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Marc Eckstein

Publications and source records attributed to Marc Eckstein.

22 records · Page 2Linked to original sources
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Physician-investigator phone elicitation of consent in the field: a novel method to obtain explicit informed consent for prehospital clinical research.

OBJECTIVE: To describe and report the feasibility of a novel field telephonic strategy to elicit explicit informed consent in prehospital trials for conditions in which patients retain decision-making capacity. METHODS: In a pilot prehospital neuroprotective stroke therapy trial, ambulances carried written informed consent forms and dedicated trial cellular phones permitting rapid connection to on call physician-investigators. The physician-investigator discussed the trial with the consent provider [patient if competent, on scene legally authorized representative (LAR) if patient not competent] by phone, while paramedics carried out prehospital care duties unimpeded. RESULTS: 32 patients met consent elicitation criteria. 20 (63%) were enrolled. The most frequent reasons for non-enrollment were: patient not competent and no available on-scene LAR-5; patient/LAR declined participation-4. Among enrollees, 15 (75%) were competent and self-enrolled; 5 (25%) were not competent and were enrolled by LAR family members. Site of consent initiation was: patient home-15 (74 = 5%), work-2(10)%, other-3(15)%. Consent was elicited via cell phone in 11 (55%) and site landline in 9 (45%). Compared with patients enrolled in prior studies employing standard in-hospital consent, prehospital consent procedures reduced time from paramedic arrival on-scene to start of study agent (26 vs 139 mins, p < 0.0001), and did not prolong the on-scene to ED arrival time (37 vs 34 min, p = 0.50). No patient/family withdrew consent during the 3-month follow-up period. CONCLUSION: Physician phone elicitation of prehospital research consent from individuals with retained competency or on-scene legally authorized representatives is feasible, permits rapid patient study entry, and does not delay field transport times.

Biomedical Research↗
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Facilitating EMS turnaround intervals at hospitals in the face of receiving facility overcrowding.

The escalating national problem of oversaturated hospital beds and emergency departments (EDs) has resulted in serious operational impediments within patient-receiving facilities. It has also had a growing impact on the 9-1-1 emergency care system. Beyond the long-standing difficulties arising from ambulance diversion practices, many emergency medical services (EMS) crews are now finding themselves detained in EDs for protracted periods, unable to transfer care of their transported patients to ED staff members. Key factors have included a lack of beds or stretcher space, and, in some cases, EMS personnel are used transiently for ED patient care services. In other circumstances, ED staff members no longer prioritize rapid turnaround of EMS-transported patients because of the increasing volume and acuity of patients already in their care. The resulting detention of EMS crews confounds concurrent ambulance availability problems, creates concrete risks for delayed EMS responses to impending critical cases, and incurs regulatory jeopardy for hospitals. Communities should take appropriate steps to ensure that delivery intervals (time elapsing from entry into the hospital to physical transfer of patient care to ED staff) remain extremely brief (less than a few minutes) and that they rarely exceed 10 minutes. While recognizing that the root causes of these issues will require far-reaching national health care policy changes, EMS and local government officials should still maintain ongoing dialogues with hospital chief administrators to mitigate this mutual crisis of escalating service demands. Federal and state health officials should also play an active role in monitoring progress and compliance.

Bed Occupancy↗
PubMedDate not supplied

The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field.

OBJECTIVE: To develop and retrospectively analyze an instrument that rapidly characterizes pretreatment stroke severity for use in prehospital acute stroke clinical trials. METHODS: The Los Angeles Motor Scale (LAMS) was constructed by assigning point values to Los Angeles Prehospital Stroke Screen (LAPSS) items of facial weakness, arm strength, and grip to yield a total 0-5 scale. The concurrent, discriminant, and predictive validities of the LAMS were probed using data from 90 patients enrolled in acute stroke clinical trials. Predictive performance of the LAMS was compared with that of the initial full National Institutes of Health Stroke Scale (NIHSS) and the five-item shortened NIHSS (sNIHSS) in projecting long-term outcomes on standard functional end points. RESULTS: LAMS score at entry averaged mean 2.6, median 2. Entry LAMS scores correlated closely with entry NIHSS scores (r=0.75). LAMS score correlations with three-month functional outcome measures were robust. Receiver operator curve analyses (c statistic) for performance in predicting three-month outcomes were: three-month modified Rankin-LAMS 0.75, sNIHSS 0.69, NIHSS 0.74; three-month Barthel Index-LAMS 0.77, sNIHSS 0.76, NIHSS 0.82; three-month NIHSS-LAMS 0.76, sNIHSS 0.62, NIHSS 0.70; and three-month GOS-LAMS 0.55, sNIHSS 0.67, NIHSS 0.76. Considering dichotomized three-month measures, entry LAMS scores were markedly lower in patients destined for excellent outcome, e.g., three-month modified Rankin score<or=1, mean entry LAMS score 2.2 versus 3.7, p=.0002. CONCLUSIONS: A motor score derived from the LAPSS rapidly quantifies stroke severity in the field and predicts functional outcomes with accuracy comparable to that of the full NIHSS and the sNIHSS.

Adult↗