The Effect of Direct Communication between Emergency Physicians and Interventional Cardiologists on Door to Balloon Times in STEMI

We developed an institutional protocol mandating emergency physicians to contact the interventional cardiologist directly in all cases of ST-segment elevation myocardial infarction (STEMI) and hypothesized that this would reduce door-to-balloon-times (DTBT). From January 2004 to July 2006, 208 patients with STEMI were treated with primary percutaneous coronary intervention (PCI). A total of 144 patients were treated before implementing the new protocol ("before") and 64 patients were treated after the implementation ("after"). The DTBT was significantly reduced from 148±101 min to 108±56 min (p<0.05). While only 25% of the "before" patients received PCI within 90 min after arrival, 50% of the "after" patients received PCI within 90 min (p<0.05). There were no significant differences between two groups in other outcomes (postprocedural TIMI flow, mortality, subsequent stroke, heart failure, shock, reinfarction, length of stay in intensive care unit, and the total hospital length of stay). In conclusion, mandating emergency physicians to directly notify interventional cardiologists of all STEMI patients reduces DTBT

The willingness of final year medical and dental students to perform bystander cardiopulmonary resuscitation in an Asian community

Background Despite the importance of early effective chest compressions to improve the chance of survival of an out-of-hospital cardiac arrest victim, it is still largely unknown how willing our Malaysian population is to perform bystander cardiopulmonary resuscitation (CPR). Aims We conducted a voluntary, anonymous self-administered questionnaire survey of a group of 164 final year medical students and 60 final year dental students to unravel their attitudes towards performing bystander CPR. Methods Using a 4-point Likert scale of “definitely yes,” “probably yes,” “probably no,” and “definitely no,” the students were asked to rate their willingness to perform bystander CPR under three categories: chest compressions with mouth-to-mouth ventilation (CC + MMV), chest compressions with mask-to-mouth ventilation (CC + PMV), and chest compressions only (CC). Under each category, the students were given ten hypothetical victim scenarios. Categorical data analysis was done using the McNemar test, chi-square test, and Fisher exact test where appropriate. For selected analysis, “definitely yes” and “probably yes” were recoded as a “positive response.” Results Generally, we found that only 51.4% of the medical and 45.5% of the dental students are willing to perform bystander CPR. When analyzed under different hypothetical scenarios, we found that, except for the scenario where the victim is their own family member, all other scenarios showed a dismally low rate of positive responses in the category of CC + MMV, but their willingness was significantly improved under the CC + PMV and CC categories. Conclusion This study shows that there are unique sociocultural factors that contribute to the reluctance of our students to perform CC + MMV. Keywords Cardiopulmonary resuscitation Mouth-to-mouth resuscitation Basic cardiac life support Asian communit

Luminescence Color Switching of Supramolecular Assemblies of Discrete Molecular Decanuclear Gold(I) Sulfido Complexes

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Au36 crown: A macrocyclization directed by metal-metal bonding interactions

Lord of the golden rings: A giant, crown-like Au36 ring aggregate with continuous metal-metal contacts (see picture; gold(I) centers are in ball and stick representation) is formed by an AuI· ··AuI bonding interaction directed self-assembly. (Figure Presented). © 2008 Wiley-VCH Verlag GmbH & Co. KGaA.link_to_subscribed_fulltex