检索结果-内蒙古大学图书馆

Relationship between coronary angioplasty laboratory volume and outcomes after hospital discharge

AMERICAN HEART JOURNAL 2002年第5期143卷 833-840页

作者： Kimmel, SE Sauer, WH Brensinger, C Hirshfeld, J Haber, HL Localio, AR Univ Penn Sch Med Ctr Clin Epidemiol & Biostat Philadelphia PA 19104 USA Univ Penn Sch Med Dept Biostat & Epidemiol Philadelphia PA 19104 USA Hosp Univ Penn Dept Med Div Cardiovasc Philadelphia PA 19104 USA

Background Although an inverse association has been established between short-term complications of percutoneous coronary interventions (PCIs) and the volume of angioplasty procedures performed by catheterization laboratories, no data are available on the association between laboratory volume and long-term outcomes. Methods A cohort study of 25,222 patients undergoing PCI in 43 laboratories in Pennsylvania from October 1994 to December 1995 was performed by use of the Pennsylvania Health Care Cost Containment Council database. The association of laboratory volume with inhospital, 1-month, and 6-month events was estimated by use of multivariable analyses adjusting for patient and procedural characteristics. Results Although a higher volume of procedures was associated with reduced inhospital coronary bypass ([CABG] 0.6 odds ratio [OR] for 400 vs <400 PCIs/year;95% CI 0.4, 0.8), it was not associated with CABG occurring within 1 month after discharge (P = .71;OR 1.0, 95% CI 0.6, 1.7). Laboratory volume was also not significantly associated with postdischarge revascularization (PCI or CABG) at 1 month (P = .58;OR 1.1, 95% CI 0.8, 1.4) or 6 months (P = .47;OR 1.04, 95% CI 0.91, 1.19). In addition, laboratory volume was not associated with rates of myocardial infarction (P =.14), death (P =.28), or the combined outcome of PCI, CABG, myocardial infarction, or death (P = .90) at 1 month after hospital discharge. Conclusions Although our study confirmed the volume/complication relationship for inhospital CABG, it did not reveal an association between volume and postdischarge events. These results suggest that inhospital complications will remain the standard for assessing laboratory volume and that selective use of higher-volume laboratories may not improve long-term outcomes.

关键词：队列研究冠状动脉分流术/标准冠状动脉分流术/利用冠状动脉再狭窄/流行病学冠状动脉再狭窄/治疗医院/统计学和数值数据多元分析心肌梗死/流行病学心肌梗死/死亡率比值比宾夕法尼亚/流行病学时间因素治疗结果女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

RBC transfusion and postoperative length of stay in the hospital or the intensive care unit among patients undergoing coronary artery bypass graft surgery: the effects of confounding factors

引用

TRANSFUSION 2000年第7期40卷 832-839页

作者： Vamvakas, EC Carven, JH NYU Med Ctr Sch Med Dept Pathol Blood Bank New York NY 10016 USA Massachusetts Gen Hosp Blood Transfus Serv Boston MA 02114 USA

BACKROUND: Data on the independent association between perioperative allogeneic blood transfusion (ABT) and postoperative length of stay at the hospital or in the intensive care unit (ICU) are sparse. STUDY DESIGN AND METHODS: The records of 421 consecutive patients undergoing coronary artery bypass graft (CABG) operations at the Massachusetts General Hospital were reviewed. The effect of perioperative ABT in explaining the variation in the postoperative length of stay (LOS) at the hospital or in the ICU was calculated after adjustment for the effects of 20 confounding factors that pertained to severity of illness, difficulty of operation, and risk of postoperative wound infection or pneumonia. RESULTS: Postoperative LOS averaged (mean +/- SE) 8.0 +/- 0.3 days in the hospital and 50.0 +/- 4.1 hours in the ICU. After adjustment for the effects of confounding factors, the postoperative length of hospitalization increased by 0.837 percent (95% CI, 0.249-1.425%) per RBC unit transfused (p<0.001), and the postoperative length of stay in the ICU increased by 0.873 percent (95% CI, -0.068-1.814%) per RBC unit transfused (p<0.10). CONCLUSION: Allogeneic blood transfusion was independently associated with longer postoperative stays in the hospital or the ICU, but the observed independent association is perhaps too small to be clinically relevant. This independent association may be due to a relationship between ABT and a higher incidence of septic complications of surgery, or it may reflect the function of blood transfusion as a surrogate marker for severity of illness.

关键词：冠状动脉分流术红细胞输注/副作用医院/统计学和数值数据重症监护病房/统计学和数值数据住院时间移植同种成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

γ-hydroxybutyrate serum levels and clinical syndrome after severe overdose

引用

ANNALS OF EMERGENCY MEDICINE 2003年第1期42卷 3-8页

作者： Sporer, KA Chin, RL Dyer, JE Lamb, R San Francisco Gen Hosp Dept Emergency Serv San Francisco CA 94110 USA Univ Calif San Francisco Sch Pharm Dept Clin Pharm San Francisco CA 94143 USA Univ Calif Los Angeles Los Angeles Cty Harbor Hosp Ctr Med Los Angeles CA USA California Poison Control Syst San Francisco Div San Francisco CA USA

Study objective: We discuss a prospective case series of patients who present with a severe gamma-hydroxybutyrate intoxication with confirmatory serum and urine gamma-hydroxybutyrate levels. Methods: Patients with a clinical suspicion of gamma-hydroxybutyrate-like drug overdoses and a Glasgow Coma Scale score of 8 or lower were identified from July 1998 through January 1999. Serial serum specimens and a single urine specimen were collected. The levels of gamma-hydroxybutyrate were performed by gas chromatography-mass spectrometry. Results: All 16 suspected severe gamma-hydroxybutyrate overdose patients had significant serum or urine levels of gamma-hydroxybutyrate. Serum levels ranged from 45 to 295 mg/L, with a median of 180 mg/L (interquartile range [IQR] 235 to 118 mg/L). Patients who developed a Glasgow Coma Scale score of 3 had serum levels that ranged from 72 to 300 mg/L, with a median of 193 mg/L (IQR 242 to 124 mg/L). The time of awakening ranged from 30 minutes to 190 minutes, with a median of 120 minutes (IQR 150 to 83 minutes). Quantitative serum gamma-hydroxybutyrate levels did not correlate with the degree of coma or the time to awakening. Urine levels ranged from 432 to 2,407 mg/L, with a median of 1,263 mg/L (IQR 1,550 to 796 mg/L). Mild transitory hypoventilation occurred in 5 of the 16 patients. Conclusion: All of our patients with clinically suspected severe gamma-hydroxybutyrate overdose were confirmed to have significant serum and urine levels of exogenous gamma-hydroxybutyrate. They presented with severe coma that lasted 1 to 2 hours. Transient hypoventilation occurred in one third of these patients.

关键词：佐剂麻醉/血液佐剂麻醉/尿急诊室医院/统计学和数值数据气相色谱-质谱法格拉斯哥昏迷量表服药过量/血液服药过量/尿前瞻性研究羟丁酸钠/血液羟丁酸钠/尿成年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Outcomes after emergency department discharge with a primary diagnosis of heart failure

引用

AMERICAN HEART JOURNAL 2001年第4期142卷 714-719页

作者： Rame, JE Sheffield, MA Dries, DL Gardner, EB Toto, KH Yancy, CW Drazner, MH Univ Texas SW Med Ctr Donald W Reynolds Cardiovasc Clin Res Ctr Dallas TX 75390 USA Univ Texas SW Med Ctr Div Gen Internal Med Dept Internal Med Dallas TX 75390 USA Univ Texas SW Med Ctr Heart Failure Res Unit Div CardiolDept Internal Med Dallas TX 75390 USA Parkland Mem Hosp & Affiliated Inst Dallas TX 75235 USA

Background Patients with decompensated chronic heart failure (CHF) are frequently evaluated in emergency departments (ED). The outcomes of such patients after discharge to the outpatient setting from the ED are not well known. Risk factors for return ED visits or subsequent hospital admission after ED discharge for CHF also are not known. Methods Charts were reviewed from all 112 patients discharged from the Parkland Memorial Hospital ED with a primary diagnosis of CHF from October to December 1998. A composite end point ("failure of outpatient therapy") was prespecified to be a recurrent ED visit for CHF, hospitalization for CHF, or death at 3 months after the index ED discharge. Results Within 3 months of the index ED visit, 61% of the study population met the composite end point. The median time to failure of outpatient therapy was 30 days. Univariate analysis of 27 clinical and demographic variables demonstrated the respiratory rate at presentation as the only predictor of failure of outpatient therapy (P=.02). Multivariate analysis of a model with 8 prespecified variables also demonstrated respiratory rate to be the only variable independently associated with an increased risk for the composite end point (odds ratio 1.6, 95% confidence interval 1.1-2.6, for each increase of 5 breaths/min). Conclusion There is a high rate of failure of outpatient therapy (61%) in patients discharged with a primary diagnosis of CHF from an urban county hospital ED. Increased respiratory rate on presentation to the ED may be associated with adverse outcomes after ED discharge for CH F.

关键词：门诊医疗急诊室医院/统计学和数值数据住院病人出院/统计学和数值数据病人再入院呼吸治疗失败治疗结果人类

来源：评论

学校读者我要写书评

暂无评论

Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions

引用

ANNALS OF EMERGENCY MEDICINE 2002年第3期39卷 238-247页

作者： Aminzadeh, F Dalziel, WB Reg Geriatr Assessment Program Ottawa Carleton Geriatr Outreach Team Nepean ON K2H 8R2 Canada

Study objective: We sought to synthesize the literature on patterns of use of emergency services among older adults, risk factors associated with adverse health outcomes, and effectiveness of intervention strategies targeting this population. Methods: Relevant articles were identified by means of an English-language search of MEDLINE, HealthSTAR, CINAHL, Current Contents, and Cochrane Library databases from January 1985 to January 2001. This search was supplemented with literature from reference sections of the retrieved publications. A qualitative approach was used to synthesize the literature. Results: Compared with younger persons, older adults use emergency services at a higher rate, their visits have a greater level of urgency, they have longer stays in the emergency department, they are more likely to be admitted or to have repeat ED visits, and they experience higher rates of adverse health outcomes after discharge. The risk factors commonly associated with the negative outcomes are age, functional impairment, recent hospitalization or ED use, living alone, and lack of social support. Comprehensive geriatric screening and coordinated discharge planning initiatives designed to improve clinical outcomes in older emergency patients have provided inconclusive results. Conclusion: Older ED patients have distinct patterns of service use and care needs. The current disease-oriented and episodic models of emergency care do not adequately respond to the complex care needs of frail older patients. More research is needed to determine the effectiveness of screening and intervention strategies targeting at-risk older ED patients.

关键词：急诊室医院/统计学和数值数据老年人身心健康评价卫生服务需求住院时间/统计学和数值数据危险因素治疗结果老年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Results of provider self-adjudication using the prudent layperson standard compared with the managed care organization's emergency department claim review process

引用

ANNALS OF EMERGENCY MEDICINE 2000年第3期36卷 212-218页

作者： Shesser, R Holtermann, K Smith, J Braun, J George Washington Univ Dept Emergency Med Washington DC 20037 USA

Study objectives: We compare the results of a provider "self-adjudicating" outpatient emergency department claims using a "presenting symptom-based" system with the managed care organization (MCO) adjudicating the claims using a "final diagnosis-based" system. Methods: All outpatient visits from one MCO to an urban, university hospital between January 1, 1998, and February 28, 1999, were included. Each record was reviewed by 2 methods to determine whether the visit qualified for payment under the MCO's benefit structure. Under the provider adjudication, symptom-based system, all visits with nursing triage levels of immediate/emergency were approved automatically. Those with triage levels of delayed/nonurgent were reviewed by an emergency physician and approved if, in the physician's opinion, the presenting symptoms met the emergency criteria under the District of Columbia's Access to Emergency Services Act. A second claims review, blinded to the first, was performed with the diagnosis-based system used by the MCO before approval of the prudent layperson standard. This review divided the records into "approve," "deny," and "suspend" categories according to the discharge International Classification of Diseases, ninth revision code. The results of the 2 reviews were compared. Results: We reviewed 1,830 records;836 (46%) cases were triaged as immediate/emergency and 994 (54%) as delayed/nonurgent. Of the 994 delayed/nonurgent visits, physician review determined that 607 (61%) met the prudent layperson standard and 387 (39%) did not. Overall, the provider self-adjudication system determined that 1,443 (78.8%) of the 1,830 visits should be approved for insurance coverage. The MCO's system approved 966 (53%), denied 335 (18%), and suspended 529 (29%). Provider self-adjudication using a symptom-based system resulted in the immediate approval of 1,443 (77.8%) visits compared with 966 (52.7%) by a diagnosis-based system (P<.001). Excluding the 529 suspended claims, McNemar's

来源：评论

学校读者我要写书评

暂无评论

Decubitus ulcers in the dying:: epidemiological, medicolegal and ethical aspects

引用

DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT 2000年第3期125卷 45-51页

作者： Heinemann, A Lockemann, U Matschke, J Tsokos, M Püschel, K Univ Klin Eppendorf Inst Rechtsmed D-22529 Hamburg Germany

Background and objectives: Pressure sores usually result from insufficient preventive measures. They are particularly onmipresent among dying persons in geriatric care. This study deals with prevalence, risk factors and the significance of the nursing environment. Patients and methods: The prevalence of pressure sores among the dead was analysed in a prospective cross-sectional study based on 10,222 postmortem examinations in a crematorium in Hamburg. Results: The overall prevalence of pressure sores from grades I to IV was 11.2% (grade 1: 6.1%, grade 11: 3%, grade III: 1.1%, grade IV: 0,9%). A final logistic regression model showed that pressure sores of Grade III or IV were associated with female gender, date of death in the summer, marasmus, stroke history, neurological disease in general, kidney disease, preceding traumatic events and nursery home residence at the time of death. More than half of all the grade IV cases were diagnosed among nursing home residents whereas those who had died in hospitals contributed to only 11.5% of all the grade IV cases (dead from private homes 34.4%). Nursing home residence was associated with female gender, marasmus and stroke history which predisposed to a higher rate of pressure. Conclusions: Nursing homes are confronted with the highest proportion of pressure sores among dying people when compared to hospitals or private home care. Failure to meet the standards of preventive action against pressure sores point to the shortfalls in the present public health sector and nursing home regulations as well as the medical responsibility for supervision of nursing care. Apart from established standards of care, medicolegal assessment of high-grade pressure sores should also take ethical considerations into account when considering maximum therapy goals among dying persons.

关键词：横断面研究伦理学医学德国/流行病学家庭护理(非专业) 医院/统计学和数值数据殡葬事宜医护疗养所/统计学和数值数据压力性溃疡/流行病学患病率季节临终医护/立法和法学临终医护/标准老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Quality of care for patients hospitalized with heart failure at academic medical centers

引用

AMERICAN HEART JOURNAL 1999年第6期137卷 1028-1034页

作者： Nohria, A Chen, YT Morton, DJ Walsh, R Vlasses, PH Krumholz, HM Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatSect Cardiovasc Med New Haven CT USA Yale Univ Sch Med Yale New Haven Hosp Ctr Outcomes Res & EvaluatDept Med New Haven CT USA Qualidigm Middletown CT USA Univ Healthsyst Chicago IL USA

Background The purpose of this study was to determine the standard of care provided by academic medical centers For the management of congestive heart failure (CHF). Methods and Results The standard of care was estimated by assessing adherence to the treatment guidelines published by the US Agency for Health Care Policy and Research among 522 patients hospitalized at 7 university hospitals with a diagnosis of CHF. Data were abstracted by retrospective chart review. Of the 522 patients analyzed, 435 (83%) had a left ventricular ejection fraction (LVEF) measured or documented. Among these patients, 192 were considered "ideal" candidates for angiotensin-converting enzyme (ACE) inhibitor therapy tie, with systolic dysfunction [LVEF <40%] and no contraindications to ACE inhibitors). In this cohort of "ideal" candidates, 138 (72%) were receiving ACE inhibitors at hospital discharge, including 60 (44%) who were prescribed doses recommended in large clinical trials. Compliance with patient education guidelines was assessed in all 487 patients who were alive at the time of discharge. Of these patients, 365 (75%) received dietary counseling, 404 (83%) were educated about exercise, 54 (11%) were instructed to follow daily weights, and 468 (96%) were counseled regarding medication compliance. Among the 87 smokers who were alive at time of discharge, 8 (9%) had documented advice to quit smoking. Conclusions This study indicates that academic medical centers performed fairly well on the assessment of LVEF, the prescription of ACE inhibitors at discharge, and on education regarding diet, exercise, and compliance with medications. However, the results suggest opportunities for improvement in ACE inhibitor dosing and patient education regarding the importance of monitoring daily weights and smoking cessation.

关键词：医学科学研究中心/标准医学科学研究中心/统计学和数值数据血管紧张素转换酶抑制药/治疗应用心脏病学科医院/标准心脏病学科医院/统计学和数值数据数据收集/方法住院/统计学和数值数据 Logistic模型质量指标卫生保健卫生保健质量/标准卫生保健质量/统计学和数值数据美国老年人老年人 80以上女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

The use and effectiveness of an emergency department observation unit for elderly patients

引用

ANNALS OF EMERGENCY MEDICINE 2003年第5期41卷 668-677页

作者： Ross, MA Compton, S Richardson, D Jones, R Nittis, T Wilson, A William Beaumont Hosp Dept Emergency Med Royal Oak MI 48072 USA Wayne State Univ Sch Med Dept Emergency Med Detroit MI USA

Study objective: Emergency department observation units are cost-effective alternatives to hospital admission for selected patients. However, the use and effectiveness of these units in the elderly population is unclear. We sought to describe the use of an ED observation unit by elderly patients (greater than or equal to65 years), to determine whether the ED observation unit is effective for them in terms of ED observation unit length of stay and hospital admission rates, and to compare efficacy and return visit rates between younger and older patients. Methods: This is a retrospective observational cohort study of consecutive adult patients sent to an ED observation unit from 1996 to 2000 at a high-volume tertiary care suburban teaching hospital. ED observation unit length of stay of less than 18 hours and admittance rates of less than 30% were used as indicators of efficacy. Diagnosis, length of stay, hospital admission rates, and 30-day return visit rates were compared between younger and older patients. Results: Twenty-two thousand five hundred and thirty adult patients were observed, with 37.2% older than 65 years of age. The most common diagnoses in elderly patients were chest pain (24.0%), dehydration (11.7%), syncope (6.5%), back pain (4.6%), and chronic obstructive pulmonary disease (3.8%). Length of stay in the ED observation unit was longer for the elderly than younger patients but still averaged less than 18 hours (15.8 hours [95% confidence interval (Cl) 15.7 to 16.0] versus 14.4 hours [95% Cl 14.3 to 14.5], respectively). Elderly patients were more likely to be admitted from the ED observation unit than younger patients (26.1% versus 18.5%);however, their overall admission rate remained less than 30%. Compared with younger patients, the odds ratios for inpatient admission of elderly patients was highest for back pain (2.10;95% Cl 1.62 to 2.73), pyelonephritis (1.78;95% Cl 1.16 to 2.71), and chest pain (1.65;95% Cl 1.44 to 1.89). Thirty-day related retu

关键词：卡方分布费用效益分析急诊室医院/组织和管理急诊室医院/统计学和数值数据医院专科病房/组织和管理医院专科病房/统计学和数值数据住院/统计学和数值数据住院时间/统计学和数值数据观察回顾性研究成年人老年人人类中年人

来源：评论

学校读者我要写书评

暂无评论

Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma

引用

ANNALS OF EMERGENCY MEDICINE 2002年第3期40卷 300-307页

作者： Keahey, L Bulloch, B Becker, AB Pollack, CV Clark, S Camargo, CA Winnipeg Childrens Hosp Pediat Emergency Serv Allergy & Clin Immunol Sect Winnipeg MB R3M 3V7 Canada Winnipeg Childrens Hosp Dept Pediat Emergency Med Winnipeg MB R3M 3V7 Canada Maricopa Cty Gen Hosp Dept Emergency Med Phoenix AZ USA Massachusetts Gen Hosp Dept Emergency Med Boston MA 02114 USA Harvard Univ Sch Med Brigham & Womens Hosp Channing LabDept Med Boston MA 02115 USA

Background: Previous studies have looked at the relationship between initial oxygen saturation (SaO(2)) and the need for admission in children presenting with an acute asthma exacerbation. If initial SaO(2) value is indeed predictive of admission, then the admission process could be initiated sooner, and time spent in the emergency department could be potentially lessened. Study objective: The objective of the current study was to examine whether initial room air SaO(2) in children presenting to the ED with acute asthma is a reliable predictor of hospital admission. Methods: This was a prospective multicenter study during 1997 and 1998 at 44 North American EDs as part of the Multicenter Airway Research Collaboration. Inclusion criteria were physician diagnosis of acute asthma and age between 2 and 17 years. The association between hospital admission and SaO(2) was examined by using logistic regression. Likelihood ratios were used to assess the diagnostic value of SaO(2). Results: Of the 1,184 children enrolled in the current study, 1,040 (88%) had a documented initial SaO(2) value on room air. The mean age of the cohort was 8 4 years, with a mean initial SaO(2) of 95%+/-4%. Overall, 241 (23%) children were admitted to the hospital. The mean SaO(2) value of children admitted to the hospital was 93%+/-5% versus 96%+/-3% for those not admitted (P<.001). The admission rate decreased with increasing SaO(2);73% (30/41) of children with an Sa value of 88% or less were admitted versus 8% (7/88) with an SaO(2) value of 100%. In the logistic regression model, children with an SaO(2) value of 88% or less were 32 (95% confidence interval 11 to 89) times more likely to be admitted than those with an SaO(2) value of 100%. The likelihood ratio for admission was 12 for children with an Sa value of 88% or less (42/1,040) but decreased to 4.6 for children with an SaO(2) value of 91% or less (130/1,040) and 2.7 for children with an SaO(2) value of 94% or less (333/1,040). Conclusion:

关键词：哮喘/分类急诊室医院/统计学和数值数据住院 Logistic模型血氧测定法试验预期值前瞻性研究 ROC曲线呼吸疾病严重程度指数青少年儿童儿童学龄前女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：