Journal of general internal medicine
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Comparative Study
Utilization of hospital resources by alcoholic and nonalcoholic patients: a prospective study.
To measure any difference in the utilization of hospital resources between alcoholic patients and nonalcoholic patients (controls) in a department of internal medicine. ⋯ The authors' results suggest that alcoholics do not use more hospital resources per admission than do nonalcoholics. Moreover, alcoholics tend to use less frequently some procedures, such as the ICU, electrocardiography, and x-ray examinations. Several hypotheses are developed to explain these results in relation to those of previous studies, which showed more use of medical care by alcoholics than by nonalcoholics.
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To develop and validate a predictive model that would allow clinicians to determine whether an electrophysiologic (EP) study is likely to result in useful diagnostic information for a patient who has unexplained syncope. ⋯ These five identified predictive factors, available from the history, the physical examination, and the initial ECG, could be useful to clinicians in selecting those patients with unexplained syncope who will have a serious arrhythmia identified by EP studies.
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To determine whether transferring the care of patients to another senior resident the day after admission to the hospital adversely affects the efficiency and quality of care. ⋯ Patients transferred to a different resident the day after admission had more laboratory tests performed and longer inpatient stays.
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Comparative Study
Reducing unnecessary coronary care unit admissions: a comparison of three decision aids.
To determine whether published decision rules for ischemic heart disease have practical value in reducing unnecessary admissions to coronary care units. ⋯ None of the decision aids could reduce unnecessary admissions without seriously increasing the rate of inappropriate discharges. However, within the clinically relevant subgroup of patients for whom the decision to admit or discharge was not obvious on clinical grounds (those without complications on presentation whom the residents chose not to discharge), the decision aids examined, used in combination to verify the need for admission, might have safely averted some unnecessary admissions.
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Multicenter Study Clinical Trial
Impact of the availability of a prior electrocardiogram on the triage of the patient with acute chest pain.
To determine whether information from a prior electrocardiogram (ECG) improves diagnostic accuracy in the emergency department (ED) evaluation of patients with acute chest pain. ⋯ When the current ECG is consistent with ischemia or infarction, the availability of a prior ECG for comparison to determine whether the ECG changes are old or new improves diagnostic accuracy and triage decisions by reducing the admission of patients without AMI or acute ischemic heart disease (increased specificity) without reducing the admission of patients with these diagnoses (unchanged sensitivity).