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Samir Patel

Publications and source records attributed to Samir Patel.

8 recordsLinked to original sources
PubMed2004

Impact of contemporary guideline compliance on risk stratification models for acute coronary syndromes in The Registry of Acute Coronary Syndromes.

We compared the predictive value of the Rush score with the Thrombolysis In Myocardial Infarction (TIMI) risk score in unselected patients with an acute coronary syndrome and evaluated the effect of compliance with established guidelines on the accuracy of these models. The Registry of Acute Coronary Syndromes is a retrospective registry of 3,754 consecutive patients (38% women; mean age 67 years) who presented with acute coronary syndrome to the emergency department between April 1, 1999, and December 31, 2000, at 9 hospitals. The primary end point was death, myocardial infarction, or urgent revascularization during hospitalization. Rush classification was based on quartiles of predicted risk of cardiac complication (<2% for class I vs >15% for class IV). The TIMI score was implemented as published. Compliance with guidelines for acute coronary syndrome was assessed with a 4-point scale based on the aggregate use of aspirin, beta blockers, heparin, and glycoprotein IIb/IIIa inhibitors. Fifteen percent of patients met the primary end point. The primary end point rates for TIMI scores 0/1, 2, 3, 4, 5, and 6/7 were 11%, 14%, 13%, 11%, 14%, and 12%, respectively (p = NS). The primary end point rates for Rush classes I, II, III, and IV were 6%, 8%, 9%, and 17%, respectively (p <0.001). After controlling for compliance with established guidelines, the odds ratio of an event increased by 46% for each unit increase in Rush score (p <0.001). After adjusting for the Rush score, the odds ratio decreased by 54% for each unit increase in compliance (p <0.001). Thus, compliance with current American College of Cardiology/American Heart Association guidelines significantly improves prognosis, regardless of the risk score. The use of established risk scores may overestimate event rates in unselected populations.

Adrenergic beta-Antagonists↗
PubMed2004

Role of surrogate markers in assessing patients with diabetes mellitus and the metabolic syndrome and in evaluating lipid-lowering therapy.

Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients with diabetes because of early detection of subclinical cardiovascular disease and active monitoring of the effectiveness of therapy. Surrogate markers of subclinical disease include conventional and contrast-enhanced ultrasound imaging of carotid artery intima-media thickness (c-IMT), 2-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, and brachial artery reactivity testing. Because these noninvasive imaging tools are relatively comfortable and entail relatively low risk to the patient, they are ideal for initial screening and for the repeated imaging that is required for monitoring the effectiveness of therapy. Moreover, when used in large numbers of patients with diabetes, prediabetes, and the MS, these imaging tools may be useful in developing and validating thresholds for the use of lipid-lowering therapy as well as clear therapeutic goals for this population. In addition, contrast-enhanced c-IMT scans now produce real-time images of the vasa vasorum and neovascularization of atherosclerotic plaque, potentially causing a paradigm shift in our view of the genesis of atherosclerosis and affecting treatment options for all populations. Thus, surrogate markers may not only help improve individual patient outcomes, they also may help direct scarce medical resources to maximize medical benefits, improve overall medical care, and minimize costs and untoward side effects.

Adult↗
PubMed2004

Three new tools for parathyroid surgery: expensive and unnecessary?

BACKGROUND: The intraoperative quick parathyroid hormone assay, the intraoperative gamma probe, and endoscopic parathyroidectomy are three very new techniques developed to facilitate parathyroid surgery. Some hospitals do not have the necessary equipment, and many, like ours, continue to operate in the time-honored way. STUDY DESIGN: We performed a retrospective chart review of 34 such operations, done with the use of Sestamibi scans, but entirely without the newer modalities. RESULTS: Four-gland exploration was carried out on all patients. Operative times ranged from 15 to 165 minutes, with a mean of 47 minutes, and incision lengths ranged from 2 to 3 cm, with a mean of 2.8 cm. There was no mortality, no reoperation, and no vocal cord or recurrent laryngeal nerve injury. Our cure rate was 100%, as determined by a fall in postoperative calcium and parathormone levels. CONCLUSIONS: In our view, the intraoperative parathyroid hormone assay, gamma probe, and endoscopic parathyroidectomy add an entirely unnecessary cost to an operation that can be completed satisfactorily with a preoperative Sestamibi scan and a thorough four-gland exploration.

Adult↗
PubMed2003

A molecular surveillance system for global patterns of drug resistance in imported malaria.

Analysis of imported malaria in travelers may represent a novel surveillance system for drug-resistant malaria. We analyzed consecutive falciparum malaria isolates from Canadian travelers from 1994 to 2000, for polymorphisms in pfcrt, dhfr, and dhps linked to chloroquine and pyrimethamine/sulfadoxine resistance. Forty percent of isolates possessed the K76 pfcrt allele, suggesting that many imported falciparum infections are still responsive to chloroquine. Travelers who had recently taken chloroquine had a significantly increased risk of harboring isolates with pfcrt resistance alleles (odds ratio = 4.47; p=0.03). The presence of two or more mutations in dhfr or dhps was found in 64.8% (95% confidence interval [CI] 54.6 to 73.9) and in 30.4% (95% CI 21.7 to 40.3) of isolates, respectively, and increased significantly over the course of the study. These molecular markers indicate that pyrimethamine/sulfadoxine resistance is increasing and is now too high to rely on this drug as a routine therapeutic agent to treat malaria in travelers.

Adolescent↗
PubMed2002

Outcomes of referrals to the ED by family physicians.

Patients are commonly referred to the emergency department (ED) by family physicians (FPs). This study was undertaken to determine the outcome of these referred patients. A prospective cohort study of 196 patients referred by FPs to the ED of an urban, tertiary referral center was performed. Key outcome measures were the rate at which investigations or interventions were performed, consultation and admission rates, and the percentage of referrals that were appropriate. Comparison was made with a random cohort of non-referred patients. Information was collected from a questionnaire completed by the emergency physician and by chart review. Eighty-six percent of patients referred to the ED had some sort of investigation or intervention performed, which was significantly higher than the 66.7% rate in non-referred patients (P <.001). Twenty-nine percent of referred patients received a consultation in the ED compared with 16.4% of non-referred patients (P <.01), and 16.0% were admitted to hospital compared with 10.0% in the non-referred group (P <.10). By using the process of care method, 75.5% of referrals by FPs to the ED were appropriate. Family physicians are quite selective in their referrals to the ED. There is a high rate of admission and specialist consultation for referred patients. The vast majority of patients who are referred receive at least 1 investigation or intervention in the ED, and most referrals are appropriate.

Adolescent↗
PubMedDate not supplied

Postoperative home visits?

PURPOSE: Because most surgery patients now recover at home rather than in the hospital, we wanted to determine whether postoperative home visits by the operating surgeon would improve medical outcomes, and whether this innovation would strengthen resident training. METHODS: A surgeon who had performed 347 procedures during a 7-month period attempted to do a home visit to each patient within 48 hours after surgery. RESULTS: Many patients had to be disqualified for various reasons, leaving 143 candidates. Of these, 44 declined to be seen, and others could not be located, so that 82 were actually visited. There were no readmissions, and no findings that might have altered the course of postoperative treatment. CONCLUSIONS: These visits seemed to reinforce patient-physician relationships, but they did not influence medical outcomes. It was felt that a phone call would probably have done as well. In addition, because of new regulations governing resident working hours, it did not appear that this was a feasible educational experience.

General Surgery↗