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Background: Clinical features among patients with refractory out-of-hospital cardiac arrest (OHCA) and initial shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia are not well-characterized., Methods: We compared clinical characteristics and coronary angiographic findings between patients with refractory OHCA (incessant ventricular fibrillation/pulseless ventricular tachycardia after ≥3 direct-current shocks) and those without refractory OHCA., Results: Between 2014 and 2018, a total of 204 patients with ventricular fibrillation/pulseless ventricular tachycardia OHCA (median age 62; males 78%) were divided into groups with (36%, 74/204) and without refractory arrest (64%, 130/204). Refractory OHCA patients had longer cardiopulmonary resuscitation (23 versus 15 minutes), more frequently required ≥450 mg amiodarone (34% versus 3.8%), and had cardiogenic shock (80% versus 55%) necessitating higher adrenaline dose (4.0 versus 1.0 mg) and higher rates of mechanical ventilation (92% versus 74%; all P <0.01). Of 167 patients (82%) selected for coronary angiography, 33% (n=55) had refractory OHCA ( P =0.035). Significant coronary artery disease (≥1 major vessel with >70% stenosis) was present in >70% of patients. Refractory OHCA patients frequently had acute coronary occlusion (64% versus 47%), especially left circumflex (20% versus 6.4%) and graft vessel (7.3% versus 0.9%; all P <0.05) compared with those without refractory OHCA. Refractory OHCA group had higher in-hospital mortality (45% versus 30%, P =0.036) and greater new requirement for dialysis (18% versus 6.3%, P =0.011). After adjustment, refractory OHCA was associated with over 2-fold higher odds of in-hospital mortality (odds ratio, 2.28 [95% CI, 1.06-4.89]; P =0.034)., Conclusions: Refractory ventricular fibrillation/pulseless ventricular tachycardia OHCA was associated with more intensive resuscitation, higher rates of acute coronary occlusion, and poorer in-hospital outcomes, underscoring the need for future studies in this extreme-risk subgroup., Competing Interests: Disclosures None.

Background: Patient factors, such as sex and body mass index (BMI), are known to influence patient radiation exposure. Body surface area (BSA) and its association with patient radiation exposure has not been well studied., Methods and Results: We analysed height, weight, BMI and BSA in consecutive patients undergoing cardiac catheterisation and percutaneous coronary intervention (PCI) at a high-volume Australian centre between September 2016 and April 2020 to assess their association with dose-area product (DAP, Gycm 2 ). The mean age of the cohort was 64.5 ± 12.3 years with males comprising 68.8% ( n = 8100, 5124 diagnostic cardiac catheterisation cases and 2976 PCI cases). Median male BMI was 28.4 kg/m 2 [IQR 25.2-32.1] versus 28.8 kg/m 2 [24.7-33.7] for females, p = 0.01. Males had higher BSA (2.0 ± 0.2 m 2 ) than females (1.78 ± 0.2 m 2 ), p = 0.001. Each 0.4 m 2 increase in BSA conferred a 1.32x fold change in DAP (95% CI 1.29-1.36, p ≤ 0.001). Each 5 kg/m 2 increase in BMI was linked to a 1.13x DAP fold change (1.12-1.14, p ≤ 0.001). Male sex conferred a 1.23x DAP fold change (1.20-1.26, p ≤ 0.001). Multivariable modelling with BMI or BSA explained 14% of DAP variance (R 2 0.67 vs. 0.53 for both, p ≤ 0.001)., Conclusions: BSA is an important anthropometric measure between the sexes and a key predictor of radiation dose and radiation exposure beyond sex, BMI, and weight.

This project educated a multidisciplinary team on the techniques of continuous quality improvement, which were then used to analyze the total medication cycle process in order to reduce the total turnaround time for STAT and ASAP orders. Members were trained in the appropriate analytical techniques, developed flow charts of the medication cycle, and developed and conducted a study of the turnaround time for STAT and ASAP orders. Three data collections were obtained: 1) baseline, 2) after flagging orders and medications to help quickly identify both, and 3) after implementation of guidelines for physicians to properly use the terms STAT and ASAP. The interventions seem to have resulted in system improvement based upon an overall decrease in turnaround time (70% for STAT orders, 54% for ASAP orders). The majority of the medication cycle time was on the patient care unit after medication delivery. Problems with the process were identified and recommendations made for future quality improvement teams.

The effects of implementing a bar-code system for issuing medical supplies to nursing units at a university teaching hospital were evaluated. Data on the time required to issue medical supplies to three nursing units at a 480-bed, tertiary-care teaching hospital were collected (1) before the bar-code system was implemented (i.e., when the manual system was in use), (2) one month after implementation, and (3) four months after implementation. At the same times, the accuracy of the central supply perpetual inventory was monitored using 15 selected items. One-way analysis of variance tests were done to determine any significant differences between the bar-code and manual systems. Using the bar-code system took longer than using the manual system because of a significant difference in the time required for order entry into the computer. Multiple-use requirements of the central supply computer system made entering bar-code data a much slower process. There was, however, a significant improvement in the accuracy of the perpetual inventory. Using the bar-code system for issuing medical supplies to the nursing units takes longer than using the manual system. However, the accuracy of the perpetual inventory was significantly improved with the implementation of the bar-code system.

By radar backscattering, observations of the moon have been made which show a systematic difference between the backscattering coefficient of waves polarized in, and perpendicular to, the local plane of incidence. The results arein agreement with a model consisting of a tenuous top layer at least 10 centimeters thick, supported by a denser underlying layer.