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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 clinical Medicine 2012年第7期3卷 758-764页

作者： Clare L. Atzema R. Alexandra 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 Institute for clinical 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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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 Institute for clinical 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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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 Institute for clinical 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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Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

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Journal of Geriatric Cardiology 2021年第9期18卷 728-738页

作者： Fu-Wei XING Li-Hua ZHANG Hai-Bo ZHANG Xue-Ke BAI Dan-Li HU Xin ZHENG Jing LI National clinical Research Center for Cardiovascular Diseases NHC Key Laboratory of Clinical Research for Cardiovascular MedicationsState Key Laboratory of Cardiovascular DiseaseFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeNational Center for Cardiovascular DiseasesBeijingChina

OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure(HF)patients with atrial fibrillation(AF),and further explore this association that differs by left ventricular ejection fraction(LVEF)*** We enrolled hospitalized HF patients with AF from China Patient-centered evaluative Assessment of Cardiac Events Prospective Heart Failure *** proportional hazard regression models were employed to calculate hazard ratio of *** primary outcome was all-cause *** Among 1762 HF patients with AF(756 women[41.4%]),1041(56%)received beta-blockers at discharge and 1272(72.2%)had an LVEF>40%.During one year follow up,all-cause death occurred in 305(17.3%),cardiovascular death occurred in203 patients(11.5%),and rehospitalizations for HF occurred in 622 patients(35.2%).After adjusting for demographic characteristics,social economic status,smoking status,medical history,anthropometric characteristics,and medications used at discharge,the use of beta-blockers at discharge was not associated with all-cause death[hazard ratio(HR):0.86;95%Confidence Interval(CI):0.65-1.12;P=0.256],cardiovascular death(HR:0.76,95%CI:0.52-1.11;P=0.160),or the composite outcome of all-cause death and HF rehospitalization(HR:0.97,95%CI:0.82-1.14;P=0.687)in the entire *** were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death,cardiovascular death,or composite *** the adjusted models,the use of beta-blockers at discharge was not associated with all-cause death,cardiovascular death,or composite outcome across the different levels of LVEF:reduced(clinical outcomes,regardless of LVEF.

关键词： Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation

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急性心肌梗死医疗保险患者介入治疗与药物治疗强度区域变化对远期预后的影响

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美国医学会杂志（中文版） 2005年第4期24卷 195-203页

作者： Therese A. Stukel F. Lee Lucas David E. Wennberg 王淑敏（译）胡大一（校） Center for the evaluative clinical sciences Dartmouth Medical School Hanover NH Institute for clinical evaluative sciences TorontoOntario Department of Health Policy Managernent and Evaluation Faculty of Medicine University of Toronto Toronto Center for Outcomes Research and Evaluation Maine Medical Center Portland

背景：与药物治疗比较，急性心肌梗死（acute myocardial infarction，AMI）患者介入治疗强度存在显著的地区差异，这种差异在卫生及政策方面的意义还不清楚。目标：评价接受积极治疗患者的相关临床特征；评估居住于积极采取介入治疗策... 详细信息

背景：与药物治疗比较，急性心肌梗死（acute myocardial infarction，AMI）患者介入治疗强度存在显著的地区差异，这种差异在卫生及政策方面的意义还不清楚。目标：评价接受积极治疗患者的相关临床特征；评估居住于积极采取介入治疗策略地区的AMI患者与居住于积极采取药物治疗策略地区的患者相比，是否具有更好的远期生存率。设计、地点及患者：在158831例老年医疗保险患者中进行该项全国性队列研究。患者于1994～1995年因首次发生并确诊AMI而入院，随访7年（平均随访3．6年）。根据居住地区介入治疗（30天内接受心导管手术）与药物治疗（出院时对适宜的患者应用β-阻滞剂）强度进行分析。基线资料来自心血管协作项目，并与医疗保险管理资料联合。主要观察指标：7年随访期间的远期生存率。结果：各地区AMI基线严重程度相似。在所有地区，较年轻、较健康的患者与年老的高危患者相比，更可能接受介入治疗和药物治疗。更多实施介入治疗的地区具备更多的心脏导管室条件；这些地区的患者无论年龄、临床指征还是危险特点如何，均更多接受介入治疗。介入和药物治疗策略采用率最高的地区与介入和药物治疗采用率最低的地区，两者未经校正的7年绝对生存率差异为6．2％。对于ST抬高和非ST抬高AMI患者，其生存率随着地区介入治疗和药物治疗强度的增高而升高。在药物治疗比例较高的地区，随着介入治疗的增加，相应的生存率提高很少甚或没有提高。结论：老年医疗保险AMI患者接受较为积极的药物治疗对改善人群的生存有益。

关键词：药物治疗策略老年医疗保险急性心肌梗死治疗患者介入治疗治疗强度远期预后远期生存率非ST抬高

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子痫前期及大脑二者关系可能与后期痴呆相关,需要深入研究

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英国医学杂志中文版 2019年第5期22卷 249-250页

作者： Joel G Ray Alison L Park 李洁(译) 毛晨晖(校) Departments of Medicine Health Policy Management and Evaluationand Obstetrics and GynecologySt Michael' s HospitalTorontoONCanada Institute for clinical evaluative sciences University of TorontoTorontoONCanada 北京协和医院神经科

在一篇相关的文章里(doi:10.1136/bmj.k4109,摘要见本期第251页),Basil及他的同事研究伴或不伴子痫前期病史的女性患痴呆的风险在中位数为21.1年的随访过后,他们报道至少一次妊娠中患有子痫前期的女性相较于没有此病史的女性患有血管性... 详细信息

在一篇相关的文章里(doi:10.1136/bmj.k4109,摘要见本期第251页),Basil及他的同事研究伴或不伴子痫前期病史的女性患痴呆的风险在中位数为21.1年的随访过后,他们报道至少一次妊娠中患有子痫前期的女性相较于没有此病史的女性患有血管性痴呆的风险高岀3.5倍(共105例),患有阿尔茨海默病的风险高1.5倍(676例),患有其他或非特异性痴呆的风险高1.4倍(947例)。

关键词：血管性痴呆子痫前期大脑阿尔茨海默病非特异性风险中位数女性

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Impact of Laboratory Value Flowsheet in Electronic Health Record (EHR) Documentation Time

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Open Journal of Nursing 2024年第1期14卷 40-50页

作者： Isabel Rosado Pogozelski Puerto Rico Department of Health COVID-19 Immunization Program San Juan PR USA Universidad Ana G Mendez Health Sciences School Nursing Department Gurabo PR USA

Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .

关键词： Electronic Health Record EHR Laboratory Results Template Documentation Time

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Percutaneous coronary interventions in the elderly:a 10-year experience in Northern New England

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Journal of Geriatric Cardiology 2005年第1期2卷 17-22页

作者： David J.Malenka James T.DeVries Samuel J.Shubrooks for the Northern New England Cardiovascular Disease Study Group Section of Cardiology Dartmouth-Hitchcock Medical Center LebanonNH Center for the evaluative clinical sciences Dartmouth Medical SchoolHanoverNHUSA for the Northern New England Cardiovascular Disease Study Group Section of Cardiology Dartmouth-Hitchcock Medical Center LebanonNHUSA for the Northern New England Cardiovascular Disease Study Group Division of Cardiology Beth Israel-Deaconess Medical Center BostonMAUSA Jr

Background There is a paucity of information available for clinical decision making applying to the elderly patient population. Therefore, data of percutaneous coronary interventions (PCI) including demographic information on the elderly patients, procedural practices, and outcomes are needed. Objectives and Methods From consecutive PCIs of participating institutions, demographics data, clinical, angiographic success and adverse clinical outcomes were collected. Standard statistical methods were used to compare crude differences in patient and procedural characteristics across age groups. Results At baseline, the prevalence of comorbid conditions ( renal failure and heart failure) increased with age. Unstable angina or a non-ST elevation MI were the most common indications for PCI across all age groups. Fewer patients ≥ 80 years old were undergoing primary PCI and older patients were somewhat less likely to receive a Ⅱb/Ⅲa receptor blocker. Slightly more patients ≥ 80 years old underwent a 2-vessel PCI ( consistent with them having more multivessel disease) and these patients were more likely to have an intervention on a Type C lesion. Compared to patients ＜ 50 years old, those aged ≥ 70 years old had a significantly increased risk of death, MI, stroke, or vascular complications at the access site. Conclusions This study suggests increasing age is associated with increasing risk for an adverse outcome following PCI. This is in part attributable to case-mix but likely, also related to the changing physiology of aging. Despite the increased risk of the procedure, the clinical success rate for PCI is quite high and makes it a reasonable alternative for the treatment of CAD in the elderly.

关键词： coronary artery disease elderly percutaneous coronary intervention

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因药物中毒住院的老年患者的药物相互作用

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美国医学会杂志（中文版） 2004年第4期23卷 181-186页

作者： DavidN．Juurlink MuhammadMamdani．PharmD AlexanderKopp AndreasLaupacis DonaldA．Redelmeier 赵秀丽 Sunnybrook and Women's College Health sciences Centre the clinical Epidemiology and Healthcare Research Program and Departments of Medicine Sunnybrook and Women's College Health sciences Centre the clinical Epidemiology and Healthcare Research Program and Pharmacy Toronto Ontario University of Toronto and the Institute for clinical evaluative sciences Toronto Ontario

背景：药物相互作用所致病患和死亡是可以预防的，但其在社会中的重要性未被充分显示。目的：研究因特定药物中毒而住院的老年患者在住院前1周是否应用了相互作用的药物。设计：3个以人群为基础的窠式病例对照研究地点:加拿大安大略省，... 详细信息

背景：药物相互作用所致病患和死亡是可以预防的，但其在社会中的重要性未被充分显示。目的：研究因特定药物中毒而住院的老年患者在住院前1周是否应用了相互作用的药物。设计：3个以人群为基础的窠式病例对照研究地点:加拿大安大略省，从1994年1月1日至2000年12月31日。病例：所有采用格列苯脲、地高辛或一种血管紧张素转换酶(ACE)抑制剂治疗的年龄≥66岁的安大略居民。病例为因药物相关毒性而住院的患者。将病例的处方记录与对照组(年龄、性别、使用相同药物以及有或无肾脏疾病方面匹配)比较观察相互作用药物(增效磺胺甲基异噁唑与格列苯脲、克拉霉素与地高辛、保钾利尿剂与ACE抑制剂)的使用情况。主要结果评估：药物中毒(分别为低血糖、地高辛中毒、高钾血症)住院与之前1周曾使用相互作用药物关系的优势比，校正诊断、接受其他药物治疗、处方药物数量和索引日期前1年住院次数。结果：在7年研究期间，909例接受格列苯脲治疗的老年患者因低血糖住院。在一级分析中，因低血糖住院的患者上周服用增效磺胺甲基异噁唑的可能性为对照组的6倍多(校正优势比，6．6；95％可信区间，4．5～9．7)。因地高辛中毒住院的患者(n=1051)上周使用克拉霉素治疗的可能性大约为12倍(校正优势比，11．7；95％可信区间，7．5～18．2)。接受ACE抑制剂治疗因高钾血症而住院的患者上周使用保钾利尿剂治疗的可能性则为对照的20倍(校正优势比，20．3；95％可信区间，13．4～30．7)。有相似适应证但未使用已知相互作用药物的(如阿莫西林、头孢呋辛和吲哒帕胺)患者发生药物毒性反应的危险未见增加。结论：许多因药物毒性而住院的老年患者发生于服用已知的可引起相互作用的药物之后。其中很多相互作用是可以避免的。

关键词：药物中毒老年人药物作用血管紧张素转换酶 ACE

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老年高危病人的他汀降脂治疗：治疗与危险的矛盾

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美国医学会杂志（中文版） 2005年第5期24卷 259-264页

作者： Dennis T. Ko Muhammad Mamdani David A. Alter 徐成斌（译） Division of Cardiology Schulich Heart Centre and Department of Medicine Sunny-brook and Women＇s College Health Sciences Centre Institute for clinical evaluative sciences Toronto On.do 不详

背景：心血管治疗（如他汀治疗）对二级预防的益处已被充分证明，但是在最有可能从中获益的病人中并未获得最佳应用。从理论上讲，积极应用这些有效治疗应该与基线心血管危险相关。目的：研究医生治疗积极性与患者基线心血管危险的关系... 详细信息

背景：心血管治疗（如他汀治疗）对二级预防的益处已被充分证明，但是在最有可能从中获益的病人中并未获得最佳应用。从理论上讲，积极应用这些有效治疗应该与基线心血管危险相关。目的：研究医生治疗积极性与患者基线心血管危险的关系。设计、地点及参试者：使用多个互联的保健管理数据库进行回顾性队列研究，这些数据库覆盖了安大略140余万老年居民。研究共包括396077例年龄≥66岁，正在接受内科治疗，截至1998年4月1日仍然存活的有心脏病史或糖尿病史韵病人。基线心血管危险用危险校正指数推导产生，据此模拟3年随访死亡概率。主要观察指标：应用他汀的可能性，在校正年龄、性别、社会经济状况及城乡居住状况后，按基线心血管危险进行分层。结果：在该二级预防队列中，仅有75617例病人（19．1％）曾予他汀处方。66～74岁的病人按基线低危、中危和高危进行分组，校正后给予他汀处方的概率分别为37．7％、26．7％和23．4％。年龄每增加1岁，预期3年死亡危险增加1％，而处方他汀类药物的可能性降低6．4％（校正后优势比，0．94；95％可信区间，0．93～0．95）。年龄与基线危险共同影响他汀类处方的概率（P〈0．001）。结论：我们发现，随着基线心血管危险以及预期死亡概率的增加，他汀类药物的处方逐渐减少。因为治疗的获益取决于基线危险性，所以他汀类药物的最大获益只有纳入了最高危的病人后才可能被充分认识。

关键词：老年高危病人他汀类药物降脂治疗回顾性队列研究心血管危险死亡概率矛盾社会经济状况二级预防糖尿病史

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