CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Most Canadian emergency departments use an unstructured, individualized approach to patients with chest pain, without data to support the safety and efficiency of this practice. We sought to determine the proportions of patients with chest discomfort in emergency departments who either had acute coronary syndrome (ACS) and were inappropriately discharged from the emergency department or did not have ACS and were held for investigation. ⋯ The current individualized approach to evaluation and disposition of patients with chest discomfort in 2 Canadian tertiary care emergency departments misses 5.3% of cases of ACS while consuming considerable health care resources for patients without coronary disease. Opportunities exist to improve both safety and efficiency.
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The vital role played by family caregivers in supporting dying cancer patients is well recognized, but the burden and economic impact on caregivers is poorly understood. We prospectively examined the psychosocial, occupational and economic impact of caring for a person with a terminal illness. ⋯ Caregivers' depression and perceived burden increase as patients' functional status declines. Strategies are needed to help reduce the psychosocial, occupational and economic burden associated with caregiving.
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The differential diagnosis of fever of unknown origin includes infectious diseases, malignancies and connective tissue diseases. Multiple myeloma is not usually included in the differential diagnosis, nor is it considered a frequent cause of cholestasis in the absence of amyloidosis. ⋯ The patient underwent a long and unfruitful series of diagnostic procedures, including liver biopsy. The clue to the diagnosis, established with a marrow biopsy, was the presence of a paraprotein in the serum.