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vancouver chest pain

Karin H Humphries, May K Lee, Mona Izadnegahdar, Min Gao, Daniel T Holmes, Frank X Scheuermeyer, Martha Mackay, Andre Mattman, Eric Grafstein
OBJECTIVE: While sex differences in the treatment and outcomes of subjects with acute coronary syndromes are well documented, little is known about the impact of cardiac troponin (cTn) levels obtained in the emergency department (ED) on the observed sex differences. We sought to determine whether cTn levels by chest pain features modify sex differences in diagnosis, treatment, and outcomes in patients presenting with chest pain suggestive of ischemia. METHODS: All adults presenting to two hospitals in Vancouver, Canada, between May 2008 and March 2013 with ischemic chest pain and with cTn testing were included in the study...
April 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jaimi H Greenslade, Edward W Carlton, Christopher Van Hise, Elizabeth Cho, Tracey Hawkins, William A Parsonage, Jillian Tate, Jacobus Ungerer, Louise Cullen
STUDY OBJECTIVE: This diagnostic accuracy study describes the performance of 5 accelerated chest pain pathways, calculated with the new Beckman's Access high-sensitivity troponin I assay. METHODS: High-sensitivity troponin I was measured with presentation and 2-hour blood samples in 1,811 patients who presented to an emergency department (ED) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule...
April 2018: Annals of Emergency Medicine
Shilo Lefresne, Robert Olson, Rosemary Cashman, Paula Kostuik, Wei Ning Jiang, Karen Levy, Michael R Mckenzie, Ann Hulstyn, Mitchell Liu, Jonn Wu, Eric Berthelet
INTRODUCTION: The Vancouver Rapid Access (VARA) clinic was designed to provide palliative radiotherapy and holistic care to patients with incurable lung cancer. Analysis of the pilot phase demonstrated improved radiotherapy wait-times and access to supportive services compared to standard practice. This study aims to prospectively assess the impact of the clinic on patient reported symptoms and quality of life. MATERIALS AND METHODS: Patient assessments are completed at baseline and by a telephone follow up four-weeks later using Likert scales adapted from the Edmonton Symptom Assessment System (scale 0-10) and European Organization for Research and Treatment of Cancer questionnaires (scale 1-4)...
October 2017: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Hyunjoo Lee, Carlos Rodriguez
No abstract text is available yet for this article.
October 9, 2017: Emergency Medicine Practice
Nariman Sepehrvand, Yinggan Zheng, Paul W Armstrong, Robert C Welsh, Justin A Ezekowitz
BACKGROUND: Several accelerated diagnostic protocols (ADPs) have been developed to allow emergency department (ED) physicians to identify appropriate patients for safe early discharge after presentation with symptom of chest pain. Most ADPs require chest pain to be described and modify the algorithm based on the subjective chest pain characteristics. We investigated the performance of three established major ADPs simplified by eliminating the need for chest pain as a descriptor. METHODS: We pooled patients from PROACT-3 and -4 trials, in which patients presenting to emergency medical services with chest pain or dyspnea were enrolled...
June 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Christina Luong, Andrew Starovoytov, Milad Heydari, Tara Sedlak, Eve Aymong, Jacqueline Saw
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an infrequent but important cause of myocardial infarction (MI) especially in younger women. However, the clinical presentation and the acuity of symptoms prompting invasive management in SCAD patients have not been described. Understanding these presenting features may improve SCAD diagnosis and management. METHODS: We reviewed SCAD patients who were prospectively followed at the Vancouver General Hospital SCAD Clinic...
June 1, 2017: Catheterization and Cardiovascular Interventions
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...
January 2017: Journal of Emergency Medicine
Marcus Eng Hock Ong, Ying Hao, Susan Yap, Pin Pin Pek, Terrance Siang Jin Chua, Faith Suan Peng Ng, Swee Han Lim
OBJECTIVES: The new Vancouver Chest Pain (VCP) Rule recommends early discharge for chest pain patients who are at low risk of developing acute coronary syndrome (ACS), and thus can be discharged within 2 hours of arrival at the emergency department (ED). This study aimed to assess the performance of the new VCP Rule for Asian patients presenting with chest pain at the ED. METHODS: This prospective cohort study involved patients attended to at the ED of a large urban centre...
January 2017: CJEM
Dylan Flaws, Martin Than, Frank Xavier Scheuermeyer, James Christenson, Barbara Boychuk, Jaimi H Greenslade, Sally Aldous, Christopher J Hammett, William A Parsonage, Joanne M Deely, John W Pickering, Louise Cullen
OBJECTIVE: The emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP) facilitates low-risk ED chest pain patients early to outpatient investigation. We aimed to validate this rule in a North American population. METHODS: We performed a retrospective validation of the EDACS-ADP using 763 chest pain patients who presented to St Paul's Hospital, Vancouver, Canada, between June 2000 and January 2003. Patients were classified as low risk if they had an EDACS <16, no new ischaemia on ECG and non-elevated serial 0-hour and 2-hour cardiac troponin concentrations...
September 2016: Emergency Medicine Journal: EMJ
Annie Y Chou, Roshan Prakash, Jennifer Rajala, Taira Birnie, Saul Isserow, Carolyn M Taylor, Andrew Ignaszewski, Sammy Chan, Andrew Starovoytov, Jacqueline Saw
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear. METHODS: We designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support...
April 2016: Canadian Journal of Cardiology
Edward W Carlton, Ahmed Khattab, Kim Greaves
STUDY OBJECTIVE: We compare the ability of 5 established risk scores to identify patients with suspected acute coronary syndromes who are suitable for discharge after a modified single-presentation high-sensitivity troponin result. METHODS: This was a prospective observational study conducted in a UK district general hospital emergency department. Consecutive adults recruited with suspected acute coronary syndrome for whom attending physicians determined evaluation with serial troponin testing was required...
December 2015: Annals of Emergency Medicine
Hyung Chae Yang, Hyong-Ho Cho, Si Young Jo, Chul Ho Jang, Yong Beom Cho
OBJECTIVES: Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. METHODS: Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration...
March 2015: Clinical and Experimental Otorhinolaryngology
Frank Xavier Scheuermeyer, Hubert Wong, Eugenia Yu, Barb Boychuk, Grant Innes, Eric Grafstein, Kenneth Gin, Jim Christenson
OBJECTIVES: Current guidelines emphasize that emergency department (ED) patients at low risk for potential ischemic chest pain cannot be discharged without extensive investigations or hospitalization to minimize the risk of missing acute coronary syndrome (ACS). We sought to derive and validate a prediction rule that permitted 20 to 30% of ED patients without ACS safely to be discharged within 2 hours without further provocative cardiac testing. METHODS: This prospective cohort study enrolled 1,669 chest pain patients in two blocks in 2000-2003 (development cohort) and 2006 (validation cohort)...
March 2014: CJEM
Louise Cullen, Jaimi H Greenslade, Martin Than, Anthony F T Brown, Christopher J Hammett, Arvin Lamanna, Dylan F Flaws, Kevin Chu, Lindsay F Fowles, William A Parsonage
OBJECTIVES: To externally evaluate the accuracy of the new Vancouver Chest Pain Rule and to assess the diagnostic accuracy using either sensitive or highly sensitive troponin assays. METHODS: Prospectively collected data from 2 emergency departments (EDs) in Australia and New Zealand were analysed. Based on the new Vancouver Chest Pain Rule, low-risk patients were identified using electrocardiogram results, cardiac history, nitrate use, age, pain characteristics and troponin results at 2 hours after presentation...
February 2014: American Journal of Emergency Medicine
Jaimi H Greenslade, Louise Cullen, Martin Than, Sally Aldous, Kevin Chu, Anthony F T Brown, A Mark Richards, Christopher J Pemberton, Peter George, William A Parsonage
OBJECTIVES: The objective of this study is to evaluate the accuracy of the Vancouver Chest Pain Rule using troponin as the only biomarker in an emergency department (ED) setting. METHODS: This is an analysis of prospectively collected data from 2 EDs in Australia and New Zealand. Trained research nurses collected clinical data using a customised case report form. Based on a modified Vancouver Chest Pain Rule using troponin as the only biomarker, low-risk patients were identified using clinical history, age, pain characteristics, electrocardiography, and troponin results at 0 and 2 hours after presentation...
July 2013: American Journal of Emergency Medicine
Mohammad Jalili, Zia Hejripour, Amir Reza Honarmand, Nasim Pourtabatabaei
OBJECTIVES: The objective was to validate the Vancouver Chest Pain Rule in an emergency department (ED) setting to identify very-low-risk patients with acute chest pain. METHODS: A prospective cohort study was conducted on consecutive patients 25 years of age and older presenting to the ED with a chief complaint of acute chest pain during January 2009 to July 2009. According to the Vancouver Chest Pain Rule, cardiac history, chest pain characteristics, physical and electrocardiogram (ECG) findings, and cardiac biomarker measurement (creatine kinase-myocardial band isoenzyme [CK-MB]) were used to identify patients with very low risk for developing acute coronary syndrome (ACS) in 30 days...
July 2012: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Sonia Singh, Bohdan Nosyk, Huiying Sun, James Malcolm Christenson, Grant Innes, Aslam Hayat Anis
OBJECTIVES: The aim of this study was to estimate the potential cost-effectiveness and expected value of perfect information of a recently derived clinical prediction rule for patients presenting to emergency departments with chest discomfort. METHODS: A decision analytic model was constructed to compare the Early Disposition Prediction Rule (EDPR) with the current standard of care. Results were used to calculate the potential cost-effectiveness of the EDPR, as well as the Value of Information in conducting further research...
2008: International Journal of Technology Assessment in Health Care
Pamela A Ratner, Roula Tzianetas, Andrew W Tu, Joy L Johnson, Martha Mackay, Christopher E Buller, Maureen Rowlands, Birgit Reime
STUDY OBJECTIVE: To find out if gender and ethnicity are associated with acute myocardial infarction (AMI) symptom recognition and the recommendation of enlisting emergency medical services. DESIGN: In an experiment, a random sample of the public was provided a scenario of a person experiencing symptoms of AMI; the gender of the character (male, female, or indeterminate) was manipulated. SETTING: Vancouver, Canada PARTICIPANTS: 976 people from a population based random sample of 3419 people, 40 years of age and older, participated in a telephone survey given in English, Cantonese, Mandarin, and Punjabi...
July 2006: Journal of Epidemiology and Community Health
Jim Christenson, Grant Innes, Douglas McKnight, Christopher R Thompson, Hubert Wong, Eugenia Yu, Barb Boychuk, Eric Grafstein, Frances Rosenberg, Kenneth Gin, Aslam Anis, Joel Singer
STUDY OBJECTIVE: Current risk stratification tools do not identify very-low-risk patients who can be safely discharged without prolonged emergency department (ED) observation, expensive rule-out protocols, or provocative testing. We seek to develop a clinical prediction rule applicable within 2 hours of ED arrival that would miss fewer than 2% of acute coronary syndrome patients and allow discharge within 2 to 3 hours for at least 30% of patients without acute coronary syndrome. METHODS: This prospective, cohort study enrolled consenting eligible subjects at least 25 years old at a single site...
January 2006: Annals of Emergency Medicine
Pauline T Truong, Freddy Abnousi, Celina M Yong, Allen Hayashi, James A Runkel, Theressa Phillips, Ivo A Olivotto
BACKGROUND: Currently, there is no standardized, comprehensive method to assess surgical scars after breast cancer surgery. This article evaluates the application of the Vancouver Scar Scale, in conjunction with patients' scar self-rating and scar-related pain, in a cohort of breast cancer patients. METHODS: Data were prospectively collected in 59 women with breast cancer. Scar assessment comprised: 1. objective rating by pairs of independent observers using the Vancouver Scar Scale; 2...
October 2005: Plastic and Reconstructive Surgery
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