173 results on '"David M, Mirvis"'
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2. Impact of High-Deductible Health Plans on Health Care Utilization and Costs
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David M. Mirvis, William T. Cecil, Panagiotis Kasteridis, Teresa M. Waters, and Cyril F. Chang
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Heterogeneous group ,Incentive ,Actuarial science ,business.industry ,Health Policy ,Health care ,Insurance Claim Review ,Health services research ,Medicine ,Medical prescription ,business ,Deductible ,Preferred provider organization - Abstract
Background. High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. Objective. To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. Data. Claims and member data from a major insurer and zip code-level census data. Study Design. Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). Results. In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronicallyill enrollees and those whoclearlyhad a choice ofplans were more likelyto increase utilization in specific categories after switching to an HDHP plan. Conclusions. Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives. more...
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- 2010
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3. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram
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E. William Hancock, Barbara J. Deal, David M. Mirvis, Peter Okin, Paul Kligfield, and Leonard S. Gettes
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Cardiology and Cardiovascular Medicine - Published
- 2009
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4. The TennCare Graduate Medical Education Plan: Ten Years Later
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David M. Mirvis, R. Christopher Walton, and Mary Ann Watson
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medicine.medical_specialty ,Career Choice ,Primary Health Care ,business.industry ,Health Policy ,Managed Care Programs ,education ,Graduate medical education ,Primary health care ,Internship and Residency ,Professional practice ,Primary care ,Plan (drawing) ,Tennessee ,Education, Medical, Graduate ,Family medicine ,Workforce ,Internal Medicine ,Medicaid Program ,medicine ,Humans ,Managed care ,business - Abstract
In 1994, Tennessee converted its Medicaid program to a managed care system--TennCare. Graduate medical education (GME) funding by TennCare was linked to several workforce goals that included increasing the number of residents training in primary care and increasing the number of primary care physicians practicing in underserved areas of Tennessee.To determine the effects of the TennCare GME plan on GME and the physician workforce of Tennessee.Bureau of TennCare GME data from 1996-2004 and American Medical Association Physician Masterfile data through 2003.Changes in filled residency positions and number of stipend supplements awarded after implementation of the TennCare GME plan. Changes in physician workforce characteristics between a 5-year period before and after implementation of TennCare.Filled primary care residency positions increased from 839 (45.2%) in 1996 to 906 (47.9%) in 2000, but declined to 862 (43.5%) by 2004. Eleven of 133 available primary care stipend supplements were awarded through 2004. The percentage of physicians remaining in Tennessee after completion of residency decreased from 46.2% before TennCare to 42.4% (P = .087) after implementation of TennCare. U.S. medical graduates remaining in state declined by 5.8% (P = .019).The major goals of the TennCare GME plan have not been achieved. Overall, physician retention has decreased and the number of U.S. medical graduates remaining in state has declined. State policymakers should consider other methods to increase the number of residents training in primary care and ultimately practicing in underserved areas of Tennessee. more...
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- 2007
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5. Recommendations for the Standardization and Interpretation of the Electrocardiogram
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Jay W, Mason, E William, Hancock, Leonard S, Gettes, James J, Bailey, Rory, Childers, Barbara J, Deal, Mark, Josephson, Paul, Kligfield, Jan A, Kors, Peter, Macfarlane, Olle, Pahlm, David M, Mirvis, Peter, Okin, Pentti, Rautaharju, Borys, Surawicz, Gerard, van Herpen, Galen S, Wagner, and Hein, Wellens more...
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Pathology ,medicine.medical_specialty ,Standardization ,diagnosis ,Statement (logic) ,International Cooperation ,electrocardiography ,MEDLINE ,Lexicon ,Sensitivity and Specificity ,Physiology (medical) ,computers ,medicine ,Humans ,Medical physics ,medicine.diagnostic_test ,business.industry ,Interpretation (philosophy) ,Foundation (evidence) ,Arrhythmias, Cardiac ,Signal Processing, Computer-Assisted ,United States ,AHA Scientific Statements ,Diagnosis code ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
This statement provides a concise list of diagnostic terms for ECG interpretation that can be shared by students, teachers, and readers of electrocardiography. This effort was motivated by the existence of multiple automated diagnostic code sets containing imprecise and overlapping terms. An intended outcome of this statement list is greater uniformity of ECG diagnosis and a resultant improvement in patient care. The lexicon includes primary diagnostic statements, secondary diagnostic statements, modifiers, and statements for the comparison of ECGs. This diagnostic lexicon should be reviewed and updated periodically. more...
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- 2007
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6. Recommendations for the Standardization and Interpretation of the Electrocardiogram
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Rory Childers, Peter W. Macfarlane, James J. Bailey, Leonard S. Gettes, David M. Mirvis, Barbara J. Deal, Jan A. Kors, Pentti M. Rautaharju, Olle Pahlm, E. William Hancock, Galen S. Wagner, Paul Kligfield, and Gerard van Herpen more...
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Statement (computer science) ,medicine.medical_specialty ,Standardization ,medicine.diagnostic_test ,Statement (logic) ,business.industry ,Interpretation (philosophy) ,Foundation (evidence) ,Context (language use) ,Heart Rhythm ,Physiology (medical) ,Medicine ,Medical physics ,business ,Lead Placement ,Cardiology and Cardiovascular Medicine ,Electrocardiography - Abstract
This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Throughout the statement, recommendations for ECG standards are placed in context of the clinical implications of evolving ECG technology. more...
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- 2007
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7. The Economics of Prevention in a Post-Managed-Care Environment
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Cyril F. Chang, David M. Mirvis, and Teresa M. Waters
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Economics and Econometrics ,medicine.medical_specialty ,Health economics ,business.industry ,Health Policy ,Public health ,Managed Care Programs ,General Medicine ,Public relations ,Health administration ,Preventive Health Services ,Humans ,Medicine ,Managed care ,Operations management ,Health education ,business ,Quality of Life Research - Abstract
((Author: please insert an abstract. This should be 4 to 5% of the length of the article (but no more than Abstract 400 words) and highlight, in an informative manner, specific important points addressed in the main body of the text. Please do not just describe the general areas covered in the manuscript. The journal style is to not cite references in the abstract so as to provide a discrete synopsis of the article)) 1. The Economics of Prevention in a Post-Managed and technical infrastructure to deliver these services, and reducing more...
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- 2004
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8. The cumulative effects of historical and physical examination findings on the prognostic value of the electrocardiogram
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David M. Mirvis and Marshall J. Graney
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Male ,medicine.medical_specialty ,Time Factors ,Systolic hypertension ,Physical examination ,Disease ,Electrocardiography ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Risk factor ,Physical Examination ,Survival analysis ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Surgery ,Hypertension ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Cohort study - Abstract
The electrocardiogram has been shown in epidemiologic studies to be an independent predictor of survival. These studies have adjusted for selected covariates simultaneously. This article assesses the value of the electrocardiogram as a predictor of survival when introduced at progressive stages of the common clinical encounter. Data collected from 4,518 patients ages of 60 to 96 years with isolated systolic hypertension who were followed-up for up to 6 years as part of the Systolic Hypertension in the Elderly Project were analyzed. Survival curves and 3- and 5-year survival rates (Cox regression methods) of groups with normal and abnormal resting electrocardiograms were compared. Blocks of covariates representing demographic information, risk factors for cardiovascular disease, clinical history, and physical examination findings were added to the survival models sequentially to mimic the sequence of the common clinical encounter, and the independent significance of the electrocardiogram as a predictor of survival was assessed at each step. An abnormal electrocardiogram was associated with reduced survival when no adjustment for covariates is made. Survival was also significantly (P more...
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- 2001
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9. From Research to Public Policy: An Essential Extension of the Translation Research Agenda
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David M. Mirvis
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Canada ,Policy making ,Public policy ,Public Policy ,Health Promotion ,General Biochemistry, Genetics and Molecular Biology ,Translational Research, Biomedical ,Humans ,Medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Action research ,Policy Making ,Research Articles ,Health policy ,Academic Medical Centers ,Evidence-Based Medicine ,business.industry ,Health Policy ,Research ,General Neuroscience ,General Medicine ,Evidence-based medicine ,Public relations ,United States ,humanities ,Policy studies ,Health promotion ,business ,Evidence-based policy - Abstract
Research translation typically includes translation from basic science into clinical research and from clinical research into everyday clinical practice. In this essay, we propose a greater emphasis on applying research findings, both basic and clinical, into effective public policies that promote health. Research can have important influences on policy by providing a scholarly basis for action research, and translation science units within academic health centers are in powerful positions to build bridges between the research and policy making communities to promote the development of evidence based policy. The results will benefit the researcher and the decision maker, as well as the research itself. more...
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- 2009
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10. Trends in Burnout and Related Measures of Organizational Stress Among Leaders of Department of Veterans Affairs Medical Centers
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Anne Osborne Kilpatrick, David M. Mirvis, and Marshall J. Graney
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Gerontology ,Leadership and Management ,business.industry ,health care facilities, manpower, and services ,Strategy and Management ,Health Policy ,education ,General Medicine ,Burnout ,Organizational stress ,law.invention ,law ,health services administration ,Organizational change ,CLARITY ,Phase model ,Survey data collection ,Medicine ,Job satisfaction ,business ,Veterans Affairs ,psychological phenomena and processes - Abstract
Psychological burnout significantly and detrimentally affects individuals and the organizations for which they work. Leaders with burnout often display characteristics that are the opposite of those required to implement major organizational change. This study was undertaken to assess the level of psychological burnout of leaders of the Department of Veterans Affairs (VA) medical centers during a period of rapid change. The objective was to quantify trends in the level of burnout and associated measures of psychological stress. Surveys of medical center directors, associate medical center directors, and chiefs of staff of each VA medical center were conducted in 1989, 1992, and 1997 to evaluate burnout, role characteristics, and job satisfaction. Burnout was measured using the Maslach Burnout Inventory and scored using the phase model of burnout. Findings demonstrated higher prevalences of more advanced levels of burnout in the 1992 and 1997 surveys than in the 1989 survey. Role clarity, perceived adequacy of resources to complete assigned tasks, and several measures of job satisfaction were lower in the 1997 survey compared to the earlier survey data. Therefore, psychological burnout and other indicators of stress increased during the 1989 to 1997 study period. These findings suggest cause for concern as the largest integrated healthcare system in the United States undertakes major organizational change to meet present and future challenges. more...
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- 1999
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11. Body Surface Electrocardiographic Mapping
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David M. Mirvis and David M. Mirvis
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- Body surface mapping, Electrocardiography, Heart--Diseases--Diagnosis
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To accomplish these objectives, the book is Body surface electrocardiographic mapping is not a new technique. It is one initially de divided into five sections. In Part I, the deve veloped many decades ago, but it has only lopment of electrocardiographic leads as well as recently matured into a powerful tool for surface mapping is viewed from an historical studying the cardiac electrical field. This book perspective. This is followed in Part II by a is intended to review, both critically and in review of the fundamental physiologic and detail, the applications of this unique method biophysical principles of electrocardiography in both clinical and experimental environments. and a discussion of basic mapping techniques. A comprehensive description of reported re Applications of these methods to the normal sults is, however, only a first goal. An equally and the abnormal heart are then presented in important objective is to explore the elec Parts III and IV, respectively. Finally, the trophysiologic and biophysical bases for the work concludes (Part V) with a consideration empirically observed electrocardiographic pat of possible future directions that body surface terns. It is only after considering these basic mapping may follow. The final result is, hope foundations that the values and the limitations fully, a thorough statement defining the cur of any electrocardiographic method can be rent s~atus of body surface electrocardiographic understood. This is particularly true for body mappmg. more...
- Published
- 2012
12. What's wrong with electrocardiography?
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David M. Mirvis
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medicine.medical_specialty ,Heart Diseases ,Electrodiagnosis ,medicine.diagnostic_test ,business.industry ,MEDLINE ,Electrocardiography ,Image Processing, Computer-Assisted ,medicine ,Physical therapy ,Humans ,Cardiology and Cardiovascular Medicine ,business - Published
- 1998
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13. Health care reform in Israel: An historical and sociopolitical conundrum
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David M. Mirvis
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medicine.medical_specialty ,HRHIS ,Economic growth ,Public Administration ,business.industry ,Public health ,International health ,Public administration ,Health promotion ,Political science ,Health care ,medicine ,Health law ,Health care reform ,Business and International Management ,business ,health care economics and organizations ,Health policy - Abstract
A new and comprehensive National Health Insurance Law was implemented in Israel on January 1, 1995. This major health care reform initiative culminated an effort lasting several decades to assure broad universal health care coverage for the population as a matter of national law. Issues that affected the development of the reform package included 1) the formation of sick funds that provide care to over 96% of the population as part of other powerful sociopolitical organizations, 2) the historical development of parallel private July 16, 1995 and governmental health care systems before Israel became a state in 1948 and the post-state maintenance of multiple health care delivery systems, and 3) the close interactions of health care systems and the political processes and parties of the nation. This paper describes the effects of these forces on resisting changes that were widely accepted as being necessary to expand access, control rising health care costs, and improve the efficiency of the nation's health ... more...
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- 1997
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14. Choosing a medical specialty: the difference between what students want and what society needs
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David M. Mirvis
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medicine.medical_specialty ,Medical education ,business.industry ,Health Policy ,Public health ,media_common.quotation_subject ,education ,Public Health, Environmental and Occupational Health ,Health services research ,Specialty ,Primary care physician ,Health administration ,Nursing ,Perception ,Commentary ,Medicine ,business ,Health policy ,media_common ,Social policy - Abstract
The choice of a specialty by medical students is a complex one that has significant implications for the future supply of physician manpower. The study by Weissman et al. portrays this choice as reflecting the degree of congruence between a student's needs and values and his or her perception of the characteristics of the various specialties. The existing shortages in the supply of various specialists in Israel may be interpreted as signifying a lack of alignment of student needs and perceptions. This commentary will extend the implications of this work to include the connection between students' choices and the physician manpower needs of society, and will focus on primary care physician shortages in the United States as but one example of the implications of these relationships. more...
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- 2013
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15. TennCare--health system reform for Tennessee
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David M. Mirvis, William B. Applegate, Gregory T. Zaar, Cyril F. Chang, and Christopher J. Hall
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Gerontology ,medicine.medical_specialty ,State Health Plans ,Pilot Projects ,Health care ,Health insurance ,Humans ,Medicine ,Cost Sharing ,health care economics and organizations ,Finance ,Medically Uninsured ,Government ,Capitation ,Medicaid ,business.industry ,Public health ,Managed Care Programs ,General Medicine ,Tennessee ,United States ,Health Care Reform ,Cumulative cost ,Medicaid Program ,Managed care ,Capitation Fee ,business ,Program Evaluation - Abstract
TennCare, the health care system reform plan implemented in Tennessee on January 1,1994, was developed with the dual objectives of controlling the rapidly rising cost of the state's Medicaid program and extending health insurance coverage to most Tennesseans without access to employer-sponsored or other government-sponsored health insurance. Beneficiaries enroll in competing, state-chartered managed care organizations that are responsible for providing broad preventive, inpatient, and outpatient services and are reimbursed by the state on a capitation basis at a rate based on a statewide global budget for health care. The program initially proposed to enroll up to 1 775 000 citizens and was projected to result in a cumulative cost savings to Tennessee and the federal government of $7.2 billion by the end of the 5-year demonstration period. However, major start-up problems encountered by the state and by managed care organizations and limitations imposed by the government have significantly constrained these expectations. At the end of its first year, more than 1.2 million citizens were enrolled, but the program incurred a $99 million deficit. Managed care organizations and hospitals have reported major financial problems, and constituency groups—especially those representing physicians—have attempted to block the program. Our objective is to describe the design and rationale of TennCare and discuss key issues the plan continues to face that may affect its long-term success. ( JAMA . 1995;274:1235-1241) more...
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- 1995
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16. The Effect of Noncritical Coronary Artery Disease on Long-Term Survival
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Roger Vander Zwaag, Jay M. Sullivan, Faten El-Zeky, David M. Mirvis, James H. Crenshaw, and Kodangudi B. Ramanathan
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Adult ,Male ,medicine.medical_specialty ,Coronary Disease ,Time ,Coronary artery disease ,Cigarette smoking ,Diabetes mellitus ,Internal medicine ,Long term survival ,medicine ,Humans ,In patient ,Normal coronary arteries ,Survival rate ,Aged ,Luminal diameter ,business.industry ,Hemodynamics ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Coronary Vessels ,Survival Analysis ,Cardiology ,Female ,business ,Follow-Up Studies - Abstract
This study was designed to determine the impact of noncritical (less than 70% narrowing of the luminal diameter) coronary stenoses on the long-term survival rate of patients with coronary artery disease. The survival rate of 3,342 patients with normal coronary arteries (Group 1A) was compared with that of 2,184 patients with only noncritical stenoses (Group IB). Similarly, the survival rate of 1,128 patients with one or more critical lesions (Group 2A) was compared with that of 5,944 cases with noncritical plus critical lesions (Group 2B). Patients with noncritical lesions had significantly lower 10-year survival rates (85.8%) than did those with normal coronary arteries (90.1%). However, the difference in survival rate was attributable to older age, male sex, and higher prevalence of cigarette smoking, diabetes mellitus, and hypertension in Group IB than in Group 1A; presence of noncritical stenoses was not a statistically significant independent determinant of survival. Long-term survival rates of the patients with one or more critical lesions (Group 2A) were equivalent to that of patients with critical stenoses plus one or more noncritical lesions (Group 2B). Therefore, 1) patients with only noncritical stenoses have more risk factors for coronary artery disease than do those with normal coronary arteries; 2) these patients have a reduced long-term survival rate that reflects these risk factors rather than the presence of noncritical lesions; and 3) in patients with critical lesions, the presence of additional non-critical stenoses does not affect the long-term survival rate. more...
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- 1995
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17. The generalist physician: A partner in a new specialty
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David M. Mirvis
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medicine.medical_specialty ,Health Care Rationing ,business.industry ,Interprofessional Relations ,Managed Care Programs ,Specialty ,Health Care Costs ,Generalist and specialist species ,Pediatrics ,United States ,Family medicine ,Internal Medicine ,medicine ,Humans ,Medicine ,Clinical Competence ,Family Practice ,Policy Making ,Cardiology and Cardiovascular Medicine ,business ,Referral and Consultation ,Specialization - Published
- 1995
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18. Long-term Survival of Patients With Coronary Artery Disease During the 1970s
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Jay M. Sullivan, Faten El-Zeky, K. B. Ramanathan, Roger Vander Zwaag, and David M. Mirvis
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Infarction ,Critical Care and Intensive Care Medicine ,medicine.disease ,Surgery ,Coronary artery disease ,Internal medicine ,Epidemiology ,Cohort ,medicine ,Derivation ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,Cardiac catheterization - Abstract
Study objective This study was undertaken to determine the effects of altered risk factors and treatment modalities on the short- and long-term survival of patients with documented coronary artery disease whose conditions were diagnosed from 1972 through 1982. Study design The study was a retrospective database analysis of clinical, angiographic, and follow-up information. Setting Data from all patients referred for cardiac catheterization at the Baptist Memorial Hospital, Memphis, Tenn, were studied. Patients Risk factors and survival of patients who underwent cardiac catheterization from 1972 through 1982 and who were followed up for at least 5 years were evaluated. Cohort A included 1,821 patients studied from 1972 through 1977; cohort B included 5,369 patients studied between 1977 and the end of 1982. Each cohort was subdivided based on type of therapy (medical or surgical) that the patients received. Measurements and results The 30-day (short-term) and 5-year (long-term) survival rates were compared by life table methods. Short-term survival improved significantly in both medical (from 94.9% to 97.5%, p Conclusions These results indicate that during the study period, a significant decline in short-term mortality occurred for patients with angiographically documented coronary artery disease. Long-term survival did not, however, improve possibly due to a complex interplay between factors that promote coronary artery disease, eg, cigarette abuse and hypercholesterolemia, and factors that determine survival, eg, increases in age and history of prior infarction and advances in medical and surgical therapy. more...
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- 1995
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19. Tennessee's option to expand Medicaid coverage: what are the issues?
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David M, Mirvis and Cyril F, Chang
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Budgets ,Medicaid ,Patient Protection and Affordable Care Act ,Decision Making ,Costs and Cost Analysis ,Humans ,Tennessee ,Insurance Coverage ,United States - Published
- 2012
20. Health care reform meets the Supreme Court: what happened?
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David M, Mirvis and Carol M, Parker
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Medically Uninsured ,Patient Protection and Affordable Care Act ,Supreme Court Decisions ,United States - Published
- 2012
21. Electrocardiography
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David M. Mirvis and Ary L. Goldberger
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- 2012
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22. Contributors
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William T. Abraham, Michael A. Acker, Michael J. Ackerman, Philip A. Ades, Elliott M. Antman, Piero Anversa, Gary J. Balady, Kenneth L. Baughman, Joshua Beckman, Michael A. Bettmann, Deepak L. Bhatt, William E. Boden, Robert O. Bonow, Eugene Braunwald, Alan C. Braverman, J. Douglas Bremner, Hugh Calkins, Christopher P. Cannon, John M. Canty, Agustin Castellanos, Bernard R. Chaitman, Ming Hui Chen, Heidi M. Connolly, Mark A. Creager, Edécio Cunha-Neto, Charles J. Davidson, Vasken Dilsizian, Stefanie Dimmeler, Pamela S. Douglas, Andrew C. Eisenhauer, Linda L. Emanuel, Edzard Ernst, James C. Fang, G. Michael Felker, Gerasimos S. Filippatos, Stacy D. Fisher, Lee A. Fleisher, Thomas Force, J. Michael Gaziano, Thomas A. Gaziano, Jacques Genest, Mihai Gheorghiade, Ary L. Goldberger, Samuel Z. Goldhaber, Larry B. Goldstein, Richard J. Gray, Barry Greenberg, Bartley P. Griffith, William J. Groh, Joshua M. Hare, Gerd Hasenfuss, David L. Hayes, Maria de Lourdes Higuchi, L. David Hillis, Farouc A. Jaffer, Mariell Jessup, Andrew M. Kahn, Jan Kajstura, Norman M. Kaplan, Adolf W. Karchmer, Irwin Klein, Harlan M. Krumholz, Raymond Y. Kwong, Philippe L. L’Allier, Richard A. Lange, Thomas H. Lee, Annarosa Leri, Martin M. LeWinter, Peter Libby, Steven E. Lipshultz, Peter Liu, Brian F. Mandell, Douglas L. Mann, Barry J. Maron, Kenneth L. Mattox, Peter A. McCullough, Darren K. McGuire, Bruce McManus, Mandeep R. Mehra, John M. Miller, David M. Mirvis, Fred Morady, David A. Morrow, Dariush Mozaffarian, Paul S. Mueller, Robert J. Myerburg, Elizabeth G. Nabel, L. Kristin Newby, Patrick T. O’Gara, Jae K. Oh, Jeffrey Olgin, Lionel H. Opie, Catherine M. Otto, Jeffrey J. Popma, Reed E. Pyeritz, B. Soma Raju, José A.F. Ramires, Margaret M. Redfield, Andrew N. Redington, Stuart Rich, Paul M Ridker, Dan M. Roden, Michael Rubart, Marc S. Sabatine, Luis A. Sanchez, Janice B. Schwartz, Christine E. Seidman, J.G. Seidman, Dhun H. Sethna, Jeffrey F. Smallhorn, Virend K. Somers, Andrei C. Sposito, Charles D. Swerdlow, Jean-Claude Tardif, Allen J. Taylor, David J. Tester, Judith Therrien, Paul D. Thompson, Robert W. Thompson, Marc D. Tischler, Peter I. Tsai, Zoltan G. Turi, James E. Udelson, Viola Vaccarino, Ronald G. Victor, Alexandra Villa-Forte, Matthew J. Wall, Carole A. Warnes, Gary D. Webb, John G. Webb, Ralph Weissleder, Jeffrey I. Weitz, Christopher J. White, Stephen D. Wiviott, Clyde W. Yancy, Andreas M. Zeiher, and Douglas P. Zipes more...
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- 2012
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23. Variation in utilization of cardiac procedures in the Department of Veterans Affairs health care system: Effect of race
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Marshall J. Graney, David M. Mirvis, F. Thomas Cloar, Robert Burns, and Larry Gaschen
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,Hospitals, Veterans ,medicine.medical_treatment ,Heart Valve Diseases ,Coronary Disease ,Health Services Accessibility ,White People ,Coronary artery disease ,Health care ,Cardiac procedures ,medicine ,Odds Ratio ,Humans ,Cardiac Surgical Procedures ,Practice Patterns, Physicians' ,Intensive care medicine ,Veterans Affairs ,Socioeconomic status ,Cardiac catheterization ,business.industry ,valvular heart disease ,Racial Groups ,Middle Aged ,medicine.disease ,Patient Discharge ,United States ,Cardiac surgery ,Black or African American ,United States Department of Veterans Affairs ,Emergency medicine ,Utilization Review ,Female ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objectives. Utilization rates for cardiac catheterization and cardiac surgery in the Department of Veterans Affairs (VA) health care system were studied to determine whether racial diierences existed in a delivery plan in which access is not determined by patient finances. Background. Prior studies have demonstrated significant differences in utilization of cardiac diagnostic and therapeutic resources by white and black patients. Reasons for the reduced utilization by black patients include socioeconomic, biologic and sociocultural effects. Methods. Computerized discharge records of 30,300 patients with coronary artery disease and 1,335 patients with valvular heart disease who were discharged from any of 172 VA Medical Centers between October 1, 1990 and September 30, 1991 were studied. Results. For patients with coronary artery disease, utilization rates of cardiac catheterization were significantly greater for white patients (503.4 procedures/1000 patients) than for black patients (433.2/1000 patients), with a relative odds ratio of 1.33, Rates for surgery (179.0 vs. 124.5/1,000 patients) were also greater for whites for blacks, with a relative odds ratio of 1.53. For the subset with valve disease, the catheterization rate was significantly greater for whites than for blacks (575.4 vs. 432.6 procedures/1,000 patients), with a relative odds ratio of 1.78. Surgical rates were not significantly different (423.8 vs. 354.6 operations/ 1,000 patients). Racial differences for both catheterization and surgery varied widely as a function of geographic region and the level of complexity of the local VA facility. Conclusions. Racial differences in resource utilization exist in a health care system in which economic influences are minimized. The pattern of these differences depends on numerous variables and suggests both biologic and sociocultural factors as underlying causes. more...
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- 1994
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24. Accountable care organizations: a real change, maybe
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David M, Mirvis
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Accountable Care Organizations ,Managed Care Programs ,Humans ,Medicare ,United States ,Quality of Health Care - Published
- 2011
25. The Tennessee Public Health Workforce Development Consortium
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Pamela D. Connor, David M. Mirvis, Nathan G. Tipton, and Aleshia Hall-Campbell
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Online learning ,Political science ,ComputingMilieux_COMPUTERSANDEDUCATION ,Public good ,Public administration ,Public health workforce - Abstract
From 2003 to 2009, the Tennessee Public Health Workforce Development Consortium (The Consortium) served as a multi-institutional collaborative effort to develop and implement academic continuing professional education programs for public health professionals in Tennessee. The Consortium included the Tennessee Department of Health (DOH), East Tennessee State University (ETSU), the University of Tennessee at Knoxville (UTK), and the University of Tennessee Health Science Center in Memphis (UTHSC). Utilizing online, distance education techniques and technologies to provide graduate level certificate programs in epidemiology, health system leadership and health care management, as well as a Master of Public Health (MPH) degree to meet the specific needs of DOH’s professional staff, the Consortium successfully implemented an innovative, cross-institutional model for the provision of public health education. The online technology not only facilitated the use of active learning approaches appropriate for older adult learners who are returning to academic work, but also helped students and faculty meet the challenges of learning and teaching across multiple, geographically distant sites. This chapter describes the central role technology played in the project in terms of fostering inter-organizational cooperation and collaboration and providing measurable educational impact. The chapter also illustrates the project’s role in forming community partnerships, as well as explaining the best practices/strategies learned from this project. more...
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- 2011
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26. Governments, public policy and health: more than just money
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David M, Mirvis
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Health Policy ,Health Behavior ,Humans ,Health Promotion ,Health Services Accessibility ,United States ,Nutrition Policy - Published
- 2011
27. Déjà vu all over again: the challenge of hospital readmissions
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David M, Mirvis
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Health Policy ,Humans ,Patient Readmission ,Centers for Medicare and Medicaid Services, U.S ,United States ,Quality of Health Care - Published
- 2011
28. Public reporting quality information: what grade do the report cards get?
- Author
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David M, Mirvis
- Subjects
Benchmarking ,Information Dissemination ,Health Facilities ,Mandatory Reporting ,United States ,Quality of Health Care - Published
- 2010
29. The uncompensated care problem: the Robin Hood model of health care financing
- Author
-
David M, Mirvis
- Subjects
Medically Uninsured ,Medicaid ,Uncompensated Care ,Humans ,Medicare ,Tennessee ,California ,United States - Published
- 2010
30. The three Tennessees: child and infant health in the three Grand Divisions of Tennessee
- Author
-
Lisa M, Mabry and David M, Mirvis
- Subjects
Residence Characteristics ,Infant Mortality ,Infant Welfare ,Infant, Newborn ,Child Welfare ,Health Status Indicators ,Humans ,Infant ,Child ,Tennessee ,Regional Health Planning ,Quality of Health Care - Abstract
Tennessee consistently ranks low among all states in measures of health. This study was undertaken to examine the differences in child and infant health conditions in the state's three Grand Divisions and the impact of these differences on Tennessee's overall rankings. An analysis of county-level data selected from the Area Resources File demonstrated that, for most measures of infant health and child health, the three divisions ranked very differently and that the overall state ranking did not accurately reflect the conditions in the divisions. Some regions, most often Middle Tennessee, ranked much higher than did the state as a whole; other regions, most often West Tennessee, ranked lower. The single overall state ranking masked these regional differences while suggesting that the entire state had equally low health outcomes. The striking health variations among the divisions that were demonstrated highlight the need to examine health conditions and implement health improvement efforts on a regional rather than a statewide basis. more...
- Published
- 2010
31. The electrocardiogram as a prognostic measure
- Author
-
David M. Mirvis
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Measure (physics) ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,General Nursing - Published
- 2000
- Full Text
- View/download PDF
32. Where have all the primary care docs gone?
- Author
-
David M, Mirvis
- Subjects
Humans ,Physicians, Family ,Personnel Selection ,Tennessee - Published
- 2009
33. Geography lessons and health care reform
- Author
-
David M, Mirvis
- Subjects
Health Care Reform ,Humans ,Health Care Costs ,Health Expenditures ,Healthcare Disparities ,Medicare ,Tennessee ,United States - Published
- 2009
34. Health insurance: why are more people uninsured now than in the past? The role of employer sponsored insurance
- Author
-
David M, Mirvis
- Subjects
Health Benefit Plans, Employee ,Medically Uninsured ,Humans ,Tennessee ,United States - Published
- 2009
35. Health care spending: how much is 'too much'? Part II: personal costs and investment
- Author
-
David M, Mirvis
- Subjects
Financing, Personal ,Health Care Rationing ,Humans ,Health Services ,Investments ,Health Services Accessibility ,United States - Published
- 2009
36. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology
- Author
-
E William, Hancock, Barbara J, Deal, David M, Mirvis, Peter, Okin, Paul, Kligfield, Leonard S, Gettes, James J, Bailey, Rory, Childers, Anton, Gorgels, Mark, Josephson, Jan A, Kors, Peter, Macfarlane, Jay W, Mason, Olle, Pahlm, Pentti M, Rautaharju, Borys, Surawicz, Gerard, van Herpen, Galen S, Wagner, and Hein, Wellens more...
- Subjects
Clinical cardiology ,medicine.medical_specialty ,Standardization ,Heart Diseases ,Cardiomegaly ,Sensitivity and Specificity ,Muscle hypertrophy ,Electrocardiography ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Terminology as Topic ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Child ,Electrodes ,medicine.diagnostic_test ,business.industry ,fungi ,Age Factors ,Infant, Newborn ,food and beverages ,Infant ,Heart Rhythm ,Heart Block ,Cardiac chamber ,Child, Preschool ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The detection and assessment of cardiac chamber hypertrophy has long been an important objective of clinical electrocardiography. Its importance has increased in recent years with the recognition that hypertrophy can be reversed with therapy, and that by doing so, adverse clinical outcomes can be more...
- Published
- 2009
37. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology
- Author
-
Galen S, Wagner, Peter, Macfarlane, Hein, Wellens, Mark, Josephson, Anton, Gorgels, David M, Mirvis, Olle, Pahlm, Borys, Surawicz, Paul, Kligfield, Rory, Childers, Leonard S, Gettes, James J, Bailey, Barbara J, Deal, E William, Hancock, Jan A, Kors, Jay W, Mason, Peter, Okin, Pentti M, Rautaharju, and Gerard, van Herpen more...
- Subjects
Clinical cardiology ,Adult ,Male ,medicine.medical_specialty ,Standardization ,Myocardial Infarction ,Myocardial Ischemia ,Infarction ,Acute ischemia ,Electrocardiography ,Heart Conduction System ,Physiology (medical) ,Internal medicine ,Terminology as Topic ,Image Processing, Computer-Assisted ,Medicine ,Humans ,Child ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Heart Rhythm ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business - Published
- 2009
38. Health care spending: how much is 'too much'? High cost vs. low value
- Author
-
David M, Mirvis
- Subjects
Health Policy ,Humans ,Health Care Costs ,Health Expenditures ,Delivery of Health Care ,United States - Published
- 2009
39. A placebo-controlled trial of continuous intravenous diltiazem infusion for 24-hour heart rate control during atrial fibrillation and atrial flutter: A multicenter study
- Author
-
Kenneth A. Ellenbogen, David M. Mirvis, Vance J. Plumb, Virgil C. Dias, and J. Thomas Heywood
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Digoxin ,Placebo-controlled study ,Placebo ,Diltiazem ,Bolus (medicine) ,Double-Blind Method ,Heart Rate ,Internal medicine ,Heart rate ,Atrial Fibrillation ,medicine ,Humans ,Infusions, Intravenous ,Aged ,business.industry ,Atrial fibrillation ,medicine.disease ,Atrial Flutter ,Anesthesia ,Cardiology ,cardiovascular system ,Female ,business ,Cardiology and Cardiovascular Medicine ,Atrial flutter ,medicine.drug - Abstract
The safety and efficacy of a 10- to 15-mg/h continuous infusion of intravenous diltiazem were evaluated in 47 patients with atrial fibrillation or flutter who first responded to 20 mg or 20 mg followed by one or more 25-mg bolus doses of open label intravenous diltiazem. Of the 47 patients, 44 responded to the bolus injection and were randomized under double-blind conditions to receive either a continuous infusion of intravenous diltiazem (10 to 15 mg/h) (23 patients) or placebo (21 patients) for up to 24 h.Seventeen (74%) of the 23 patients receiving diltiazem infusion and none of the 21 with placebo infusion maintained a therapeutic response for 24 h (p < 0.001). Over 24 h, patients receiving diltiazem infusion lost response significantly more slowly than did those receiving placebo infusion (p < 0.001). Nonresponders to the double-blind infusion were given an additional bolus injection of open label intravenous diltiazem and administered an open label 24-h intravenous diltiazem infusion. The overall proportion of patients maintaining a response to a 24-h infusion of intravenous diltiazem under double-blind or open label conditions combined was 83% (34 of 41).Efficacy of the 24-h infusion of intravenous diltiazem was similar in elderly versus young patients, those who did versus those who did not receive digoxin and those weighing more...
- Published
- 1991
- Full Text
- View/download PDF
40. Effects of myocardial infarction on cardiac electrical field properties using a numerical expansion technique
- Author
-
David M. Mirvis, F.J. Claydon, and Leslie A. Ingram
- Subjects
Male ,medicine.medical_specialty ,Myocardial Infarction ,Infarction ,Electrocardiography ,QRS complex ,Dogs ,Internal medicine ,medicine ,Animals ,Sinus rhythm ,cardiovascular diseases ,Myocardial infarction ,Circumflex ,Lead (electronics) ,medicine.diagnostic_test ,business.industry ,Models, Cardiovascular ,medicine.disease ,Electrophysiology ,medicine.anatomical_structure ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
This study was undertaken to quantify basic cardiac electrical field properties using the Karhounen-Loeve (K-L) numerical expansion technique after experimental myocardial infarction. Transmural anterior myocardial infarction was produced in seven dogs by injection of liquid latex into the anterior descending artery; posterior myocardial infarction was produced in five dogs by injection of the circumflex artery. Body surface potentials from 84 electrodes were recorded during sinus rhythm prior to and 1 week after infarction. Electrical field properties during the QRS, ST, and QRST intervals were computed by the K-L method based upon areas calculated for each lead. The ratio of the sum of magnitude of the first three eigenvectors to the sum of all computed eigenvectors expressed as a percentage was used as a measure analogous to field dipolarity. Values before infarction were high during the QRS (97.1% +/- 2.0%, mean +/- 1SD), ST (96.0% +/- 5.1%), and QRST (97.7% +/- 2.7%) intervals, with no significant difference between the three periods. After infarction, the ratio during QRS decreased significantly, with lower values after posterior (61.9% +/- 11.7%) than after anterior (91.1% +/- 6.0%) infarction (p less than 0.001). Values during ST and QRST intervals were not significantly changed by infarction. Spatial patterns of the first eigenvector indicated that the derived QRS area electric field is directed away from the myocardial lesion for both anterior and posterior infarcts. Thus, experimental myocardial infarction produces significant changes in cardiac electrical field properties as measured by the K-L technique. more...
- Published
- 1991
- Full Text
- View/download PDF
41. Interactive effects of ST-T wave abnormalities on survival of patients with coronary artery disease
- Author
-
Kodangudi B. Ramanathan, Faten El-Zeky, James Crenshaw, Roger Vander Zwaag, V. Maddock, Jay M. Sullivan, David M. Mirvis, and Frank H. Kroetz
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hemodynamics ,Cardiomegaly ,Coronary Disease ,Coronary artery disease ,Electrocardiography ,Risk Factors ,Internal medicine ,T wave ,medicine ,Humans ,Myocardial infarction ,Cardiac catheterization ,Ejection fraction ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Databases, Bibliographic ,Survival Analysis ,Survival Rate ,medicine.anatomical_structure ,Cardiology ,Regression Analysis ,Female ,Abnormality ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Previous studies have documented a reduced survival time in patients with an electrocardiographic (ECG) ST-T wave abnormality. This study was designed to determine the clinical, hemodynamic and angiographic correlates of this observation. Data from 9,731 patients undergoing cardiac catheterization from 1976 through 1986 were analyzed; 5,531 had severe (greater than 70%) obstruction of at least one major coronary artery, 1,706 had mild (10 to 69%) obstruction and 2,494 had no obstruction. Of the patients with severe obstruction, 2,536 were treated medically and 2,995 were treated by surgical revascularization. Patients with an ST-T abnormality had more clinical risk factors (including older age and greater prevalence of diabetes mellitus, hypertension and prior myocardial infarction) and greater left ventricular dysfunction (including higher end-diastolic pressure and ventricular volume, reduced ejection fraction and greater prevalence of contraction abnormality) than did those without this ECG pattern. Survival time was significantly (p less than 0.01) reduced in subsets of patients with an ST-T abnormality and with severe or mild coronary artery disease; in those without coronary disease, ST-T changes did not correlate with reduced survival. Stepwise regression analysis was applied to each group to determine the independent predictors of 5-year survival. In patients with severe disease or no disease, an ST-T abnormality was not chosen as an independent predictor of 5-year survival; in the group with mild disease, ST-T changes were an independent predictor of reduced survival. Thus, the independent impact of an ST-T abnormality on survival is dependent on the severity of underlying coronary artery disease. more...
- Published
- 1991
- Full Text
- View/download PDF
42. Health and economic development: introduction to the symposium
- Author
-
Joy A, Clay and David M, Mirvis
- Subjects
Mississippi ,Health Status ,Poverty Areas ,Congresses as Topic ,Models, Theoretical - Abstract
This symposium explores the role of health as an 'economic engine' in the lower Mississippi River Delta region of the United States. The health as an economic engine model proposes that health is an important and perhaps critical determinant of economic growth and development. This model is the reverse of the more commonly considered paradigm in which economic conditions are major determinants of health status. This reframing of the conventional pathway draws upon an existing and extensive internationally-based body of knowledge, predominantly from research done in Africa and Asia. We suggest, in this symposium, that the health as an economic engine model can also be applied within the United States, particularly in regions that are economically underdeveloped and have poor health. This reframing has significant implications for population health policy as public health advancement can be legitimately argued to be an investment rather than just an expense. Viewing health as an economic engine supports a call to community-based participatory action on the part of policy makers, researchers, and educators to further both public and private investment in health, particularly for children and the poor. more...
- Published
- 2008
43. Health as an economic engine: evidence for the importance of health in economic development
- Author
-
David M, Mirvis, Cyril F, Chang, and Arthur, Cosby
- Subjects
Evidence-Based Medicine ,Economics ,Health Status ,Poverty Areas ,Humans ,Healthcare Disparities - Abstract
Most discussions on the relationships between health and economic conditions have focused on the impact of differences in personal finances or national economic conditions on health. Recently, however, the role of health as an 'economic engine' has been promoted. This paradigm proposes that better health leads to economic development. Evidence from historical, national, and transnational studies have shown that improved health increases economic growth through impacts on micro- and macro-economic factors. In this review, we will summarize the evidence supporting these concepts as a basis for discussing their implications for underdeveloped regions within the United States. more...
- Published
- 2008
44. Health and economic development: reframing the pathway
- Author
-
David M, Mirvis and Joy A, Clay
- Subjects
Economics ,Poverty Areas ,Humans ,Public Policy ,Health Promotion ,Health Status Disparities ,Models, Theoretical ,Southeastern United States ,Midwestern United States - Abstract
The papers included in this symposium provide a compelling rationale for the role of health as an engine of economic growth, and thus for investing in health improvement as an important step in improving economic growth in the Mississippi Delta. This newer model of the relation between health and wealth, positioning health as an investment and as an important determinant of economic growth, has substantial implications for health-related public policy and for the business sector. Societal support of health promoting initiatives through public policy, especially for children and for the poor, are important efforts for improving health and for realizing the economic benefits of health improvement. more...
- Published
- 2008
45. The effects of race and insurance on potentially avoidable hospitalizations in Tennessee
- Author
-
Cyril F. Chang, David M. Mirvis, and Teresa M. Waters
- Subjects
Adult ,Insurance, Health ,Discharge data ,Adolescent ,business.industry ,Health Policy ,Racial Groups ,Insurance type ,Middle Aged ,Tennessee ,Insurance Coverage ,Hospitalization ,Race (biology) ,Relative risk ,Environmental health ,Insurance status ,Health care ,Ambulatory Care ,Medicine ,Humans ,Racial differences ,business ,Insurance coverage ,Aged - Abstract
This study examined effects of race and insurance on the risk of potentially avoidable hospitalizations (PAHs) in Tennessee. Applying the current Agency for Healthcare Research and Quality definitions for ambulatory-care-sensitive conditions to inpatient discharge data, the study found hospitalized Black patients more likely than their White counterparts to have experienced a PAH for chronic conditions. In contrast, Black inpatients' risk was lower than that of White inpatients for acute conditions after controlling for covariates. The results also showed the strong influence of insurance coverage. Finally, an analysis of racial differences in the relative risks for PAHs using data grouped by insurance status showed that hospitalized Blacks within each subset had a greater risk of having a PAH than hospitalized Whites, although the risk varied with insurance type. The variations of PAH risks across racial and insurance categories, together with the extra risks associated with chronic conditions, deserve greater examination. more...
- Published
- 2008
46. Health care utilization data in Tennessee: inpatient discharges, 2005
- Author
-
Cyril F, Chang and David M, Mirvis
- Subjects
Male ,Cerebrovascular Disorders ,Heart Diseases ,Humans ,Female ,Pneumonia ,Tennessee ,Patient Discharge - Abstract
Data on the utilization of healthcare services are useful for assessing the health status of the general population and the delivery of hospital services in a state that is facing major health and healthcare challenges. They can assist health planning and health system reform efforts by allowing comparisons to other states and to national averages, by identifying patient groups with unusually high utilization rates, by tracking trends in utilization over time, and by demonstrating the effects of various healthcare reforms. This report summarizes hospital inpatient discharge data for patients treated in Tennessee's non-federal, short-stay hospitals in 2005. The analysis focuses on the hospital utilization patterns of leading acute and chronic conditions for racial and gender groups. more...
- Published
- 2008
47. Evaluating heart disease presciptions-filled as a proxy for heart disease prevalence rates
- Author
-
Ronald E, Cossman, Jeralynn S, Cossman, Wesley L, James, Troy, Blanchard, Richard K, Thomas, Louis G, Pol, Arthur G, Cosby, and David M, Mirvis
- Subjects
Behavioral Risk Factor Surveillance System ,Heart Diseases ,Population Surveillance ,Humans ,Drug Prescriptions ,United States - Abstract
Heart disease is the leading cause of death in the U.S. Yet, prevalence rates are not reported at the county level. Not knowing how many have the disease, and where they are, may be a knowledge barrier to effective health care interventions. We use heart disease drug prescriptions-filled as a proxy measure for prevalence of heart disease. We test the correlation to the Behavioral Risk Factor Surveillance System (BRFSS) and find positive, statistically significant correlations. Next we illustrate the geographic patterns revealed using the county-level prevalence estimate maps. This information can be used to provide a better understanding of sub-state variations in disease patterns and subsequently target the delivery of health resources to small areas in need. more...
- Published
- 2008
48. Chronic Therapy for Congestive Heart Failure with Benazepril HCl, a New Angiotensin Converting Enzyme Inhibitor
- Author
-
Jamal K. Ghali, Jeffrey G. Shanes, Michael P. Cinquegrani, Jacqueline DeSilva, Jerald Insel, David M. Mirvis, Michael J. Boland, Stanley A. Rubin, and John J. Whalen
- Subjects
Male ,Heart disease ,Peripheral edema ,Benazepril ,Angiotensin-Converting Enzyme Inhibitors ,Renin ,Humans ,Medicine ,Pulmonary wedge pressure ,Aged ,Heart Failure ,biology ,business.industry ,Hemodynamics ,Angiotensin-converting enzyme ,General Medicine ,Benzazepines ,Middle Aged ,medicine.disease ,Blood pressure ,Heart failure ,Anesthesia ,biology.protein ,Female ,medicine.symptom ,business ,medicine.drug ,Paroxysmal Nocturnal Dyspnea - Abstract
Benazepril HCl is an orally effective angiotensin converting enzyme (ACE) inhibitor previously shown to have significant acute hemodynamic benefits in patients with congestive heart failure. In this study, 21 patients with New York Heart Association Class III or IV congestive heart failure were treated with 2 to 15 mg of benazepril HCl as a single daily oral dose for 28 days to determine the clinical and hemodynamic value of chronic therapy. Each patient underwent clinical evaluation during the 28-day period, as well as invasive hemodynamic studies on the first two and last two days of the trial. Plasma ACE activity and aldosterone levels fell significantly and renin levels rose after therapy. Benazepril HCl produced significant (p less than 0.01) reductions in arterial pressure and systemic vascular resistance, with corresponding increases in cardiac output and decreases in pulmonary artery wedge pressure. Responses after 28 days of therapy were equivalent to those after the initial doses. Clinical effects included reduced rest, exertional and paroxysmal nocturnal dyspnea, as well as reduced peripheral edema. Only one patient developed symptomatic orthostatic hypotension. Thus, benazepril HCl, given once daily, is an effective and well tolerated oral agent for the chronic treatment of advanced congestive heart failure. more...
- Published
- 1990
- Full Text
- View/download PDF
49. Recommendations for the standardization and interpretation of the electrocardiogram: part II: electrocardiography diagnostic statement list a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology
- Author
-
Jay W, Mason, E William, Hancock, Leonard S, Gettes, James J, Bailey, Rory, Childers, Barbara J, Deal, Mark, Josephson, Paul, Kligfield, Jan A, Kors, Peter, Macfarlane, Olle, Pahlm, David M, Mirvis, Peter, Okin, Pentti, Rautaharju, Borys, Surawicz, Gerard, van Herpen, Galen S, Wagner, and Hein, Wellens more...
- Subjects
Electrocardiography ,International Cooperation ,Humans ,Arrhythmias, Cardiac ,Signal Processing, Computer-Assisted ,Sensitivity and Specificity ,United States - Abstract
This statement provides a concise list of diagnostic terms for ECG interpretation that can be shared by students, teachers, and readers of electrocardiography. This effort was motivated by the existence of multiple automated diagnostic code sets containing imprecise and overlapping terms. An intended outcome of this statement list is greater uniformity of ECG diagnosis and a resultant improvement in patient care. The lexicon includes primary diagnostic statements, secondary diagnostic statements, modifiers, and statements for the comparison of ECGs. This diagnostic lexicon should be reviewed and updated periodically. more...
- Published
- 2007
50. Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology
- Author
-
Paul, Kligfield, Leonard S, Gettes, James J, Bailey, Rory, Childers, Barbara J, Deal, E William, Hancock, Gerard, van Herpen, Jan A, Kors, Peter, Macfarlane, David M, Mirvis, Olle, Pahlm, Pentti, Rautaharju, Galen S, Wagner, Mark, Josephson, Jay W, Mason, Peter, Okin, Borys, Surawicz, and Hein, Wellens more...
- Subjects
Standardization ,diagnosis ,International Cooperation ,computer.software_genre ,Lexicon ,Sensitivity and Specificity ,Electrocardiography ,Physiology (medical) ,intervals ,computers ,Medicine ,Humans ,In patient ,Statement (computer science) ,Interpretation (logic) ,business.industry ,Arrhythmias, Cardiac ,Signal Processing, Computer-Assisted ,electrophysiology ,United States ,AHA Scientific Statements ,potentials ,tests ,Artificial intelligence ,Diagnosis code ,Cardiology and Cardiovascular Medicine ,business ,computer ,Natural language processing ,Forecasting - Abstract
This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Throughout the statement, recommendations for ECG standards are placed in context of the clinical implications of evolving ECG technology. more...
- Published
- 2007
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