Susan S. Fish's research while affiliated with Boston Medical Center and other places

Publications (18)

Article
The application of basic ethical principles to resuscitation research and other research in the emergency and critical care settings presents a particular challenge. The emergency exception from informed consent (EFIC) rule (21 CFR 50.24 and 45 CFR 46.101[i]) addresses a particular vulnerability: that which occurs when persons cannot consent due to...
Article
Thisstudy examines the potential number of patients who would be diverted from hospitals without percutaneous coronary intervention (PCI) capability, to centers with this capability, as a result of prehospital triage strategies for patients with suspected acute myocardial infarction (AMI). All patients with AMI admitted during a 1-year study period...
Article
We obtain preliminary information on the neuropsychological performance of house officers at the beginning and end of a shift while they worked consecutive night shifts in the emergency department. We prospectively studied interns working 12-hour consecutive night shifts in an urban Level I trauma center ED. All consecutive non-emergency medicine i...
Article
Full-text available
To determine whether mathematically equivalent but conceptually different presentations of risk from radioactive isotope exposure might affect the rate of agreement to participate in a hypothetical research study. This was a prospective study of consenting English-speaking subjects more than 18 years of age who were asked whether they would agree t...
Article
To describe the characteristics of a large group of patients who presented to emergency departments with cocaine-associated symptoms consistent with acute cardiac ischemia (ACI) and to determine the incidence of confirmed ACI including acute myocardial infarction (AMI) in this population. We performed a substudy on all patients in a multicenter pro...
Article
Study objective: To describe the characteristics of a large group of patients who presented to emergency departments with cocaine-associated symptoms consistent with acute cardiac ischemia (ACI) and to determine the incidence of confirmed ACI including acute myocardial infarction (AMI) in this population. Methods: We performed a substudy on all pat...
Article
A framework for the ethical conduct of research is constructed within this article. The historical developments and current state of ethical principles and regulations guiding ethical conduct of research are reviewed, while situations unique to emergency medicine research are highlighted. Also discussed are the related issues of scientific miscondu...
Article
Alcohol abuse is one of the most common causes of seizures in adults. In a randomized, double-blind study, we compared lorazepam with placebo for the prevention of recurrent seizures related to alcohol. Over a 21-month period, we studied consecutive patients with chronic alcohol abuse who were at least 21 years of age and who presented to the emerg...
Article
Approximately 6 million U.S. patients present to emergency departments annually with symptoms suggesting acute cardiac ischemia. Triage decisions for these patients are important but remain difficult. To test whether computerized prediction of the probability of acute ischemia, used with electrocardiography, improves the accuracy of triage decision...
Article
To determine the one-year mortality and incidence of myocardial infarction (MI) post-hospital discharge or ED release for patients with cocaine-associated chest pain. A prospective, observational study of an inception cohort of consecutive patients who presented to one of four municipal hospital EDs with cocaine-associated chest pain. Patients were...
Article
Full-text available
Carboxyhemoglobin (COHb) levels were measured in patients who came to an emergency department complaining of acute chest pain. For subjects not receiving prior oxygen therapy, those with cocaine-related chest pain (n = 10) had a higher mean COHb level than a comparison group (n = 28) with nonischemic chest pain (4.50 +/- 2.40 vs 2.73 +/- 0.66; p <...
Article
To describe a large cohort of patients who had chest pain following cocaine use, and to determine the incidence of and clinical characteristics predictive for myocardial infarction in this group of patients. A prospective observational cohort study of consecutive patients with cocaine-associated chest pain was conducted in six municipal hospital em...
Article
This paper focuses on the implications of an inadequate public health/ preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public he...
Article
To determine the effectiveness of IV phenytoin in the prevention of recurrent alcohol-related seizures during a six-hour observation period. Prospective, randomized, double-blind trial comparing IV phenytoin with normal saline placebo, conducted from January 1990 through December 1991. Emergency department of an inner-city, university-affiliated, t...
Article
The optimal medical regimen for the treatment of cocaine associated myocardial ischemia has not been defined. While animal and human data demonstrate the risks of beta-adrenergic blockade, studies in the cardiac catheterization laboratory suggest a beneficial role of nitroglycerin. We performed a prospective multicenter observational study to evalu...

Citations

... In addition, the finding that patients from areas with higher measures of socioeconomic stress were more likely to visit the ED for conditions that may otherwise be considered preventable by robust, reliable primary care further supports the position of the ED as a critical element of the healthcare safety net. 30,31 The fact that patients from disadvantaged areas are more likely to rely on the ED for routine care, or even at times preventative care, only further reinforces the need for robust emergency care systems as an essential part of the fabric of the public health system. ...
... Chest pain is the leading cause of cocaine-associated emergency department visits [10]. Acute coronary syndrome (ACS) associated with cocaine abuse differs from cocaineunrelated ACS: myocardial infarction is considerably less likely to be confirmed [11], and suspected ST-elevation myocardial infarction (STEMI) is more likely to be revealed as false STEMI (i.e., nonocclusive myocardial infarction) [12]. Furthermore, these patients are more likely to be of younger age and male gender and to have lower socioeconomic status, while common cardiovascular risk factors such as diabetes and hypertension are less frequent [13]. ...
... Cessation of cocaine use is the first-line treatment for cocaine-induced cardiomyopathy, leading to significant improvement in systolic functioning; however, recurrence of cardiomyopathy is associated with relapse [26]. Additional medical therapy for cocaine-induced cardiomyopathy and heart failure is consistent with the published guidelines for managing heart failure (except for beta-blockers). ...
... CP is the most frequent complaint reported in patients using cocaine with reported 40% of the patients presenting with some degree of chest discomfort. 10 Studies on the incidence of myocardial infarction (MI) in patients with cocaine-associated CP have reported divergent results ranging from 0.7% to 6%. [11][12][13][14] Nevertheless, considering that cocaine use has been linked with premature coronary artery disease (CAD) and MI, patients with history of cocaine use in the ED warrant careful consideration in terms of workup and disposition from the ED. 6,15 There is a paucity of real-world information in regard to nationwide ED visits, disposition from ED, hospitalization rates, resource use, and outcomes in patients presenting to the ED with CP. ...
... Interestingly, back in the 1990s, cocainerelated chest pain was managed conservatively. Hollander et al. reported that 83 out of 246 patients with CIMI were found to have gotten better with nitroglycerine alone [6]. One prospective study found the early use of lorazepam plus nitroglycerine is more efficacious and safer than nitroglycerine alone with a significant reduction in chest pain score [7]. ...
... Pope et al found that only 2.1 percent of patients with chest pain having acute myocardial infarction were discharged from the emergency department. 6 Patients with acute myocardial infarction who are mistakenly discharged from the emergency department have short-term mortality rates of about 25 percent, at least twice what would be expected if they were admitted. 7 It is therefore of utmost importance to emphasize the evaluation of chest pain and to discriminate chest pain of acute myocardial infarction from noncardiac chest pain. ...
... Abrupt decrease or cessation of alcohol use often causes withdrawal symptoms ranging from anxiety and insomnia to delirium tremens, seizures, and death [3,4]. Most ED-based studies have described treatment of patients with severe withdrawal [5][6][7][8][9]. However, most ED patients are not critically ill and are discharged home [10]. ...
... Because of the unexpected and sudden nature of the cardiac events and because both dose strategies are recommended by the American Heart Association and the International Liaison Committee on Resuscitation, the commission accepted the concept of presumed consent and approved exemption from the requirement for informed consent. 25 However, informed consent was deemed necessary, and was obtained from the parents or legal guardians of all the patients, for continued participation in data collection and follow-up after hospital discharge. ...
... 11,12 Risk of CVD among PWH is also associated with substance use; cocaine users are at greater risk of cardiovascular complications. 13,14 Excessive cocaine use is associated with both acute and chronic cardiovascular toxicity, [15][16][17] myocardial ischemia, 18 myocardial infarction, 19 arrhythmias, 20 and cardiomyopathy. [21][22][23] Additionally, PWH who use cocaine have an increased risk of type 2 myocardial infarctions, which can be attributed to oxygen demand and supply mismatch associated with cocaine use. ...