FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2152765281> ?p ?o ?g. }

• W2152765281 endingPage "23" @default.
• W2152765281 startingPage "22" @default.
• W2152765281 abstract "Editor's Capsule Summary for Stiell et al1Stiell I. Clement C.M. Brison R.J. et al.Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments.Ann Emerg Med. 2011; 57: 13-21Abstract Full Text Full Text PDF PubMed Scopus (99) Google ScholarWhat is already known on this topic: There is controversy about whether rhythm or rate control should be the primary goal of emergency department (ED) management of atrial fibrillation and flutter.What question this study addressed: What variation exists in the care of ED patients with rapid atrial fibrillation or flutter?What this study adds to our knowledge: In chart review of 1,068 patients in 8 academic Canadian hospitals, 88% had atrial fibrillation and 12% flutter. Rhythm control was attempted in 60% of patients; electrocardioversion, in 44%. Eighty three percent of patients were discharged home. There was considerable variation among sites.How this is relevant to clinical practice: These 8 hospitals use different strategies, all of which seem safe. The optimal practice has not been defined. What is already known on this topic: There is controversy about whether rhythm or rate control should be the primary goal of emergency department (ED) management of atrial fibrillation and flutter. What question this study addressed: What variation exists in the care of ED patients with rapid atrial fibrillation or flutter? What this study adds to our knowledge: In chart review of 1,068 patients in 8 academic Canadian hospitals, 88% had atrial fibrillation and 12% flutter. Rhythm control was attempted in 60% of patients; electrocardioversion, in 44%. Eighty three percent of patients were discharged home. There was considerable variation among sites. How this is relevant to clinical practice: These 8 hospitals use different strategies, all of which seem safe. The optimal practice has not been defined. 1Stiell et al1Stiell I. Clement C.M. Brison R.J. et al.Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments.Ann Emerg Med. 2011; 57: 13-21Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar hypothesize that treatment of recent-onset atrial fibrillation/flutter will vary substantially from hospital to hospital.AWhat reasons do the authors give for generating this hypothesis? Do you agree with their reasoning?BConsider the matrix below, which contrasts the medical evidence in support of a specific process of care with the variation in practice for that condition. Can you think of medical conditions that fall into each of the boxes? Into which box (A, B, C, and D) does the management of acute atrial fibrillation fall? Discuss the arguments for and against a practice pattern that falls into each box.Tabled 1Variability of CareLowHighEvidence supporting a specific strategyLowABHighCD Open table in a new tab CIs variation always a bad thing? Is standardization always a good thing? In 2010, how much variation is desirable for the management of acute-onset atrial fibrillation?2This article seeks to explain variation at the hospital level.AWhat is the inherent structure of the data used in this study? Who determines each patient's treatment? What N is used for this study? What are the possible Ns for this study? Make an argument for and against each unit of analysis that you identify.BAn alternative analysis of these data would involve a multilevel model with patients nested within physicians and physicians nested within hospitals. One could then compare the variation in practice among the physicians at each site with the variation in practice among sites. Do you think this is worth doing? Sketch out what (extreme) results are possible and what result you would expect to find.CImagine you found that between-hospital variation exceeded inter-physician variation. What does that say about the practice of emergency medicine? What implications does it have for methods of changing practice?DThe regression models used in this study treat the patient as the unit of analysis, predicting whether a particular patient will be rhythm or rate controlled according to the patient's demographic and clinical characteristics and the emergency department (ED) providing treatment. The investigators used backward stepwise regression on a pool of 12 patient-level clinical variables selected because they would adjust hospital effects for case mix. Explain how this model is supposed to work and how it should be interpreted. Discuss any problems with the methods of model specification, selection of candidate variables, and variable selection. Can you describe how alternative models such as one that sought to predict hospital rhythm/rate control proportions from patient, physician, and hospital characteristics might work?3Roughly 60% of patients were treated with rhythm control, implying that the majority of physicians at these 8 hospitals thought that a return to sinus rhythm was in the best interest of the patients included in this study.AWhat is the evidence about rate versus rhythm control for ED patients with acute-onset atrial fibrillation?BIf a patient in atrial fibrillation is converted to sinus rhythm, what are the chances that the patient will return to atrial fibrillation/flutter in the next few months? If a patient is rate controlled and remains in atrial fibrillation/flutter, what is the short-term risk of atrial clot formation? What is the short-term risk of thromboembolic sequelae? If a patient is chemically or electrically cardioverted to sinus rhythm, what is the short-term risk of atrial thrombus formation or thromboembolic sequelae?CWhat outcomes are of interest when comparing rate control with rhythm control? What are the ideal times to measure such outcomes? How does your list compare with those reported in Table 3 of the article by Stiell et al?1Stiell I. Clement C.M. Brison R.J. et al.Variation in management of recent-onset atrial fibrillation and flutter among academic hospital emergency departments.Ann Emerg Med. 2011; 57: 13-21Abstract Full Text Full Text PDF PubMed Scopus (99) Google ScholarDWhat types of studies would help you determine the preferred strategy? Do those studies exist? If not, why not?4The 8 Canadian hospitals discharged 83% of study subjects from the ED (range 74% to 95%). In this same issue of Annals, Barrett et al2Barrett T.W. Martin A.R. Storrow A.B. et al.A clinical prediction model to estimate risk for 30-day adverse events in emergency department patients with symptomatic atrial fibrillation.Ann Emerg Med. 2011; 57: 1-12Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar reported that at a large US academic teaching hospital, only 23% of similar patients were discharged.AWhat could account for such a dramatic difference in practice style? Are there any characteristics of the sites that would account for the difference?BAre there any other medical conditions for which the discharge rates between the 2 countries diverge so dramatically? Compared with other parts of the first world whose practice is aberrant, the United States or Canada?CCan you think of a reason why patients who have achieved rhythm or rate control in the ED might still benefit from hospital admission?DIf you were in charge of a nationwide health care system, what strategy would you select and why? What information would be most helpful in making such a decision? Variation in Management of Recent-Onset Atrial Fibrillation and Flutter Among Academic Hospital Emergency DepartmentsAnnals of Emergency MedicineVol. 57Issue 1PreviewAlthough recent-onset atrial fibrillation and flutter are common arrhythmias managed in the emergency department (ED), there is insufficient evidence to help physicians choose between 2 competing treatment strategies, rate control and rhythm control. We seek to evaluate variation in ED management practices for recent-onset atrial fibrillation and flutter patients at multiple Canadian sites and to determine whether hospital site was an independent predictor of attempted cardioversion. Full-Text PDF" @default.
• W2152765281 created "2016-06-24" @default.
• W2152765281 creator A5046846349 @default.
• W2152765281 creator A5084507799 @default.
• W2152765281 date "2011-01-01" @default.
• W2152765281 modified "2023-10-17" @default.
• W2152765281 title "To Shock or Not to Shock: That is the Question; is There an Answer?" @default.
• W2152765281 cites W1841210729 @default.
• W2152765281 cites W1971221723 @default.
• W2152765281 cites W1971505725 @default.
• W2152765281 cites W1973133775 @default.
• W2152765281 cites W1974436785 @default.
• W2152765281 cites W1980550338 @default.
• W2152765281 cites W1994231358 @default.
• W2152765281 cites W1997013992 @default.
• W2152765281 cites W1998792094 @default.
• W2152765281 cites W2001549869 @default.
• W2152765281 cites W2004076684 @default.
• W2152765281 cites W2004260493 @default.
• W2152765281 cites W2009312581 @default.
• W2152765281 cites W2010550566 @default.
• W2152765281 cites W2015176605 @default.
• W2152765281 cites W2016742969 @default.
• W2152765281 cites W2020521036 @default.
• W2152765281 cites W2030826176 @default.
• W2152765281 cites W2031970430 @default.
• W2152765281 cites W2032227708 @default.
• W2152765281 cites W2035892036 @default.
• W2152765281 cites W2042472315 @default.
• W2152765281 cites W2042660765 @default.
• W2152765281 cites W2050989535 @default.
• W2152765281 cites W2051359647 @default.
• W2152765281 cites W2051599542 @default.
• W2152765281 cites W2051656435 @default.
• W2152765281 cites W2052755535 @default.
• W2152765281 cites W2053132213 @default.
• W2152765281 cites W2060103808 @default.
• W2152765281 cites W2062093372 @default.
• W2152765281 cites W2066601816 @default.
• W2152765281 cites W2068706699 @default.
• W2152765281 cites W2088077953 @default.
• W2152765281 cites W2092252727 @default.
• W2152765281 cites W2100410292 @default.
• W2152765281 cites W2108191500 @default.
• W2152765281 cites W2110253 @default.
• W2152765281 cites W2110431512 @default.
• W2152765281 cites W2114775432 @default.
• W2152765281 cites W2119384358 @default.
• W2152765281 cites W2119657311 @default.
• W2152765281 cites W2124719424 @default.
• W2152765281 cites W2124805101 @default.
• W2152765281 cites W2126596713 @default.
• W2152765281 cites W2129925362 @default.
• W2152765281 cites W2131260805 @default.
• W2152765281 cites W2139054312 @default.
• W2152765281 cites W2151074096 @default.
• W2152765281 cites W2161283927 @default.
• W2152765281 cites W2162131419 @default.
• W2152765281 cites W2167155279 @default.
• W2152765281 cites W2169537907 @default.
• W2152765281 cites W2319445361 @default.
• W2152765281 cites W2325460018 @default.
• W2152765281 cites W2749611376 @default.
• W2152765281 cites W2797732082 @default.
• W2152765281 cites W2917119495 @default.
• W2152765281 cites W3143584426 @default.
• W2152765281 cites W2750426121 @default.
• W2152765281 doi "https://doi.org/10.1016/j.annemergmed.2010.11.001" @default.
• W2152765281 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21183081" @default.
• W2152765281 hasPublicationYear "2011" @default.
• W2152765281 type Work @default.
• W2152765281 sameAs 2152765281 @default.
• W2152765281 citedByCount "0" @default.
• W2152765281 crossrefType "journal-article" @default.
• W2152765281 hasAuthorship W2152765281A5046846349 @default.
• W2152765281 hasAuthorship W2152765281A5084507799 @default.
• W2152765281 hasConcept C126322002 @default.
• W2152765281 hasConcept C2781300812 @default.
• W2152765281 hasConcept C71924100 @default.
• W2152765281 hasConceptScore W2152765281C126322002 @default.
• W2152765281 hasConceptScore W2152765281C2781300812 @default.
• W2152765281 hasConceptScore W2152765281C71924100 @default.
• W2152765281 hasIssue "1" @default.
• W2152765281 hasLocation W21527652811 @default.
• W2152765281 hasLocation W21527652812 @default.
• W2152765281 hasOpenAccess W2152765281 @default.
• W2152765281 hasPrimaryLocation W21527652811 @default.
• W2152765281 hasRelatedWork W1506200166 @default.
• W2152765281 hasRelatedWork W1995515455 @default.
• W2152765281 hasRelatedWork W2048182022 @default.
• W2152765281 hasRelatedWork W2080531066 @default.
• W2152765281 hasRelatedWork W2604872355 @default.
• W2152765281 hasRelatedWork W2748952813 @default.
• W2152765281 hasRelatedWork W2899084033 @default.
• W2152765281 hasRelatedWork W3031052312 @default.
• W2152765281 hasRelatedWork W3032375762 @default.
• W2152765281 hasRelatedWork W3108674512 @default.
• W2152765281 hasVolume "57" @default.

• next