Clinical Transformation Through Change Management Case Study: Chest Pain in the Emergency Department.

Introduction/background: Adults with chest pain presenting to an emergency department are high-risk and high-volume. A methodology which gathers practicing physicians together to review evidence and share practice experience to formulate a written algorithm with key decision points and measures is discussed with implementation, based on change management principles, and results.

Methods: A methodology was followed to "establish the standard-of-care".

Safety and efficacy of internal mammary artery grafts for left main coronary artery disease. A preliminary report.

Questions regarding the relative safety and efficacy of internal mammary artery (IMA) grafts versus saphenous vein grafts (SVG) in patients with left main coronary artery disease (LMCAD) have not been specifically addressed in the literature. To elucidate this point, we analyzed 196 patients with LMCAD who underwent myocardial revascularization between January 1975 and December 1981, 98 by IMA and SVG and 98 by SVG, IMA was used most often to bypass the left anterior descending (LAD). Chi Square and "t" tests were performed on all demographic, cardiac and operative data comparing IMA to SVG.

Coronary bypass for left main disease in patients over 70 years of age.

Seventy-one consecutive patients over 70 years of age underwent isolated coronary bypass surgery for left main coronary artery (LMCA) disease between September 1975 and December 1982. All patients had angina; 6% were in NYHA functional class II, 30% class III, and 64% class IV. Intravenous nitroglycerin was required in 25% of patients.