2篇
您的检索式：作者名="Andrew L Singer"
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| 1 | Hospital resource intensity and cirrhosis mortality in United States显示文摘AIM To determine whether hospital characteristics predict cirrhosis mortality and how much variation in mortality is attributable to hospital differences.METHODS We used data from the 2005-2011 Nationwide Inpatient Sample and the American Hospital Association Annual survey to identify hospitalizations for decompensated cirrhosis and corresponding facility characteristics. We created hospital-specific risk and reliability-adjusted odds ratios for cirrhosis mortality, and evaluated patient and facility differences based on hospital performance quintiles. We used hierarchical regression models to determine the effect of these factors on mortality. RESULTS Seventy-two thousand seven hundred and thirty-three cirrhosis admissions were evaluated in 805 hospitals. Hospital mean cirrhosis annual case volume was 90.4(range 25-828). Overall hospital cirrhosis mortality rate was 8.00%. Hospital-adjusted odds ratios(a OR) for mortality ranged from 0.48 to 1.89. Patient characteristics varied significantly by hospital a OR for mortality. Length of stay averaged 6.0 ± 1.6 days, and varied significantly by hospital performance(P < 0.001). Facility level predictors of risk-adjusted mortality were higher Medicaid case-mix(OR = 1.00, P = 0.029) and LPN staffing(OR = 1.02, P = 0.015). Higher cirrhosis volume(OR = 0.99, P = 0.025) and liver transplant program status(OR = 0.83, P = 0.026) were significantly associated with survival. After adjusting for patient differences, era, and clustering effects, 15.3% of variation between hospitals was attributable to differences in facility characteristics. CONCLUSION Hospital characteristics account for a significant proportion of variation in cirrhosis mortality. These findings have several implications for patients, providers, and health care delivery in liver disease care and inpatient health care design. | Amit K Mathur Apurba K Chakrabarti Jessica L Mellinger Michael L Volk Ryan Day Andrew L Singer Winston R Hewitt Kunam S Reddy Adyr A Moss | 2017 | World Journal of Gastroenterology2017，23，10： | 0 |
| 2 | Solid pancreas transplant: Pushing forward显示文摘Pancreas transplant has evolved significantly in recent years. It has now become a viable treatment option on type 1 diabetic patients with poorly controlled diabetes on conventional treatment, insulin intolerance, hypoglycaemia unawareness, brittle diabetes and/or end-stage kidney disease. The purpose of this review is to provide an overview of pancreas transplant historical origins and current barriers to broader utilization of pancreata for transplant, with a focus on areas for future improvement to better pancreas transplant care. Donor pancreata remain underutilized; pancreatic allograft discard rates remain close to 30% in the United States. Donations after cardiac death(DCD) pancreata are seldom procured. Study groups from Europe and the United Kingdom showed that procurement professionalization and standardization of technique, as well as development of independent regional procurement teams might increase organ procurement efficiency, decrease discards and increase pancreatic allograft utilization. Pancreas transplant programs should consider exploring pancreas procurement opportunities on DCD and obese donors. Selected type 2 diabetics should be considered for pancreas transplant. Longer follow-up studies need to be performed in order to ascertain the long-term cardiovascular and quality of life benefits following pancreas transplant; the outcomes of which might eventually spearhead advocacy towards broader application of pancreas transplant among diabetics. | Emmanouil Giorgakis Amit K Mathur Harini A Chakkera Kunam S Reddy Adyr A Moss Andrew L Singer | 2018 | World Journal of Transplantation2018，8，7： | 0 |
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