Internal medicine journal
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Internal medicine journal · Oct 2013
Observational StudyImpact of a decision rule on duration of continuous cardiac monitoring of patients with suspected acute coronary syndrome in an emergency department.
To determine the effect of introducing a decision rule on the duration of continuous cardiac monitoring (CCM) for patients with suspected acute coronary syndrome in an adult emergency department (ED). ⋯ Introduction of this decision rule did not decrease the median CCMED. All adverse events after the intervention occurred in appropriately monitored patients, including patients with initially negative high-sensitivity troponin T, suggesting that the decision rule would not compromise patient safety.
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Internal medicine journal · Sep 2013
Does measurement of ankle-brachial index contribute to prediction of adverse health outcomes in older Chinese people?
This study examined whether ankle-brachial index (ABI) is predictive of all-cause mortality, cardiovascular mortality, hospital admission for stroke, ischaemic heart disease or myocardial infarction among older people aged 65 years and above, and whether the inclusion of ABI in prediction models adds any incremental value to traditional cardiovascular risk factors. ⋯ ABI measurement (<0.9) predicted adverse outcomes with high specificity but low sensitivity. However, it added little incremental value to prediction of adverse outcomes using traditional cardiovascular risk factors.
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Internal medicine journal · Sep 2013
Review Case ReportsExertional heat stroke, rhabdomyolysis and susceptibility to malignant hyperthermia.
Unexpectedly severe exertional heat stroke and rhabdomyolysis should prompt a clinician to look for susceptibility to malignant hyperthermia. We report a case of exertional heat stroke and rhabdomyolysis in a man later determined to have the malignant hyperthermia phenotype. We review the existing literature regarding this association and suggest future research that could address areas of remaining clinical uncertainty.
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Internal medicine journal · Sep 2013
Clinical TrialPilot study of the effects of bariatric surgery and continuous positive airway pressure treatment on vascular function in obese subjects with obstructive sleep apnoea.
The mechanisms by which obesity and obstructive sleep apnoea (OSA) may contribute to endothelial dysfunction are unclear. ⋯ This pilot study demonstrates that 6 months of CPAP may be sufficient to improve endothelium-dependent microvascular reactivity, while substantial surgically induced weight loss did not result in improvements. Further research should be directed towards comparative effectiveness trials using these novel surrogate outcomes, as well as hard cardiovascular outcomes.
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Internal medicine journal · Sep 2013
ReviewUtility and assessment of non-technical skills for rapid response systems and medical emergency teams.
Efforts are ongoing to improve outcomes from cardiac arrest and medical emergencies. A promising quality improvement modality is use of non-technical skills (NTS) that aim to address human factors through improvements in performance of leadership, communication, situational awareness and decision-making. Originating in the airline industry, NTS training has been successfully introduced into anaesthesia, surgery, emergency medicine and other acute medical specialities. ⋯ Discussion covers methods to assess and refine NTS and NTS training to optimise performance in the clinical environment. Increasing attention should be applied to yielding meaningful patient and organisational outcomes from use of NTS. Similarly, implementation of any training course should receive appropriate scrutiny to refine team and institutional performance.