No abstract

Using a prospectively collected database of patients undergoing cardiac catheterization, we sought to compare the outcomes of procedures performed by supervised physician assistants (PAs) with those performed by supervised cardiology fellows-in-training. Outcome measures included procedural length, fluoroscopy use, volume of contrast media, and complications including myocardial infarction, stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema requiring intubation, and vascular complications. Class 3 and 4 congestive heart failure was more common in patients who underwent procedures by fellows compared with those undergoing procedures by PAs (P = 0.001). PA cases tended to be slightly faster (P = 0.05) with less fluoroscopic time (P < 0.001). The incidence of major complications within 24 hr of the procedure was similar between the two groups (0.54% in PA cases and 0.58% in fellow cases). Under the supervision of experienced attending cardiologists, trained PAs can perform diagnostic cardiac catheterization, including coronary angiography, with complication rates similar to those of cardiology fellows-in-training.

In an effort to define the role that substance abuse has to play in head injuries, a prospective study of 204 patients presenting to the Accident and Emergency (A&E) Department over a 10-week period was carried out. Urine samples were collected and assayed for the presence of common drugs of abuse and alcohol. One or other substance (drugs or alcohol) was detected in 43% of patients. The association between alcohol and head injuries has been confirmed and the importance of drugs in this area has been addressed and found to be of some significance. More rapid and accurate methods of assaying these substances may improve our management of head injury patients.