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David A Feldstein

Publications and source records attributed to David A Feldstein.

10 recordsLinked to original sources
PubMed2005

Low-molecular weight heparin for pulmonary embolism: a shot in the dark?

Both meta-analyses included large numbers of patients from randomized controlled trials with objectively diagnosed PE or VTE. Quinlan has the advantage of only including trials of patients with documented PE, which more closely pertains to the patient in the clinical question. The study was of excellent quality and showed no difference in rates of recurrent PE or mortality. It supports a trend towards a decrease in recurrent PE with the use of LMWH vs. UFH, without an increased rate of adverse events. The study by van Dongen et al further supports the use of LMWH in the combined group of patients with PE or DVT. Van Dongen shows a decrease in any symptomatic VTE, major bleeding, and all cause mortality in this group.

Accidental Falls↗
PubMed2005

Evidence-based practice: what a start and 'Oh, the possibilities'.

Evidence-based medicine (EBM) was introduced in the early 1990s. In less than 15 years, it has dramatically changed the way that medicine is practiced and taught. Improvements in informatics and evidence resources have helped overcome some of the initial problems and allowed busy clinicians to use EBM in practice. Many barriers to using EBM still remain. Further work on translating evidence into patient care decisions and understanding patients' preferences is required in order to realize the improvements that EBM's early proponents envisioned.

Evidence-Based Medicine↗
PubMed2005

Clinician's guide to systematic reviews and meta-analyses.

Systematic reviews answer clinical questions by finding and evaluating all available evidence. The systematic review is a powerful tool to help clinicians use evidence for patient care decisions. There are many sources for high-quality systematic reviews. Like all scientific studies there are potential biases, but systematic reviews have many benefits over narrative reviews. To ensure appropriate use of systematic reviews, clinicians must evaluate them in a logical, step-by-step manner. This article will review the benefits of systematic reviews, how to locate them, and how to evaluate their quality and results.

Decision Making↗
PubMed2005

Preventing contrast-induced nephropathy: a basic solution.

This is a good quality study that demonstrates a dramatic decrease in the incidence of contrast nephropathy with the use of sodium bicarbonate infusion prior to contrast administration. However, this study does have some shortcomings. The small sample size resulted in relatively wide confidence intervals and made the generally low attrition rate more significant. The data was not analyzed on an intention-to-treat basis, which could lead to an overestimation of the benefits of bicarbonate. None of the patients developing contrast nephropathy went on to require dialysis. The authors note that the length of hospital stay was adversely affected by the development of contrast nephropathy, although they do not report the extent to which this occurred and whether or not the increase in hospital days was significant. This study did not include the use of N-acetylcysteine, which has been shown to decrease the risk of contrast-induced nephropathy in some studies.

Acetylcysteine↗