1932. Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media.
作者: Yossi Rosman.;Arik Eisenkraft.;Nadav Milk.;Arthur Shiyovich.;Nimrod Ophir.;Shai Shrot.;Yitshak Kreiss.;Michael Kassirer.
来源: Ann Intern Med. 2014年160卷9期644-8页
On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events.
1935. Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study.
作者: Frederick A Masoudi.;Xiaojuan Mi.;Lesley H Curtis.;Pamela N Peterson.;Jeptha P Curtis.;Gregg C Fonarow.;Stephen C Hammill.;Paul A Heidenreich.;Sana M Al-Khatib.;Jonathan P Piccini.;Laura G Qualls.;Adrian F Hernandez.
来源: Ann Intern Med. 2014年160卷9期603-11页
Trials comparing implantable cardioverter-defibrillator (ICD) therapy with cardiac resynchronization therapy with a defibrillator (CRT-D) are limited to selected patients treated at centers with extensive experience.
1936. Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study.
作者: Joshua A Roth.;Ruth Etzioni.;Teresa M Waters.;Mary Pettinger.;Jacques E Rossouw.;Garnet L Anderson.;Rowan T Chlebowski.;Joann E Manson.;Mark Hlatky.;Karen C Johnson.;Scott D Ramsey.
来源: Ann Intern Med. 2014年160卷9期594-602页
The findings of the Women's Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial's $260 million cost (2012 U.S. dollars).
1937. Changes in mortality after Massachusetts health care reform: a quasi-experimental study.
The Massachusetts 2006 health care reform has been called a model for the Affordable Care Act. The law attained near-universal insurance coverage and increased access to care. Its effect on population health is less clear.
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