Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis and cholecystitis in a canadian emergency department.

OBJECTIVES: Cholelithiasis and cholecystitis are common conditions that frequently require patients to come to the Emergency Department (ED) and undergo diagnostic imaging. The purpose of this study was to evaluate the test characteristics of emergency physician performed point-of-care ultrasound (POCUS) to diagnose cholelithiasis and cholecystitis in a Canadian ED. METHODS: A health records review was performed on all ED patients > 17 years of age for whom POCUS was performed to diagnose cholelithiasis and cholecystitis in a Canadian academic ED over a 5-year period. The sensitivity, specificity, predictive values, and likelihood ratios were calculated. The gold standard used for diagnosis was pathology, laparoscopy, radiology-performed comprehensive ultrasonography, followed by computed tomography scans. RESULTS: A total of 577 patients were included in the study. The sensitivity and specificity of POCUS to diagnose cholelithiasis was 95.2% (95% CI 91.1-97.8%) and 93.1% (95% CI 90.1-95.4%). The positive and negative likelihood ratios for POCUS to diagnose cholelithiasis were found to be 14 and 0.05; the negative predictive value was 97.6% (95% CI 95.5-98.7%). The sensitivity and specificity of POCUS to diagnose cholecystitis was 67.1% (95% CI 54.9-77.9%) and 97.6% (95% CI 95.9-98.8%). The positive and negative likelihood ratios for POCUS to diagnose cholecystitis were found to be 28 and 0.34; the negative predictive value was 95.6% (95% CI 93.9-96.8%). CONCLUSION: POCUS is reliable for the diagnosis of cholelithiasis and for ruling in cholecystitis. In cases where POCUS is negative or indeterminate for cholecystitis, further imaging should be obtained as clinical suspicion warrants.

RéSUMé: OBJECTIFS: La cholélithiase et la cholécystite sont des troubles médicaux courants qui obligent fréquemment les patients à se rendre aux urgences et subir une imagerie diagnostique. Le but de cette étude était d'évaluer les caractéristiques des tests de l'échographie au point d'intervention (POCUS) effectuée par des médecins urgentistes pour diagnostiquer la cholélithiase et la cholécystite dans une urgence canadienne. MéTHODES: Un examen des dossiers médicaux a été effectué sur tous les patients des services d'urgence, âgés de plus de 17 ans pour lesquels POCUS a été réalisée pour diagnostiquer la cholélithiase et la cholécystite dans un service d'urgence universitaire canadien sur une période de 5 ans. La sensibilité, la spécificité, les valeurs prédictives et les rapports de vraisemblance ont été calculés. L'étalon-or utilisé pour le diagnostic était la pathologie, la laparoscopie, l'échographie complète réalisée par radiologie, suivie de la tomodensitométrie. RéSULTATS: Au total, 577 patients ont été inclus dans l'étude. La sensibilité et la spécificité de POCUS pour diagnostiquer la cholélithiase étaient de 95.2% (IC 95% 91.1­97.8%) et 93.1% (IC 95% 90.1­95.4%). Les rapports de vraisemblance positifs et négatifs pour POCUS pour diagnostiquer la cholélithiase se sont révélés à 14 et 0.05; la valeur prédictive négative était de 97.6% (IC à 95% 95.5­98.7%). La sensibilité et la spécificité de POCUS pour diagnostiquer la cholécystite étaient de 67,1% (IC à 95% 54.9­77.9%) et de 97.6% (IC à 95% 95.9­98.8%). Les rapports de vraisemblance positifs et négatifs pour POCUS pour diagnostiquer la cholécystite se sont révélés à 28 et 0.34; la valeur prédictive négative était de 95.6% (IC à 9.5% 93.9­96.8%). CONCLUSION: POCUS est fiable pour le diagnostic de la cholélithiase et de la cholécystite. Dans les cas où le POCUS est négatif ou indéterminé pour la cholécystite, une imagerie supplémentaire doit être obtenue en cas de suspicion clinique.

Assessing the Impact of ED Triage Directives on Febrile Oncology Patient Wait Times.

INTRODUCTION: Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. METHODS: A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. RESULTS: We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. DISCUSSION: Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality.

Isometric exercise training lowers resting blood pressure and improves local brachial artery flow-mediated dilation equally in men and women.

INTRODUCTION: Isometric resistance training has repeatedly shown to be an effective exercise modality in lowering resting blood pressure (BP), yet associated mechanisms and sex differences in the response to training remain unclear. Exploration into potential sex differences in the response to isometric resistance training is necessary, as it may allow for more optimal and sex-based exercise prescription, thereby maximizing the efficacy of the training intervention. PURPOSE: Therefore, we investigated, in normotensives, whether sex differences exist in the response to isometric handgrip (IHG) training. METHODS: Resting BP and endothelium-dependent vasodilation (brachial artery flow-mediated dilation; FMD) were assessed in 11 women (23 ± 4 years) and 9 men (21 ± 2 years) prior to and following 8 weeks of IHG training (four, 2-min unilateral contractions at 30 % of maximal voluntary contraction; 3 days per week). RESULTS: Main effects of time were observed (all P < 0.05), whereby IHG training reduced systolic BP (Δ 8 ± 6 mmHg), diastolic BP (Δ 2 ± 3 mmHg), mean arterial pressure (Δ 4 ± 3 mmHg), and pulse pressure (Δ 5 ± 7 mmHg), accompanied by increases in absolute (Δ 0.09 ± 0.15 mm) and relative (Δ 2.4 ± 4.1 %) brachial artery FMD; however, no significant sex differences were observed in the magnitude of post-training change in any variable assessed (all P > 0.05). CONCLUSION: IHG training effectively lowers resting BP and improves endothelium-dependent vasodilation in men and women, without significant sex differences in the magnitude of response.

Sit, breathe, smile: effects of single and weekly seated Qigong on blood pressure and quality of life in long-term care.

Long-term care (LTC) facilities house individuals with diverse combinations of cognitive and physical impairments, and the practice of Seated Qigong eliminates common exercise barriers. This study hypothesized: 1) a single session would lower blood pressure (BP) and improve quality of life (QOL) in a generalized LTC population, and 2) these responses would be attenuated with chronic (weekly) Seated Qigong practice. Ten residents (6 female; 86 ± 7 years) participated in 1X/week Seated Qigong sessions for 10-weeks. BP and QOL were assessed pre- and post-session at baseline and following 5- and 10-weeks of Qigong. Systolic BP was significantly reduced immediately post-session after 10-weeks of Qigong (P = 0.03), yet unchanged at baseline and after 5-weeks (all P > 0.05). Diastolic BP and QOL remained unchanged (P > 0.05). A session of Seated Qigong elicits a hypotensive response with exposure, supporting the notion that repeated sessions may provide advantageous health benefits.