In an accompanying editorial in the December 17 JAMA , Thomas H. Lee, M.D., M.Sc., and Herbert L. Cooper, M.D., from Partners Community HealthCare, Inc., Boston, Mass., write that the Ottawa Knee Rule joins only a handful of guidelines that have been prospectively proven valid and that have also undergone an economic and clinical evaluation as they were implemented. They write that physicians often ignore guidelines because few guidelines have been shown to have a beneficial impact on patient care, because many are sent in the mail in the form of flowsheets and reprints without introduction or endorsement from someone they know, and because many guidelines don't allow physicians to use their own judgment. Lee and Cooper add that while a decrease in the proportion of patients undergoing knee radiography will not save the health care system from its current financial pressures, a broader application of some of the principals used to teach the Ottawa Knee Rule might. W. Douglas Weaver, M.D., of the Heart and Vascular Institute, Henry Ford Health System, in Detroit, Mich., and colleagues examined 10 randomized trials conducted from January 1985 through March 1996. Angioplasty uses a balloon to widen narrowed coronary arteries.
Thrombolytic therapy uses drugs to dissolve blood clots.
Unless the procedural success rates and outcomes for angioplasty are equivalent to those reported in these trials, there may be little advantage over thrombolytic therapy. These might include the relatively short follow-up period, and that fact that PTCA patients were discharged from the hospital sooner than those receiving thrombolytic therapy. His colleagues have received grants from Guidant, Genentech, Scitech, Glaxo-Wellcome, Merck, and DuPont Corporation. Colleague Amadeo Betriu, M.D., serves as an Advisory Board Member for Bard-USCI Boston Scientific. Dr. Yusuf is supported by a Medical Research Council of Canada Scientist Award.