BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outco...
详细信息
BACKGROUND: Perforated necrotizing enterocolitis is a major cause of morbidity and mortality in premature infants, and the optimal treatment is uncertain. We designed this multicenter randomized trial to compare outcomes of primary peritoneal drainage with laparotomy and bowel resection in preterm infants with perforated necrotizing enterocolitis. METHODS: We randomly assigned 117 preterm infants (delivered before 34 weeks of gestation) with birth weights less than 1500 g and perforated necrotizing enterocolitis at 15 pediatric centers to undergo primary peritoneal drainage or laparotomy with bowel resection. Postoperative care was standardized. The primary outcome was survival at 90 days postoperatively. Secondary outcomes included dependence on parenteral nutrition 90 days postoperatively and length of hospital stay. RESULTS: At 90 days postoperatively, 19 of 55 infants assigned to primary peritoneal drainage had died (34.5 percent), as compared with 22 of 62 infants assigned to laparotomy (35.5 percent, P = 0.92). The percentages of infants who depended on total parenteral nutrition were 17 of 36 (47.2 percent) in the peritoneal-drainage group and 16 of 40 (40.0 percent) in the laparotomy group (P = 0.53). The mean (±SD) length of hospitalization for the 76 infants who were alive 90 days after operation was similar in the primary peritoneal-drainage and laparotomy groups (126±58 days and 116±56 days, respectively; P = 0.43). Subgroup analyses stratified according to the presence or absence of radiographic evidence of extensive necrotizing enterocolitis (pneumatosis intestinalis), gestational age of less than 25 weeks, and serum pH less than 7.30 at presentation showed no significant advantage of either treatment in any group. CONCLUSIONS: The type of operation performed for perforated necrotizing enterocolitis does not influence survival or other clinically important early outcomes in preterm infants.
Objective To study the prevalence of ocular disorders in adults with intellectual disabilit ies(IDs )in the *** Cross-sectional surv *** A stratified random sample(for age more than 50years and Down syndrome DS)of 159...
详细信息
Objective To study the prevalence of ocular disorders in adults with intellectual disabilit ies(IDs )in the *** Cross-sectional surv *** A stratified random sample(for age more than 50years and Down syndrome DS)of 1598participants drawn from a base population of 9012adult users of ID s ervices with mild to profound intellectual disabilitie s in the *** Participants underwent on-site visual screening on the basis of a *** were related to degree of ID,occurrence of DS,age,and a diagn osis of visual im-pairment or *** to o phthalmologists fol-lowed when visual impairment was dia *** out-come measures Diagnosis of ocular di sorders and their *** Refractive errors were most prevalent (60.6%),followed by strabismus(44.1%)and lens opacities(18.1%).Besides these,in participants dia g-nosed as visually impaired,cerebra l visual impairment was the most common untreatable disorder(12.6%),followed by macular degeneration(5.4%).Compared with known figures from general populations,t he prevalence of ocular diagnoses in adults with ID was signi ficantly *** occurrence of refractive errors and strabismus was signifi-cantly related to DS(odds ratioOR,2.16;95%con-fidence intervalCI,1.56to 3.00;and OR,2.47;95%CI,1.93to 3.17,respectively).Lens opacities had an independent relation with age more than 50years(OR,4.23;95%CI,3.04to 5.88)and DS(OR,8.27;95%CI,5.95to 11.49).Keratoconus was independently re-lated to DS(OR,7.65;95%CI,3.91to 14.96)and degree of ID(OR,5.56;95%CI,2.79to 11.06).Corneal opacities also were related to DS(OR,2.70;95%CI,1.41to 5.18)and degree of ID(OR,5.53;95%CI,2.66to 11.48).The risk of ocular hypertension was increased by age more than 50years(OR,2.54;95%CI,1.16to 5.57)and severe or profound ID(OR,4.86;95%CI,2.06to 10.63);DS decreased the risk(OR,0.21;95%CI,0.05to 0.94).Conclusions In1539adults with ID in the Netherlands,high prevalences of ocular disorders were ***
Robert Kaplan和David Norton教授于1992在哈佛商业评论上发表的研究论文——《平衡计分卡——以指标驱动业绩》(The Balanced Scorecard—Measures That Drive Performance)标志着平衡计分卡的正式问世,并成为平衡计分卡管理体系发展...
详细信息
Robert Kaplan和David Norton教授于1992在哈佛商业评论上发表的研究论文——《平衡计分卡——以指标驱动业绩》(The Balanced Scorecard—Measures That Drive Performance)标志着平衡计分卡的正式问世,并成为平衡计分卡管理体系发展与成熟的第一个里程碑。当今。
暂无评论