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accelerated diagnostic protocol

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https://www.readbyqxmd.com/read/29138293/icare-acs-improving-care-processes-for-patients-with-suspected-acute-coronary-syndrome-a-study-of-cross-system-implementation-of-a-national-clinical-pathway
#1
Martin P Than, John W Pickering, Jeremy M Dryden, Sally J Lord, S Andrew Aitken, Sally J Aldous, Kate E Allan, Michael W Ardagh, John W N Bonning, Rosie Callender, Laura R E Chapman, Jonathan P Christiansen, Andre P J Cromhout, Louise Cullen, Joanne M Deely, Gerard P Devlin, Katherine A Ferrier, Christopher M Florkowski, Christopher M A Frampton, Peter M George, Gregory J Hamilton, Allan S Jaffe, Andrew J Kerr, G Luke Larkin, Richard M Makower, Timothy J E Matthews, William A Parsonage, W Frank Peacock, Bradley F Peckler, Nicholaas C van Pelt, Louise Poynton, A Mark Richards, Anthony G Scott, Mark B Simmonds, David Smyth, Oliver P Thomas, Andrew C Y To, Stephen A Du Toit, Richard W Troughton, Kim M Yates
BACKGROUND : Efforts to safely reduce length of stay for emergency department patients with symptoms suggestive of acute coronary syndrome (ACS) have had mixed success. Few system-wide efforts affecting multiple hospital emergency departments have ever been evaluated. We evaluated the effectiveness of a nationwide implementation of clinical pathways for potential ACS in disparate hospitals. METHODS : This was a multicenter pragmatic stepped-wedge before-and-after trial in 7 New Zealand acute care hospitals with 31 332 patients investigated for suspected ACS with serial troponin measurements...
November 14, 2017: Circulation
https://www.readbyqxmd.com/read/29096671/community-led-responses-for-elimination-core-a-study-protocol-for-a-community-randomized-controlled-trial-assessing-the-effectiveness-of-community-level-reactive-focal-drug-administration-for-reducing-plasmodium-falciparum-infection-prevalence-and-incidence
#2
Daniel J Bridges, John M Miller, Victor Chalwe, Hawela Moonga, Busiku Hamainza, Rick Steketee, Kafula Silumbe, Jenala Nyangu, David A Larsen
BACKGROUND: Zambia is pushing for, and has made great strides towards, the elimination of malaria transmission in Southern Province. Reactive focal test and treat (RFTAT) using rapid diagnostic tests and artemether-lumefantrine (AL) has been key in making this progress. Reactive focal drug administration (RFDA) using dihydroartemisinin-piperaquine (DHAP), may be superior in accelerating clearance of the parasite reservoir in humans due to the provision of enhanced chemoprophylactic protection of at-risk populations against new infections...
November 2, 2017: Trials
https://www.readbyqxmd.com/read/29077588/implementation-of-a-5-minute-magnetic-resonance-imaging-screening-protocol-for-prostate-cancer-in-men-with-elevated-prostate-specific-antigen-before-biopsy
#3
Jakob Weiss, Petros Martirosian, Mike Notohamiprodjo, Sascha Kaufmann, Ahmed E Othman, Ulrich Grosse, Konstantin Nikolaou, Sergios Gatidis
PURPOSE: The aims of this study were to establish a 5-minute magnetic resonance (MR) screening protocol for prostate cancer in men before biopsy and to evaluate effects on Prostate Imaging Reporting and Data System (PI-RADS) V2 scoring in comparison to a conventional, fully diagnostic multiparametric MR imaging (mpMRI) approach. MATERIALS AND METHODS: Fifty-two patients with elevated prostate-specific antigen levels and without prior biopsy were prospectively included in this institutional review board-approved study...
October 26, 2017: Investigative Radiology
https://www.readbyqxmd.com/read/29028638/malignant-hyperthermia-versus-thyroid-storm-in-a-patient-with-symptomatic-graves-disease-a-case-report
#4
Sara M Strowd, Michael B Majewski, Jennifer Asteris
Malignant hyperthermia and thyroid storm are intraoperative emergencies with overlapping symptoms but different treatment protocols. We faced this diagnostic dilemma in a 25-year-old patient with symptomatic hyperthyroidism, elevated free T3 and free T4, and low thyroid-stimulating hormone from Graves disease despite treatment with propranolol 80 mg daily and methimazole 40 mg every 8 hours. During thyroidectomy, he developed hyperthermia and hypercarbia without tachycardia. When the rate of rise of PaCO2 and temperature accelerated, we treated the patient for malignant hyperthermia, a diagnosis subsequently confirmed by genetic testing...
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28987133/implementing-change-evaluating-the-accelerated-chest-pain-risk-evaluation-acre-project
#5
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/28976478/compressed-sensing-accelerated-3-dimensional-magnetic-resonance-cholangiopancreatography-application-in-suspected-pancreatic-diseases
#6
Liang Zhu, Xi Wu, Zhaoyong Sun, Zhengyu Jin, Elisabeth Weiland, Esther Raithel, Tianyi Qian, Huadan Xue
OBJECTIVES: The aims of this study were to prospectively evaluate image quality, duct visibility, and diagnostic performance in duct-related pathologies of compressed-sensing (CS) accelerated 3-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) prototype protocols and compare these with those of conventional 3D MRCP protocol in patients with suspected pancreatic diseases. MATERIAL AND METHODS: The institutional review board approved this prospective study and all patients provided written informed consent...
September 26, 2017: Investigative Radiology
https://www.readbyqxmd.com/read/28961567/abbreviated-mri-and-accelerated-mri-for-screening-and-diagnosis-of-breast-cancer
#7
Deepa Sheth, Hiroyuki Abe
Although published studies have revealed that magnetic resonance imaging (MRI) is by far the most effective imaging modality for cancer detection, it is currently considered cost-ineffective for screening women at an intermediate risk for breast cancer. The concept of an "abbreviated MRI" protocol has recently emerged as a possible solution for reducing the cost of MRI. The abbreviated MRI is a shortened version of the standard MRI, consisting of a single early phase dynamic contrast enhanced (DCE) series. Several clinical studies have shown that this MRI protocol would not affect sensitivity or specificity for breast MRI screening purposes...
October 2017: Topics in Magnetic Resonance Imaging: TMRI
https://www.readbyqxmd.com/read/28950384/diagnostic-accuracy-of-an-mri-protocol-of-the-knee-accelerated-through-parallel-imaging-in-correlation-to-arthroscopy
#8
Johannes Walter Schnaiter, Frank Roemer, Axel McKenna-Kuettner, Hans-Joachim Patzak, Matthias Stefan May, Rolf Janka, Michael Uder, Wolfgang Wuest
Purpose Parallel imaging allows for a considerable shortening of examination times. Limited data is available about the diagnostic accuracy of an accelerated knee MRI protocol based on parallel imaging evaluating all knee joint compartments in a large patient population compared to arthroscopy. Materials and Methods 162 consecutive patients with a knee MRI (1.5 T, Siemens Aera) and arthroscopy were included. The total MRI scan time was less than 9 minutes. Meniscus and cartilage injuries, cruciate ligament lesions, loose joint bodies and medial patellar plicae were evaluated...
September 26, 2017: RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
https://www.readbyqxmd.com/read/28934299/a-novel-copro-diagnostic-molecular-method-for-qualitative-detection-and-identification-of-parasitic-nematodes-in-amphibians-and-reptiles
#9
Lucas G Huggins, Christopher J Michaels, Sheena M Cruickshank, Richard F Preziosi, Kathryn J Else
Anthropogenic disturbance via resource acquisition, habitat fragmentation and climate change, amongst other factors, has led to catastrophic global biodiversity losses and species extinctions at an accelerating rate. Amphibians are currently one of the worst affected classes with at least a third of species categorised as being threatened with extinction. At the same time, they are also critically important for many habitats and provide man with a powerful proxy for ecosystem health by acting as a bioindicator group...
2017: PloS One
https://www.readbyqxmd.com/read/28806989/maximising-value-from-a-united-kingdom-biomedical-research-centre-study-protocol
#10
Trisha Greenhalgh, Pavel V Ovseiko, Nick Fahy, Sara Shaw, Polly Kerr, Alexander D Rushforth, Keith M Channon, Vasiliki Kiparoglou
BACKGROUND: Biomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country's international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) apply the evidence base on how best to support the various partnerships in this large, multi-stakeholder research system and (2) research how these partnerships play out in a new, ambitious programme of translational research...
August 14, 2017: Health Research Policy and Systems
https://www.readbyqxmd.com/read/28742643/sensitive-troponin-i-and-stress-testing-in-the-emergency-department-for-the-early-management-of-chest-pain-using-2-hour-protocol
#11
Shahriar Dadkhah, Zakaria Almuwaqqat, Samian Sulaiman, Husein Husein, Quang Nguyen, Saad Ali, Tuncay Taskesen
BACKGROUND: Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs...
September 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28711126/care-of-metabolic-and-endocrine-conditions-in-the-observation-unit
#12
REVIEW
Anwar Dayan Osborne
Accelerated therapeutic protocols targeting metabolic conditions are ideal for observation unit care. Because many conditions, such as hypokalemia and hyperglycemia, have little to no diagnostic uncertainty, the care in the unit is often straightforward. Additionally, some components of care for the endocrine condition may exhaust services, such as phlebotomy. Hence, this discussion focuses resource utilization and management considerations for the purposes of matching the level of care to the severity of the conditions...
August 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28705816/diagnostic-performance-of-a-10-minute-gadolinium-enhanced-brain-mri-protocol-compared-with-the-standard-clinical-protocol-for-detection-of-intracranial-enhancing-lesions
#13
J Fagundes, M G Longo, S Y Huang, B R Rosen, T Witzel, K Heberlein, R G Gonzalez, P Schaefer, O Rapalino
BACKGROUND AND PURPOSE: The development of new MR imaging scanners with stronger gradients and improvement in coil technology, allied with emerging fast imaging techniques, has allowed a substantial reduction in MR imaging scan times. Our goal was to develop a 10-minute gadolinium-enhanced brain MR imaging protocol with accelerated sequences and to evaluate its diagnostic performance compared with the standard clinical protocol. MATERIALS AND METHODS: Fifty-three patients referred for brain MR imaging with contrast were scanned with a 3T scanner...
July 13, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28647935/evaluation-of-patients-with-acute-chest-pain-using-spect-myocardial-perfusion-imaging-prognostic-implications-of-mildly-abnormal-scans
#14
Ronen Goldkorn, Alexey Naimushin, Roy Beigel, Ekaterina Naimushin, Michael Narodetski, Shlomi Matetzky
BACKGROUND: While patients presenting to emergency departments (ER) with chest pain are increasingly managed in chest pain units (CPU) that utilize accelerated diagnostic protocols for risk stratification, such as single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), data are lacking regarding the prognostic implications of mildly abnormal scans in this population. OBJECTIVES: To evaluate the prognostic implications of mildly abnormal SPECT MPI results in patients with acute chest pain...
June 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28601817/the-organisational-value-of-diagnostic-strategies-using-high-sensitivity-troponin-for-patients-with-possible-acute-coronary-syndromes-a-trial-based-cost-effectiveness-analysis
#15
Paul Jülicher, Jaimi H Greenslade, William A Parsonage, Louise Cullen
OBJECTIVES: To evaluate hospital-specific health economic implications of different protocols using high-sensitivity troponin I for the assessment of patients with chest pain. DESIGN: A cost prediction model and an economic microsimulation were developed using a cohort from a single centre recruited as part of the (ADAPT) trial, a prospective observational trial conducted from 2008 to 2011. The model was populated with 40 000 bootstrapped samples in five high-sensitivity troponin I-enabled algorithms versus standard care...
June 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28574665/simultaneous-multislice-based-5-minute-lumbar-spine-mri-protocol-initial-experience-in-a-clinical-setting
#16
Maria G Longo, Joana Fagundes, Susie Huang, William Mehan, Thomas Witzel, Himanshu Bhat, Keith Heberlein, Bruce R Rosen, Daniel Rosenthal, Ramon G Gonzalez, Pamela W Schaefer, Otto Rapalino
BACKGROUND AND PURPOSE: Previous studies have used parallel imaging (PI) techniques to decrease spine magnetic resonance imaging (MRI) protocol acquisition times. Recently developed MRI sequences allow even faster acquisitions. Our purpose was to develop a lumbar spine MRI protocol using PI with GRAPPA (generalized autocalibrating partially parallel acquisition) and a simultaneous multislice (SMS)-based sequence and to evaluate its diagnostic performance compared to a standard lumbar spine MRI protocol...
June 2, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28515106/direct-comparison-of-2-rule-out-strategies-for-acute-myocardial-infarction-2-h-accelerated-diagnostic-protocol-vs-2-h-algorithm
#17
MULTICENTER STUDY
Karin Wildi, Louise Cullen, Raphael Twerenbold, Jaimi H Greenslade, William Parsonage, Jasper Boeddinghaus, Thomas Nestelberger, Zaid Sabti, Maria Rubini-Giménez, Christian Puelacher, Janosch Cupa, Lukas Schumacher, Patrick Badertscher, Karin Grimm, Nikola Kozhuharov, Claudia Stelzig, Michael Freese, Katharina Rentsch, Jens Lohrmann, Wanda Kloos, Andreas Buser, Tobias Reichlin, John W Pickering, Martin Than, Christian Mueller
BACKGROUND: We compared 2 high-sensitivity cardiac troponin (hs-cTn)-based 2-h strategies in patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED): the 2-h accelerated diagnostic protocol (2h-ADP) combining hs-cTn, electrocardiogram, and a risk score, and the 2-h algorithm exclusively based on hs-cTn concentrations and their absolute changes. METHODS: Analyses were performed in 2 independent diagnostic cohorts [European Advantageous Predictors of Acute Coronary Syndrome Evaluation (APACE) study, Australian-New Zealand 2-h Accelerated Diagnostic Protocol to Assess patients with chest Pain symptoms using contemporary Troponins as the only biomarker (ADAPT) study] employing hs-cTnT (Elecsys) and hs-cTnI (Architect)...
July 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28506591/early-echocardiography-has-a-low-yield-in-patients-with-transient-ischemic-attack
#18
Elie Harmouche, Ghada A Mahmoud, Michael Ross, Jason Hockenberry, Robin Dharia, Fadi Nahab
STUDY OBJECTIVE: Current guidelines recommend patients presenting with transient ischemic attack (TIA) undergo echocardiography to evaluate for a cardiac source. However, echocardiography is not available daily at many centers. We assessed the yield from early transthoracic echocardiography (TTE) in consecutive patients with TIA evaluated in an emergency department observation unit (EDOU) protocol. METHODS: This observational cohort study took place in an academic medical center from January 1, 2011 to July 31, 2013...
May 11, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28500753/a-0-hour-1-hour-protocol-for-safe-early-discharge-of-chest-pain-patients
#19
Arash Mokhtari, Bertil Lindahl, Alexandru Schiopu, Troels Yndigegn, Ardavan Khoshnood, Patrik Gilje, Ulf Ekelund
OBJECTIVES: Guidelines recommend a 0-hour/1-hour high-sensitivity cardiac troponin T (hs-cTnT) diagnostic strategy in acute chest pain patients. There are, however, little data on the performance of this strategy when combined with clinical risk stratification. We aimed to evaluate the diagnostic accuracy of an accelerated diagnostic protocol (ADP) using the 0-hour/1-hour hs-cTnT strategy together with an adapted Thrombolysis In Myocardial Infarction (TIMI) score and electrocardiogram (ECG) for ruling out major adverse cardiac events (MACE) within 30 days...
May 13, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28437852/a-diagnostic-microdosing-approach-to-investigate-platinum-sensitivity-in-non-small-cell-lung-cancer
#20
Si-Si Wang, Maike Zimmermann, Hongyong Zhang, Tzu-Yin Lin, Michael Malfatti, Kurt Haack, Kenneth W Turteltaub, George D Cimino, Ralph de Vere White, Chong-Xian Pan, Paul T Henderson
The platinum-based drugs cisplatin, carboplatin and oxaliplatin are often used for chemotherapy, but drug resistance is common. The prediction of resistance to these drugs via genomics is a challenging problem since hundreds of genes are involved. A possible alternative is to use mass spectrometry to determine the propensity for cells to form drug-DNA adducts-the pharmacodynamic drug-target complex for this class of drugs. The feasibility of predictive diagnostic microdosing was assessed in non-small cell lung cancer (NSCLC) cell culture and a pilot clinical trial...
August 1, 2017: International Journal of Cancer. Journal International du Cancer
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