Asunto(s)
Planificación en Salud Comunitaria/organización & administración , Participación de la Comunidad/métodos , Medicina Basada en la Evidencia/organización & administración , Investigación sobre Servicios de Salud/organización & administración , Relaciones Comunidad-Institución , Guías como Asunto , Humanos , Evaluación de Necesidades , Evaluación de Resultado en la Atención de Salud , Desarrollo de Programa , Proyectos de Investigación/normas , Apoyo a la Investigación como Asunto/organización & administración , Estados Unidos , United States Agency for Healthcare Research and QualityAsunto(s)
Antibacterianos/uso terapéutico , Raspado Dental/normas , Periodontitis/terapia , Aplanamiento de la Raíz/normas , Adulto , Amoxicilina/uso terapéutico , Clorhexidina/uso terapéutico , Enfermedad Crónica , Terapia Combinada , Raspado Dental/métodos , Medicina Basada en la Evidencia , Humanos , Metronidazol/uso terapéutico , Minociclina/uso terapéutico , Índice Periodontal , Periodontitis/diagnóstico , Periodontitis/tratamiento farmacológico , Periodontitis/microbiología , Proyectos de Investigación , Aplanamiento de la Raíz/métodos , Tetraciclina/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Patients with transient ischemic attack (TIA) or stroke frequently first contact their primary care physician rather than seeking care at a hospital emergency department. The purpose of the present study was to identify a group of patients seen by primary care physicians in an office setting for a first-ever TIA or stroke and characterize their evaluation and management. METHODS: Practice audit based on retrospective, structured medical record abstraction from 27 primary care medical practices in 2 geographically separate communities in the eastern United States. RESULTS: Ninety-five patients with a first-ever TIA and 81 with stroke were identified. Seventy-nine percent of those with TIA vs 88% with stroke were evaluated on the day their symptoms occurred (P =.12). Only 6% were admitted to a hospital for evaluation and treatment on the day of the index visit (2% TIA; 10% stroke; P =.03); only an additional 3% were admitted during the subsequent 30 days. Specialists were consulted for 45% of patients. A brain imaging study (computed tomography or magnetic resonance imaging) was ordered on the day of the index visit in 30% (23% TIA, 37% stroke; P =.04), regardless of whether the patient was referred to a specialist. Carotid ultrasound studies were obtained in 28% (40% TIA, 14% stroke; P<.001), electrocardiograms in 19% (18% TIA, 21% stroke; P =.60), and echocardiograms in 16% (19% TIA, 14% stroke; P =.34). Fewer than half of patients with a prior history of atrial fibrillation (n = 24) underwent anticoagulation when evaluated at the index visit. Thirty-two percent of patients (31% TIA, 33% stroke; P =.70) were not hospitalized and had no evaluations performed during the first month after presenting to a primary care physician with a first TIA or stroke. Of these patients, 59% had a change in antiplatelet therapy on the day of the index visit. CONCLUSIONS: Further primary care physician education regarding the importance of promptly and fully evaluating patients with TIA or stroke may be warranted, and barriers to implementation of established secondary stroke prevention strategies need to be carefully explored. Arch Intern Med. 2000;160:2941-2946
Asunto(s)
Medicina Interna , Ataque Isquémico Transitorio/terapia , Pautas de la Práctica en Medicina , Accidente Cerebrovascular/terapia , Anciano , Comorbilidad , Hospitalización , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/epidemiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Estados UnidosRESUMEN
BACKGROUND: Most treatment of patients at risk for stroke is provided in the ambulatory setting. Although many studies have addressed the proportion of eligible patients with atrial fibrillation (AF) receiving warfarin sodium, few have addressed the quality of their anticoagulation management. OBJECTIVE: As a comprehensive assessment of quality, we analyzed the proportion of eligible patients receiving warfarin, the proportion of time their international normalized ratios (INRs) were within the target range, and, when an out-of-target range INR value occurred, the time until the next INR measurement was made. METHODS: Retrospective review of the medical records of 660 patients with AF managed by general internists and family practitioners in Rochester, NY, and the Research Triangle area of North Carolina. RESULTS: Only 34.7% of eligible patients with AF received warfarin. The INR values were out of the target range approximately half the time, and the response to these values was not always timely. For all the measures considered, both Rochester practices with access to an anticoagulation service had higher (albeit not ideal) quality of warfarin management than the remaining practices. CONCLUSIONS: We found significant deficiencies in the practice of warfarin management and suggestive evidence that anticoagulation services can partially ameliorate these deficiencies. More research is needed to describe the quality of anticoagulation management in typical practice and how this management can be improved.
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Warfarina/uso terapéutico , Adulto , Anciano , Fibrilación Atrial/complicaciones , Femenino , Humanos , Relación Normalizada Internacional , Masculino , Auditoría Médica , Persona de Mediana Edad , New York , North Carolina , Estudios Retrospectivos , Accidente Cerebrovascular/etiologíaAsunto(s)
Disuasivos de Alcohol/uso terapéutico , Alcoholismo/tratamiento farmacológico , Acamprosato , Disulfiram/uso terapéutico , Política de Salud , Humanos , Litio/uso terapéutico , Naltrexona/uso terapéutico , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Serotoninérgicos/uso terapéutico , Taurina/análogos & derivados , Taurina/uso terapéutico , Estados UnidosRESUMEN
In patients with atrial septum defect and mitral stenosis, respectively, the ventilation and blood gas parameters were compared before and after cardiac operation. In general postoperatively no reversibility of preoperatively proved pulmonary functional disturbances could be established. Only in individual cases a discrete improvement of some of the functional indicators could be observed. Therefore, the operative intervention on the heart should be performed possibly before the onset of irreversible pulmonary structural changes.