Prospective observational study of acute coronary syndromes in China: practice patterns and outcomes
Runlin GaoAnushka PatelWei GaoDayi HuDong HuangLing Yuan KongWei QiYangfeng WuYue YangPhilip J. HarrisCharles S. AlgertP. GroenesteinF. Turnbull
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Abstract:
To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice.A multicentre prospective survey of sociodemographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS.Large urban public hospitals.Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (MI) or unstable angina pectoris.Myocardial infarction/re-infarction, heart failure, death.Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres.This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guidelines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways.Keywords:
Unstable angina
Many questions in human health research can only be answered with observational studies. In contrast to controlled experiments or well-planned, experimental randomized clinical trials, observational studies are subject to a number of potential problems that may bias their results.Some of the more important problems affecting observational studies are described and illustrated by examples. Additional information is provided with reference to a selection of the literature.Factors that may bias the results of observational studies can be broadly categorized as: selection bias resulting from the way study subjects are recruited or from differing rates of study participation depending on the subjects' cultural background, age, or socioeconomic status, information bias, measurement error, confounders, and further factors.Observational studies make an important contribution to medical knowledge. The main methodological problems can be avoided by careful study planning. An understanding of the potential pitfalls is important in order to critically assess relevant publications.
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72 preschoolers and 72 school children observed the original discrimination of nonreversal shift (NRS) followed by 14 NRS trials by themselves. The observational trials were 10 or 30 in each age group. The correct (_??_) or incorrect (×) responses on the 1st (unchanged pair) and the 2nd (changed pair) trials of NRS were mainly measured. In preschoolers, both dependent observational-learning mode (_??_-× responses: DOL) and independent observational-learning mode (_??_-_??_ and ×-×: IOL) were found, but no observational-trial effects on the modes were found. In school children, DOL occurred significantly more than IOL in both groups, and the observational-trial effect was also found. Subproblem analyses suggested that the _??_-× responses were indeed the “dependent” mode rather than the “independent” one.
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