scholarly journals Study of Non-Stress Test as a Screening Tool in Low Risk Pregnancies at Term Gestation

2020 ◽  
Keyword(s):  
Screening Tool ◽  
Stress Test ◽  
Low Risk

scholarly journals Correlation of admission labour admission test in low risk pregnancies with pregnancy outcome

2019 ◽  
Vol 8 (5) ◽  
pp. 1880
Author(s):  
Preeti Sharma ◽  
Nikita Gandotra ◽  
Deepti Rana ◽  
Sabia Rasheed ◽  
Anil Kumar Sharma
Keyword(s):  
Prospective Observational Study ◽  
Screening Tool ◽  
Stress Test ◽  
Mode Of Delivery ◽  
Screening Method ◽  
Low Risk ◽  
Age Group ◽  
Admission Test ◽  
Pathological Group

Background: Aim of the study was to evaluate the role of NST (labour admission test) as a screening method in management of low risk pregnancies and to study the correlation of NST with fetal outcome.Methods: A prospective observational study conducted over 500 patients managed at our centre after proper evaluation. Patients were evaluated for mode of delivery and neonatal outcome.Results: The maximum number 352 of patients belonged to 20-30 years age group, 113 patients belonged to 31-35 age group. 200 patients were of 37-40 weeks gestation and 185 were of 40-41 weeks gestation. There were 125 patients in the 41-42 weeks gestational period. Among the 500 pregnant mothers who were included in the study 82.6% had Normal NST, 11.6% had suspicious and 5.8% had pathological NST. Cesarean rate was 14.4% in normal NST group, 58.62% in suspicious group and 72.41% in pathological group study. 6.77% in Normal group had meconium stained liquor at delivery whereas 29.31% in suspicious group and 37.93% in pathological group had same.Conclusions: The non-stress test is an important screening tool to identity the fetus in jeopardy in utero. This enables an appropriate timely intervention to achieve the most favorable outcome.

Abstract 16592: The Diamond-Forrester Criterion Significantly Overestimates the Risk of Obstructive Coronary Artery Disease in Patients Presenting to the Emergency Department With Low-Risk Chest Pain

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Todd Lecher ◽  
William R Davidson ◽  
Andrew Foy
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Pretest Probability ◽  
Low Risk ◽  
High Cholesterol ◽  
Observation Unit ◽  
Diamond Forrester

Introduction: We sought to (1) classify patients who underwent stress echocardiography in an emergency department observation unit based on their pretest probabilities of obstructive CAD using the Diamond-Forrester criterion, (2) to compare observed versus expected frequencies of obstructive CAD based on the Diamond-Forrester risk categories of low (<25%), intermediate (25-75%), and high (>75%) pretest probability of disease, and (3) to test the association of traditional cardiovascular risk factors (age, gender, hypertension, diabetes, high cholesterol, and smoking) with obstructive CAD. METHODS: Retrospective review of the electronic medical record for patients who presented to the emergency department with chest pain and underwent observation followed by stress echocardiography between the period January 1, 2012 to December 31, 2012. Patients were classified as low, intermediate, or high risk for obstructive CAD using the Diamond-Forrester criterion. Main outcome measures were stress echocardiography results as well as receipt of cardiac catheterization and results. RESULTS: A total of 504 patients were included in the final analysis. Overall, 4.8% had a positive stress test and only 1.2% had angiographic evidence of obstructive CAD. In each category of risk, the observed frequency of obstructive CAD was significantly lower than expected. Having a high pretest probability as defined by the Diamond-Forrester criterion was significantly associated with obstructive CAD. Age, gender, diabetes, hypertension, high cholesterol, and smoking were not independently associated with evidence of obstructive CAD; nor were any composites of these risk factors. CONCLUSIONS: The traditional Diamond-Forrester criterion significantly overestimates the probability of obstructive CAD in ED observation unit patients. Reliance on the Diamond-Forrester criterion and other traditional risk factors associated with obstructive CAD in the outpatient setting could lead to faulty Bayesian reasoning, overuse of non-invasive imaging, and improper interpretation of test results in an ED population of low-risk chest pain patients. Further work is required to determine an optimal risk-assessment strategy for this patient population.

Abstract 17369: Addressing Missed Opportunities for Cardiometabolic Primary Prevention of Veterans Referred for Stress Testing

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ysanne Johnson ◽  
Sheila M Mattei ◽  
Matthew Burg ◽  
Judith L Meadows
Keyword(s):  
Risk Reduction ◽  
Stress Testing ◽  
Stress Test ◽  
Standard Of Care ◽  
Low Risk ◽  
Stress Tests ◽  
Missed Opportunities ◽  
Presenting Symptoms ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Introduction: Patients presenting to stress testing have a high prevalence of cardiometabolic risk factors (RF) which are not at guideline supported goals. Referral to stress testing is often a patient’s first presentation to CV care and represents a missed opportunity for delivery of risk reduction strategies. Hypothesis: Implementation of a cardiometabolic prevention initiative for cardiology-naïve patients referred to stress testing will result in improved delivery of guideline-directed prevention care. Methods: A consecutive prospective cohort of patients who underwent stress testing (12/1/2019-1/31/2020) after implementation of a linked cardiometabolic prevention referral for those with low risk stress tests was compared to a retrospective standard of care (SOC) cohort (9/1/2019-10/1/2019) from a single center Veterans Hospital. Outcomes assessed were change in CV risk reduction care at 90 days following stress test. Results: Of 181 patients, 62.5% were naïve to cardiology specialty care, had >1 CV risk factor not meeting guideline goals, 6% had typical angina as presenting symptoms, and greater than 70% of stress tests were normal or low risk. Baseline CV RF were common and failed to reach goals in SOC and intervention cohorts respectively with LDL above goal (40 vs. 33%), stage 1 or greater hypertension (67 vs 81%), Diabetes with HgA1c > 7 (48 vs. 21%), overweight or obese (68 vs. 79%), current tobacco (11 vs. 12%), and elevated mean 10-year ASCVD risk (32 vs.20%). At 90 days, 28% of SOC cohort had intensification of CV prevention care as compared to 76% of intervention cohort (X 2 26.8, p<0.05). Conclusions: A stress testing setting represents a valuable opportunity to deliver cardiometabolic prevention care. Integration of risk reduction strategies is imperative to shift from cardiac disease management to patient centered health promotion.

scholarly journals 30. Implementation of the PEN-FAST Penicillin Allergy Screening Tool in the Emergency Department During Medication Reconciliation

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S137-S138
Author(s):  
Satwinder Sony Kaur ◽  
David T Adams ◽  
Brittany Parker
Keyword(s):  
Emergency Department ◽  
Screening Tool ◽  
Healthcare Providers ◽  
Low Risk ◽  
Penicillin Allergy ◽  
Secondary Outcome ◽  
Beta Lactam ◽  
Decision Tool ◽  
Allergy Test ◽  
Risk Patients

Abstract Background The purpose of this study is to implement the PEN-FAST Penicillin Allergy Screening Tool in the emergency department to identify low risk patients with inappropriate penicillin-related allergies to transition them to a beta-lactam. Newly published, validated, penicillin allergy clinician decision tool (PEN-FAST) allows healthcare providers to identify low risk penicillin allergies with a negative predictive value of 96%. This quick, five question clinical decision tool allows healthcare providers and antimicrobial stewardship programs to identify patients who would also test negative if a formal penicillin allergy test was performed, making the process to confidently identify inappropriately labeled penicillin-related allergies more efficient. Methods During routine medication reconciliations, pharmacists will identify patients who have a documented penicillin-related allergy in the EMR and use the PEN-FAST screening tool. Patients meeting inclusion criteria will have their penicillin-related allergy updated in the EMR based upon their assessed risk of very low, low, moderate, or high. The primary outcomes for this study are the percentage of patients screened that were classified as “very low and low risk” and percentage penicillin-related allergies updated. The secondary outcomes are the percentage of patients that required antibiotic therapy (post-allergy update) that were transitioned to a beta-lactam, inpatient broad-spectrum antibiotic usage before and after allergy update, and time spent interviewing each patient. Results A total of 59 patients were interviewed using the PEN-FAST Tool. The results for the primary outcomes indicate 92% (n=54) of patient allergies updated in the EMR, 24% (n=13) of patients classified as “very low risk” and 34% (n=18) of patients classified as “low risk”. Results for the secondary outcome showed out of the 36 patients that were on non-beta lactams during allergy update, 72% (n=26) of those patients were transitioned to a beta-lactam. The average time to complete the PEN-FAST Tool was 4.2 minutes. Conclusion The results of this study support the use of the PEN-FAST Tool in efficiently updating patient’s allergies in the EMR and identifying low risk patients who may be eligible for beta-lactam therapy. Disclosures All Authors: No reported disclosures

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p&lt; 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

Abstract 324: Ankle Brachial Index as a Predictor for Abnormal Cardiovascular Stress Test and Cardiovascular Outcomes

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Muhammad T Shakoor ◽  
Amir Mohani ◽  
Khawar Maqsood ◽  
Amir Lotfi
Keyword(s):  
Chest Pain ◽  
Risk Stratification ◽  
Odds Ratio ◽  
Stress Testing ◽  
Stress Test ◽  
Ankle Brachial Index ◽  
Low Risk ◽  
Study Cohort ◽  
Risk Population ◽  
One Year

Background: The combination of ankle brachial index (ABI) and other risk stratification tools has been evaluated previously. However baseline ABI in patients admitted for chest pain prior to stress testing to predict increased probability of abnormal stress test and MACE (major cardiovascular adverse events) has not been studied. Methods: Patients (n= 342) admitted for chest pain with normal or unchanged electrocardiogram and negative troponin T who were referred for myocardial perfusion study were enrolled in this prospective observational study and followed for one year. The first part of the study was to assess if an abnormal ABI increases the probability of an abnormal stress test and the second part was to measure one-year outcome for MACE (Angina, MI, CHF, TIA/Stroke and deaths) based on their stress test and ABI results. Multivariable logistic regression modeling is used to interpret the data. Results: In our study population 83% of the patients had Framingham risk score less than 20. Twenty-nine percent of the patients with normal ABI and 40% of the patients with abnormal ABI had abnormal stress test. The difference is statistically insignificant. After adjusting for different variables abnormal ABI was found to have stronger correlation with MACE (Odds ratio 2.9, p 0.01, CI 1.2 - 6.7) as compared to abnormal stress test (Odds ratio 0.92, p 0.84 CI 0.3 - 2.1). Conclusion: In our study cohort an abnormal ABI, irrespective of the stress test results, was an independent predicator of MACE at one year. We can conclude that there is very weak temporal relationship between abnormal ABI and abnormal stress test in low risk population and asymptomatic peripheral vascular disease is a strong independent predictor of MACE, even in this low risk population. We can also conclude that ABI during stress testing can be used for risk stratification. Future studies may need more power in this low risk population.

Discharging Low Risk Patient's with a Negative Stress Test—What is the Risk of an ACS Event?

2008 ◽  
Vol 17 ◽  
pp. S95
Author(s):  
Philip Tideman ◽  
Rosy Tirimacco ◽  
Paul Simpson
Keyword(s):  
Stress Test ◽  
Low Risk

scholarly journals Validation of the Ceredigion Youth Screening Tool

2018 ◽  
Vol 62 (12) ◽  
pp. 3727-3745
Author(s):  
Gareth Norris ◽  
Gwyn Griffith ◽  
Megan West
Keyword(s):  
Young People ◽  
Screening Tool ◽  
Positive Impact ◽  
Low Risk ◽  
Risk Indicators ◽  
Youth Offenders ◽  
Formal Evaluation ◽  
The Individual ◽  
Statistical Risk ◽  
Initial Results

Evidence suggests that only a small minority of youth offenders will continue their behaviour in the longer term and largely independent of any interventions they may receive (Bateman, 2011; Haines & Case, 2015). Hence, “screening out” this larger low-risk cohort could have a positive impact upon the individual through a reduction in stigmatisation/labelling and free up resources for higher risk clients. This article outlines development of the Ceredigion Youth Screening Tool (CYSTEM)—developed and tested to address the two facets of criminality and vulnerability—closely aligned to the eight key risk indicators identified in the Risk-Needs-Responsivity (R-N-R) literature (Andrews & Bonta, 2010). Initial results with two cohorts of 372 young people indicate good convergent and discriminative validity in screening out the lowest level referrals, while also identifying 90% of potential future offenders. More importantly, CYSTEM is able to screen out approximately 35% of the low-risk offenders that are unlikely to require formal evaluation and/or intervention. It is suggested that the streamlining of this process using CYSTEM reduces demand on staff time and decreases the stigmatisation of young people referred for minor offences. Potential improvements to the tool and future developments in statistical risk prediction are also discussed.

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