Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Catheter Cardiovasc Interv ; 81(2): 223-31, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22488783

RESUMO

BACKGROUND: Studies assessing the timing of percutaneous coronary interventions (PCI) in patients with Non-ST segment elevation Acute Coronary Syndromes (NSTE-ACS) have failed to generate a consensus on how early PCI should be performed in such patients. PURPOSE: This meta-analysis compares clinical outcomes at 30 days in NSTE-ACS patients undergoing PCI within 24 hours of presentation (early PCI) with those receiving PCI more than 24 hours after presentation (delayed PCI). DATA SOURCES: Data were extracted from searches of MEDLINE (1990-2010) and Google scholar and from scrutiny of abstract booklets from major cardiology meetings (1990-2010). STUDY SELECTION: Randomized clinical trials (RCTs) that included the composite endpoint of death and non-fatal myocardial infarction (MI) at 30 days after PCI were considered. DATA EXTRACTION: Two independent reviewers extracted data using standard forms. The effects of early and delayed PCI were analyzed by calculating pooled estimates for death, non-fatal MI, bleeding, repeat revascularization and the composite endpoint of death or non-fatal MI at 30 days. Univariate analysis of each of these variables was used to create odds ratios. DATA SYNTHESIS: Seven studies with a total of 13,762 patients met the inclusion criteria. There was no significant difference in the odds of the composite endpoint of death or non-fatal MI at 30 days between patients undergoing early PCI and those receiving delayed PCI (OR-0.83, 95%CI 0.62-1.10). Patients receiving delayed PCI experienced a 33% reduction in the odds of repeat revascularization at 30 days compared to those undergoing early PCI (OR-1.33, 95%CI 1.14-1.56, P=0.0004).Conversely, patients undergoing early PCI experienced lower odds of bleeding than those receiving delayed PCI (OR-0.76, 95%CI 0.63-0.91, P = 0.0003). CONCLUSIONS: In NSTE-ACS patients early PCI doesn't reduce the odds of the composite endpoint of death or non-fatal MI at 30 day. This strategy is associated with lower odds of bleeding and higher odds of repeat revascularization at 30 days than a strategy of delayed PCI.


Assuntos
Síndrome Coronariana Aguda/terapia , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Tempo para o Tratamento , Síndrome Coronariana Aguda/mortalidade , Idoso , Feminino , Hemorragia/etiologia , Hemorragia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Razão de Chances , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
2.
J Am Med Inform Assoc ; 28(4): 856-861, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33596593

RESUMO

Health and biomedical informatics graduate-level degree programs have proliferated across the United States in the last 10 years. To help inform programs on practices in teaching and learning, a survey of master's programs in health and biomedical informatics in the United States was conducted to determine the national landscape of culminating experiences including capstone projects, research theses, internships, and practicums. Almost all respondents reported that their programs required a culminating experience (97%). A paper (not a formal thesis), an oral presentation, a formal course, and an internship were required by ≥50% programs. The most commonly reported purposes for the culminating experience were to help students extend and apply the learning and as a bridge to the workplace. The biggest challenges were students' maturity, difficulty in synthesizing information into a coherent paper, and ability to generate research ideas. The results provide students and program leaders with a summary of pedagogical methods across programs.


Assuntos
Currículo , Educação de Pós-Graduação , Informática Médica/educação , Inquéritos e Questionários , Estados Unidos
3.
Telemed J E Health ; 15(3): 277-82, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19382866

RESUMO

Research is yet to fully examine the utility and effectiveness of telehealth in primary care resident ambulatory training. This study examined the attitudes of preceptors, residents, and nurses on (1) the impact of telehealth on healthcare; (2) the impact of telehealth on the work activity of resident clinics; (3) the impact of telehealth on resident training in the outpatient setting; and (4) the impact of telehealth on relationships. There were three focus groups, one each of preceptors (N = 5), residents (N = 10), nurses (N = 7). Eight focus group themes evolved regarding the use of telehealth in the resident clinic: (1) impact on patient/provider relationships; (2) consistent with the values of those using telehealth; (3) logistics; (4) reduces patient transfers; (5) appropriate level of care; (6) reimbursement concerns; (7) psychological risk; and (8) impact on resident/attending relationships. Though as yet not generalizable, results of this pilot study suggest that there is general acceptability of telehealth in ambulatory resident training settings, but there is concern about the impact that telehealth may have on relationships, logistics, finances, and the need to see patients face-to-face when there is greater complexity.


Assuntos
Atitude do Pessoal de Saúde , Educação a Distância , Internato e Residência , Telemedicina , Instituições de Assistência Ambulatorial , Grupos Focais , Humanos , Missouri , Preceptoria , Atenção Primária à Saúde
4.
Hemodial Int ; 14(4): 355-63, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20955270

RESUMO

Multiple myeloma complicated by acute renal failure is a diagnosis often encountered by the practicing nephrologist. The role of plasmapheresis in such patients has been of interest for decades. Three randomized controlled trials (RCTs) and multiple observational trials have evaluated the potential role of plasmapheresis in the management of this condition. This systematic review presents the results of these trials regarding survival benefits, recovery from dialysis, and improvement in renal function. A comprehensive search revealed 56 articles. Of these, only 8 articles met our inclusion criteria (3 RCTs, 1 correction of results, and 4 observational trials). Two of the 3 RCTs showed no difference in survival benefit. Two of the 3 RCTs showed a greater percentage of patients stopping dialysis in the intervention group; however, these results were not reproduced in the largest trial. All the studies showed an improvement in renal function for patients receiving plasmapheresis; however, only 2 RCTs and 1 retrospective study showed a statistically significant improvement in renal function among patients who received plasmapheresis in comparison with a control group. Our systematic review does not suggest a benefit of plasmapheresis independent of chemotherapy for multiple myeloma patients with acute renal failure in terms of overall survival, recovery from dialysis, or improvement in renal function.


Assuntos
Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Plasmaferese , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Humanos , Mieloma Múltiplo/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
5.
Diabetes Educ ; 35(5): 752-60, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19783766

RESUMO

PURPOSE: The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). METHODS: Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not. RESULTS: Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education. CONCLUSIONS: The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.


Assuntos
Diabetes Mellitus/reabilitação , Educação de Pacientes como Assunto , Mecanismo de Reembolso , Autocuidado , Redução de Custos/economia , Coleta de Dados , Diabetes Mellitus/economia , Diabetes Mellitus/psicologia , Custos de Cuidados de Saúde , Humanos , Estudos Longitudinais , Medicare/economia , Assistência ao Paciente/economia , Educação de Pacientes como Assunto/economia , Mecanismo de Reembolso/economia , Telefone , Estados Unidos
6.
J Med Syst ; 29(4): 343-55, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16178333

RESUMO

Diabetes is a chronic disease that causes a great deal of morbidity and mortality and poor quality of life for millions of people. Continuing care and patient education help maintain a good control of the disease and prevent complications. Since current available resources are limited to providing such an education during clinic or physician visits only, alternative ways to educate people about diabetes need to be identified. In this article we discuss the implementation of an automated diabetes education call center, we define the evaluation procedures we adopted, we summarize general guidelines for the implementation of the entire system based on our experience, and we present preliminary results about the use of the call center. We believe our system is providing "active health" since we deliver educational messages to patients at regular intervals and at the time of their choice without waiting for their actions.


Assuntos
Diabetes Mellitus , Linhas Diretas , Internet , Educação de Pacientes como Assunto/métodos , Telecomunicações/organização & administração , Telemedicina , Humanos , Missouri , Estudos de Casos Organizacionais , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa