Abstract:
OBJECTIVE:To validate prospectively the use of an artificial neural network to identify myocardial infarction in patients presenting to an emergency department with anterior chest pain. DESIGN:Prospective, blinded testing. SETTING:Tertiary university teaching center. PATIENTS:A total of 331 consecutive adult patients presenting with anterior chest pain. MEASUREMENTS:Diagnostic sensitivity and specificity with regard to the diagnosis of acute myocardial infarction. MAIN RESULTS:An artificial neural network was trained on clinical pattern sets retrospectively derived from the cases of 351 patients hospitalized with a high likelihood of having myocardial infarction. It was prospectively tested on 331 consecutive patients presenting to an emergency department with anterior chest pain. The ability of the network to distinguish patients with from those without acute myocardial infarction was compared with that of physicians caring for the same patients. The physicians had a diagnostic sensitivity of 77.7% (95% CI, 77.0% to 82.9%) and a diagnostic specificity of 84.7% (CI, 84.0% to 86.4%). The artificial neural network had a sensitivity of 97.2% (CI, 97.2% to 97.5%; P = 0.033) and a specificity of 96.2% (CI, 96.2% to 96.4%; P less than 0.001). CONCLUSION:An artificial neural network trained to identify myocardial infarction in adult patients presenting to an emergency department may be a valuable aid to the clinical diagnosis of myocardial infarction; however, this possibility must be confirmed through prospective testing on a larger patient sample.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Baxt WGdoi
10.7326/0003-4819-115-11-843subject
Has Abstractpub_date
1991-12-01 00:00:00pages
843-8issue
11eissn
0003-4819issn
1539-3704journal_volume
115pub_type
杂志文章abstract:BACKGROUND:The comparative effectiveness of rheumatoid arthritis therapies is uncertain. PURPOSE:To compare the benefits and harms of disease-modifying antirheumatic drugs (DMARDs) for adults with rheumatoid arthritis. DATA SOURCES:Records limited to the English language and studies of adults were identified by using...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-148-2-200801150-00192
更新日期:2008-01-15 00:00:00
abstract::Individual differences in metabolism of the sulfonamides may predispose patients to idiosyncratic reactions. Sulfonamides are metabolized by N-acetylation (mediated by a genetically polymorphic enzyme) and oxidation to potentially toxic metabolites. We examined 6 patients who had severe reactions to sulfonamides and c...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-2-179
更新日期:1986-08-01 00:00:00
abstract:BACKGROUND:Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究
doi:10.7326/0003-4819-150-5-200903030-00008
更新日期:2009-03-03 00:00:00
abstract:PURPOSE:To develop a clinical perspective on bilateral massive adrenal hemorrhage and an algorithm for its diagnosis and treatment. DATA IDENTIFICATION:Case reports were identified through a computer search using MEDLIN (1976 to 1987), and from bibliographies in review articles (up to 1978). STUDY SELECTION:Twelve re...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-110-3-227
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:To assess internists' familiarity with, confidence in, and attitudes about practice guidelines issued by various organizations. DESIGN:Cross-sectional, self-administered survey. PARTICIPANTS:Questionnaires were mailed to a stratified random sample of 2600 members of the American College of Physicians (ACP) ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-120-11-199406010-00008
更新日期:1994-06-01 00:00:00
abstract::Neuroblastoma, the second commonest solid tumor in children, is a neoplasm of the peripheral autonomic nervous system that usually occurs before children are 6 years old. Therapy of localized tumor (clinical stage I and II) and of a special form of metastatic tumor (clinical stage IV-S) is usually successful, but trea...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-97-6-873
更新日期:1982-12-01 00:00:00
abstract::Many investigations consider the presence of e antigen (HBeAg) valuable in predicting which patients with acute hepatitis B are at risk of remaining infected and developing chronic liver disease. We tested this hypothesis in a retrospective study of serial samples from patients undergoing long-term hemodialysis. We fo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-3-310
更新日期:1978-09-01 00:00:00
abstract:OBJECTIVE:To evaluate the risk for chronic renal disease associated with regular use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN:Multicenter case-control study. PATIENTS:Patients were 554 North Carolina residents (age range, 30 to 79 years) hospitalized between 1980 and 1982 with a discharge d...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-3-165
更新日期:1991-08-01 00:00:00
abstract:OBJECTIVE:To appraise the measurement properties of the Canadian Cardiovascular Society (CCS) classification of stable angina pectoris. DATA SOURCES:Relevant articles were identified through a MEDLINE search (1976 to November 1991). Bibliographies of retrieved articles were also reviewed. STUDY SELECTION:Studies chos...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-117-8-677
更新日期:1992-10-15 00:00:00
abstract::Axial, dual spin-echo magnetic resonance (MR) images, taken at the level of the pulmonary arteries and gated to the cardiac cycle, were qualitatively and quantitatively evaluated in nine patients with primary pulmonary arterial hypertension and six controls. In controls and patients, intravascular signal intensity was...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-103-3-317
更新日期:1985-09-01 00:00:00
abstract::The coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a series of workshops during whi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-7-200904070-00115
更新日期:2009-04-07 00:00:00
abstract:PURPOSE:To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of intervention...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-119-12-199312150-00006
更新日期:1993-12-15 00:00:00
abstract::We evaluated the usefulness of computed tomography (CT) brain scanning in alcoholic patients with withdrawal seizures (n = 151) and other neurologic problems (n = 87) and compared the findings of a detailed neurologic examination to the results of CT scanning. In patients with seizures, nearly 50% of CT scans were nor...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-4-519
更新日期:1981-04-01 00:00:00
abstract:BACKGROUND:Treatment of chronic hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) for 6 weeks achieves sustained virologic response (SVR) rates of 95% in some patients. If effective, shorter therapeutic courses could improve adherence and treatment costs. OBJECTIVE:To determine factors predictive ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/M15-0642
更新日期:2015-12-15 00:00:00
abstract::The approximately 1.2 million inmates in U.S. correctional institutions have a high prevalence of communicable diseases, such as human immunodeficiency virus (HIV) infection, tuberculosis, hepatitis B virus infection, and gonorrhea. Before their incarceration, most inmates had limited access to health care, which, tog...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-118-2-199301150-00010
更新日期:1993-01-15 00:00:00
abstract::Intensive care is one of the largest, most expensive, and complex components of U.S. health care. Errors and the resulting adverse events are, however, common in intensive care units (ICUs). Theories about errors in high-risk environments, developed by aviation and other industries, provide insight into why ICUs are p...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-140-12-200406150-00013
更新日期:2004-06-15 00:00:00
abstract:BACKGROUND:Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality. PURPOSE:To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of diff...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M14-1539
更新日期:2015-02-03 00:00:00
abstract::A recent, widely publicized meta-analysis of 42 clinical trials concluded that rosiglitazone was associated with an approximately 43% increased risk for myocardial infarction and an approximately 64% increased risk for cardiovascular death. The sensitivity of these conclusions to several methodological choices was not...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-147-8-200710160-00182
更新日期:2007-10-16 00:00:00
abstract:BACKGROUND:Cardiovascular disease (CVD) is the leading cause of death in the United States. PURPOSE:To update a systematic review about the benefits of aspirin for the primary prevention of cardiovascular events in adults aged 40 years or older and to evaluate effect modification in subpopulations. DATA SOURCES:MEDLI...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M15-2113
更新日期:2016-06-21 00:00:00
abstract:BACKGROUND:Although several agents are available to treat osteoporosis, the relative efficacy and toxicity of these agents when used to prevent fractures has not been well described. PURPOSE:To compare the benefits in fracture reduction and the harms from adverse events of various therapies for osteoporosis. DATA SOU...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-148-3-200802050-00198
更新日期:2008-02-05 00:00:00
abstract:OBJECTIVE:To describe the diagnostic difficulties, response to therapy, and clinical features of lymphomatoid papulosis and the cumulative frequency of transformation to lymphoma. DESIGN:Case series. SETTING:University hospitals. METHODS:The records of 21 patients with lymphomatoid papulosis who were seen from 1986 ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-122-3-199502010-00009
更新日期:1995-02-01 00:00:00
abstract:BACKGROUND:Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE:To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES:The authors systematically searched the English-lang...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-144-10-200605160-00125
更新日期:2006-05-16 00:00:00
abstract::Of 5379 patients who had received radiation treatment at our institution for benign conditions of the head and neck, 318 developed thyroid cancer 3 to 42 years later. We report follow-up observations (median interval from diagnosis to recurrence or last contact, 10 years; longest interval, 31) for 296 of these patient...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-3-405
更新日期:1986-09-01 00:00:00
abstract:Background:The benefits of pay-for-performance (P4P) programs are uncertain. Purpose:To update and expand a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. Data Sources...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/M16-1881
更新日期:2017-03-07 00:00:00
abstract:BACKGROUND:Adherence to short-term continuous positive airway pressure (CPAP) may predict long-term use. Unfortunately, initial CPAP intolerance may lead to poor adherence or abandonment of therapy. OBJECTIVE:To determine whether a short course of eszopiclone at the onset of therapy improves long-term CPAP adherence m...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.7326/0003-4819-151-10-200911170-00006
更新日期:2009-11-17 00:00:00
abstract:BACKGROUND:The cause of cancer-associated venous limb gangrene is unknown but could paradoxically be due to warfarin. OBJECTIVE:To determine the pathogenesis of venous gangrene in a patient with cancer. DESIGN:Case report. SETTING:University hospital in Ontario, Canada. PATIENT:66-year-old woman with metastatic lun...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-135-8_part_1-200110160-00009
更新日期:2001-10-16 00:00:00
abstract::Recently acquired knowledge about vitamin D metabolism has improved our understanding in different varieties of osteomalacia. Many new causes of osteomalacia continue to be found. Radiologic and biochemical changes are not always characteristic and may occasionally be misleading. Bone biopsy after a double tetracyclin...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-89-6-966
更新日期:1978-12-01 00:00:00
abstract:OBJECTIVE:To describe the relation between glycated hemoglobin and the incidence or progression, or both, of diabetic microvascular complications in persons with insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). DESIGN:Population-based on cohort study. SETTING:An 11-county area in southern...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-1_part_2-199601011-00003
更新日期:1996-01-01 00:00:00
abstract::Between 1978 and 1985, the number of active internists in the United States increased from 64,000 to 91,000, and by 1998 the number will have increased to 141,000. This growth represents an increase of 121% for a 20-year period, during which time the population of the United States is expected to increase only 19%. Th...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-1-93
更新日期:1987-07-01 00:00:00
abstract:BACKGROUND:Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain. OBJECTIVE:To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-146-10-200705150-00003
更新日期:2007-05-15 00:00:00