A dissertation submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The purpose of this research is to conduct a descriptive study of cases that presented with thoracic complaints to Durban University of Technology chiropractic Day Clinic from the 13 January 1995 to 30 November 2005. This is a retrospective, quantitative, non-experimental, clinical survey. The sample size for this study included 7111 cases obtained from the Durban University of Technology chiropractic day clinic. There were no thoracic cases recorded in the random sample for the year 1995, therefore the random sample allocated for this year was subtracted from the total sample. 249 Thoracic cases were included in this research. The overall prevalence for the time period 1996 - 2005 was 3.5%. Gender: 248 of the 249 patients had recorded gender information. The majority were female 54.8% while 45.2% were male. Age: The ages ranged from 11 to 73 years. The mean age was 33.3 years. Occupation: 241 patients had a recorded occupation. 21.6% of them were classified as active or non-sedentary while the majority had sedentary jobs. The main complaint was mid-back pain which was noted in 41.4% of the population. Thoracic facet syndrome was the primary diagnosis given in 74.7% of the population; myofasciitis was the second most diagnosed condition with 8.8% of the population having this primary diagnosis. The most common treatment was joint manipulation, which was used in 82.6% of the cases, followed by soft tissue therapy (79.4%) and stretches (44.9%). The facets that were most commonly found to be fixated were in the T5 toT8 region. The investigative procedure that was used most often in the sample was x-rays. Fourteen patients were sent for x-rays (5.6%). One patient was sent for a blood test (0.4%). No other investigative procedures were used in these patients. Even though the overall prevalence of thoracic pain sufferers was only 3.5% over the ten year period, it is still an area of pain that must be investigated. The thoracic spine has been overlooked as a major region for research. This study has proved that there is need for continuing research in this area, to assist chiropractors to treat the thoracic spine more effectively. / M

The accurate exclusion of myocardial ischemia as the cause of acute chest pain is a clinically demanding and resource intensive process. An estimated three to five million patients present to emergency departments in the United States each year with chest pain of uncertain etiology. Emergency departmente valuation of patients presenting with acute chest pain has traditionally involved patient history, physical examination, electrocariography, and cardiac enzyme evaluation. Unfortunately these methods suffer from suboptimal sensitivity and specificity. The majority of these patients will not have myocardial ischemia as the cause of their chest pain. Out of concern for the potential complications and legal consequences of a missed diagnosis of AMI, emergency physicians commonyl recommend hospital admission for all patients at risk of acute ischemia. Resulting in unnecessary admissions and tremendous cost. The goal of this project is to develop a research-based approach to the assessment and management of chest pain patients presenting to the Emergency Department. A chest pain observation unit will be designed for out-patient evaluation of those patients at moderate to low risk of acute coronary ischemia to rule out occult cardiovascular disease. The chest pain center model presented in this project will guide this unit structure. A community outreach educational program to and a continuous quality management program was also developed.

Abstract The prevalence of coronary heart disease (CHD) and associated manifestations with ischaemic resting electrocardiogram (ECG) changes, clinical findings and sociodemographic factors were studied in 1990–1991 among an elderly population in southwestern Finland. One of the specific aims was to describe the health-related quality of life of elderly coronary heart disease patients, i.e. the associations between CHD and physical, psychological, cognitive and social functioning. 488 men and 708 women aged 64 years and over (93% of those eligible) participated in this cross-sectional epidemiological survey in the rural district of Lieto. The participants were examined and interviewed during two visits to the local health centre. An ECG and a chest x-ray were taken and a clinical examination was made by a doctor. The Rose questionnaire was used to determine the prevalence of angina pectoris (AP). The Minnesota codes were used in the analyses of ECG findings. The medical records were reviewed. The prevalence of AP was 9.1% (95% Confidence Interval 6.7–12.0) among men and 4.9% (3.5–6.8) among women. The respective figures for past myocardial infarction (MI) (based on the medical records or a major or moderate Q/QS item on ECG, codes 1.1–1.2) were 13.9% (10.9–17.0) and 6.5% (4.8–8.6). Ischaemic ECG findings (codes 1.1–1.3, 4.1–4.4, 5.1–5.3, 7.1) were common: 32.9% (28.7–37.1) of men and 39.3% (35.7–43.0) of women had such changes. The total prevalence of CHD, including AP, MI, past coronary bypass surgery or angioplasty or ischaemic ECG findings, was 37.7% (33.4–42.0) in men and 42.0% (38.3–45.6) in women. The patients and controls were mainly aged, non-institutionalized, community-living persons. The patients with CHD (AP and/or a past MI) had more difficulties in physical functioning than their age- and sex-matched controls. According to logistic regression analyses, CHD was not independently associated with difficulties in physical functioning. However, physical disability was associated with the use of cardiovascular drugs and also with old age, the use of psychotropic drugs, depression and cancer. More male patients than controls had depression measured on the Zung Self-Rating Depression Scale. The depression had often gone undiagnosed, especially among men. Among men, the most important factors associated with depression were difficulties in physical functioning and widowhood or divorce, while among women, previous depression and the use of ACE inhibitors emerged as significant. There were no differences between the patients and controls in cognitive functioning. The male patients had a higher frequency in visiting activity than the controls. Old age, difficulties in physical functioning, CHD and chronic obstructive pulmonary disease were associated with impaired social functioning. In conclusion, CHD is common in the Finnish elderly. The clinical picture of CHD in elderly people is varying. It seems that CHD has no independent impact on functional disability in the elderly. Old age, sociodemographic factors, medication and other chronic diseases are also contributors.

Myocardial infarction is the primary diagnosis to rule out in emergency department chest pain patients. In this retrospective, multi-site study, we compared logistic regression (LR) with machine learning (ML) in predicting which patients were at risk of major adverse cardiac events (MACE) and abnormal troponin. Of the 1,538 patients identified over 43 days, 1,014 were retained of whom 70 suffered a MACE. LR and ML models for MACE were internally validated and achieved similar area under curve (AUC): 0.89 (95% CI: 0.87, 0.93) and 0.92 (95% CI: 0.89, 0.94) respectively. Abnormal troponin models had overlapping AUCs. Two novel clinical decision scores were derived: the Preliminary Chest Pain Risk Score with a sensitivity of 100.00% (95% CI: 94.87%, 100.00%) for identifying low risk chest pain patients and the Ultra-Low Risk Troponin Score which could be used in lieu of troponin. Future prospective studies will be required to externally validate these scores.

No description available.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 4 uppsatser.

Chest pain is one of the most common symptoms responsible for emergency department and primary care office visits in the United States. Chest pain can be noncardiac and may be attributed to multiple causes. Esophageal disorders including reflux, motility and functional conditions, affect a large proportion of patients with NCCP and lead to significant morbidity. The use of HRM has changed the diagnostic approach to esophageal motility disorders. It is the most specific and sensitive test for diagnosing motor disorders and a promising procedure in detecting dysmotility disorders in patients with NCCP. Despite the increased sensitivity of HRM, the main indications for esophageal manometry exclude NCCP. This study assessed the percentage of undiagnosed esophageal motility disorders in patients with NCCP referred for high resolution manometry. Differences in HRM findings in patients with NCCP versus patients meeting AGA recommendations for the clinical use of esophageal manometry were also compared. A retrospective descriptive design was utilized. Two hundred-nineteen patient charts were reviewed. One hundred sixty-eight (77%) patients underwent HRM and met AGA recommendations for esophageal manometry; 51 (23%) patients underwent the procedure after receiving a NCCP diagnosis. Findings showed that 116 (69%) patients in the AGA group had abnormal findings while 52 (31%) did not. In the NCCP group 34 (67%) had abnormal findings compared to 17 (33%) who did not. To compare normal and abnormal HRM findings in patients with NCCP versus those meeting AGA criteria, Chi-Square analysis was performed between the groups. The results were not statistically significant (p = 0.10). iv There were no significant differences in the results of HRM in both groups indicating the findings on HRM are the same despite the indication for the procedure. The findings support the use of HRM as a diagnostic tool in patients with chest pain after cardiac workup and endoscopic evaluation. This indicates a possible need to update the AGA indications for esophageal manometry and increase the awareness among healthcare providers regarding the use of HRM in patients with chest pain. Implication for future research is also discussed.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1459962. ProQuest document ID: 1674094541. Includes bibliographical references (p. 27-29)

Background: Early post-percutaneous coronary intervention chest pain (EPPCP) appears to be a common clinical phenomenon. EPPCP has not been fully explained or studied in the literature despite the abundance of clinical trials on percutaneous coronary intervention (PCI). The objective of this questionnaire-based survey is to assess the current perception of EPPCP among practicing interventional cardiologists nationwide. Methods: A survey questionnaire was designed utilizing the Survey Monkey tool to address the perceptions and current practices regarding key aspects of EPPCP among interventional cardiologists. The survey was sent to the interventional cardiologists via email. Results: The survey questionnaire regarding EPPCP was provided to 2615 practicing interventional cardiologists and resulted in 623 total survey responses, with 503 of those respondents completing all eight survey questions. A total of 50.2% of the interventional cardiologists perceive that the incidence of EPPCP is 5–10%, and 57.5% consider that repeat angiography or PCI is rarely needed (1 in 1000 cases). A total of 47.1% of the participants think that EPPCP is due to transient microvascular dysfunction, while 39% perceive it as a different entity requiring a different approach. When asked about developing a standardized labeling for the phenomenon of EPPCP, 34.8% of responders indicated that they believe EPPCP should be labeled as a benign form of chest pain/angina, and 28% preferred to describe EPPCP in non-standardized terms. Among interventional cardiologists, 80% thought that the treatment of this entity is a combination of reassurance and vasodilators and, without ischemic ECG changes, medical management is appropriate. Conclusion: A total of 72% of interventional cardiologists in our survey preferred to label EPPCP as standard nomenclature to facilitate communication between healthcare providers, patients and families in a consistent way. There is a diversity of opinion regarding EPPCP, no standard nomenclature, and no guideline to standardize practice. Further large-scale prospective studies are needed to better understand the pathophysiological mechanisms, optimal management strategies, prognostic implications, and clinical reporting of EPPCP.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 61 leaves, Annexures A-E, 1-5 / Research is more than merely an academic exercise. It is a key ingredient in establishing chiropractic’s role in an evolving health care system (Dallas, 1997). Very little is known about the changes in the chiropractic patient population over time (Hartvigsen et al. 2003). Despite the widespread use of chiropractic, good descriptive data on chiropractors and their patients are limited (Coulter and Shekelle, 2005). Few studies have been reported which deal specifically with patients attending chiropractic teaching clinics (Nyiendo and Olsen, 1988). A teaching clinic is an outpatient clinic that provides health care for patients, as opposed to inpatients treated in a hospital. Teaching clinics are traditionally operated by educational institutes and provide free or low-cost services to patients (http://en.wikipedia.org/wiki/Teaching_clinic). In April 1994 the chiropractic day clinic was officially opened at the former Technikon Natal (now the Durban University of Technology). Thousands of patients have been treated at this clinic over this twelve year period. In 1994, Elga Renate Drews, conducted research aimed at identifying characteristics of chiropractic patients and their complaints at the chiropractic teaching clinic at Technikon Natal and private practices in South Africa. This survey was conducted from February 1994 to the end of April 1994. 162 Patients were involved in this study. A survey was completed which included the patient’s age, gender, occupation, presenting condition, duration of complaint, previous treatment, referral, severity, quality of pain and their disability. A comparison was made between patients seen in private practice and at the teaching clinic. It was found that generally both populations were very similar, with the exception of the patients’ age and occupation. No other research investigating patient characteristics has been undertaken at Durban University of Technology chiropractic day clinic after 1994. Furthermore, in the study conducted by Drews no mention was made of the type of treatment that was given to patients either in private practice or at the teaching clinic. Although the first successful chiropractic adjustment recorded was in the thoracic spine by Dr. D.D. Palmer, research since then has focused on the lumbar spine (Di Fabio, 1992). In reviewing literature relating to the thoracic spine, it is apparent that in comparison to the cervical and lumbar regions, the thoracic spine has been neglected (Edmonston and Singer, 1997). In South Africa there remains a paucity of information on the types of thoracic conditions chiropractors treat and the management protocols. The present research aimed to shed light on this aspect by collecting data from one of only two chiropractic teaching clinics in South Africa, namely the Durban University of Technology chiropractic day clinic. The purpose of this research was to investigate the age, gender, occupation (whether of a sedentary or non-sedentary nature), prevalence of pain, presenting complaints, common conditions treated and common management protocols of patients who presented with thoracic pain to the Durban University of Technology Chiropractic Day Clinic.