Validation of a rule for termination of resuscitation in out-of-hospital cardiac arrest.

Background: We prospectively evaluated a clinical prediction rule to be used by emergency medical technicians (EMTs) trained in the use of an automated external defibrillator for the termination of basic life support resuscitative efforts during out-of-hospital cardiac arrest. The rule recommends termination when there is no return of spontaneous circulation, no shocks are administered, and the arrest is not witnessed by emergency medical-services personnel. Otherwise, the rule recommends transportation to the hospital, in accordance with routine practice.

Ischemic scleroderma wounds successfully treated with hyperbaric oxygen therapy.

Hyperbaric oxygen therapy (HBOT) has been used to treat refractory wounds for the last several decades, with the majority of research focusing on wounds secondary to arterial insufficiency. We describe 2 patients with scleroderma with intractable bilateral extremity ulcers. Local ischemia was identified using transcutaneous oximetry.

Randomized treatment trial in mild traumatic brain injury.

Objective: To determine whether multidisciplinary treatment of mild traumatic brain injury (MTBI) improves neurobehavioral outcome at 6 months postinjury.

Methods: Subjects with MTBI were randomly assigned to treatment (n=97) or nontreatment (control, n=94) groups. Treated patients were assessed within 1 week of injury and thereafter managed by a multidisciplinary team according to clinical need for a further 6 months.

Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial.

The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652-Digital vs.

Quality control for digital mammography in the ACRIN DMIST trial: part I.

The Digital Mammography Imaging Screening Trial, conducted by the American College of Radiology Imaging Network, is a clinical trial designed to compare the accuracy of full-field digital mammography (FFDM) versus screen-film mammography in a screening population. Five FFDM systems from four manufacturers (Fischer, Fuji, General Electric, and Lorad) were employed in the study at 35 clinical sites. A core physics team devised and implemented tests to evaluate these systems.

The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer.

One of the most important factors associated with local recurrence after lumpectomy in breast cancer patients is the status of the surgical margin. Standard surgical practice is to obtain clear margins even if this requires a second surgical procedure. It is assumed that reexcision to achieve clear margins when positive margins are present at initial excision is as effective as complete tumor removal at a single procedure; however, the efficacy of reexcision in this context has not been well studied.

A gender-focused perspective on health service utilization in comorbid bipolar I disorder and alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions.

Objectives: This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data.

Method: The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version.

Administrative data accurately identified intensive care unit admissions in Ontario.

Background And Objectives: To evaluate the accuracy of Ontario administrative health data for identifying intensive care unit (ICU) patients.

Materials And Methods: Records from the Critical Care Research Network patient registry (CCR-Net) were linked to the Ontario Health Insurance Program (OHIP) database and the Canadian Institute for Health Information (CIHI) database. The CCR-Net was considered the criterion standard for assessing the accuracy of different OHIP or CIHI codes for identifying ICU admission.

Is blood superior to crystalloid cardioplegia? A meta-analysis of randomized clinical trials.

Background: Many small, randomized, controlled trials have evaluated the effectiveness of blood as compared with crystalloid cardioplegia for myocardial protection during cardiac surgery. Blood cardioplegia provides a closer approximation to normal physiology, which may translate into measurable clinical benefits. This meta-analysis describes the effectiveness of blood cardioplegia in lowering adverse postoperative outcomes.

Development of measures of the quality of emergency department care for children using a structured panel process.

Background: Performance measures are essential components of public reporting and quality improvement. To date, few such measures exist to provide a comprehensive assessment of the quality of emergency department services for children.

Objectives: Our goal was to use a systematic process to develop measures of emergency department care for children (0-19 years) that are (1) based on research evidence and expert opinion, (2) representative of a range of conditions treated in most emergency departments, (3) related to links between processes and outcomes, and (4) feasible to measure.

High-resolution imaging of the intracranial arterial and venous systems following a single contrast injection.

Purpose: To generate two separate three-dimensional (3D) high spatial resolution images of the intracranial arterial and venous systems using a single contrast injection.

Materials And Methods: A 3D contrast-enhanced (CE) magnetic resonance angiography (MRA) acquisition was modified to create two separate k-space data sets to encode the arterial and venous enhancement signals individually after contrast agent injection. Following an automated detection of contrast arrival, the central k-space views corresponding to the arterial phase were acquired for the first eight seconds.

Onychomycosis therapies: strategies to improve efficacy.

The combination of relatively high treatment failure rates and infection relapse rates warrants consideration of ways in which antifungal therapy can be delivered so that efficacy rates can be improved. These involve the combination of available therapies and/or a modification of treatment regimens.

Therapies for onychomycosis: a review.

Onychomycosis, a chronic fungal infection of the nail, can be treated using various modalities. Surgical, chemical, topical, and oral methods are reviewed in this article, with an emphasis on the three systemic treatments approved by the US Food and Drug Administration: terbinafine, itraconazole, and griseofulvin.

Diagnosing onychomycosis.

Onychomycosis is the most prevalent nail disease, representing nearly half of all clinically diagnosed onychopathies. Given the pervasive nature of the disease and that successful treatment depends on the proper identification of the causative organism,accurate and reliable methods of diagnosis are necessary. This article discusses the efficacy of the various methods used for the diagnosis of onychomycosis.

The use of intravitreal corticosteroids, evidence-based and otherwise.

Purpose Of Review: To provide a current update on the use of intravitreal corticosteroids as a treatment for a variety of retinal diseases.

Recent Findings: Pharmacokinetic studies demonstrate that a single 4 mg injection of intravitreal triamcinolone acetonide is present in the vitreous for up to 3 months. Many recent studies demonstrate a significant reduction in macular edema often with a significant improvement in vision for up to several months followed by a waning of treatment effect and recurrence of macular edema.

Preoperative function and gender predict pattern of functional recovery after hip and knee arthroplasty.

Gender, preoperative function, and other variables were explored as predictors of recovery after total hip and knee arthroplasty. One hundred fifty-two subjects (63.8 +/- 10.

Cyclooxygenase-2 (COX-2) immunostaining does not correlate with the degree of vulvar neoplasia.

Objective: The cyclooxygenase-2 (COX-2) enzyme is up-regulated in inflammatory and neoplastic conditions. In the last decade, its biological role has been investigated in various pre-invasive and invasive cancers with the hope that it can serve as a target for cancer prevention and treatment.

Methods: We evaluated the expression of COX-2 in vulvar biopsies to determine its relationship to the degree of dysplasia.

Stability of the metastatic spine pre and post vertebroplasty.

Objective: Vertebrae with lytic metastases have an elevated risk of burst fracture and resultant neurologic compromise. Prophylactic vertebroplasty has the potential to reduce pain and the risk of burst fracture in the metastatic spine. The purpose of this study was to quantify the ability of vertebroplasty to stabilize metastatically involved vertebrae against the risk of burst fracture initiation with a standardized model of vertebral metastases.

Rheumatoid arthritis-associated inflammatory leg ulcers: a new treatment for recalcitrant wounds.

Patients with rheumatoid arthritis may develop leg ulcers of varied aetiologies, including venous disease, infection and inflammation (vasculitis or pyoderma gangrenosum). The leg ulcers in rheumatoid arthritis patients may involve several of these aetiological factors and are often difficult to heal. Both the ulcers and the treatments are often painful, and these ulcers may be present for years.

Peritoneal dialysis: a clinical update congestive heart failure and PD.

Background: There is a belief that peritoneal dialysis may be an important treatment modality for refractory heart failure, allowing at least an improvement in quality if not quantity of life during the last stage of this debilitating chronic disease. This paper examines the rationale behind this modality, critically appraises the available literature, calls for more research in the area and puts forward a framework for considering peritoneal dialysis in refractory heart failure.

Conclusion: When faced with a patient with refractory heart failure admitted to hospital on multiple occasions because of complications of volume overload, the following approach to initiating peritoneal dialysis should be considered: subjects for dialysis must have a minimal blood pressure, and those whose hemodynamic status improves with diuresis, even though they develop a pre-renal picture, may be the best candidates.

Percutaneous vertebroplasty in patients with intractable pain from osteoporotic or metastatic fractures: A prospective study using quality-of-life assessment.

Purpose: Percutaneous vertebroplasty (PVP) is a minimally invasive outpatient procedure whereby vertebral compression fractures are stabilized by the injection of bone cement, or polymethyl methacrylate (PMMA). Rapid partial or complete pain relief can usually be achieved through this procedure. We prospectively evaluate the efficacy of PVP in the relief of pain and improvement in quality of life of patients with intractable pain from osteoporotic and metastatic fractures.