Abstract:
OBJECTIVES:Cardiac troponin (cTn) measurement is useful for diagnosing myocardial infarction (MI), particularly in the inpatient setting. A growing body of literature suggests that cTn may be useful for evaluating chronic conditions in the outpatient environment; however, little is known regarding cTn ordering patterns in this setting. We sought to investigate patterns of care and outcomes for patients evaluated with cTn in the outpatient setting. We hypothesized that a majority of outpatient cTn orders would be for the purpose of diagnosing possible MI. METHODS:We analyzed 228 patients who had outpatient orders for standard-sensitivity troponin T assays placed at our institution between January 1, 2013 and December 18, 2015. Data were divided into two cohorts based on the intended utility of cTn measurement: orders placed to evaluate for possible MI versus orders placed for some other purpose. RESULTS:Of the 228 patients, 161 were evaluated for possible MI and 67 for other reasons. Risk factors (hypertension P = 0.32, diabetes mellitus P = 0.41, coronary disease P = 0.38, heart failure P = 0.098, and chronic kidney disease P = 0.70) were similar between the cohorts. In the suspected MI cohort, an electrocardiogram was obtained in only 77% of patients, and only 13.1% were sent to the emergency department (ED) for further evaluation. Within the suspected MI cohort, 10.5% (n = 17) had elevated cTn and the majority of these patients (n = 10) were not sent to the ED. CONCLUSIONS:The majority of outpatient cTn orders were intended to evaluate for MI, although electrocardiograms were frequently not ordered and few patients were sent for further ED evaluation. Providers should be encouraged to use cTn testing in a manner that minimizes the potential risk to patients with possible MI.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Ross SJ,Shah NH,Noutong Njapo SA,Cordiner DJ,Winchester DEdoi
10.14423/SMJ.0000000000000971subject
Has Abstractpub_date
2019-05-01 00:00:00pages
295-300issue
5eissn
0038-4348issn
1541-8243pii
SMJ50701journal_volume
112pub_type
杂志文章abstract::Amiodarone, a benzofuran derivative, has proven useful in the control of serious cardiac arrhythmias. We reviewed the English language medical literature to characterize clinical, radiographic, scintigraphic, pathologic, diagnostic, and prognostic data concerning amiodarone pulmonary toxicity. Our review showed that f...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:
更新日期:1993-01-01 00:00:00
abstract::Parameters for significant risk of aspiration have been defined as a gastric pH less than 2.5 and/or a volume greater than 25 ml. We investigated the effects of metoclopramide and cimetidine, alone and in combination, on the pH and volume of gastric contents of patients taking nothing by mouth before general anesthesi...
journal_title:Southern medical journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00007611-198611000-00009
更新日期:1986-11-01 00:00:00
abstract::Nearly three million persons in the United States are viremic with hepatitis C (HCV). Despite a decreasing incidence of HCV in this country, the prevalence of HCV-related chronic liver disease is increasing. Most infections in the United States are acquired by intravenous drug use. The chronicity rate of HCV is high, ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.SMJ.0000118903.35704.30
更新日期:2004-04-01 00:00:00
abstract::Transfusion in the pediatric age group requires careful consideration of the patient's weight and age because of potential problems with intravascular volume and difficulty with administration of the blood product. Different age groups have varied disease processes that require specific blood components. A correct dia...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:The number of methicillin-resistant STaphylococcus aureus (MRSA) infections in the hospital setting is increasing but little is known of its prevalence in the community. In a 1986-1987 study, the prevalence in dermatology outpatient clinics was <0.9%. This study reports changes in the same facilities from 19...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199804000-00011
更新日期:1998-04-01 00:00:00
abstract::Atopic dermatitis (AD) is a common diagnosis seen in both children and adults, and it is often the first manifestation of atopic disease. Research has shown a strong correlation between serum IgE levels, the severity of atopic dermatitis, and co-existing asthma and/or allergic rhinitis. Omalizumab (Xolair, East Hanove...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181de0cf6
更新日期:2010-06-01 00:00:00
abstract::Perennial allergic rhinitis (PAR) can have a significant impact on a patient's quality of life. While allergen avoidance is the first line of management for PAR, complete avoidance is difficult. Therapeutic options available for PAR include intranasal corticosteroids (INS), H1-antihistamines, decongestants and local c...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/SMJ.0b013e3180485560
更新日期:2007-07-01 00:00:00
abstract::The neuroleptic malignant syndrome (NMS) is a rare but potentially lethal disorder associated with the administration of neuroleptic agents. This syndrome may be underdiagnosed because it is poorly understood and often unrecognized. It affects all age groups and has a 20% mortality. Presenting features include extrapy...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198603000-00018
更新日期:1986-03-01 00:00:00
abstract::Chronic myelomonocytic leukemia (CMML) is a relatively rare, heterogeneous syndrome classified as a myelodysplastic syndrome according to the French-American-British classification system. The patient's presenting symptom was a pigmented skin nodule that, although common for cases of acute monoblastic leukemia, is pec...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000054224.50737.4C
更新日期:2003-07-01 00:00:00
abstract::Studies at "the Farm," a community of spiritually gathered young people in Summertown, Tenn, have shown that it is possible to sustain a normal pregnancy on a vegan diet. The source of dietary protein (ie, animal or vegetable) does not seem to affect birth weight, as long as vegans are health conscious, receive contin...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198706000-00007
更新日期:1987-06-01 00:00:00
abstract::We have reported a case of spontaneous dissection of the internal carotid artery, with MRI and angiographic findings. We conclude that MRI is a beneficial noninvasive test for the detection and study of carotid artery dissection. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199109000-00021
更新日期:1991-09-01 00:00:00
abstract::We retrospectively reviewed the charts of 190 hospitalized patients who had human immunodeficiency virus (HIV) antibody testing at our medical center in 1986 and 1987. From 1986 to 1987, HIV antibody testing increased fourfold based on total hospital discharges. Nine patients (5%) tested positive by enzyme immunoassay...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199001000-00008
更新日期:1990-01-01 00:00:00
abstract::Aspergilloma is a common complication of cystic lung disease; it is widely considered to be a saprophytic colonization and local or disseminated invasion is unusual. We describe a patient with stage IV sarcoidosis and bilateral aspergillomas in whom locally invasive disease led to spinal cord compression. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198405000-00028
更新日期:1984-05-01 00:00:00
abstract::To our knowledge, this is the first known case of a patient with leptospirosis and very elevated CSF, which caused hydrocephalus. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0b013e3181a0ae80
更新日期:2009-05-01 00:00:00
abstract::A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and ...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-198312000-00014
更新日期:1983-12-01 00:00:00
abstract::Valvular heart disease accounts for considerable morbidity and some mortality among patients with end-stage renal disease (ESRD). To determine the prevalence and severity of valvular and perivalvular abnormalities, including valvular thickening, stenosis, calcification, regurgitation, and mitral annular calcification ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199501000-00009
更新日期:1995-01-01 00:00:00
abstract::Eighty-five overriding tibial shaft fractures (46 open, 39 closed) were treated at Ochsner Foundation Hospital between 1960 and 1972. Nine different treatment methods were employed by seven orthopedic surgeons. The best results were obtained in the nine patients treated by open reduction and either compression plating...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197601000-00014
更新日期:1976-01-01 00:00:00
abstract::Injuries from sea urchins result from penetration of the calcareous spines into the skin. Local pain of several days' duration is the most common symptom, but systemic reaction from toxins found in certain species can occur. There is no uniformly accepted successful treatment other than cleansing the wound. Attempts t...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197704000-00029
更新日期:1977-04-01 00:00:00
abstract:OBJECTIVES:Guidelines have recommended that risk stratification be performed in patients diagnosed with an acute pulmonary embolism (PE). No study has described the use of risk stratification in routine clinical practice. The purpose of this study was to measure the frequency and impact of risk stratification on treatm...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/SMJ.0000000000000053
更新日期:2014-02-01 00:00:00
abstract::The risks of morbidity and mortality associated with transfusion are so great that no transfusion should be given until it is decided that it is absolutely necessary and then only with the utmost care. The unfavorable effects of transfusion reviewed are: hemolytic reaction; bacterial contamination; febrile reaction du...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1976-04-01 00:00:00
abstract:OBJECTIVES:The lack of access to diagnostic imaging in resource-limited settings (RLSs) poses a worldwide problem. Advances in ultrasound (US) imaging technology bridge this gap, particularly when examinations are performed by physicians and integrated into the patient encounter, termed point-of-care ultrasound (POCUS)...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000826
更新日期:2018-07-01 00:00:00
abstract::A rare case of alveolar rhabdomyosarcoma of the urinary bladder, manifested as a systemic disease in a 51-year-old woman, was diagnosed at necropsy. Diffuse lytic bone lesions and extensive bone marrow involvement with a leukoerythroblastic blood picture led to an initial clinical diagnosis of a hematologic malignancy...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198704000-00031
更新日期:1987-04-01 00:00:00
abstract::Sickle cell disease (SCD) is the most common hereditary disorder and affects 30 million people worldwide. Advances in science have improved overall survival in patients with SCD and as such, more patients are reaching reproductive age and are becoming pregnant. SCD in pregnancy leads to multiple complications that put...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.14423/SMJ.0000000000000514
更新日期:2016-09-01 00:00:00
abstract::A large number of drugs can induce pulmonary disease. We report the case of a female patient who was receiving cyproterone acetate for severe hirsutism. After 4 months of cyproterone therapy, she had dyspnea, pulmonary infiltrates, and a restrictive ventilatory defect. Bronchoalveolar lavage showed CD8+ lymphocytosis ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199710000-00016
更新日期:1997-10-01 00:00:00
abstract::Three patients seen recently at Wilford Hall USAF Medical Center emphasize the point that coccidioidomycosis may resemble lymphoma because of persistence of adenopathy on the chest roentgenogram after the initial infiltrate has resolved. Such a clinical picture strongly indicates dissemination and is probably sufficie...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197705000-00007
更新日期:1977-05-01 00:00:00
abstract::Recommendations concerning postoperative extubation after thymectomy for myasthenia gravis are presently based upon retrospective chart reviews. We present the results of a prospective investigation of time to extubation after thymectomy for 14 patients over a 12-month period based upon a protocol that included preope...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199106000-00007
更新日期:1991-06-01 00:00:00
abstract::Sometimes physicians assume responsibilities to third parties when undertaking the care of patients. Physicians have been held liable to third parties, though strangers to the patients, for failing to warn regarding the communicability of contagious diseases. Two suits have been allowed against physicians by third par...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197606000-00031
更新日期:1976-06-01 00:00:00
abstract::Many factors contribute to the attainment of adult height, including genetic and environmental variables. To assess the relationship between menarcheal age and adult height, measured adult height and recalled menarcheal age were compared by regression analysis in 425 women. The overall regression equation, Height = 15...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198904000-00009
更新日期:1989-04-01 00:00:00
abstract::All indexed cases of typhoid fever occurring in children over a ten-year period in Jacksonville, Fla, were studied retrospectively. This review revealed that anorexia was the most common gastrointestinal complaint and that neurologic symptoms and signs were nearly as common as gastrointestinal signs. There was a signi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197902000-00008
更新日期:1979-02-01 00:00:00
abstract::Malignant secondary parotid neoplasms are uncommon. Among 545 malignant parotid tumors, we found 52 (9%) that did not arise primarily in the parotid gland. Lymphomas or tumors of hematopoietic origin were excluded from this study. All patients had a parotid mass (two bilateral), one third of which were painful; 20% ha...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198109000-00007
更新日期:1981-09-01 00:00:00