PubMed · 7404540
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K Rasmussen. 1980-05-20. [Pacemaker-decentralisation?].. https://pubmed.ncbi.nlm.nih.gov/7404540/
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Thrombolytic therapy reduces mortality in patients with acute myocardial infarction. Early treatment is crucial and any system which reduces 'door-to-needle' time without placing the patient at risk is to be encouraged. A group of 20 patients with suspected heart attack was assessed by coronary care nurses and preregistration house officers with regard to: time of symptom onset; admission 12 lead electrocardiogram, presence of contraindications to thrombolytic therapy. Nurses and house officers were asked to state whether or not they considered thrombolysis indicated, and if so, which agent they would recommend on an 'intention to treat' basis. Participating staff were given the option of referral for senior medical opinion. There was no difference in nurses' and house officers' stated intentions regarding thrombolytic therapy. A group of 46 patients was assessed by nurses alone on an 'intention to treat' basis; in this latter group nurses' management intentions were identical to those of the responsible doctor prescribing treatment. Appropriately trained nurses can assess patients with suspected heart attack accurately and safely for thrombolytic therapy. In practice, this could reduce delays to thrombolysis and merits further scrutiny.
OBJECTIVE: This study was to determine whether different digital display formats for portable chest radiographs of coronary care unit patients would provide comparable information for clinical care. In particular, we tried to ascertain whether 1024 x 1024 pixel (1K) images on a picture archiving and communication system (PACS) workstation would be comparable to 1760 x 2140 pixel (2K) images on workstations or to digital films. If comparability could be proved, we hypothesized that 1K workstations could considerably lower equipment and film costs and facilitate image transmission from point to point. MATERIALS AND METHODS: Four chest radiologists read a panel of chest studies assembled from 98 coronary care unit patients, comparing 1K and 2K soft-copy images with digital hard copies. For all three image types for the 98 patients, the readers evaluated nine image parameters that the cardiologists deemed essential for clinical decision making. Two other chest radiologists reviewed each patient's three image types, historical chest images, current and prior radiologic reports, and medical record to determine the consensus, or "truth findings." RESULTS: With one exception (small pleural effusions), the receiver operating characteristic analysis showed no significant differences in the clinical information derived from the three image types. CONCLUSION: For clinical management in a coronary care unit, comparable information can be obtained from digital radiologic chest studies using a 1K x 1K soft-copy format, a 2K x 2K soft-copy format, or a hard copy (film). Substantial savings in cost and time are therefore possible by using soft-copy images and lower resolution (1K x 1K) workstations and, when necessary, by transmitting images on regular telephone lines.
The purpose of this study was to determine the use of ultrasonic tissue characterization (UTC) for the diagnosis of acute myocardial infarction (AMI). Real-time UTC and conventional 2-dimensional echocardiography were performed with a research prototype and commercially available ultrasonoscope, respectively, in 60 consecutive patients with suspected AMI. Diagnosis of AMI was documented by the presence of 2 of the 3 following clinical criteria: (1) typical history, (2) characteristic electrocardiographic changes, and (3) an increase in creatine phosphokinase-MB. Myocardial infarction was present in 24 of 60 patients and absent in 36 of 60 patients. Tissue characterization correctly diagnosed the presence of myocardial infarction in 22 of 24 patients and the absence in 33 of 36 patients. Two-dimensional echocardiography detected the presence of myocardial infarction in 21 of 24 patients and the absence in 34 of 36 patients. UTC had 2 false-negative and 3 false-positive studies, all in the region of apical infarcts. Two-dimensional echocardiography had 3 false-negative studies in patients with non-Q-wave myocardial infarction and 2 false-positive studies in patients with complete left bundle branch block. Both techniques had a comparable sensitivity, specificity, and accuracy.