Acute Chest Pain Triage and Management Guideline Effects on Patient Safety and Physiological Outcomes in a Primary Care Office Setting

Background: Heart disease remains the number one killer of Americans with an estimated 599,413 deaths in 2013 attributed to this condition and its treatment has inflated to an annual cost of $190 billion. This mortality is partially attributed to ineffective outpatient triage, management, and treatment of patients with acute chest pain. Methods: The purpose of this newly proposed acute chest pain triage and management guideline was: (1) to decrease inappropriate wait times and incongruous office appointments resulting in delay of care, patients being referred to the emergency room (ER) or, direct admissions to the hospital from the primary care office setting, and (2) to increase appropriate management for those patients experiencing the symptom of chest pain in the primary care setting by increasing the skill and comfort level of staff and providers in triaging and managing those patients in the primary care office setting. Results: Problem resolution was accomplished via employment of a multi-step acute chest pain guideline. This quality improvement plan (QIP) was successful in decreasing patients presenting to the primary care office with acute chest pain by 30.5%. Office staff and providers acquired a valuable resource and increased personal comfort level when triaging and managing acute chest pain in the outpatient primary care office setting. Conclusions: Sustainable use of the new guideline will promote cost savings for the primary care office and, more importantly, reduced delay of care and will reduce mortality rates for patients with acute chest pain

Presidential Popularity and Reputation

This paper reports on the results of an empirical study of relationships between the popularity of US presidents and economic variables. Traditionally, these relationships are based on the hypothesis that voters hold the incumbent President responsible for the economic situation. We derive an alternative specification of popularity, based on the hypothesis that political parties perform better on different issues. Empirical evidence turns out to be strongly in favour of our hypothesis. Our findings have important implications for studies on government behaviour in which it is assumed that one of the objectives of administrations is to maximise votes

A latent green fluorescent styrylcoumarin probe for the selective growth and detection of Gram negative bacteria

A novel, green fluorescent β-alanylstyrylcoumarin derivative was synthesized and evaluated for its performance as a fluorogenic enzyme substrate on a range of clinically relevant microorganisms. The substrate was selectively hydrolysed by β-alanyl aminopeptidase producing P. aeruginosa resulting in an on-to-off fluorescent signal. Growth inhibitory effect of the substrate was observed on Gram positive bacteria and yeasts. Meanwhile, Gram negative species, despite their extremely protective cell envelope, showed ready uptake and accumulation of the substrate within their healthy growing colonies displaying intense green fluorescence.NHMR

A sensitive and specific β-alanyl aminopeptidase-activated fluorogenic probe for the detection of Pseudomonas aeruginosa

We report the synthesis of the sensitive and specific fluorogenic self-immolative substrate 8b, which is hydrolzyed by β-alanyl aminopeptidase (BAP), resulting in a 1,6-elimination and the release of the highly fluorescent hydroxycoumarin 6b. This fluorophore 6b is retained within bacterial colonies, so has potential for the detection of P. aeruginosa (a BAP producer); it also has potential in liquid media due to the rapid and strong signal release from the substrate 8b, and lack of self-quenching or photobleaching.NHMR