Dataset Information

Troponin: think before you request one.

ABSTRACT: Acute myocardial infarction (ACS) is one of the most common presentations in acute hospital settings. Troponin (cTn) has emerged as one of the most sensitive biochemical markers for the diagnosis of ACS. However, if used inappropriately and in the absence of true clinical context then it can be elevated in a number of non cardiac conditions and lead to false clinical diagnosis, inappropriate workup, and increased patient stay in hospital. The cost of unnecessary clinical testing is another aspect of the problem. At Royal Gwent Hospital in Newport (one of the busiest district general hospitals in Wales) we retrospectively analysed the nature of troponin requests over a random period of one week, specifically looking for the indications and final diagnostic impact. In many cases it was found that requests were made without any clinical justification. One of the main and probably unavoidable reasons for this was that requests were made from triage before patient was assessed by a clinician. However, steps were taken to clarify common clinical indications for suspected cardiac diagnosis in which troponin was useful. Additionally, the "tick box" practice for inappropriate laboratory investigations was discouraged. A repeat audit was done on similar basic principles and a measurable improvement was identified, with a potential for significant impact in future.

SUBMITTER: Gardezi SA

PROVIDER: S-EPMC4645907 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Troponin: think before you request one.

Gardezi Syed Anjum SA

BMJ quality improvement reports 20150325 1

Acute myocardial infarction (ACS) is one of the most common presentations in acute hospital settings. Troponin (cTn) has emerged as one of the most sensitive biochemical markers for the diagnosis of ACS. However, if used inappropriately and in the absence of true clinical context then it can be elevated in a number of non cardiac conditions and lead to false clinical diagnosis, inappropriate workup, and increased patient stay in hospital. The cost of unnecessary clinical testing is another aspec ...[more]

PMID: 26734360

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Project description:Using the think/no-think paradigm (Anderson & Green, 2001), researchers have found that suppressing retrieval of a memory (in the presence of a strong retrieval cue) can make it harder to retrieve that memory on a subsequent test. This effect has been replicated numerous times, but the size of the effect is highly variable. Also, it is unclear from a neural mechanistic standpoint why preventing recall of a memory now should impair your ability to recall that memory later. Here, we address both of these puzzles using the idea, derived from computational modeling and studies of synaptic plasticity, that the function relating memory activation to learning is U-shaped, such that moderate levels of memory activation lead to weakening of the memory and higher levels of activation lead to strengthening. According to this view, forgetting effects in the think/no-think paradigm occur when the suppressed item activates moderately during the suppression attempt, leading to weakening; the effect is variable because sometimes the suppressed item activates strongly (leading to strengthening) and sometimes it does not activate at all (in which case no learning takes place). To test this hypothesis, we ran a think/no-think experiment where participants learned word-picture pairs; we used pattern classifiers, applied to fMRI data, to measure how strongly the picture associates were activating when participants were trying not to retrieve these associates, and we used a novel Bayesian curve-fitting procedure to relate this covert neural measure of retrieval to performance on a later memory test. In keeping with our hypothesis, the curve-fitting procedure revealed a nonmonotonic relationship between memory activation (as measured by the classifier) and subsequent memory, whereby moderate levels of activation of the to-be-suppressed item led to diminished performance on the final memory test, and higher levels of activation led to enhanced performance on the final test.

Dataset Information

Troponin: think before you request one.

Publications

Troponin: think before you request one.

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