Henry Ford HEART Score Randomized Trial: Rapid Discharge of Patients Evaluated for Possible Myocardial Infarction.

BACKGROUND: Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications. METHOD AND RESULTS: A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0.04 ng/mL at 0 and 3 hours) were randomized to immediate discharge (n=53) versus management in an observation unit with stress testing (n=52). The primary end points were 30-day total charges and length of stay. Secondary end points were all-cause death, nonfatal AMI, rehospitalization for evaluation of possible AMI, and coronary revascularization at 30 days. Patients randomized to early discharge, compared with those who were admitted for observation and cardiac testing, spent less time in the hospital (median 6.3 hours versus 25.9 hours; P<0.001) with an associated reduction in median total charges of care ($2953 versus $9616; P<0.001). There were no deaths, AMIs, or coronary revascularizations in either group. One patient in each group was lost to follow-up. CONCLUSIONS: Among patients evaluated for possible AMI in the emergency department with a modified HEART score ≤3, early discharge without stress testing as compared with transfer to an observation unit for stress testing was associated with significant reductions in length of stay and total charges, a finding that has tremendous potential national healthcare expenditure implications. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT03058120.

Exploring possibilities of achieving sustainability in solid waste management.

The solid waste management scenario in the recent years has shifted towards a more sustainable approach. This paper brings in to focus the waste management methods that can be adopted using Bangalore as case study, in order to achieve economic viability and explores the sustainable options that conserves both natural and man-made resources and averts ecological risks. Bangalore, the Garden City of India with a population of 6 million is facing the daunting task of handling 3613 tonnes of municipal solid waste per day. Added to this are the constraints that are faced by the authorities such as poor political back up, inadequate infrastructure, insufficient funds and lack of public support. Attempts have been made to clear wastes by door to door collection method, introduction of push carts, which separate biodegradable wastes from non biodegradable wastes, deployment of auto tippers to clear slum wastes etc. under the guidance of Bangalore Agenda Task Force (government appointed body) and Bangalore Mahanagara Palike (city municipal corporation). Integrated waste management system is proposed as an option, which include collection, transport and processing of wastes in an environmentally sound way. The methods to overcome constraints in waste management and the future plans and actions that will bring about a significant change in the current waste management practices are also discussed in the paper.