NIS

Preoperative determinants of surgical risk in elderly patients with meningioma are not fully defined. This study was undertaken to determine whether the Charlson comorbidity index could be used to accurately predict postoperative outcomes among older patients with meningiomas undergoing neurosurgical resection and thereby make a selection for surgery easier. We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998-2005). Patients 65 years of age and older who underwent tumor resection of intracranial meningiomas were identified by International Classification of Diseases, 9th revision, coding. The primary independent variable in multivariate regression was the Charlson comorbidity score, and the primary outcome was inpatient death. Secondary outcomes included inpatient complications, length of stay, and total hospital charges. We identified 5717 patients (66.6% female, and 81.8% white) with mean age of 73.6 years. Mean Charlson comor...

Flavonoids are polyphenolic compounds of natural occurrence produced by plants that are largely consumed both for therapeutic purposes and as food. Experimental data have shown that many flavonoids could inhibit thyroperoxidase activity, decreasing thyroid hormones ...

Influenza vaccination is now recommended for all ages; CDC pneumococcal polysaccharide vaccination (PPV) recommendations are comorbidity-based in nonelderly patients. We constructed a Markov model to estimate the cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Patients were followed for 10 years, with differing time horizons examined in sensitivity analyses. With 100% vaccine uptake, dual vaccination cost $37,700/QALY gained compared to a CDC recommendation strategy; with observed vaccine uptake, dual vaccination cost $5,300/QALY. Results were sensitive to shorter time horizons, favoring CDC recommendations. We found dual vaccination of all 50-year-olds economically reasonable. Shorter duration models may not fully account for PPV effectiveness.

This paper contributes to identify systematic problems in NIS using Thinking Process (TOC-TP) and to eliminate the bottlenecks, which results in improving the innovation process and efficiency of NIS. The Case study in this research is the NIS of Iran. The national documents of the innovation system were studied and all problems of NIS mentioned in documents were gathered.
The causal relationships between the systematic problems were identified by the survey and grouped into 6 components by Exploratory Factor Analysis: weakness in technology diffusion mechanisms, the lack of centralized governance on science and technology policy, the government’s pivotal role as an executor in education and research, weak laws and regulations in the field of research and technology, the lack of adequate financial resources in R&D and the lack of any perspective on the creation of wealth and entrepreneurship among the actors of research and technology. Finally the bottleneck of Iran’s NIS was recognized by Thinking Process tools: the small participation of private sector in research and education system as the result of government’s pivotal role as an executor of Iran’s national innovation system. So the researchers could diagnose the policy gaps related to the identified bottlenecks.

Multiple regional trauma systems have been implemented over the past 3 decades to achieve the goal of regionalized care for injured patients. The American College of Surgeons Committee on Trauma (ACS-COT) advocates that seriously injured patients should be treated in designated Level I trauma centers that meet criteria including admitting more than 1,200 injured patients annually. Reliable measures are needed to evaluate the implementation of regionalized care nationally. The goal of this study was to measure the proportion of seriously injured patients treated at high injury–volume hospitals.We performed a retrospective observational study of injured patients hospitalized in the US during the years 1995 to 2003, drawn from the Nationwide Inpatient Sample. Hospitals were ranked in order of annual volume of injured patient admissions. A patient’s severity of injury was calculated using ICD-9–based Injury Severity Score (ICISS). The principal measure was the proportion of seriously injured patients (ICISS ≤ 0.90) admitted to high-volume hospitals.Nine hundred fifteeen injured patients admitted per year is the empiric threshold for hospitals with a high injury volume. Only 7% of hospitals in the US meet this volume threshold. Sixty percent of seriously injured patients are treated in these high-volume hospitals; within the elder (age 65 years or older) subset, this percentage is lower.The proportion of seriously injured patients in high-volume hospitals is a functional metric that provides a practicable and comprehensive measure of regionalized trauma care in the US. Injured elder Americans have less access to experienced trauma hospitals.