BACKGROUND & AIMS: :Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

背景与目标： : 将小型独立实践转变为以患者为中心的医疗之家被广泛认为是改革美国医疗体系的关键一步。我们的团队在改善初级保健实践方面进行了超过15年的研究。我们发现了小型初级保健实践的四个特征，这些特征严重抑制了他们向这种新护理模式转变的能力。我们发现，小型实践以医师为中心，缺乏医师之间的有意义的沟通，以专制领导行为为主导，并且被那些被赋予缺乏想象力的角色的中层临床医生服务不足。我们的分析表明，除了支付改革之外，还需要改变初级保健医生的思维方式。除非初级保健医生能够采用新的心理模式，并以新的方式思考自己和他们的做法，否则他们和他们的做法将很难创建创新的护理团队，成为学习型组织，并在医疗保健社区内充当好公民。

BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： : 医疗保健的改善缓慢，部分原因是医生和护士缺乏质量改进，患者安全和专业团队合作方面的技能。本文报道了Josiah Macy Jr的质量和安全重组计划。基金会和医疗保健改善研究所，试图将改善和患者安全纳入医疗和护理学校课程。在2009-10的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动 (其中87% 是跨专业的，涉及医学和护理学生)，涉及六所大学的1,374学生相遇。这项工作产生了见解-在本文中描述-学习目标需要跨专业教育; 如何为所有学生创建基于临床的改进学习; 以及如何证明对学生行为，组织实践和对患者的利益的影响。该计划通常遇到的限制因素是缺乏足够数量的临床教职员工，他们准备教授有关改善护理的知识。更重要的是，缺乏针对此类计划的强大评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: :Venous thromboembolism (VTE) is a potentially serious complication occurring in 1%-2% of hospitalized medical patients. Despite this low absolute risk, as many as 82% of medical patients are considered to be at increased risk of developing VTE and are eligible for medical thromboprophylaxis. In this commentary, The author will discuss the main findings of a recent paper published in Clinical Epidemiology that questions the large proportion of individuals who are eligible for medical thromboprophylaxis, and also discuss the potential implications for the prevention of VTE. The recent paper demonstrated that when a population is divided into high- and low-risk groups, the maximum absolute risk depends on the inverse of the proportion of patients that is considered to be high risk. Consequently, even an effective treatment will only result in a small reduction in the absolute risk when the high-risk group comprises the largest proportion of this population. For medical thromboprophylaxis, this implies that even patients considered to be at high-risk for developing VTE have a maximum absolute VTE risk of 2% when the overall risk is 1.6%. Therefore, even an effective preventive initiative will only result in a small risk reduction. This small potential benefit should be weighed against potential harms associated with prophylaxis, mainly bleeding events. Still, there may be a reasonable overall balance between prevention of pulmonary embolism and major bleeding, mainly because major bleeding events are rare. Nonetheless, this discussion underscores that future risk prediction models should aim to predict the benefits and harms in individual patients in order to provide optimal care for the right patients.

背景与目标： : 静脉血栓栓塞 (VTE) 是一种潜在的严重并发症，发生在住院患者的1% 2% 中。尽管绝对风险较低，但仍有多达82% 的医疗患者被认为患有VTE的风险增加，并且有资格进行医疗血栓预防。在这篇评论中，作者将讨论最近发表在《临床流行病学》上的一篇论文的主要发现，该论文质疑了有资格进行医疗血栓预防的大部分个体，并讨论了预防VTE的潜在影响。最近的论文表明，当人群分为高风险组和低风险组时，最大绝对风险取决于被认为是高风险的患者比例的倒数。因此，当高危人群占该人群的最大比例时，即使是有效的治疗也只能导致绝对风险的小幅降低。对于医疗血栓预防，这意味着即使被认为处于发生VTE的高风险的患者，当总体风险1.6% 时，也具有2% 的最大绝对VTE风险。因此，即使是有效的预防举措，也只会导致很小的风险降低。应权衡这种小的潜在益处与预防相关的潜在危害，主要是出血事件。尽管如此，预防肺栓塞和大出血之间可能存在合理的总体平衡，主要是因为大出血事件很少。尽管如此，该讨论强调了未来的风险预测模型应旨在预测单个患者的收益和危害，以便为合适的患者提供最佳护理。

BACKGROUND & AIMS: :Diagnostic accuracy for radiologists is above that expected by chance when they are exposed to a chest radiograph for only one-fifth of a second, a period too brief for more than a single voluntary eye movement. How do radiologists glean information from a first glance at an image? It is thought that this expert impression of the gestalt of an image is related to the everyday, immediate visual understanding of the gist of a scene. Several high-speed mechanisms guide our search of complex images. Guidance by basic features (such as color) requires no learning, whereas guidance by complex scene properties is learned. It is probable that both hardwired guidance by basic features and learned guidance by scene structure become part of radiologists' expertise. Search in scenes may be best explained by a two-pathway model: Object recognition is performed via a selective pathway in which candidate targets must be individually selected for recognition. A second, nonselective pathway extracts information from global or statistical information without selecting specific objects. An appreciation of the role of nonselective processing may be particularly useful for understanding what separates novice from expert radiologists and could help establish new methods of physician training based on medical image perception.

背景与目标： : 放射科医生的诊断准确性高于偶然的预期，当他们仅暴露于胸片5分之1秒时，这一时期太短暂，无法进行一次自愿的眼球运动。放射科医生如何从图像的第一眼就收集信息？人们认为，对图像完形的这种专家印象与对场景要点的日常，即时视觉理解有关。几种高速机制指导我们搜索复杂的图像。基本特征 (例如颜色) 的指导不需要学习，而复杂场景属性的指导是学习的。基本特征的硬连线指导和场景结构的学习指导都可能成为放射科医生专业知识的一部分。场景中的搜索可以通过两途径模型来最好地解释: 对象识别是通过选择性途径执行的，在该途径中，必须单独选择候选目标进行识别。第二种非选择性途径从全局或统计信息中提取信息，而无需选择特定对象。了解非选择性处理的作用对于了解新手与专业放射科医生之间的区别可能特别有用，并且可以帮助建立基于医学图像感知的医师培训新方法。

BACKGROUND & AIMS: :Epilepsy affects a larger number of individuals than previously thought-up to 2% of the population-and its effects reach further. Yet epilepsy, with its associated lingering stigma and fear, has remained in the background in terms of services and research. Traditional quantitative research often falls short when trying to describe the impact of epilepsy on the lives of individuals and their families. In the present study, focus groups were held throughout South Carolina to discuss individuals' experiences with accessing epilepsy-related services and health care, and what life with epilepsy is like. Following qualitative data analysis, findings included two themes. One theme focuses on the ongoing search for services and help. The second theme concerns the experiences of living life with epilepsy. Also highlighted are recommendations for potential improvements in public awareness and professional training, and helpful interventions.

背景与目标： : 癫痫影响的个体数量比以前想象的要多-达到2% 的人口-其影响进一步扩大。然而，癫痫，伴随着挥之不去的耻辱和恐惧，在服务和研究方面仍然是背景。在试图描述癫痫对个人及其家庭生活的影响时，传统的定量研究往往不足。在本研究中，在南卡罗来纳州举行了焦点小组讨论个人获得与癫痫相关的服务和医疗保健的经验，以及癫痫的生活是什么样的。在定性数据分析之后，调查结果包括两个主题。一个主题侧重于正在进行的服务和帮助搜索。第二个主题涉及癫痫生活的经历。还强调了有关提高公众意识和专业培训以及有益干预措施的建议。

BACKGROUND & AIMS: :Egyptian medical papyri date the Santorini eruption, and reconcile the hitherto perceived dichotomy between archaeological/historical and scientific data. The medical documentation describes ailments, which can only have arisen from a volcanic source: ash fallout, rain acidified by ash, and a plume. Furthermore, the Egypt described by the medical texts matches the one in the series of so-called biblical plagues. This match in turn provides the length of time, 19 months, between the initial and final phases of the eruption, each phase contributing to the otherwise odd accumulation of sulfates spread over two consecutive biennia (1603-1600 BC) in Greenland's ice core. As a result, the initial phase of the eruption can be dated to August 21, 1603 BC, and the final one to March 1601 BC, in full agreement with the radiocarbon data (1627-1600 BC) based on the outermost ring on the branch of an olive tree killed by the eruption.

背景与目标： : 埃及医学纸莎草纸可以追溯圣托里尼喷发，并调和迄今认为的考古/历史和科学数据之间的二分法。医学文件描述了只能由火山来源引起的疾病: 灰烬沉降物，被灰烬酸化的雨水和羽流。此外，医学文献所描述的埃及与所谓的圣经瘟疫系列中的埃及相匹配。此匹配又提供了喷发的初始阶段和最终阶段之间的19个月的时间长度，每个阶段都导致了格陵兰岛冰核中连续两个两年期 (公元前1603-1600年) 散布的硫酸盐的奇数积累。结果，喷发的初始阶段可以追溯到公元前1603年8月21日，最后一个可以追溯到公元前1601年3月，这与放射性碳数据 (公元前1627-1600年) 完全一致。橄榄树被喷发杀死。

BACKGROUND & AIMS: We report the response to risperidone in seven hospitalized, adult patients who presented psychotic symptoms etiologically related to a general medical condition. The conditions included brain surgery in two, and anticardiolipin syndrome, renal failure, epilepsy, lupus, and metastatic carcinoma in one each. Four patients had failed previous treatment with at least one typical antipsychotic agent. Response to risperidone was assessed by the Brief Psychiatric Rating Scale (BPRS). Serum was collected for measurement of steady-state trough risperidone and 9-hydroxyrisperidone concentrations at effective doses in three patients. Amelioration of psychotic symptoms was noted in all seven patients. Mean (+/- SD) BPRS scores were reduced significantly from baseline (63.0 +/- 15.1) to endpoint (27.0 +/- 3.5; p < 0.01). The mean effective daily dose of risperidone was 3.1 +/- .7 mg and time to response was 4.7 +/- 2.4 days. Risperidone was not present at detectable concentrations in the three patients studied. The mean steady-state trough serum concentration of 9-hydroxyrisperidone in the three patients assessed was 20.3 +/- 9.8 ng/ml. These preliminary findings, which suggest that risperidone is a safe and effective agent in patients with psychotic symptoms due to various medical conditions, need to be confirmed by randomized, antipsychotic comparison trials involving a larger number of patients.

背景与目标： 我们报告了7名住院成年患者对利培酮的反应，这些患者表现出与一般医疗状况相关的精神病症状。疾病包括两种脑部手术，以及抗心磷脂综合征，肾衰竭，癫痫，狼疮和转移性癌各一种。四名患者先前使用至少一种典型的抗精神病药治疗失败。通过简明精神病评定量表 (BPRS) 评估对利培酮的反应。在三名患者中以有效剂量收集血清以测量稳态谷利培酮和9-羟基利培酮浓度。所有7例患者的精神病症状均得到改善。平均 (+/- SD) BPRS评分从基线 (63.0 +/- 15.1) 到终点 (27.0 +/- 3.5; p < 0.01) 显著降低。利培酮的平均有效日剂量为3.1 +/- .7 mg，反应时间为4.7 +/- 2.4天。在研究的三名患者中，利培酮不存在可检测的浓度。在评估的三名患者中，9-羟基利培酮的平均稳态谷血清浓度为20.3/- 9.8 ng/ml。这些初步发现表明，利培酮是一种安全有效的药物，用于由于各种医疗条件引起的精神病症状的患者，需要通过涉及更多患者的随机抗精神病比较试验来证实。

BACKGROUND & AIMS: :"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.

背景与目标： : “急救人员” 是接受过高级急救培训的人员，他们可以与救护车服务同时做出反应，并且通常比救护车服务更快地应对可疑的医疗紧急情况。Hatzolah是一个基于halakhic (犹太法律) 原则的志愿第一响应者小组，位于墨尔本大都市的局部地区，以色列以外的大屠杀幸存者密度最高。来自该社区的维多利亚州大都会救护车服务 (MAS) 的 “呼叫” 数量很少，这表明许多人不愿与 “穿制服的” 外部机构联系。Hatzolah是一个自治组织，根据适应的MAS临床实践指南和临床治理流程运作。Hatzolah响应者接受为期18个月的MAS培训课程，包括急救，心肺复苏，半自动除颤器的使用和氧气治疗。我们描述了Hatzolah服务的前11年 (1995-2005年)。每年就诊的患者数量稳步上升，达到867 2005年的峰值。最常见的呼叫原因是跌倒 (19.4%)，胸痛 (9.7%) 或呼吸窘迫 (7.6%)。对于所有病例，Hatzolah的中位反应时间为2或3分钟。他们参加了35例心脏骤停患者 (中位反应时间为2分钟)，并在MAS之前到达29个呼叫 (83%)。19例 (54% 例) 心脏骤停患者被复苏并活着从现场转移。在运输的那些中，明显更多的具有可电击的心律 (50% v 13%，P = 0.03)。五 (14%) 幸存下来出院。Hatzolah已发展成为一个为MAS提供补充服务的组织。它是建立其他大都会社区急救小组的典范。

BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:A growing body of literature shows that many universities and colleges are making educational portfolios part of their faculty assessment and student's learning plan for both undergraduate and graduate programs. We provide an outline for the development of a medical educator's portfolio, including an electronic version. DESCRIPTION:Guidelines for the development of an educational portfolio focusing on medical education are provided, including design, format, and content. An electronic version of the portfolio, which combines flexibility and ease of revision, is also described, including formats for publication and distribution. Student reflections on the e-portfolio are presented, and potential applications of the e-portfolio in medical education are described. CONCLUSION:We believe that portfolio development is a valuable application that provides rich documentation of participants' educational history, accomplishments, and intellectual property as related to their professional learning and growth.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVES:To examine the long-term relationships between costs, utilization, and patient-centered medical home (PCMH) clinical practice systems. STUDY DESIGN:Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared. METHODS:Multivariate regressions adjusting for patient demographics, health status, and autoregressive errors compared PPC-RS scores and study outcomes for the entire cohort and 3 subcohorts defined by medical complexity (medication count 0-2 [n = 29,657], 2-6 [n = 19,505], >7 [n = 9229]). Outcomes (adjusted to 2005 dollars) were total costs, outpatient costs, inpatient costs, inpatient days, and emergency department (ED) use. RESULTS:For the entire cohort, a 10% increase in PPC-RS scores was associated with 3.9 (medication count: 0-2), 6 (3-6), and 11.6 (>7) fewer ED visits per 1000 in 2005; and 5.1, 7.6, and 13.6 fewer ED visits in 2009. That 10% increase was not associated with the 0-2 medication subcohort's total (-$22/person in 2005; $184/person in 2009), outpatient (-$11/person in 2005; $42/person in 2009), or inpatient ($26/person in 2005; $29/person in 2009) costs. However, it was associated with significantly decreased total (-$446/person in 2005; -$184/person in 2009) and outpatient (-$241/person in 2005; -$54/person in 2009) costs for the most medically complex subcohort (>7 medications). CONCLUSIONS:Association of PCMH clinical practice systems with reduced costs appears limited to the most medically complex patients.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women. METHODS:This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors. RESULTS:We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum. CONCLUSIONS:We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

背景与目标：

BACKGROUND & AIMS: :Human choline dehydrogenase (CHD) is located in the inner membrane of mitochondria primarily in liver and kidney and catalyzes the oxidation of choline to glycine betaine. Its physiological role is to regulate the concentrations of choline and glycine betaine in the blood and cells. Choline is important for regulation of gene expression, the biosynthesis of lipoproteins and membrane phospholipids and for the biosynthesis of the neurotransmitter acetylcholine; glycine betaine plays important roles as a primary intracellular osmoprotectant and as methyl donor for the biosynthesis of methionine from homocysteine, a required step for the synthesis of the ubiquitous methyl donor S-adenosyl methionine. Recently, CHD has generated considerable medical attention due to its association with various human pathologies, including male infertility, homocysteinuria, breast cancer and metabolic syndrome. Despite the renewed interest, the biochemical characterization of the enzyme has lagged behind due to difficulties in the obtainment of purified, active and stable enzyme. This review article summarizes the medical relevance and the physiological roles of human CHD, highlights the biochemical knowledge on the enzyme, and provides an analysis based on the comparison of the protein sequence with that of bacterial choline oxidase, for which structural and biochemical information is available.

背景与目标： : 人胆碱脱氢酶 (CHD) 位于线粒体的内膜中，主要位于肝脏和肾脏中，并催化胆碱氧化为甘氨酸甜菜碱。它的生理作用是调节血液和细胞中胆碱和甘氨酸甜菜碱的浓度。胆碱对于调节基因表达，脂蛋白和膜磷脂的生物合成以及神经递质乙酰胆碱的生物合成很重要; 甘氨酸甜菜碱作为主要的细胞内渗透保护剂和甲基供体，从高半胱氨酸生物合成蛋氨酸，合成无处不在的甲基供体S-腺苷甲硫氨酸所需的步骤。最近，由于CHD与各种人类疾病有关，包括男性不育，同型半胱氨酸尿症，乳腺癌和代谢综合征，引起了广泛的医学关注。尽管重新引起了人们的兴趣，但由于难以获得纯化，活性和稳定的酶，该酶的生化特性仍然落后。本文综述了人类CHD的医学相关性和生理作用，重点介绍了该酶的生化知识，并根据蛋白质序列与细菌胆碱氧化酶的序列进行了比较，提供了结构和生化信息。

BACKGROUND & AIMS: OBJECTIVE:To describe the timing of cardiac arrest detection in relation to episodes of Medical Emergency Team (MET) review and routine nursing observations. DESIGN AND SETTING:Retrospective observational study in a university-affiliated hospital. PATIENTS:279 cardiac arrests involving ward patients MEASUREMENTS AND RESULTS:Cardiac arrests were allocated to one of 24 1-h intervals (24:00-00:59, 01:00-01:59, etc.). The actual hourly rate of cardiac arrests was related to the expected average hourly rate. Peak levels of cardiac arrest detection occurred during times of routine overnight nursing clinical observations between 02:00 and 03:00 (OR 3.06) and 06:00-07:00 (OR 1.95). The lowest level of cardiac arrest detection occurred between 20:00 and 21:00 (OR 0.42). After introduction of the MET there were 162 cardiac arrests, 28% of which occurred shortly after an initial MET call. The odds ratio for risk of cardiac arrest during periods of lowest MET activation (24:00-08:00) when compared with periods of highest MET activation (16:00-24:00) was 2.26. CONCLUSIONS:Cardiac arrest detection in our hospital is episodic with peak levels corresponding to periods of overnight routine nursing observations following a period when patient review is likely to be low. After the introduction of the MET there was an inverse link between detection of cardiac arrests and levels of MET activation over the 24-h period. Increased overnight utilization and earlier MET activation may further reduce the incidence of cardiac arrests at our hospital.

背景与目标：