Abstract:
INTRODUCTION:Physician decisions drive most of the increases in health care expenditures, yet virtually no published literature has sought to understand the types of evidence used by physicians as they make decisions in real time. METHODS:Ten pediatric cardiologists recorded every clinically significant decision made during procedures, test interpretation, or delivery of inpatient and outpatient care during 5 full days and 5 half days of care delivery. The basis for each decision was assigned to one of 10 predetermined categories, ranging from arbitrary and anecdotal, to various qualities of published studies, to parental preference and avoiding a lawsuit. RESULTS:During the 7.5 days, 1188 decisions (158/day) were made. Almost 80% of decisions were deemed by the physicians to have no basis in any prior published data and fewer than 3% of decisions were based on a study specific to the question at hand. CONCLUSIONS:In this pilot study, physicians were unable to cite a formal evidence source for most of their real-time clinical decision making, including those that consumed medical resources. Novel approaches to building an evidence base produced from real-time clinical decisions may be essential for health care reform based on data.
journal_name
Congenit Heart Disjournal_title
Congenital heart diseaseauthors
Darst JR,Newburger JW,Resch S,Rathod RH,Lock JEdoi
10.1111/j.1747-0803.2010.00433.xsubject
Has Abstractpub_date
2010-07-01 00:00:00pages
339-42issue
4eissn
1747-079Xissn
1747-0803pii
CHD433journal_volume
5pub_type
杂志文章abstract::We describe a simple technique for chest wall reconstruction in pentalogy of Cantrell using split-thickness cartilage grafts. This technique provides a robust reconstruction, gives immediate and excellent cosmetic results, allows for skeletal and tissue growth, and avoids the use of synthetic material. ...
journal_title:Congenital heart disease
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abstract:INTRODUCTION:Perturbations in the CACNA1C-encoded L-type calcium channel α-subunit have been linked recently to heritable arrhythmia syndromes, including Timothy syndrome, Brugada syndrome, early repolarization syndrome, and long QT syndrome. These heritable arrhythmia syndromes may serve as a pathogenic basis for auto...
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journal_title:Congenital heart disease
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doi:10.1111/j.1747-0803.2010.00382.x
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journal_title:Congenital heart disease
pub_type: 杂志文章,评审
doi:10.1111/j.1747-0803.2010.00467.x
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abstract:OBJECTIVE:The use of video-assisted thoracoscopic surgery (VATS) is becoming increasingly common in the treatment of congenital heart defects, particularly for the division of vascular rings. We compare the short-term outcomes of vascular ring division by VATS as opposed to open thoracotomy and discuss new issues raise...
journal_title:Congenital heart disease
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doi:10.1111/j.1747-0803.2007.00086.x
更新日期:2007-03-01 00:00:00
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journal_title:Congenital heart disease
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更新日期:2014-03-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/chd.12749
更新日期:2019-05-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章,多中心研究
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journal_title:Congenital heart disease
pub_type: 杂志文章
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2011.00488.x
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2011.00514.x
更新日期:2012-01-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/chd.12257
更新日期:2015-03-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章,评审
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更新日期:2012-11-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
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更新日期:2019-09-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/chd.12089
更新日期:2014-05-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/chd.12732
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/chd.12662
更新日期:2018-09-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2007.00148.x
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2008.00174.x
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pub_type: 杂志文章,评审
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2011.00608.x
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journal_title:Congenital heart disease
pub_type: 杂志文章,多中心研究
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更新日期:2017-05-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2011.00513.x
更新日期:2012-01-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
doi:10.1111/j.1747-0803.2011.00618.x
更新日期:2012-03-01 00:00:00
abstract::Williams-Beuren syndrome (WBS) is a multisystem genetic disorder comprising of craniofacial, developmental, and cardiac malformations. The most common cardiac defects found are supravalvar aortic stenosis and peripheral pulmonary stenosis. However, WBS should be regarded as a general arteriopathy consisting of stenose...
journal_title:Congenital heart disease
pub_type: 杂志文章,评审
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更新日期:2014-05-01 00:00:00
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journal_title:Congenital heart disease
pub_type: 杂志文章
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journal_title:Congenital heart disease
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journal_title:Congenital heart disease
pub_type: 杂志文章
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