Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.

Decision makers in health care are increasingly interested in using high-quality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidence-based knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers.

The development and role of predictive instruments in acute coronary events: improving diagnosis and management.

The diagnosis and management of acute myocardial infarction and unstable angina pectoris are frequent challenges for emergency department staff. Strategies must quickly and accurately identify all patients requiring admission, monitoring, and reperfusion therapy to maximize outcomes without overdiagnosing. The Acute Cardiac Ischemia Time-Insensitive Predictive Instrument and the Thrombolytic Predictive Instrument are two decision-support tools designed to address this need.