Energy drink consumption is a health issue primarily of the adolescent and young adult male population. It is linked to increased substance abuse and risk-taking behaviors. The most common adverse events affect the cardiovascular and neurological systems. The most common ingredient in energy drinks is caffeine, and it is believed that the adverse events are related to its effects, as well as potentiating effects of other stimulants in these drinks. Education, regulation, and further studies are required.
SummaryBackground: Repeated hospital readmissions are frequent and increasing over time in patients with heart failure (HF). The predictors for readmission in patients with HF are not completely understood.Hypothesis: The study was undertaken to investigate the time course of readmission by specific cause in patients with HF, and to examine the independent effects of HF etiology and left ventricular (LV) function on cause-specific readmissions.Methods: A retrospective cohort of 493 consecutive patients with HF was followed for readmission for 16.5 ± 12.3 months. Ischemic etiology of HF was defined as history of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), or ≥ 70% coronary stenosis. Left ventricular function was assessed echocardiographically. Cause-specific readmissions were classified as HF, cardiovascular disease (CVD) other than HF, and other non-CVD.Results: The annual readmission rate was 56.6%. Median time to readmission was 91 days, with 18.3% patients readmit-
Background: Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios. We assessed multivariable predictors and overall appropriateness of MPI studies performed in a rural tertiary care setting. Hypothesis: We hypothesized that appropriate utilization rates of SPECT MPI imaging in a rural tertiary care center are similar for cardiology and non cardiology providers. Methods: We reviewed all SPECT MPI studies performed for over a 6-month period at our center. Using 67 scenarios in AUC, we categorized these studies as appropriate, inappropriate, uncertain, or unclassifiable. Results: Of 328 MPI studies, 287 (88%) studies were classified as appropriate, 18 (5.5%) as inappropriate, 23 (7%) as uncertain, and none as unclassifiable. Preoperative testing accounted for 44% of the inappropriate studies; 61% of uncertain tests were ordered for cardiovascular risk assessment in patients with prior normal coronary angiography or normal stress tests. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46). Patients with inappropriate and uncertain studies were younger than patients with appropriate studies (P = 0.007). Conclusions: We found that a majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty. Few common scenarios accounted for the majority of the inappropriate or uncertain studies.
BackgroundPrevious investigators have reported a significant increase in the utilization of imaging studies in cardiovascular medicine, disproportionate to the prevalence of cardiovascular disease. 1 As a result, utilization of imaging studies is now being closely scrutinized by the healthcare payers, often necessitating preauthorization. The Deficit Reduction Act of 2005 implemented a new cap system for reimbursement of imaging studies, which includes cardiac radionuclide imaging and echocardiography.
Background:
Appropriate use criteria (AUC) for Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging (MPI) were revised in 2009 to include 15 new clinical scenarios. Prior studies showed that ∼15 % of MPI studies were requested for inappropriate indications, mostly by non-cardiology providers. Although awareness of the AUC has improved, few studies have specifically evaluated the impact of 2009 AUC in an electronic, integrated, rural health care system.
Methods:
All MPI studies done between April - Sep 2011 were reviewed in this single centre study at a rural, electronic, integrated health care system. Using 67 scenarios in AUC guidelines, these studies were classified into four categories: Appropriate (A), Inappropriate (I), Uncertain (U) and Unclassifiable. To estimate the independent impact of ordering provider specialty on level of appropriateness, multivariable analysis was performed using backward stepwise variable selection.
Results:
During 6 month study period, 328 patients underwent MPI. Overall, 287 (87.5%) studies were classified as (A), 18 (5.5%) as (I), 23 (7%) as (U) and none were deemed as unclassifiable out of these 328 studies. Preoperative testing accounted for 8 (44%) of the total 18 (I) studies. Of the 23 studies classified as (U), 16 (70%) were performed for patients with new or worsening symptoms and prior normal coronary angiography or prior normal stress imaging study. The ordering physician specialty (cardiologists vs. non-cardiologists) did not show a multivariable correlation with appropriateness of the test (p=0.46). Results are summarized in Fig. 1
Conclusion:
In a rural, integrated, electronic, health care system; majority of providers, regardless of their specialty utilized MPI studies for (A) indications. Only 5.5% of MPI studies were ordered for (I) indications, suggesting a significant decrease in (I) tests compared to prior reports, which may reflect an increase in awareness of the revised 2009 criteria. However, certain common scenarios still account for a majority of small proportion of (I) studies. These findings may suggest a continuing need for provider education and possibly focusing the preauthorization triage process only for (I) clinical scenarios.
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