1,102 research outputs found
Which diagnostic tests are most useful in a chest pain unit protocol?
Background
The chest pain unit (CPU) provides rapid diagnostic assessment for patients with acute, undifferentiated chest pain, using a combination of electrocardiographic (ECG) recording, biochemical markers and provocative cardiac testing. We aimed to identify which elements of a CPU protocol were most diagnostically and prognostically useful.
Methods
The Northern General Hospital CPU uses 2–6 hours of serial ECG / ST segment monitoring, CK-MB(mass) on arrival and at least two hours later, troponin T at least six hours after worst pain and exercise treadmill testing. Data were prospectively collected over an eighteen-month period from patients managed on the CPU. Patients discharged after CPU assessment were invited to attend a follow-up appointment 72 hours later for ECG and troponin T measurement. Hospital records of all patients were reviewed to identify adverse cardiac events over the subsequent six months. Diagnostic accuracy of each test was estimated by calculating sensitivity and specificity for: 1) acute coronary syndrome (ACS) with clinical myocardial infarction and 2) ACS with myocyte necrosis. Prognostic value was estimated by calculating the relative risk of an adverse cardiac event following a positive result.
Results
Of the 706 patients, 30 (4.2%) were diagnosed as ACS with myocardial infarction, 30 (4.2%) as ACS with myocyte necrosis, and 32 (4.5%) suffered an adverse cardiac event. Sensitivities for ACS with myocardial infarction and myocyte necrosis respectively were: serial ECG / ST segment monitoring 33% and 23%; CK-MB(mass) 96% and 63%; troponin T (using 0.03 ng/ml threshold) 96% and 90%. The only test that added useful prognostic information was exercise treadmill testing (relative risk 6 for cardiac death, non-fatal myocardial infarction or arrhythmia over six months).
Conclusion
Serial ECG / ST monitoring, as used in our protocol, adds little diagnostic or prognostic value in patients with a normal or non-diagnostic initial ECG. CK-MB(mass) can rule out ACS with clinical myocardial infarction but not myocyte necrosis(defined as a troponin elevation without myocardial infarction). Using a low threshold for positivity for troponin T improves sensitivity of this test for myocardial infarction and myocardial necrosis. Exercise treadmill testing predicts subsequent adverse cardiac events
The influence of oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people
Objective: To investigate the impact of the oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people. Background To our knowledge, there have been no studies on this topic in patients aged 75 years or older.
Material and methods: Thirty outpatients of a university dental clinic (median [IQR] age of 77.00 [75-82] years) participated. The OHIP-14, a dental examination, a speech intelligibility study and an articulation examination were conducted.
Results: Distortions of rhotacisms and sigmatisms were most common, followed by distortions of labiodentals and apicoalveolars. Seven participants (23%) required dental treatment. Distortions of rhotacisms were lowest in participants with loss of teeth in the posterior part of the maxilla and equal in participants with edentulous maxilla and loss of teeth in the anterior part of the maxilla (P = 0.014). Labiodental distortions were lowest in participants with loss of teeth in the posterior part of the maxilla, but were higher in participants with loss of teeth in the anterior part of the maxilla and highest in participants with an edentulous maxilla (P = 0.035). People with normal mouth opening had lower percentage of labiodental distortions than people with a reduced mouth opening (P = 0.05). The proportion of participants with inadequate denture hygiene and distortions of bilabials was 71.4% compared to 10.5% for participants with adequate denture hygiene (P = 0.005).
Conclusion: Dentists must consider the impact of a denture on speech, but also should be aware of other oral health factors that influence the speech and quality of life of elders
Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care
Objectives To measure the effectiveness and cost effectiveness
of providing care in a chest pain observation unit compared
with routine care for patients with acute, undifferentiated chest
pain.
Design Cluster randomised controlled trial, with 442 days
randomised to the chest pain observation unit or routine care,
and cost effectiveness analysis from a health service costing
perspective.
Setting The emergency department at the Northern General
Hospital, Sheffield, United Kingdom.
Participants 972 patients with acute, undifferentiated chest
pain (479 attending on days when care was delivered in the
chest pain observation unit, 493 on days of routine care)
followed up until six months after initial attendance.
Main outcome measures The proportion of participants
admitted to hospital, the proportion with acute coronary
syndrome sent home inappropriately, major adverse cardiac
events over six months, health utility, hospital reattendance and
readmission, and costs per patient to the health service.
Results Use of a chest pain observation unit reduced the
proportion of patients admitted from 54% to 37% (difference
17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65,
P < 0.001) and the proportion discharged with acute coronary
syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates
of cardiac event were unchanged. Care in the chest pain
observation unit was associated with improved health utility
during follow up (0.0137 quality adjusted life years gained, 95%
confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of
£78 per patient (–£56 to £210, P = 0.252).
Conclusions Care in a chest pain observation unit can improve
outcomes and may reduce costs to the health service. It seems
to be more effective and more cost effective than routine care
Identifying a human rights–based approach to obesity for States and civil society
Summary Obesity and its comorbidities pose daunting challenges to global health and development in the 21st century. This paper reviews some commonalities between obesity and another global health challenge, the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). International human rights law was an important catalyst for civil society movements that helped to overcome inertia and generate political will for State action in response to HIV and AIDS. Drawing on the HIV experience, the authors propose a conceptual model for a human rights?based response to obesity founded on the twin pillars of State obligations and civil society engagement. Framing States' obligations to address the global obesity pandemic as a matter of international law, informed by the examples of the United Nations ?International Guidelines on HIV/AIDS and Human Rights? and the General Comments of the United Nations human rights treaty bodies on HIV and AIDS, provides a normative framework to guide State actions and opportunities to engage the extensive accountability mechanisms of the United Nations international human rights system. In addition, it provides civil society organizations with the language and tools to demand State action on obesity. The authors call for similar authoritative guidance for States on the application of international human rights law to obesity
Organizational and Supervisory Apology Effectiveness: Apology Giving in Work Settings
We synthesize the interdisciplinary literature into a heuristic for crafting effective organizational and supervisory apologies (the OOPS four-component apology). In the first experiment, we demonstrate how an offense committed by an organization is perceived to be more egregious than an offense committed by a friend or supervisor. Furthermore, results did not support that OOPS apologies are unequally effective if issued by a friend, supervisor, or organization. In the second experiment, we test OOPS apology-training effectiveness. Results indicated that trained participants crafted more effective apologies. Our apology heuristic is an innovation for training business communicators how to apologize effectively.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline
Single versus dual antiplatelet therapy following peripheral arterial endovascular intervention for chronic limb threatening ischaemia:retrospective cohort study
ObjectivesAntiplatelet therapy following peripheral arterial endovascular intervention lacks high quality evidence to guide practice. The aim of this study was to assess the effect of three months of dual antiplatelet therapy on amputation-free survival following peripheral arterial endovascular intervention in patients with chronic limb threatening ischemia.MethodsA retrospective review of symptomatic patients undergoing primary peripheral arterial endovascular intervention over a seven-year period was performed. The primary outcome measure was amputation-free survival. A sample size calculation based on previous cohort studies suggested that 629 limbs would be required to show a difference between single and dual therapy. Kaplan-Meier estimates and multivariate logistic regression analysis of recorded baseline characteristics was performed to determine predictors of amputation-free survival. Dual antiplatelet therapy was routinely given for 3 months.Results754 limbs were treated with primary angioplasty and/or stenting over a 7-year period, 508 of these for chronic limb threatening ischemia. There was no difference in unadjusted amputation-free survival between patients with chronic limb threatening ischaemia taking single vs. dual antiplatelet therapy (69% vs. 74% respectively Log rank Chi2 = 0.1, p = .72). After adjusting for confounders, at 1 year there was also no significant difference in amputation-free survival between patients taking single vs. dual antiplatelet therapy [OR 0.8, 95% CI 0.5-1.2, p = .3]. There was no difference in rates of major bleeding between single and dual antiplatelet therapy.ConclusionsThere was no clear evidence of reduced amputation-free survival in patients with chronic limb threatening ischemia undergoing peripheral arterial endovascular intervention being treated with dual antiplatelet therapy for 3 months. This is at odds with other retrospective case series and highlights the limitations in basing clinical practice on such data. There is a need for an adequately powered, independent randomised trial to definitively answer the question
Prevalence and correlates of self-reported state of teeth among schoolchildren in Kerala, India
BACKGROUND: Oral health status in India is traditionally evaluated using clinical indices. There is growing interest to know how subjective measures relate to outcomes of oral health. The aims of the study were to assess the prevalence and correlates of self-reported state of teeth in 12-year-old schoolchildren in Kerala, India. METHODS: Cross-sectional survey data were used. The sample consisted of 838 12-year-old schoolchildren. Data was collected using clinical examination and questionnaire. The clinical oral health status was recorded using Decayed, Missing and Filled Teeth (DMFT) and Oral Hygiene Index – Simplified (OHI-S). The questionnaire included questions on sociodemographics, self reports of behaviour, knowledge and oral problems and a single-item measuring self-reported state and satisfaction with appearance of teeth. The Kappa values for test-retest of the questionnaire ranged from 0.55 to 0.97. RESULTS: Twenty-three per cent of the schoolchildren reported the state of teeth as bad. Multivariate logistic regression showed significant associations between schoolchildren who reported to have bad teeth and poor school performance (Odds Ratio (OR) = 2.5), having bad breath (OR = 2.4), food impaction (OR = 1.7) dental visits (OR = 1.6), being dissatisfied with appearance of teeth (OR = 4.2) and caries experience (OR = 1.7). The explained variance was highest when the variables dental visits, bleeding gums, bad breath, food impaction and satisfaction with appearance were introduced into the model (19%). CONCLUSION: A quarter of 12-year-olds reported having bad teeth. The self-reported bad state of teeth was associated with poor school performance, having bad breath and food impaction, having visited a dentist, being dissatisfied with teeth appearance and having caries experience. Information from self-reports of children might help in planning effective strategies to promote oral health
Modal Analysis and Coupling in Metal-Insulator-Metal Waveguides
This paper shows how to analyze plasmonic metal-insulator-metal waveguides
using the full modal structure of these guides. The analysis applies to all
frequencies, particularly including the near infrared and visible spectrum, and
to a wide range of sizes, including nanometallic structures. We use the
approach here specifically to analyze waveguide junctions. We show that the
full modal structure of the metal-insulator-metal (MIM) waveguides--which
consists of real and complex discrete eigenvalue spectra, as well as the
continuous spectrum--forms a complete basis set. We provide the derivation of
these modes using the techniques developed for Sturm-Liouville and generalized
eigenvalue equations. We demonstrate the need to include all parts of the
spectrum to have a complete set of basis vectors to describe scattering within
MIM waveguides with the mode-matching technique. We numerically compare the
mode-matching formulation with finite-difference frequency-domain analysis and
find very good agreement between the two for modal scattering at symmetric MIM
waveguide junctions. We touch upon the similarities between the underlying
mathematical structure of the MIM waveguide and the PT symmetric quantum
mechanical pseudo-Hermitian Hamiltonians. The rich set of modes that the MIM
waveguide supports forms a canonical example against which other more
complicated geometries can be compared. Our work here encompasses the microwave
results, but extends also to waveguides with real metals even at infrared and
optical frequencies.Comment: 17 pages, 13 figures, 2 tables, references expanded, typos fixed,
figures slightly modifie
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