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The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 - blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature156767
Source
Can J Cardiol. 2008 Jun;24(6):455-63
Publication Type
Article
Date
Jun-2008
Author
Raj S Padwal
Brenda R Hemmelgarn
Nadia A Khan
Steven Grover
Finlay A McAlister
Donald W McKay
Thomas Wilson
Brian Penner
Ellen Burgess
Peter Bolli
Michael D Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Simon W Rabkin
Martin Dawes Dawes
Rhian M Touyz
Chaim Bell
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Can J Cardiol. 2008 Jun;24(6):455-63
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Blood Pressure Determination - standards
Canada
Clinical Competence
Diagnosis, Differential
Education, Medical, Continuing - standards
Humans
Hypertension - diagnosis - drug therapy - physiopathology
Practice Guidelines as Topic
Program Evaluation - trends
Risk Assessment - methods
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
Notes
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Clin Sci (Lond). 2001 Dec;101(6):671-911724655
Cites: Stroke. 2002 Jul;33(7):1776-8112105351
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Diabetes Care. 2004 Jan;27(1):247-5514693997
Cites: Hypertension. 2004 Jan;43(1):10-714638619
Cites: Hypertension. 2004 May;43(5):963-915037557
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Circulation. 1991 Jan;83(1):356-621984895
Cites: JAMA. 1996 May 22-29;275(20):1571-68622248
Cites: Arch Intern Med. 1996 Jul 8;156(13):1414-208678709
Cites: Arch Intern Med. 1998 Mar 23;158(6):655-629521231
Cites: Am J Cardiol. 2005 Jan 1;95(1):29-3515619390
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):573-8116755312
Cites: Can J Cardiol. 2006 May 15;22(7):606-1316755316
Cites: Hypertension. 2006 Aug;48(2):219-2416801488
Cites: N Engl J Med. 2006 Oct 12;355(15):1551-6216980380
Cites: Arch Intern Med. 2006 Nov 13;166(20):2191-20117101936
Cites: Lancet. 2007 Jan 20;369(9557):201-717240286
Cites: AJR Am J Roentgenol. 2007 Mar;188(3):798-81117312071
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
Cites: Can J Cardiol. 2007 May 15;23(7):539-5017534460
Cites: J Hypertens. 2007 Jun;25(6):1311-717563546
Cites: Kidney Int. 2007 Aug;72(3):260-417507905
Cites: Hypertension. 2007 Sep;50(3):467-7317679652
Cites: N Engl J Med. 2000 Mar 30;342(13):905-1210738048
PubMed ID
18548142 View in PubMed
Less detail

The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature151165
Source
Can J Cardiol. 2009 May;25(5):279-86
Publication Type
Article
Date
May-2009
Author
Raj S Padwal
Brenda R Hemmelgarn
Nadia A Khan
Steven Grover
Donald W McKay
Thomas Wilson
Brian Penner
Ellen Burgess
Finlay A McAlister
Peter Bolli
Machael D Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Chaim Bell
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Michel Vallée
Ramesh Prasad
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Can J Cardiol. 2009 May;25(5):279-86
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Clinical Competence
Combined Modality Therapy
Education, Medical, Continuing - standards
Female
Guideline Adherence
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Prognosis
Randomized Controlled Trials as Topic
Risk Management
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
Notes
Cites: Diabetes Care. 2004 Jan;27(1):247-5514693997
Cites: JAMA. 2008 Jul 9;300(2):197-20818612117
Cites: Hypertension. 2004 May;43(5):963-915037557
Cites: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-7615286277
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Circulation. 1991 Jan;83(1):356-621984895
Cites: JAMA. 1996 May 22-29;275(20):1571-68622248
Cites: Arch Intern Med. 1996 Jul 8;156(13):1414-208678709
Cites: Arch Intern Med. 1998 Mar 23;158(6):655-629521231
Cites: Am J Cardiol. 2005 Jan 1;95(1):29-3515619390
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):573-8116755312
Cites: Can J Cardiol. 2006 May 15;22(7):606-1316755316
Cites: N Engl J Med. 2006 Oct 12;355(15):1551-6216980380
Cites: Arch Intern Med. 2006 Nov 13;166(20):2191-20117101936
Cites: Lancet. 2007 Jan 20;369(9557):201-717240286
Cites: AJR Am J Roentgenol. 2007 Mar;188(3):798-81117312071
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
Cites: Can J Cardiol. 2007 May 15;23(7):539-5017534460
Cites: J Hypertens. 2007 Jun;25(6):1311-717563546
Cites: Kidney Int. 2007 Aug;72(3):260-417507905
Cites: Hypertension. 2007 Sep;50(3):467-7317679652
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: N Engl J Med. 2000 Mar 30;342(13):905-1210738048
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Clin Sci (Lond). 2001 Dec;101(6):671-911724655
Cites: Stroke. 2002 Jul;33(7):1776-8112105351
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Can J Cardiol. 2008 Jun;24(6):455-6318548142
Cites: Can J Cardiol. 2008 Jun;24(6):465-7518548143
Cites: Hypertension. 2004 Jan;43(1):10-714638619
PubMed ID
19417858 View in PubMed
Less detail

The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy.

https://arctichealth.org/en/permalink/ahliterature124290
Source
Can J Cardiol. 2012 May;28(3):270-87
Publication Type
Article
Date
May-2012
Author
Stella S Daskalopoulou
Nadia A Khan
Robert R Quinn
Marcel Ruzicka
Donald W McKay
Daniel G Hackam
Simon W Rabkin
Doreen M Rabi
Richard E Gilbert
Raj S Padwal
Martin Dawes
Rhian M Touyz
Tavis S Campbell
Lyne Cloutier
Steven Grover
George Honos
Robert J Herman
Ernesto L Schiffrin
Peter Bolli
Thomas Wilson
Ross D Feldman
M Patrice Lindsay
Brenda R Hemmelgarn
Michael D Hill
Mark Gelfer
Kevin D Burns
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Donna McLean
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Jean-Martin Boulanger
Pierre Larochelle
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Janusz Kaczorowski
Luc Trudeau
Simon L Bacon
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Maxime Lamarre-Cliché
Marshall Godwin
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
Brian Penner
Robert A Hegele
Philip A McFarlane
Mukul Sharma
Norman R C Campbell
Debra Reid
Luc Poirier
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, McGill University, Montreal, Québec, Canada. stella.daskalopoulou@mcgill.ca
Source
Can J Cardiol. 2012 May;28(3):270-87
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - methods
Canada
Cardiovascular Diseases - etiology - prevention & control
Education, Medical, Continuing - standards
Evidence-Based Medicine - standards
Female
Health Education - standards
Humans
Hypertension - complications - diagnosis - therapy
Male
Middle Aged
Monitoring, Physiologic - methods
Practice Guidelines as Topic - standards
Prognosis
Risk assessment
Treatment Outcome
Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2012. The new recommendations are: (1) use of home blood pressure monitoring to confirm a diagnosis of white coat syndrome; (2) mineralocorticoid receptor antagonists may be used in selected patients with hypertension and systolic heart failure; (3) a history of atrial fibrillation in patients with hypertension should not be a factor in deciding to prescribe an angiotensin-receptor blocker for the treatment of hypertension; and (4) the blood pressure target for patients with nondiabetic chronic kidney disease has now been changed to
PubMed ID
22595447 View in PubMed
Less detail

An exploratory study of factors influencing resuscitation skills retention and performance among health providers.

https://arctichealth.org/en/permalink/ahliterature123106
Source
J Contin Educ Health Prof. 2012;32(2):126-33
Publication Type
Article
Date
2012
Author
Vernon Curran
Lisa Fleet
Melanie Greene
Author Affiliation
Faculty of Medicine, Memorial University of Newfoundland, Canada. vcurran@mun.ca
Source
J Contin Educ Health Prof. 2012;32(2):126-33
Date
2012
Language
English
Publication Type
Article
Keywords
Certification
Clinical Competence - standards - statistics & numerical data
Education, Medical, Continuing - standards
Educational Measurement
Female
Focus Groups
Health Personnel - psychology
Humans
Life Support Care - psychology
Male
Newfoundland and Labrador
Qualitative Research
Questionnaires
Regional Health Planning
Resuscitation - education
Retention (Psychology)
Rural Health Services - manpower
Urban Health Services - manpower
Abstract
Resuscitation and life support skills training comprises a significant proportion of continuing education programming for health professionals. The purpose of this study was to explore the perceptions and attitudes of certified resuscitation providers toward the retention of resuscitation skills, regular skills updating, and methods for enhancing retention.
A mixed-methods, explanatory study design was undertaken utilizing focus groups and an online survey-questionnaire of rural and urban health care providers.
Rural providers reported less experience with real codes and lower abilities across a variety of resuscitation areas. Mock codes, practice with an instructor and a team, self-practice with a mannequin, and e-learning were popular methods for skills updating. Aspects of team performance that were felt to influence resuscitation performance included: discrepancies in skill levels, lack of communication, and team leaders not up to date on their skills. Confidence in resuscitation abilities was greatest after one had recently practiced or participated in an update or an effective debriefing session. Lowest confidence was reported when team members did not work well together, there was no clear leader of the resuscitation code, or if team members did not communicate.
The study findings highlight the importance of access to update methods for improving providers' confidence and abilities, and the need for emphasis on teamwork training in resuscitation. An eclectic approach combining methods may be the best strategy for addressing the needs of health professionals across various clinical departments and geographic locales.
PubMed ID
22733640 View in PubMed
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Application of a responsive evaluation approach in medical education.

https://arctichealth.org/en/permalink/ahliterature186515
Source
Med Educ. 2003 Mar;37(3):256-66
Publication Type
Article
Date
Mar-2003
Author
Vernon Curran
Jeanette Christopher
Francine Lemire
Alice Collins
Brendan Barrett
Author Affiliation
Faculty of Medicine, Memorial University of Newfoundland, Canada Faculty of Education, Memorial University of Newfoundland, Canada. vcurran@mun.ca
Source
Med Educ. 2003 Mar;37(3):256-66
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Clinical Competence
Curriculum
Education, Medical, Continuing - standards
Feasibility Studies
Humans
Newfoundland and Labrador
Program Evaluation - methods
Software Design
Abstract
This paper reports on the usefulness of a responsive evaluation model in evaluating the clinical skills assessment and training (CSAT) programme at the Faculty of Medicine, Memorial University of Newfoundland, Canada. The purpose of this paper is to introduce the responsive evaluation approach, ascertain its utility, feasibility, propriety and accuracy in a medical education context, and discuss its applicability as a model for medical education programme evaluation.
Robert Stake's original 12-step responsive evaluation model was modified and reduced to five steps, including: (1) stakeholder audience identification, consultation and issues exploration; (2) stakeholder concerns and issues analysis; (3) identification of evaluative standards and criteria; (4) design and implementation of evaluation methodology; and (5) data analysis and reporting. This modified responsive evaluation process was applied to the CSAT programme and a meta-evaluation was conducted to evaluate the effectiveness of the approach.
The responsive evaluation approach was useful in identifying the concerns and issues of programme stakeholders, solidifying the standards and criteria for measuring the success of the CSAT programme, and gathering rich and descriptive evaluative information about educational processes. The evaluation was perceived to be human resource dependent in nature, yet was deemed to have been practical, efficient and effective in uncovering meaningful and useful information for stakeholder decision-making.
Responsive evaluation is derived from the naturalistic paradigm and concentrates on examining the educational process rather than predefined outcomes of the process. Responsive evaluation results are perceived as having more relevance to stakeholder concerns and issues, and therefore more likely to be acted upon. Conducting an evaluation that is responsive to the needs of these groups will ensure that evaluative information is meaningful and more likely to be used for programme enhancement and improvement.
PubMed ID
12603765 View in PubMed
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[Are younger physicians satisfied with their education?].

https://arctichealth.org/en/permalink/ahliterature198318
Source
Ugeskr Laeger. 2000 May 1;162(18):2581-2
Publication Type
Article
Date
May-1-2000
Author
M. Engberg
Source
Ugeskr Laeger. 2000 May 1;162(18):2581-2
Date
May-1-2000
Language
Danish
Publication Type
Article
Keywords
Attitude of Health Personnel
Denmark
Education, Medical - standards
Education, Medical, Continuing - standards
Humans
Physicians - psychology
Questionnaires
Notes
Comment On: Ugeskr Laeger. 2000 Feb 21;162(8):1076-910741246
PubMed ID
10846964 View in PubMed
Less detail

Assessment of specialists in cardiovascular practice.

https://arctichealth.org/en/permalink/ahliterature148764
Source
Nat Rev Cardiol. 2009 Oct;6(10):659-67
Publication Type
Article
Date
Oct-2009
Author
Kamran Ahmed
Hutan Ashrafian
George B Hanna
Ara Darzi
Thanos Athanasiou
Author Affiliation
Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. k.ahmed@imperial.ac.uk
Source
Nat Rev Cardiol. 2009 Oct;6(10):659-67
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Cardiology - education - standards
Certification - standards
Clinical Competence - standards
Curriculum
Education, Medical, Continuing - standards
Educational Measurement
Europe
Health Knowledge, Attitudes, Practice
Healthcare Disparities
Humans
Malpractice
Medical Errors - prevention & control
North America
Program Development
Program Evaluation
Quality of Health Care - standards
Social Responsibility
Abstract
Assessment of medical specialists was introduced to ensure patient safety and to maintain professional knowledge. Cardiovascular specialist assessment is challenging, as the ongoing development of new technologies is associated with increased requirements for up-to-date training and acquisition of new skills. The cardiovascular specialties include cardiology, vascular interventional radiology, cardiac surgery and vascular surgery. Assessment within these disciplines involves evaluation of knowledge in addition to technical and nontechnical skills, a process that is termed recertification or maintenance of certification. Increasingly, there is a demand for professional accountability through recertification because of concerns about professional negligence and increased awareness of medical errors. In this article we describe the process of recertification in different geographical regions and discuss the role of current tools used to recertify cardiovascular specialists and, in particular, how their use can contribute to the requirements of patient care.
PubMed ID
19724254 View in PubMed
Less detail

Breaking bad news: impact of a continuing medical education workshop.

https://arctichealth.org/en/permalink/ahliterature181559
Source
J Palliat Care. 2003;19(4):238-45
Publication Type
Article
Date
2003
Author
Roger Ladouceur
François Goulet
Robert Gagnon
Richard Boulé
Gilles Girard
André Jacques
Jacques Frenette
Robert Carrier
Viateur Lalonde
Claude Bélisle
Author Affiliation
Department of Family Medicine, Université de Montréal, Canada.
Source
J Palliat Care. 2003;19(4):238-45
Date
2003
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Attitude to Health
Education, Medical
Education, Medical, Continuing - standards
Female
Follow-Up Studies
Health Knowledge, Attitudes, Practice
Holistic Health
Humans
Male
Medicine
Middle Aged
Neoplasms - diagnosis - psychology
Physician-Patient Relations
Physicians, Family - education - psychology
Program Evaluation
Quebec
Questionnaires
Role Playing
Specialization
Truth Disclosure
Abstract
To evaluate the impact of an interactive continuing medical education workshop designed to help physicians in breaking bad news to their patients.
Analysis of post-workshop questionnaires from 539 physicians assessing the retention of the key concepts and the perception of the potential impact of the workshop on their practice immediately after the workshop and six months later.
The most significant concepts retained by the respondents are: the need to take into consideration the whole patient (42.7% post-workshop and 45.6% of follow-up responses), the need to be prepared for the consultation (11.6% and 15%), the importance of better guiding the interview (18.8% and 13.6%), and the value of taking more time during the consultation (5.8% and 8.3%). Analysis of paired responses on the post-workshop and the follow-up questionnaires shows that 35% of the concepts retained are identical.
The majority of physicians retained the key concepts, both immediately following the workshop and in the longer term.
PubMed ID
14959593 View in PubMed
Less detail

Changes in acute myocardial infarction risk and patterns of practice for patients older and younger than 70 years, 1987-90.

https://arctichealth.org/en/permalink/ahliterature223548
Source
Can J Cardiol. 1992 Jul-Aug;8(6):596-600
Publication Type
Article
Author
T J Montague
R Y Wong
J R Burton
K S Bay
D J Catellier
K K Teo
Author Affiliation
Epidemiology Coordinating and Research (EPICORE) Centre, University of Edmonton, Alberta.
Source
Can J Cardiol. 1992 Jul-Aug;8(6):596-600
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Age Factors
Aged
Aged, 80 and over
Alberta - epidemiology
Anti-Arrhythmia Agents - therapeutic use
Aspirin - therapeutic use
Calcium Channel Blockers - therapeutic use
Education, Medical, Continuing - standards
Female
Hospital Mortality
Hospitals, University
Humans
Male
Myocardial Infarction - drug therapy - epidemiology - mortality
Nitrates - therapeutic use
Physician's Practice Patterns - standards - trends
Retrospective Studies
Sex Factors
Thrombolytic Therapy - standards
Treatment Outcome
Abstract
To evaluate temporal changes in risk and patterns of hospital practice for acute myocardial infarction (AMI).
Retrospective analysis of age-related medical therapy and outcome of 342 consecutive patients (132 at least 70 years old and 210 younger than 70) with AMI between July 1, 1989, and June 30, 1990, and comparison with data from two previous analyses of AMI practice in 1987 (n = 207) and 1988-89 (n = 402).
Tertiary care medical centre.
No direct interventions; results of the two previous AMI practice pattern analyses, however, were propagated during the practice time of the most recent analysis.
In 1989-90, hospital mortality was higher (19%) among patients at least 70 years old compared with patients younger than 70 (8%) (P less than 0.01). Therapies proven by repeated clinical trials to be effective in reducing AMI risk were all used less frequently in patients aged at least 70 years: thrombolysis (20 versus 43%); beta-blockers (41 versus 62%); acetylsalicylic acid (71 versus 87%); and nitrates (86 versus 97%). Qualitatively, these age-specific patterns of AMI mortality and therapy were similar to previous studies. Quantitatively, however, comparing 1987 with 1989-90 demonstrated parallel and marked increases in the use of all proven medications in both age groups, ranging from 42 to 230% (P less than 0.01). There was also a significant overall decrease in mortality from the 1987 patient cohort (20%) to the 1989-90 cohort (13%) (P less than 0.05). The decrease in mortality was entirely due to decreased mortality within the group 70 years or older; 35% in 1987 versus 19% in 1989-90 (P less than 0.05). Mortality in the AMI patients younger than 70 years old remained unchanged from 1987 to 1989-90.
Pattern of practice analyses were associated with, and may have contributed to, improved patient care and outcomes in AMI. Increased use of effective AMI medical therapy had a greater benefit in elderly higher risk AMI patients than lower risk younger patients. Persisting age-specific differences in AMI therapy may respond to more direct quality improvement measures, such as critical path management.
PubMed ID
1354568 View in PubMed
Less detail

[Consequences of reduced working hours for continuing education of physicians].

https://arctichealth.org/en/permalink/ahliterature220875
Source
Tidsskr Nor Laegeforen. 1993 Jun 10;113(15):1877-81
Publication Type
Article
Date
Jun-10-1993
Author
H. Petersen
E. Willumsen
K A Grøttum
S. Kjus
B. Mikkelsen
A. Kleppe
Author Affiliation
Medisinsk avdeling, Regionsykehuset i Trondheim.
Source
Tidsskr Nor Laegeforen. 1993 Jun 10;113(15):1877-81
Date
Jun-10-1993
Language
Norwegian
Publication Type
Article
Keywords
Education, Medical, Continuing - standards
Health Priorities
Humans
Norway
Physician's Role
Questionnaires
Research
Workload
Abstract
Since 1960 the working hours for hospital doctors in training have been reduced by 12.5 hours per week. A questionnaire was sent to all departments in Norway involved in the education of specialists, asking them about the consequences of this reduction. The survey showed that the working time actually paid for today is not so short (42-46 hours per week). It showed indirectly, however, that the time available for education must have been reduced. About 50% stated that the reduction in working hours has had a negative effect on the extent and quality of the education. Nearly all confirmed a conflict of priorities between clinical routines and education. There were seldom opportunities to read medical literature or do research during working hours. There has been no reduction in routine work nor any increase in staff, in spite of a considerable increase in duties connected with the education of specialists.
PubMed ID
8322332 View in PubMed
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56 records – page 1 of 6.