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Low risk ACS

Paul I Musey, John A Lee, Cassandra A Hall, Jeffrey A Kline
BACKGROUND: Approximately 80% of patients presenting to emergency departments (ED) with chest pain do not have any true cardiopulmonary emergency such as acute coronary syndrome (ACS). However, psychological contributors such as anxiety are thought to be present in up to 58%, but often remain undiagnosed leading to chronic chest pain and ED recidivism. METHODS: To evaluate ED provider beliefs and their usual practices regarding the approach and disposition of patients with low risk chest pain associated with anxiety, we constructed a 22-item survey using a modified Delphi technique...
March 14, 2018: BMC Emergency Medicine
Timothy Feeney, Manuel Castillo-Angeles, John W Scott, Stephanie L Nitzschke, Ali Salim, Adil H Haider, Joaquim M Havens
BACKGROUND: Emergency general surgery (EGS) is an independent risk factor for morbidity and mortality, and seven procedures account for 80% of the National burden of operative EGS. We aimed to characterize the excess morbidity and mortality attributable to these procedures based on the level of procedural risk. METHODS: Retrospective analysis of the ACS National Surgical Quality Improvement Project (ACS-NSQIP) database. (2005-2014). Seven EGS procedures were stratified as high risk and low risk...
March 7, 2018: American Journal of Surgery
Phillip M Mitchell, Cory A Collinge, David E O'Neill, Jesse E Bible, Hassan R Mir
OBJECTIVES: To determine whether sarcopenia is an independent predictor of mortality in geriatric acetabular fractures. DESIGN: Retrospective cohort. SETTING: ACS Level I trauma center. PATIENTS/PARTICIPANTS: One hundred and forty-six patients over the age 60 with acetabular fractures treated at our institution over a 12-year period. MAIN OUTCOME MEASUREMENTS: The primary outcome was 1-year mortality, collected using the Social Security Death Index...
March 5, 2018: Journal of Orthopaedic Trauma
C Helten, D Naguib, L Dannenberg, M Pöhl, A Ayhan, T Hohlfeld, B Levkau, M Kelm, T Zeus, A Polzin
BACKGROUND: High on-treatment platelet reactivity (HTPR) to antiplatelet medication leads to ischemic events, while low on-treatment platelet reactivity (LTPR) increases bleeding risk. However, various trials failed to demonstrate superiority of tailored antiplatelet regimes (ARCTIC, ANTARCTIC, Trigger-PCI, GRAVITAS). TROPICAL-ACS was the first study that proved benefit of tailoring antiplatelet medication according to platelet function analyzing. A potential reason may be that different platelet function assays were used in these trials...
March 7, 2018: Journal of Thrombosis and Haemostasis: JTH
Kimberley Jacobs, Molly Posa, Whitney Spellicy, Jaclyn Otero, Maria Kelly
BACKGROUND: Pediatric exposure to influenza-infected adult caregivers (AC) is a significant risk factor for developing influenza. Poor access to vaccines contributes to low adult vaccination rates. We offered adult vaccination at regularly scheduled pediatric office visits and examined barriers to improve future vaccination rates. METHODS: Via a retrospective chart review, we identified ACs who received an influenza vaccination at one of three pediatric clinics within an academic center from August 2015 to May 2016...
March 2, 2018: Pediatric Infectious Disease Journal
Marcie Fisher-Borne, Alexander J Preiss, Molly Black, Kate Roberts, Debbie Saslow
OBJECTIVE: Human papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings...
March 2018: Academic Pediatrics
Thomas Moumneh, Vanessa Richard-Jourjon, Emilie Friou, Fabrice Prunier, Caroline Soulie-Chavignon, Jacques Choukroun, Betty Mazet-Guilaumé, Jérémie Riou, Andréa Penaloza, Pierre-Marie Roy
In patients consulting in the Emergency Department for chest pain, a HEART score ≤ 3 has been shown to rule out an acute coronary syndrome (ACS) with a low risk of major adverse cardiac event (MACE) occurrence. A negative CARE rule (≤ 1) that stands for the first four elements of the HEART score may have similar rule-out reliability without troponin assay requirement. We aim to prospectively assess the performance of the CARE rule and of the HEART score to predict MACE in a chest pain population. Prospective two-center non-interventional study...
March 2, 2018: Internal and Emergency Medicine
Marcello Arca, David Ansell, Maurizio Averna, Francesca Fanelli, Katherine Gorcyca, Şerban R Iorga, Aldo P Maggioni, Georges Paizis, Radovan Tomic, Alberico L Catapano
BACKGROUND AND AIMS: Statin utilization and lipid goal achievement were estimated in a large sample of Italian patients at high/very-high cardiovascular (CV) risk. METHODS: Patients aged ≥18 years with a valid low-density lipoprotein cholesterol (LDL-C) measurement in 2015 were selected from the IMS Health Real World Data database; non-high-density lipoprotein cholesterol (non-HDL-C) was assessed in those with available total cholesterol measurements. Index dates were defined as the last valid lipid measurement in 2015...
February 17, 2018: Atherosclerosis
X Y Zhao, J X Li, X F Tang, J J Xu, Y Song, H H Wang, L J Xu, J Chen, Y Zhang, L Song, L J Gao, S B Qiao, Y J Yang, R L Gao, B Xu, J Q Yuan
Objective: To evaluate the prognostic value of Global Registry of Acute Coronary Events(GRACE) discharge score for long-term out-of-hospital death in acute coronary syndrome (ACS) after drug-eluting stents (DES) and with Dual-antiplatelet Therapy (DAPT). Methods: Our study was a prospective, observational, single center (Fuwai Hospital of China) study.A total of 6 431consecutive ACS patients underwent percutaneous coronary intervention(PCI)between January 2013 and December 2013 were involved.The primary endpoint was all-cause death and second endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of all-cause death, myocardial infarction, revascularization, stent thrombosis or stroke...
February 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Megan Christine Kaszuba, Lee Ang Tan, Roham Moftakhar, Manish Kumar Kasliwal
Intracranial arachnoid cysts (ACs) are relatively common findings that can be seen in up to 2% of patients. They are generally found incidentally with a benign clinical course and can be usually managed by observation. We report an unusual case of a middle fossa AC presenting with spontaneous intracystic hemorrhage along with subdural hematoma (SDH) causing significant mass effect and midline shift requiring surgical treatment. Even though the risk of hemorrhage in patients with AC is very low, the presence of AC is a known risk factor for SDH...
January 2018: Asian Journal of Neurosurgery
Ming Fang, Qiaohui Qian, Zhihong Zhao, Luoning Zhu, Jinwen Su, Xinming Li
To investigate the combination of high-sensitivity C-reactive protein (hs-CRP) and Low-density lipoprotein (LDL)-C as the targets for statin treatment in patients with acute coronary syndrome (ACS). This single-center, prospective, randomized study was performed in 400 patients treated with atorvastatin 40 mg/day for 1 month and then with atorvastatin 20 mg/day as maintenance. The patients were randomized to the LDL group (LDL-C target of < 2.07 mmol/L according to the Chinese dyslipidemia guidelines) and to the LDL-CRP group (LDL-C target of < 2...
February 23, 2018: International Heart Journal
Madeline Lemke, Alyson Mahar, Paul J Karanicolas, Natalie G Coburn, Calvin H L Law, Julie Hallet
BACKGROUND: Risk of red blood cell transfusion (RBCT) in partial hepatectomy is 17-27%; strategies to reduce transfusions can be targeted in patients at increased risk. A Three Point Transfusion Risk Score (TRS) was previously developed to predict patients' risk of transfusion during and following hepatectomy. Here, it was subject to external validation using the ACS-NSQIP database. METHODS: TRIPOD guidelines were followed. A validation cohort was created with the ACS-NSQIP dataset...
February 16, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Stanislav Ryndin, Andrew Delozier, Michael Stanley
Acute compartment syndrome (ACS) is a diagnosis that requires high-clinical suspicion especially in cases when the initial causal event could be considered insignificant. We present a novel case presentation of ACS associated with minor trauma in a patient with a previous history of compartment syndrome in the same extremity from a motor vehicle accident 10 years prior to presentation. To the best of our knowledge, this is the first reported case of recurrent ACS. Due to the possibility of significant morbidity, including loss of limb, it is imperative to recognize the presentation quickly so proper surgical intervention can occur...
February 2018: Journal of Surgical Case Reports
Dustin G Mark, Jie Huang, Uli Chettipally, Mamata V Kene, Megan L Anderson, Erik P Hess, Dustin W Ballard, David R Vinson, Mary E Reed
BACKGROUND: Both the modified History, Electrocardiogram, Age, Risk factors and Troponin (HEART) score and the Emergency Department Assessment of Chest pain Score (EDACS) can identify patients with possible acute coronary syndrome (ACS) at low risk (<1%) for major adverse cardiac events (MACE). OBJECTIVES: The authors sought to assess the comparative accuracy of the EDACS (original and simplified) and modified HEART risk scores when using cardiac troponin I (cTnI) cutoffs below the 99th percentile, and obtain precise MACE risk estimates...
February 13, 2018: Journal of the American College of Cardiology
Karen L Tang, Louise Pilote, Hassan Behlouli, Jenny Godley, William A Ghali
BACKGROUND: Perception of low subjective social status (SSS) relative to others in society or in the community has been associated with increased risk of cardiovascular disease. Our objectives were to determine whether low SSS in society was associated with barriers to access to care or hospital readmission in patients with established cardiovascular disease, and whether perceptions of discordantly high SSS in the community modified this association. METHODS: We conducted a prospective cohort study from 2009 to 2013 in Canada, United States, and Switzerland in patients admitted to hospital with acute coronary syndrome (ACS)...
February 6, 2018: BMC Cardiovascular Disorders
James E Andruchow, Peter A Kavsak, Andrew D McRae
This article synthesizes current best evidence for the evaluation of patients with suspected acute coronary syndrome (ACS) using high-sensitivity troponin assays, enabling physicians to effectively incorporate them into practice. Unlike conventional assays, high-sensitivity assays can precisely measure blood cardiac troponin concentrations in the vast majority of healthy individuals, facilitating the creation of rapid diagnostic algorithms. Very low troponin concentrations on presentation accurately rule out acute myocardial infarction (AMI) and enable the discharge of approximately 20% of patients after a single test, whereas an additional 30%-40% of patients can be safely discharged after short-interval serial sampling in as little as 1 or 2 hours...
February 2018: Canadian Journal of Cardiology
Anne M Stey, Charles D Vinocur, R Lawrence Moss, Bruce L Hall, Mark E Cohen, Kari Kraemer, Clifford Y Ko, Brian D Kenney, Loren Berman
BACKGROUND: This study aimed to determine whether (1) the propensity for concurrent fundoplication during gastrostomy varies among hospitals, and (2) postoperative morbidity differs among institutions performing fundoplication more or less frequently. METHODS: Children who underwent gastrostomy with or without concurrent fundoplication were identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS-NSQIP-P). A hierarchical multivariate regression modeled the excess effects that hospitals exerted over propensity for concurrent fundoplication adjusting for preoperative clinical variables...
February 5, 2018: Surgical Endoscopy
Issa Pour-Ghaz, Tamunoinemi Bob-Manuel, Hemnishil K Marella, Jayna Kelly, Amit Nanda, William Paul Skelton, Rami N Khouzam
One of the major issues in management of the acute coronary syndrome (ACS) is classification of patients with atypical presentation who have low risk of having a coronary episode at presentation. There have been multiple studies on the stratification of high risk patients and medical management of such cases, however, there is a sub-class of patients who do not fit any category. In this paper, we have looked at the current literature on stratification of patients based on the study tools available and the risk of having a coronary episode during the following year...
January 2018: Annals of Translational Medicine
Daisuke Watanabe, Akio Horiguchi, Shinsuke Tasaki, Kenji Kuroda, Akinori Sato, Junichi Asakuma, Keiichi Ito, Tomohiko Asano
Although obesity defined by a high body mass index (BMI) is generally associated with increased risk of renal cell carcinoma (RCC), low BMI has paradoxically been associated with increased tumor aggressiveness and poor prognosis. As anorexia-cachexia syndrome (ACS) is associated with decreased BMI and is frequently observed in patients with advanced RCC, the present study investigated the association of BMI with tumor aggressiveness and prognosis in RCC in relation to ACS. The association of BMI with clinicopathological parameters was analyzed in 503 consecutive patients who underwent surgery for RCC...
January 2018: Molecular and Clinical Oncology
Dmitry Zavlin, Kevin T Jubbal, Anthony Echo, Shayan A Izaddoost, Jeffrey D Friedman, Olushola Olorunnipa
Mandibular fractures are rare, most commonly occurring in young male patients who present with facial trauma. The etiology, incidence, and presentation vary among previous publications depending on cultural and socioeconomic factors of the region of origin. This multi-institutional study aims to present demographic characteristics, surgical treatment, and clinical outcomes of surgical repair of mandible fractures in the United States. An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) adult databases of the years 2006 through 2014 was performed identifying 940 patients with an International Classification of Diseases, version 9 (ICD-9) diagnosis of either closed or open fracture of the mandible...
March 2018: Craniomaxillofacial Trauma & Reconstruction
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