Changing perspectives in coronary care

MacMillan, R. L.; Brown, K. W. G.; Peckham, Gerald B.; Kahn, Otto Hermann; Dc, Hutchison; Patón, M Marín

doi:10.1016/0002-9149(67)90022-7

Cited by 45 publications

(2 citation statements)

References 5 publications

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“…O tratamento do IAM até o início da década de 60, antes do advento da unidade coronariana (UC), era caracterizado pelo conjunto de procedimentos analgesia, oxigenoterapia, repouso e sedação -com eficácia presumida através de dados históricos, mas não quantificada -, sendo a letalidade hospitalar de então de 30% a 40% (Day, 1963;Brown et al, 1963;Julian et al, 1964;MacMillan et al, 1967;Lown et al, 1967a). Cerca de 40% dessas mortes eram devidas a arritmias graves -fibrilação ventricular e assistolia -em pacientes sem insuficiência cardíaca grave ( Julian et al, 1964;Lown et al, 1967a).…”

Section: Conjunto Original (Eo)unclassified

“…Todos eles registraram benefícios (efetividade) bem menores para os respectivos referentes que os estudos de Lown, mas crescentes, tanto para as manobras de ressuscitação como para a prevenção de paradas cardía-cas. A queda da letalidade para o conjunto de pacientes de IAM variou de 42% a 57,5%, tomando-se por base uma letalidade prévia (Eo) bastante superior à de Lown, com variação correspondente da letalidade hospitalar (UC, incluindo enfermaria) de 24,7% a 17% (Brown et al, 1963;Day, 1963Day, , 1965Nachlas, 1965;Kimball et al, 1966;Goble, 1966;MacMillan et al, 1967;Killip & Kimball, 1967;Lawrie et al, 1967;Marshall et al, 1968;Christiansen et al, 1971), sendo que os estudos com mediana de delta tempo mais reduzido e processo de assistência mais adequado tenderam a apresentar efetividade maior.…”

Section: Eficácia De Conjuntos Tecnológicosunclassified

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Metodologia para a estimativa de padrões de qualidade: o caso do infarto agudo do miocárdio

1996

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Section: Conjunto Original (Eo)unclassified

Section: Eficácia De Conjuntos Tecnológicosunclassified

Metodologia para a estimativa de padrões de qualidade: o caso do infarto agudo do miocárdio

1996

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Evaluation of Cardiac Care Units and Myocardial Infarction

McGuire¹

1972

Arch Intern Med

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Selected items of medical history, physical and laboratory findings, diagnoses, and treatment methods in 770 patients were stored by computer to assess utilization and effectiveness of medical care in a cardiac care unit. Utilization was expressed in terms of the distribution of final diagnoses and selected, cardiac complications in addition to occupancy rate. Effectiveness was expressed in terms of incidence and location of deaths from theoretically preventable causes, and in terms of resuscitation results, in addition to mortality in acute myocardial infarction. The same data permitted a study of prognostic factors in acute myocardial infarction. Excess mortality was associated with diabetes, previous heart failure, and age of 65 years or greater. Systematic collection of routinely available clinical information permits studies of hospital operations and of specific diseases, provided basic assumptions about objectives of care are acceptable.Medical auditing involves the enumeration of relatively rou¬ tine activities, as contrasted to experi¬ mental activities, in the general area of patient care. The purposes of such audits could include analyses of hospi-(Dr. McGuire). tal operating efficiency, studies of professional personnel performance, or clinical research concerning se¬ lected diseases. In order for a single collection of information to serve more than one purpose, the volume of data recorded for each patient must be relatively great, and there must be more uniformity in definitions of medical terms and standards than is routinely followed in medical prac¬ tice.While major limitations thus hin¬ der useful auditing of total hospital populations covering a wide range of diseases and activities, the grouping of patients into special care facilities for related diseases may make audit¬ ing more successful. This effort was undertaken at the University of Vir¬ ginia cardiac care unit in 1967. An¬ swers to 92 questions concerning items of medical history, physical and laboratory findings, complications, treatment methods, and results of treatment in 770 consecutive patients were stored by computer. A review of this experience suggested that in¬ dices of unit effectiveness other than the commonly used death rate in acute myocardial infarction are desir¬ able, and that specific deficiencies in medical management techniques can be revealed. The application of these same data to a study of prognostic factors in myocardial infarction was also illustrated. MethodsA study form was completed on every patient admitted to a four-bed cardiac care unit during a 36-month period in 1967 to 1970. In addition to the usual identifying data, coded entries were made from a list of ten possible diagnoses, 27 electrocardiographic findings and arrhythmias, and 25 drug or electrical treatment methods. Each patient was classified in terms of one of five possible primary diagnoses (listed in Table 1), and in terms of any of several po¬ tentially applicable secondary diagnoses, such as hypertension, diabetes, valvular heart disease. Va...

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