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https://www.readbyqxmd.com/read/28987133/implementing-change-evaluating-the-accelerated-chest-pain-risk-evaluation-acre-project
#1
William A Parsonage, Tanya Milburn, Sarah Ashover, Wade Skoien, Jaimi H Greenslade, Louise McCormack, Louise Cullen
OBJECTIVE: To evaluate hospital length of stay (LOS) and admission rates before and after implementation of an evidence-based, accelerated diagnostic protocol (ADP) for patients presenting to emergency departments (EDs) with chest pain. DESIGN: Quasi-experimental design, with interrupted time series analysis for the period October 2013 - November 2015. Setting, participants: Adults presenting with chest pain to EDs of 16 public hospitals in Queensland. INTERVENTION: Implementation of the ADP by structured clinical re-design...
August 4, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28987132/improved-assessment-of-chest-pain-trial-impact-assessing-patients-with-possible-acute-coronary-syndromes
#2
Louise Cullen, Jaimi H Greenslade, Tracey Hawkins, Chris Hammett, Shanen O'Kane, Kimberley Ryan, Kate Parker, Jessica Schluter, Emily Dalton, Anthony Ft Brown, Martin Than, W Frank Peacock, Allan Jaffe, Peter K O'Rourke, William A Parsonage
OBJECTIVE: To examine the safety and efficacy of the Improved Assessment of Chest pain Trial (IMPACT) protocol, a strategy for accelerated assessment of patients presenting to emergency departments (EDs) with chest pain. DESIGN, SETTING AND PARTICIPANTS: IMPACT was an intervention trial at a single tertiary referral hospital (Royal Brisbane and Women's Hospital) during February 2011 - March 2014. 1366 prospectively recruited patients presenting to the ED with symptoms of suspected acute coronary syndrome (ACS) were stratified into groups at low, intermediate or high risk of an ACS...
August 4, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28975819/surgical-and-clinical-decision-making-in-isolated-long-thoracic-nerve-palsy
#3
Shelley S Noland, Emily M Krauss, John M Felder, Susan E Mackinnon
BACKGROUND: Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. METHODS: In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed...
October 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28969808/management-of-atraumatic-posterior-interosseous-nerve-palsy
#4
REVIEW
Kohila Vani Sigamoney, Abbas Rashid, Chye Yew Ng
The posterior interosseous nerve (PIN) is susceptible to a number of traumatic and atraumatic pathologies. In this article, we aim to review our current understanding of the etiology, pathology, diagnosis, treatment options, and published outcomes of atraumatic PIN palsy. In general, the etiology of atraumatic PIN palsy can be divided into mechanical, which is caused by an extrinsic compressive force on the nerve, and nonmechanical, which is caused by an intrinsic inflammatory reaction within the nerve. As per this discussion, there are 3 causes for atraumatic PIN palsy...
October 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28967259/solid-state-nanopore-analysis-of-diverse-dna-base-modifications-using-a-modular-enzymatic-labeling-process
#5
Fanny Wang, Osama K Zahid, Brandi Swain, Derek Parsonage, Thomas Hollis, Scott Harvey, Dr Fred Perrino, Rahul M Kohli, Ethan W Taylor, Adam R Hall
Many regulated epigenetic elements and base lesions found in genomic DNA can both directly impact gene expression and play a role in disease processes. However, due to their non-canonical nature, they are challenging to assess with conventional technologies. Here, we present a new approach for the targeted detection of diverse modified bases in DNA. We first use enzymatic components of the DNA base excision repair pathway to install an individual affinity label at each location of a selected modified base with high yield...
October 2, 2017: Nano Letters
https://www.readbyqxmd.com/read/28956267/acute-shoulder-pain-followed-by-shoulder-weakness-and-atrophy-a-characteristic-presentation-of-parsonage-turner-syndrome
#6
Sneha Sundaram, Ingeborg Schafhalter-Zoppoth
No abstract text is available yet for this article.
September 27, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28926848/-parsonage-turner-syndrome-case-report
#7
Alexander Katzer, Wolf-Peter Niedermauntel, Jörg Rump
Neuralgic amyotrophy of the shoulder (Parsonage-Turner syndrome) is a rare condition of unknown aetiology which manifests as acute neuropathy of the brachial plexus. Diagnosis is based on typical symptoms and physical examination. In addition, magnetic resonance imaging of the affected shoulder and the cervical spine is advisable, in order to distinguish this syndrome from other conditions with similar symptoms. There is no specific treatment for neuralgic amyotrophy, but in about 50 - 67% of cases complete recovery occurs within two to three years, depending on the severity of the symptoms when they first appear...
September 19, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28884231/infant-brachial-neuritis-following-a-viral-prodrome-a-case-in-a-6-month-old-child-and-review-of-the-literature
#8
Oliver D Mrowczynski, Sara T Langan, Elias B Rizk
INTRODUCTION: Brachial neuritis, commonly known as Parsonage-Turner syndrome, affects two to three people per 100,000 and presents with pain and weakness of the arm and shoulder. Brachial neuritis is uncommon in infants. METHODS: Here, we present the case of a 6-month old female, who presented with right upper extremity weakness and paresis following a viral prodrome. We also present a summary of all reported cases of brachial neuritis in infants. RESULTS: This is the youngest case of brachial neuritis diagnosed at our institution...
September 7, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28864718/assessment-of-the-2016-national-institute-for-health-and-care-excellence-high-sensitivity-troponin-rule-out-strategy
#9
Edward Watts Carlton, John William Pickering, Jaimi Greenslade, Louise Cullen, Martin Than, Jason Kendall, Richard Body, William A Parsonage, Ahmed Khattab, Kim Greaves
OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK...
September 1, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28853127/winging-of-the-scapula-diagnosed-as-parsonage-turner-syndrome-a-case-report
#10
Christine Carroll, Bill Bass
A 24-year-old active duty female Soldier complained of right shoulder burning, stinging, electrical shock-like pain with radiation to the right hand after completing a ruck march. She also complained of swelling and feelings of her cold right hand. Examination showed a deficit in the deltoid, upper trapezius, supraspinatus, and also right winging of the scapula. She also exhibited weakness to right arm, weak right hand grip, and decreased sensation over the dorsal right hand. The right hand was also noticed to be colder to touch than the left one...
July 2017: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/28843779/endogenous-regulatory-cysteine-sulfenylation-of-erk-kinases-in-response-to-proliferative-signals
#11
Jeremiah D Keyes, Derek Parsonage, Rama D Yammani, LeAnn C Rogers, Chelsea Kesty, Cristina M Furdui, Kimberly J Nelson, Leslie B Poole
ERK-dependent signaling is key to many pathways through which extracellular signals are transduced into cell-fate decisions. One conundrum is the way in which disparate signals induce specific responses through a common, ERK-dependent kinase cascade. While studies have revealed intricate ways of controlling ERK signaling through spatiotemporal localization and phosphorylation dynamics, additional modes of ERK regulation undoubtedly remain to be discovered. We hypothesized that fine-tuning of ERK signaling could occur by cysteine oxidation...
November 2017: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/28759527/18f-fdg-uptake-in-parsonage-turner-syndrome
#12
Gary Sem Wye Yoong, Arvind Kumar Sinha, Lih Kin Khor, Yazeed Nasser Bin Dous, James Thomas Patrick Decourcy Hallinan
A 55-year-old man with large B-cell lymphoma developed atraumatic left shoulder pain. F-FDG PET/CT revealed new left supraspinatus and infraspinatus muscle uptake while the initial disease resolved. Given the discrepancy between initial disease treatment response and new left shoulder findings, an MRI scan was performed. This demonstrated diffuse supraspinatus and infraspinatus muscle edema and enhancement with no focal lesion. Muscle biopsy was negative for lymphoma, but features of muscle denervation were seen...
October 2017: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/28739618/atypical-presentation-of-parsonage-turner-syndrome-confounded-by-surgical-rotator-cuff-injury
#13
Dustin Adam Greenhill, Hesham Abdelfattah, Joseph S Torg, Joseph Milo Sewards
Parsonage-Turner syndrome (PTS) is a rare neuropathy that commonly presents as unexpected severe shoulder and arm pain that eventually subsides while weakness or paralysis ensues. During exceptions to this classic presentation, confirming PTS can be challenging. Alternative causes of upper extremity pain may confound the diagnostic algorithm. Moreover, objective findings from necessary diagnostic tests depend on when those tests are performed. We present an atypical onset of PTS, whereby the initial presentation of severe neuropathic pain was preceded by mild shoulder pain that should decrease one's clinical suspicion for PTS...
July 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28665875/neuralgic-amyotrophy-attributed-incorrectly-to-block-related-injury-understanding-errors-in-clinical-reasoning
#14
Joseph M Neal, Susan S Porter, Barry P Wilson
OBJECTIVE: We report a case of misdiagnosed neuralgic amyotrophy (brachial plexus neuritis, Parsonage-Turner syndrome). Our primary objective is to review the scientific basis for errors in clinical reasoning. CASE REPORT: We herein report a patient in whom signs and symptoms compatible with neuralgic amyotrophy presented after shoulder surgery. The patient's brachial plexopathy was attributed incorrectly as a complication of interscalene brachial plexus block. The true diagnosis was made only after the patient developed neuralgic amyotrophy in the contralateral upper extremity after a subsequent shoulder surgery on that side, this time without a brachial plexus block...
September 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28601817/the-organisational-value-of-diagnostic-strategies-using-high-sensitivity-troponin-for-patients-with-possible-acute-coronary-syndromes-a-trial-based-cost-effectiveness-analysis
#15
Paul Jülicher, Jaimi H Greenslade, William A Parsonage, Louise Cullen
OBJECTIVES: To evaluate hospital-specific health economic implications of different protocols using high-sensitivity troponin I for the assessment of patients with chest pain. DESIGN: A cost prediction model and an economic microsimulation were developed using a cohort from a single centre recruited as part of the (ADAPT) trial, a prospective observational trial conducted from 2008 to 2011. The model was populated with 40 000 bootstrapped samples in five high-sensitivity troponin I-enabled algorithms versus standard care...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28578913/cardiac-troponin-and-exercise-still-much-to-learn
#16
EDITORIAL
W A Parsonage, L Ruane
No abstract text is available yet for this article.
July 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28574204/rational-clinical-evaluation-of-suspected-acute-coronary-syndromes-the-value-of-more-information
#17
David G Hancock, Ming-Yu Anthony Chuang, Rebecca Bystrom, Amera Halabi, Rachel Jones, Matthew Horsfall, Louise Cullen, William A Parsonage, Derek P Chew
OBJECTIVE: Many meta-analyses have provided synthesised likelihood ratio data to aid clinical decision-making. However, much less has been published on how to safely combine clinical information in practice. We aimed to explore the benefits and risks of pooling clinical information during the ED assessment of suspected acute coronary syndrome. METHODS: Clinical information on 1776 patients was collected within a randomised trial conducted across five South Australian EDs between July 2011 and March 2013...
June 2, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#18
MULTICENTER STUDY
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John W Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
July 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28439773/parsonage-turner-syndrome-due-to-autochthonous-acute-genotype-3f-hepatitis-e-virus-infection-in-a-nonimmunocompromised-55-year-old-patient
#19
A Velay, W Kack-Kack, F Abravanel, S Lhomme, P Leyendecker, L Kremer, P Chamouard, J Izopet, S Fafi-Kremer, H Barth
Hepatitis E virus (HEV) infection is an emerging autochthonous disease in industrialized countries. Extra-hepatic manifestations, in particular neurologic manifestations, have been reported in HEV infection. Only a few cases of hepatitis E-associated Parsonage-Turner syndrome have been reported, and HEV genotypes were rarely determined. Here, we report the case of a Parsonage-Turner syndrome associated with an acute autochthonous HEV infection in a 55-year-old immunocompetent patient. HEV genomic RNA was detected in serum and cerebrospinal fluid samples (CSF), and molecular phylogenetic analysis of HEV was performed...
April 24, 2017: Journal of Neurovirology
https://www.readbyqxmd.com/read/28418520/rapid-rule-out-of-acute-myocardial-infarction-with-a-single-high-sensitivity-cardiac-troponin-t-measurement-below-the-limit-of-detection-a-collaborative-meta-analysis
#20
John W Pickering, Martin P Than, Louise Cullen, Sally Aldous, Ewoud Ter Avest, Richard Body, Edward W Carlton, Paul Collinson, Anne Marie Dupuy, Ulf Ekelund, Kai M Eggers, Christopher M Florkowski, Yonathan Freund, Peter George, Steve Goodacre, Jaimi H Greenslade, Allan S Jaffe, Sarah J Lord, Arash Mokhtari, Christian Mueller, Andrew Munro, Sebbane Mustapha, William Parsonage, W Frank Peacock, Christopher Pemberton, A Mark Richards, Juan Sanchis, Lukas P Staub, Richard Troughton, Raphael Twerenbold, Karin Wildi, Joanna Young
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI). Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain. Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016)...
May 16, 2017: Annals of Internal Medicine
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