JAMA : the journal of the American Medical Association
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Randomized Controlled Trial Clinical Trial
Diabetic retinopathy after two years of intensified insulin treatment. Follow-up of the Kroc Collaborative Study. The Kroc Collaborative Study Group.
The progression of retinopathy was reevaluated at two years in 64 of the 68 patients with mild to moderate diabetic retinopathy, originally randomly assigned for an eight-month period either to intensified diabetic control with continuous subcutaneous insulin infusion (CSII) or to unchanged conventional injection treatment. Twenty-three of the 34 patients in the former group and 24 of the 34 in the latter agreed to continue to follow their original treatment assignment for a further 16 months. The others crossed over at the end of the first eight months of the study. ⋯ Glycemic separation was maintained at two years between the two groups continuing to receive the assigned treatment; during this time the mean retinopathy level deteriorated with conventional injection treatment and improved with CSII. At two years the degree of retinopathy in the two treatment groups was indistinguishable, with some trend to lesser overall deterioration with CSII. It is concluded that, in diabetics with mild to moderate nonproliferative retinopathy, the acceleration in activity associated with tightened control is not sustained and does not initiate vasoproliferative deterioration in retinopathy.
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The etiology of mycosis fungoides is obscure, and the risk factors for its occurrence are poorly documented. This investigation uses data from nine US population-based cancer registries to investigate the descriptive epidemiology of this disorder. From 1973 through 1984, 721 newly diagnosed cases of mycosis fungoides were reported to these registries (0.29 cases per 100,000 population per year). ⋯ Blacks were twice as likely to be afflicted as whites, and the incidence among men was more than twice the incidence among women. The geographic variation in incidence was associated with several demographic variables, including population density, family income, and concentration of physicians. Analysis of mortality among these patients revealed no evidence of detection bias.
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The national status of regional trauma system development was evaluated by a survey sent to all state emergency medical services directors and state chairpersons of the American College of Surgeons Committee on Trauma. Eight essential components of a regional trauma system based on criteria set forth by the American College of Surgeons were listed. ⋯ The remaining 29 states had yet to initiate the process of trauma center designation. In response to these shortcomings, an attempt was made to define the barriers to trauma system implementation and a step-by-step process was outlined for the development, management, and analysis of a comprehensive system of trauma care.