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ABSTRACT: To identify symptom profiles of depression and anxiety in patients with an acute coronary syndrome (ACS), to examine changes in symptom profiles over time, and finally, to examine the effects of age and sex on patients' symptom profiles.
One hundred ACS patients with mild to severe symptoms of depression and/or anxiety at 1 month post-hospital discharge were enrolled in a randomized trial of cognitive behavioral therapy. Latent class and latent transition analyses were used to identify symptom profiles and describe change over the time in profile membership.
A two-class solution was selected to describe depression and anxiety symptom profiles. Class I (76% of patients at baseline) was labeled "depression and some anxiety symptoms." Class II (24% of patients at baseline) was labeled "anxiety and some depression symptoms." Approximately 25% of patients in the treatment condition transitioned from the depression and some anxiety symptoms class to the anxiety and some depression symptoms class at follow-up compared to 10% of patients in the control condition at follow-up; nearly 50% of patients in the control condition showed worsening of symptoms as compared to 28% in the treatment condition. Results suggested age differences in the probabilities of transitioning between the classes; older patients were more likely to continue having depression and some anxiety symptoms at the time of follow-up.
Identifying symptom profiles of depression and anxiety in patients with an ACS may improve diagnostic practices and help to design tailored interventions.
The International Journal of Psychiatry in Medicine 01/2011; 42(2):195-210. · 1.03 Impact Factor
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ABSTRACT: Prior authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior authorization policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability.
We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients.
In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prepolicy to 20% postpolicy. The prior authorization policy was associated with a small sustained decrease in therapy initiation overall (9 per 10,000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients.
Prior authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
Archives of internal medicine 05/2009; 169(8):750-6. · 11.46 Impact Factor
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ABSTRACT: The aim of this study was to examine whether quetiapine is superior to placebo in the treatment of adolescents with conduct disorder.
This was a 7-week, randomized, double-blind, placebo-controlled pilot study with two parallel arms. Nine youths were randomly assigned to receive quetiapine, and 10 youths were randomly assigned to receive placebo. Patients were assessed weekly throughout the trial. Quetiapine was dosed twice daily, and medications could be titrated flexibly through the end of study week 5. The dose was fixed for the final 2 weeks of the study. The primary outcome measures were the clinician-assessed Clinical Global Impressions-Severity (CGI-S) and-Improvement (CGI-I) scales. Secondary outcome measures included parent-assessed quality of life, the overt aggression scale (OAS), and the conduct problems subscale of the Conners' Parent Rating Scale (CPRS-CP).
The final mean dose of quetiapine was 294 +/- 78 mg/day (range 200-600 mg/day). Quetiapine was superior to placebo on all clinician-assessed measures and on the parent-assessed quality of life rating scale. No differences were found on the parent-completed OAS and CPRS-CP. Quetiapine was well tolerated. One patient randomized to quetiapine developed akathisia, requiring medication discontinuation. No other extrapyramidal side effects occurred in patients receiving active drug.
This methodologically controlled pilot study provides data that quetiapine may have efficacy in the treatment of adolescents with conduct disorder. Because of the preliminary nature of the study, further research with larger samples is needed to confirm these findings.
Journal of Child and Adolescent Psychopharmacology 05/2008; 18(2):140-56. · 2.88 Impact Factor
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ABSTRACT: Although initial research suggests that computerized physician order entry reduces pediatric medication errors, no comprehensive error surveillance studies have evaluated the effect of computerized physician order entry on children. Our objective was to evaluate comprehensively the effect of computerized physician order entry on the rate of inpatient pediatric medication errors.
Using interrupted time-series regression analysis, we reviewed all charts, orders, and incident reports for 40 admissions per month to the NICU, PICU, and inpatient pediatric wards for 7 months before and 9 months after implementation of commercial computerized physician order entry in a general hospital. Nurse data extractors, who were unaware of study objectives, used an established error surveillance method to detect possible errors. Two physicians who were unaware of when the possible error occurred rated each possible error.
In 627 pediatric admissions, with 12,672 medication orders written over 3234 patient-days, 156 medication errors were detected, including 70 nonintercepted serious medication errors (22/1000 patient-days). Twenty-three errors resulted in patient injury (7/1000 patient-days). In time-series analysis, there was a 7% decrease in level of the rates of nonintercepted serious medication errors. There was no change in the rate of injuries as a result of error after computerized physician order entry implementation.
The rate of nonintercepted serious medication errors in this pediatric population was reduced by 7% after the introduction of a commercial computerized physician order entry system, much less than previously reported for adults, and there was no change in the rate of injuries as a result of error. Several human-machine interface problems, particularly surrounding selection and dosing of pediatric medications, were identified. Additional refinements could lead to greater effects on error rates.
PEDIATRICS 04/2008; 121(3):e421-7. · 4.47 Impact Factor
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ABSTRACT: This study evaluated how a change in gatekeeping model at a health maintenance organization affected performance indicators for specialty outpatient mental health care. Gatekeeping in one division changed from in-person evaluations to a call center with routine authorization for the first eight visits. Using 1996-1999 claims data (including 2 years pre- and 2 years postintervention), the study compared performance indicator results in the affected division and another where the model did not change. Subjects included 122,751 continuously enrolled persons. Dependent variables were mental health emergency room use, treatment initiation, treatment engagement, and family treatment for child patients. After controlling for secular trends at the other division and enrollee characteristics, the division that changed gatekeeping experienced no significant impact on most indicators and an increase in family treatment for children. The move to call-center gatekeeping did not appear to have a negative impact on treatment process as reflected in these indicators.
The Journal of Behavioral Health Services & Research 02/2008; 35(1):3-19. · 1.32 Impact Factor
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ABSTRACT: In this study we assessed the views of parents of children referred to specialty care and the views of the children's primary care and specialty physicians about parents' roles as information intermediaries.
We enrolled 179 patients who were newly referred from primary care pediatricians in 22 practices to 15 pediatric subspecialists in 5 specialties in a study of primary care pediatrician-specialist communication. Parents, primary care pediatricians, and specialists completed questionnaires by mail or telephone at the first visit and 6 months later. Questions included perceived responsibilities of parents as information conduits between primary care pediatricians and specialists. Opinions of parents, primary care pediatricians, and specialists about parents' roles were compared for the sample as a whole, as well as for individual cases. Agreement between parents and providers was assessed. Demographic and clinical determinants of parents reporting themselves as "comfortable with" or "acting" as primary intermediaries were assessed using logistic regression.
More parents (44%) than primary care physicians (30%) felt comfortable with parents acting as primary communicators between their children's physicians; 31% of parents who reported that they were the primary communicators felt uncomfortable in that role, and there was no agreement between parents and physicians about the role of parents in individual cases. Although no demographic characteristics of children or parents were associated with parent comfort as the primary communicator, parents of children who saw the same specialist more than once during the 6-month period felt more comfortable in this role. The presence of a chronic condition was not associated with parent comfort.
Although parents report more comfort with their own ability as information intermediaries than do their children's physicians, the role in which they feel comfortable is highly variable. Physicians should discuss with parents the roles they feel comfortable in assuming when specialty referrals are initiated.
PEDIATRICS 01/2008; 120(6):1238-46. · 4.47 Impact Factor
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ABSTRACT: To measure how a change in gatekeeping model affects utilization of specialty mental health services.
Secondary data from health insurance claims for services during 1996-1999. The setting is a managed care organization that changed gatekeeping model in one of its divisions, from in-person evaluation to the use of a call-center.
We evaluate the impact of the change in gatekeeping model by comparing utilization during the 2 years before and 2 years after the change, both in the affected division and in another division where gatekeeping model did not change. The design is thus a controlled quasi-experimental one. Subjects were not randomized. Key dependent variables are whether each individual had any specialty mental health visits in a year; the number of visits; and the proportion of users exceeding eight visits in a year. Key explanatory variables include demographic variables and indicators for patient diagnoses and their intervention status (time-period, study group).
Claims data were aggregated to create analytic files with one record per member per year, with variables reporting demographic characteristics and mental health service use.
After controlling for secular trends at the other division, the division which changed gatekeeping model eventually experienced an increase in the proportion of enrollees receiving specialty mental health treatment, of 0.5 percentage point. Similarly, there was an increase of about 0.6 annual visits per user, concentrated at the low end of the distribution. These changes occurred only in the second year after the gatekeeping changes.
The results of this study suggest that the gatekeeping changes did lead to increases in utilization of mental health care, as hypothesized. At the same time, the magnitude of the increase in access and mean number of visits that we found was relatively modest. This suggests that while the change from face-to-face specialty gatekeeping to call-center intake does increase utilization, it is unlikely to overwhelm a system with new demand or create huge cost increases.
Health Services Research 03/2007; 42(1 Pt 1):104-23. · 2.16 Impact Factor
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ABSTRACT: Effective communication between primary care and specialty physicians is essential for comanagement when children are referred to specialty care. We sought to determine rates of physician-reported communication between primary care physicians and specialists, the clinical impact of communication or its absence, and patient- and practice system-level determinants of communication for a cohort of children referred to specialty care.
We enrolled 179 patients newly referred from general pediatricians in 30 community practices to 15 pediatric medical specialists in 5 specialties. Primary care physicians and specialists completed questionnaires at the first specialty visit and 6 months later. Questions covered communication received by primary care physicians and specialists, its impact on care provision, system characteristics of practices, and roles of physicians in treatment. We used multivariate logistic regression to determine associations between practice system and patient characteristics and the dependent variable of reported primary care physician-specialist communication.
Specialists reported communication from referring primary care physicians for only 50% of initial referrals, whereas primary care physicians reported communication from specialists after 84% of initial consultations. Communication was strongly associated with physicians' reported ability to provide optimal care. System characteristics associated with reported primary care physician-specialist communication were computer access to chart notes and lack of delays in receipt of information. Associated patient characteristics included non-Medicaid insurance, no additional specialists seen, and specialty to which referred. Physicians favored comanagement of referred patients in more than two thirds of the cases.
Although a prerequisite for optimal care, communication from primary care physicians to specialists is frequently absent. Interventions should promote widely accessible clinical information systems and target children with complex needs and public insurance.
PEDIATRICS 11/2006; 118(4):1341-9. · 4.47 Impact Factor
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ABSTRACT: This study assessed the relationship between depression severity and job performance among employed primary care patients.
In a 2001-2004 longitudinal observational study of depression's affect on work productivity, 286 patients with DSM-IV major depressive disorder and/or dysthymia were compared to 93 individuals with rheumatoid arthritis, a condition associated with work disability, and 193 depression-free healthy control subjects. Participants were employed at least 15 hours per week, did not plan to stop working, and had no major medical comorbidities. Measures at baseline, six, 12, and 18 months included the Work Limitations Questionnaire for work outcomes, and the Patient Health Questionnaire-9 for depression.
At baseline and each follow-up, the depression group had significantly greater deficits in managing mental-interpersonal, time, and output tasks, as measured by the Work Limitations Questionnaire: The rheumatoid arthritis group's deficits in managing physical job demands surpassed those of either the depression or comparison groups. Improvements in job performance were predicted by symptom severity. However, the job performance of even the "clinically improved" subset of depressed patients remained consistently worse than the control groups.
Multiple dimensions of job performance are impaired by depression. This impact persisted after symptoms have improved. Efforts to reduce work-impairment secondary to depression are needed.
American Journal of Psychiatry 10/2006; 163(9):1569-76. · 12.54 Impact Factor
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ABSTRACT: Between 15% and 25% of children and adolescents seen in pediatric primary care have a behavioral health disorder with significant psychopathology, high functional impairment, and frequent psychiatric diagnostic comorbidity. Because child psychiatry services are frequently unavailable, primary care clinicians are frequently left managing these children without access to child psychiatry consultation. We describe Targeted Child Psychiatric Services (TCPS), a new model of pediatric primary clinician-child psychiatry collaborative care, and describe program utilization and characteristics of children referred over the first 18 months of the program using a retrospective chart review. The TCPS model can serve a large number of pediatric primary care practices and provide collaborative help with the evaluation and treatment of complex attention deficit hyperactivity disorder, depression, anxiety disorders, and pediatric psychopharmacology.
Clinical Pediatrics 07/2006; 45(5):423-34. · 1.15 Impact Factor
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ABSTRACT: To determine patterns and knowledge of nonmedical use of stimulants among a sample of college students.
Completion of an anonymous survey consisting of 23 questions designed to explore college student use of medications intended to treat attention-deficit/hyperactivity disorder.
A private liberal arts college in New England.
Three hundred forty-seven undergraduate students.
Nonmedical use of stimulants.
Thirty-one students (9.2%) reported nonmedical stimulant use. Two hundred forty students (71.4%) had peers who used nonprescribed stimulants, 149 (44.3%) knew of peers who made stimulant medication-seeking visits to a physician although they did not believe that they had attention-deficit/hyperactivity disorder, and 178 (53.0%) knew of people who sold stimulants to students. Nonprescription users were significantly more knowledgeable about the effects of stimulants than nonusers, and nonusers whose peers used nonprescribed stimulants were more knowledgeable about the effects of stimulants than nonusers whose peers did not use nonprescribed stimulants. After controlling for age, race, and sex, the variables that predicted nonmedical use of stimulants were beliefs that stimulants help individuals study better, stay awake, and lose weight.
A substantial proportion of college students in this sample were using nonprescribed stimulants. Among nonusers, those whose peers use nonprescribed stimulants were much more knowledgeable about the effects of stimulant use than those whose peers do not use stimulants. This knowledge may confer an increased risk of future nonmedical stimulant use if students become tempted to seek the beneficial effects experienced by their peers.
Archives of Pediatrics and Adolescent Medicine 06/2006; 160(5):481-5. · 4.14 Impact Factor
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ABSTRACT: Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms.
1662 participants in Project Viva, a US cohort study.
Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated.
The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31).
Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.
Journal of Epidemiology & Community Health 03/2006; 60(3):221-7. · 3.19 Impact Factor
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ABSTRACT: We investigated correlations between measures of proactive and reactive aggression subtype, and the severity and frequency of overt aggression and psychiatric diagnosis in a clinically referred sample of children compared to a non-referred community comparison group free of psychiatric diagnosis. All measures of aggression were significantly correlated suggesting that there might be an underlying aggression construct that is manifested in distinct but correlated domains of aggression across diverse psychiatric diagnoses in referred children. Regression analysis revealed robust correlations between the number of lifetime psychiatric diagnoses adjusted for lifetime duration of illness and all measures of aggression. Our results support the need to consider the development of psychosocial and psychopharmacological treatment interventions specifically targeting excessive maladaptive aggression within and across multiple psychiatric diagnoses in children.
Child Psychiatry and Human Development 02/2006; 37(1):1-14. · 1.93 Impact Factor
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ABSTRACT: Poor mood adjustment to chronic medical illness is often accompanied by decrements in function.
To evaluate the effectiveness of a telephone-based intervention for psychologic distress and functional impairment in cardiac illness.
Randomized, controlled trial.
We recruited survivors of acute coronary syndromes using the Hospital and Anxiety Depression Scale (HADS) with scores indicative of mood disturbances at 1-month postdischarge. Recruited patients were randomized to experimental or control status. Intervention patients received 6 30-minute telephone counseling sessions to identify and address illness-related fears and concerns. Control patients received usual care. Patients' responses to the HADS and the Workplace Social Adjustment Scale (WSAS) were collected at baseline, 2, 3, and 6 months using interactive voice recognition technology. At baseline, the PRIME-MD was used to establish diagnosis of depression. We used mixed effects regression to study changes in outcomes.
We enrolled 100 patients. Mean age was 60; 67% of the patients were male. Findings confirmed that the intervention group had a 27% improvement in depression symptoms (P=.05), 27% in anxiety (P=.02), and a 38% improvement in home limitations (P=.04) compared with controls. Symptom improvement tracked those for WSAS measures of home function (P=.04) but not workplace function.
The intervention had a moderate effect on patient's emotional and functional outcomes that were observed during a critical period in patients' lives. Patient convenience, ease of delivery, and the effectiveness of the intervention suggest that the counseling can help patients adjust to chronic illness.
Journal of General Internal Medicine 01/2006; 20(12):1084-90. · 2.83 Impact Factor
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ABSTRACT: The primary aim of this pilot study was to ascertain if psychiatric medications could be reduced in a convenience sample of seriously emotionally disturbed children and adolescents over the course of residential treatment. We also sought to understand factors correlated with reduction in the number of medications during treatment. A review of the treatment of 141 patients (n = 112 admitted on medication and n = 29 admitted on no medication) admitted to, and discharged from, a residential treatment setting between 1992 and 2001 was undertaken. Significantly more children were discharged from treatment on no medications than were admitted to residential treatment on no medications. In children receiving more than 1 medication at admission, the number of combined medications was significantly reduced over the course of residential treatment. However, the majority of children admitted on medications continued on some psychiatric medications, indicating that psychopharmacology continued to play an important role in their treatment. In 112 patients admitted on psychoactive medications, our pilot data suggests that improvement in externalizing, internalizing, psychotic, and autistic psychopathology while in residential treatment, the presence of an intact family (adoptive or biological), the absence of a history of either sexual or physical abuse, and the type of medication used appear to be factors that correlate with a reduced use of medications in this population.
Journal of Child and Adolescent Psychopharmacology 05/2005; 15(2):302-10. · 2.88 Impact Factor
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ABSTRACT: This study comprehensively assessed the work outcomes of employees with depression.
We collected baseline and six-month follow-up survey data from 229 employees with depression and two employee comparison groups: a group of healthy patients for the control group (N=173) and a group with rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes included new unemployment and, within the employed subgroup, job retention (versus job turnover), presenteeism (that is, diminished on-the-job performance and productivity), and absenteeism.
At the six-month follow-up, persons with depression had more new unemployment--14 percent for persons in the dysthymia group, 12 percent for persons in the major depression group, and 15 percent for persons in the group with both dysthymia and major depression, compared with 2 percent for persons in the control group and 3 percent for persons in the rheumatoid arthritis group. Among participants who were still employed, those with depression had significantly more job turnover, presenteeism, and absenteeism.
In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences.
Psychiatric Services 01/2005; 55(12):1371-8. · 2.38 Impact Factor
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ABSTRACT: To examine the relationship between adherence to antidepressant medications and HbA1c levels among patients with diabetes in a managed care setting.
The analysis included measures of HbA1c levels before, during, and after initial antidepressant use among 568 patients with diabetes enrolled in the Harvard Pilgrim Health Care insurance plan from 1991-1995. Adherence was defined as four refills in a six-month period after the first antidepressant prescription. General linear models using SAS PROC MIXED were used to estimate the effects of covariates including antidepressant adherence on HbA1c levels over time, comparing patients who were adherent to antidepressant medications to those patients who were non-adherent to antidepressant medications.
Adherence to antidepressant treatment was not significantly associated with HbA1c levels among diabetic patients who are antidepressant users. Younger age, use of insulin and oral medications, and female gender were all significantly associated with HbA1c levels over time.
Although we did not observe any association between level of adherence to antidepressant therapy among diabetic patients and levels of glucose control, our results confirm previously established associations between patient characteristics and glycemic control. Further research is needed to disentangle the complex relationship among antidepressant treatment adherence and diabetes outcomes.
The International Journal of Psychiatry in Medicine 02/2004; 34(4):291-304. · 1.03 Impact Factor
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ABSTRACT: These studies evaluated the influence of hepatic arterial flow on biliary secretion after cold ischemia. Preparation of livers for transplantation or hepatic support impairs biliary secretion. The earliest indication of cold preservation injury during reperfusion is circulatory function. Arterial flow at this time may be critical for bile secretion. Porcine livers were isolated, maintained at 4 degrees for 2 h and connected in an extracorporeal circuit to an anesthetized normal pig. The extracorporeal livers were perfused either by both the hepatic artery and portal vein (dual) or by the portal vein alone (single). Incremental doses of sodium taurocholate were infused into the portal vein of both the dual and single perfused livers, and the bile secretion was compared. Most endogenous bile acids are lost during hepatic isolation. After supplementation, the biliary secretion of phosphatidyl choline and cholesterol was significantly better in the dual than single vessel-perfused livers; however, no difference was seen in bilirubin output. Single perfused livers were completely unable to increase biliary cholesterol in response to bile acid. The dependence of bile cholesterol secretion on arterial flow indicates the importance of this flow to the detoxification of compounds dependent on phosphatidyl choline transport during early transplantation.
American Journal of Transplantation 03/2003; 3(2):148-55. · 6.39 Impact Factor
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ABSTRACT: National guidelines have encouraged increased use of thrombolytic therapy for elderly patients with acute myocardial infarction (AMI). However, evidence supporting thrombolytic therapy in patients 75 years and older is lacking. In a retrospective cohort study of 2659 elderly AMI patients, we determined the association between thrombolytic use and in-hospital mortality by age and among patients with or without absolute or relative contraindications to thrombolytic treatment.
We abstracted the medical records of 2659 elderly patients admitted with AMI at 37 Minnesota community hospitals between 1992 and 1996. The main outcome measure was in-hospital mortality, controlling for demographic, clinical, comorbidity, and severity-of-illness variables.
Sixty-three percent of 719 eligible patients received thrombolytic therapy. Twenty-seven percent of thrombolytic recipients had absolute contraindications to treatment. Patients receiving thrombolytic agents had fewer and less severe comorbidities than those not receiving thrombolytic therapy. There was a 4% increase in the odds of death for every 1-year increase in age for all thrombolytic recipients vs nonrecipients (odds ratio [OR], 1.04 per year; 95% confidence interval [CI], 1.01-1.08; P =.03). Among patients with 1 or more contraindication, the OR for death associated with thrombolytic use was 1.57 (95% CI, 1.03-2.40; P =.04). The adjusted odds of death among eligible thrombolytic recipients (vs nonrecipients) increased significantly with age (OR, 1.08 per year; 95% CI, 1.02-1.14; P =.008). Among eligible patients aged 80 to 90 years, the predicted odds of death among thrombolytic recipients vs nonrecipients was 1.4. Among eligible patients younger than 80 years, thrombolytic use was associated with reduced mortality.
Our findings suggest the need for more research on the effectiveness of thrombolytic therapy for AMI patients 75 years and older and for more careful selection of elderly patients for this treatment.
Archives of Internal Medicine 04/2002; 162(5):561-8. · 11.46 Impact Factor
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Journal of the Royal Statistical Society Series C Applied Statistics 02/2000; 49(3):385-397.
