Characteristic Mechanisms and Outcome of Cardiopulmonary Arrest in Congestive Heart Failure Patients

Recent studies suggest the mechanism of sudden death in congestive heart failure (CHF) patients is less frequently VT/VF than previously believed. In order to further understand the characteristics and mechanisms of death in CHF patients, we evaluated 146 patients who underwent cardiopulmonary resuscitation during hospitalization for congestive heart failure, ischemic heart disease, and noncardiac causes. Clinical characteristics and outcomes are described below:CHF/CardiacnonCHF/CardiacnoncardiacN302690Age63 (49.71)67 (60.72)63 (29.71)Sex (% male)375860Initial Rhythm N(%)VT/VF7 (25)11 (44)24 (27)Asystole6 (21.4)6 (24)33 (37.5)Bradycardia5 (17.9)2 (8)6 (6.8)EMD6 (21.4)1 (4)13 (148)Other4 (14.3)5 (20)12 (136)ROSC21 (70)13 (50)51 (56.7)Survival to D/C1 (3.3)4 (15.4)2 (2.2)Patients with nonCHF/Cardiac disease had a higher ROSC than patients with CHF and noncardiac diseases (p=0.016). In summary, patients with CHF often experience cardiopulmonary arrest with bradycardic or EMD arrests. Although patients with CHF are resuscitated with a high degree of success their in-hospital survival was low. Furthermore, the high rate of bradycardic and EMD arrests may explain the low in-hospital survival rates

Improving the Culture of Ethical Behavior in the Financial Sector: Time to Expressly Provide for Private Enforcement Against Aiders and Abettors of Securities Fraud

Financial markets do not function well when fraud is pervasive. It has been well documented that financial fraud has increased following changes in securities law that occurred in the 1990\u27s. Also around September of 2009, the investigations into the SEC examinations of Bernard Madoff Investment Securities, LLC were completed and released to the public. The simple facts reveal an alarming level of incompetence and lack offinancial literacy on the part of the guardians of the integrity of our financial markets. I suggest two important tools for addressing these problems. One is to supplement enforcement of anti-fraud rules with more private attorney generals by expressly creating a private right of action for aiding and abetting violations of securities laws. This will foster a stronger culture of integrity and ethical conduct in the auditing profession. An additional tool is to increase financial literacy in our law schools which supply the regulators of our markets