Impact of a teaching attending physician on medical student, resident, and faculty perceptions and satisfaction.

Objectives: To determine if a dedicated teaching attending for medical student education improves medical student, attending physician, and resident perceptions and satisfaction.

Methods: Two dedicated teaching attending physician shifts were added to the clinical schedule each week. A before-after trial compared medical student evaluations from 2000 to 2004 (preteaching attending physician) to medical student evaluations from 2005 to 2006 (teaching attending physician).

Optimizing primary PCI beyond "door to intervention time"--are we there yet?

Aim: To assess the effects of shortened door-to-intervention (DTI) time on appropriate clinical decisions regarding the four most critical and costly decisions during primary percutaneous coronary intervention (PCI): cath-lab activation (CLA), use of glycoprotein IIb/IIIa inhibitors (GPI), use of PCI, and deployment of drug-eluting stent (DES).

Background: STEMI PCI patients are frequently subject to decision making based on abbreviated medical encounter and limited medical information.

Methods: Clinical data were prospectively collected in a STEMI registry over 19 months.

Right coronary artery anatomical variants: where and how?

Background: Ectopic origin of the right coronary artery (RCA) occurs in approximately 1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization.

Length of hospital stay after percutaneous coronary interventions.

Introduction And Aim: Post-percutaneous coronary intervention (PCI) length of hospital stay (LOHS) is one of the key modifiers of hospital cost and quality assessment. Commencing 2000, the cardiovascular services at our institution engaged in a continuous quality improvement program to reduce post-PCI LOHS.

Methods: All PCI patients were screened for potential early discharge.

The disconfirmation paradigm: throughput times and emergency department patient satisfaction.

This study examined the relationship between throughput times, expectations, and patient satisfaction using the Disconfirmation Paradigm (DP), which proposes that dissatisfaction arises when service expectations are not met. Before discharge or admission, adult emergency department (ED) patients estimated how long they waited for three intervals (Perceived Times): triage to patient care area, patient care area placement to physician evaluation, and physician evaluation to disposition. Acceptable waiting times and satisfaction for the same intervals were then provided by the subject (Acceptable Times and Throughput Time Satisfaction, respectively).

Application of the Continuous Glucose Monitoring System (CGMS) in the 72-hour fast test in two patients with hypoglycemia.

Objective: Hypoglycemia occurs in several pathologic states, and the supervised 72-h fast is the classic diagnostic test for hypoglycemia caused by insulinoma. The Continuous Glucose Monitoring System (CGMS), Medtronic MiniMed, Northridge, CA) is an appropriate method to detect asymptomatic hypoglycemia episodes in diabetes mellitus patients. In the present study, we use the CGMS to monitor glucose dynamics during a 72-h fast.

Chyloperitoneum: CT diagnosis.

We describe a patient with ovarian cancer in whom computed tomography revealed a fat-fluid level within ascites, indicating chyloperitoneum. The significance of this finding is discussed, and a mechanism underlying the unusual radiological appearance is suggested.

Coronary vein diameter and flow direction in patients with portal hypertension: evaluation with duplex sonography and correlation with variceal bleeding.

Objective: The purpose of this study was to compare the diameter of the coronary vein and the direction of flow within it between patients with portal hypertension and control subjects.

Subjects And Methods: We used pulsed Doppler sonography to measure the diameter of the coronary vein and to determine the direction of flow within it in 50 control subjects and 50 patients with portal hypertension. The sonographic findings were correlated with the presence of esophageal varices seen at endoscopy and with history of variceal hemorrhage.