Role of the cycle ergometer stress test in chest pain with low-intermediate risk

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

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The role of Hashimoto thyroiditis in predicting radioiodine ablation efficacy and prognosis of low to intermediate risk differentiated thyroid cancer

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01644-1 ◽

2021 ◽

Author(s):

Domenico Albano ◽

Francesco Dondi ◽

Valentina Zilioli ◽

Maria Beatrice Panarotto ◽

Alessandro Galani ◽

...

Keyword(s):

Thyroid Cancer ◽

Treatment Response ◽

Differentiated Thyroid Cancer ◽

Hashimoto Thyroiditis ◽

Prognostic Impact ◽

Intermediate Risk ◽

Excellent Response ◽

Radioiodine Ablation ◽

One Year

Abstract Objective The baseline treatment of differentiated thyroid cancer (DTC) consists of thyroidectomy followed by postoperative risk-adapted radioiodine therapy (RAIT) when indicated. The choice of most appropriate RAI activities to administer with the aim to reach an efficient remnant ablation and reduce the risk of recurrence is yet an open issue and the detection of basal factors that may predict treatment response seems fundamental. The aim of this study was to investigate the potential role of Hashimoto thyroiditis (HT) in predicting 1-year and 5-year treatment response after RAIT and prognosis. Methods We retrospectively included 314 consecutive patients (174 low-risk and 140 intermediate-risk) who received thyroidectomy plus RAIT. One-year and 5-year disease status was evaluated according to 2015 ATA categories response based upon biochemical and structural findings. Results HT was reported histopathologically in 120 patients (38%). DTC patients with concomitant HT received a higher number of RAITs and cumulative RAI activities. Initial RAIT reached an excellent response in 63% after one year and 84% after 5 years. The rate of excellent response one year and 5-year after first RAIT was significantly lower in HT groups, compared to not HT (p < 0.001). Instead, HT did not have a prognostic role considering PFS and OS; while stimulate thyroglobulin (sTg) at ablation was significantly related to survival. Conclusions HT may affect the efficacy of RAIT in low to intermediate risk DTC, particularly reducing the successful rate of excellent response after RAIT. Instead, HT did not have a prognostic impact such as stimulated sTg.

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Su1887 The Role of Esophageal Manometry and 24 Hour pH With Impedance Studies in the Evaluation of Patients With Non-Cardiac Chest Pain

Gastroenterology ◽

10.1016/s0016-5085(13)61852-1 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-501

Author(s):

Rashad C. Wilkerson ◽

Fouad J. Moawad ◽

Corinne L. Maydonovitch ◽

Lavern Belle ◽

Yen-Ju Chen

Keyword(s):

Chest Pain ◽

Esophageal Manometry

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Clinical judgement in chest pain: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02666-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Mishita Goel ◽

Shubhkarman Dhillon ◽

Sarwan Kumar ◽

Vesna Tegeltija

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Tobacco Use ◽

Stress Test ◽

Artery Bypass ◽

Pretest Probability ◽

Clinical Judgement ◽

Test Results ◽

Cardiac Stress ◽

History Of

Abstract Background Cardiac stress testing is a validated diagnostic tool to assess symptomatic patients with intermediate pretest probability of coronary artery disease (CAD). However, in some cases, the cardiac stress test may provide inconclusive results and the decision for further workup typically depends on the clinical judgement of the physician. These decisions can greatly affect patient outcomes. Case presentation We present an interesting case of a 54-year-old Caucasian male with history of tobacco use and gastroesophageal reflux disease (GERD) who presented with atypical chest pain. He had an asymptomatic electrocardiogram (EKG) stress test with intermediate probability of ischemia. Further workup with coronary computed tomography angiography (CCTA) and cardiac catheterization revealed multivessel CAD requiring a bypass surgery. In this case, the patient only had a history of tobacco use but no other significant comorbidities. He was clinically stable during his hospital stay and his testing was anticipated to be negative. However to complete workup, cardiology recommended anatomical testing with CCTA given the indeterminate EKG stress test results but the results of significant stenosis were surprising with the patient eventually requiring coronary artery bypass grafting (CABG). Conclusion As a result of the availability of multiple noninvasive diagnostic tests with almost similar sensitivities for CAD, physicians often face this dilemma of choosing the right test for optimal evaluation of chest pain in patients with intermediate pretest probability of CAD. Optimal test selection requires an individualized patient approach. Our experience with this case emphasizes the role of history taking, clinical judgement, and the risk/benefit ratio in deciding further workup when faced with inconclusive stress test results. Physicians should have a lower threshold for further workup of patients with inconclusive or even negative stress test results because of the diagnostic limitations of the test. Instead, utilizing a different, anatomical test may be more valuable. Specifically, the case established the usefulness of CCTA in cases such as this where other CAD diagnostic testing is indeterminate.

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Utility of Routine Exercise Stress Testing among Intermediate Risk Chest Pain Patients Attending an Emergency Department

Heart Lung and Circulation ◽

10.1016/j.hlc.2015.03.025 ◽

2015 ◽

Vol 24 (9) ◽

pp. 879-884 ◽

Cited By ~ 8

Author(s):

Jaimi H. Greenslade ◽

William Parsonage ◽

Ariel Ho ◽

Adam Scott ◽

Emily Dalton ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Stress Testing ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Intermediate Risk ◽

Pain Patients

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Stress Cardiac MR Imaging Compared with Stress Echocardiography in the Early Evaluation of Patients Who Present to the Emergency Department with Intermediate-Risk Chest Pain

Radiology ◽

10.1148/radiol.13130557 ◽

2014 ◽

Vol 271 (1) ◽

pp. 56-64 ◽

Cited By ~ 12

Author(s):

John F. Heitner ◽

Igor Klem ◽

Derek Rasheed ◽

Abhinav Chandra ◽

Han W. Kim ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Mr Imaging ◽

Stress Echocardiography ◽

Intermediate Risk ◽

Cardiac Mr ◽

Early Evaluation

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AI technologies and their impact on supply chain resilience during COVID-19

International Journal of Physical Distribution & Logistics Management ◽

10.1108/ijpdlm-12-2020-0434 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Sachin Modgil ◽

Shivam Gupta ◽

Rébecca Stekelorum ◽

Issam Laguir

Keyword(s):

Artificial Intelligence ◽

Supply Chain ◽

Information Processing ◽

Supply Chains ◽

Failure Modes ◽

Stress Test ◽

Weak Links ◽

Content Type ◽

Supply Chain Resilience

PurposeCOVID-19 has pushed many supply chains to re-think and strengthen their resilience and how it can help organisations survive in difficult times. Considering the availability of data and the huge number of supply chains that had their weak links exposed during COVID-19, the objective of the study is to employ artificial intelligence to develop supply chain resilience to withstand extreme disruptions such as COVID-19.Design/methodology/approachWe adopted a qualitative approach for interviewing respondents using a semi-structured interview schedule through the lens of organisational information processing theory. A total of 31 respondents from the supply chain and information systems field shared their views on employing artificial intelligence (AI) for supply chain resilience during COVID-19. We used a process of open, axial and selective coding to extract interrelated themes and proposals that resulted in the establishment of our framework.FindingsAn AI-facilitated supply chain helps systematically develop resilience in its structure and network. Resilient supply chains in dynamic settings and during extreme disruption scenarios are capable of recognising (sensing risks, degree of localisation, failure modes and data trends), analysing (what-if scenarios, realistic customer demand, stress test simulation and constraints), reconfiguring (automation, re-alignment of a network, tracking effort, physical security threats and control) and activating (establishing operating rules, contingency management, managing demand volatility and mitigating supply chain shock) operations quickly.Research limitations/implicationsAs the present research was conducted through semi-structured qualitative interviews to understand the role of AI in supply chain resilience during COVID-19, the respondents may have an inclination towards a specific role of AI due to their limited exposure.Practical implicationsSupply chain managers can utilise data to embed the required degree of resilience in their supply chains by considering the proposed framework elements and phases.Originality/valueThe present research contributes a framework that presents a four-phased, structured and systematic platform considering the required information processing capabilities to recognise, analyse, reconfigure and activate phases to ensure supply chain resilience.

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