Abstract:
OBJECTIVE:To identify differences in the incidences of myocardial infarction in women and men with chest pain. DESIGN:Prospective multicenter cohort study. SETTING:Emergency rooms of three university and four community hospitals. PATIENTS:7,734 emergency room patients with acute chest pain. MEASUREMENTS AND MAIN RESULTS:Myocardial infarction was diagnosed in 10% of the 3,896 women, compared with 19% of the 3,838 men, yielding an age-adjusted relative risk of myocardial infarction for women of 0.54 (95% confidence interval 0.48, 0.60). Physicians were equally adept at admitting women and men with myocardial infarctions, but men without myocardial infarction or unstable angina were significantly more likely to be admitted than were women without these diagnoses. Most clinical and electrocardiographic features indicating a risk of myocardial infarction were present in both women and men, but several high-risk features were less commonly present in women. After adjusting for the other factors that correlate with each patient's probability of having acute myocardial infarction, the relative risk of myocardial infarction was the same in women as men when the emergency department electrocardiogram showed the classic changes associated with acute myocardial infarction, but the risk was 40% lower in women when such electrocardiographic changes were not present. CONCLUSIONS:Clinical features that predict myocardial infarction in men predict myocardial infarction in women to a similar extent. However, female gender is associated with about a 40% lower rate of myocardial infarction except when classic electrocardiographic evidence is present on the emergency department electrocardiogram.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Cunningham MA,Lee TH,Cook EF,Brand DA,Rouan GW,Weisberg MC,Goldman Ldoi
10.1007/BF02599688subject
Has Abstractpub_date
1989-09-01 00:00:00pages
392-8issue
5eissn
0884-8734issn
1525-1497journal_volume
4pub_type
临床试验,杂志文章,多中心研究abstract:BACKGROUND:Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-018-4767-1
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:Our goal was to establish whether psychosocial risk factors for nonadherence, previously identified as negative predictors of warfarin prescribing, are predictors of adverse events for patients with nonvalvular atrial fibrillation receiving warfarin. DESIGN:Retrospective cohort analysis. SETTING:Ohio Medica...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.0242.x
更新日期:2005-12-01 00:00:00
abstract::Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process pr...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3564-3
更新日期:2016-04-01 00:00:00
abstract::We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and house...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599588
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND:The 2016 presidential election and the controversial policy agenda of its victor have raised concerns about how the election may have impacted mental health. OBJECTIVE:Assess how mental health changed from before to after the November 2016 election and how trends differed in states that voted for Donald Tru...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06328-6
更新日期:2020-10-31 00:00:00
abstract::Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.012004247.x
更新日期:1997-04-01 00:00:00
abstract::The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episo...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-010-1295-z
更新日期:2010-06-01 00:00:00
abstract::This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse commu...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-015-3298-2
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women. OBJECTIVE:To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women'...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0395-x
更新日期:2007-12-01 00:00:00
abstract::Attempts to explain the high cost of care in teaching hospitals have yielded conflicting results. This study was conducted to compare hospital charges and lengths of stay for two groups of patients: one cared for by a resident team and the other cared for by attending physicians. The study was conducted at a universit...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02602350
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Residents demonstrate scholarly activity by presenting posters at academic meetings. Although recommendations from national organizations are available, evidence identifying which components are most important is not. OBJECTIVE:To develop and test an evaluation tool to measure the quality of case report pos...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-008-0860-1
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND/OBJECTIVE:Diet books dominate the New York Times Advice Best Seller list and consumers cite such books as an important source of nutrition information. However, the scientific support for nutrition claims presented as fact (nutrition facts) in diet books is not known. DESIGN/MEASUREMENTS:We assessed the qua...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00501.x
更新日期:2006-07-01 00:00:00
abstract:BACKGROUND:Opioid-dependent patients often have co-occurring chronic illnesses requiring medications that interact with methadone. Methadone maintenance treatment (MMT) is typically provided separately from medical care. Hence, coordination of medical care and substance use treatment is important to preserve patient sa...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1043-4
更新日期:2009-09-01 00:00:00
abstract::Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners unde...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-0918-8
更新日期:2009-05-01 00:00:00
abstract::The quality of diabetes care delivered to patients falls below the expectations of practice guidelines and clinical trial evidence. Studies in many jurisdictions with varying health care systems have shown that recommended processes of care occur less often than they should; hence, outcomes of care are inadequate. Man...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-006-0027-x
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Postmenopausal women with a prior fracture have an increased risk for future fracture. Whether a history of non-vertebral fracture defines a group of women with low bone mass but without osteoporosis for whom alendronate would prevent new non-vertebral fracture is not known. SUBJECTS AND METHODS:Secondary a...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0622-0
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:Disparities can be caused by minorities receiving care in low-quality settings. The patient-centered medical home (PCMH) has been identified as a model of high-quality primary care that can eliminate disparities. However, Latinos are less likely to have PCMHs. OBJECTIVE:To identify Latino subgroup variation...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1119-1
更新日期:2009-11-01 00:00:00
abstract:IMPORTANCE:Sexual minority women with and at-risk for human immunodeficiency virus (HIV) may face increased risks of violence. OBJECTIVE:To understand the relationship between sexual minority status and violence; and how high-risk sex and substance use mediate that relationship among women with and at-risk for HIV. D...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-014-2832-y
更新日期:2014-08-01 00:00:00
abstract:BACKGROUND:Primary care providers (PCPs) vary in skills to effectively treat depression. Key features of evidence-based collaborative care models (CCMs) include the availability of depression care managers (DCMs) and mental health specialists (MHSs) in primary care. Little is known, however, about the relationships bet...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-014-2807-z
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Resident duty hour restrictions have resulted in more frequent patient care handoffs, increasing the need for improved quality of residents' sign-out process. OBJECTIVE:To characterize resident sign-out process and identify effective strategies for quality improvement. DESIGN:Mixed methods analysis of resi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1885-4
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Mentorship is perceived to play a significant role in the career development and productivity of academic clinicians, but little is known about the characteristics of mentorship. This knowledge would be useful for those developing mentorship programs. OBJECTIVE:To complete a systematic review of the qualita...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-009-1165-8
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. OBJECTIVE:To determine whether an increase in information feedback without changes ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05004-8
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To examine changes in the quality of primary care experienced and reported by Medicare beneficiaries from 1998 to 2000. DESIGN:Longitudinal observational study. SETTING:Thirteen states with large, mature Medicare HMO markets. PARTICIPANTS:Probability sample of noninstitutionalized Medicare beneficiaries ag...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2004.30381.x
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8(th) grade level. Currently, electronic health record (EHR) providers partner with companies that produce P...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-012-2046-0
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Despite known benefits of influenza vaccination and coverage by Medicare Part B, elderly minority patients are less likely to receive influenza vaccination than whites. OBJECTIVES:To test whether a nonphysician-initiated standardized offer of influenza vaccination to all elderly primary care patients would ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00401.x
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:Questions persist about how learning healthcare systems should integrate audit and feedback (A&F) into quality improvement (QI) projects to support clinical teams' use of performance data to improve care quality. OBJECTIVE:To identify how a virtual "Hub" dashboard that provided performance data for patients...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06160-y
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:The gap in asthma prevalence, morbidity, and mortality is increasing in low-income racial/ethnic minority groups as compared with Caucasians. In order to address these disparities,alternative beliefs and behaviors need to be identified. OBJECTIVE:To identify causal models of asthma and the context of conven...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00624.x
更新日期:2006-12-01 00:00:00
abstract::To determine if physician specialty is associated with underutilization and underdosing of angiotensin-converting enzyme inhibitors among patients with heart failure, we reviewed the charts of 214 outpatients with decreased systolic function at an urban academic medical center. Regardless of whether patients were care...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1997.07110.x
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:To address concerns that the Hospital Readmissions Reduction Program (HRRP) unfairly penalized safety net hospitals treating patients with high social and functional risks, Medicare recently modified HRRP to compare hospitals with similar proportions of high-risk, dual-eligible patients ("peer group hospital...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06222-1
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters. DESIGN:Cross-sectional study. SETTING:General internal medicine outpatient clinic associated with an urban, academic...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1046/j.1525-1497.1999.07238.x
更新日期:1999-07-01 00:00:00