Publications (31) View all
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Article: ED to catheterization laboratory: a roundtable integrating trials with practice.
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ABSTRACT: Clinical trials are the foundation underlying clinical decision-making. However, stringent inclusion and exclusion criteria may reduce the generalizability of their results, especially for patients seen in the emergency department (ED). Guideline recommendations, based on clinical trials and pertinent registries, apply to broad populations, but not all patients cared for at the bedside fit the predefined categories that make guidelines practical. Furthermore, these documents may not incorporate the latest evidence. As a result, other factors (eg, individual patient characteristics, clinician experience, cost, regulatory labels, expert opinions) often result in clinical decision-making that varies from strict adherence to guideline recommendations. These challenges demonstrate a need to integrate clinical data and guidelines advice with actual ED practice in a manner that will be consistent with decisions made later in the continuum of care. In recognition of these issues, a roundtable was convened in New York City on June 5, 2009, to discuss the implications of recent trials involving patients with non-ST-segment elevation acute coronary syndromes. Eight physicians, representing both emergency medicine and cardiology, shared information on advances and clinical trial results in antiplatelet treatment, guidelines, and other developments in patient care. This article is based on transcripts of their presentations and the ensuing discussions that were of particular importance for emergency physicians. Although guidelines and clinical registries can provide broad direction for practice, there is no substitute for a prospective, multidisciplinary, institution-specific, consistent, evidence-based approach to patient management.The American journal of emergency medicine 10/2010; 29(9):1203-16. · 1.54 Impact Factor -
Article: Acute coronary syndromes: from the emergency department to the catheterization laboratory-integrating evidence from recent ACS/NSTEMI trials into clinical practice: an evidence-based review of recent clinical trial results and report on a roundtable discussion.
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ABSTRACT: Over the past 2 years, multiple clinical trials have reported results that will influence the treatment of patients with non-ST-segment elevation acute coronary syndromes (ACS) for many years to come. However, large-scale clinical trials take years to complete, during which time the underlying landscape may shift. Thus, while clinical trials provide baseline information to help physicians make evidence-based decisions regarding patient care, trials must be interpreted in the context of current treatment guidelines and practices. In addition, regulatory and advisory board decisions, case reports, clinician experience, and patient factors have a clear but difficult-to-measure impact on practice patterns. In recognition of the wide range of information affecting physicians' decision-making processes in patients with ACS, a roundtable was convened on June 5, 2009, in New York City to discuss the implications of recent data for clinical practice. Eight clinicians from the disciplines of cardiology and emergency medicine shared information and opinions on recent advances in antiplatelet treatment, clinical trial results, guidelines, and other issues related to patient care. This article is derived from transcripts of their presentations and the surrounding discussions at this meeting, with the intent of reporting both quantitative information on recent advances in the management of ACS and qualitative information and opinions from participants. Each author held primary responsibility for the writing and editing of his or her section, and participated in the editing of the entire manuscript.Journal of Interventional Cardiology 11/2010; 24(2):119-36. · 1.18 Impact Factor -
Article: Do diabetic patients have higher in-hospital complication rates when admitted from the emergency department for possible myocardial ischemia?
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ABSTRACT: To compare in-hospital complication rates for diabetic and nondiabetic patients admitted from the emergency department (ED) for possible myocardial ischemia. This was a prospective, observational study of consecutive consenting patients presenting to a suburban university hospital ED during study hours with typical and atypical symptoms consistent with cardiac ischemia. Demographic, historical, and clinical data were recorded by trained research assistants using a standardized, closed-question, data collection instrument. Inpatient records were reviewed by trained data abstractors to ascertain hospital course and occurrence of complications. Final discharge diagnosis of acute myocardial infarction (AMI) was assigned by World Health Organization criteria. Categorical and continuous data were analyzed by chi-square and t-tests, respectively. All tests were two-tailed with alpha set at 0.05. There were 1,543 patients enrolled who did not have complications at initial presentation; 283 were diabetic. The rule-in rate for AMI was 13.8% for nondiabetic patients and 17.7% for diabetic patients (p = 0.09). Times to presentation were similar for nondiabetic vs diabetic patients [248 minutes (95% CI = 231 to 266) vs 235 minutes (95% CI = 202 to 269); p = 0.32]. Nondiabetic patients tended to be younger [56.6 years (95% CI = 55.8 to 57.4) vs 61.6 years (95% CI = 60.2 to 63.1); p = 0.001] and were less likely to be female (34.3% vs 48.1%; p = 0.001). The two groups had similar prevalences for initial electrocardiograms diagnostic for AMI (5.5% vs 7.4%; p = 0.21). There was no significant difference between nondiabetic and diabetic patients for the occurrence of the following complications after admission to the hospital: congestive heart failure (1.3% vs 1.1%, p = 0.77); nonsustained ventricular tachycardia (VT) (1.3% vs 1.2%, p = 0.93); sustained VT (1.2% vs 1.1%, p = 0.85); supraventricular tachycardia (1.7% vs 3.2%, p = 0.12); bradydysrhythmias (1.9% vs 1.1%, p = 0.33); hypotension necessitating the use of pressors (0.9% vs 1.1%, p = 0.76); cardiopulmonary resuscitation (0.2% vs 0.7%, p = 0.10); and death (0.3% vs 0.7%, p = 0.34). One or more complications occurred with similar frequencies for patients in the two groups (6.3% vs 5.7%; p = 0.70). No statistically significant difference was found in the postadmission complication rates for initially stable diabetic vs nondiabetic patients admitted for possible myocardial ischemia. Based on these results, the presence or absence of diabetes as a comorbid condition does not indicate a need to alter admitting decisions with respect to risk for inpatient complications.Academic Emergency Medicine 04/2000; 7(3):264-8. · 1.86 Impact Factor -
Article: The effect of introducing bedside TV sets on patient satisfaction in the ED.
American Journal of Emergency Medicine 02/2000; 18(1):119-20. · 1.98 Impact Factor -
Article: Evaluation of two strategies for complying with state-mandated lead screening in the emergency department. Naussau-Suffolk Lead Committee, Naussau-Suffolk Lead Center.
Academic Emergency Medicine 09/1999; 6(8):849-51. · 1.86 Impact Factor
