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大疱相关性眼内炎的临床特点和视力结果

世界核心医学期刊文摘（眼科学分册） 2005年第2期1卷 59-59页

作者： busbee b.G. Recchia F.M. kaiser R. 王建洲 Retina Service Ne w England Eye Center Boston MA United States Dr.

Purpose To analyze the clinical characteristics and treatment outcomes of pati ents with bleb-associated endophthalmitis (bAE). Design Retrospective, non comp arative, interventional case series. Participants Consecutive patients treated a t one institution for bAE. Interventions Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitre al injection of antibiotics (tap and inject). Methods Retrospective analysis of 68 consecutive cases of bAE between July 1, 1989 and June 30, 2001. Clinical pre sentation, treatment modality, microbiologic data, and clinical course were anal yzed. Visual outcomes were compared between vitrectomy and tap-and-inject grou ps, culture-positive and culture-negative groups, and early and late times. Ma in outcome measures Snellen visual acuities (VAs) at 3 months and 12 months afte r treatment and at most recent follow-up. Results The incidence of no light per ception (NLP) at 12 months after treatment for bAE was 35%. Vitreous isolates i ncluded streptococcal species (32%of positive cultures), Staphylococcus epiderm idis (26%), Enterococcus, and Serratia (12%each). Patients with a positive vit reous culture had significantly worse VA (median, hand movements HM at 3 and 1 2 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months an d LP at 12 months) and a significantly higher rate of NLP vision than patients t reated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P=0.09). Conclusions bleb associated endophthalmitis causes significant visual morbidity. Patients with culture-neg ative bAE and patients treated with prompt PPV may achieve better visual outcome .

关键词：眼内炎大疱玻璃体手术无光感眼科机构细菌培养阴性微生物检查临床病程对比性病例研究

Technology Deployment to Improve Clinical Outcomes

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中国医疗设备 2016年第1期31卷 1-5页

作者： T.M.Judd L.Jacobs M.Jansen b.birch clinical technology kaiser permanentebrth boardAtlantaGA30305USA the permanente journal presidentbrth boardAtlantaGA30305USA iron bow healthcare solutions AtlantaGAUSA innovation and advanced technology kaiser permanente it0aklandGAUSA

Improved child, newborn, and maternal health(CNM) is a top priority in developing countries. Many factors must be addressed simultaneously to improve clinical outcomes for CNM. A public-private project in Haiti that will deploy the World Health Organization(WHO) evidence-based medicine(EbM) and essential interventions utilizing CNM healthcare technologies(HT), is expected to be a model for improving national health systems. The CNM mortality rates in Haiti are the highest in the western hemisphere with rates similar to those found in Afghanistan and several African countries. Several factors perpetuating this crisis are noted, as well as the most cost-effective interventions proven to decrease CNM mortality rates in low-and middle-income countries. To create major change in health system infrastructure, two strategies are presented, requiring appropriate and leading-edge health technologies(HT), e.g., wireless cellular-network-based Telemedicine(TM):(1) Development of a countrywide network of geographical "Community Care Grids" to facilitate implementation of frontline interventions;(2) The construction of a central hospital(called bethesda Referral and Teaching Hospital-bRTH NGO) that will provide secondary and tertiary care for communities throughout the country, including helping local hospitals and clinics practice EbM care. We believe that these strategies-supported by HT will fast track improvement in CNM mortality rates throughout the country and that in a relatively short period of time Haiti's health care system will be among the leaders in the region. Primary factors contributing to the CNM crisis, all addressed by TM:(1) Limited access: demographics, geography, cost, transportation;(2) Inadequate health care facilities: less than 20 NICU beds for 10 million population; bRTH to provide 80 bed NICU and 40 bed PICU in 225 bed hospital;(3) Health care practitioners: inadequate numbers and training;(4) Low % of skilled attendants now at deliveries;(5) Low % of

关键词：临床医学工程世界卫生组织顾问委员会美国FDA 医疗技术管理医疗设备 301医院临床工程

basel支架成本效益试验(bASKET)指导支架的临床使用

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世界核心医学期刊文摘（心脏病学分册） 2007年第8期3卷 40-40页

作者： Rocca H.-P.b.-L. kaiser C. Pfisterer M. 王海玲 Division of Cardiology University Hospital Basel CH 4031 Switzerland

目的:目前尚不确定,哪些患者能从药物洗脱支架(DES)治疗[较之裸金属支架(bMS)]获得长期临床预后方面的最大益处。方法和结果:纳入连续826例行血管成形术治疗的患者,患者以2∶1比例随机分组接受DES和bMS,随访18个月,观察心脏性死亡/心肌... 详细信息

目的:目前尚不确定,哪些患者能从药物洗脱支架(DES)治疗[较之裸金属支架(bMS)]获得长期临床预后方面的最大益处。方法和结果:纳入连续826例行血管成形术治疗的患者,患者以2∶1比例随机分组接受DES和bMS,随访18个月,观察心脏性死亡/心肌梗死(MI)和非MI相关性靶血管血运重建(TVR)。对患者资料进行分析,确定支架类型与患者/血管特征在预测终点事件方面的相互作用。

关键词： bASKET 靶血管血运重建心脏性死亡血管成形术 basel 终点事件血管桥事件预测小血管

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医院内感染

中华传染病杂志 1986年第2期4卷 113-116页

作者： Daniel b. Klein 刁会正 Unlversity 0f California San FranciscoKaiser HospitalHaywardCalifornia 中华医学会上海分会

近年来,对许多以往致死性疾病的治疗已经取得了很大的进展.现今医师们已有更多的治疗方法,挽救患者的生命.器官移植、血液透析、创伤性监护设备、肺呼吸器等,这些治疗已普遍应用.不幸的是,这些进展对医院内感染的发生也提供了新的和更... 详细信息

近年来,对许多以往致死性疾病的治疗已经取得了很大的进展.现今医师们已有更多的治疗方法,挽救患者的生命.器官移植、血液透析、创伤性监护设备、肺呼吸器等,这些治疗已普遍应用.不幸的是,这些进展对医院内感染的发生也提供了新的和更多的机会.

关键词：治疗方法致死性疾病医院内感染血液透析器官移植监护设备呼吸器创伤性应用医师生命患者

Neck dissection does not add to morbidity or mortality of laryngectomy

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2019年第4期5卷 215-221页

作者： Christopher C.Xiao Sarah A.Imam Shaun A.Nguyen Marc P.Camilon Andrew b.baker Terry A.Day Eric J.Lentsch Department of Otolaryngology-Head and Neck Surgery Kaiser PermanenteNorthern CaliforniaOaklandCA94612USA Department of Health and Human Performance The CitadelCharlestonSC29409USA Department of Otolaryngology-Head and Neck Surgery Medical University of South CarolinaCharlestonSC29425USA Oregon Health&Science University Ear Nose&ThroatPortlandOR97239USA

Objectives:To examine the national rates of complications,readmission,reoperation,death and length of hospital stay after *** explore the risks of neck dissection with laryngectomy using ***:The American College of Surgeons National Quality Improvement Program(ACS-NSQIP)database was reviewed *** database was analyzed for patients undergoing laryngectomy with and without neck ***,perioperative complication,reoperation,readmission,and death variables were ***:754 patients who underwent total laryngectomy during this time were *** analysis showed average age was 63 years old,566(75.1%)were white,and 598(79.3%)were *** these patients,520(69.0%)included a neck dissection while 234(31.0%)did *** comparing patients who received a neck dissection to those who did not,there were no significant differences in median length of hospital stay(12.5 days w/vs.13.3 days w/o,P=0.99),rates of complication(40%w/vs.35%w/o,P=0.23),reoperation(13.5%w/vs.14%w/o,P=0.81),readmission(14%w/vs.18%w/o,P=0.27),and death(1.3%w/vs.1.3%w/o,P>0.99).Furthermore,neck dissection did not increase the risk of complication(P=0.23),readmission(P=0.27),reoperation(P=0.81),death(P=0.94),or lengthened hospital stay(P=0.38).Conclusions:Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total *** results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.

关键词： Laryngectomy Neck dissection Total laryngectomy Complication rates Outcomes

New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion

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Family Medicine and Community Health 2020年第4期8卷 84-89页

作者： Heather Angier Nathalie Huguet David Ezekiel-Herrera Miguel Marino Teresa Schmidt beverly b Green Jennifer E DeVoe Family Medicine Oregon Health&Science UniversityPortlandOregonUSA biostatistics Group Oregon Health&Science University-Portland State University School of Public HealthPortlandOregonUSA Research OCHINPortlandOregonUSA kaiser Permanente Washington Health Research Institute SeattleWashingtonUSA

Objective To assess the Affordable Care Act(ACA)Medicaid expansion’s impact on new hypertension and diabetes diagnoses in community health centres(CHCs).Design Rates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in difference(DID)pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did *** We used electronic health record data(pre-ACA:1 January 2012-31 December 2013-post-ACA:1 January 2014-31 December 2016)from the Accelerating Data Value Across a National Community Health Center Network clinical data *** included clinics with≥50 patients contributing to person-time at risk in each study *** Patients aged 19-64 with≥1 ambulatory visit in the study period were *** then excluded patients who were pregnant during the study period(N=127530).For the hypertension outcome,we excluded individuals with a diagnosis of hypertension prior to the start of the study period,those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit,and those who had a diagnosis more than 3 years after their last visit(pre-ACA non-expansion N=130973;expansion N=193198;post-ACA non-expansion N=186341;expansion N=251015).For the diabetes analysis,we excluded patients with a diabetes diagnosis prior to study start,on their first visit or first visit after inactive patient status,and diagnosis while not an active patient(pre-ACA non-expansion N=145435;expansion N=198558;post-ACA non-expansion N=215039;expansion N=264644).Results In non-expansion states,adjusted hypertension diagnosis rates saw a relative decrease of 6%,while in expansion states,the adjusted rates saw a relative increase of 7%(DID 1.14,95%CI 1.11 to 1.18).For diabetes diagnosis,adjusted rates in non-expansion states experienced a significant relative increase of 28%and in expansion states the relative increase was 25%

关键词： diagnosis hypertension expansion

新生儿血清总胆红素水平≥250mg/L的临床转归研究

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世界核心医学期刊文摘（儿科学分册） 2006年第12期2卷 3-4页

作者： Newman T.b. Liljestrand P. Jeremy R.J. 张振 Department of Epidemiology and biostatistics School of MedicineUniversity of CaliforniaSan FranciscoSan FranciscoCAUnited States Dr.

bACKGROUND:The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined. METHODS:We identified 140 infants with neonatal total serum bilirubin levels of at least 25mg per deciliter (428 μmol per liter) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants born from 1995 through 1998 in kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records,interviews,responses to questionnaires,and neurodevelopmental evaluations that had been performed in a blinded ***:Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 μmol per liter) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter(513 μmol per liter) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in 5. Follow-up data to the age of at least two years were available for 132 of 140 children with a history of hyperbilirubinemia (94 percent) and 372 of 419 controls (89 percent) and included formal evaluation at a mean (±SD) age of 5.1±0.12 years for 82 children (59 percent)and 168 children (40 percent),respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests,95 percent confidence intervals excluded a 3-point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia(17 percent) had “questionable”or abnormal findings on neurologic examination,as compared with 48 controls (29 percent; P = 0.05; adjusted odds ratio,0.47; 95 percent confidence interval,0.23 to 0.98; P =0.04). The frequencies of parental concern and reported behavioral problems also wer

关键词：新生儿血清 g/L 总胆红素水平临床转归换血治疗血清总胆红素光照治疗足月产核黄疸电子病

主分量分析在区域性气候分型中应用的统计试验研究

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大气科学 1992年第6期16卷 649-658页

作者：龚晓峰 M. b. Richman 辽宁省气象局沈阳110001 美国俄克拉何马大学中尺度天气研究所

主分量分析在大气科学研究中的应用日益广泛,但对其应用的可行性和可靠性的研究则比较欠缺.本文对主分量分析的三种方法,即非旋转主分量、正交旋转的方差极大法和斜交旋转的Harris-kaiser Case Ⅱb^Tb法,在区域气候分型研究中的应用进... 详细信息

主分量分析在大气科学研究中的应用日益广泛,但对其应用的可行性和可靠性的研究则比较欠缺.本文对主分量分析的三种方法,即非旋转主分量、正交旋转的方差极大法和斜交旋转的Harris-kaiser Case Ⅱb^Tb法,在区域气候分型研究中的应用进行了计算分析和精度拟合,同时进行了区域分割和Monte-Carlo模拟的统计试验.结果表明,非旋转主分量的分型拟合精度不佳,两种旋转主分量方法的效果很好,其中正交旋转又优于斜交旋转.区域范围的变化对旋转主分量方法的分型结果影响不大,对非旋转主分量分析的影响较大.样本大小的变化对主分量分析的各种方法无明显影响.

关键词：主分量分析区域气候分型研究

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血清总胆红素≥250mg/L新生儿的预后

世界核心医学期刊文摘(神经病学分册) 2006年第11期 2-3页

作者： Newman T.b Liljestrand P Jeremy R.J. 谢琰臣 Department of Epidemiology and biostatistics School of Medicine University of California San Francisco San Francisco CA United States Dr.

bACKGROUND: The neurodevelopmental risks associated with high total serum bilirubin levels in newborns are not well defined. METHODS: We identified 140 infants with neonatal total serum bilirubin levels of at least 25 mg per deciliter (428 μmol per liter) and 419 randomly selected controls from a cohort of 106,627 term and near-term infants born from 1995 through 1998 in kaiser Permanente hospitals in northern California. Data on outcomes were obtained from electronic records, interviews, responses to questionnaires, and neurodevelopmental evaluations that had been performed in a blinded fashion. RESULTS: Peak bilirubin levels were between 25 and 29.9 mg per deciliter (511 μmol per liter) in 130 of the newborns with hyperbilirubinemia and 30 mg per deciliter (513 μmol per liter) or more in 10 newborns; treatment involved phototherapy in 136 cases and exchange transfusion in 5. Follow-up data to the age of at least two years were available for 132 of 140 children with a history of hyperbilirubinemia (94 percent) and 372 of 419 controls (89 percent) and included formal evaluation at a mean (±SD) age of 5.1±0.12 years for 82 children (59 percent) and 168 children (40 percent), respectively. There were no cases of kernicterus. Neither crude nor adjusted scores on cognitive tests differed significantly between the two groups; on most tests, 95 percent confidence intervals excluded a 3-point (0.2 SD) decrease in adjusted scores in the hyperbilirubinemia group. There was no significant difference between groups in the proportion of children with abnormal neurologic findings on physical examination or with documented diagnoses of neurologic abnormalities. Fourteen of the children with hyperbilirubinemia (17 percent) had “questionable”or abnormal findings on neurologic examination, as compared with 48 controls (29 percent; P = 0.05; adjusted odds ratio, 0.47; 95 percent confidence interval, 0.23 to 0.98; P = 0.04). The frequencies of parental concern and reported behavioral

关键词：血清总胆红素新生儿高胆红素血症预后