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The correlation existing between the automated external defibrillators (AEDs) and survival after in-hospital cardiac arrest is analyzed. The application of AEDs is not shown to enhance the survival of such patients.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2010.06.029 Byline: Zachary D. Goldberger, Javier A. Valle, Vineet K. Dandekar, Paul S. Chan, Dennis T. Ko, Brahmajee K. Nallamothu Abstract: Carotid intima-media thickness (CIMT) is increasingly being used as a surrogate end point in randomized control trials (RCTs) of novel cardiovascular therapies. However, it remains unclear whether changes in CIMT that result from these therapies correlate with nonfatal myocardial infarction (MI). Article History: Received 17 May 2010; Accepted 17 June 2010 Article Note: (footnote) Zachary D. Goldberger, MD, is a Robert Wood Johnson Foundation Clinical Scholar.

A study was conducted to investigate the association between a lack of health insurance and financial constraints on accessing care among those with health insurance and the time taken from onset to hospital admission in acute myocardial infarction (AMI). Results indicated that such factors did contribute to delays in seeking emergency care for AMI.

The study attempts to evaluate the efficacy and safety of contraindicated medications like enoxaparin and eptifibatide among dialysis patients undergoing percutaneous coronary intervention (PCI). The results indicate that in many cases use of such drugs led to an increased risk of in-hospital major bleeding.

The study attempts to estimate racial differences in survival for patients following in-hospital cardiac arrests and the factors associated with it. The results indicate that African-American patients were less likely to survive discharge as compared to white patients and also that most of the racial differences were associated with the hospital in which African-American patients received care.

The case study of a middle-aged female teacher with a history of hypertension approaching urgent care with symptoms of chest pressure and light-headedness is analyzed. Relevant pathological tests were carried out and the condition was diagnosed as apical ballooning syndrome which closely resembles the symptoms of myocardial infarction.

A study was conducted to evaluate the low-dose ionizing radiation exposure that occurs after medical imaging procedures. Results indicate that such procedures lead to high cumulative effective doses of radiation.

The study attempts to evaluate the hospital 30-day risk-standardized mortality rates (RSMRs) for those patients that have been discharged with acute myocardial infarction (AMI). The results indicate that there was a significant decrease in hospital mortality rate for patients with AMI.

A case study of a 64-year old man admitted to emergency department with sudden-onset blurred vision in both eyes and diplopia as well as frontal headache is presented. The unusually high concentration of eosinophils in the blood was found to be the red flag that helped to characterize multisystem illnesses due to accumulation of eosinophils in any tissue that could result in injury because of their proinflammatory effect.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2008.02.018 Byline: Ioana Popescu (a)(b), Brahmajee K. Nallamothu (c), Mary S. Vaughan-Sarrazin (a)(b), Peter Cram (a)(b) Abstract: Supporters of specialty hospitals claim these facilities provide better patient care; however, empirical data on quality of care in specialty hospitals are limited. Author Affiliation: (a) The Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center, Iowa City, IA (b) The Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA (c) The Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI Article History: Received 27 February 2007; Accepted 14 February 2008 Article Note: (footnote) The study is supported by a grants from the National Center for Research Resources, Bethesda, MD (K23 RR01997201), National Heart, Lung, and Blood Institute, Bethesda, MD, and the Robert Wood Johnson Physician Faculty Scholars Program, Stanford, CA (Dr Cram); from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs (HFP 04-149) (Dr Vaughan-Sarrazin); and from the Agency for Health care Research and Quality (1R01HS015571-01A1) (Dr Nallamothu). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.10.051 Byline: Jeremy W. Buckley (a), Eric R. Bates (a), Brahmajee K. Nallamothu (a)(b) Abstract: In 2005, Michigan expanded primary percutaneous coronary intervention (P-PCI) capability to 12 hospitals without on-site cardiac surgery. We determined the potential impact of this expansion on geographic access to P-PCI for patients. Author Affiliation: (a) University of Michigan Medical School, Ann Arbor, MI (b) VA Health Services Research & Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI Article History: Received 28 June 2007; Accepted 1 October 2007

A study to examine how there is a delay in defibrillation given to patients in hospitals in the U.S. after cardiac arrest, which is ultimately responsible for their death, is conducted. Results conclude that delays in defibrillation after cardiac arrest are common and are associated with lower rate of survival.

The primary percutaneous coronary intervention (PCI) is a reperfusion therapy, which improves the chances of survival of a patient by reestablishing blood flow in the infracted artery.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.06.031 Byline: Vivian Ho (a)(b), Joseph S. Ross (c)(d), Brahmajee K. Nallamothu (e), Harlan M. Krumholz (f)(g)(h) Abstract: Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates. Author Affiliation: (a) Baker Institute for Public Policy, Rice University, Houston, TX (b) Department of Medicine, Baylor College of Medicine (c) Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY (d) Geriatrics Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY (e) Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI (f) Department of Medicine, Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, New Haven, CT (g) Department of Epidemiology and Public Health, Section of Health Policy and Administration, Yale University School of Medicine, New Haven, CT (h) Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Article History: Received 29 January 2007; Accepted 19 June 2007 Article Note: (footnote) Dr Ross was a scholar in the Robert Wood Johnson Clinical Scholars Program at Yale University sponsored by the Robert Wood Johnson Foundation at times during his involvement in the project., Support was given from a grant awarded to Dr Ho by the National Heart, Lung, and Blood Institute (R01 HL073825-01A1).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.04.052 Byline: Catherine Kim (a)(b), Ana V. Diez Roux (c), Timothy P. Hofer (d)(e), Brahmajee K. Nallamothu (d)(f), Steven J. Bernstein (d)(f), Mary A.M. Rogers (g) Abstract: Individuals of low socioeconomic status (SES) have reduced access to coronary artery bypass graft surgery (CABG). It is unknown if low-SES CABG patients have reduced access to hospitals with better outcomes. Author Affiliation: (a) Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI (b) Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI (c) Department of Epidemiology, Robert Wood Johnson Health and Society Scholars Program, University of Michigan School of Public Health, Ann Arbor, MI (d) Department of Veterans Affairs, VA Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (e) Department of Internal Medicine, Michigan Diabetes Research and Training Center, The Robert Wood Johnson Clinical Scholars Program, University of Michigan, School of Medicine, Ann Arbor, MI (f) Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI (g) Division of General Internal Medicine, Department of Medicine, Patient Safety Enhancement Program, University of Michigan School of Medicine, Ann Arbor, MI Article History: Received 29 January 2007; Accepted 1 April 2007 Article Note: (footnote) This study was supported by a grant from the Robert Wood Johnson Health and Society Scholars Program, the American Diabetes Association, and NIDDK K23-DK071552.

The cause of deep vein thrombosis in otherwise healthy women, possibly due to the long-term use of oral contraceptives is put forth.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.01.006 Byline: Ali Mahajerin (a), Hitinder S. Gurm (a), Thomas T. Tsai (a), Paul S. Chan (a), Brahmajee K. Nallamothu (a)(b) Abstract: The use of vasodilators to improve long-term outcomes in asymptomatic patients with chronic aortic insufficiency (AI) is controversial. Author Affiliation: (a) Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (b) Health Services Research and Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI Article History: Received 18 November 2006; Accepted 10 January 2007

A study was conducted among Medicare beneficiaries to determine whether the opening of specialty cardiac hospitals was associated with greater population-based rates of coronary revascularization. Results revealed that opening a specialty cardiac hospital within a hospital referral region (HRR) was associated with increasing use of coronary revascularization among Medic are beneficiaries.

A study is conducted to examine different hospital strategies associated with a faster door-to-balloon time during primary percutaneous coronary intervention. Results show that many specific hospital strategies are associated with a significant reduction in the door-to-balloon time during treatment.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.03.025 Byline: Brahmajee K. Nallamothu (a)(b), Paul A. Taheri (c), William G. Barsan (d), Eric R. Bates (b) Abstract: Many cardiovascular experts have called for the creation of specialized myocardial infarction centers and networks in the United States analogous to the current model for major trauma. Patients suffering ST-elevation myocardial infarction (STEMI) and trauma share an essential feature that makes the argument for regionalization persuasive: rapid triage and treatment by highly trained personnel improve survival in both conditions. Despite this similarity, however, the trauma system may be limited as a model for regionalizing STEMI care. First, the development of trauma systems has been hindered by the struggle for sufficient and stable funding, competing interests among individual stakeholders, and the overall lack of desire for state-sponsored healthcare planning in the United States. These same obstacles would need to be overcome if STEMI care is regionalized. Second, unique characteristics related to STEMI care, such as its varied clinical presentation and more lucrative reimbursement, will create new challenges. In this article, we briefly review the current status of trauma systems in the United States and describe why the regionalization of STEMI care may require different methods of healthcare organization. Author Affiliation: (a) Health Services Research and Development Center of Excellence, VA Medical Center, Ann Arbor, MI (b) Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI (c) Section of Trauma Burn and Critical Care, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (d) Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI Article History: Received 21 December 2005; Accepted 20 March 2006 Article Note: (footnote) Conflicts of Interest Disclosures: The authors have no potential conflicts of interests that affected the reporting of this work., Dr Nallamothu is being supported as a clinical scholar under a K12 grant from the National Institutes of Health (RR017607-01) and a grant by the Mardigian Foundation.

A study was conducted to determine correlations among acute myocardial infarction (AMI) core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates. The results indicated that the publicly reported AMI process measures capture a small proportion of the variation in hospital's risk-standardized short-term mortality rates.

A case study of a 36-year-old woman suffering from chest pain in her 34th week of pregnancy, which may be the result of various conditions, ranging from benign to life-threatening diseases is presented. The patient's hospital course was complicated by an episode of ventricular fibrillation one day after the percutaneous coronary intervention and after three days, labor was induced and she delivered a healthy baby girl.

Frequent urination that is painful and bloody is a fairly accurate sign of a urinary tract infection in women, especially when accompanied by back pain. Vaginal discharge or vaginal irritation reduce the likelihood of urinary tract infection, according to researchers who analyzed nine studies that evaluated the diagnosis of urinary tract infection based on a physical exam and medical history., Context Symptoms suggestive of acute urinary tract infection (UTI) constitute one of the most common reasons for women to visit clinicians. Although the clinical encounter typically involves taking a history and performing a physical examination, the diagnostic accuracy of the clinical assessment for UTI remains uncertain. Objective To review the accuracy and precision of history taking and physical examination for the diagnosis of UTI in women. Data Sources We conducted a MEDLINE search for articles published from 1966 through September 2001 and manually reviewed bibliographies, 3 commonly used clinical skills textbooks, and contacted experts in the field. Study Selection Studies were included if they contained original data on the accuracy or precision of history or physical examination for diagnosing acute uncomplicated UTI in women. One author initially screened titles and abstracts found by our search. Nine of 464 identified studies met inclusion criteria. Data Extraction Two authors independently abstracted data from the included studies. Disagreements were resolved by discussion and consensus with a third author. Data Synthesis Four symptoms and 1 sign significantly increased the probability of UTI: dysuria (summary positive likelihood ratio (LR], 1.5; 95% confidence interval [CI], 1.2-2.0), frequency (LR, 1.8; 95% CI, 1.1-3.0), hematuria (LR, 2.0; 95% CI, 1.3-2.9), back pain (LR, 1.6; 95% CI, 1.2-2.1), and costovertebral angle tenderness (LR, 1.7; 95% CI, 1.1-2.5). Four symptoms and 1 sign significantly decreased the probability of UTI: absence of dysuria (summary negative LR, 0.5; 95% CI, 0.3-0.7), absence of back pain (LR, 0.8; 95% CI, 0.7-0.9), history of vaginal discharge (LR, 0.3; 95% CI, 0.1-0.9), history of vaginal irritation (LR, 0.2; 95% CI, 0.1-0.9), and vaginal discharge on examination (LR, 0.7; 95% CI, 0.5-0.9). Of all individual diagnostic signs and symptoms, the 2 most powerful were history of vaginal discharge and history of vaginal irritation, which significantly decreased the likelihood of UTI when present (LRs, 0.3 and 0.2, respectively). One study examined combinations of symptoms, and the resultin g LRs were more powerful (24.6 for the combination of dysuria and frequency but no vaginal discharge or irritation). One study of patients with recurrent UTI found that self-diagnosis significantly increased the probability of UTI (LR, 4.0). Conclusions In women who present with 1 or more symptoms of UTI, the probability of infection is approximately 50%. Specific combinations of symptoms (eg, dysuria and frequency without vaginal discharge or irritation) raise the probability of UTI to more than 90%, effectively ruling in the diagnosis based on history alone. In contrast, history taking, physical examination, and dipstick urinalysis are not able to reliably lower the posttest probability of disease to a level where a UTI can be ruled out when a patient presents with 1 or more symptoms.

A 32-year-old man who developed chest pain and loss of consciousness after smoking crack cocaine was found to have an aortic dissection. Aortic dissection occurs when the aorta tears and blood begins to flow between the layers of the aorta.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2008.04.024 Byline: Harindra C. Wijeysundera (a), John J. You (b)(c)(d), Brahmajee K. Nallamothu (e), Harlan M. Krumholz (f)(g), Warren J. Cantor (h), Dennis T. Ko (a)(d) Abstract: Although the use of an early invasive strategy among patients with ST-segment elevation myocardial infarctions (STEMI) who are treated initially with fibrinolytic therapy is common, the safety and efficacy of this approach remains uncertain. We performed a meta-analysis to best estimate the benefits and harms of an early invasive strategy in STEMI patients treated initially with full-dose intravenous fibrinolytic therapy, as compared to a traditional strategy of ischemia-guided management. Author Affiliation: (a) Division of Cardiology, Schulich Heart Center and Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada (b) Department of Medicine, McMaster University, Hamilton, Ontario, Canada (c) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (d) Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e) Health Services and Research Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, MI (f) Section of Health Policy and Administration, Department of Epidemiology and Public Health; Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT (g) Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, CT (h) Division of Cardiology, Southlake Regional Health Center, Newmarket, Ontario, Canada Article History: Received 12 February 2008; Accepted 28 April 2008 Article Note: (footnote) Dr. Wijeysundera is supported by a University of Toronto, Department of Medicine Clinician Scientist Training Program, and a research fellowship award from the Canadian Institute of Health Research (CIHR) (Ottawa, Ontario, Canada). Dr. You is supported by a McMaster University Department of Medicine Internal Career Research Award. Dr. Ko is supported by a Heart and Stroke Foundation of Ontario Clinician Scientist Award. This project is funded in part by a CIHR operating grant., Dr. Warren Cantor has received consulting fees, speaker's honoraria, and unrestricted research grants from Hoffman La Roche Canada (Montreal, Quebec, Canada).

The study analyzes the various problems, benefits and disadvantages related to the performance of ad hoc percutaneous coronary intervention (PCI). The results demonstrate that cardiologists should stop ad hoc PCI till the time new researches are being conducted to demonstrate its significance.

The article discusses obesity, which is on the rise places an individual at a greater risk of mortality and morbidity. Rimonabant is being used as a means of treatment for obesity and its positive and negative effects are discussed.