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Chest pain assessment clinic

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https://www.readbyqxmd.com/read/28802985/clinical-analysis-of-48-h-emergency-department-visit-post-outpatient-extracorporeal-shock-wave-lithotripsy-for-urolithiasis
#1
Chin-Heng Lu, Junne-Yih Kuo, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, William J S Huang, Howard H H Wu, Yen-Hwa Chang, Alex T L Lin, Kuang-Kuo Chen
BACKGROUND: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital...
August 9, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28793384/factors-that-influence-care-priority-for-chest-pain-patients-using-the-manchester-triage-system
#2
Carine Lais Nonnenmacher, Ananda Ughini Bertoldo Pires, Vitor Monteiro Moraes, Amália de Fátima Lucena
AIMS AND OBJECTIVES: Analyze crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28776131/pure-distraction-injury-of-t1-2-with-quad-fever
#3
Jun-Yeong Seo, Chae-Moon Lim, Young-Hoon Kim, Kee-Yong Ha
INTRODUCTION: We report a pure distraction injury of the upper thoracic spine and uncontrolled hyperthermia without an infectious cause. Quad fever appears in the first several weeks to months after a cervical or upper thoracic SCI and is characterized by an extreme elevation in body core temperature beyond 40 °C without an infectious cause. Discriminating between infectious and noninfectious causes is important, and a thorough clinical assessment is required. MATERIALS AND METHODS: A 52-year-old male visited the emergency room complaining of back pain with complete paralysis [American Spinal Injury Association (ASIA) A] of both lower extremities after a pedestrian-motor vehicle accident...
August 3, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28763554/does-this-child-have-pneumonia-the-rational-clinical-examination-systematic-review
#4
REVIEW
Sonal N Shah, Richard G Bachur, David L Simel, Mark I Neuman
Importance: Pneumonia is a leading cause of morbidity and mortality in children. It is important to identify the clinical symptoms and physical examination findings associated with pneumonia to improve timely diagnosis, prevent significant morbidity, and limit antibiotic overuse. Objective: To systematically review the accuracy of symptoms and physical examination findings in identifying children with radiographic pneumonia. Data Sources and Study Selection: MEDLINE and Embase (1956 to May 2017) were searched, along with reference lists from retrieved articles, to identify diagnostic studies of pediatric pneumonia across a broad age range that had to include children younger than age 5 years (although some studies enrolled children up to age 19 years); 3644 unique articles were identified, of which 23 met inclusion criteria...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28761679/the-safety-efficacy-and-cost-effectiveness-of-stress-echocardiography-in-patients-with-high-pretest-probability-of-coronary-artery-disease
#5
Alexandros Papachristidis, Daniela Cassar Demarco, Damian Roper, Ioannis Tsironis, Michael Papitsas, Jonathan Byrne, Khaled Alfakih, Mark J Monaghan
OBJECTIVE: In this study, we assess the clinical and cost-effectiveness of stress echocardiography (SE), as well as the place of SE in patients with high pretest probability (PTP) of coronary artery disease (CAD). METHODS: We investigated 257 patients with no history of CAD, who underwent SE, and they had a PTP risk score >61% (high PTP). According to the National Institute for Health and Care Excellence guidance (NICE CG95, 2010), these patients should be investigated directly with an invasive coronary angiogram (ICA)...
2017: Open Heart
https://www.readbyqxmd.com/read/28760210/a-randomized-trial-of-a-1-hour-troponin-t-protocol-in-suspected-acute-coronary-syndromes-design-of-the-rapid-assessment-of-possible-acs-in-the-emergency-department-with-high-sensitivity-troponin-t-rapid-tnt-study
#6
Cynthia Papendick, Andrew Blyth, Anil Seshadri, Michael J R Edmonds, Tom Briffa, Louise Cullen, Stephen Quinn, Jon Karnon, Anthony Chuang, Adam J Nelson, Matthew Horsfall, Erin Morton, Derek P Chew
BACKGROUND: Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive...
August 2017: American Heart Journal
https://www.readbyqxmd.com/read/28747182/recurrent-primary-mediastinal-giant-cell-tumor-of-soft-tissue-with-radiological-findings-a-rare-case-report-and-literature-review
#7
Qiongjie Hu, Jian Peng, Liming Xia
BACKGROUND: Giant cell tumor of soft tissue (GCT-ST), which histologically resembles GCT of bone, is a rare tumor. Usually, it is located in the lower extremities and trunk. GCT-ST, occurring in mediastinum, is extremely rare. CASE PRESENTATION: We encountered an 18-year-old Chinese woman who had mild dull pain on the left side of back. The following chest computed tomography (CT) showed a heterogeneous mass deeply situated in the posterior mediastinum with compression of the lung and invasion of the adjacent rib...
July 26, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28742837/risk-factors-associated-with-posttraumatic-stress-disorder-in-us-veterans-a-cohort-study
#8
Jan Müller, Sarmila Ganeshamoorthy, Jonathan Myers
OBJECTIVE: To assess the association between clinical and exercise test factors and the development of posttraumatic stress disorder (PTSD) in US Veterans. PATIENTS AND METHODS: Exercise capacity, demographics and clinical variables were assessed in 5826 veterans (mean age 59.4 ± 11.5 years) from the Veterans Affairs Healthcare System in Palo Alto, CA. The study participants underwent routine clinical exercise testing between the years 1987 and 2011. The study end point was the development of PTSD...
2017: PloS One
https://www.readbyqxmd.com/read/28730895/incidence-treatment-strategies-and-outcomes-of-acute-coronary-syndrome-with-and-without-ongoing-myocardial-ischaemia-results-from-the-czech-3-registry
#9
Petr Tousek, Klara Staskova, Anna Mala, Martin Sluka, Alexandra Vodzinska, Radek Jancar, Denisa Maluskova, Jiri Jarkovsky, Petr Widimsky
BACKGROUND: Patients with acute coronary syndrome with signs of ongoing myocardial ischaemia at first medical contact should be indicated for immediate invasive treatment. AIM: To assess the incidence, treatment strategies and outcomes of acute coronary syndrome in a large unselected cohort of patients with respect to the signs of ongoing myocardial ischaemia. METHODS: The CZECH-3 registry included 1754 consecutive patients admitted for suspected acute coronary syndrome to 43 hospitals during a 2-month period in the autumn of 2015...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28730842/comparison-of-distinctive-clinical-and-cardiac-magnetic-resonance-features-between-st-elevation-myocardial-infarction-patients-with-incomplete-myocardial-rupture-and-those-with-moderate-to-severe-pericardial-effusion
#10
Víctor Pineda, Jaume Figueras, Sergio Moral, Jordi Bañeras, José Rodríguez-Palomares, Artur Evangelista, David García-Dorado
BACKGROUND: Whether patients with incomplete myocardial rupture (IMR) present distinctive clinical and cardiac magnetic resonance features from those with moderate-severe pericardial effusion (⩾10 mm (PE)) remains unknown Methods: We compared the clinical, angiographic and cardiac magnetic resonance characteristics of nine patients with IMR (diagnosed angiographically and/or by cardiac magnetic resonance) with 29 with PE, and also with 38 without IMR or PE with evidence of transmural necrosis (reference group) matched for age, gender and year of admission...
July 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28730686/high-resolution-manometry-assessment-of-the-lower-esophageal-sphincter-after-contraction-normative-values-and-clinical-correlation
#11
D A Carlson, P J Kahrilas, M Tye, Z Listernick, K Ritter, I Wong, Y Xiao, V Bul, J E Pandolfino
BACKGROUND: The Chicago Classification v3.0 proposed extending the distal contractile integral (DCI) measurement domain to include the lower esophageal sphincter (LES) to enhance the detection of esophageal hypercontractility. However, normative and clinical data for this approach are unreported. We aimed to describe the application of an extended DCI measurement in asymptomatic controls and patients. METHODS: High-resolution manometry (HRM) of 65 asymptomatic controls and 72 patients with normal motility were evaluated retrospectively...
July 21, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/28726114/sex-related-differences-in-serum-matrix-metalloproteinase-9-screening-non-calcified-and-mixed-coronary-atherosclerotic-plaques-in-outpatients-with-chest-pain
#12
Chun Gu, Fang Wang, Zhihui Hou, Bin Lv, Yang Wang, Xiangfeng Cong, Xi Chen
The objective of this study is to evaluate the clinical feasibility of serum matrix metalloproteinase-9 (MMP-9) for screening plaque composition as assessed by coronary computed tomography angiography (CCTA) in outpatients with chest pain,and the effects of sex on this feasibility. Eight hundred and sixty-two consecutive outpatients with chest pain were divided into three groups according to the results of CCTA: non-plaque (NP, n = 474), calcified plaques (CPs, n = 179), non-calcified and mixed plaques (NCPs and MPs, n = 209)...
July 19, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/28716296/clinical-and-radiologic-predictive-factors-of-rib-fractures-in-outpatients-with-chest-pain
#13
REVIEW
Liang Zhang, Colm J McMahon, Samir Shah, Jim S Wu, Ronald L Eisenberg, Justin W Kung
PURPOSE: To identify the clinical and radiologic predictive factors of rib fractures in stable adult outpatients presenting with chest pain and to determine the utility of dedicated rib radiographs in this population of patients. METHOD AND MATERIALS: Following Institutional Review Board approval, we performed a retrospective review of 339 consecutive cases in which a frontal chest radiograph and dedicated rib series had been obtained for chest pain in the outpatient setting...
May 30, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/28713853/factors-associated-with-acute-postoperative-pain-following-breast-reconstruction
#14
Anita R Kulkarni, Andrea L Pusic, Jennifer B Hamill, Hyungjin M Kim, Ji Qi, Edwin G Wilkins, Randy S Roth
INTRODUCTION: Post-mastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. In an attempt to identify at-risk patients, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. METHODS: Women (N = 2207; one-week 82...
March 2017: JPRAS Open
https://www.readbyqxmd.com/read/28698323/performance-of-highly-sensitive-cardiac-troponin-t-assay-to-detect-ischaemia-at-pet-ct-in-low-risk-patients-with-acute-coronary-syndrome-a-prospective-observational-study
#15
Beata Morawiec, Stephane Fournier, Maxime Tapponnier, John O Prior, Pierre Monney, Vincent Dunet, Nathalie Lauriers, Frederique Recordon, Catalina Trana, Juan-Fernando Iglesias, Damian Kawecki, Olivier Boulat, Daniel Bardy, Sabine Lamsidri, Eric Eeckhout, Olivier Hugli, Olivier Muller
BACKGROUND: Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. PURPOSE: To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. METHODS: Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled...
July 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28684906/hospital-admissions-and-mortality-in-patients-with-copd-exacerbations-and-vertebral-body-compression-fractures
#16
Sergi Pascual-Guardia, Diana Badenes-Bonet, Clara Martin-Ontiyuelo, Flavio Zuccarino, Judith Marín-Corral, Alejandro Rodríguez, Esther Barreiro, Joaquim Gea
BACKGROUND: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known. OBJECTIVE: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28684218/the-relationship-between-s-adenosylhomocysteine-and-coronary-artery-lesions-a-case-control-study
#17
Xinrui Huang, Xin Lv, Hui Song, Qing Yang, Yuemin Sun, Wenjuan Zhang, Xiangdong Yu, Shaozhuang Dong, Wei Yao, Yongle Li, Qing Wang, Bei Wang, Liya Ma, Guowei Huang, Yuxia Gao
The role of homocysteine (Hcy) in the pathogenesis of coronary artery disease (CAD) is controversial, as decreased Hcy levels have not demonstrated consistent clinical benefits. Recent studies propose that S-adenosylhomocysteine (SAH), and not Hcy, plays a role in cardiovascular disease (CVD). We aimed to assess the relationship between plasma SAH and coronary artery lesions. Participants (n=160; aged 40-80years) with chest pain and suspected CAD underwent coronary angiography (CAG) for assessment of coronary artery stenosis, and were assigned to either the atherosclerosis (AS) or CAD group...
August 2017: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/28683951/diagnosis-and-exclusion-of-pulmonary-embolism
#18
Jeffrey A Kline
BACKGROUND: Failure to test for pulmonary embolism (PE) can be a lethal mistake, but PE and produces symptoms similar to many other diseases. Overtesting for PE has negative consequences. OBJECTIVES: Use published evidence to create a rationale and safe diagnostic approach for ambulatory and emergency patients with suspected PE in 2017. FINDINGS: Pulmonary embolism need not be pursued in patients with no symptoms of PE in the present or recent history (dyspnea, chest pain, cough or syncope), and always normal vital signs...
June 7, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28674630/a-specialty-specific-multimodality-educational-quality-improvement-initiative-to-deimplement-rarely-appropriate-myocardial-perfusion-imaging
#19
David E Winchester, Carsten Schmalfuss, Christian D Helfrich, Rebecca J Beyth
OBJECTIVE: Investigations of Appropriate Use Criteria (AUC) education have shown a mixed effect on changing provider behaviour. At our facility, rarely appropriate myocardial perfusion imaging (MPI) differs by specialty; awareness of AUC is low. Our objective is to investigate if specialty-specific, multimodality education could reduce rarely appropriate MPI. METHODS: We designed education focused on the rarely appropriate MPI ordered most often by each specialty...
2017: Open Heart
https://www.readbyqxmd.com/read/28674627/clinical-and-cost-effectiveness-of-adapted-cognitive-behaviour-therapy-for-non-cardiac-chest-pain-a-multicentre-randomised-controlled-trial
#20
Peter Tyrer, Helen Tyrer, Richard Morriss, Michael Crawford, Sylvia Cooper, Min Yang, Boliang Guo, Roger T Mulder, Samuel Kemp, Barbara Barrett
OBJECTIVE: To investigate the cost-effectiveness of a modified form of cognitive behavioural therapy (CBT) for recurrent non-cardiac chest pain. METHODS: We tested the effectiveness and cost-effectiveness of a modified form of CBT for chest pain (CBT-CP)(4-10 sessions) in patients who attended cardiology clinics or emergency medical services repeatedly. Patients were randomised using a remote web-based system to CBT-CP or to standard care in the clinic. Assessments were made at baseline and at 6 months and 12 months...
2017: Open Heart
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