BACKGROUND: Symptoms, a key element in the patient's decision to seek care, are critical to appropriate triage, and influence decisions to pursue further evaluation and initiation of treatment. Although many studies have described symptoms associated with acute coronary syndromes (ACS), few, if any, have examined symptom predictors of ACS and whether they differ by patients' age. OBJECTIVES: To explore symptom predictors of ACS in younger (< 70 years) and older (> or = 70 years) patients. To test the hypothesis that typical symptoms are predictive of ACS in younger patients, but are less predictive in older patients. METHOD: Secondary analysis of observational data gathered on 531 patients presenting to the emergency department of a regional cardiac referral center in New England with symptoms suggestive of ACS. RESULTS: Bivariate analyses revealed no symptoms significantly (p < .01) associated with ACS in older patients. In younger patients presence of chest symptoms and the total number of typical symptoms reported were significantly (p < .01) associated with ACS. After adjustment for age and gender, typical symptoms that were positive predictors of ACS in younger patients included chest symptoms (OR 2.37, 95% CI 1.32-4.27, p = .004) and arm pain (OR 1.78, 95% CI 1.03-3.09, p = .040). Additionally, the total number of typical symptoms reported (OR 1.68, 95% CI 1.31-2.15, p < .001) was a positive predictor of ACS in younger patients. The atypical symptom of fatigue (OR 2.52, 95% CI 1.10-5.81, p = .029) was a significant positive predictor of ACS, whereas dizziness/faintness (OR .50, 95% CI .26-.91, p = .024) was a significant negative predictor of ACS in younger patients. Logistic regression analysis using the entire sample revealed an interaction between age and number of typical symptoms indicating that younger patients had a 36% greater odds for ACS for each additional typical symptom present compared with older patients (OR 1.36, 95% CI 1.02-1.83, p = .038 for interaction between age and number of typical symptoms reported). The model with the interaction between age and chest symptoms revealed a borderline association (p = .10 for the interaction between age and chest symptoms), with younger patients being more likely than older patients to report chest symptoms. CONCLUSIONS: Typical symptoms are predictive of ACS in younger patients and less predictive in older patients.

Acute Disease↗

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Physician integration in the CQI process: a beginning.

Continuous quality improvement (CQI) is vitally important to professionals in the field of healthcare quality. Many of us have met the challenge and have successfully introduced CQI principles to the employees in our hospitals. However, physicians, who play a key role in our hospitals, have not, for the most part, been directly involved in hospitals' organizational education efforts. This article focuses on involving physicians in the CQI process. It explains the approaches that were used to inform them about CQI principles, to encourage their feedback, and to elicit their participation in the hospitalwide quality improvement program.

Attitude of Health Personnel↗

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Use of neuroendocrine hormones to promote reconstitution after bone marrow transplantation.

A survey of the previous literature and the data shown here indicate that neuroendocrine hormones such as growth hormone and prolactin may be of potential clinical use after bone marrow transplantation (BMT) to promote hematopoietic and immune recovery. The amounts of hormones used in our model do not promote weight gain suggesting that their lymphohematopoietic actions were independent of their anabolic effects. While the hormones may not produce the same extent of immune/hematopoietic effects when compared to conventional hematopoietic and immune stimulating cytokines (i.e. IL-2 or G-CSF), their pleiotropic effects and limited toxicity after systemic administration makes them attractive to test in the post-BMT setting. However, more work needs to be performed to understand the mechanism(s) of their action, particularly with regard to T-cell function and development.

Animals↗

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Nominal group technique: a process for identifying diabetes self-care issues among patients and caregivers.

Explore the source record for details and available documents.

Activities of Daily Living↗

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All our patients need to know about intensified diabetes management they learned in fourth grade.

It may be feasible for some patients using simplified meal-planning approaches and short-acting insulin regimens to use an insulin pump instead of 2 daily injections of 70/30 insulin. Although this approach may not be possible for everyone, the methods discussed in this article open the door for some individuals whose main stumbling blocks are calculating insulin dosing and grams of CHO. In our practice, we have seen repeatedly that simplified approaches for counting CHO intake and calculating insulin dose can work successfully even with intensive insulin management. It is our challenge as diabetes health professionals to continually search for creative ways to help our patients simplify their daily diabetes management tasks. In many cases, the patient is more likely to commit to healthful changes when the meal plan is simpler and more visual. It is not possible, however, to make patients proficient in CHO counting and insulin dosing in one visit. Referral to a registered dietitian who specializes in diabetes allows a tailored plan to be developed with each individual based on health parameters, treatment goals, lifestyle, and cognitive skills.

Blood Glucose↗

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EN 552: validating 25 kGy as a sterilization dose.

EN 552 and ISO 11137 present challenges to the historically accepted dose of 25 kGy for sterilizing medical devices. New demands are being made of manufacturers who must now supply experimental evidence to substantiate the effectiveness of 25 kGy. This article explains those demands and provides guidance on meeting them. Some of the shortcomings of the standards and, in particular, the alarming cost issues are examined.

Equipment and Supplies↗

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A preliminary report of the use of botulinum toxin type A in infants with clubfoot: four case studies.

This report describes the use of botulinum toxin type A (BTX-A) in four infants with very severe clubfoot deformity. The gastrocnemius and posterior tibial muscles were injected with BTX-A after the patients reached a treatment plateau in physical therapy. Significant improvement in foot dorsiflexion and foot flexibility was seen in two patients, and surgery was not required. Surgical intervention was necessary in the remaining two patients, both of whom were ultimately diagnosed with a demyelinating neuropathy. The use of botulinum toxin as an adjunct to conservative care in infants with clubfoot is discussed.

Anti-Dyskinesia Agents↗

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