Journal of general internal medicine
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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).
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Clinical preventive services have always been recognized by clinicians as an important part of primary care medicine, but for many years there has been some uncertainty as to the effectiveness of these maneuvers in preventing disease and exactly how and when they should be performed. The recent report of the U. ⋯ The recommendations provide guidance on how to design an appropriate package of services based on the medical history and risk profile of each patient. This article describes the historical background behind the formation of the task force, its methodology and rationale, and the format of the final report, the "Guide to Clinical Preventive Services." The potential implications of this report and its limitations are also discussed.