检索结果-内蒙古大学图书馆

Understanding racial differences in cardiovascular care and outcomes: Issues for the new millennium

AMERICAN HEART JOURNAL 2000年第5期139卷 764-766页

作者： East, MA Peterson, ED Duke Clin Res Inst Durham NC USA

In 1984, Oberman and Cutter1 reported that black cardiac patients treated at the University of Alabama were less likely to undergo cardiac catheterization or bypass surgery than their white counterparts. That same year, Haywood2 found that blacks enrolled in a large -blocker trial had higher long-term mortality rates than whites. Over the ensuing 15 years, dozens of papers have confirmed that racial differences in cardiac care are nearly ubiquitous in the US healthcare system.1,3-23 Similarly, most,4,24 but not all,25 subsequent studies have found that blacks with coronary disease generally have lower long-term survival rates than whites.

关键词：非洲大陆世系人群冠心病/人种学冠心病/死亡率文化交叉比较欧洲大陆世系人群预测卫生服务易得程度/统计学和数值数据心肌血管重建术/统计学和数值数据危险因素存活率分析美国退伍军人/统计学和数值数据老年人人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Are physicians aware of which of their patients have indwelling urinary catheters?

引用

AMERICAN JOURNAL OF MEDICINE 2000年第6期109卷 476-480页

作者： Saint, S Wiese, J Amory, JK Bernstein, ML Patel, UD Zemencuk, JK Bernstein, SJ Lipsky, BA Hofer, TP Univ Michigan Sch Med Dept Internal Med Ann Arbor MI USA Univ Calif San Francisco Sch Med Dept Med San Francisco CA 94143 USA Univ Washington Sch Med Dept Med Seattle WA 98195 USA Vet Affairs Ann Arbor Healthcare Syst Vet Affairs Ctr Practice Management & Outcomes Ann Arbor MI USA Vet Affairs Puget Sound Hlth Care Syst Primary & Specialty Med Care Seattle WA USA

PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters. METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient. RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Over all, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more Likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7;95% confidence interval, 2.1 to 6.7, P<0.001). CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted. Am J Med. 2000;109: 476-480. (

关键词：觉知导管留置临床工作能力卫生设施管理人员/统计学和数值数据医院大学/统计学和数值数据医院退伍军人/统计学和数值数据感染控制实习医师和住院医师职务/统计学和数值数据医学审核医师/统计学和数值数据前瞻性研究学生医科/统计学和数值数据导尿管插入术/方法导尿管插入术/利用老年人女(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

Prevalence of dyspepsia, heartburn, and peptic ulcer disease in veterans

引用

AMERICAN JOURNAL OF GASTROENTEROLOGY 1999年第8期94卷 2086-2093页

作者： Dominitz, JA Provenzale, D VA Puget Sound Hlth Care Syst Seattle Div 111GI Dept Med Div Gastroenterol Seattle WA 98108 USA Univ Washington Sch Med Seattle WA USA Vet Affairs Med Ctr Hlth Serv Res & Dev Durham NC 27705 USA Duke Univ Med Ctr Dept Med Div Gastroenterol Durham NC 27710 USA

OBJECTIVE: Medications used to treat gastrointestinal symptoms account for a substantial share of pharmacy expenses for veterans affairs medical centers. Prior studies have shown that the prevalence of peptic ulcer disease is higher in veterans than in nonveterans. Our aim was to determine the prevalence of upper gastrointestinal symptoms among patients seeking health care in the Department of Veterans Affairs outpatient clinics. METHODS: A total of 1582 veterans completed a previously validated bowel symptom questionnaire in the following clinics: gastroenterology (n = 693), walk-in (n = 403), general medicine (n = 379), and women's health (n = 107). RESULTS: Overall response was 78%. Dyspepsia was reported in 30%, 37%, 44%, and 53% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Heartburn, at least weekly, was reported in 21%, 21%, 28%, and 40% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Prior peptic ulcer disease (PUD) was reported in 29%, 26%, 22%, and 44% of patients in general medicine, walk-in, women's health, and gastroenterology clinics, respectively. Dyspepsia, heartburn, and PUD were significantly associated with increased physician visits and lower general health. CONCLUSIONS: Dyspepsia and heartburn are common symptoms among veterans. Lifetime prevalence of PUD is high among veterans. Gastrointestinal symptoms have a significant impact on health care utilization and general health. These prevalence estimates provide a basis for studies of resource utilization and for cost-effectiveness analyses of the treatment of gastrointestinal disorders in the veteran population. Moreover, the high prevalence of symptoms helps to explain the high utilization of gastrointestinal medications. (Am J Gastroenterol 1999;94:2086-2093. (C) 1999 by Am. Coll. of Gastroenterology).

关键词：费用效益分析横断面研究消化不良/经济学消化不良/流行病学卫生资源/经济学卫生资源/利用胃灼热/经济学胃灼热/流行病学发病率北卡罗来纳消化性溃疡/经济学消化性溃疡/流行病学转诊和会诊/经济学转诊和会诊/利用退伍军人/统计学和数值数据成年人老年人女(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

Variations in the use of cardiac procedures in the Veterans Health Administration

引用

AMERICAN HEART JOURNAL 1999年第4期137卷 706-713页

作者： Mirvis, DM Graney, MJ Univ Tennessee Dept Prevent Med Memphis TN 38105 USA Univ Tennessee Dept Med Memphis TN 38105 USA Dept Vet Affairs Med Ctr Memphis TN USA

Background Considerable variability exists in the use of cardiac procedures for patients with heart disease. One cause for this variability is the availability of local facilities to perform these procedures. This study was initiated to identify health system features that are related to rates of catheterization, percutaneous coronary angioplasty, and coronary artery bypass graft surgery in the Veterans Affairs health care system in which structured referral systems are intended to compensate for variation in local resource availability Methods Medical records of 30,901 patients admitted to a Veterans Affairs medical center with coronary artery disease were analyzed. Odds ratios (OR) and 95% confidence intervals (CI) for undergoing each procedure, based on clinical variables (age, sex, race, coronary artery disease type, and a computed comorbidity score), and local Veterans Affairs facility features (geographic region, primary service area size, and hospital complexity) were estimated by logistic regression. Results Regression models demonstrated significant associations between the odds of undergoing each procedure and medical center geographic and complexity features, after adjustment for clinical variables. Associations included the presence of a cardiac catheterization laboratory For undergoing catheterization (OR 1.86, CI 1.76 to 1.95) and the presence of a cardiac surgical program for angioplasty (OR 1.46, CI 1.36 to 1.57) and bypass grafting (OR 1.43, CI 1.34 to 1.53). Including health system variables in addition to clinical variables in the regression models improved the discriminating ability of the models by 44.2% to 51.4%. Conclusions Geographic location and the complexity of the local Veterans Affairs hospital are important determinants of the use of cardiac procedures in the Veterans Affairs health care system, even though referral networks are intended to correct for local differences in hospital complexity.

关键词：血管成形术经腔经皮冠状动脉/利用置信区间冠状动脉分流术/利用卫生服务易得程度/统计学和数值数据心脏导管插入术/利用医院退伍军人/统计学和数值数据医院退伍军人/利用 Logistic模型病案心肌缺血/外科学比值比医师诊疗模式/统计学和数值数据美国美国退伍军人事务部利用情况审核/统计学和数值数据老年人女(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

Racial variation in the use of laparoscopic cholecystectomy in the Department of Veterans Affairs Medical System

引用

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 1999年第6期188卷 604-622页

作者： Arozullah, AM Ferreira, MR Bennett, RL Gilman, S Henderson, WG Daley, J Khuri, S Bennett, CL Vet Affairs Med Ctr Cooperat Studies Program Coordinating Ctr 151K Hines IL 60141 USA Brockton W Roxbury Vet Affairs Med Ctr W Roxbury MA USA Northwestern Univ Sch Med Dept Med Chicago IL 60611 USA Univ Chicago Robert Wood Johnson Clin Scholars Program Chicago IL 60637 USA VA Employee Educ Syst Long Beach CA USA Harvard Univ Sch Med Boston MA USA Beth Israel Deaconess Med Ctr Div Gen Med & Primary Care Boston MA USA Brigham & Womens Hosp Boston MA 02115 USA Northwestern Univ Sch Med VA Chicago Hlth Care Syst Lakeside Div Chicago IL USA

Background: While studies have found racial differences in the rates of use of established invasive cardiac and cerebrovascular procedures, no study has evaluated racial variation in the rates of adoption of new surgical procedures. For patients undergoing laparoscopic cholecystectomy, the procedure represents a new and safe option that shortens the duration of postoperative hospitalization by almost one week. In this study, we evaluated whether, in the equal access Veterans Affairs (VA) medical system, the rate of adoption of this procedure and improvements in the duration of postoperative hospitalization differed between African-American and Caucasian patients. Study Design: Data were obtained from two sources-administrative claims fries and prospectively compiled clinical data from medical records and patient interviews. In both data sets, frequency of use, length of stay, and outcomes for African-American and Caucasian patients undergoing minimally invasive and open gallbladder surgery were analyzed for the first four years of use of the procedure in the VA system (1992 to 1995). Results: Analyses based on claims files indicated that, after adjustment for potentially confounding variables, African-American patients who underwent cholecystectomy in VA medical centers were 25% less likely to undergo a minimally invasive cholecystectomy during the first 4 years of use of the new procedure (adjusted odds ratio, 0.74;95% confidence interval, 0.66-0.83). Shortening of the average postoperative length of stay from 9 days or more in the prelaparoscopic era to less than 4.5 days for patients undergoing the laparoscopic procedure occurred in the first year for Caucasian patients, but did not occur until the fourth year for African-American patients (p < 0.001). The overall difference in postoperative length of stay between African-American and Caucasian patients more than doubled from 1.7 days before introduction of laparoscopic cholecystectomy to 3.8 days in the fourth y

关键词：非洲裔美国人/统计学和数值数据胆囊切除术/死亡率胆囊切除术/利用胆囊切除术腹腔镜/死亡率胆囊切除术腹腔镜/利用共病现象欧洲大陆世系人群/统计学和数值数据医院死亡率医院退伍军人/统计学和数值数据住院时间比值比美国美国退伍军人事务部成年人老年人女(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

Health status in VA patients: Results from the Veterans Health Study

引用

AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第1期14卷 28-38页

作者： Kazis, LE Ren, XS Lee, A Skinner, K Rogers, W Clarke, J Miller, DR Edith Nourse Rogers Mem Vet Adm Hosp VA Hlth Serv Res & Dev Field Program 152 Ctr Hlth Qual Outcomes & Econ Res Hlth Outcomes Sect Bedford MA 01730 USA New England Med Ctr Hlth Inst Boston MA 02215 USA

Recently, the Veterans Administration (VA) Under Secretary for Health has designated functional status as one of the domains of value for the system, given its increasing importance for clinical care. The Veterans Health Study (VHS) was designed to assist the VA in monitoring out comes and measuring the case mix of patients who use the Vk The Veterans SF-36 (short form functional status assessment for veterans) was administered to 2425 veterans receiving ambulatory care. Measures of the Veterans SF 36 were strongly correlated with sociodemographics and morbidities of the veterans. Young veterans had poorer mental health status than older veterans. Veterans who used ambulatory care in the VHS reported lower levels of health status, reflecting more disease than a non VA civilian population. These measures of health are important indicators of the disease burden or case mix of the patients and are pertinent to health systems such as the VA for resource allocation decisions and as outcomes of care.

关键词：门诊医疗设施/利用波士顿诊断相关患者组健康状况最小二乘法分析前瞻性研究美国美国退伍军人事务部/利用退伍军人/统计学和数值数据成年人老年人老年人 80以上人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Substance abuse as a predictor of VA medical care utilization among Vietnam veterans

引用

JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第2期26卷 126-139页

作者： Virgo, KS Price, RK Spitznagel, EL Ji, THC St Louis Univ Ctr Hlth Sci Dept Surg St Louis MO 63110 USA Washington Univ Sch Med Dept Math St Louis MO USA Washington Univ Sch Med Dept Psychiat St Louis MO USA

The primary objective was to determine whether Vietnam veterans who had alcohol or drug use problems prior to, during, or immediately after the war used Veterans Administration (VA) health care sen,ices more intensively during the next two decades than Vietnam veterans without these behaviors, The secondary objective was to identify predictors of VA health services utilization among data collected at service discharge. Logistic and ordinary least squares regression were used to model the effect of predisposing, enabling, and need factors on utilization of VA health services (N = 571). Results show that Vietnam veterans who had substance use problems either before or immediately after Vietnam used VA health care services more intensively during the next two decades than Vietnam veterans without these behaviors. Depression and psychiatric care seeking were also important predictors, More research is needed to evaluate the impact of health system characteristics and private sector use on the predictive ability of the models.

关键词：随访研究健康调查医院退伍军人/利用病人接受卫生保健的程度统计学(主题) 物质相关性障碍/流行病学美国/流行病学退伍军人/心理学退伍军人/统计学和数值数据越南成年人人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Predicting discharge outcomes of VA nursing home residents

引用

JOURNAL OF AGING AND HEALTH 1997年第2期9卷 244-265页

作者： Mehr, DR Williams, BC Fries, BE UNIV MICHIGAN MED CTR ANN ARBOR MI 48109 USA VET ADM MED CTR ANN ARBOR MI 48105 USA

This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays. Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987. Six-month outcomes for 3 groups were considered: all residents (n=5,895), and those remaining in care after 6 (n=2,815) and 12 months (n=1,812), respectively. Logistic regression was used to evaluate predictors of death and community discharge. Limited activities of daily living (ADL) dependency, younger age, and receipt of rehabilitation services most consistently predicted community discharge. ADL dependency, older age, oxygen use, terminally ill prognosis, malignancy, and congestive heart failure most consistently predicted mortality. For both dependent variables, predictive ability declined as stay length increased. Predicting death and community discharge become increasingly problematic as stay lengthens. Comparing observed versus expected discharge outcomes has limited usefulness as a quality-improvement tool.

关键词：日常生活活动年龄因素老人疗养院住院时间 Logistic模型死亡率医护疗养所/统计学和数值数据结果评价(卫生保健) 病人出院/统计学和数值数据时间因素美国退伍军人/统计学和数值数据老年人人类

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：