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Cardiology. Pain management

Harry Klimis, Aravinda Thiagalingam, Mikhail Altman, Emily Atkins, Gemma Figtree, Harry Lowe, N Wah Cheung, Pramesh Kovoor, A Robert Denniss, Clara K Chow
Chest pain is common and places a significant burden on hospital resources. Many patients with undifferentiated low to intermediate risk chest pain are admitted to hospital. Rapid Access Cardiology (RAC) services are hospital co-located cardiologist-led outpatient clinics that provide rapid assessment and immediate management but not long term management. This service model is described as part of chest pain management and the National Service Framework for coronary heart disease in the United Kingdom (UK)...
November 16, 2016: Internal Medicine Journal
Gregory Plotnikoff, Melissa Barber
INTRODUCTION: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. CASE PRESENTATION: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine...
2016: Permanente Journal
Robert Battat, Marc Jhonson, Lorne Wiseblatt, Cruff Renard, Laura Habib, Manouchka Normil, Brian Remillard, Timothy F Brewer, Galit Sacajiu
BACKGROUND: Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti...
October 19, 2016: BMC Medical Education
John W Pickering, Jaimi H Greenslade, Louise Cullen, Dylan Flaws, William Parsonage, Sally Aldous, Peter George, Andrew Worster, Peter A Kavsak, Martin P Than
BACKGROUND: The new European Society of Cardiology guidelines to rule-in and rule-out acute myocardial infarction (AMI) in the emergency department include a rapid assessment algorithm based on high-sensitivity cardiac troponin and sampling at 0 and 1 hour. Emergency department physicians require high sensitivity to confidently rule-out AMI, whereas cardiologists aim to minimize false-positive results. METHODS: High-sensitivity troponin I and T assays were used to measure troponin concentrations in patients presenting with chest-pain symptoms and being investigated for possible acute coronary syndrome at hospitals in New Zealand, Australia, and Canada...
November 15, 2016: Circulation
Géraldine Layani, Richard Fleet, Renée Dallaire, Fatoumata K Tounkara, Julien Poitras, Patrick Archambault, Jean-Marc Chauny, Mathieu Ouimet, Josée Gauthier, Gilles Dupuis, Alain Tanguay, Jean-Frédéric Lévesque, Geneviève Simard-Racine, Jeannie Haggerty, France Légaré
BACKGROUND: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. METHODS: We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada...
July 2016: CMAJ Open
Craig M Alpert, Michael A Smith, Scott L Hummel, Ellen K Hummel
Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion...
September 3, 2016: Heart Failure Reviews
Catherine Hatzantonis, Marcin Czyz, Renata Pyzik, Bronek M Boszczyk
BACKGROUND: Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications...
August 17, 2016: European Spine Journal
Ricardo C Cury, Suhny Abbara, Stephan Achenbach, Arthur Agatston, Daniel S Berman, Matthew J Budoff, Karin E Dill, Jill E Jacobs, Christopher D Maroules, Geoffrey D Rubin, Frank J Rybicki, U Joseph Schoepf, Leslee J Shaw, Arthur E Stillman, Charles S White, Pamela K Woodard, Jonathon A Leipsic
The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report...
July 2016: Journal of Cardiovascular Computed Tomography
Ricardo C Cury, Suhny Abbara, Stephan Achenbach, Arthur Agatston, Daniel Berman, Matthew Budoff, Karin Dill, Jill Jacobs, Christopher Maroules, Geoffrey Rubin, Frank J Rybicki, Joseph Schoepf, Leslee Shaw, Arthur Stillman, Charles White, Pamela Woodard, Jonathon Leipsic
The intent of CAD-RADS - Coronary Artery Disease Reporting and Data System is to create a standardized method to communicate findings of coronary CT angiography (coronary CTA) in order to facilitate decision-making regarding further patient management. The suggested CAD-RADS classification is applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by coronary CTA. It ranges from CAD-RADS 0 (Zero) for the complete absence of stenosis and plaque to CAD-RADS 5 for the presence of at least one totally occluded coronary artery and should always be interpreted in conjunction with the impression found in the report...
June 14, 2016: Journal of the American College of Radiology: JACR
Mette Jensen Stochkendahl, Jan Sørensen, Werner Vach, Henrik Wulff Christensen, Poul Flemming Høilund-Carlsen, Jan Hartvigsen
AIMS: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. METHODS AND RESULTS: 115 adults aged 18-75 years with acute, non-specific chest pain of musculoskeletal origin were recruited from a cardiology department in Denmark. After ruling out acute coronary syndrome and receiving usual care, patients with musculoskeletal chest pain were randomised to 4 weeks of community-based chiropractic care (n=59) or to a single information session aimed at encouraging self-management as complementary to usual care (n=56)...
2016: Open Heart
Jennifer P Stevens, Kathy Baker, Michael D Howell, Robert B Banzett
BACKGROUND: Dyspnea (breathing discomfort) can be as powerfully aversive as pain, yet is not routinely assessed and documented in the clinical environment. Routine identification and documentation of dyspnea is the first step to improved symptom management and it may also identify patients at risk of negative clinical outcomes. OBJECTIVE: To estimate the prevalence of dyspnea and of dyspnea-associated risk among hospitalized patients. DESIGN: Two pilot prospective cohort studies...
2016: PloS One
Douglas G Sward, Kinjal N Sethuraman, Jennifer S Wong, Robert E Rosenthal
We describe two cases of myocardial infarction with ST-segment elevation on electrocardiogram associated with carbon monoxide (CO) poisoning, a condition rarely reported in the literature. The first was a 62-year-old woman who experienced chest pain in the emergency department (ED) while being assessed for exposure to carbon monoxide in her home. The second was an 80-year-old man who fainted at home and was found to have ST elevation during the ED workup. After hospitalization, he returned home and soon thereafter had difficulty walking and speaking...
January 2016: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
Timothy Horeczko, Jeanny K Park, Courtney Mann, Angelo Milazzo
OBJECTIVE: We compare pediatric cardiac risk classification and management recommendations between emergency physicians (EPs) and pediatric cardiologists (PCs) in children with a suspected new cardiac disorder. METHODS: We prospectively compared the work-up, assessment, classification, and disposition of patients aged 0 to 21 years presenting to the emergency department with a potential cardiac etiology in whom an electrocardiogram (ECG) was performed. The criterion standard was a blinded assessment by the PC-electrophysiologist after review of the history, physical examination, ancillary tests, and ECG...
March 3, 2016: Pediatric Emergency Care
Neha Sekhri, Pablo Perel, Tim Clayton, Gene S Feder, Harry Hemingway, Adam Timmis
BACKGROUND AND OBJECTIVE: Diagnostic models used in the management of suspected angina provide no explicit information about prognosis. We present a new prognostic model of 10-year coronary mortality in patients presenting for the first time with suspected angina to complement the Diamond-Forrester diagnostic model of disease probability. METHODS AND RESULTS: A multicentre cohort of 8762 patients with suspected angina was followed up for a median of 10 years during which 233 coronary deaths were observed...
June 1, 2016: Heart: Official Journal of the British Cardiac Society
Jeong Ho Park, Ki Ok Ahn, Sang Do Shin, Won Chul Cha, Hyun Wook Ryoo, Young Sun Ro, Taeyun Kim
BACKGROUND: Interhospital transfer delays for ST-elevation myocardial infarction (STEMI) patients requiring primary percutaneous coronary intervention (PCI) may be shortened by improved regional care systems. We evaluated the transfer process and first door-to-balloon (D1toB) time in STEMI patients who underwent interhospital transfer for primary PCI. METHODS AND RESULTS: We evaluated the D1toB time in 1837 patients who underwent interhospital transfer for primary PCI from the Cardiovascular Disease Surveillance program in Korea...
May 2016: American Journal of Emergency Medicine
David A Kane, Kevin G Friedman, David R Fulton, Robert L Geggel, Susan F Saleeb
OBJECTIVES: To determine if patients evaluated using the pediatric chest pain standardized clinical assessment and management plan (SCAMP) in cardiology clinic were later diagnosed with unrecognized cardiac pathology, and to determine if other patients with cardiac pathology not enrolled in the SCAMP would have been identified using the algorithm. STUDY DESIGN: Patients 7-21 years of age, newly diagnosed with hypertrophic or dilated cardiomyopathy, coronary anomalies, pulmonary embolus, pulmonary hypertension, pericarditis, or myocarditis were identified from the Boston Children's Hospital (BCH) cardiac database between July 1, 2010 and December 31, 2012...
February 26, 2016: Congenital Heart Disease
Jessica Howard-Anderson, Ashley Busuttil, Sarah Lonowski, Sitaram Vangala, Nasim Afsar-Manesh
BACKGROUND: Patient engagement is critical in delivering high-quality care. However, literature investigating patient perspectives on readmissions is lacking. OBJECTIVES: To understand patients' beliefs and attitudes about 30-day readmissions and to elucidate areas for improvement aimed at reducing readmissions. DESIGN: In person survey. SETTING: Academic medical center and affiliated community hospital. PATIENTS: Patients with 30-day readmissions to medicine and cardiology services...
June 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Weihao Xu, Wenjie Guo, Tingshu Yang
OBJECTIVE: To study the diagnosis and treatment of hypereosinophilic syndrome complicated with thromboembolism. METHODS: A retrospective analysis of a patient with hypereosinophilic syndrome diagnosed and treated in the Department of Cardiology, PLA General Hospital was performed. A literature research was performed with "hypereosinophilic syndrome" as the Chinese key word in Wanfang database and China national knowledge internet and "hypereosinophilic syndrome, hypereosinophilia, eosinophilia" as the English key words in PubMed and Embase database...
December 2015: Chinese Journal of Tuberculosis and Respiratory Diseases
Luis Ayerbe, Esteban González, Valentina Gallo, Claire L Coleman, Andrew Wragg, John Robson
BACKGROUND: The clinical assessment of patients with chest pain of recent onset remains difficult. This study presents a critical review of clinical predictive tools for the assessment of patients with chest pain. METHODS: Systematic review of observational studies and estimation of probabilities of coronary artery disease (CAD) in patients with chest pain. Searches were conducted in PubMed, Embase, Scopus, and Web of Science to identify studies reporting tools, with at least three variables from clinical history, physical examination or ECG, produced with multivariate analysis, to estimate probabilities of CAD in patients with chest pain of recent onset, published from inception of the database to the 31st July 2015...
2016: BMC Cardiovascular Disorders
Daniela Cassar Demarco, Alexandros Papachristidis, Damian Roper, Ioannis Tsironis, Jonathan Byrne, Khaled Alfakih, Mark Monaghan
OBJECTIVES: To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. DESIGN: We undertook a large retrospective study to investigate the outcomes of stress echocardiography...
November 2015: JRSM Open
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