hospitalization for a principal or secondary diagnosis of ocular trauma (total hospitalized ocular injury) was 77.1 per 100,000 persons (95% confidence interval, 75.1-79.2), There was a 38% decline in the rate of total hospitalized ocular injury during this 10-year period, Men had twice the rates of women over all age groups. The highest rate occurred in the 17- to 19-year age group, with rates of 220.7 and 123,4 per 100,000 in men and women, respectively. Whites had a higher rate than blacks and nonwhites-nonblacks, Almost a third of the injuries were contusions of the eye and adnexa, Among men, the leading causes were machinery or tools (21%), fights (18%), transport accidents (18%), and sports and training (11%). Only 7% were related to weaponry or war, and of these, 90% were from nonbattle activities. CONCLUSION: The type and cause of injury suggest that preventive measures may be effective in decreasing the incidence of ocular trauma requiring hospitalization in US Army personnel, (C) 2000 by Elsevier Science Inc. All rights reserved.

关键词：年龄分布眼损伤/流行病学医院记录/统计学和数值数据住院/统计学和数值数据医院军队/统计学和数值数据发病率军事医学/统计学和数值数据军事人员/统计学和数值数据美国/流行病学青少年成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：