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Thomas D Rea

Publications and source records attributed to Thomas D Rea.

At least 37 records · Page 2Linked to original sources
PubMed2004

Incidence of out-of-hospital cardiac arrest.

Estimates of the incidence of out-of-hospital primary cardiac arrest (CA) have typically relied solely upon emergency medical service or death certificate records and have not investigated incidence in clinical subgroups. Overall and temporal patterns of CA incidence were investigated in clinically defined groups using systematic methods to ascertain CA. Estimates of incidence were derived from a population-based case-control study in a large health plan from 1986 to 1994. Subjects were enrollees aged 50 to 79 years who had had CA (n = 1,275). A stratified random sample of enrollees who had not had CA was used to estimate the population at risk with various clinical characteristics (n = 2,323). Poisson's regression was used to estimate incidence overall and for 3-year time periods (1986 to 1988, 1989 to 1991, and 1992 to 1994). The overall CA incidence was 1.89/1,000 subject-years and varied up to 30-fold across clinical subgroups. For example, incidence was 5.98/1,000 subject-years in subjects with any clinically recognized heart disease compared with 0.82/1,000 subject-years in subjects without heart disease. In subgroups with heart disease, incidence was 13.69/1,000 subject-years in subjects with prior myocardial infarction and 21.87/1,000 subject-years in subjects with heart failure. Risk decreased by 20% from the initial to the final time period, with a greater decrease observed in those with (25%) compared with those without (12%) clinical heart disease. Thus, CA incidence varied considerably across clinical groups. The results provide insights regarding absolute and population-attributable risk in clinically defined subgroups, information that may aid strategies aimed at reducing mortality from CA.

Age Factors↗
PubMed2004

Public access defibrillation in out-of-hospital cardiac arrest: a community-based study.

BACKGROUND: The dissemination and use of automated external defibrillators (AEDs) beyond traditional emergency medical services (EMS) into the community has not been fully evaluated. We evaluated the frequency and outcome of non-EMS AED use in a community experience. METHODS AND RESULTS: The investigation was a cohort study of out-of-hospital cardiac arrest cases due to underlying heart disease treated by public access defibrillation (PAD) between January 1, 1999, and December 31, 2002, in Seattle and surrounding King County, Washington. Public access defibrillation was defined as out-of-hospital cardiac arrest treated with AED application by persons outside traditional emergency medical services. The EMS of Seattle and King County developed a voluntary Community Responder AED Program and registry of PAD AEDs. During the 4 years, 475 AEDs were placed in a variety of settings, and more than 4000 persons were trained in cardiopulmonary resuscitation and AED operation. A total of 50 cases of out-of-hospital cardiac arrest were treated by PAD before EMS arrival, which represented 1.33% (50/3754) of all EMS-treated cardiac arrests. The proportion treated by PAD AED increased each year, from 0.82% in 1999 to 1.12% in 2000, 1.41% in 2001, and 2.05% in 2002 (P=0.019, test for trend). Half of the 50 persons treated with PAD survived to hospital discharge, with similar survival for nonmedical settings (45% [14/31]) and out-of-hospital medical settings (58% [11/19]). CONCLUSIONS: PAD was involved in only a small but increasing proportion of out-of-hospital cardiac arrests.

Aged↗
PubMed2004

Time trends in the use of beta-blockers and other pharmacotherapies in older adults with congestive heart failure.

BACKGROUND: Evidence supporting pharmacotherapy of congestive heart failure (CHF) has grown substantially over the past decade and includes large, placebo-controlled trials with mortality end points. We describe beta-blocker and other medication temporal treatment trends of CHF in the Cardiovascular Health Study, a community-based cohort study of 5888 adults > or =65 years of age. METHODS: Prescription medication data were collected from hospital discharge summaries for incident CHF events and at in-study annual clinic visits for prevalent CHF cases from 1989 to 2000. Change in use of agents over time was estimated by using generalized estimating equations while adjusting for potential confounding factors of age, sex, race, and cardiovascular and pulmonary comorbidities. RESULTS: Among 1033 incident CHF events, beta-blocker use after diagnosis increased an average of 2.4 percentage points annually (95% CI, 1.5 to 3.4 points) from 1989 to 2000. The increasing trend was consistent throughout follow-up. Among participants with coronary disease and/or hypertension and among those with low ejection fractions (<45%), beta-blocker use remained flat from 1989 to 1994 and increased 4.7 points annually (2.5 to 6.9) and 10.0 points annually (6.1 to 13.8), respectively, from 1995 to 2000. Among participants without coronary disease or hypertension, there was no overall increase in use. Use of renin-angiotensin system inhibitors increased 2.3 points annually (1.0 to 3.5), digoxin use decreased 2.4 points annually (-3.6 to -1.1), and loop diuretic use remained flat between 1989 and 2000. In general, treatment trends were similar for prevalent CHF. CONCLUSIONS: Treatment of CHF has changed gradually in the 1990s and may in part reflect the influence of CHF clinical trial evidence.

Adrenergic beta-Antagonists↗
PubMed2004

Incidence of EMS-treated out-of-hospital cardiac arrest in the United States.

BACKGROUND: The potential impact of efforts to improve the chain of survival for out-of-hospital sudden cardiac arrest (SCA) is unclear in part because estimates of the incidence of treatable cases of SCA are uncertain. The aim of the investigation was to determine a representative national incidence of emergency medical services (EMS)-treated all-rhythm and ventricular fibrillation (VF) SCA as well as survival. METHODS: We used Medline to identify peer-reviewed articles published between 1 January 1980 and 31 March 2003 that reported a US community's EMS SCA experience. Inclusion criteria required the study to include at least 25 cases, report the total number of all-rhythm and/or ventricular fibrillation arrests, and provide information about population size and study duration. Incidence was computed by dividing the total number of SCA events by the product of the community's population and the study duration. RESULTS: Reports from 35 communities met the inclusion criteria. A total of 35,801 all-rhythm EMS-treated cardiac arrests occurred during 62.11 million person-years of observation resulting in an overall incidence of 54.99 per 100,000 person-years. The incidence of ventricular fibrillation-rhythm SCA was 21.32 per 100,000 person-years. Sensitivity analyses generally produced similar results. Applying these results to the US population, 155,000 persons would experience EMS-treated all-rhythm SCA and 60,000 persons would experience EMS-treated ventricular fibrillation-rhythm SCA annually in the US. Survival was 8.4% for all-rhythm and 17.7% for ventricular fibrillation SCA. CONCLUSION: The results provide a framework to assess opportunities and limitations of EMS care with regard to the public health burden of SCA.

Emergency Medical Services↗
PubMed2004

Quality of life and prognosis among survivors of out-of-hospital cardiac arrest.

PURPOSE OF REVIEW: We reviewed the topic of quality of life and prognosis of out-of-hospital cardiac arrest survivors, focusing on more recent developments. RECENT FINDINGS: In 2003 to 2004, published experiences from Canada, the United States, and Europe indicate that the quality of life among out-of-hospital cardiac arrest survivors is acceptable and that prognosis may be improving over time. However, a minority of survivors has substantial neurologic impairment that adversely affects the quality of life and prognosis. Recent investigations indicate that bystander CPR, early defibrillation by nontraditional first responders, and active induction of hypothermia offer potential means to improve functional outcomes that may translate into better quality of life and prognosis. Acute treatment of the underlying etiology and effective secondary prevention also can benefit the out-of-hospital cardiac arrest survivor, although only a portion who could benefit appear to receive these therapies. SUMMARY: The optimal strategy for improving long-term outcomes requires a multifaceted, integrative approach that begins with prehospital care and extends to secondary prevention.

Cardiopulmonary Resuscitation↗
PubMed2004

Out-of-hospital care of critical drug overdoses involving cardiac arrest.

OBJECTIVES: Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). METHODS: The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000. RESULTS: Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support. CONCLUSIONS: In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease.

Adult↗
PubMed2003

Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest.

BACKGROUND: During the past quarter century, advances in treatment of cardiovascular disease have occurred that might potentially benefit survivors of sudden cardiac arrest (SCA). Little is known, however, about the temporal patterns in long-term survival among persons resuscitated from SCA. We hypothesized that long-term survival would improve over time and that this temporal pattern would be most evident for cardiac causes of death. METHODS AND RESULTS: The investigation was a retrospective cohort study of survival among persons who were discharged alive from the hospital after resuscitation from out-of-hospital SCA due to heart disease in King County, Wash, between May 1, 1976, and December 31, 2001 (n=2035). Calendar time was divided into four 5-year intervals: 1976 to 1980, 1981 to 1985, 1986 to 1990, and 1991 to 1995, and one 6-year interval, 1996 to 2001. Age-adjusted survival curves were constructed, and Cox proportional-hazards regression was used to compute hazard ratios (HRs) for the association between mortality and time period. During 11 201 person-years of follow-up, 1334 persons died. Compared with the initial time period, the HR for total mortality was 0.86 (95% confidence interval, 0.73 to 1.01) for 1981 to 1985, 0.82 (0.69 to 0.96) for 1986 to 1990, 0.66 (0.55 to 0.79) for 1991 to 1995, and 0.58 (0.47 to 0.71) for 1996 to 2001 (HR for trend=0.87 [0.84 to 0.91] for each successive time period). In analyses that assessed cardiac mortality, an even stronger temporal association was evident (HR for trend=0.79 [0.75 to 0.84]). CONCLUSIONS: Long-term survival after resuscitation from SCA improved steadily over time in this cohort. To continue this trend, future studies should identify circumstances in which proven treatments are underutilized as well as investigate new therapies that might benefit survivors of SCA.

Cardiopulmonary Resuscitation↗
PubMed2003

Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective.

BACKGROUND: Little is known about temporal trends in survival and prognostic characteristics of patients with out-of-hospital cardiac arrest treated by emergency medical services (EMS). We hypothesized that an evolving combination of beneficial and adverse factors may contribute to temporal patterns of survival. METHODS AND RESULTS: We evaluated a population-based cohort of EMS-treated adult patients with cardiac arrest (n=12 591) from 1977 to 2001 in King County, Washington. Time was grouped into an initial 5-year period and 5 successive 4-year periods. We sought to determine the potential impact of temporal changes in prognostic factors typically beyond EMS control termed "fate" factors (for example, patient age) and factors implemented by EMS termed "program" factors (programs of dispatcher-assisted cardiopulmonary resuscitation and basic life support defibrillation). Several characteristics associated with survival changed over time. Observed survival did not change over time among all patients with cardiac arrest (OR=0.98 [0.95, 1.01], trend for each successive time period) and improved over time among patients with witnessed ventricular fibrillation (OR=1.05 [1.01, 1.09]). In models that included all patients with cardiac arrest and controlled for fate factors, advancing time period was associated with an increase in survival (OR=1.08 [1.05, 1.11]). Conversely, in models that controlled for program factors, advancing time period was associated with a decrease in survival (OR=0.95 [0.93, 0.98]). Results were similar among patients with witnessed ventricular fibrillation. CONCLUSIONS: The static temporal pattern of survival from cardiac arrest appeared to result from an evolving balance of prognostic factors. Programs implemented by EMS appeared to counter adverse temporal trends in prognostic factors typically beyond EMS control.

Acute Disease↗
PubMed2003

Factors impeding dispatcher-assisted telephone cardiopulmonary resuscitation.

STUDY OBJECTIVE: Dispatcher-assisted telephone cardiopulmonary resuscitation (CPR) instruction can increase the proportion of sudden cardiac arrest victims who receive bystander CPR and has been associated with improved survival. Most sudden cardiac arrest victims, however, do not receive bystander CPR. The study objective was to examine factors that may impede implementation of telephone CPR. METHODS: We reviewed dispatcher audio recordings and emergency medical services reports for 404 cases of sudden cardiac arrest that occurred from July 1, 2000, to June 30, 2002, in the study county to assess the phase (1, instructions not offered; 2, instructions offered but declined; or 3, instructions offered and accepted but CPR not implemented) and specific factors within each phase that potentially impede telephone CPR. RESULTS: Twenty-five percent (99/404) of victims received bystander CPR without dispatch assistance, 34% (139/404) received telephone CPR, and 41% (166/404) did not receive bystander CPR. Each phase of telephone CPR process impeded the implementation of CPR: (1) instructions not offered in 48% (80/166); (2) instructions offered but declined in 31% (52/166); and (3) instructions offered and accepted but CPR not implemented in 21% (34/166). During the first phase, telephone CPR was potentially impeded most frequently because the victim was reported to have signs of life (51/80, 64%); during the second and third phases, telephone CPR was most often impeded because of bystander physical limitation (32/86, 37%). Emotional distress, disease transmission, disagreeable victim characteristics, or medicolegal concerns uncommonly impeded telephone CPR (10/86, 12%). CONCLUSION: Factors potentially impeding telephone CPR can be identified. Although many are logistically challenging, some may be addressable and hence provide opportunities to strengthen the chain of survival.

Aged↗
PubMed2003

Defibrillation waveform and post-shock rhythm in out-of-hospital ventricular fibrillation cardiac arrest.

BACKGROUND: The importance of the defibrillation waveform on the evolving post-shock cardiac rhythm is uncertain. The primary objective of this study was to evaluate cardiac rhythms following the first defibrillation shock, comparing biphasic truncated exponential (BTE), monophasic damped sinusoidal (MDS), and monophasic truncated exponential (MTE) waveforms in patients experiencing out-of-hospital ventricular fibrillation cardiac arrest (OHCA). METHODS: We reviewed the automated external defibrillator (AED) and emergency medical services (EMS) records of 366 patients who suffered OHCA and were treated with defibrillation shocks by first-tier emergency responders between 1 January 1999 and 31 August 2002 in King County, Washington. The post first shock rhythms were determined at 5, 10, 20, 30, and 60 s and compared according to defibrillation waveform. RESULTS: The MDS and BTE waveforms were associated with significantly higher frequency of defibrillation than the MTE waveform, though only the BTE association persisted to 30 and 60 s. No difference in defibrillation rates was detected between MDS and BTE waveforms. By 60 s, an organized rhythm was present in a greater proportion for BTE (40.0%) compared with MDS (25.4%, P=0.01) or MTE (26.5%, P=0.07). CONCLUSION: In this retrospective cohort investigation, MDS and BTE waveforms had higher first shock defibrillation rates than the MTE waveform, while patients treated with the BTE waveform were more likely to develop an organized rhythm within 60 s of the initial shock. The results of this investigation, however, do not provide evidence that these surrogate advantages are important for improving survival. Additional investigation is needed to improve the understanding of the role of waveform and its potential interaction with other clinical factors in order to optimize survival in OHCA.

Aged↗
PubMed2003

Digoxin therapy and the risk of primary cardiac arrest in patients with congestive heart failure: effect of mild-moderate renal impairment.

BACKGROUND AND OBJECTIVE: The cardiac safety of digoxin therapy for congestive heart failure (CHF) is a source of concern, especially among those with renal impairment. METHODS: Using a case-control design, we examined the risk of primary cardiac arrest (PCA) associated with digoxin therapy within three levels of renal function. RESULTS: After adjustment for other clinical characteristics, digoxin therapy for CHF was not associated with an increased risk of PCA [odds ratio (OR)=0.97, 95% confidence interval (CI) 0.59-1.62] among patients with normal renal function (serum creatinine </=1.1 mg/dL). In contrast, digoxin therapy was associated with a modest increase in risk (OR=1.58, CI 0.89-2.80) among patients with mild renal impairment (serum creatinine=1.2-1.4 mg/dL); and a twofold increase in risk (OR=2.39, CI 1.37-4.18) among patients with moderate renal impairment (serum creatinine=1.5-3.5 mg/dL). CONCLUSIONS: These findings suggest that the risks of digoxin may offset the benefits among patients with moderately impaired renal function, but not among patients with normal renal function.

Aged↗
PubMed2003

Emergency medical services and mortality from heart disease: a community study.

STUDY OBJECTIVES: Little is known regarding the potential effects of emergency medical services (EMS) on total heart disease mortality. Although EMS may provide health benefits in less acute cardiac conditions, its immediate, measurable, and direct effect on heart disease mortality is through resuscitation of persons suffering out-of-hospital cardiac arrest. The purpose of this study was to examine the involvement and potential mortality benefit of out-of-hospital EMS care of cardiac arrest on community heart disease mortality. METHODS: The investigation was an observational study of all persons with death events resulting from heart disease as defined by heart disease deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in a single county from January 1, 2000, through December 31, 2000. The county of study has a population of nearly 2 million people and is composed of urban, suburban, and rural components. State vital records and EMS reports were used to ascertain deaths resulting from heart disease and deaths averted. RESULTS: In the year 2000, 3,577 persons died as a result of heart disease, and 128 persons were successfully resuscitated and discharged from the hospital, for a total of 3,705 death events. EMS responded to 39% (1,428/3,705) of all heart disease death events and 57% (1,428/2,516) of out-of-hospital events, resulting in a 3.5% (128/3,705) reduction in overall heart disease mortality and a 5.1% (128/2,516) reduction in out-of-hospital mortality. CONCLUSION: EMS was involved in the majority of out-of-hospital heart disease death events, resulting in a measurable reduction in heart disease mortality.

Aged↗
PubMed2003

Hormone replacement therapy and the risk of incident congestive heart failure: the Cardiovascular Health Study.

BACKGROUND: The development of congestive heart failure (CHF) in older persons is related to a variety of mechanisms. Hormone replacement therapy (HRT) affects several of the pathways that may be important in the development of CHF. We hypothesized that HRT would be associated with a decreased risk of incident CHF. METHODS: Using Cox proportional-hazards regression, we assessed the risk of incident CHF (n = 304) associated with time-dependent past and current use of HRT compared to never use. The Cardiovascular Health Study is a prospective cohort study of community-dwelling adults aged 65 years and older. This analysis included female participants without a history of CHF at baseline (n = 3223). RESULTS: At baseline, 62% were never users, 26% were past users, and 12% were current users of HRT. Compared with never users, the multivariable relative risk (RR) of CHF was 1.01 (95% confidence interval [95% CI] 0.76,1.34) for past users and 1.34 (0.93,1.94) for current users. Results were similar among most treatment and clinical subgroups, except that the association of current HRT with CHF appeared to depend on body mass index (BMI) or osteoporosis status. The RR was 0.82 (0.43,1.60) for normal weight women, 1.65 (0.95,2.88) for overweight women, and 2.22 (1.06,4.67) for obese women (p = 0.01 for interaction). Similarly, the RR was 0.15 (0.04,0.65) for women with osteoporosis and 1.82 (1.25,2.65) for women without osteoporosis (p = 0.001 for interaction). CONCLUSIONS: Overall, HRT was not associated with the risk of incident CHF, although BMI and osteoporosis appeared to modify the association of HRT with CHF. The risk of CHF was lower in patients with lower BMI or osteoporosis.

Aged↗
PubMed2002

Genetic variants of coagulation factor XIII, postmenopausal estrogen therapy, and risk of nonfatal myocardial infarction.

We hypothesized that possession of either of 2 functional coagulation factor XIII polymorphisms, one within subunit A (Val34Leu) and one within subunit B (His95Arg), might modulate the prothrombotic effects of estrogen and help to explain the variation in incidence of arterial thrombotic events among postmenopausal women using hormone replacement therapy. In a population-based case-control study of 955 postmenopausal women, we assessed the associations of factor XIII genotypes and their interactions with estrogen therapy on risk of nonfatal myocardial infarction (MI). The presence of the factor XIIIA Leu34 allele was associated with a reduced risk of MI (odds ratio [OR] = 0.70, 95% confidence interval [95% CI] = 0.51-0.95). The presence of the factor XIIIB Arg95 allele had little association with MI risk. Neither factor XIII polymorphism alone significantly modified the association between the risk of MI and current estrogen use. In exploratory analyses, however, there was a significant factor XIII subunit gene-gene interaction. Compared to women homozygous for both common factor XIII alleles, the Arg95 variant was associated with a reduced risk of MI in the presence of the Leu34 variant (OR = 0.36, 95% CI = 0.17-0.75) but not in the absence of the Leu34 variant (OR = 1.11, 95% CI = 0.69-1.79). Moreover, among women who had at least 2 copies of the variant factor XIII alleles and were current estrogen users, the risk of MI was reduced by 70% relative to estrogen nonusers with fewer than 2 factor XIII variant alleles (P value for interaction =.03). If confirmed, these findings may permit a better assessment of the cardiovascular risks and benefits associated with postmenopausal estrogen therapy.

Adult↗
PubMed2002

Smoking status and risk for recurrent coronary events after myocardial infarction.

BACKGROUND: Questions remain about the importance of smoking and smoking cessation after incident myocardial infarction. OBJECTIVE: To assess the association between smoking status and risk for recurrent coronary events. DESIGN: Retrospective, population-based, inception cohort study. SETTING: Health maintenance organization from 1986 to 1996. PATIENTS: 2619 persons who survived to hospital discharge after a first myocardial infarction. MEASUREMENTS: Relative risk (RR), assessed by using Cox proportional hazards regression analysis, for recurrent coronary events in nonsmokers (persons with no history of smoking), former smokers (persons who had stopped smoking before infarction), quitters (persons who stopped smoking after infarction), and active smokers (persons who continued smoking after infarction). RESULTS: At the time of incident infarction, 33.6% of patients were nonsmokers, 35.5% were former smokers, and 30.9% were active smokers. Of the 808 persons who were active smokers at the time of incident infarction, 449 quit smoking during hospitalization or after discharge. With nonsmokers as the reference group, the multivariable RR for recurrent coronary events (n = 433) was 1.17 (95% CI, 0.93 to 1.43) for former smokers and 1.51 (CI, 1.10 to 2.07) for active smokers. Among quitters, the RR decreased as duration of cessation increased: With nonsmokers as the reference group, the RR for quitters was 1.62 (CI, 1.02 to 2.61) if the duration of cessation was 0 to less than 6 months, 1.60 (CI, 0.97 to 2.60) if the duration was 6 to less than 18 months, 1.48 (CI, 0.76 to 2.51) if the duration was 18 to less than 36 months, and 1.02 (CI, 0.54 to 1.86) if the duration was 36 months or more (P = 0.01 for trend). CONCLUSION: After incident myocardial infarction, smoking was associated with an elevated risk for recurrent coronary events. In persons who quit smoking after infarction, the risk declined to equal that of nonsmokers by 3 years after cessation.

Adult↗
PubMed2002

A systematic study of Epstein-Barr virus serologic assays following acute infection.

We determined the presence of IgG and IgM antibody to viral capsid antigen (VCA-IgG, VCA-IgM) and IgG antibody to the Epstein-Barr virus nuclear antigen (EBNA) by indirect immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA) during the acute illness and at 1, 2, 6, and 48 months in a prospective population-based case series of 95 persons with an acute illness serologically confirmed as Epstein-Barr virus infection. The acute illness was characterized by the presence of VCA-IgG and VCA-IgM (by ELISA) and by the absence of EBNA in most, but not all, patients. During follow-up, VCA-IgG antibodies remained detectable in all patients, while the proportion with VCA-IgM declined and the number with detectable EBNA antibodies steadily increased. The primary differences between the 2 serologic test methods were the increased persistence of VCA-IgM during follow-up by ELISA and the earlier detection of EBNA by IFA. Clinicians should consider the illness stage and the laboratory technique to appropriately interpret serologic test results in suspected cases of mononucleosis caused by the Epstein-Barr virus.

Adolescent↗
PubMedDate not supplied

Prevalence of automated external defibrillators at cardiac arrest high-risk sites.

OBJECTIVE: Automated external defibrillators (AEDs) distributed throughout communities may improve survival from cardiac arrest. The purpose of this study was to determine if AEDs were present at high-risk locations for cardiac arrest in King County, Washington. METHODS: The authors compiled a list of sites based on a five-year study that identified public sites with the highest incidence of cardiac arrests in King County. They conducted a structured telephone survey with the manager, director, or owner of those high-risk sites. RESULTS: Of the 263 identified high-risk cardiac arrest sites, we obtained information for 228 (87%) sites. Overall, 87 of 228 (38%) high-risk sites had one or more AEDs. The AED dissemination varied greatly by type of site. The airport, the two county jails, the five public sports venues, and the nine ferries/train terminals each reported at least one AED on site. In contrast, none of the 13 shelters and 19% of health clubs/gyms reported an AED on site. Nearly half (44%) of sites without AEDs cited cost as a factor preventing them from purchasing AEDs in the future. CONCLUSION: Although AEDs have diffused into high-risk sites in this community, the diffusion appears to vary by the type of site.

Electric Countershock↗