Feasibility of a rapid diagnosis discussion tool for reducing misdiagnosis of patients presenting to emergency departments with abdominal pain

Objectives

Providing accurate and timely diagnoses is challenging in ED settings. We evaluated the feasibility and effectiveness of a short, structured rapid diagnosis discussion (RaDD) between a patient's initial doctor and a second doctor for patients presenting to ED with abdominal pain.

Methods

Controlled pre-post, mixed-methods pilot study in a metropolitan hospital network in Melbourne, Australia. Comparisons were made between an ED using RaDD for a 1-month period (n = 155) and two control EDs within the same hospital network (n = 2227) using standard practices. A short survey of 27 clinicians was also undertaken.

Results

Provisional diagnoses changed in 24.7% (95% confidence interval 19.0, 30.4) of all cases for which a RaDD case report sheet was completed, and clinicians' confidence in their decision-making was significantly higher when using RaDD (r = 0.27). RaDD significantly increased the likelihood that patients would be sent to the short stay unit and have a blood test ordered, and significantly reduced the likelihood that patients would be discharged home from the ED or leave at their own risk. Usage of the RaDD tool was low (25.2% of eligible cases), and qualitative feedback indicated that time limitations inhibited uptake.

Conclusions

RaDD encouraged clinicians to take a more cautious, risk-averse approach to care and improved confidence in their diagnostic decisions. However, cost effectiveness of these outcomes and possible implementation barriers need to be further considered in subsequent studies.     

Comparison of cardiovascular risk calculation tools in pharmacy practice

ObjectiveTo examine the use of various cardiovascular disease (CVD) risk estimation calculators in pharmacy practice.DesignLongitudinal cohort study.SettingMidwestern university worksite from August 2008 through May 2012.ParticipantsUniversity employees with hypertension, dyslipidemia, and diabetes.InterventionRisk estimation calculators were applied to data from a pharmacist-run chronic disease management program.Main outcome measureDifference in estimated CVD risk from multiple estimation calculators.ResultsAt baseline and 12 months, non–lab-based tools reported significantly higher 10-year CVD risk percentages compared with lab-based tools among the same cohort of patients (10.63% vs. 8.71% at baseline, P < 0.001; 9.34% vs. 7.31% at 12 months, P < 0.001). In addition, the electronic version of 10-year CVD risk reported significantly higher values than the paper version when applied to the same patient cohort (7.31% vs. 6.60% at 12 months, P = 0.018).ConclusionCVD risk estimation tools report significantly different values and are not interchangeable. Pharmacists using non–lab-based tools should expect significantly higher risk estimates than estimates derived from lab-based tools and therefore should use the same version of the estimation tool over the long term.     

The Long Live Kids campaign: awareness of campaign messages

Media interventions are one strategy used to promote physical activity, but little is known about their effectiveness with children. As part of a larger evaluation, the purpose of this study was to assess the short-term effect of a private industry sponsored media literacy campaign, Long Live Kids, aimed at children in Canada. Specifically, we investigated children's awareness of the campaign and its correlates. Using a cohort design, a national sample (N?=?331, male?=?171; mean age?=?10.81, SD?=?0.99) completed a telephone survey two weeks prior to the campaign release, and again 1 year later. Only 3% of the children were able to recall the Long Live Kids campaign unprompted and 57% had prompted recall. Logistic regression found family income (Wald χ(2)?=?11.06, p?$60,000/yr) were between 3.5 to 5 times more likely to have campaign recall compared with children living in a low-income households (<$20,000/yr). These findings suggest that media campaigns developed by industry may have a role in promoting physical activity to children although our findings identified a knowledge gap between children living in high- and low-income households. Future research needs to examine how children become aware of such media campaigns and how this mediated information is being used by children.     

Bone mineral accrual from 8 to 30 years of age: An estimation of peak bone mass

Bone area (BA) and bone mineral content (BMC) were measured from childhood to young adulthood at the total body (TB), lumbar spine (LS), total hip (TH), and femoral neck (FN). BA and BMC values were expressed as a percentage of young‐adult values to determine if and when values reached a plateau. Data were aligned on biological ages [years from peak height velocity (PHV)] to control for maturity. TB BA increased significantly from ?4 to +4 years from PHV, with TB BMC reaching a plateau, on average, 2 years later at +6 years from PHV (equates to 18 and 20 years of age in girls and boys, respectively). LS BA increased significantly from ?4 years from PHV to +3 years from PHV, whereas LS BMC increased until +4 from PHV. FN BA increased between ?4 and +1 years from PHV, with FN BMC reaching a plateau, on average, 1 year later at +2 years from PHV. In the circumpubertal years (?2 to +2 years from PHV): 39% of the young‐adult BMC was accrued at the TB in both males and females; 43% and 46% was accrued in males and females at the LS and TH, respectively; 33% (males and females) was accrued at the FN. In summary, we provide strong evidence that BA plateaus 1 to 2 years earlier than BMC. Depending on the skeletal site, peak bone mass occurs by the end of the second or early in the third decade of life. The data substantiate the importance of the circumpubertal years for accruing bone mineral. © 2011 American Society for Bone and Mineral Research