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Prehosp Emerg Care ; : 1-9, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-31985326


AbstractObjective: Use of point-of-care (POC) troponin (cTn) testing in the Emergency Department (ED) is well established. However, data examining POC cTn measurement in the prehospital setting, during ambulance transport, are limited. The objective of this study was to prospectively test the performance of POC cTn measurement by paramedics to detect myocardial infarction (MI) among patients transported to the ED for acute chest pain. Methods: A prospective cohort study of adults with non-traumatic chest pain was conducted in three Emergency Medical Services agencies (December 2016 to January 2018). Patients with ST-elevation MI on ECG were excluded. During ambulance transport paramedics initiated intravenous access, collected blood, and used a POC device (i-STAT; Abbott Laboratories) to measure cTn. Following ED arrival, participants received standard evaluations including clinical blood draws for cTn measurement in the hospital central lab (AccuTnI +3 assay; Beckman Coulter, or cTnI-Ultra assay; Siemens). Blood collected during ambulance transport was also analyzed for cTn in the central lab. Index visit MI was adjudicated by 3 experts using central lab cTn measures from the patient's clinical blood draws. Test characteristics (sensitivity, specificity, and predictive values) for detection of MI were calculated for POC and central lab cTn measurement of prehospital blood and compared with McNemar's test. Results: During the study period prehospital POC cTn results were obtained on 421 patients, of which 5.0% (21/421) had results >99th percentile upper reference limit. MI was adjudicated in 16.2% (68/421) during the index visit. The specificity and positive predictive value of the POC cTn measurement were 99.2% (95% CI 97.5-99.8%) and 85.7% (95% CI 63.7-97.0%) for MI. However, the sensitivity and NPV of prehospital POC cTn were 26.5% (95% CI 16.5-38.6%) and 87.5% (95% CI 83.9-90.6%). Compared to POC cTn, the central lab cTn measurement of prehospital blood resulted in a higher sensitivity of 67.9% (95% CI 53.7-80.1%, p < 0.0001), but lower specificity of 92.4% (95% CI 88.4-95.4%, p = 0.0001). Conclusions: Prehospital POC i-STAT cTn measurement in patients transported with acute chest pain was highly specific for MI but had low sensitivity. This suggests that prehospital i-STAT POC cTn could be useful to rule-in MI, but should not be used to exclude MI.

Am J Health Behav ; 43(6): 1016-1029, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31662162


Objective: In this study, we evaluated whether exercise prior to memory encoding or during memory consolidation can influence episodic memory function after being exposed to a stressful environment. Methods: We conducted 3 between-group randomized controlled experiments among young adults. We assessed episodic memory (via logic memory task) at the beginning of the experiment and approximately 45 minutes later. Across the 3 experiments, we varied the temporal period (eg, before memory encoding or during consolidation) of the acute bout of exercise (15-minute moderate-intensity exercise) and psychological stress induction. Results: Across all 3 experiments there was a statistically significant main effect for time for memory function, but there were no time x group interaction effects. Conclusion: Memory declined across the 2 assessment periods, but for all 3 experiments, exercise was not associated with memory function after being exposed to a stressful stimulus.