Improving triage accuracy through a modified nurse-administered emergency department assessment of chest pain score on patients with chest pain at triage (EDACT): A prospective observational study.

BACKGROUND: Chest pain triage in our emergency department (ED) prioritize patients for consultation based on unstructured nursing gestalt. The Emergency Department Assessment of Chest Pain Score (EDACS) identifies patients at low-risk for major adverse cardiac events and may provide standardization for chest pain triage in ED. METHODS: We conducted a prospective observational study, including adult patients with chief complaint of chest pain who were self-conveyed. We aimed to evaluate the overall diagnostic performance of a modified EDACS in triaging these patients. RESULTS: Data was collected over 6 weeks, with 284 patients included in the final analysis. Nursing gestalt had higher sensitivity (97.6%, 95% confidence interval [CI] 87.4% to 99.9% versus EDACS 45.2%, 95% CI 29.8% to 61.3%), while modified EDACS provided higher specificity (76.4%, 95% CI 70.6% to 81.6%, versus nursing gestalt 29.8%, 95% CI 24.1% to 35.9%). EDACS with electrocardiogram had significantly better area under the receiver operating characteristic curve statistic (0.712; 95% CI 0.631 to 0.793) than EDACS alone (0.608; 95% CI 0.528 to 0.689) and nursing gestalt (0.637; 95% CI 0.600 to 0.674) (p = 0.0324). CONCLUSIONS: Further studies should explore if modified EDACS, together with nursing gestalt, can improve triage accuracy for ED patients with chest pain.

Risk assessment model for heart failure in Chinese patients with Takayasu's arteritis.

OBJECTIVES: We aimed to construct and validate a risk assessment model to identify risk factors for heart failure (HF) in patients with Takayasu's arteritis (TAK). METHODS: Three hundred sixty-five patients with TAK were recruited in the East China Takayasu Arteritis Cohort from January 2012 to December 2019. Patients were assigned into training and validation sets following a 2:1 ratio according to the date of enrollment. Clinical characteristics were compared between heart failure (HF) and non-HF subgroups in the training set, and a risk assessment model for HF and its scoring algorithm was established based on logistic regression, which was tested in the validation set. RESULTS: Among total of 74 (20.27%) TAK patients exhibited HF, and 55 cases (74.32%) were in the training set. The risk factors for HF of TAK patients included onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension. We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients in the training set with the score ≥ 3 appeared to be associated with an increased risk of HF with an area under curve (AUC) of 0.88 and 0.90 in Model 1 and Model 2 respectively. The AUC reached to 0.88 and 0.89 in the validation set that proved the accuracy of the model. CONCLUSIONS: We presented a risk assessment model of HF in TAK, which may help clinicians alert the complication of HF in the patients with specifically cardiac impairments. Key Points • Heart failure was not rare in Chinese Takayasu's arteritis patients, and there were approximately 20% of patients with heart failure in ECTA cohort. • Cardiac involvements on echocardiography include pathological valvular and atrioventricular abnormalities. • The onset age >38 years, serum tumor necrosis factor (TNF)-α concentration >10 pg/ml, aortic valve involvement, coronary artery involvement, and pulmonary hypertension were risk factors for heart failure in Takayasu's arteritis patients. • We constructed the model without TNF-α (Model 1) and with TNF-α (Model 2). Patients with the risk assessment model score of ≥ 3 appeared to be associated with an increased risk of heart failure.

Research on the Development of Religious Tourism and the Sustainable Development of Rural Environment and Health.

The purpose of the research is to explore how to reach a consensus on the development of cultural tourism and the sustainability of the entire rural environment from the perspective of different rights holders. Using Beigang Township in Taiwan as a case study, we first conducted a questionnaire survey and analyzed 600 respondents by statistical verifications method, then used an interview method to compile suggestions from experts and scholars, and finally conducted a field survey to collect actual information. After summarizing, organizing, and analyzing all the data, the study was examined in a multivariate manner. This study concludes that creating parking spaces, providing a comfortable resting place, facilitating the exchange of ideas, and improving the environmental literacy of the public will increase the public attention to issues such as village visibility, people interaction, ancient architecture, culture and totems, public health and transportation, and entrepreneurial development, as well as address the concerns of local residents and some men and people over 31-40 years old. By doing so, we can improve community building and security, enrich cultural resources, build and develop sufficient industries, stabilize prices, obtain a safe and hygienic village environment, increase the desire to revisit, become a recommendation for family travel, and achieve the goal of sustainable development of rural environment and health.

Clinical Islet Transplantation for Adults With Type 1 Diabetes in Canada: Referral Patterns and Eligibility Assessment.

OBJECTIVES: Careful selection for clinical islet transplantation (CIT) is required because of limited organ supply and the risks for lifelong immunosuppression. However, the indications for this novel treatment may not be widely known, and selection criteria continue to evolve. We sought to describe the pattern of referrals to our centre and the most common factors determining eligibility for CIT. METHODS: We performed a retrospective chart review of all applications for CIT received at the University of Alberta between May 2009 and April 2012. Demographics and clinical data were abstracted along with the sources of referral. Application results and reasons for eligibility or ineligibility were determined. For ineligible subjects, the primary reason for ineligibility was noted. RESULTS: We received 246 applications (mean age 43; range, 13 to 78 years; 54% male) from across Canada. The majority (81%) were self-referrals, with the remainder coming from specialists (15%) or primary care physicians (4%). Of the applicants, 19% were deemed eligible and were accepted for waitlisting. Acceptance rates were not different between physician referrals and self-referrals (25% vs. 18%; p=ns). The main reasons for ineligibility were no indication (39%); contraindications (metabolic, 21%; medical comorbidity, 17%; psychosocial, 8%) or personal factors (15%). CONCLUSIONS: Most referrals were received from people with diabetes, but acceptance rates were not significantly lower than for physician referrals. It will be important to increase awareness of severe hypoglycemia or glycemic lability as major indications for CIT among patients and physicians and to evaluate any impact this may have on the current acceptance rate of 19%.

Ultra-high-performance liquid chromatography-quadrupole/time of flight mass spectrometry based chemical profiling approach to rapidly reveal chemical transformation of sulfur-fumigated medicinal herbs, a case study on white ginseng.

Sulfur-fumigation may induce chemical transformation of medicinal herbs. Development of rapid method to reveal potential sulfur-fumigation induced chemical transformation of herbs is a very important issue for efficacy and safety of herb application. In present study, a new strategy was proposed to rapidly reveal chemical transformation of sulfur-fumigated herbs by ultra-high-performance liquid chromatography-quadrupole/time of flight mass spectrometry (UHPLC-QTOF-MS/MS) based chemical profiling approach. The non-fumigated herb was water-wetted and further treated with burning sulfur to get sulfur-fumigated herb. Then the chemical fingerprints of both non-fumigated and sulfur-fumigated samples were compared by UHPLC-QTOF-MS/MS analysis. The identities of all detected peaks, in particular those newly generated in sulfur-fumigated samples were confirmed by comparing the mass spectra and retention times of peaks with that of reference compounds, and/or tentatively assigned by matching empirical molecular formula with that of published compounds, and/or elucidating quasi-molecular ions and fragment ions referring to available literature information. The identification could be rationalized through deducing possible reactions involved in the generation of these newly detected compounds. The proposed strategy was extensively investigated in the case of white ginseng. Total 82 components were detected in non-fumigated and sulfur-fumigated white ginseng samples, among them 35 sulfur-containing compounds detected only in sulfur-fumigated white ginseng and its decoction were assigned to be sulfate or sulfite derivatives of original ginsenosides, and were deduced to be generated via reactions of esterification, addition, hydrolysis and dehydration during sulfur-fumigation and decocting of white ginseng. The established approach was applied to discriminate sulfur-fumigated white ginseng among commercial samples from America, Canada, and Hong Kong SAR, Macau SAR and Mainland of China, which indicated that the proposed approach is rapid and specific, and should also be useful for investigation of potential chemical transformation of other sulfur-fumigated medicinal herbs.

The impact of systemic lupus erythematosus on women's sexual functioning.

INTRODUCTION: The effect of systemic lupus erythematosus (SLE) on women's sexual functioning has been rarely assessed. AIM: The aim of this study is to evaluate the impact of SLE on women's sexual functioning. METHODS: A total of 302 consecutive female outpatients with SLE were provided with a questionnaire composed of the Female Sexual Function Index (FSFI), questions for sociodemographic characteristics and comorbidities. Similarly, 2,159 hospital female employees were assessed as the control group. In patients, data of SLE duration and Sjögren's syndrome were derived from the chart records and the disease activity was assessed using the SLE Disease Activity Index 2000. MAIN OUTCOME MEASURES: The FSFI scores were compared between the patients and the controls. Correlates of the FSFI scores were determined in the patients. RESULTS: Of 302 eligible patients, 92.4% (279/302) responded, in addition to 73.2% (1,580/2,159) of controls. Ninety-five percent (255/268) of the respondent patients were in no-to-mild SLE disease activity. Among the respondents, 171 (61.3%) patients and 930 (58.9%) controls were sexually active in the previous month, P = 0.446. Of the sexually active patients, 52.5% (85/162) had impaired sexual function (the FSFI total score < 26.55) and so did 47.1% (408/867) of the sexually active controls, P = 0.206. With adjustment of age group, marital status and education level, patients had lower FSFI scores than controls only in the domains of lubrication and pain. Significant risk factors for lower FSFI scores in the patients included persistent activity or flare of SLE, menstrual cycle disturbances, and vascular disease. With further adjustment of other risk factors, only vascular disease remained significant as a risk factor for impaired sexual function (odds ratio = 5.7; 95% confidence interval 1.6-20.1). CONCLUSION: When not in an exacerbation period, the impact of SLE on women's sexual functioning is not great and is related to vascular factors.

[Value of MRI in the assessment of invasion depth by endometrial carcinoma].

OBJECTIVE: To evaluate the value of MR imaging in the assessment of invasion depth by endometrial carcinoma. METHODS: Data of 122 patients with endometrial carcinoma proved by postoperative pathology were retrospectively reviewed. Preoperatively, all patients underwent conventional and contrast-enhanced MR scan. Compared with the results of pathology, the sensitivity, specificity and accuracy of different invasion depth determined by MRI were analyzed with SPSS software based on whether the junctional zone was involved or not as the criterion of myometrial invasion. RESULTS: (1) Based on MRI image, the tumor was confined to the endometrium in 17 patients, causing superficial myometrial invasion 60, deep-myometrial invasion 40 and having penetrated the serosa 5. Compared with postoperative pathology results, the incidence of sensitivity, specficity and accuracy of MRI assessment for tumor confined to endometrium was 64.7%, 94.3%, 90.2%, respectively; to superficial myometrial invasion: 64.6%, 82.5%, 70.5%, respectively; to deep-myometrial invasion: 94.4%, 77.9%, 80.3%, respectively; to tumor having penetrated the serosa: 80.0%, 99.1%, 98.4%, respectively. (2) Based on intact junctional zone as the criterion of tumor confined to endometrium, the sensitivity, specficity, accuracy, positive and negative predictive value was 92.9%, 67.9%, 73.1%, 43.3%, 97.3%, respectively. Based on the interruption of junctional zone as the criterion of tumor having involved the myometrium, the sensitivity, specficity, accuracy, positive and negative predictive value was 67.9%, 92.9%, 73.1%, 97.3%, 43.3%, respectively. CONCLUSION: MRI is valuable in the assessment of the invasion depth by endometrial carcinoma, and the dose plays an important role for the clinician in selecting proper way of therapy.

Primary screening with liquid-based cytology in an unscreened population in rural China, with an emphasis on reprocessing unsatisfactory samples.

OBJECTIVE: To determine the sensitivity and specificity of liquid-based cytology in a high-risk, unscreened population. STUDY DESIGN: A cross-sectional comparative trial of multiple screening techniques. This report focuses on the performance of liquid-based cytology using biopsy as the standard. RESULTS: In total, 1,997 women were screened. All subjects had a minimum of five cervical biopsies. Of the subjects, 4.3% had CIN 2 on biopsy. The ThinPrep Pap with ASCUS as positive had a sensitivity for CIN 2 of 94% and specificity of 78%; the sensitivity for CIN 3 was 98% and for cancer, 100%. The unsatisfactory rate due to bloody specimens was 7.9% (158/1,997). After reprocessing, the unsatisfactory rate was 0.15% (3/1,997). CONCLUSION: Reprocessing effectively recovers ThinPrep samples otherwise unsatisfactory due to blood and mucus. The ThinPrep Pap test is a highly sensitive screening test when used in a high-risk, unscreened population.