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https://www.readbyqxmd.com/read/27919865/shared-decision-making-in-patients-with-low-risk-chest-pain-prospective-randomized-pragmatic-trial
#1
Erik P Hess, Judd E Hollander, Jason T Schaffer, Jeffrey A Kline, Carlos A Torres, Deborah B Diercks, Russell Jones, Kelly P Owen, Zachary F Meisel, Michel Demers, Annie Leblanc, Nilay D Shah, Jonathan Inselman, Jeph Herrin, Ana Castaneda-Guarderas, Victor M Montori
OBJECTIVE:  To compare the effectiveness of shared decision making with usual care in choice of admission for observation and further cardiac testing or for referral for outpatient evaluation in patients with possible acute coronary syndrome. DESIGN:  Multicenter pragmatic parallel randomized controlled trial. SETTING:  Six emergency departments in the United States. PARTICIPANTS:  898 adults (aged >17 years) with a primary complaint of chest pain who were being considered for admission to an observation unit for cardiac testing (451 were allocated to the decision aid and 447 to usual care), and 361 emergency clinicians (emergency physicians, nurse practitioners, and physician assistants) caring for patients with chest pain...
December 5, 2016: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/27909451/gender-differences-in-somatic-symptoms-and-current-suicidal-risk-in-outpatients-with-major-depressive-disorder
#2
Hong Jin Jeon, Jong-Min Woo, Hyo-Jin Kim, Maurizio Fava, David Mischoulon, Seong Jin Cho, Sung Man Chang, Doo-Heum Park, Jong Woo Kim, Ikki Yoo, Jung-Yoon Heo, Jin Pyo Hong
OBJECTIVE: Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS: A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS: On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women...
November 2016: Psychiatry Investigation
https://www.readbyqxmd.com/read/27896227/stress-first-single-photon-emission-computed-myocardial-perfusion-imaging
#3
C I Aquino, M Scarano, F Squame, G Casaburi, S L Nori, L Pace
BACKGROUND: Myocardial perfusion imaging (MPI) with single photon emission tomography (SPET) is widely used in coronary artery disease evaluation. Recently major dosimetric concerns have arisen. The aim of this study was to evaluate if a pre-test scoring system could predict the results of stress SPET MPI, thus avoiding two radionuclide injections. METHODS: All consecutive patients (n=309) undergoing SPET MPI during the first 6 months of 2014 constituted the study group...
November 2016: Translational Medicine @ UniSa
https://www.readbyqxmd.com/read/27885658/early-skin-to-skin-contact-for-mothers-and-their-healthy-newborn-infants
#4
REVIEW
Elizabeth R Moore, Nils Bergman, Gene C Anderson, Nancy Medley
BACKGROUND: Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs...
November 25, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27862670/do-gender-and-race-make-a-difference-in-acute-coronary-syndrome-pretest-probabilities-in-the-emergency-department
#5
Paul I Musey, Jeffrey A Kline
STUDY OBJECTIVES: To test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in a large cohort of chest pain patients stratified by race or gender. Secondarily we wanted to test for any differences in rates of ACS, rates of 90 day returns, cost, and chest radiation exposure after these stratifications. METHODS: This is a secondary analysis of a prospective outcomes study of ED patients with chest pain and shortness of breath...
November 12, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27846006/chest-pain-risk-scores-can-reduce-emergent-cardiac-imaging-test-needs-with-low-major-adverse-cardiac-events-occurrence-in-an-emergency-department-observation-unit
#6
Hao Wang, Katherine Watson, Richard D Robinson, Kristina H Domanski, Johnbosco Umejiego, Layton Hamblin, Sterling E Overstreet, Amanda M Akin, Steven Hoang, Meena Shrivastav, Michael Collyer, Ryan N Krech, Chet D Schrader, Nestor R Zenarosa
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography. METHODS: A prospective observational single center study was conducted from January 2014 through June 2015...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846005/novel-emergency-department-risk-score-discriminates-acute-coronary-syndrome-among-chest-pain-patients-with-known-coronary-artery-disease
#7
Matthew T Crim, Scott A Berkowitz, Mustapha Saheed, Jason Miller, Amy Deutschendorf, Gary Gerstenblith, Peter Hill, Frederick K Korley
BACKGROUND: Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS). METHODS: We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27846004/implementation-of-a-risk-stratification-and-management-pathway-for-acute-chest-pain-in-the-emergency-department
#8
Christopher W Baugh, Jeffrey O Greenberg, Simon A Mahler, Joshua M Kosowsky, Jeremiah D Schuur, Siddharth Parmar, George R Ciociolo, Christina W Carr, Roya Ghazinouri, Benjamin M Scirica
OBJECTIVES: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources. METHODS: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27842923/mean-heart-scores-for-hospitalized-chest-pain-patients-are-higher-in-more-experienced-providers
#9
Jeff Dubin, Eric Kiechle, Matt Wilson, Christian Timbol, Rahul Bhat, Dave Milzman
BACKGROUND: The HEART score has been validated as a predictor of major adverse cardiac events (MACEs) in emergency department patients complaining of chest pain. Our objective was to determine the extent of physician variation in the HEART score of admitted patients stratified by years of experience. METHODS: We performed a retrospective medical record review at an academic tertiary care emergency department to determine HEART score, outcome of hospitalization, and 30-day MACE...
October 18, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27810290/comparison-of-the-grace-heart-and-timi-score-to-predict-major-adverse-cardiac-events-in-chest-pain-patients-at-the-emergency-department
#10
J M Poldervaart, M Langedijk, B E Backus, I M C Dekker, A J Six, P A Doevendans, A W Hoes, J B Reitsma
BACKGROUND: The performance of the GRACE, HEART and TIMI scores were compared in predicting the probability of major adverse cardiac events (MACE) in chest pain patients presenting at the emergency department (ED), in particular their ability to identify patients at low risk. METHODS: Chest pain patients presenting at the ED in nine Dutch hospitals were included. The primary outcome was MACE within 6weeks. The HEART score was determined by the treating physician at the ED...
October 30, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27796707/comparison-of-clinical-based-and-ecg-based-triage-of-acute-chest-pain-in-the-emergency-department
#11
Melanie Dechamps, Diego Castanares-Zapatero, Patrick Vanden Berghe, Philippe Meert, Alessandro Manara
In the Emergency Department, chest pain triage systems are based on either clinical features or ECG recording. In this prospective, single-center, observational study, we aimed to compare the diagnostic performance of these triage systems in distinguishing acute coronary syndromes (ACS) from diseases of mild severity. Patients were sorted into the triage systems based on collected data at admission and on a systematic 12-lead ECG performed at triage. The final diagnosis was determined after a 30-day follow-up...
October 28, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27785479/severe-progressive-scoliosis-in-an-adult-female-possibly-secondary-thoracic-surgery-in-childhood-treated-with-scoliosis-specific-schroth-physiotherapy-case-presentation
#12
Andrea Lebel, Victoria Ashley Lebel
BACKGROUND: Scoliosis is a complex three-dimensional (3D) spinal deformity. Acquired scoliosis in early childhood may progress into adulthood and pose an increased risk of health problems and reduction in quality of life. In Canada, patients with scoliosis are not referred for physiotherapeutic scoliosis-specific exercises (PSSE) despite the fact that Schroth physiotherapy, a scoliosis-specific 3D posture training and exercise program, can be effective in reducing pain and improving scoliosis curves, vital capacity, and overall quality of life in scoliosis patients...
2016: Scoliosis and Spinal Disorders
https://www.readbyqxmd.com/read/27765481/cost-analysis-of-the-history-ecg-age-risk-factors-and-initial-troponin-heart-pathway-randomized-control-trial
#13
Robert F Riley, Chadwick D Miller, Gregory B Russell, Erin N Harper, Brian C Hiestand, James W Hoekstra, Cedric W Lefebvre, Bret A Nicks, David M Cline, Kim L Askew, Simon A Mahler
INTRODUCTION: The HEART Pathway is a diagnostic protocol designed to identify low-risk patients presenting to the emergency department with chest pain that are safe for early discharge. This protocol has been shown to significantly decrease health care resource utilization compared with usual care. However, the impact of the HEART Pathway on the cost of care has yet to be reported. METHODS AND RESULTS: We performed a cost analysis of patients enrolled in the HEART Pathway trial, which randomized participants to either usual care or the HEART Pathway protocol...
October 5, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27765299/prognostic-value-of-coronary-artery-calcium-score-in-acute-chest-pain-patients-without-known-coronary-artery-disease-systematic-review-and-meta-analysis
#14
REVIEW
Kongkiat Chaikriangkrai, Ghanshyam Palamaner Subash Shantha, Hye Yeon Jhun, Patompong Ungprasert, Gardar Sigurdsson, Faisal Nabi, John J Mahmarian, Su Min Chang
STUDY OBJECTIVE: Coronary artery calcium score (CACS) is a well-established test for risk stratifying asymptomatic patients. Recent studies also indicate that CACS may accurately risk stratify stable patients presenting to the emergency department (ED) with acute chest pain; however, many were underpowered. The purpose of this systematic review and meta-analysis is to evaluate the prognostic value and accuracy of a zero (normal) CACS for identifying patients at acceptable low risk for future cardiovascular events who might be safely discharged home from the ED...
December 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27752608/troponin-assay-use-in-the-emergency-department-for-management-of-patients-with-potential-acute-coronary-syndrome-current-use-and-future-directions
#15
William R Fox, Deborah B Diercks
Troponins are proteins commonly found in cardiac tissue that are released during myocardial ischemia or necrosis. These troponins can be detected by assays that can then be used to guide clinical decision-making and disposition, especially if the suspected insult is related to acute coronary syndrome. Timing of troponin measurement can be important as elevations may not be detectible immediately after an insult. New assays have been designed to detect troponin con-centrations previously too low to be detected by conventional assays...
March 2016: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/27745728/documentation-of-heart-score-discordance-between-emergency-physician-and-cardiologist-evaluations-of-ed-patients-with-chest-pain
#16
W Kelly Wu, Maame Yaa A B Yiadom, Sean P Collins, Wesley H Self, Ken Monahan
INTRODUCTION: A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores. METHODS: We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist...
September 28, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27692651/best-clinical-practice-current-controversies-in-the-evaluation-of%C3%A2-low-risk-chest-pain-with-risk-stratification-aids-part-2
#17
Brit Long, Alex Koyfman
BACKGROUND: Chest pain accounts for 10% of emergency department (ED) visits annually, and many of these patients are admitted because of potentially life-threatening conditions. A substantial percentage of patients with chest pain are at low risk for a major cardiac adverse event (MACE). OBJECTIVE: We investigated controversies in the evaluation of patients with low-risk chest pain, including clinical scores, decision pathways, and shared decision-making. DISCUSSION: ED patients with chest pain who have negative biomarker results and nonischemic electrocardiograms are at low risk for MACE...
September 27, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27687049/cardiology-consultation-reduces-provocative-testing-rates-in-an-ed-observation-unit
#18
Troy Madsen, Cameron Smyres, Talmage Wood, Tamara Moores, Matthew Fuller, Virgil Davis, Kurt Bernhisel
BACKGROUND: In evaluating patients with chest pain, emergency department observation units (EDOUs) may use a staffing model in which emergency physicians determine patient testing (EP model) or a model similar to a chest pain unit (CPU) in which cardiologists determine provocative testing (CPU model). METHODS: We performed a prospective study with 30-day telephone follow-up for all chest pain patients placed in our EDOU. Halfway through the study period, our EDOU transitioned from an EP model to a CPU model...
September 17, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27665208/clinical-evaluation-versus-undetectable-high-sensitivity-troponin-for-assessment-of-patients-with-acute-chest-pain
#19
Juan Sanchis, Sergio García-Blas, Arturo Carratalá, Ernesto Valero, Anna Mollar, Gema Miñana, Vicente Ruiz, Jose Vicente Balaguer, Mercé Roqué, Xavier Bosch, Julio Núñez
Decision-making in acute chest pain remains challenging despite normal (below ninety-ninth percentile) high-sensitivity troponin (hs-cTn). Some studies suggest that undetectable hs-cTn, far below the ninety-ninth percentile, might rule out acute coronary syndrome. We investigated clinical data in comparison to undetectable hs-cTnT. The study comprised 682 patients (November 2010 to September 2011) presenting at the emergency department with chest pain and normal hs-cTnT (<14 ng/l). The main end point was major adverse cardiac events (MACE: death, myocardial infarction, readmission for unstable angina, or revascularization) at a 4-year median follow-up; secondary end point was 30-day MACE...
August 31, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27639685/comparison-of-quantity-of-calcific-deposits-by-multidetector-computed-tomography-in-the-aortic-valve-and-coronary-arteries
#20
Philippe J van Rosendael, Vasileios Kamperidis, William K F Kong, Alexander R van Rosendael, Nina A Marsan, Jeroen J Bax, Victoria Delgado
The aim of this study was to compare the calcium burden of the aortic valve and coronary arteries with multidetector computed tomography (MDCT) in a propensity score-matched population of patients with a bicuspid versus a tricuspid aortic valve. From an ongoing clinical registry of patients who underwent MDCT, 70 patients with bicuspid aortic valve and 210 patients with tricuspid aortic valve were matched based on age, gender, cardiovascular risk factors, chest pain symptoms, and MDCT indication. Aortic valve calcium and the presence and severity of coronary artery disease were analyzed...
August 23, 2016: American Journal of Cardiology
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