Showing papers by "Lee Goldman published in 1981"
TL;DR: The easily administered Specific Activity Scale was equally reproducible and valid when used by a nonphysician and was especially better than the other systems for the evaluation of true class II patients and was significantly less likely to underestimate treadmill performance.
Abstract: Reproducibility and validity are prerequisites for a useful clinical scale. We therefore prospectively tested the reproducibility and validity of the New York Heart Association criteria and the Canadian Cardiovascular Society criteria for the assessment of cardiac functional class and compared these criteria with a new Specific Activity Scale based on the metabolic costs of specific activities. The New York Heart Association estimates made by two physicians had a reproducibility of only 56%, and only 51% of the estimates agreed with treadmill exercise performance. Functional estimates based on the Canadian Cardiovascular Society criteria were significantly more reproducible (73%), but not significantly more valid. The Specific Activity Scale was as reproducible as the Canadian Cardiovascular Society criteria, and its 68% validity was significantly higher than the validities of the other systems. The easily administered Specific Activity Scale was equally reproducible and valid when used by a nonphysician. It was especially better than the other systems for the evaluation of true class II patients and was significantly less likely to underestimate treadmill performance. Although no set of questions can perfectly predict exercise tolerance, the Specific Activity Scale deserves wider prospective testing.
936 citations
TL;DR: Continuation of propranolol up to the time of surgery appears safe from an anesthetic standpoint and may also help to postpone the risk of the withdrawal rebound syndrome until after oral propr ethanol therapy can be reinstituted.
Abstract: • Signs consistent with the propranolol withdrawal rebound syndrome may occur when propranolol hydrochloride administration is temporarily discontinued because of major noncardiac surgical procedures. The time course of the appearance of these signs indicates that the risk of the propranolol withdrawal rebound syndrome peaks about four to seven days after drug discontinuation. Continuation of propranolol up to the time of surgery appears safe from an anesthetic standpoint and may also help to postpone the risk of the withdrawal rebound syndrome until after oral propranolol therapy can be reinstituted. (Arch Intern Med141:193-196, 1981)
52 citations
TL;DR: To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients from the data bank.
Abstract: • To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients (OMP) from the data bank. The faculty cardiologists' original estimates proved to be as accurate as those of the data bank's OMP, and the faculty revised their estimates minimally in response to the data bank's OMP. Conversely, the cardiology fellows' original estimates were less accurate than the data bank's OMP, and under all observed circumstances the fellows responded more to the data bank's OMP than did the faculty. As a result, the accuracy of the fellows' final estimates was similar to the accuracies of both the faculty cardiologists and the data bank's OMP. Computerized data banks seem more likely to have impact when their information is provided to physicians who are relatively inexperienced with the disease in question. (Arch Intern Med1981;141:1631-1634)
23 citations
TL;DR: It is concluded that both patient and physician characteristics influence the adequacy of anemia evaluations and that objective audits may be a useful adjunct to the usual subjective methods for evaluating house officers' performances.
Abstract: • To determine the correlates of the adequacy of the diagnostic evaluation of anemia, we conducted a prospective study on the medical services of a university-affiliated hospital. With the use of explicit criteria mapping techniques, the conditions of 204 (79%) anemic inpatients were adequately evaluated. By multiple regression analysis, the adequacy of evaluation showed significant correlations with the identity of the responsible house officer, the severity of the anemia, the patient's sex, and the service in which the patient received care. The performances of individual house officers were not significantly correlated with their subjective rankings by either their supervising residents or their attending faculty; however, a composite subjective ranking derived from the average of these two subjective rankings did correlate with objective performance in the anemia audit. We conclude that both patient and physician characteristics influence the adequacy of anemia evaluations and that objective audits may be a useful adjunct to the usual subjective methods for evaluating house officers' performances. ( Arch Intern Med 1981;141:1199-1202)
8 citations