Sex differences in characteristics and outcome in acute coronary syndrome patients in the Netherlands

Background Sex differences in acute coronary syndrome (ACS) have been reported, but little is known about the situation in the Netherlands. M

Random Exchange Quantum Heisenberg Chains

The one-dimensional quantum Heisenberg model with random $\pm J$ bonds is studied for $S=\frac{1}{2}$ and $S=1$. The specific heat and the zero-field susceptibility are calculated by using high-temperature series expansions and quantum transfer matrix method. The susceptibility shows a Curie-like temperature dependence at low temperatures as well as at high temperatures. The numerical results for the specific heat suggest that there are anomalously many low-lying excitations. The qualitative nature of these excitations is discussed based on the exact diagonalization of finite size systems.Comment: 13 pages, RevTex, 12 figures available on request ([email protected]

Ecologische effecten van duinboog- en washoverherstel

Contains fulltext : 72225.pdf (publisher's version ) (Open Access)130 p

Eilanden natuurlijk. Natuurlijke dynamiek en veerkracht op de Waddeneilanden

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Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department: A Stepped-Wedge, Cluster Randomized Trial

Item does not contain fulltextBackground: The HEART (History, Electrocardiogram, Age, Risk factors, and initial Troponin) score is an easy-to-apply instrument to stratify patients with chest pain according to their short-term risk for major adverse cardiac events (MACEs), but its effect on daily practice is unknown. Objective: To measure the effect of use of the HEART score on patient outcomes and use of health care resources. Design: Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT01756846). Setting: Emergency departments in 9 Dutch hospitals. Patients: Unselected patients with chest pain presenting at emergency departments in 2013 and 2014. Intervention: All hospitals started with usual care. Every 6 weeks, 1 hospital was randomly assigned to switch to "HEART care," during which physicians calculated the HEART score to guide patient management. Measurements: For safety, a noninferiority margin of a 3.0% absolute increase in MACEs within 6 weeks was set. Other outcomes included use of health care resources, quality of life, and cost-effectiveness. Results: A total of 3648 patients were included (1827 receiving usual care and 1821 receiving HEART care). Six-week incidence of MACEs during HEART care was 1.3% lower than during usual care (upper limit of the 1-sided 95% CI, 2.1% [within the noninferiority margin of 3.0%]). In low-risk patients, incidence of MACEs was 2.0% (95% CI, 1.2% to 3.3%). No statistically significant differences in early discharge, readmissions, recurrent emergency department visits, outpatient visits, or visits to general practitioners were observed. Limitation: Physicians were hesitant to refrain from admission and diagnostic tests in patients classified as low risk by the HEART score. Conclusion: Using the HEART score during initial assessment of patients with chest pain is safe, but the effect on health care resources is limited, possibly due to nonadherence to management recommendations. Primary Funding Source: Netherlands Organisation for Health Research and Development