“Real life use” of troponin in the emergency department: a survey of over 3000 cases

Introduction

The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED).

Materials and methods

3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I.

Results

Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (> 40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographyc changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value.

Conclusions

Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes.Key words: troponin I, acute coronary syndrome, emergency service, hospital, chest pain     

Exploring Best Management Practices for Geospatial Data in Academic Libraries

Due to the exponential growth of spatial information, effective management and curation of geospatial data has become a central concern for GIS libraries. Although geospatial data are often generated based on a set of well-established standards and protocols, best management practices in geospatial data services are still limited. In this paper, the authors review the common challenges of geospatial data management and curation, which include the application of big data, the emergence of Web GIS, and the advancement of cyberinfrastructures. A spatial education project is used as an example to discuss potential best management practices to address these challenges. It is demonstrated that librarians need to be involved at the early stage of a research project and work closely with researchers at all stages of the data life cycle for effective data management. With early involvement of a GIS librarian in the full project development process, all three challenges can be addressed by using best management practices in organizing, managing, publishing, distributing, and preserving the geospatial data.     

Assisting secondary support teachers to work in the recommended service delivery model: introducing the concept of a subculture of learning support

The original concept of a subculture of learning support in secondary schools developed from a study of ‘Support Teachers, Learning Difficulties’ in New South Wales, Australia. The study examined the influence of school culture on the service delivery model used by these support teachers in three case studies, one of which is reported in this article. Both research and policy recommend consultation and co‐teaching with a minimum of withdrawal of students with learning difficulties for intensive instruction. To employ the recommended service delivery model it was found that support teachers need to be immersed in a subculture of learning support within the school, which involves interacting with others who share similar values and beliefs about the education of students with learning difficulties. If such a subculture does not exist the support teacher must play a major role in its development. The use of the recommended service delivery model will enhance the education provided for students with learning difficulties.     

Implementing curriculum evaluation: case study of a generic undergraduate degree in health sciences

This case study presents a longitudinal, evidence‐based approach to health science curriculum reform and evaluation. Curriculum in higher education must meet the needs of diverse stakeholders and must respond to dynamic local, national and international contexts, and this creates challenges for evaluation. The long lead time prior to the introduction of new or revised university curriculum (at least two years), the length of degree programmes (three to five years) and the lag time in the availability of objective indicators of degree outcomes (at least one year post‐graduation) mean that findings may be obsolete before an evaluation can be completed. Few would argue that evaluation is important and methods and approaches for conducting curriculum evaluation are proposed in the literature, although few published reports of the outcomes of comprehensive evaluations are evident. This paper discusses potential for evaluation to establish responsive communication between students, teaching staff and programme administrators, ensuring a match between the intended, implemented and attained curriculum.     

Benefits of a physical activity intervention for men with prostate cancer

The purpose of the current study was to examine the viability of conducting a theory-based physical activity (PA) intervention on men with prostate cancer, and the impact of PA on quality of life (QOL). Participants were 31 men, average age of 67 years, with localized or metastatic prostate cancer undergoing androgen deprivation therapy (ADT). Global QOL, fatigue, and PA measures were conducted at baseline and following the 12-week intervention. An additional follow-up testing was conducted 4 months following the intervention (n = 18). Both moderate and strenuous bouts of exercise, as well as functional capacity, increased significantly from pre- to posttest. Both fatigue severity and resting heart rate decreased significantly at posttest. A trend toward improved global QOL was also noted. It was concluded that a 12-week home-based PA intervention may provide health and QOL benefits for prostate cancer patients undergoing ADT. Practitioners are encouraged to promote PA for prostate cancer survivors.