The interobserver reliability of a novel qualitative point of care assay for heart-type fatty acid binding protein.

BACKGROUND: Heart-type fatty acid-binding protein (h-FABP) may help to improve the early diagnosis of acute coronary syndromes in patients presenting to the Emergency Department (ED) with chest pain. A novel qualitative point of care h-FABP lateral flow immunoassay (True Rapid, FABPulous BV) could provide results to clinicians within just 5min. Given the qualitative nature of this test and prior to evaluation in a large diagnostic study, we aimed to determine inter-observer reliability when interpreted contemporaneously by staff in the ED. METHODS: In a nested prospective cohort study including adult patients with suspected cardiac chest pain, venous blood samples were tested for h-FABP (FABPulous BV) on arrival and 3h later. Each test result was independently interpreted by two different investigators after 5min. The investigators were blinded to each other's interpretation and recorded their findings on separate case report forms. We determined interobserver reliability by calculating the Cohen's kappa score and 95% confidence intervals. RESULTS: A total of 43 test results (from 31 patients) were each interpreted by two independent investigators. Absolute agreement between investigators was 93.0%, with a Cohen's kappa of 0.81 (95% CI 0.6-1.0), indicating near perfect agreement. In total there were three (7.0%) disagreements. In each case one investigator reported a 'weak positive' result while the other interpreted the result as 'negative'. CONCLUSIONS: These findings demonstrate the interobserver reliability of a qualitative point of care h-FABP assay. Further work must evaluate diagnostic accuracy and determine the clinical implications of the small rate of disagreement

Lexical retrieval after Arabic aphasia: Syntactic access and predictors of spoken naming

Research into anomia has been carried out in English and many Indo-European languages extensively, but not in Arabic. Previous studies have investigated predictors of successful lexical retrieval after anomia, and access to syntax during lexical retrieval. The aim of the current study is to examine impaired lexical retrieval in Arabic at two levels: predictors of lexical retrieval, and access to syntax during lexical retrieval, via checking whether syntactic cueing (using the definite article/əl-/'the' prior to nouns) facilitates noun retrieval in Arabic aphasia, with regard to naming speed and accuracy, and establishing the determinants of aphasic noun retrieval in Arabic. Three participants with anomia following CVA named 186 pictures from a published Arabic database in two conditions: bare noun condition, and determiner + noun condition. Participants' accuracy and reaction times were compared in both conditions. Furthermore, a multiple regression analysis was carried out to test the effect of psycholinguistic variables (visual complexity, name agreement, age of acquisition, imageability and other intrinsic variables) on successful lexical retrieval to determine predictors of Arabic noun retrieval after anomia. The production of the determiner + noun in picture naming facilitated spoken naming in all three participants. Nouns produced with the determiner were produced faster and more accurately than their counterparts produced without the determiner. The two participants with agrammatism produced morpho-syntactic errors in the bare noun condition, but not in the determiner + noun condition, suggesting that the determiner sets up a noun phrase frame with a slot for the noun to be filled, resulting in responses that are faster and more accurate. Age of acquisition and imageability were the only two variables that had influence across the participants. These results have theoretical and clinical implications for lexical retrieval models

Oral ibandronate reduces the risk of skeletal complications in breast cancer patients with metastatic bone disease: results from two randomised, placebo-controlled phase III studies

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid.

OBJECTIVES: Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG. METHODS: We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic regression in one cohort and validated in two similar prospective studies. RESULTS: The HE-MACS model was derived in 796 patients and validated in cohorts of 474 and 659 patients. HE-MACS incorporated age, sex, systolic blood pressure plus five historical variables to stratify patients into four risk groups. On validation, 5.5 and 12.1% (pooled total 9.4%) patients were identified as 'very low risk' (potential immediate rule out) with a pooled sensitivity of 99.5% (95% confidence interval: 97.1-100.0%). CONCLUSION: Using only the patient's history and ECG, HE-MACS could 'rule out' ACS in 9.4% of patients while effectively risk stratifying remaining patients. This is a very promising tool for triage in both the prehospital environment and ED. Its impact should be prospectively evaluated in those settings

Clinical utility of magnetocardiography in cardiology for the detection of myocardial ischemia

It is a review article. The abstract is not availabl

How events in emergency medicine impact doctors' psychological well-being

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ. Background: Emergency medicine is a high-pressured specialty with exposure to disturbing events and risk. We conducted a qualitative study to identify which clinical events resulted in emotional disruption and the impact of these events on the well-being of physicians working in an ED. Methods: We used the principles of naturalistic inquiry to conduct narrative interviews with physicians working in the ED at Central Manchester University Hospitals NHS Foundation Trust, between September and October 2016. Participants were asked, Could you tell me about a time when an event at work has continued to play on your mind after the shift in which it occurred was over?' Data were analysed using framework analysis. The study had three a priori themes reported here. Other emergent themes were analysed separately. Results: We interviewed 17 participants. Within the first a priori theme (clinical events') factors associated with emotional disruption included young or traumatic deaths, patients or situations that physicians could relate to, witnessing the impact of death on relatives, the burden of responsibility (including medical error) and conflict in the workplace. Under theme 2 (psychological and physical effects), participants reported substantial upset leading to substance misuse, sleep disruption and neglecting their own physical needs through preoccupation with caring. Within theme 3 (impact on relationships), many interviewees described becoming withdrawn from personal relationships following clinical events, while others described feeling isolated because friends and family were non-medical. Conclusions: Clinical events encountered in the ED can affect a physician's psychological and physical well-being. For many participants these effects were negative and long lasting