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المؤلفون: Francis Okongo, Donald Maxwell Parkin, David Martin Ogwang, Biying Liu
المصدر: International Journal of Cancer. 144:2985-2991
مصطلحات موضوعية: Male, Cancer Research, Adolescent, Population, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Neoplasms, medicine, Humans, Uganda, Registries, Child, education, Cervical cancer, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), Infant, Newborn, Infant, Cancer, medicine.disease, Cancer registry, Non-Hodgkin's lymphoma, Oncology, Child, Preschool, 030220 oncology & carcinogenesis, Female, Skin cancer, business, Demography
الوصف: Gulu Cancer Registry was established in 2014 to assess the incidence and survival of cancer in 4 districts of the Acholi Sub-region of northern Uganda. Here we report the results of the first 4 years of registration (2013-2016) in this largely rural population of 771,514. In total there were 1627 cases of cancers registered; 644 among men (corresponding to an ASR of 106.7 per 100,000 population) and 983 cancer cases among women (ASR 118.5 per 100,000). The most common cancers were cancers of the cervix and non-Hodgkin Lymphoma in females, and non-Hodgkin Lymphoma, Kaposi Sarcoma, prostate and liver cancers in men. Incidence rates of Burkitt lymphoma in children were high in comparison to elsewhere in Africa, whilst the incidence of breast cancer in women was rather low. The figures suggest a rather different pattern from that observed in the metropolitan population of Kampala, where there has been a cancer registry since 1951. This helps to provide a more complete picture of the national cancer profile, permitting more targeted interventions in prevention, early detection and treatment services.
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المؤلفون: Kevin Haynes, Thomas Harkins, Nancy D. Lin, Crystal Garcia, Vinit P. Nair, Sean D. Pokorney, Noelle M. Cocoros, David Martin, Sana M. Al-Khatib, Christopher B. Granger, Lauren E. Parlett, Hussein R. Al-Khalidi, Jennifer C. Goldsack, Cheryl N. McMahill-Walraven, Richard Platt, Debbe McCall, Hana Lipowicz
المصدر: Am Heart J
مصطلحات موضوعية: Male, medicine.medical_specialty, Anemia, Population, Administration, Oral, Pharmacy, Comorbidity, 030204 cardiovascular system & hematology, Health Services Misuse, Risk Assessment, Article, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Risk Factors, Internal medicine, Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, education, Stroke, Aged, Aged, 80 and over, education.field_of_study, Health Services Needs and Demand, Insurance, Health, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Quality Improvement, United States, Cohort, Female, Diagnosis code, Cardiology and Cardiovascular Medicine, business
الوصف: BACKGROUND: Although oral anticoagulants (OACs) have been shown to substantially reduce the risk of stroke and other thromboembolic events in patients with atrial fibrillation (AF), these medications are significantly underutilized in clinical practice. However, many studies showing underuse of OACs predated the advent of the non-vitamin K antagonist oral anticoagulants. We conducted this study to examine use of OACs in a large commercially insured population, which was enrolled in a randomized trial to address underuse of OACs. METHODS: Administrative health care claims data from 5 research partners who participate in the FDA-Catalyst, a program of the Sentinel Initiative, were queried in September 2017 to identify patients ≥30 years old with ≥365 days of medical/pharmacy coverage, ≥2 diagnosis codes for AF, a CHA(2)DS(2)-VASc score ≥2, absence of selected conditions for which OAC use is contraindicated, and no evidence of OAC use in the 365 days prior to the index AF diagnosis. The identified cohort has been targeted for enrollment in the IMPACT-AFib trial, a randomized clinical trial evaluating the effect of patient and provider education interventions on the use of OACs. RESULTS: A total of 241,044 AF patients met the cohort eligibility criteria prior to assessment of OAC treatment. In this cohort, 220,869 (92%) patients were ≥ 65 years old and 94,459 (39%) patients were ≥ 80 years old. Patients were randomized to early or delayed intervention. Among 120,522 patients randomized to the early intervention arm, 43,826 (36%) had no evidence of OAC use in the prior 12 months. Compared with patients with evidence of an OAC use in the prior 12 months, patients without OAC use were more likely to be 80 years of age or older, women, and residents of the Midwest region. Patients without OAC use were more likely to have a history of anemia (52% vs. 48%) and less likely to have diabetes (39% vs. 44%), a history of stroke or TIA (17% vs. 20%), and a history of heart failure (40% vs. 48%). The mean CHA(2)DS(2)-VASc score was 5 for both the OAC and no-OAC recipients; however, patients with no OAC use had a higher ATRIA score (39% vs. 35%). CONCLUSIONS: Data from a large privately insured population show that despite a high risk of stroke, over one third of patients with AF and no obvious contraindications to an OAC were not treated with an OAC in the prior 12 months. Thus, there is an unmet medical need for studies that develop evidence-based interventions that could lead to greater use of OACs in patients with AF who are at risk for stroke.
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المؤلفون: Hal David Martin, RobRoy L. Martin, Benjamin R. Kivlan
المصدر: International Journal of Sports Physical Therapy. 12:1163-1173
مصطلحات موضوعية: 030222 orthopedics, medicine.medical_specialty, education.field_of_study, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Population, Neurectomy, Physical examination, Sequela, medicine.disease, Surgery, 03 medical and health sciences, Entrapment, 0302 clinical medicine, medicine.anatomical_structure, medicine, Clinical Commentary, Manual therapy, business, education, 030217 neurology & neurosurgery, Neurolysis, Pelvis
الوصف: The purpose of this clinical commentary is to review the anatomy, etiology, evaluation, and treatment techniques for nerve entrapments of the hip region. Nerve entrapment can occur around musculotendinous, osseous, and ligamentous structures because of the potential for increased strain and compression on the peripheral nerve at those sites. The sequela of localized trauma may also result in nerve entrapment if normal nerve gliding is prevented. Nerve entrapment can be difficult to diagnose because patient complaints may be similar to and coexist with other musculoskeletal conditions in the hip and pelvic region. However, a detailed description of symptom location and findings from a comprehensive physical examination can be used to determine if an entrapment has occurred, and if so where. The sciatic, pudendal, obturator, femoral, and lateral femoral cutaneous are nerves that can be entrapped and serve a source of hip pain in the athletic population. Manual therapy, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education are potential interventions. When conservative treatment is ineffective at relieving symptoms surgical treatment with neurolysis or neurectomy may be considered. Level of Evidence 5
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::35b96166763cbfe03869ce7e9fd33cbc
https://doi.org/10.26603/ijspt20171163 -
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المؤلفون: Mahdi Malekpour, Diane Leonard, Denise Torres, Susan Baro, James Dove, Nina Neuhaus, Mohsen Shabahang, Jeffrey Wild, Marie Hunsinger, Kenneth Widom, Joseph Blansfield, David Martin, Megan Rapp
المصدر: The American Journal of Surgery. 213:399-404
مصطلحات موضوعية: Adult, Diagnostic Imaging, Male, Patient Transfer, Rural Population, Emergency Medical Services, medicine.medical_specialty, Time Factors, education, Population, Traumatology, Cohort Studies, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, medicine, Emergency medical services, Humans, 030212 general & internal medicine, Young adult, Referral and Consultation, Patient transfer, Aged, Retrospective Studies, Patient Care Team, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Retrospective cohort study, General Medicine, Middle Aged, Pennsylvania, Emergency medicine, Wounds and Injuries, Female, Surgery, Rural Health Services, Rural area, business, Cohort study
الوصف: The majority of the US population live in urban areas, yet more than half of all trauma deaths occur in rural areas. The Rural Trauma Team Development Course (RTTDC) is developed to improve the outcomes of rural trauma and we aimed to study its effect on patient transfer.Trauma referrals 2 years before the RTTDC training were compared with referrals 2 years after the course.Of the 276 studied patients, 97 were referred before the RTTDC training and 179 patients were referred after the course. Transfer acceptance time was significantly shorter after the RTTDC training (139.2 ± 87.1 vs 110 ± 66.3 min, P = .003). The overall transfer time was also significantly reduced following the RTTDC training (257.4 ± 110.8 vs 219.2 ± 86.5 min, P = .002). Patients receiving pretransfer imaging had a significantly higher transfer time both before and after RTTDC training (all Ps.01). Mortality was nearly halved (6.2% vs 3.4%) after the RTTDC training.The RTTDC training was associated with reduced transfer acceptance time and reduced transfer time.
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المؤلفون: Anna A. Kuang, Brian S. Diggs, Nick O. Esmonde, Heike Gries, Martin A. Schreiber, Nathan R. Selden, David Martin, Jeffrey L. Koh
المصدر: Journal of Craniofacial Surgery. 27:1527-1531
مصطلحات موضوعية: medicine.medical_specialty, Population, Blood Loss, Surgical, Hemorrhage, 030230 surgery, Hematocrit, Craniosynostosis, Craniosynostoses, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Blood product, Antifibrinolytic agent, Humans, Medicine, education, Retrospective Studies, education.field_of_study, Surgical team, medicine.diagnostic_test, business.industry, Infant, General Medicine, Perioperative, medicine.disease, Antifibrinolytic Agents, Surgery, Tranexamic Acid, Otorhinolaryngology, Anesthesia, business, 030217 neurology & neurosurgery, Tranexamic acid, medicine.drug
الوصف: Pediatric cranial vault remodeling for repair of craniosynostosis is associated with significant blood loss and transfusion requirements. Beginning in 2011, the authors evaluated the impact tranexamic acid (TXA) on blood loss and blood product transfusion for children less than 15 months of age undergoing primary surgical repair of nonsyndromic single suture craniosynostosis.Following institutional review board approval, the authors performed a retrospective study of all children undergoing surgical correction of craniosynostosis at Oregon HealthScience University from 2005 to 2015. All available records were reviewed, and patient data were collected from the time of preoperative evaluation until discharge, comparing patient and clinical variables before and after the implementation of perioperative TXA.Of a total of 259 patients with craniosynostosis, 187 had nonsyndromic single-suture involvement; 69 of these patients (36.9%) received TXA. A single surgical team (AAK and NRS) performed all operations. Median age at the time of surgery was 8.1 months (interquartile range [IQR] of 6.0-9.8 months). The TXA group had a significant reduction in estimated intraoperative blood loss (26 mL/kg versus 36 mL/kg, P 0.001), cell saver volume transfused 6 mL/kg versus 10 mL/kg, P 0.001), red cell transfusion volume (32 mL/kg versus 42 mL/kg, P 0.001), exposure to plasma transfusion (0% versus 24% P 0.001), exposure to cryoprecipitate transfusion (0% versus 16%, P 0.001), and exposure to platelet transfusion (0% versus 7.6% P = 0.03). Despite reduced red cell transfusion, the TXA-treated patients exhibited similar postoperative hematocrits (30.4 versus 30.3 P = 0.906) to those not treated with TXA. Use of TXA was associated with reduced length of stay (4 days IQR 3-4 versus 4 days IQR 4-5, P 0.001) and reduced postoperative output from surgically placed drains (181 mL versus 311 mL P 0.001). There was no difference in postoperative complications between groups and no deaths in either group.The introduction of TXA for nonsyndromic single-suture synostosis repair at our institution has significantly reduced blood loss and blood product and plasma transfusion during and following primary cranial vault remodeling for single suture craniosynostosis. Postoperative hematocrit was similar in the TXA-treated and untreated groups despite reduced red cell transfusion in the treated group. In addition, TXA use in this population has eliminated the need for plasma transfusion, and is associated with a shorter hospital stay. No difference in postoperative complications was observed. Our data provide support for further investigation of TXA treatment to improve clinical outcomes in children undergoing pediatric cranial vault remodeling.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9a995e7704c58fd784d2f1f9cd88d528
https://doi.org/10.1097/scs.0000000000002835 -
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المصدر: Echocardiography (Mount Kisco, N.Y.). 35(5)
مصطلحات موضوعية: Male, medicine.medical_specialty, Heart Ventricles, Ventricular Dysfunction, Right, Population, Constriction, Pathologic, 030204 cardiovascular system & hematology, Metabolic equivalent, Hiatal hernia, 03 medical and health sciences, 0302 clinical medicine, Left atrial, Internal medicine, medicine, Ventricular outflow tract, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Heart Atria, education, Aged, Retrospective Studies, education.field_of_study, Exercise Tolerance, business.industry, Stomach, Compression (physics), medicine.disease, Echocardiography, Doppler, medicine.anatomical_structure, Hernia, Hiatal, Echocardiography, Cardiology, Ventricular Function, Right, Atrial Function, Left, Female, Cardiology and Cardiovascular Medicine, business, Large hiatal hernia, Follow-Up Studies
الوصف: INTRODUCTION Large hiatal hernia (HH) is often associated with left atrial (LA) compression, anteroposterior cardiac compression (manifesting as reduced right ventricular outflow tract (RVOT) diameter), and left ventricular (LV) compression (manifesting as systolic paradoxical outward motion (LV-PM) of the posterobasal LV segment). Exercise impairment, also common in this population, improves following HH surgery. We aimed to identify echocardiographic parameters independently associated with exercise impairment due to HH-mediated cardiogenic compression. METHODS Patients with a large HH (>30% intra-thoracic stomach, n = 163) referred for cardiac evaluation were included. Echocardiographic parameters were retrospectively analyzed in relation to HH-related LA compression severity and the presence of LV-PM. Echocardiographic parameters independently associated with exercise capacity were identified by multivariable analysis. RESULTS Mean baseline metabolic equivalents were reduced (70 ± 28% predicted). Moderate-severe LA compression and LV-PM were present in 91 of 163 (56%) and 65 of 162 (40%) patients, respectively. Patients with moderate-severe LA compression and LV-PM had decreased LA and LV dimensions. Moderate-severe LA compression was also associated with reduced RVOT diameter while LV-PM predicted a greater reduction in LV volumes. LA compression and RVOT diameter were independently associated with baseline exercise capacity and increased following HH surgery performed in a subgroup (n = 72, LA diameter: 14 ± 5 vs 20 ± 4 mm/m2 ; RVOT diameter: 17 ± 3 vs 19 ± 3 mm/m2 , P
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المؤلفون: Sam Wilding, David Martin, Graham Moon
المصدر: Healthplace. 52
مصطلحات موضوعية: Adult, Male, Health (social science), Geography, Planning and Development, Population, Population Dynamics, 0211 other engineering and technologies, 02 engineering and technology, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Humans, 030212 general & internal medicine, Longitudinal Studies, Association (psychology), education, Poverty, Aged, Demography, Transients and Migrants, education.field_of_study, Internal migration, Mental Disorders, Multilevel model, Public Health, Environmental and Occupational Health, 021107 urban & regional planning, Emigration and Immigration, Middle Aged, Mental health, Preference, United Kingdom, Mental Health, Socioeconomic Factors, Multilevel Analysis, Survey data collection, Residence, Demographic economics, Female, Psychology
الوصف: Individuals with mental health needs are more likely to migrate than the general population, but the effects of migration preference and place of residence are often overlooked. These issues are addressed through the application of a novel origin and destination multilevel model to survey data. In comparison to those with good mental health, individuals with poor mental health are more likely to make undesired moves and this is moderated, but not explained by place of residence. Implications for understanding the mental health and migration relationship, and its impact on service provision are then proposed.
وصف الملف: text
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المؤلفون: Albert L. Waldo, Impact Study Investigators, John Ip, David Martin, Mark S. Wathen, Malcolm M. Bersohn, Wassim K Choucair, Joseph G. Akar, Jonathan L. Halperin, Gregory Y.H. Lip
المصدر: The American journal of cardiology. 118(11)
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.drug_class, Population, Administration, Oral, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Atrial Fibrillation, Medicine, Humans, 030212 general & internal medicine, education, Stroke, Blood Coagulation, New York Heart Association Class I, Aged, education.field_of_study, Univariate analysis, biology, Dose-Response Relationship, Drug, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, Vitamin K antagonist, Middle Aged, medicine.disease, Defibrillators, Implantable, Transthyretin, Treatment Outcome, Cardiology, biology.protein, Female, Cardiology and Cardiovascular Medicine, business, medicine.drug
الوصف: Implanted cardiac arrhythmia devices can detect atrial tachyarrhythmias (atrial high-rate episodes [AHREs]) that are considered to correlate with atrial fibrillation and risk of stroke. In the IMPACT trial, oral anticoagulation was initiated when AHREs were detected by implanted cardioverter-defibrillators and withdrawn when they abated, according to a protocol accounting both for AHRE duration as detected by remote device monitoring and stroke risk assessment. In this analysis, we ascertained determinants of time in therapeutic range (TTR) among protocol-determined vitamin K antagonist–treated patients during the trial. We enrolled 2,718 patients with at least 1 additional stroke risk factor (CHADS 2 score ≥1) at 104 arrhythmia centers. The sex, age 2 R 2 ) score is a simple clinical-derived score designed to aid decision-making on whether a patient is likely to achieve good anticoagulation control on vitamin K antagonist (e.g., warfarin), which was calculated and related to TTR achieved using the Rosendaal method. We analyzed 229 patients (mean age 66.7 years; mean CHADS 2 score 2.85 [SD 1.1]) with mean TTR of 0.536 (SD 0.23) overall. Univariate analysis identified 5 variables associated with differences in mean TTR. Mean TTR was lower in those who were women (p = 0.031), of black race (p = 0.005) and in New York Heart Association class IV (p = 0.014), whereas hemoglobin >13.5 g/dl (p = 0.010) and New York Heart Association class I (p = 0.037) were associated with higher mean TTR. There was a significant difference in mean TTR value between US and non-US sites (Canada and Germany) (mean TTR for US: 0.513 vs non-US: 0.686; p 2 R 2 scores of 4 (p = 0.007) and higher (Δ = 0.0612, 95% CI 0.0005 to 0.1219) for patients with SAMe-TT 2 R 2 scores of 1 (p = 0.048). Linear regression confirmed a significant association between lower SAMe-TT 2 R 2 score and improved anticoagulation control (p = 0.0021) with a 1-unit decrease in SAMe-TT 2 R 2 score associated with an increase in TTR of 0.0404 (95% CI 0.0149 to 0.0659). In conclusion, clinical, geographical, and demographic factors were associated with the quality of anticoagulation control as reflected by TTR. Although overall TTR in this population was poor, lower SAMe-TT 2 R 2 scores were associated with better TTR.
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المؤلفون: Sarah A. Nisly, Eliza A. Dy-Boarman, David Martin
المصدر: Currents in pharmacy teachinglearning. 9(1)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, 020205 medical informatics, Attitude of Health Personnel, education, Population, Pharmacy, 02 engineering and technology, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, 0202 electrical engineering, electronic engineering, information engineering, medicine, Humans, Mass Screening, 030212 general & internal medicine, General Pharmacology, Toxicology and Pharmaceutics, Health screening, Curriculum, Event (probability theory), Geriatrics, education.field_of_study, business.industry, Pharmacy school, Students, Pharmacy, Education, Pharmacy, Family medicine, Health education, Female, Empathy, business
الوصف: Background While many schools have incorporated geriatric pharmacy education into their curricula, questions remain as to how these experiences shape student perceptions of the geriatric population. The objective of this study was to assess student comfort levels and perceptions toward the geriatric patient population before and after participation in a single health screening and education event. Methods Student perceptions about the elderly (measured via the Geriatrics Attitude Survey) and comfort levels in caring for geriatric patients were assessed before and after an event. Results Twenty-two students completed pre-event and post-event surveys. Students were primarily female (73%), and half were completing their second year of pharmacy school (50%). Global student perceptions of geriatric patients positively changed from baseline following event participation ( p = 0.023). Results reveal significant increases from baseline in student comfort levels with communicating, screening, and counseling elderly patients ( p Conclusion The Geriatrics Attitude Survey is a useful tool in assessing the value of a geriatric experience. Participation in this geriatric experience caused a statistically significant positive change in global perception scores. Additionally, survey results indicate that interactions with geriatric patients at a single event increased student comfort in communication, screening, and counseling.
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المؤلفون: Jennifer Kim, Gordon Wong, David Martin, David J. Tybor, David G. Li, Deeb N. Salem, Roger D. Mitty, Jeffrey Lasker
المصدر: BMJ Open
مصطلحات موضوعية: Male, Students, Medical, Cost effectiveness, Cross-sectional study, Cost-Benefit Analysis, 0302 clinical medicine, Surveys and Questionnaires, Health care, Odds Ratio, Medicine, 030212 general & internal medicine, Schools, Medical, education.field_of_study, Health Equity, 030503 health policy & services, health policy, General Medicine, Middle Aged, 3. Good health, medical ethics, Female, 0305 other medical science, Adult, medicine.medical_specialty, Attitude of Health Personnel, Clinical Decision-Making, Decision Making, education, Population, Young Adult, 03 medical and health sciences, Sex Factors, Physicians, Humans, Hospitals, Teaching, cost-effectiveness, Health policy, Ethics, decision analysis, business.industry, Research, Equity (finance), Internship and Residency, Cross-Sectional Studies, medical equity, Family medicine, business, Medical ethics, Boston, Decision analysis
الوصف: Objective To determine the attitudes of physicians and trainees in regard to the roles of both cost-effectiveness and equity in clinical decision making. Design In this cross-sectional study, electronic surveys containing a hypothetical decision-making scenario were sent to medical professionals to select between two colon cancer screening tests for a population. Setting Three Greater Boston academic medical institutions: Tufts University School of Medicine, Tufts Medical Centre and Lahey Hospital and Medical Centre. Participants 819 medical students, 497 residents-in-training and 671 practising physicians were contacted electronically using institutional and organisational directories. Main outcome(s) and measure(s) Stratified opinions of medical providers and trainee subgroups regarding cost-effectiveness and equity. Results A total of 881 respondents comprising 512 medical students, 133 medical residents-in-training and 236 practising physicians completed the survey (total response rate 44.3%). Thirty-six per cent of medical students, 44% of residents-in-training and 53% of practising physicians favoured the less effective and more equitable screening test. Residents-in-training (OR 1.49, CI 1.01 to 2.21; p=0.044) and practising physicians (OR 2.12, CI 1.54 to 2.92; p