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Chest pain assessment clinic

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https://www.readbyqxmd.com/read/28320636/the-significance-of-equivocal-exercise-treadmill-ecg-for-intermediate-risk-chest-pain-assessment-insight-from-coronary-ct-angiography-data
#1
Gary T E Lau, Henry Wei, Jo Wickham, Andrew C Y To
BACKGROUND: Exercise treadmill test (ETT) is commonly the first-line investigation in troponin-negative chest pain patients. Inconclusive results are common and often lead to repeated functional testings. Coronary computed tomographic angiography (CCTA) has excellent negative predictive value for coronary artery disease detection and may play an important role in their diagnostic workup. We aim to analyse ETT and CCTA findings to understand their modern roles in intermediate risk chest pain population with inconclusive ETT...
March 1, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28297341/assessment-of-monte-carlo-algorithm-for-compliance-with-rtog-0915-dosimetric-criteria-in-peripheral-lung-cancer-patients-treated-with-stereotactic-body-radiotherapy
#2
Damodar Pokhrel, Sumit Sood, Rajeev Badkul, Hongyu Jiang, Christopher McClinton, Christopher Lominska, Parvesh Kumar, Fen Wang
The purpose of the study was to evaluate Monte Carlo-generated dose distributions with the X-ray Voxel Monte Carlo (XVMC) algorithm in the treatment of peripheral lung cancer patients using stereotactic body radiotherapy (SBRT) with non-protocol dose-volume normalization and to assess plan outcomes utilizing RTOG 0915 dosimetric compliance criteria. The Radiation Therapy Oncology Group (RTOG) protocols for non-small cell lung cancer (NSCLC) currently require radiation dose to be calculated using tissue density heterogeneity corrections...
May 2016: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/28292858/predictive-value-of-age-and-sex-specific-nomograms-of-global-plaque-burden-on-coronary-computed-tomography-angiography-for-major-cardiac-events
#3
Christopher Naoum, Daniel S Berman, Amir Ahmadi, Philipp Blanke, Heidi Gransar, Jagat Narula, Leslee J Shaw, Leonard Kritharides, Stephan Achenbach, Mouaz H Al-Mallah, Daniele Andreini, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Kavitha Chinnaiyan, Benjamin Chow, Ricardo C Cury, Augustin DeLago, Allison Dunning, Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp A Kaufmann, Yong-Jin Kim, Erica Maffei, Hugo Marquez, Gianluca Pontone, Gilbert Raff, Ronen Rubinshtein, Todd C Villines, James Min, Jonathon Leipsic
BACKGROUND: Age-adjusted coronary artery disease (CAD) burden identified on coronary computed tomography angiography predicts major adverse cardiovascular event (MACE) risk; however, it seldom contributes to clinical decision making because of a lack of nomographic data. We aimed to develop clinically pragmatic age- and sex-specific nomograms of CAD burden using coronary computed tomography angiography and to validate their prognostic use. METHODS AND RESULTS: Patients prospectively enrolled in phase I of the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes) were included (derivation cohort: n=21,132; 46% female) to develop CAD nomograms based on age-sex percentiles of segment involvement score (SIS) at each year of life (40-79 years)...
March 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28291726/change-in-angiogram-derived-management-strategy-of-patients-with-chest-pain-when-some-ffr-data-are-available-how-consistent-is-the-effect
#4
Vinayak Nagaraja, Mamas Mamas, Michael Mahmoudi, Campbell Rogers, Nick Curzen
BACKGROUND: The assessment of patients presenting with angina using invasive angiography alone is imperfect. By contrast, fractional flow reserve (FFR) allows for assessment of lesion-specific ischemia, which is predictive of clinical outcome. A series of studies has demonstrated that the availability of FFR data at the time of diagnostic angiography leads to significant differences in the management of those patients. HYPOTHESIS: The objective of this paper is to describe assess the consistency in the difference in management resulting from an FFR-directed versus and angiogram-directed strategy in appropriate observational and randomized trials...
February 27, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28289555/gender-differences-in-post-traumatic-stress
#5
Maria Grazia Modena, Daniele Pettorelli, Giulia Lauria, Elisa Giubertoni, Erminio Mauro, Valentina Martinotti
Acute stress can trigger cardiovascular events and disease. The earthquake is an "ideal" natural experiment for acute and chronic stress, with impact mainly on the cardiovascular system. On May 20th and 29th, 2012, two earthquakes of magnitude 5.9° to 6.4° on the Richter scale, hit the province of Modena and Reggio Emilia, an area of the north-center of Italy never considered at seismic risk. The purpose of our study was to assess whether there were gender-specific differences in stress-induced incidence of cardiovascular events and age of patients who arrived at the Emergency Departments (ED) of the three main teaching hospitals of the University of Modena and Reggio Emilia...
2017: BioResearch Open Access
https://www.readbyqxmd.com/read/28286847/protocol-adherence-in-prehospital-medical-care-provided-for-patients-with-chest-pain-and-loss-of-consciousness-a-brief-report
#6
Mostafa Mehrara, Nader Tavakoli, Marzieh Fathi, Babak Mahshidfar, Mohammad Amin Zare, Azita Asadi, Saeedeh Hosseinzadeh, Mehdi Safdarian
INTRODUCTION: Although many protocols are available in the field of the prehospital medical care (PMC), there is still a notable gap between protocol based directions and applied clinical practice. This study measures the rate of protocol adherence in PMC provided for patients with chest pain and loss of consciousness (LOC). METHOD: In this cross-sectional study, 10 educated research assistants audited the situation of provided PMC for non-traumatic chest pain and LOC patients, presenting to the emergency department of a tertiary level teaching hospital, compare to national recommendations in these regards...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28283286/prophylactic-platelet-transfusion-plus-supportive-care-versus-supportive-care-alone-in-adults-with-dengue-and-thrombocytopenia-a-multicentre-open-label-randomised-superiority-trial
#7
David C Lye, Sophia Archuleta, Sharifah F Syed-Omar, Jenny G Low, Helen M Oh, Yuan Wei, Dale Fisher, Sasheela S L Ponnampalavanar, Limin Wijaya, Linda K Lee, Eng-Eong Ooi, Adeeba Kamarulzaman, Lucy C Lum, Paul A Tambyah, Yee-Sin Leo
BACKGROUND: Dengue is the commonest vector-borne infection worldwide. It is often associated with thrombocytopenia, and prophylactic platelet transfusion is widely used despite the dearth of robust evidence. We aimed to assess the efficacy and safety of prophylactic platelet transfusion in the prevention of bleeding in adults with dengue and thrombocytopenia. METHODS: We did an open-label, randomised, superiority trial in five hospitals in Singapore and Malaysia...
March 7, 2017: Lancet
https://www.readbyqxmd.com/read/28282354/diagnostic-evaluation-of-nontraumatic-chest-pain-in-athletes
#8
Byron Moran, Sean Bryan, Ted Farrar, Chris Salud, Gary Visser, Raymond Decuba, Deborah Renelus, Tyler Buckley, Michael Dressing, Nicholas Peterkin, Eric Coris
This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes...
March 2017: Current Sports Medicine Reports
https://www.readbyqxmd.com/read/28281735/high-sensitive-troponin-levels-in-patients-with-chest-pain-and-kidney-disease-a-multicenter-registry-the-tropic-study
#9
Flavia Ballocca, Fabrizio D'Ascenzo, Claudio Moretti, Roberto Diletti, Carlo Budano, Alberto Palazzuoli, Matthew J Reed, Tullio Palmerini, Dariusz Dudek, Alfredo Galassi, Pierluigi Omedè, Nicolas M Mieghem, David Ferenbach, Marco Pavani, Diego Della Riva, Nick L Mills, Ron T Van Domburgh, Andrea Mariani, Artur Dziewierz, Marco di Cuia, Robert Jan van Geuns, Felix Zijlstra, Serena Bergerone, Sebastiano Marra, Giuseppe Biondi Zoccai, Fiorenzo Gaita
BACKGROUND: Accuracy of high sensitive troponin (hs-cTn) to detect coronary artery disease (CAD) in patients with renal insufficiency is not established. The aim of this study was to evaluate the prognostic role of high sensitivity troponin T and I in patients with chronic kidney disease (CKD). METHODS: All consecutive patients with chest pain, renal insufficiency (eGFR < 60 mL/min/1.73 m²) and high sensitive troponin level were included. The predictive value of baseline and interval troponin (hs-cTnT and I) for the presence of CAD was assessed...
March 10, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28270128/the-effect-of-referral-templates-on-out-patient-quality-of-care-in-a-hospital-setting-a-cluster-randomized-controlled-trial
#10
Henrik Wåhlberg, Per Christian Valle, Siri Malm, Øistein Hovde, Ann Ragnhild Broderstad
BACKGROUND: The assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care. METHODS: A cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location...
March 7, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28267033/factors-influencing-utilization-of-hospital-services-by-adult-sickle-cell-disease-patients-a-systematic-review
#11
Irina Benenson, Yuri Jadotte, Mercedes Echevarria
BACKGROUND: Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures. OBJECTIVES: The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients...
March 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28264612/a-dose-finding-trial-with-a-novel-ingenol-derivative-ingenol-disoxate-leo-43204-for-field-treatment-of-actinic-keratosis-on-full-face-or-250cm-2-on-the-chest
#12
Marc Bourcier, Linda Stein Gold, Lyn Guenther, Camilla M Andreassen, Johan Selmer, Gary Goldenberg
PURPOSE: Actinic keratoses (AKs) may progress to squamous cell carcinoma and can occur in cancerized fields as sub-clinical and clinically visible lesions. Ingenol disoxate gel is a topical field therapy for AK. This Phase I/II trial aimed to assess the safety and efficacy of ingenol disoxate on full face or chest in patients with AKs. MATERIALS AND METHODS: Part 1 was a phase-I, open-label, dose-escalation trial investigating the maximum tolerated dose of ingenol disoxate...
March 7, 2017: Journal of Dermatological Treatment
https://www.readbyqxmd.com/read/28262338/differences-in-presentation-management-and-outcomes-in-women-and-men-presenting-to-an-emergency-department-with-possible-cardiac-chest-pain
#13
Lorcan Ruane, Jaimi H Greenslade, William Parsonage, Tracey Hawkins, Christopher Hammett, Carolyn Sp Lam, Thomas Knowlman, Shaela Doig, Louise Cullen
BACKGROUND: Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. METHODS: Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014...
February 17, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28256404/panic-disorder-in-patients-presenting-to-the-emergency-department-with-chest-pain-prevalence-and-presenting-symptoms
#14
Jaimi H Greenslade, Tracey Hawkins, William Parsonage, Louise Cullen
BACKGROUND: Patients with panic disorder experience symptoms such as palpitations, chest pain, dizziness, and breathlessness. Consequently, they may attend the Emergency Department (ED) to be assessed for possible emergency medical conditions. Recognition of panic disorder within the ED is low. We sought to establish the prevalence of panic disorder in patients presenting to the for ED investigation of potential acute coronary syndrome. We also sought to characterise the cohort of patients with panic disorder in terms of presenting symptoms, risk factors, medical history and major adverse cardiac events (MACE)...
February 16, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28243397/effect-of-fluoxetine-administration-on-clinical-and-echocardiographic-findings-in-patients-with-mitral-valve-prolapse-and-generalized-anxiety-disorder-randomized-clinical-trial
#15
Reza Jafarzadeh Esfehani, Homan Kamranian, Majid Jalalyazdi
BACKGROUND: Mitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP. OBJECTIVE: The aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety. METHODS: This randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015...
January 2017: Electronic Physician
https://www.readbyqxmd.com/read/28237735/emergency-medical-dispatch-priority-in-chest-pain-patients-due-to-life-threatening-conditions-a-cohort-study-examining-circadian-variations-and-impact-of-the-education
#16
Araz Rawshani, Nina Rawshani, Carita Gelang, Jan-Otto Andersson, Anna Larsson, Angela Bång, Johan Herlitz, Martin Gellerstedt
BACKGROUND AND AIMS: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30days. METHODS: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC. Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest)...
February 16, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28236543/diagnostic-and-prognostic-values-of-the-v-index-a-novel-ecg-marker-quantifying-spatial-heterogeneity-of-ventricular-repolarization-in-patients-with-symptoms-suggestive-of-non-st-elevation-myocardial-infarction
#17
Roger Abächerli, Raphael Twerenbold, Jasper Boeddinghaus, Thomas Nestelberger, Patrick Mächler, Roberto Sassi, Massimo W Rivolta, Ebadollah Kheirati Roonizi, Luca T Mainardi, Nikola Kozhuharov, Maria Rubini Giménez, Karin Wildi, Karin Grimm, Zaid Sabti, Petra Hillinger, Christian Puelacher, Ivo Strebel, Janosch Cupa, Patrick Badertscher, Isabelle Roux, Ramun Schmid, Remo Leber, Stefan Osswald, Christian Mueller, Tobias Reichlin
BACKGROUND: The V-index is an ECG marker quantifying spatial heterogeneity of ventricular repolarization. We prospectively assessed the diagnostic and prognostic values of the V-index in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). METHODS: We prospectively enrolled 497 patients presenting with suspected NSTEMI to the emergency department (ED). Digital 12-lead ECGs of five-minute duration were recorded at presentation. The V-index was automatically calculated in a blinded fashion...
February 7, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28218802/non-invasive-ventilation-for-cystic-fibrosis
#18
REVIEW
Fidelma Moran, Judy M Bradley, Amanda J Piper
BACKGROUND: Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis by providing ventilatory support and avoiding tracheal intubation. Using non-invasive ventilation, in the appropriate situation or individuals, can improve lung mechanics through increasing airflow and gas exchange and decreasing the work of breathing. Non-invasive ventilation thus acts as an external respiratory muscle. This is an update of a previously published review...
February 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28213932/correlations-between-electrocardiogram-and-biomarkers-in-acute-pulmonary-embolism-analysis-of-zatpol-2-registry
#19
Piotr Kukla, Dariusz A Kosior, Andrzej Tomaszewski, Katarzyna Ptaszyńska-Kopczyńska, Katarzyna Widejko, Robert Długopolski, Andrzej Skrzyński, Piotr Błaszczak, Kamil Fijorek, Marcin Kurzyna
BACKGROUND: Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism. METHODS: We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014...
February 18, 2017: Annals of Noninvasive Electrocardiology
https://www.readbyqxmd.com/read/28210363/using-the-electronic-medical-record-to-reduce-unnecessary-ordering-of-coagulation-studies-for-patients-with-chest-pain
#20
Jeremiah S Hinson, Binoy Mistry, Yu-Hsiang Hsieh, Nicholas Risko, David Scordino, Karolina Paziana, Susan Peterson, Rodney Omron
INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies...
February 2017: Western Journal of Emergency Medicine
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