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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 17-18页

作者： Stukel T.A. Lucas F.L. Wennberg D.E. 任付先 dr. inst. for clin. evaluative sciences G106-2075 Bayview Ave Toronto Ont. M4N 3M5 Canada

Context: The health and policy implications of the marked regional variations in intensity of invasive compared with medical management of patients with acute myocardial infarction(AMI) are unknown. Objectives: To evaluate patient clin.cal characteristics associated with receiving more intensive treatment; and to assess whether AMI patients residing in regions with more intensive invasive treatment and management strategies have better longterm survival than those residing in regions with more intensive medical management strategies. Design, Setting, and Patients: National cohort study of 158831 elderly Medicare patients hospitalized with first episode of confirmed AMI in 1994-1995, followed up for 7 years(mean, 3.6 years), according to the intensity of invasive management(perfor-mance of cardiac catheterization within 30 days) and medical management(prescription of βblockers to appropriate patients at discharge) in their region of residence. Baseline chart reviews were dr.wn from the Cooperative Cardiovascular Project and linked to Medicare health administrative data. Main Outcome Measure: Long-term survival over 7 years of followup. Results: Patient baseline AMI severity was similar across regions. In all regions, younger and healthier patients were more likely than older high-risk patients to receive invasive treatment and medical therapy. Regions with more invasive treatment practice styles had more cardiac catheterization laboratory capacity; patients in these regions were more likely to receive interventional treatment, regardless of age, clin.cal indication, or risk profile. The absolute unadjusted difference in 7-year survival between regions providing the highest rates of both invasive and medical management strategies and those providing the lowest rates of both was 6.2%. For both ST-and non-ST-segment elevation AMI patients, survival improved with regional intensity of both invasive and medical management. In areas with higher rates of medical management,

关键词：治疗强度急性心肌梗死医保患者药物治疗地区差别 β受体阻断剂远期生存率介入治疗队列研究心导管室

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心脏性和非心脏性病症对除颤器植入后存活率的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第10期3卷 51-52页

作者： Lee D.S. Austin P.C. 孙凯 inst.tute for clin.cal evaluative sciences TorontoCanada Dr.

目的:调查接受埋藏式心脏复律除颤器(ICD)患者的预后以及年龄、性别和并存病对存活率的影响。背景:年龄、性别和并存病可能显著影响ICD植入者的预后。方法:利用加拿大安大略省全省数据库。

关键词：心脏性性别病症并存病

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心衰药物治疗中的风险-治疗不匹配

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世界核心医学期刊文摘(心脏病学分册) 2006年第2期 20-21页

作者： Lee D. S. Juurlink D. N. Laupacis A. 王亭忠 inst.tute for clin.cal evaluative sciences 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

Context: Patients with heart failure have a wide spectrum of mortality risks. To maximize the benefit of available pharmacotherapies, patients with high mortality risk should receive high rates of dr.g therapy. Objective: To examine patterns of dr.g therapy and underlying mortality risk in patients with heart failure. Design, Setting, and Patients: In the Enhanced Feedback for Effective Cardiac Treatment(EFFECT) population-based cohort(1999-2001) of 9942 patients with heart failure hospitalized in Ontario, Canada, we evaluated 1418 patients with documented left ventricular ejection fraction of 40% or less and aged 79 years or younger with low-,average-, and high-predicted risk of death within 1 year; all patients survived to hospital discharge. Administration of angiotensin-converting enzyme(ACE) inhibitors, ACE inhibitors or angiotensin II receptor blockers(ARBs), and β -adr.noreceptor antagonists was evaluated according to predicted risk of death. Main Outcome Measure: Heart failure dr.g administration rates at time of discharge and 90 days after hospital discharge. Results: At hospital discharge, prescription rates for patients in the low-, average-, and high-risk groups were 81% , 73% , 60% , respectively, for ACE inhibitors; 86% , 80% , 65% , respectively, for ACE inhibitors or ARBs; and 40% , 33% , 24% , respectively, for β -adr.noreceptor antagonists(all Pdr.noreceptor antagonists for the 3 risk groups, respectively(all Pdr.g administration in those patients at increasing risk was maintained up to 1 year postdischarge(P< .001). After accounting for varying survival time and potential contraindications to therapy, low-risk patients were more likely to receive ACE inhibitors or ARBs(adjusted hazard ratio HR , 1.61; 95

关键词：心衰心衰患者 ARB 药物治疗 β受体阻断剂死亡风险不匹配

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循证药物治疗依从性和急性心肌梗死远期死亡率的关系

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 4-5页

作者： Rasmussen J.N. Alter D.A. 黄浙勇 inst.tute for clin.cal evaluative sciences 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

背景：药物依从性对存活率的影响程度如何尚不为人知，部分原因在于死亡率差异可能更多地源自“健康遵从效应”行为特性，而不是药物治疗作用。目的：探讨药物治疗依从性与急性心肌梗死（AMI）存活患者死亡率的关系。设计、地点和参与... 详细信息

背景：药物依从性对存活率的影响程度如何尚不为人知，部分原因在于死亡率差异可能更多地源自“健康遵从效应”行为特性，而不是药物治疗作用。目的：探讨药物治疗依从性与急性心肌梗死（AMI）存活患者死亡率的关系。设计、地点和参与者：该观察性纵向人群研究纳入1999-2003年加拿大安大略省31455例老年AMI存活者。所有患者被予以他汀类药物、β受体阻断剂或钙通道阻断剂（钙通道阻断剂缺乏改善存活率的循证医学证据，作为对照）。主要观察指标：患者被分为依从性高（依从天数百分比≥80％）、中（依从天数百分比40％～79％）和低（依从天数百分比〈40％）三类。应用多因素生存分析和倾向分析比较其远期死亡率（中位随访2．4年），分析中校正了社会人口统计学因素、疾病严重性、共病和同时采用的循证治疗手段等因素。

关键词：药物治疗依从性远期死亡率急性心肌梗死循证医学证据钙通道阻断剂社会人口统计学 β受体阻断剂药物依从性

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冠状动脉搭桥术后长期无症状存活者的生活质量与普通人群相当

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世界核心医学期刊文摘（心脏病学分册） 2006年第6期2卷 28-29页

作者： Bradshaw P.J. Jamrozik K.D. Gilfillan I.S. Thompson P.L. 黎一兵 inst.tute for clin.cal evaluative sciences(ICES) 2075 Bayview Avenue Toronto Ont. M4N 3M5 Canada Dr.

Background: Health- related quality of life(HRQOL) among long- term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. Methods: A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft(CABG) surgery in Western Australia. A random stratified sample of 2500 was dr.wn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health- related quality of life was measured with Short Form 36 and EuroQol visual analogue scale. Results: Response was 82% (n=2061). Health- related quality of life declin.d with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex- standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow- up(33% ), symptoms of heart failure equivalent to New York Heart Association(NYHA) classes II to IV(34% ), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow- up,HRQOL was no different from that of the general population. Conclusion: Overall, the quality of life among long- term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow- up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.

关键词：健康相关生活质量 CABG术后冠状动脉搭桥术长期存活者普通人群无症状 HRQOL 视觉模拟评分年龄增长澳大利亚

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冠状动脉搭桥手术患者出院后结局的性别差异

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 21-22页

作者： Guru V. Fremes S.E. Austin P.C. 郭俊 inst.tute for clin.cal evaluative sciences G106 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clin.cal and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clin.cal preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.

关键词：性别差异冠状动脉搭桥血运重建不稳定型心绞痛非致死性血管成形术心脏事件充血性心力衰竭患

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对存在治疗选择偏倚的观察性研究的分析:采用倾向评分和工具变量法评价有创性心脏治疗对AMI患者生存率的影响

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世界核心医学期刊文摘（心脏病学分册） 2007年第7期3卷 5-6页

作者： Stukel T.A. Fisher E.S. Wennberg D.E. 黄浙勇 inst.tute for clin.cal evaluative sciences G106 2075 Bayview Ave Toronto Ont. M4N 3M5 Canada Dr.

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、... 详细信息

背景：在观察性研究中，对治疗组和非治疗组间结果的比较可能会因组间患者预后的差异而产生偏倚，常见的原因是未发现的治疗选择偏倚。目的：比较4种分析方法排除观察性研究中选择偏倚的效果：多因素模型风险校正、倾向评分风险校正、倾向评分匹配法和工具变量法。设计、地点和患者：此项全国性队列研究纳入1994—1995年间122124例享有医疗保险的老年急性心肌梗死（AMI）住院患者（65～84岁），所有病例均适合行心导管术。基线资料来自心血管合作项目，并与医疗保险管理数据连接，以确保足够充分的预后参数。

关键词：心脏治疗倾向评分 AMI患者偏倚工具生存率有创性老年急性心肌梗死

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Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding

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International Journal of clin.cal Medicine 2012年第7期3卷 758-764页

作者： Clare L. Atzema R. Alexandr. Stefan Refik Saskin Greg Michlik Peter C. Austin Department of Emergency Services Sunnybrook Health Sciences Centre Toronto Canada Division of Emergency Medicine Department of Medicine University of Toronto Toronto Canada The inst.tute for clin.cal evaluative sciences Toronto Canada

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.

关键词： Teaching Education Procedures Emergency Department Video

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Encouraging kids to hop,skip,and jump：Emphasizing the need for higher-intensity physical activity in childcare

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Journal of Sport and Health Science 2018年第3期7卷 333-336页

作者： Molly dr.ediger Leigh M.Vanderloo Stephanie Truelove Brianne A.Bruijns Patricia Tucker school of occupational therapy university of western ontario elborn collegeLondonOntario N6G 1H1Canada child health and evaluative sciences the hospital for sick childrenTorontoON M5G OA4Canada health and rehabilitation sciences university of western ontario elborn collegeLondon.Ontario N6G 1H1Canada

*** Daily physical activity（PA）participation is crucial to the health and well-being of young *** with total physical activity（TPA;all-intensity）,moderate-to-vigorous physical activity（MVPA）,or energetic play,is associated with greater health benefits,particularly for preschoolers（3-4 years）,including but not limited to improved bone and skeletal properties and cognitive and psychosocial health.1 Centered on this,both Canada and Australia have recently established 24-Hour Movement Guidelines for the Early Years,recommending that.

关键词： Encouraging kids to hop,skip,and jump:Emphasizing the need for higher-intensity physical activity in childcare

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Gender differences in mental health service utilization among respondents reporting depression in a national health survey

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Health 2013年第10期5卷 1561-1571页

作者： Katherine L. W. Smith Flora I. Matheson Rahim Moineddin James R. Dunn Hong Lu John Cairney Richard H. Glazier Centre for Research on Inner City Health Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital Toronto Canada inst.tute for clin.cal evaluative sciences Toronto Canada

This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.

关键词： Depression Gender Mental Health Service Utilization Survey Medical Records

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