A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Endoscopic retrograde cholangiopancreatography (ERCP) is a technically difficult procedure that requires extensive training to achieve competency. The study was undertaken to assess retrospectively whether advanced ERCP training made a difference in the competency of a physician who was performing ERCPs for eleven years before taking an extra year of advanced training in ERCP. The physician did not get any ERCP experience during the two-year formal fellowship between 1995-97, and learned ERCPs from colleagues post formal GIfellowship for four years after which he was given privileges to independently perform ERCPs. Data were collected on 172 and 213 patients who underwent ERCP before and after the training year respectively. Chi-square test was utilized to analyze the data. Baseline characteristics including height, weight, race and indications for ERCP were similar in the two groups. The results of the study showed that rates of biliary cannulation increased from the Pre-ERCP fellowship rate of 83% to 93% (Chi- Square = 9.06, p = 0.0026) and a reduction in postprocedure pancreatitis from 8.1% to 2.7% (Chi- Square = 4.56, p = 0.0327). Data in this study indicate that extra training in ERCP improves outcomes of ERCP in a single operator’s experience.

<p>There are several categories of dental problems in children that cannot be treated optimally in the office settings and are best managed in the hospital theatre. The ability to treat children in the hospital environment in order to provide comprehensive dental care using general anaesthesia(GA) is a valuable option to the paediatric dentist, despite some degree of risk to the patient. General anaesthesia provides optimum conditions for restorative treatment such as maximum contamination control, immobilization of the patient, efficiency and effectiveness, and elimination of reflexes.</p>

Thesis (Ph. D.)--Johns Hopkins University. / Vita. Published also as no. 3 of the Johns Hopkins studies in philosophy and psychology, and as The Psychological review, v. 11, no. 4, whole no. 47.

No description available.

<p>There are several categories of dental problems in children that cannot be treated optimally in the office settings and are best managed in the hospital theatre. The ability to treat children in the hospital environment in order to provide comprehensive dental care using general anaesthesia(GA) is a valuable option to the paediatric dentist, despite some degree of risk to the patient. General anaesthesia provides optimum conditions for restorative treatment such as maximum contamination control, immobilization of the patient, efficiency and effectiveness, and elimination of reflexes.</p>

Magister Scientiae Dentium - MSc(Dent) / There are several categories of dental problems in children that cannot be treated optimally in the office settings and are best managed in the hospital theatre. The ability to treat children in the hospital environment in order to provide comprehensive dental care using general anaesthesia(GA) is a valuable option to the paediatric dentist, despite some degree of risk to the patient. General anaesthesia provides optimum conditions for restorative treatment such as maximum contamination control, immobilization of the patient, efficiency and effectiveness, and elimination of reflexes. / South Africa

Administrative data was anonymously linked to a clinical registry, to evaluate the validity of diabetes algorithms in youth. In addition, incident youth with T2DM (n=342) in Manitoba (1-18 years) from Jan.1986-2009 identified from the clinical registry were anonymously linked to healthcare records in order to evaluate complications, compared to youth with type 1 diabetes (T1DM) (n=1011) and non-diabetes (non-DM) controls (n=1710). The algorithm including 1 or more hospitalizations or two or more outpatient claims over two years was the most valid. Youth with T2DM had a 47% increased risk of any complication and a 2.29 fold increased risk of renal complication. Age at diagnosis, HgA1c and ace inhibitor/angiotensin receptor blocker use (ACE/ARB) were significant risk factors for any complication. Risk factors for renal complications included ACE/ARB use, albuminuria and diagnosis prior to 2000. Survival at 10 years was 91.4% (T2DM) vs. 99.5% (T1DM) vs. 100% (non-DM); p<0.0001.

Administrative data was anonymously linked to a clinical registry, to evaluate the validity of diabetes algorithms in youth. In addition, incident youth with T2DM (n=342) in Manitoba (1-18 years) from Jan.1986-2009 identified from the clinical registry were anonymously linked to healthcare records in order to evaluate complications, compared to youth with type 1 diabetes (T1DM) (n=1011) and non-diabetes (non-DM) controls (n=1710). The algorithm including 1 or more hospitalizations or two or more outpatient claims over two years was the most valid. Youth with T2DM had a 47% increased risk of any complication and a 2.29 fold increased risk of renal complication. Age at diagnosis, HgA1c and ace inhibitor/angiotensin receptor blocker use (ACE/ARB) were significant risk factors for any complication. Risk factors for renal complications included ACE/ARB use, albuminuria and diagnosis prior to 2000. Survival at 10 years was 91.4% (T2DM) vs. 99.5% (T1DM) vs. 100% (non-DM); p<0.0001.

acase@tulane.edu / Study aim: This study aimed to assess the individualized treatment goals (A1C, Blood Pressure, LDL-C) for patients with type 2 diabetes mellitus (T2DM), which lead to optimal health outcomes by different treatment strategies. Background and significance: The evidences in medical guidelines came from clinical trials with highly selected patients, whereas the treatment goals may differ in some subgroups. Additionally, considerable confusions on treatment target has resulted from recent changes in guidelines. So, there is a critical need to examine heterogeneity in optimal goals that lead to the most efficacious treatment options. Methods: A retrospective longitudinal study was conducted for veterans with T2DM by using US Veterans Affairs (VA) Administrative Database (Jan 2005 and Dec 2015). Longitudinal medical records were prepared for each 6-month cycle and multivariate longitudinal regression was used to estimate the risk of microvascular and macrovascular complication events and mortality. Second-degree polynomial and splines were applied in the model to identify the optimal goals in their associations with lowest risk of clinical outcomes by controlling the demographic characteristics, medical history, and medications. Results: 124,651 patients with T2DM were selected, with 62.68 years old (SD=10.96) and 6.72 (SD=6.68) follow-up years at average. In general population, A1C=6.06, LDL-C=106.10 and BP=137.90/98.00 were associated with lowest mortality risk. As of achieving lowest risk of microvascular and macrovascular complication, the optimal goals were A1C=6.81, LDL-C=109.10; and A1C=6.76, LDL-C=111.65, SBP=130.60 respectively. The optimal goals differed between age and racial subgroups. Lower SBP for younger patients and lower LDL-C for blacks were identified with better health outcomes. Conclusions: Individualized treatment goals were identified and multi-faceted treatment strategies targeting hypertension, hyperglycemia and hyperlipidemia may improve health outcome in veterans with T2DM. In addition to general ADA recommended goals, health system may examine their own large, more diverse patients with T2DM for better quality of care. / 1 / Qian Shi

No description available.