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Faster Treatment (faster + treatment)
Selected AbstractsIncremental Benefit of 80-Lead Electrocardiogram Body Surface Mapping Over the 12-Lead Electrocardiogram in the Detection of Acute Coronary Syndromes in Patients Without ST-elevation Myocardial Infarction: Results from the Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT MI) TrialACADEMIC EMERGENCY MEDICINE, Issue 9 2010Brian J. O'Neil MD ACADEMIC EMERGENCY MEDICINE 2010; 17:932,939 © 2010 by the Society for Academic Emergency Medicine Abstract Background:, The initial 12-lead (12L) electrocardiogram (ECG) has low sensitivity to detect myocardial infarction (MI) and acute coronary syndromes (ACS) in the emergency department (ED). Yet, early therapies in these patients have been shown to improve outcomes. Objectives:, The Optimal Cardiovascular Diagnostic Evaluation Enabling Faster Treatment of Myocardial Infarction (OCCULT-MI) trial was a multicenter trial comparing a novel 80-lead mapping system (80L) to standard 12L ECG in patients with chest pain and presumed ACS. This secondary analysis analyzed the incremental value of the 80L over the 12L in the detection of high-risk ECG abnormalities (ST-segment elevation or ST depression) in patients with MI and ACS, after eliminating all patients diagnosed with ST-elevation MI (STEMI) by 12L ECG. Methods:, Chest pain patients presenting to one of 12 academic EDs were diagnosed and treated according to the standard care of that site and its clinicians; the clinicians were blinded to 80L results. MI was defined by discharge diagnosis of non,ST-elevation MI (NSTEMI) or unstable angina (UA) with an elevated troponin. ACS was defined as discharge diagnosis of NSTEMI or UA with at least one positive test result (troponin, stress test, angiogram) or revascularization procedure. Results:, Of the 1,830 patients enrolled in the trial, 91 patients with physician-diagnosed STEMI and 225 patients with missing 80L or 12L data were eliminated from the analysis; no discharge diagnosis was available for one additional patient. Of the remaining 1,513 patients, 408 had ACS, 206 had MI, and one had missing status. The sensitivity of the 80L was significantly higher than that of the 12L for detecting MI (19.4% vs. 10.4%, p = 0.0014) and ACS (12.3% vs. 7.1%, p = 0.0025). Specificities remained high for both tests, but were somewhat lower for 80L than for 12L for detecting both MI and ACS. Negative and positive likelihood ratios (LR) were not statistically different between groups. In patients with severe disease (defined by stenosis > 70% at catheterization, percutaneous coronary intervention, coronary artery bypass graft, or death from any cause), the 80L had significantly higher sensitivity for detecting MI (with equivalent specificity), but not ACS. Conclusions: Among patients without ST elevation on the 12L ECG, the 80L body surface mapping technology detects more patients with MI or ACS than the 12L, while maintaining a high degree of specificity. [source] Not just another case of nausea and vomiting: A review of postinfectious gastroparesisJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2010Allison R. Thorn MSN, FNP-BC (Family Nurse Practitioner) Purpose: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of postinfectious gastroparesis (PIGP). Data sources: Review of literature using Medscape, the Internet, and PubMed. The following search terms were used: gastroparesis, postinfectious gastroparesis, postviral gastroparesis, and idiopathic gastroparesis. There was no limitation placed on publication year. Only articles in English were used. Conclusions: PIGP is a rare illness that can affect all ages and both genders, although more prominent in middle-aged women. It is defined as delayed gastric emptying after an acute self-limited viral infection in the absence of mechanical obstruction. Limited research is available on PIGP. It is a complicated disorder with an unclear pathogenesis and narrow treatment options, therefore affecting the patient's quality of life significantly. Fortunately, the prognosis of PIGP is good, although in some instances it can take years to recover completely. Implications for practice: There is a huge lack of awareness of PIGP among primary care providers (PCPs). The importance of this illness is greatly underestimated. Educating PCPs about PIGP leads to quicker referrals and therefore faster treatment for patients, which in turn improves their health and quality of life, and thereby decreases healthcare costs as well. [source] Self-ligating brackets in orthodontics: do they deliver what they claim?AUSTRALIAN DENTAL JOURNAL, Issue 1 2009PG Miles Abstract Self-ligating brackets have enjoyed recent popularity in the orthodontic marketplace with various claims made including faster ligation, lower friction, faster treatment, less pain, waking up the tongue, and fewer appointments. Although various designs of self-ligating brackets have been available for many years they have only recently surged in popularity on the back of these claims but what evidence is there to support these claims? This review article examines the current available evidence regarding treatment duration, influence on archform, and the speed of tying and untying self-ligating brackets compared with conventional brackets and methods of ligation. [source] Milnacipran and pindolol: a randomized trial of reduction of antidepressant latencyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2003Michael T. Isaac Abstract Background New, better tolerated and faster treatments for depression are needed. Patients are understandably unhappy with having to wait 3 to 4 weeks for a response to an antidepressant, while experiencing side effects almost immediately. This frequently has an adverse effect on compliance and engagement with treatment. Aims The primary objective was to assess the activity of pindolol on the onset of antidepressive response of milnacipran. The secondary objective was to assess the number of responders among the patients who received milnacipran and pindolol versus patients who received milnacipran and placebo. The tertiary objective was to evaluate the safety of milnacipran and pindolol versus milnacipran and placebo. Method Randomized, double-blind, placebo-controlled study over 42 days. Setting Inner city London community mental health teams. Participants 80 patients were selected and gave written consent to treatment, 78 were randomized (39 in each group) and evaluated for safety (intention-to-treat, ITT, safety data set), 77 (ITT efficacy data set), and 64 (per protocol, PP, data set) were evaluated for efficacy. The mean age was 31.9 for the pindolol group and 32.3 for the placebo. Intervention All patients received milnacipran 50,mg twice a day plus either pindolol 2.5,mg (the ,pindolol group') or matching placebo (the ,placebo group') three times a day. Outcome measures The main efficacy variable was the Montgomery,Åsberg depression rating scale (MADRS) score at days 0, 4, 7, 10, 14, 21, 28, 42 on PP data set in an observation carried (OC) approach. Secondary efficacy variables were clinical global impression (global improvement) and Hamilton depression rating scale (HDRS). Results Improvement in MADRS total score was greater in the pindolol group than in the placebo group from day 7 (p=0.03). Responder rates in the clinical global impression were 97.2% for the pindolol group and 60.6% for the placebo group. The treatment was well tolerated with the most common side effects being nausea (28.2%; 35.9%), vomiting (7.7%; 23.1%), hot flushes (15.4%; 5.1%) and sweating (12.8%; 12.8%). Conclusion The milnacipran and pindolol combination is safe, well tolerated and efficacious in major depression, and represents a rational strategy for the possible acceleration or potentiation of antidepressant action. Copyright © 2003 John Wiley & Sons, Ltd. [source] A rapid method to clinically assess the effect of an anti-acne formulationINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 1 2010N. Muizzuddin J. Cosmet. Sci., 60, 25,29 (January/February 2009) Synopsis Historically, clinical evaluation of acne treatment has been based on direct visual assessment and the counting of lesions over a period of several weeks of treatment. However, with advancing technology there has been ever-increasing speed in the effectiveness of these treatments. To successfully assess these faster treatments, acne pathology needs to be evaluated in a shorter time frame. The object of these studies was to develop techniques to evaluate individual acne lesions in a shorter time frame and to assess speedier treatment technologies. Ten healthy volunteers with acne lesions on their upper backs were recruited for the study. Two inflamed acne lesions were selected for each treatment, along with lesions to be left untreated, on each volunteer. Each lesion was marked, photographed, and visually graded. A skin surface microscope (Scopeman) was used to visualize size and to grade the lesions by two experts every day for five days. The sites were treated once a day for the course of the study. There was a remarkable reduction in the size and erythema of acne lesions after treatment with the acne formulation as compared to the untreated and vehicle-treated lesions. Individual lesions, both treated and untreated, appeared resolved in 14 days. This resolution can be noticeably accelerated by topical treatments. We have developed a simple and faster clinical method to evaluate the effects of topical anti-acne technology. [source] | ||||||||||