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Biomedical subjects

L Goldman

Publications and source records attributed to L Goldman.

At least 343 records · Page 19Linked to original sources
PubMed1985

Evaluation of prognostic classifications for patients with syncope.

To evaluate two published sets of prognostic classifications for patients with syncope, 176 consecutive patients who presented to an emergency room with syncope were studied. Although relatively few patients had cardiac syncope, these data confirmed their high one-year mortality. At the other extreme, it was also confirmed that patients who were 30 years of age or less or 70 years of age or less and had vasovagal/psychogenic syncope or syncope of unknown cause had a benign prognosis, with only two deaths in 225 patients in pooled data. However, these data did not confirm the previously reported prognoses for "medium-risk patients" or for patients with diagnosable noncardiovascular causes of syncope, largely because of differences in criteria for patient eligibility. It is concluded that available data allow over 70 percent of patients with syncope to be placed into either very-high or very-low-risk groups. However, further investigation, taking into account differences in patient selection criteria, will be required before accurate prognostic classifications can be derived for the nearly 30 percent of patients who do not fall into one of these extreme prognostic categories.

Adolescent↗
PubMed1985

Comparative costs versus symptomatic and employment benefits of medical and surgical treatment of stable angina pectoris.

For patients who underwent cardiac catheterization for stable angina pectoris at the authors' hospital, initial treatment charges including the cardiac catheterization were approximately $28,000 for coronary surgery and $6,000 for medical therapy. Even after controlling for disease severity and after including medical patients who crossed over to surgery, the slightly increased 3-year follow-up costs of medical therapy offset only approximately 11% of the far higher initial costs of surgery. Surgical patients were more likely to have sustained, substantial symptomatic improvement at 3 years (68% vs. 53%, P less than 0.05) but were no more likely to have, maintain, or regain a job. Although the cost-effectiveness of coronary surgery may compare favorably with other modern therapies for other conditions, coronary surgery did not pay for itself at 3-year follow-up in our patients.

Angina Pectoris↗
PubMed1985

Treatment of hypertension and its effect on cardiovascular risk factors: data from the Framingham Heart Study.

Analysis of the Framingham Heart Study experience between 1958 and 1970 showed a progressive increase in the rate of treatment and control of hypertension. With cross-sectional criteria to define diastolic hypertension, the treatment rate rose from 35% in 1958 through 1960 to 69% in 1968 through 1970 (p less than .001), and the treatment rate for sustained hypertension rose from 55% in 1958 through 1960 to 85% in 1968 through 1970 (p less than .001). Treated hypertensive subjects had higher pretreatment values of blood pressure but not of other cardiovascular risk factors than untreated hypertensive subjects. Treatment was more successful in controlling hypertension in later years (p less than .001), but in all years treatment reduced systolic and diastolic blood pressure without causing significant changes in mean serum cholesterol or glucose levels. In treated hypertensive subjects, the 8 year predicted risk of coronary heart disease declined by 2.3 events per 100 people compared with that in untreated hypertensive subjects (p less than .0001). The observed incidence of coronary heart disease was consistent with these predictions and suggested that treatment may be especially beneficial in subjects who have systolic blood pressures of 180 mm Hg or higher and who are treated for more than 2 successive years.

Adult↗
PubMed1985

Acute chest pain in the emergency room. Identification and examination of low-risk patients.

Clinical and laboratory data from 596 patients who came to an emergency room complaining of chest pain indicated that no single variable could identify low-risk patients as well as a normal ECG. A combination of three variables--sharp or stabbing pain, no history of angina or myocardial infarction, and pain with pleuritic or positional components or pain that was reproduced by palpation of the chest wall--defined a very-low-risk group in which ECGs did not add accuracy to the evaluation and were potentially misleading; however, only 48 patients (8%) fell into this category. Standard cardiac enzyme levels were of almost no use as an emergency room indicator of myocardial infarction. These findings emphasize the difficulty of identifying patients at low risk for myocardial infarction or unstable angina in the emergency room without consideration of many factors from the history, the physical examination, and the ECG.

Acute Disease↗
PubMed1984

On-site physician staffing in a community hospital intensive care unit. Impact on test and procedure use and on patient outcome.

To determine whether on-site physician staffing changed test and procedure use and improved patient outcome in a community hospital intensive care unit (ICU), we studied all ICU admissions for matched periods before and after the staffing change. Compared with the 463 year-1 patients, the 491 year-2 patients were no more likely to receive life-support interventions (respirators, dialysis, or pacemakers), but had substantially more monitoring interventions, such as pulmonary artery catheters (22% v 2%, P less than .0001) and arterial catheters (9% v 0%, P less than .0001). After controlling for factors that predicted death (age, mental status at time of admission, reason for ICU admission), year-2 patients were significantly more likely to survive the ICU and subsequent hospital stay (P = .01). Nearly all of the improvement of survival rate took place among patients with intermediate likelihoods of death; this improved survival rate persisted at the 12-month follow-up (P = .01).

Female↗
PubMed1984

Care of patients with a low probability of acute myocardial infarction. Cost effectiveness of alternatives to coronary-care-unit admission.

We conducted a cost-effectiveness analysis to examine the clinical and economic consequences of alternatives to admission to a coronary-care unit for patients who have a relatively low probability of acute myocardial infarction. Despite the fact that all our assumptions were slanted to favor the current standard policy of admission to a coronary-care unit, our analysis shows that admission to an intermediate-care unit providing resuscitative facilities and prophylactic lidocaine is highly cost effective. For patients with about a 5 per cent probability of infarction, admission to a coronary-care unit would cost $2.04 million per life saved and $139,000 per year of life saved, as compared with intermediate care. For the expected number of such patients annually in the United States, the cost would be $297 million to save 145 lives. At probabilities of infarction up to about 20 per cent, the incremental cost to save a year of life by choosing a coronary-care unit over an intermediate-care unit would be higher than the estimated cost of saving a year of life by treating a 40-year-old man with mild hypertension. Our results suggest that many patients who have a low risk of acute myocardial infarction would be appropriate candidates for admission to an intermediate-care unit.

Ambulatory Care↗
PubMed1984

Thromboembolism in patients with atrial fibrillation.

On retrospective review of records of 150 patients with atrial fibrillation (AF), 31% experienced a stroke or peripheral embolism. The AF was not associated with cardiac valvular disease in 80% of the 150 patients. Most of the cerebral infarcts were large, disabling, and unheralded by transient ischemic attack. The thromboembolism typically occurred in patients whose AF was undetected prior to the infarction. Half of the patients with an ischemic event suffered multiple events, with one fourth of the recurrences arising within two weeks.

Adult↗
PubMed1984

Empiric comparison of multivariate analytic techniques: advantages and disadvantages of recursive partitioning analysis.

The recent ready availability of recursive partitioning analysis has provided medical investigators with an alternative to the usual parametric multivariate techniques. We believe that recursive partitioning analysis has several distinct advantages: it provides a simple and intuitive method for classifying subjects, it is designed to identify synergistic interactions among factors, it may identify nonlinear relationships with the endpoint, it provides a simple format for constructing homogeneous risk strata, and it considers prior probabilities and penalties for misclassification in its variable selection process. Conversely, parametric multivariate techniques have several advantages over recursive partitioning analysis: they may be better at finding predictive factors during the later stages of the selection process, they may be less subject to the problems of multiple testing and over-training, and they may be better able to account for the full predictive power of a continuous factor. Although neither type of technique is better in all situations, we believe that recursive partitioning analysis will often be the preferred multivariate method and is especially useful for identifying interaction terms that may then be included in parametric multivariate analyses.

Adult↗
PubMed1984

Current and future developments in laser surgery.

Following the first application of the laser in surgery, the development of its instrumentation and techniques in many surgical disciplines has been rapid. An overview is provided of the present and future use of surgical lasers. New laser systems and developments include high-output argon lasers; more miniaturization and flexibility; combinations of lasers; copper and gold head lasers; and selection beam lasers.

Eye Protective Devices↗