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Atrial fibrillation (AF) is the most common arrhythmia presentation to the emergency department (ED) and frequently results in admission to the hospital. Although rarely life-threatening and not usually an emergent condition, AF places a large burden on our health-care system. The objective of this study was to describe the practices of ED physicians in the management of AF in a large urban Canadian city.
From January 1, 2010 to December 31, 2010, patients with a primary diagnosis of AF were identified across 10 EDs in Toronto, Canada (N=2,609). Fifty patients were selected at random from each hospital for a detailed chart review (n=500).
Two hundred thirty-two patients (46%) received rate control, and 129 (26%) received rhythm control with the remainder (28%) receiving neither therapy. Sixty-seven percent of patients were discharged home. Most patients (79%) were symptomatic on arrival; however, only a minority of these (31%) received rhythm control. Factors that were associated with rhythm control included younger age, duration of palpitations ≤ 48 hours, a lower CHADS2 score, and the absence of left ventricular dysfunction.
Our data suggest a wide range of practice amongst ED physicians treating patients presenting to the ED with a primary diagnosis of AF. A randomized trial is needed to better understand the optimal management strategy in this patient population and setting.
Wing feather mite burdens on seven species of passerine birds (Carduelis carduelis – goldfinch; C. chloris – greenfinch; Serinus serinus – serin; Sylvia atricapilla – blackcap; Sylvia melanocephala – Sardinian warbler; Turdus merula – blackbird; Passer domesticus – house sparrow) from Portugal were assessed by the subjective semi-quantitative scoring system of Behnke et al. (1995) in order to evaluate more fully the accuracy and reliability of the technique. Our analysis indicated that in all species, scores allocated to flight feathers showed a significant positive relationship with mite counts as assessed through microscopical examination of the same feathers. However, there were differences between species of birds. Of the species examined, goldfinches and greenfinches showed the weakest relationships between assigned mite scores and actual mite numbers indicating that the technique was less accurate when applied to these species compared with the remaining five. No evidence was found that anything more was to be gained from scoring both wings, rather than just one. Feather mites (Proctophyllodes spp., Trouessartia incisa) were also detected on tail feathers, but the assessment of these feathers presented additional problems and it was concluded that in the interests of minimizing handling time of birds, tail scores had little more to offer. We conclude that scoring all the flight feathers (including all primary, secondary, and tertiary feathers) on one entire wing, but alternating between left and right wings of birds within a species, represents an acceptable compromise between sufficiently detailed examination and minimization of bird handling time in the field.
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