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https://www.readbyqxmd.com/read/29054440/external-validation-of-heart-type-fatty-acid-binding-protein-high-sensitivity-cardiac-troponin-and-electrocardiography-as-rule-out-for-acute-myocardial-infarction
#1
Christopher B Van Hise, Jaimi H Greenslade, William Parsonage, Martin Than, Joanna Young, Louise Cullen
OBJECTIVE: To externally validate a clinical decision rule incorporating heart fatty acid binding protein (h-FABP), high-sensitivity troponin (hs-cTn) and electrocardiogram (ECG) for the detection of acute myocardial infarction (AMI) on presentation to the Emergency Department. We also investigated whether this clinical decision rule improved identification of AMI over algorithms incorporating hs-cTn and ECG only. DESIGN AND METHODS: This study included data from 789 patients from the Brisbane ADAPT cohort and 441 patients from the Christchurch TIMI RCT cohort...
October 17, 2017: Clinical Biochemistry
https://www.readbyqxmd.com/read/29046004/-coronary-computed-tomography-angiography-in-patients-with-stable-coronary-artery-disease
#2
Helen Ullrich, Tommaso Gori
The guidelines on the management of stable coronary artery disease (SCAD) recommend the use of coronary computed tomography angiography (CTA) in the process of diagnosing coronary artery disease in patients with low intermediate pre-test probability for SCAD. Particularly in cases where stress electrocardiogram or stress imaging provides unclear results, a computed tomographic examination can be considered as a reliable alternative to invasive coronary angiography. Due to its high negative predictive value, coronary CTA can provide accurate information on the presence of coronary artery stenosis and thus coronary artery disease can be reliably excluded without the risks associated with invasive procedures...
October 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28992867/early-exclusion-of-major-adverse-cardiac-events-in-emergency-department-chest-pain-patients-a-prospective-observational-study
#3
Yuk-Ki Leung, Nga-Man Cheng, Cangel Pui-Yee Chan, Anna Lee, Jeffrey Ka-Tak Wong, Bryan Ping-Yen Yan, Anil Tejbhan Ahuja, Colin Alexander Graham, Timothy Hudson Rainer
BACKGROUND: The current evaluation of patients with chest pain presenting to an emergency department (ED) with suspected acute coronary syndrome (ACS) is a lengthy process involving serial measurements of troponin. OBJECTIVE: We aimed to validate the diagnostic accuracy of a Thrombolysis in Myocardial Infarction (TIMI) score with single high-sensitive cardiac troponin T (hs-cTnT) for early rule out of 30-day major adverse cardiac events (MACE), and to compare the TIMI score with combinations of heart-type fatty acid binding protein (H-FABP) and a modified HEART (history, electrocardiogram, age, risk factors, troponin) score...
September 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28987133/implementing-change-evaluating-the-accelerated-chest-pain-risk-evaluation-acre-project
#4
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
#5
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/28973402/2017-update-on-medical-overuse-a-systematic-review
#6
Daniel J Morgan, Sanket S Dhruva, Eric R Coon, Scott M Wright, Deborah Korenstein
Importance: Overuse of medical care is a well-recognized problem. Objective: To identify and highlight original research articles published in 2016 that are most relevant to understanding medical overuse or strategies to reduce it. Evidence Review: A structured review of English-language articles on PubMed published in 2016 coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adults...
October 2, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28971650/-cardiac-magnetic-resonance-as-a-tool-for-rapid-diagnosis-of-eosinophilic-myocarditis
#7
Amnon Eitan, Jonathan Lessick, Robert Zukermann
Eosinophilic myocarditis is a rare disease with an unknown etiology, that may be severe and even lethal. Early treatment based on steroids may prevent deterioration and even lead to complete cure, but it requires rapid diagnosis. The gold standard for diagnosis of the disease is by endomyocardial biopsy but this test has low sensitivity and involves risks to the patient. This case report presents a patient who was admitted with complaints of chest pain. During her workup, with the help of cardiac MRI, eosinophilic myocarditis with mild deterioration in heart function was diagnosed...
September 2017: Harefuah
https://www.readbyqxmd.com/read/28959069/lumbar-spine-x-ray-as-a-standard-investigation-for-all-low-back-pain-in-ghana-is-it-evidence-based
#8
Abena Y Tannor
BACKGROUND: Low back pain (LBP) has a prevalence of 84% in Africa. The commonest form of imaging is plain lumbar spine x-ray. It gives a radiation dose equivalent to 65 times a chest x-ray dose and sends one of the highest doses to the human reproductive organs. The commonest cause of LBP in Africa is degenerative disease. X-ray findings do not change mode of treatment yet most physicians still routinely request for x-rays. METHODS: This is a systematic review of databases including The Cochrane, CINAHL plus, AMED, and MEDLINE...
March 2017: Ghana Medical Journal
https://www.readbyqxmd.com/read/28954802/henry-ford-heart-score-randomized-trial-rapid-discharge-of-patients-evaluated-for-possible-myocardial-infarction
#9
Tiberio M Frisoli, Richard Nowak, Kaleigh L Evans, Michael Harrison, Maath Alani, Saira Varghese, Mehnaz Rahman, Samantha Noll, Katherine R Flannery, Alex Michaels, Mishel Tabaku, Gordon Jacobsen, James McCord
BACKGROUND: Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications. METHOD AND RESULTS: A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0...
October 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28950300/frequency-and-angiographic-characteristics-of-coronary-microvascular-dysfunction-in-stable-angina-a-hybrid-imaging-study
#10
Iida Stenström, Teemu Maaniitty, Valtteri Uusitalo, Mikko Pietilä, Heikki Ukkonen, Sami Kajander, Maija Mäki, Jeroen J Bax, Juhani Knuuti, Antti Saraste
Aims: Coronary microvascular dysfunction (CMD) can cause angina in the absence of obstructive coronary artery disease (CAD). We studied the frequency and angiographic characteristics of CMD in symptomatic patients with suspected stable CAD and identified CMD as diffusely abnormal coronary vasodilator capacity by positron emission tomography (PET) perfusion imaging. Methods and results: We recruited prospectively 189 patients with intermediate pre-test probability of CAD who underwent coronary computed tomography angiography and quantitative 15O-water PET perfusion imaging followed by invasive coronary angiography, and assessment of fractional flow reserve when feasible...
July 27, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28949393/troponinniv%C3%A3-er-ger-nu-b%C3%A3-ttre-hj%C3%A3-lp-vid-misst%C3%A3-nkt-hj%C3%A3-rtinfarkt-l%C3%A3-ga-niv%C3%A3-er-kan-med-h%C3%A3-g-s%C3%A3-kerhet-utesluta-hj%C3%A3-rtinfarkt-%C3%A2-nya-analysmetoder-%C3%A3-kar-den-medicinska-s%C3%A3-kerheten
#11
Ola Hammarsten, Christian Bjurman, Martin Holzmann, Bertil Lindahl
Assessment of troponin levels on the emergency ward  Patients with myocardial infarction are at a high risk of sudden death and new cardiovascular events. For this reason, it is important to identify these patients and device treatment to reduce the risk. Patients who seek care with symptoms indicative of myocardial infarction, mainly chest pain, constitute a large proportion of patients at our emergency departments. However, only 5-10 % of these patients have myocardial infarction, whereas the majority has benign causes of their symptoms...
September 25, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28947562/magnitude-and-characteristics-of-patients-who-survived-an-acute-myocardial-infarction
#12
Mayra Tisminetzky, Tracy Y Wang, Jerry Gurwitz, Lisa A Kaltenbach, David McManus, Joel Gore, Eric Peterson, Robert J Goldberg
BACKGROUND: The purpose of this study was to describe the magnitude and characteristics of patients who did not experience any significant major adverse cardiovascular event early (within 6 weeks) and late (during the first year) after hospital discharge for an acute myocardial infarction (AMI). METHODS AND RESULTS: Data from 12 243 patients discharged after an AMI from 233 sites across the United States in the TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study were analyzed...
September 25, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28942912/an-evolving-role-for-cancer-rehabilitation-in-the-era-of-low-dose-lung-computed-tomography-screening
#13
REVIEW
Sean Robinson Smith, Ashish Khanna, Eric M Wisotzky
Lung cancer is the number one cause of cancer-related death worldwide, and is often detected in the later stages. Use of low-dose chest computed tomography in at-risk patients provides earlier detection and is being adopted as the standard screening tool, replacing less precise methods of radiography and sputum cytology. In the past, late detection of disease meant that rehabilitation interventions attempted to salvage function and to improve aerobic capacity to the point where patients could tolerate the sometimes-extensive oncologic treatment, including lobectomy or pneumonectomy...
September 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28934782/the-dose-dependent-effects-of-ketoprofen-on-dynamic-pain-after-open-heart-surgery
#14
Vedat Eljezi, Claire Biboulet, Henri Boby, Pierre Schoeffler, Bruno Pereira, Christian Duale
BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce postoperative pain, in both static (i.e., at rest) and dynamic contexts (e.g., during coughing or mobilization), and reduced doses could improve their efficacy/tolerance balance. OBJECTIVES: To test this hypothesis of efficacy after open heart surgery, in which NSAIDs are poorly used, particularly for safety concerns. STUDY DESIGN: Randomized, double-blind trial. SETTING: Single-center, French university hospital...
September 2017: Pain Physician
https://www.readbyqxmd.com/read/28923845/high-sensitivity-cardiac-troponin-i-as-a-gatekeeper-for-coronary-computed-tomography-angiography-and-stress-testing-in-patients-with-acute-chest-pain
#15
Maros Ferencik, Thomas Mayrhofer, Michael T Lu, Pamela K Woodard, Quynh A Truong, W Frank Peacock, Fabian Bamberg, Benjamin C Sun, Jerome L Fleg, John T Nagurney, James E Udelson, Wolfgang Koenig, James L Januzzi, Udo Hoffmann
BACKGROUND: Most patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) undergo noninvasive cardiac testing with a low diagnostic yield. We determined whether a combination of high-sensitivity cardiac troponin I (hs-cTnI) and cardiovascular risk factors might improve selection of patients for cardiac testing. METHODS: We included patients from the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) I and II trials who presented to the ED with acute chest pain and were referred for cardiac testing...
September 18, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28913755/management-and-clinical-outcome-of-stable-coronary-artery-disease-in-austria-results-from-5%C3%A2-years-of-the-clarify-registry
#16
Irene M Lang, Roza Badr-Eslam, Nicola Greenlaw, Robin Young, Philippe Gabriel Steg
BACKGROUND: The population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry...
September 14, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28904659/-pulmonary-embolism-at-the-university-hospital-campus-of-lome-togo-a-retrospective-study-about-51-cases
#17
Soulemane Pessinaba, Yaovi Dodzi Molba Atti, Soodougoua Baragou, Machihude Pio, Yaovi Afassinou, Mohamed Kpélafia, Edem Goeh-Akué, Findibé Damorou
INTRODUCTION: This study provides an analysis of the evolutionary, clinical and epidemiological aspects of pulmonary embolism at the University Hospital Campus of Lome. METHODS: We conducted a retrospective, analytic and descriptive study over a period of 39 months (November 1 , 2011- January 31, 2015). All the medical records of patients hospitalized for PE in the Department of Cardiology at the University Hospital Campus were analyzed. RESULTS: The prevalence of PE was 3...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28898794/surgical-management-of-late-bullet-embolization-from-the-abdomen-to-the-right-ventricle-case-report
#18
Ramos Mayo Alan Elison, Diaz Elizondo Jose Antonio, Segura Marin Hector, Lopez Garnica Dolores, Treviño Garza Francisco Xavier
INTRODUCTION: Secondary embolus from gun projectile is a rare entity, it represents a clinical and therapeutic dilemma because the potential complications involving central and peripheral circulation. Each case reported in the literature represents a challenge because their unique and different clinical scenarios. PRESENTATION OF CASE: We present the management of a 33-year-old man with past history of a gunshot wound on left flank with no evidence of any exit wounds, treated with exploratory laparotomy without removing the gunshot bullet from the abdomen...
September 4, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28895038/a-retrospective-external-validation-study-of-the-heart-score-among-patients-presenting-to-the-emergency-department-with-chest-pain
#19
Matthew Jay Streitz, Joshua James Oliver, Jessica Marie Hyams, Richard Michael Wood, Yevgeniy Mikhaylovich Maksimenko, Brit Long, Robert Michael Barnwell, Michael David April
Emergency physicians must be able to effectively prognosticate outcomes for patients presenting to the Emergency Department (ED) with chest pain. The HEART score offers a prognostication tool, but external validation studies are limited. We conducted an external retrospective validation study of the HEART score among ED patients presenting to our ED with chest pain from 1 January 2014 to 9 June 2014. We utilized chart review methodology to abstract data from each patient's electronic medical record. We collected data relevant to each of the five elements of the HEART score: history, electrocardiogram (ECG) interpretation, patient age, patient risk factors, and troponin levels...
September 11, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28888269/depression-is-associated-with-recurrent-chest-pain-with-or-without-coronary-artery-disease-a-prospective-cohort-study-in-the-emergency-department
#20
Yeunjung Kim, Morgan Soffler, Summer Paradise, Qurat-Ul-Ain Jelani, James Dziura, Rajita Sinha, Basmah Safdar
BACKGROUND: Only a small fraction of acute chest pain in the emergency department (ED) is due to obstructive coronary artery disease (CAD). ED chest pain remains associated with high rates of recidivism, often in the presence of nonobstructive CAD. Psychological states such as depression, anxiety, and elevation of perceived stress may account for this finding. The objective of the study was to determine whether psychological states predict recurrent chest pain (RCP). METHODS: We conducted a prospective cohort study of low- to moderate-cardiac risk ED patients admitted to the Yale Chest Pain Center with acute chest pain...
September 2017: American Heart Journal
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