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  • 1
    Online-Ressource
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    Does Concordance with Guideline Triage Recommendations Affect Clinical Care of Patients with Possible Acute Coronary Syndrome?
    SAGE Publications ; 2007
    In:  Medical Decision Making Vol. 27, No. 4 ( 2007-07), p. 423-437
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 27, No. 4 ( 2007-07), p. 423-437
    Kurzfassung: Background. The Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline recommends outpatient management for patients at low risk and admission to a monitored bed for patients at intermediate-high risk of adverse short-term outcomes, but the clinical consequences of adhering to these recommendations are unclear. Methods. This analysis included 7466 adults who presented to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and who participated in 3 prospective clinical effectiveness trials during the period 1993 to 2001. The authors used logistic regression to assess the impact of concordance with guideline triage recommendations on subsequent diagnostic testing, follow-up care, and 30-day mortality and applied propensity score methods to adjust for selection bias. Results. Among low-risk patients (n = 1099), ED discharge was not associated with higher mortality and did not increase the need for emergency care or hospitalization during follow-up (adjusted odds ratio [OR] = 1.0, 95% confidence interval [CI] = 0.63—1.6 for ED revisits); however, 1.7% of discharged low-risk patients had confirmed ACS. Among intermediate- to high-risk patients (n = 6367), admission to a monitored bed was not associated with reduction in 30-day mortality but significantly reduced the need for follow-up ED care (adjusted OR = 0.81, 95% CI = 0.69—0.96). Conclusions. This analysis supports the practice of discharging low-risk ED patients with symptoms of possible ACS but highlights the need to arrange timely follow-up (or to perform additional risk stratification in the ED prior to discharge). It also confirms the benefit of admitting ED patients with intermediate- to high-risk characteristics to a monitored bed.
    Materialart: Online-Ressource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X07302557
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2007
    ZDB Id: 2040405-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
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    The Impact of Unstable Angina Guidelines in the Triage of Emergency Department Patients with Possible Acute Coronary Syndrome
    SAGE Publications ; 2006
    In:  Medical Decision Making Vol. 26, No. 6 ( 2006-11), p. 606-616
    Details
    In: Medical Decision Making, SAGE Publications, Vol. 26, No. 6 ( 2006-11), p. 606-616
    Kurzfassung: Objective. The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain. Methods. The authors conducted a prospective guideline implementation trial with pre-post design in the emergency departments of 1 university hospital and 1 university-affiliated community teaching hospital from January 2000 to May 2001. They enrolled 1140 adults who presented with chest pain or other symptoms of possible ACS. The intervention included the following: 1) physician training in use of the AHCPR risk groups, 2) algorithm for risk stratification, and 3) group feedback. To determine how accurately physicians interpreted the guideline algorithm, the authors compared their risk ratings with actual guideline risk groups. Results. No significant difference in physician triage decisions was observed between baseline and intervention periods. Analysis of physician's risk ratings during the intervention period revealed low overall concordance with actual guideline risk groups (kappa = 0.31); however, physician's risk ratings showed superior discrimination in identifying patients with confirmed ACS (receiver operating characteristic [ROC] area .81 v. .74, P = 0.008). Strict adherence to guideline recommendations would have resulted in hospitalizing 9% more non-ACS patients without lowering the rate of missed ACS. Conclusion. Implementation of the AHCPR guideline did not improve triage decisions in emer gency department patients with possible ACS. Assessing physician triage solely based on concordance with the AHCPR guideline may not accurately reflect the quality of patient care.
    Materialart: Online-Ressource
    ISSN: 0272-989X , 1552-681X
    URL: Article
    DOI: 10.1177/0272989X06295358
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2006
    ZDB Id: 2040405-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
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    The Stratification of Foods on the Basis of Overall Nutritional Quality: The Overall Nutritional Quality Index
    SAGE Publications ; 2009
    In:  American Journal of Health Promotion Vol. 24, No. 2 ( 2009-11), p. 133-143
    Details
    In: American Journal of Health Promotion, SAGE Publications, Vol. 24, No. 2 ( 2009-11), p. 133-143
    Kurzfassung: Consumer understanding of nutrition information is key to making dietary choices consistent with guidelines. The development of an objective, science-based, and universally applicable system of nutrition guidance would be of considerable potential value to the public health. Design. A multidisciplinary expert panel was convened to develop the Overall Nutritional Quality Index (ONQI). Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm based on the overall nutritional quality of food was developed and subjected to consumer research and validation testing. Results. The ONQI algorithm incorporates over 30 entries representing both micronutrient and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes. The basic entry in the algorithm is a weighted trajectory score, which compares nutrient concentration in a food to the recommended concentration of a given nutrient in a healthful diet. In content validity testing, ONQI rankings and expert panel rankings correlated highly (R = .92; p 〈 .001). In regression analysis, aggregated ONQI scores for total diet corresponded well with the Healthy Eating Index (p 〈 .001) in the National Health and Nutrient Examination Survey 2003–2006 cohort (n = 15,900). Consumer research indicated strong appeal to consumers of the ONQI system in general, and the scores on a 1 to 100 scale specifically. A system for acquiring nutrient data, meeting U.S. Food and Drug Administration and U.S. Department of Agriculture standards, has been established so that virtually any food, beverage, meal, or recipe can be scored. Conclusions. The ONQI is a sophisticated nutrition guidance system developed by a multidisciplinary group independently of all food industry interests with excellent initial performance in both consumer research and validation testing. Combined with a consumer education program, the ONQI has considerable potential to improve dietary patterns, and consequently the public health. Prospective study of effects on dietary patterns and health outcomes is warranted.
    Materialart: Online-Ressource
    ISSN: 0890-1171 , 2168-6602
    URL: Article
    DOI: 10.4278/ajhp.080930-QUAN-224
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2009
    ZDB Id: 2134271-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
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    A Component Architecture for High-Performance Scientific Computing
    SAGE Publications ; 2006
    In:  The International Journal of High Performance Computing Applications Vol. 20, No. 2 ( 2006-05), p. 163-202
    Details
    In: The International Journal of High Performance Computing Applications, SAGE Publications, Vol. 20, No. 2 ( 2006-05), p. 163-202
    Kurzfassung: The Common Component Architecture (CCA) provides a means for software developers to manage the complexity of large-scale scientific simulations and to move toward a plug-and-play environment for high-performance coputing. In the scientific computing context, component models also promote collaboration using independently developed software, thereby allowing particular individals or groups to focus on the aspects of greatest interest to them. The CCA supports parallel and distributed coputing as well as local high-performance connections between components in a language-independent manner. The design places minimal requirements on components and thus facilitates the integration of existing code into the CCA environment. The CCA model imposes minimal ovehead to minimize the impact on application performance. The focus on high performance distinguishes the CCA from most other component models. The CCA is being applied within an increasing range of disciplines, including cobustion research, global climate simulation, and computtional chemistry.
    Materialart: Online-Ressource
    ISSN: 1094-3420 , 1741-2846
    URL: Article
    DOI: 10.1177/1094342006064488
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2006
    ZDB Id: 2017480-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
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    Decision Making in Traffic Stop Encounters: A Multivariate Analysis of Police Behavior
    SAGE Publications ; 2006
    In:  Police Quarterly Vol. 9, No. 2 ( 2006-06), p. 184-209
    Details
    In: Police Quarterly, SAGE Publications, Vol. 9, No. 2 ( 2006-06), p. 184-209
    Kurzfassung: In recent years, there has been a growth in public concern over police decision-making practices during traffic enforcement. Catch phrases such as “racial profiling,” “driving while Black,” and “driving while brown” typify the public’s concern that race and ethnicity have undue influence on police discretion. This study analyzes traffic stop data from a medium-sized midwestern community to better understand this facet of police behavior. Although the authors contend that “proving” racial profiling may be outside of current empirical capabilities, useful insights can still be obtained by examining broader aspects of traffic enforcement behaviors. The analysis indicated that race was powerful in shaping police decision-making patterns, but so were gender, age, and situational considerations. A number of implications for research and policy emerging from the analysis are discussed.
    Materialart: Online-Ressource
    ISSN: 1098-6111 , 1552-745X
    URL: Article
    DOI: 10.1177/1098611104264990
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2006
    ZDB Id: 2094909-1
    SSG: 2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
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    Application of Community-Based Participatory Research Methods to a Study of Complementary Medicine Interventions at End of Life
    SAGE Publications ; 2005
    In:  Complementary health practice review Vol. 10, No. 2 ( 2005-04), p. 91-104
    Details
    In: Complementary health practice review, SAGE Publications, Vol. 10, No. 2 ( 2005-04), p. 91-104
    Kurzfassung: Community-based participatory research (CBPR) principles can be successfully applied to the design and implementation of a complementary medicine study for adults with end-stage AIDS. The Yale Prevention Research Center partnered with Leeway, Inc., an AIDS-dedicated nursing facility, and other academic and clinical entities to conduct a randomized, controlled pilot trial of meditation and massage on quality of life at the end of life. Using CBPR principles, a methodology was developed that was scientifically rigorous, highly respectful, and acceptable to the 91% minority study population. Using continuous, open communication among all involved parties, challenges were satisfactorily addressed in a timely manner. Fifty-eight residents (97% of those eligible) with end-stage AIDS participated from November 2001 to September 2003. Subjects received 1-month interventions of meditation, massage, combined meditation and massage, or standard care. The study of quality-of-life in end-stage AIDS poses unique challenges well met by applying CBPR principles to an academic-community research partnership.
    Materialart: Online-Ressource
    ISSN: 1533-2101
    URL: Article
    DOI: 10.1177/1533210105279443
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2005
    ZDB Id: 2968855-3
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
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    Panel discussion of case study 1
    SAGE Publications ; 2005
    In:  Clinical Trials Vol. 2, No. 4 ( 2005-08), p. 319-324
    Details
    In: Clinical Trials, SAGE Publications, Vol. 2, No. 4 ( 2005-08), p. 319-324
    Materialart: Online-Ressource
    ISSN: 1740-7745 , 1740-7753
    URL: Article
    DOI: 10.1191/1740774505cn103oa
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2005
    ZDB Id: 2159773-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
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    Promoting Healthy People 2010 Through Small Grants
    SAGE Publications ; 2009
    In:  Health Promotion Practice Vol. 10, No. 1 ( 2009-01), p. 24-33
    Details
    In: Health Promotion Practice, SAGE Publications, Vol. 10, No. 1 ( 2009-01), p. 24-33
    Kurzfassung: The Department of Health and Human Services initiated a pilot “microgrant” or small grants program in 2001 to promote Healthy People 2010 (HP 2010) implemented by the Yale-Griffin Prevention Research Center. This article describes the 103 agencies funded under this initiative and 67 control group agencies. It evaluates the HP 2010 focus areas targeted and the effectiveness of promoting HP 2010 objectives through microgrants. Forty-four percent of the grant recipients and 79% of the control group agencies indicated low levels of familiarity with HP 2010 goals. Changes in knowledge of HP 2010 goals for the microgrant group increased significantly from 5.24 ± 3.67 to 7.83 ± 1.86 (p 〈 .05). The results suggest that microgrants can be a useful mechanism to plant the seeds for developing community and organizational capacity to define local health priorities, practice and test new initiatives or expand existing programs and promote knowledge about HP 2010.
    Materialart: Online-Ressource
    ISSN: 1524-8399 , 1552-6372
    URL: Article
    DOI: 10.1177/1524839906289048
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2009
    ZDB Id: 2036801-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
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    Type IV FDP Avulsion: Lessons Learned Clinically and through Review of the Literature
    SAGE Publications ; 2009
    In:  HAND Vol. 4, No. 4 ( 2009-12), p. 357-361
    Details
    In: HAND, SAGE Publications, Vol. 4, No. 4 ( 2009-12), p. 357-361
    Kurzfassung: The type IV flexor digitorum profundus avulsion is a rare injury involving fracture of the volar base of the distal phalanx and separation of the tendon from the fracture fragment. Recommendations for management are sparse and are substantiated only by a few isolated case reports. We recently encountered two of these injuries, both of which proved challenging, particularly with regard to joint incongruity and tendon adhesions. In reviewing the literature, it is apparent that no consensus exists regarding surgical strategies. However, based on our experience and that of other authors, we can suggest the following: (1) high index of suspicion of this potentially deceptive injury, with use of magnetic resonance imaging or ultrasound if preoperative confirmation is needed; (2) rigid bony fixation that prevents dorsal subluxation of the distal phalanx; (3) tendon repair that is independent of the bony fixation; and (4) early range of motion therapy.
    Materialart: Online-Ressource
    ISSN: 1558-9447 , 1558-9455
    URL: Article
    DOI: 10.1007/s11552-009-9199-2
    Sprache: Englisch
    Verlag: SAGE Publications
    Publikationsdatum: 2009
    ZDB Id: 2316440-2
    Standort Signatur Einschränkungen Verfügbarkeit
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