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Biomedical subjects

David Zitner

Publications and source records attributed to David Zitner.

7 recordsLinked to original sources
PubMed2004

Evidence-based cardiovascular care in the community: a population-based cross-sectional study.

BACKGROUND: Ischaemic heart disease and congestive heart failure are common and important conditions in family practice. Effective treatments may be underutilized, particularly in women and the elderly. The objective of the study was to determine the rate of prescribing of evidence-based cardiovascular medications and determine if these differed by patient age or sex. METHODS: We conducted a two-year cross-sectional study involving all hospitals in the province of Nova Scotia, Canada. Subjects were all patients admitted with ischaemic heart disease with or without congestive heart failure between 15 October 1997 and 14 October 1999. The main measure was the previous outpatient use of recommended medications. Chi-square analyses followed by multivariate logistic regression analyses were used to examine age-sex differences. RESULTS: Usage of recommended medications varied from approximately 60% for beta-blockers and angiotensin converting enzyme (ACE) inhibitors to 90% for antihypertensive agents. Patients aged 75 and over were significantly less likely than younger patients to be taking any of the medication classes. Following adjustment for age, there were no significant differences in medication use by sex except among women aged 75 and older who were more likely to be taking beta-blockers than men in the same age group. CONCLUSIONS: The use of evidence-based cardiovascular medications is rising and perhaps approaching reasonable levels for some drug classes. Family physicians should ensure that all eligible patients (prior myocardial infarction, congestive failure) are offered beta-blockers or ACE inhibitors.

Aged↗
PubMed2004

Knowledge management in pediatric pain: mapping on-line expert discussions to medical literature.

Clinical decision-making can be vastly improved with the availability of the right medical knowledge at the right time. This concept paper presents a knowledge management re-search program to (a) identify, capture and organize the tacit knowledge inherent within on-line problem-solving discussions between pediatric pain practitioners; (b) establish linkages between topic-specific pediatric pain discussions and corresponding published medical literature on children's pain available at PubMed--i.e. linking tacit expert knowledge to explicit medical literature; and (c) make these knowledge re-sources available to pediatric pain practitioners via the WWW for timely access to various modalities of clinical knowledge.

Artificial Intelligence↗
PubMed2003

Undocumented patient information: an impediment to quality of care.

PURPOSE: Poor documentation in medical records might reduce the quality of care and undermine analyses based on retrospective chart reviews. We assessed the documentation of cardiac risk factors and cardiac history in the records of patients hospitalized with myocardial infarction or heart failure. METHODS: We performed a retrospective cohort study involving direct chart audit of all consecutive hospitalizations for myocardial infarction (n = 2,109) or heart failure (n = 3,392) in Nova Scotia, Canada, from October 15, 1997, to October 14, 1998. The main outcome measures were the documentation rates for prespecified clinical items, including cardiac risk factors and history of myocardial infarction or heart failure, which were recognized as indicators of the quality of care for the conditions under study. RESULTS: Information was not documented in a high proportion of cases, ranging from 9% (smoking) to 58% (previous history of heart failure) in charts from patients hospitalized for myocardial infarction, and from 19% (smoking) to 69% (hyperlipidemia) in charts from heart failure hospitalizations. Lack of documentation was more common in women and the elderly. CONCLUSION: Documentation of important clinical information is poor even in the hospital charts of patients with severe conditions. This quality-of-care issue has implications for health services and outcomes research, including the development of report cards.

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PubMed2003

Is sane management possible in a crazy world?

Most people benefit from healthcare. However, Canadians remain dissatisfied because too often we receive faulty care and delayed care, not supported by evidence. Browman and colleagues relate successful efforts to introduce evidence-based care. They show that strong champions can be effective even in insane environments. The collaborative approach suggested is moving and thoughtful. Sharing between knowledge and financial stewards, including the use of stories, is especially valuable when financial stewardshipis not possible because we lack information about the local outcomes of care. Goodwill between stewards is especially necessary when there are few external incentives to provide excellent care. In healthcare good deeds are punished, not rewarded. Canadian governments fail to regulate healthcare because of the conflict of interest arising when the same group not only regulates care but also functions as insurer, governor, administrator and evaluator. We need radical change to eliminate the perverse incentives and bizarre management practices that bedevil our healthcare system and impede the use of evidence. Fundamental changes in organization and evaluation proposed by the Halifax Chamber of Commerce and the Kirby and Mazankowski committees will help. Separating the functions of insurer, administrator, evaluator and regulator is ethical and necessary.

Canada↗