Being seen within 48 hours--what do patients think?

A questionnaire survey of 1000 patients was carried out to determine the proportion of patients attending a large genitourinary medicine department in Newcastle upon Tyne who wish to be seen within 48 hours. The Department of Health target for patients offered an appointment within 48 hours is 100%. Its target for the proportion of patients seen within 48 hours is 95%. Patients were surveyed to ascertain their preference about waiting times for appointments within the clinic. In total, only 33% stated that they wished always to be seen within the government's target of 48 hours.     

Being “On Stage”: Improving Platform Presentation Skills with Microteaching Exercises and Feedback

ABSTRACT

In just over 20 years, all 78 million baby boomers will have reached their “coming of age.” When this demographic milestone occurs, one in every five Americans will be at least 65 years old; millions will have comorbid and chronic conditions requiring better prepared health care providers and markedly improved services than are presently available. Thus, geroeducators must teach current and future practitioners what they need to know to help their patients have the best possible old age. To ensure that this outcome occurs, teachers must observe students and practitioners demonstrating their ability to perform taught skills competently. Using microteaching and feedback can help clinical educators be those better teachers of the caregivers of older people.     

The Prehospital Electrocardiogram in Acute Myocardial Infarction: Is Its Full Potential Being Realized?

Objectives. This study sought to examine the management and subsequent outcomes of patients with a prehospital electrocardiogram (ECG) in a large, voluntary registry of myocardial infarction.Background. The prehospital ECG has been proposed as a means of rapidly identifying patients with acute myocardial infarction who might be eligible for reperfusion therapy.Methods. The characteristics and outcomes of patients with a prehospital ECG were compared with those without a prehospital ECG in the National Registry of Myocardial Infarction 2 data base. Included in the analysis were those patients who presented to the hospital within 12 h of an acute myocardial infarction. Excluded were patients with an in-hospital infarction, transferred-in referrals and self-transported patients.Results. Prehospital ECGs were obtained in 3,768 (5%) of 66,995 National Registry of Myocardial Infarction 2 patients meeting study criteria. Median time from myocardial infarction symptom onset until hospital arrival was longer among those having a prehospital ECG (152 vs. 91 min, p < 0.001). However, once in the hospital, the prehospital ECG group experienced a shorter median time to the initiation of either thrombolysis (30 vs. 40 min, p < 0.001) or primary angioplasty (92 vs. 115 min, p < 0.001). The prehospital ECG group was more likely to receive thrombolytic therapy (43% vs. 37%, p < 0.001) and to undergo primary angioplasty (11% vs. 7%, p < 0.001). Also, the prehospital ECG group was more likely to undergo coronary arteriography (55% vs. 40%, p < 0.001), angioplasty (24% vs. 16%, p < 0.001) or bypass surgery (10% vs. 6%, p < 0.001). The in-hospital mortality rate was 8% in patients with a prehospital ECG and 12% in those without a prehospital ECG (p < 0.001). After adjusting for baseline covariates utilizing multiple logistic regression analysis, this mortality difference remained statistically significant (odds ratio 0.83, 95% confidence interval 0.71 to 0.96, p = 0.01).Conclusions. The prehospital ECG is infrequently utilized for diagnosing myocardial infarction, and among patients with a prehospital ECG, is associated with a longer time from symptom onset to hospital arrival. Despite these shortcomings, the prehospital ECG is a test that may potentially influence the management of patients with acute myocardial infarction through wider, faster in-hospital utilization of reperfusion strategies and greater usage of invasive procedures, factors that may possibly reduce short-term mortality. Efforts to implement the prehospital ECG more widely and more rapidly may be indicated.(J Am Coll Cardiol 1997;29:498–505)     

Spontaneous Coronary Artery Dissection: Does Being Unemployed Matter? Insights from the GSCAD Registry

BackgroundSpontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and is linked to poor mental and physical health.ObjectiveTo examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD.MethodsWe conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not.ResultsThe median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in-hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021.ConclusionAdverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.