Search

Background: Chest pain is a frequent cause of health care contacts. We examined the prehospital management, in-hospital discharge diagnoses, and mortality of patients calling a non-emergency and emergency medical service with chest pain. Methods: The Copenhagen Emergency Medical Services (EMS) consists of a non-emergency medical helpline (calls to 1813) and emergency medical service (1-1-2 calls). We included all calls to the Copenhagen EMS with a primary complaint of chest pain from 2014 to 2018 in Copenhagen, Denmark. The outcomes were: emergency response (ambulance dispatch, other transports/self-transport/home visits, self-care, and unknown/cancelled response), in-hospital diagnosis within 7 days after the call (cardiovascular, pulmonary, or other non-cardiovascular/pulmonary) and 30-day mortality. Results: Among 4,834,071 calls, 91,671 were registered with chest pain at the Copenhagen EMS. The first call for each patient was kept for analysis (n = 66,762). In total, 91.4% were referred to the hospital, 75.8% (n = 50,627) received an ambulance and 15.6% (n = 10,383) received other transport/self-transport/home visits. Overall, 26.9% (n = 17,937) were diagnosed with a cardiovascular disease, 5.2% (n = 3,490) a pulmonary disease, 52.8% (n = 35.242) other non-cardiovascular/pulmonary disease, and 15.1% (n = 10,093) received no diagnosis. Among ambulance-transported patients, the prevalence of cardiovascular discharge diagnoses was higher (32.1%) and fewer received no diagnosis (11.0%). Cardiovascular disease was less prevalent among patients not transported by ambulance and patients not referred to hospital at all (2-13.4%) and in patients ≤ 40 years of age (< 10%). The 30-day mortality was below 5% regardless of diagnosis (0.6-4%), and 65,704 (98.4%) were still alive 30 days later. Conclusion: Nearly all patients calling with chest pain were referred for treatment. Among ambulance-transported patients, around half of the patients did not have a cardiovascular/pulmonary disease. While current practices appear reasonable, improved differentiation of chest pain patients in telephone consultations could potentially both improve the treatment and management of these patients and reduce the in-hospital burden of non-acute chest pain consultations. [ABSTRACT FROM AUTHOR]

Background: Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. Methods: This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months postimplementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. Results: The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019–September 10, 2020) and the post-implementation period (September 11, 2020–December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45–2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as “good.” Conclusion: In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as “good.” [ABSTRACT FROM AUTHOR]

Noncardiac chest pain is a challenging condition often encountered by primary care providers, emergency medicine physicians, and gastroenterologists. It is frequently accompanied by persistent symptoms, diagnostic uncertainty, decreased quality of life, and high health care burden. Gastroesophageal reflux disease is the most common esophageal cause followed by functional chest pain, and at least half of patients with noncardiac chest pain have psychiatric comorbidities such as anxiety or depression. Management is focused on identification of an underlying cause to target treatment and address psychiatric comorbidities. This article discusses the evaluation and management of the common gastrointestinal causes of noncardiac chest pain. [ABSTRACT FROM AUTHOR]

Chest pain is one of the most prevalent causes of Emergency Department (ED) admission and could be a presenting symptom of Acute Coronary Syndrome (ACS). The aim of this review was to provide an overview of the research about troponin and its limitations and new biomarkers used in patients with cardiovascular diseases, with a special focus on soluble Suppression of Tumorigenicity 2 (sST2) and Soluble Urokinase Plasminogen Activator Receptor (suPAR). In January 2024, a PubMed and Reviews in Cardiovascular Medicine (RCM) search was carried out to identify all relevant papers in the past five years. 80 articles were included in the final review. ssT2 and suPAR are involved in both acute and chronic cardiovascular disease and can predict the risk of adverse events. sST2 and suPAR are promising biomarkers that, in combination with troponin, could help in the management of patients with chest pain in the ED. Further studies are needed to validate their role in management of ACS in this specific setting. [ABSTRACT FROM AUTHOR]

The article focuses on practical tips for pediatricians in diagnosing and managing precordial catch syndrome (PCS), a common yet underrecognized cause of chest pain in children and youth. It aims to increase awareness among primary care physicians to help them identify PCS, which is generally benign but can cause significant anxiety and unnecessary testing. It provides a detailed overview of PCS symptoms, suggests ways to differentiate it from other potential diagnoses.

People experiencing homelessness may use emergency medical services to access health care. We sought to examine the relationship between homelessness and prehospital evaluation and treatment of chest pain. We obtained 2019 data of all emergency medical services activations from a single 9-1-1 provider in San Francisco, California with a clinician's primary impression of chest pain. Using chart review, we categorized patients as experiencing homelessness or not and determined treatment rates between the two groups based on local chest pain/acute coronary syndrome protocol. We then stratified the two groups based on primary impression subcategories: "chest pain–not cardiac" and "chest-pain–cardiac/STEMI"; ST elevation myocardial infarction (STEMI). A total of 601 chest pain calls were analyzed after excluding non-transports and pediatric patients. 120 incidents (20%) involved patients experiencing homelessness. Across all chest pain impressions, people experiencing homelessness were less likely to receive aspirin (35% vs 53%; p < 0.001), intravenous access (38% vs 62%; p < 0.001), and nitroglycerin (21% vs 39%; p < 0.001). No patients experiencing homelessness received analgesic medication, though only 4% of other patients received this intervention (0% vs 4%; p = 0.020). People experiencing homelessness were more likely to receive a clinical impression of "chest pain–not cardiac" compared to "chest pain–cardiac/STEMI" (68% vs 32%; p < 0.001). Results were less significant in most fields when adjusted for impression sub categorizations: "chest pain–not cardiac" versus "chest pain–cardiac/STEMI." Greater than 97% of all patients received 12 lead electrocardiograms. Significant disparities were observed between patients experiencing and not experiencing homelessness in the prehospital treatment of chest pain. Larger scale evaluations are needed to further assess potential disparities in care for people experiencing homelessness in the prehospital setting. Using prehospital clinician impression as a proxy for acuity may mask existing bias and disparity; however, 12-lead ECG acquisition, the key diagnostic tool, was appropriately performed in more than 97% of all chest pain patients. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT) has better resolution than that of intravascular ultrasound. OCT provides vital information during percutaneous coronary intervention (PCI) procedure and is associated with better procedural and inhospital outcomes along with improved survival rate. In the present article, we have investigated three special cases including anomalous separate origin of the left circumflex artery at our hospital. We have reported the feasibility and safety of OCT-guided PCI in these three cases. [ABSTRACT FROM AUTHOR]

Background High-resolution computed tomography (CT) is the most reliable sensitive noninvasive imaging procedure recommended in the diagnosis, assessment, the severity, and follow-up of coronavirus disease 2019 (COVID-19). It has a qualitative and quantitative role. The COVID-19 Reporting and Data System evaluates the probability of COVID-19 pulmonary involvement, and the corresponding CT severity score, which evaluates the approximate percentage of each of the five lobes’ involvement. Research question We aimed to illustrate chest CT typical and atypical manifestations in COVID-19 patients regarding their age, sex, patients’ symptoms, and CT severity score. Study design and methods We conducted a cross-sectional study on 120 patients more than or equal to 18 years with confirmed COVID-19 infection (PCR positive) during the period from April 2021 to October 2021, who were admitted to Ain Shams University Isolation Hospitals, where all patients’ clinical data and CT chest imaging for these patients will be collected. [ABSTRACT FROM AUTHOR]

Introduction: Urine drug screens (UDS) have unproven clinical utility in emergency department (ED) chest pain presentations. A test with such limited clinical utility may exponentiate biases in care, but little is known about the epidemiology of UDS use for this indication. We hypothesized that UDS utilization varies nationally across race and gender. Methods: This was a retrospective observational analysis of adult ED visits for chest pain in the 2011-2019 National Hospital Ambulatory Medical Care Survey. We calculated the utilization of UDS across race/ethnicity and gender and then characterized predictors of use via adjusted logistic regression models. Results: We analyzed 13,567 adult chest pain visits, representative of 85.8 million visits nationally. Use of UDS occurred for 4.6% of visits (95% CI 3.9%-5.4%). White females underwent UDS at 3.3% of visits (95% CI 2.5%-4.2%), and Black females at 4.1% (95% CI 2.9%-5.2%). White males were tested at 5.8% of visits (95% CI 4.4%-7.2%), while Black males were tested at 9.3% of visits (95% CI 6.4%-12.2%). A multivariate logistic regression model including race, gender, and time period shows significantly increased odds of ordering UDS for Black patients (odds ratio [OR] 1.45 (95% CI 1.11-1.90, p = 0.007)) and male patients (OR 2.0 (95% CI 1.55-2.58, p < 0.001) as compared to White patients and female patients. Conclusion: We identified wide disparities in the utilization of UDS for the evaluation of chest pain. If UDS were used at the rate observed for White women, Black men would undergo nearly 50,000 fewer tests annually. Future research should weigh the potential of the UDS to magnify biases in care against the unproven clinical utility of the test. [ABSTRACT FROM AUTHOR]

Background: Pleurisy is an inflammation of the parietal pleura and is characterized by pleuritic pain. The most common cause of pleurisy is infection; other causes include rheumatoid arthritis, malignancy, rib fractures, or trauma. Possible causes of chest pain associated with golf include costochondritis, stress fractures of the ribs, intercostal muscle strain, or, rarely, Tietze’s syndrome and slipping rib syndrome. Case: A 64-year-old female presented with intractable chest pain that began 4 months prior while playing golf. No specific cause was found after various examinations. There was persistent pain despite medical treatment. Ultrasonography (US) was performed over the painful areas, which revealed focal pleural effusions. A mixture of ropivacaine and triamcinolone was injected into the focal pleural effusions using US guidance, which dramatically relieved her pain. Conclusions: This case demonstrates that US can be used as a diagnostic and therapeutic modality for intractable chest pain with an undetected pathology. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Selecting noninvasive diagnostic tests for coronary artery disease can be a daunting task to acute care NPs. This article provides an overview of the pathophysiology of coronary artery disease, relevant noninvasive diagnostic imaging modalities, and an evidence-based approach to guide subsequent diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Background: Cold gel pad application and deep relaxation exercise are interventions that can be applied to reduce pain during chest tube removal. Aim: The study was conducted to find out the effect of local cold application and relaxation exercise on pain level during chest tube removal in patients undergoing open heart surgery. Methods: It was conducted an experimental study in 90 patients who underwent heart surgery. Local cold gel pad was applied to the patients in cold application group, rytmic breathing exercise was given to the patients in relaxation group, routine procedures were applied in control group during chest tube removal. The patient's pain levels were measured with VAS before, immediately after and 15 minutes after the procedure. Results: It was determined that the mean VAS scores in the cold application group and relaxation exercise group was significantly lower than the control group. Local coldf gel pad application were not found more effective than relaxation group in reducing procedural pain level. Conclusions: Cold gel pack application and relaxation exercise were found to be effective in reducing pain level in our study. Further studies that examine the effectiveness of cold gel pad and deep breathing exercises on the interventional pain should be performed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chest wall pain affects many patients following chest surgery, fractures, or malignancies, and can be very difficult to manage with normal pharmacologic agents. Intercostal ablation provides one alternative treatment modality for patients suffering from intercostal pain. Intercostal cryoneurolysis involves using extreme cold to cause Wallerian degeneration of the targeted intercostal nerve. This article reviews the patient selection, technique, and complications in the utilization of intercostal neurolysis in the treatment of intractable chest pain. [ABSTRACT FROM AUTHOR]

Objective: Chest pain is a large health care burden in Australia and around the world. Its management requires specialist assessment and diagnostic tests, which can be costly and often lead to unnecessary hospital admissions. There is a growing unmet clinical need to improve the efficiency and management of chest pain. This study aims to show the cost-benefit of rapid access chest pain clinics (RACC) as an alternative to hospital admission.Design: Retrospective cost-benefit analysis for 12 months.Setting: RACCs in three Sydney tertiary referral hospitals.Main Outcome Measures: Cost per patient.Results: Hospitals A, B and C implemented RACCs but each operating with slightly different staffing, referral patterns, and diagnostic services. All RACCs had similar costs per patient of AUD$455.25, AUD$427.12 and AUD$474.45, hospitals A, B and C respectively, and similar cost benefits per patient of AUD$1,168.75, AUD$1,196.88 and AUD$1,149.55, respectively. At least 28%, 26% and 29% of these RACC patients for hospitals A, B, and C, respectively, would have otherwise had to have been admitted to hospital for the model to be cost-beneficial.Conclusion: This study shows that a RACC model of care is cost-beneficial in the state of NSW as an alternative strategy to inpatient care for managing chest pain. Scaling up to a national level could represent an even larger benefit for the Australian health system. [ABSTRACT FROM AUTHOR]

Aims The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population. Methods and results Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P  < 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P  = 0.33). Over the follow-up period (median 717, interquartile range 93–1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P  < 0.005), revascularization (7.3% vs. 3.5%, P  < 0.005), further functional testing 33.4% vs. 8.7% (P  < 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P  < 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low—CCT-2.3% and SE-3.3%—with no significant difference (P  = 0.16). Conclusion Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings. [ABSTRACT FROM AUTHOR]

Aim: This executive summary of the clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. These guidelines present an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated and shared decision-making with patients is recommended. [ABSTRACT FROM AUTHOR]

Aim: This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.Methods: A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended. [ABSTRACT FROM AUTHOR]

Background Large-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China are rare. Methods This study is a retrospective study based on data from the Hospital Quality Monitoring System (HQMS) database. This study included emergency patients admitted with ACS to hospitals that uploaded clinical data continuously to the database from 2013 to 2016. Propensity score matching was used to compare hospitals with and without CPC accreditation during this period. A longitudinal self-contrast comparison design with mixed-effects models was used to compare management of ACS before and after accreditation. Results A total of 798 008 patients with ACS from 746 hospitals were included in the analysis. After matching admission date, hospital levels and types and adjusting for possible covariates, patients with ACS admitted to accredited CPCs had lower in-hospital mortality (0R=0.70, 95% CI 0.53 to 0.93), shorter length of stay (LOS; adjustedmultiplicative effect=0.89, 95% CI 0.84 to 0.94) and more percutaneous coronary intervention (PCI) procedures (OR=3.53, 95% CI 2.20 to 5.66) than patients admitted in hospitals without applying for CPC accreditation. Furthermore, when compared with the 'before accreditation' group only in accredited CPCs, the in-hospital mortality and LOS decreased and the usage of PCI were increased in both 'accreditation' (for in-hospital mortality: 0R=0.86, 95% CI 0.79 to 0.93; for LOS: 0.94, 95% CI 0.93 to 0.95; for PCI: OR=1.22, 95% CI 1.18 to 1.26) and 'after accreditation' groups (for in-hospital mortality: 0R=0.90, 95% CI 0.84 to 0.97; for LOS: 0.89, 95% CI 0.89 to 0.90; for PCI: OR=1.36, 95% CI 1.33 to 1.39). The significant benefits of decreased in-hospital mortality, reduced LOS and increased PCI usage were also observed for patients with acute myocardial infarction. Conclusions CPC accreditation is associated with better management and in-hospital clinical outcomes of patients with ACS. CPC establishment and accreditation should be promoted and implemented in countries with high levels of ACS. [ABSTRACT FROM AUTHOR]

We present the case of a 75‐year‐old woman with typical myocardial infarction but a negative coronary angiogram. Echocardiography identified the rare cause of her chest pain: a mobile mass on the aortic valve that obstructed the coronary ostium. The histopathology revealed a papillary fibroelastoma (PFE), and her chest pain was relieved after surgical resection of the mass. [ABSTRACT FROM AUTHOR]

Inadvertent malpositioning of a cardiac pacing lead into the left heart chambers is a rare complication of transvenous pacing. We report a patient with a history of a transient ischemic attack and chronic chest pain whose left atrial pacing lead location was revealed by transesophageal three‐dimensional (3D) echocardiography during evaluation of an inter‐atrial shunt. [ABSTRACT FROM AUTHOR]

Objective: To describe the case of a 21-year-old female with previously diagnosed neurofibromatosis type 1 (NF-1) with neck, scapular, lumbar, and temporomandibular discomfort along with headaches. Clinical features: The patient had chronic tightness and pain in the cervicothoracic region as well as pain in the lumbar spine at the site of prior neurofibroma removal. Radiographs demonstrated multilevel osseous changes. In addition to NF-1, she was diagnosed with cervical myalgia, tension-type headaches, and chronic temporomandibular joint disorder. Intervention and outcomes: Treatment consisted of a course of manual therapy including cervical flexion-distraction, myofascial release, patient education on workplace ergonomics, and an at-home active care plan. The patient experienced a reduction in pain and headache frequency. Manual therapy in the form of cervical flexion-distraction with myofascial release and education on workplace ergonomics were effective in reducing neck and thoracic pain as well as reducing headache frequency in a 21-year-old with NF-1. [ABSTRACT FROM AUTHOR]

Background: Wide variation exists for hospital admission rates for the evaluation of possible acute coronary syndrome, but there are limited data on physician-level variation. Our aim is to describe physicians' rates of admission for suspected acute coronary syndrome and associated 30-day major adverse events.Methods: We conducted a retrospective analysis of adult emergency department chest pain encounters from January 2016 to December 2017 across 15 community emergency departments within an integrated health system in Southern California. The unit of analysis was the Emergency physician. The primary outcome was the proportion of patients admitted/observed in the hospital. Secondary analysis described the 30-day incidence of death or acute myocardial infarction.Results: Thirty-eight thousand seven hundred seventy-eight patients encounters were included among 327 managing physicians. The median number of encounters per physician was 123 (interquartile range, 82-157) with an overall admission/observation rate of 14.0%. Wide variation in individual physician admission rates were observed (unadjusted, 1.5%-68.9%) and persisted after case-mix adjustments (adjusted, 5.5%-27.8%). More clinical experience was associated with a higher likelihood of hospital care. There was no difference in 30-day death or acute myocardial infarction between high- and low-admitting physician quartiles (unadjusted, 1.70% versus 0.82% and adjusted, 1.33% versus 1.29%).Conclusions: Wide variation persists in physician-level admission rates for emergency department chest pain evaluation, even in a well-integrated health system. There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians. This suggests an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care. [ABSTRACT FROM AUTHOR]

Experiences of pain, especially chest pain, can be not only uncomfortable but also frightening. Among children and adolescents, symptoms of chest pain are relatively common, affecting about one in 10 youth. Chest pain symptoms can vary widely in presentation, in terms of their quality, frequency, severity, and history. When presenting during childhood and adolescence, chest pain rarely signifies a cardiac or health problem. Identifiable causes of chest pain typically are related to underlying pulmonary or gastrointestinal conditions. Less than 5% of pediatric chest pain cases are estimated to be related to actual heart disease. The vast majority of cases of chest pain, estimated at 80% to 85%, are benign and are described as "idiopathic," with an unknown cause. These cases are generally labeled as noncardiac chest pain (NCCP). [ABSTRACT FROM AUTHOR]

Background: A number of Australian hospitals are piloting outpatient rapid access chest pain clinics (RACC) as a new clinical pathway. These clinics aim to provide an alternative to inpatient care for timely access to specialist cardiology assessment whilst improving quality of care and experience. An understanding of overall patient satisfaction can be considered a marker of overall clinical success, contributes to cost-effectiveness, and is needed to develop improvement strategies. We aimed to evaluate uncertainty, satisfaction and experience among patients treated in a RACC.Methods: All consecutive patients presenting with troponin negative intermediate risk chest pain treated in a new RACC in a public quaternary teaching hospital over a 12-month period, were invited to participate in two core components: A paper-based questionnaire, and a one-month follow-up telephone structured interview. Patient satisfaction and uncertainty were assessed by the short form of the Mishel Uncertainty in Illness Scale (MUIS) and Picker Dimensions of care.Results: There was a 51.2% response rate (190/371). Patients ranged in age from 20 to 89 years (56.4±13.6 years) and 47% were female. Findings illustrated a global high level of satisfaction in all areas: care, comfort, communication and engagement, with low levels of uncertainty in illness experienced by patients.Conclusion: There were high levels of satisfaction and minimal uncertainty for patients related to their management and care in the RACC during the study period. These results have formed part of the formal cost-effectiveness assessment of the RACC used to support its transition from a pilot implementation to standard of care at the study centre. [ABSTRACT FROM AUTHOR]

Background: Cardiac chest pain is a typical complaint experienced by patients with Acute Coronary Syndrome (ACS) in Emergency Departments (EDs). Pharmacological therapy is one major intervention used to reduce cardiac chest pain due to ACS. However, this therapy does not optimally and completely reduce cardiac chest pain; therefore, additional therapy is greatly required. Purpose: This study aimed to examine the effect of Dhikr therapy as one of the additional therapies for the cardiac chest pain experienced by patients with ACS in EDs. Methods: This quasi-experimental research was conducted using a pretest-posttest control group design. As many as 52 patients with ACS were recruited using a consecutive sampling technique and then equally divided into the intervention and control group. The intervention group received both pharmacological and Dhikr therapy approximately for 17 minutes, while the control group only received the pharmacological therapy based on the hospital's protocol. The Numeric Pain Rating Scale (NPRS) was used to measure the intensity of cardiac chest pain, and both paired and independent t-tests were utilized to analyze the data. Results: The results showed that there was a significant difference in pain reduction in both groups (p=0.000), although the decrease in the intervention group was higher than that in the control group. Furthermore, the pain reduction was significantly different between groups (p=0.021) Conclusion: Dhikr combined with pharmacological therapy reduced the intensity of cardiac chest pain in ACS patients better than the use of pharmacological therapy alone. Therefore, this study recommends the combination of pharmacological and Dhikr therapy for patients with ACS. [ABSTRACT FROM AUTHOR]

This case reports successful treatment of intractable, idiopathic chest wall and rib pain of five years duration in a fifty-year-old female patient, using acupuncture and related modalities. Patient had suffered from idiopathic chest wall pain without significant improvement with conventional therapies. Her condition was resolved in five treatments, which included manual acupuncture, electroacupuncture, running cupping and press needles. It is noted that this was a sample size of n=1. Further studies with larger sample sizes should be conducted to see if acupuncture and related modalities can help patients experiencing this kind of severe, unremitting pain. A further limitation of this case is that it is not yet known whether or not her chest wall and rib pain will reoccur, but, if it does recur, this approach can offer a relatively low cost, effective and safe alternative to conventional biomedical treatments. [ABSTRACT FROM AUTHOR]

Background: Chest pain is a leading complaint in emergency settings. Timely emergency medical services (EMS) responses can reduce delays to treatment and improve clinical outcomes for acute myocardial infarction patients and other medical emergencies. We investigated national-level EMS response, scene, and transport times for acute chest pain patients in the United States. Methods: A retrospective analysis was performed using 2015–2016 data from the National EMS Information System (NEMSIS). Eligible patients were identified as having a provider impression of chest pain or discomfort and not due to trauma or resulting in cardiac arrest during EMS care. Descriptive analyses of prehospital time intervals and patient-, response-, and system-level covariates were performed. Multivariable logistic regression was used to measure associations between meeting response and scene time benchmarks (8-min and 15-min, respectively) and covariates. Results: Our study identified 1,672,893 eligible EMS encounters of chest pain. Patients had a mean age of 63.1 years (SD = 14.8). The population was evenly distributed by sex (51% male; 49% female). Most encounters occurred in home or residence (58%) and had lights and sirens response to scene (84%). Most encounters were in urban areas (78%). The median (interquartile range, IQR) response time was 7 (5–10) minutes. The median (IQR) scene time was 16 (12–20) minutes. The median (IQR) transport time was 13 (8–20) minutes. Generally, median response and transport times were longer in rural and frontier areas compared to urban and suburban areas. Only 65% and 49% met the 8-min response and 15-min scene time benchmarks. Responding with lights and sirens was associated with greater compliance with EMS response time benchmark. EMS care of older age groups and females was less likely to meet the scene time benchmark. Conclusions: Substantial proportions of EMS encounters for chest pain did not meet response and scene time benchmarks. Regional and urban-rural differences were observed in adherence with the response time benchmark. Our findings also suggest age and gender disparities in on-scene delays by EMS. Our study contributes important evidence on timely EMS responses for cardiac chest pain and provides suggestions for EMS system benchmarking and quality improvement. [ABSTRACT FROM AUTHOR]

Chest pain is a very common symptom in pediatric patients. Although children with chest pain are relatively unlikely to be suffering from significant cardiac diseases, it is important not to overlook life-threatening diseases. Complete history taking and physical examination--which involves identifying the duration of pain, onset, character, associated symptoms, and aggravating factors--are extremely important. The most common causes of pediatric chest pain are idiopathic and musculoskeletal, while less than 3% of cases are of cardiac origin. Recent studies indicate that chest pain resulted from psychosomatic disorders increases in non-cardiac chest pain in children and adolescents. The reassurance of the benign nature of chest pain is enough in most cases of non-cardiac chest pain in children and adolescents. When echocardiography is performed on patients with exertional chest pain, it is important to confirm the origin of coronary artery to exclude any coronary anomaly. Exertional chest pain, combined syncope, and symptoms of myocardial ischemia should raise the suspicion of significant cardiac diseases. When the chest pain is accompanied by red flag signs, physicians must refer the patients to a pediatric cardiologist. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to evaluate if there is an association between patient–physician language concordance and adverse patient outcomes or physician adherence to clinical recommendations for emergency department (ED) patients with chest pain. Methods: We conducted a retrospective observational study of adult ED chest pain encounters with a troponin order from May 2016 to September 2017 across 15 community EDs. Outcomes were 30‐day acute myocardial infarction or all‐cause mortality, hospital admission/observation, or noninvasive cardiac testing. To assess patient outcomes, we used the overall cohort. To assess adherence to clinical recommendations, we used a subgroup of patients with a low‐risk HEART score. A mixed‐effects logistic regression model was used to compare the odds of the outcomes between language concordant and discordant patient–physician pairs, controlling for patient characteristics. Results: Overall, 52,014 ED encounters were included (10,791 low‐risk HEART encounters). Of those 6,452 (12.4%) encounters were language discordant and 1.7% in each group had an adverse outcome. Adjusted models demonstrated no increased risk for language discordant ED encounters when comparing adverse outcomes (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.6 to 1.5) for all patients or recommended care (OR = 1.02, 95% CI = 0.87 to 1.2) for low‐risk patients. Conclusions: No associations were found between patient–physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care. [ABSTRACT FROM AUTHOR]

Copyright of Journal of University of Anbar for Pure Science is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The Victorian Emergency Minimum Dataset (VEMD) collects administrative and clinical data for all presentations to Victorian public ED. The present study aimed to examine the level of agreement between the VEMD data and the medical record for a sample of patients coded as having acute cardiovascular conditions (acute coronary syndrome, stroke and transient ischaemic attack [TIA]) and unspecified chest pain in the VEMD. Methods: Six months of data provided to the VEMD from a large metropolitan hospital was obtained, and a random sample of 10% of cases (n = 310) were selected for review. Data for eight VEMD items were compared for concordance to data recorded in the ED medical record. Results: Complete concordance between the VEMD and medical records for all eight items was observed only for 101 (33%) presentations. Overall, the least concordant variables were those with a high number of coding options: usual type of accommodation (76%), referral pattern (84%) and primary diagnosis (85%). The concordance of the VEMD primary diagnosis varied when examined as individual codes (range 75%–100%) and when combined (acute coronary syndrome = 94%, stroke or TIA = 85% and chest pain unspecified = 75%). The level of agreement for some items improved when VEMD codings were combined. Conclusion: When compared to the medical record, our data suggest there is likely variation in the accuracy of some VEMD items, and suggests a larger prospective validation of the VEMD is warranted. For researchers using existing VEMD data, combining of some codes may be necessary. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the implementation of a new health-literacy-tested patient decision aid for chest pain in Emergency Department (ED) patients. Outcomes included disposition, knowledge, decisional conflict and satisfaction prior to discharge. Patient health literacy was explored as a factor that may explain disparities in sub-group analysis of all outcomes.Methods: A health-literacy adapted tool was deployed using a pre/post intervention design. Patients enrolled during the intervention period were given the adapted chest pain decision aid that was used in conversation with their emergency medicine physician to decide on their course of action prior to being discharged.Results: A total of 169 participants were surveyed and used in the final analysis. Patients in the usual care group were 2.6 times more likely to be admitted for chest pain than patients in the intervention group. Knowledge scores were higher in the intervention group, while no significant differences were observed in decisional conflict and patient satisfaction, or by patient health literacy level.Conclusion and Practice Implications: Using the adapted chest pain decision tool in emergency medicine may improve knowledge and reduce admissions, while addressing known barriers to understanding related to patient health literacy. [ABSTRACT FROM AUTHOR]

Chest arthralgia refers to a disease characterized by chest pain, even chest pain, shortness of breath and inability to lie down. The disease is recurrent in clinical, causing great harm to the life of patients. In this paper, Professor Li Ji based on Xiaoyao Powder in the treatment of chest arthralgia two cases were analyzed, showing Professor Li Ji clinical treatment of chest arthralgia ideas and methods, in order to fill a corner for clinical treatment of chest arthralgia. [ABSTRACT FROM AUTHOR]

Objective: Complaints of chest pain are one of the most common reasons that people visit emergency departments (EDs). However, more than 50% of patients who present to EDs with chest pain do not have identifiable cardiac disease or other medical conditions. A pilot study was conducted to investigate if using low‐intensity (LI) cognitive behavioural therapy (CBT) in the ED at Flinders Medical Centre, South Australia, reduced the reported levels of anxiety and depression, re‐presentation rates, and the associated cost of patients presenting to the ED with non‐cardiac chest pain. Method: A convenience sample (n = 35) was recruited from people who presented to the ED with non‐cardiac chest pain and screened positive for psychological distress. If eligible, participants were referred to the Improving Access to Psychological Therapies@Flinders (IAPT@Flinders) service and, following completion, hospital medical records were reviewed to investigate the number of presentations to the ED and the subsequent costs of each presentation, in the 3 months prior and 3 months preceding treatment. Results: There was a decrease in self‐reported levels of depression and anxiety after the completion of treatment, and a suggested 59% decrease in ED admissions and a 69% cost saving. Conclusions: The potential health benefits and cost savings as a result of LICBT for patients who present to ED's with non‐cardiac chest pain warrant further investigation utilising a robust and economically validated trial. [ABSTRACT FROM AUTHOR]

The article presents the Thoracic Paravertebral Neurolysis for the Treatment of Intractable Chest Wall Pain Caused by Neoplasms. Topics discussed include Cancer-associated chest wall pain is caused by primary and metastatic neoplasms invading the chest wall and pleura and can be controlled by conventionally recommended systemic analgesics; and describe the effect of thoracic paravertebral neurolysis on intractable chest wall pain caused by neoplasms invading the chest wall and pleura.

The article focuses on guidelines developed through the International Liaison Committee on Resuscitation and adopted by seven resuscitation councils around the world are widely implemented across emergency care systems with each update eagerly awaited by millions of end-users. Topics include the Society for Academic Emergency Medicine leadership into the science of practice guideline creation and dissemination, and the evidence-based guidance for undifferentiated repeat chest pain.

Abstract Background We sought to determine whether gender disparities exist in the prehospital management of chest pain (CP) or out-of-hospital cardiac arrest (OHCA) among patients who accessed the emergency medical services (EMS) system. Methods We obtained 2010–2013 data from the National Emergency Medical Services Information System and identified all EMS activations for CP or OHCA by adults 40 years of age or older. We selected American Heart Association medications and procedures to manage cardiovascular events. We stratified women and men by age (<65 years vs. ≥65 years), race (White vs. Black), clinical condition (CP vs. OHCA), same EMS agency, and calendar year. We determined the gender-specific treatment proportions for each stratum and calculated the weighted percentage difference in treatment between women and men. Results Approximately 2.4 million CP and 284,000 OHCA activations were analyzed. Women with CP received a lower percentage of recommended treatments than men. For every 100 EMS activations by women with CP, 2.8 fewer received aspirin (95% CI, −4.8 to −0.8). The greatest gap in CP care was that women were significantly less likely to be transported using lights and sirens than men (−4.6%; 95% CI, −8.7% to −0.5%). More than 90% of OHCA activations were resuscitated; however, women were significantly less likely to be resuscitated compared with men (−1.3%; 95% CI, −2.4% to −0.2%). Conclusions Small to modest disparities between otherwise similar women and men in the EMS treatment of CP and OHCA suggest the need for further evaluation and research with detailed contextual and outcome data. [ABSTRACT FROM AUTHOR]

The objectives of this study are to report the responses of emergency department (ED) clinicians regarding the characteristics and management of patients with noncardiac chest pain (NCCP) and to explore clinician experiences with the current standard of care and whether nonpharmacologic or nonsurgical referral options would be considered. A cross-sectional survey was delivered to 40 ED clinicians from hospitals in Winnipeg, Manitoba from 2012 to 2013. Data were reduced descriptively and thematically summarized to assess the characteristics of patients with NCCP along with the responses of ED clinicians regarding the management of NCCP. The survey response was 27 (67.5% response rate). They reported that patients with NCCP comprised a considerable amount of ED care and are a variable and heterogeneous population. Respondents agreed (63.0%) that onsite and on-call providers for NCCP referral would assist in patient management. Further, ED clinicians (66.7%) would consider referring patients with NCCP to a nonpharmacologic, nonsurgical clinical research study. Clinicians in this study wanted better access to on-site referrals and outpatient clinics for patients experiencing NCCP after discharge and would consider nonpharmacologic or nonsurgical referral. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain. Methods: Adult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE—cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests. Results: A total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low‐risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%–100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac‐related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36). Conclusions: The HEART Pathway had a 100% NPV for 1‐year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1‐year objective testing was not significant. [ABSTRACT FROM AUTHOR]

Background. Clinical short-term risk stratification is a recommended approach in patients with chest pain and possible acute myocardial infarction (AMI) to further improve high safety of biomarker-based rule-out algorithms. The study aim was to assess clinical performance of baseline concentrations of high-sensitivity cardiac troponin T (hs-TnT) and copeptin and the modified HEART score (mHS) in early presenters to the emergency department with chest pain. Methods. This cohort study included patients with chest pain with onset maximum of 6 h before admission and no persistent ST-segment elevation on electrocardiogram. hs-TnT, copeptin, and the mHS were assessed from admission data. The diagnostic and prognostic value for three baseline rule-out algorithms: (1) single hs-TnT < 14 ng/l, (2) hs-TnT < 14 ng/l/mHS ≤ 3, and (3) hs-TnT < 14 ng/l/mHS ≤ 3/copeptin < 17.4 pmol/l, was assessed with sensitivity and negative predictive value. Primary diagnostic endpoint was the diagnosis of AMI. Prognostic endpoint was death and/or AMI within 30 days. Results. Among 154 enrolled patients, 44 (29%) were classified as low-risk according to the mHS; AMI was diagnosed in 105 patients (68%). For ruling out AMI, the highest sensitivity and NPV from all studied algorithms were observed for hs-TnT/mHS/copeptin (100%, 95% CI 96.6–100, and 100%, 95% CI 75.3–100). At 30 days, the highest event-free survival was achieved in patients stratified with hs-TnT/mHS/copeptin algorithm (100%) with 100% (95% CI 75.3–100) NPV and 100% (95% CI 96.6–100) sensitivity. Conclusions. The combination of baseline hs-TnT, copeptin, and the mHS has an excellent sensitivity and NPV for short-term risk stratification. Such approach might improve the triage system in emergency departments and be a bridge for inclusion to serial blood sampling algorithms. [ABSTRACT FROM AUTHOR]

Introduction: Patients with limited English proficiency may be at risk for inc omplete history collection, potentially a patient safety issue. While federal l aw requires qualified medical interpreters be provided for these patients, little is known about the quality of information obtained in these encounters. Our study compared the medical histories obtained by physicians in the emergency department (ED) based on whether the patients primarily spoke English or Spanish. Methods: This was a prospective, observational study conducted at a single, urban, academic ED during a six-month time period. Resident and faculty physicians caring for adult patients with a chief complaint of chest or abdominal pain were eligible for participation. Patient encounters were directly observed by medical students who had been trained using simulated encounters. Observers documented which key historical data points were obtained by providers, including descriptions of pain (location, quality, severity, radiation, alleviating/aggravating factors), past medical/family/surgical history, and social history, in addition to the patient's language in providing history. Providers, interpreters, and observers were blinded to the nature of the study. We used chi-square analyses to examine differences in whether specific elements were collected based on the primary language of the patient. Results: Encounters with 753 patients were observed: 105 Spanish speaking and 648 English speaking. Chi-square analyses found no statistically significant differences in any history questions between Spanish-speaking and English-speaking patients, with the exception that questions regarding alleviating factors were asked more often with Spanish-speaking patients (45%) than English-speaking patients (30%, p=.003). The average percentages of targeted history elements obtained in Spanish and English encounters were 60% and 57%, respectively. Conclusion: In this study at a large, urban, academic ED, the medical histories obtained by physicians were similar between English-speaking and Spanish-speaking patients. This suggests that the physicians sought to obtain medical histories at the same level of detail despite the language barrier. One limitation to consider is the Hawthorne effect; however, providers and observers were blinded to the nature of the study in an attempt to minimize the effect. [ABSTRACT FROM AUTHOR]