The high cost of low value care.

THE HIGH COST OF LOW VALUE CARE. Trans Am Clin Climatol Assoc. 2019;130:60-70 Authors: McGinn T, Cohen S, Khan S, Richardson S, Oppenheim M, Wang J Abstract The main focus of this study is bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From our work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, we integrated the highly validated Wells' criteria into the electronic health record at two of our major academic tertiary hospitals. The Wells' clinical decision support tool triggered for patients being evaluated for PE and therefore determined a patients' pretest probability for having a PE. There were 12,759 patient visits representing 11,836 patients, 51% had no D-dimer, 41% had a negative D-dimer, and 9% had a positive D-dimer. Our study gave us an opportunity to determine which patients were very low probabilities for PE, with no need for further testing. PMID: 31516165 [PubMed - in process]
Source: Transactions of the American Clinical and Climatological Association - Category: General Medicine Tags: Trans Am Clin Climatol Assoc Source Type: research

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We present our 4 years experience on this subject. SUBJECTS AND METHODS: We retrospectively studied 2178 lung perfusion scintigraphies (LPS). Of them 1846 were performed to patients suspected for APE admitted to the emergency departments of the University Polyclinic of Bari and examined immediately by our Nuclear Medicine Department. Contingency tables and odds ratio (OR) were used to estimate the relation between symptoms, risk factors, D-dimers dosage, other imaging diagnostic tools and LPS results. RESULTS: Lung perfusion scintigraphy was positive for APE in 309/1846 (16.7%) patients which then were treated succ...
Source: Hellenic Journal of Nuclear Medicine - Category: Nuclear Medicine Tags: Hell J Nucl Med Source Type: research
ConclusionsOur method supported or altered clinical decision-making and treatment in this cohort. A diagnostic tool for PE without intravenous contrast agent or radiation is of great benefit for certain patients.
Source: European Journal of Radiology Open - Category: Radiology Source Type: research
Conclusions: Elevated cTn is independent predictor of short and long-term mortality. The predictive power of cTn increases when combined with the clinical probability score. Further, larger prospective studies are needed to confirm the findings of the present study. PMID: 31559033 [PubMed]
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Conclusion: Although attention to thrombosis risk factors, clinical symptoms, and laboratory findings, can be helpful in screening patients with suspected PE, considering the ability of CT scan in confirming or ruling out other possible differential diagnoses, it seems that a revision should be done to lower the threshold of ordering this diagnostic modality for suspected cases. PMID: 31555771 [PubMed]
Source: Accident and Emergency Nursing - Category: Emergency Medicine Authors: Tags: Arch Acad Emerg Med Source Type: research
Abstract Pulmonary embolism is a life-threatening disease. Its development is generally thought to be due to causes collectively known as the Virchow's triad. Chronic inflammations are associated with the activation of coagulation and increased risks of venous thromboembolic events. Asthma is one of the chronic inflammatory diseases associated with procoagulants and antifibrinolytic activities in the airways. Coagulation is activated in patients with asthma with the following steps of pathophysiology: Increased tissue factor expression in various cell types, decreased activity of the anticoagulant protein C system...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
A 57-year-old male with known history of obstructive sleep apnea was admitted for shortness of breath. On exam, patient was tachycardic with increased jugular venous pressure. Electrocardiogram showed sinus tachycardia with right ventricular strain and ST-segment depressions in the lateral leads. A computed tomography pulmonary angiography (CTPA) demonstrated no evidence of pulmonary embolism. Incidentally, a double aortic arch (DAA) was noted on CTPA (Fig. 1, Fig. 2). On laboratory exam, the patient had elevated troponin I at 0.276 ng/mL.
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Tags: Case report Source Type: research
An 11-year-old boy with Klippel-Trenaunay syndrome with right lower extremity and pelvic venous ectasia underwent prophylactic embolization of persistent sciatic vein and markedly ectatic internal iliac vein using 24 coils (20 mm x 20 cm to 12 mm x 14 cm) (Nester; Cook Inc, Bloomington, Indiana) (Fig 1) to reduce risk of pulmonary embolism. He presented to the emergency department 3 days later with mild chest discomfort. Scout image from computed tomography (CT) pulmonary angiogram showed completely displaced coil nest in the chest (Fig 2).
Source: Journal of Vascular and Interventional Radiology : JVIR - Category: Radiology Authors: Tags: Extreme IR Source Type: research
Guidelines and high-quality studies recommend using clinical decision-making (CDM) tools over clinical gestalt when evaluating a patient for pulmonary embolism. The purpose of this study is to investigate our computed tomography pulmonary angiogram (CTPA) utilization patterns and identify causal factors.
Source: Canadian Association of Radiologists Journal - Category: Radiology Authors: Tags: Trauma and Emergency Room Imaging / L ’imagerie des urgences et des traumatismes Source Type: research
Abstract Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating CTEPH from APE. Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality cardiovascular imaging. Here, the a...
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Abstract BACKGROUND: Pulmonary computed tomography angiography (CTA) contains a wealth of information regarding the diagnosis and impact of acute pulmonary embolism (PE). Echocardiography remains the recommended examination to detect signs of right ventricular (RV) dysfunction in patients with shock or hypotension following PE. OBJECTIVES: To detect the relationship between clot volume in pulmonary CTA and different parameters of RV dysfunction assessed by echocardiography and pulmonary CTA in patients with acute PE. METHODS: A cross-sectional study was performed on patients with acute PE from June 2017 ...
Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Tags: Cardiovasc J Afr Source Type: research
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