Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?

OBJECTIVES: This study sought to assess the maximal rate of acute Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency that can be achieved in unselected patients. BACKGROUND: Early and complete (TIMI grade 3 flow) reperfusion is an important therapeutic goal during acute myocardial infarction. However, thrombolysis, although widely used, is often contraindicated or ineffective. The selective use of primary and rescue percutaneous transluminal coronary angioplasty (PTCA) may increase the number of patients receiving reperfusion therapy. METHODS: A cohort of 500 consecutive unselected patients with acute myocardial infarction were prospectively treated using a patency-oriented scheme: Thrombolysis-eligible patients received thrombolysis (n = 257) and underwent 90-min angiography to detect persistent occlusion for treatment with rescue PTCA. Emergency PTCA (n = 193) was attempted in patients with contraindications to thrombolysis, cardiogenic shock or uncertain diagnosis and in a subset of patients admitted under "ideal conditions." A small group of patients (n = 38) underwent acute angiography without PTCA. Conventional medical therapy was used in 12 patients with contraindications to both thrombolysis and PTCA. RESULTS: Ninety-eight percent of patients received reperfusion therapy (thrombolysis, PTCA or acute angiography), and angiographically proven early TIMI grade 3 patency was achieved in 78%. Among patients with TIMI grade 3 patency, thrombolysis alone was the strategy used in 37%, emergency PTCA in 40% and rescue PTCA after failed thrombolysis in 15%; spontaneous patency occurred in 8%. CONCLUSIONS: Reperfusion therapy can be provided to nearly every patient (98%) with acute myocardial infarction. Rescue and direct PTCA provided effective early reperfusion to patients in whom thrombolysis failed or was excluded.     

Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction?

Much remains to be understood about how low socioeconomic status (SES) increases cardiovascular disease and mortality risk. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1993) were used to estimate the associations between acute myocardial infarction and income, all-cause mortality, and cardiovascular mortality in a population-based sample of 2,272 Finnish men, with adjustment for 23 biologic, behavioral, psychologic, and social risk factors. Compared with the highest income quintile, those in the bottom quintile had age-adjusted relative hazards of 3.14 (95% confidence interval (CI) 1.77-5.56), 2.66 (95% CI 1.25-5.66), and 4.34 (95% CI 1.95-9.66) for all-cause mortality, cardiovascular mortality, and AMI, respectively. After adjustment for risk factors, the relative hazards for the same comparisons were 1.32 (95% CI 0.70-2.49), 0.70 (95% CI 0.29-1.69), and 2.83 (95% CI 1.14-7.00). In the lowest income quintile, adjustment for risk factors reduced the excess relative risk of all-cause mortality by 85%, that of cardiovascular mortality by 118%, and that of acute myocardial infarction by 45%. These data show how the association between SES and cardiovascular mortality and all-cause mortality is mediated by known risk factor pathways, but full "explanations" for these associations will need to encompass why these biologic, behavioral, psychologic, and social risk factors are differentially distributed by SES.     

Lower thrombolytic use for African Americans with myocardial infarction: an influence of clinical presentation?

BACKGROUND: After myocardial infarction, African Americans have been reported to undergo fewer catheterization and revascularization procedures than whites, but few studies have addressed racial variations in the delivery of thrombolytic therapy. METHODS: We conducted a retrospective analysis of data prospectively collected on consecutive patients admitted with acute myocardial infarction to the 16-bed coronary care unit of a large, urban teaching hospital. RESULTS: Over a 5-year period, 1948 consecutive patients were admitted with acute myocardial infarction to a single coronary care unit. Thrombolysis was administered to 19% of 1024 African Americans and 29% of 924 whites (P <.01). The initial diagnostic impression on admission was "definite" infarction less often in African Americans (30%) than in whites (43%, P <.001), a difference that appeared to largely account for the difference in thrombolytic administration in a multivariable model. Mortality adjusted for age and concomitant illnesses was similar in African Americans compared with whites (relative risk 1.0, 95% confidence interval 0.78 to 1.51). CONCLUSIONS: Much of the racial variation in thrombolytic administration could be accounted for by differences in clinical presentation, an issue that requires further study.     

Thrombolytic therapy versus primary angioplasty. Which offers the best outcome after myocardial infarction?

The best technique for reestablishing blood flow after myocardial infarction has been the subject of heated debate for more than a decade. An the answer is still elusive. Which option is the safest? Which salvages the most heart tissue? Dr Faxon explains the pros and cons of both thrombolysis and angioplasty and discusses the "90 rule," which helps determine the optimal reperfusion strategy for each individual patient.     

Is visible infarction on computed tomography associated with an adverse prognosis in acute ischemic stroke?

BACKGROUND AND PURPOSE: It is unclear whether visible infarction on a CT scan at any time after the stroke is an adverse prognostic factor once other factors such as stroke severity are taken into consideration. We examined whether visible infarction was associated with a poor outcome after stroke using univariate and multivariate analyses, including easily identifiable clinical baseline variables, and adjusting for time from stroke onset to CT. METHODS: All inpatients and outpatients with an acute ischemic stroke attending our hospital stroke service were examined by a stroke physician and entered into a register prospectively. The CT scan was coded prospectively for the site and size of any relevant recent visible infarct. The patients were followed up at 6 months to ascertain their functional status with the use of the modified Rankin Scale. Analyses of the effect of visible infarction on the outcomes "dead or dependent" or "dead" at 6 months were performed with adjustment for time from stroke to CT, clinical stroke type (lacunar, hemispheric, or posterior circulation), and in a multiple logistic regression model to adjust for confounding baseline variables such as stroke severity. RESULTS: In 993 patients in the stroke registry, visible infarction increased the risk of being dead or dependent at 6 months (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9 to 3.3) or dead (OR, 4.5; 95% CI, 2.7 to 7.5), both on its own and after adjustment for time from stroke to CT, stroke symptoms, and other important clinical prognostic variables (OR for death or dependence in the predictive model, 1.5; 95% CI, 1.0 to 2.0; OR for death, 2.4; 95% CI, 1.4 to 4.1). CONCLUSIONS: Visible infarction on CT is an adverse prognostic indicator (albeit of borderline significance) even after adjustment for stroke severity and time lapse between the stroke and the CT scan.     

What place for endoscopic sphincterotomy in treatment of acute pancreatitis?

STUDY AIM: A prospective study was undertaken in order to evaluate the effects of endoscopic sphincterotomy on the evolution of biliary and idiopathic acute pancreatitis. PATIENTS AND METHODS: Among 320 patients with acute pancreatitis observed from 1986 to 1996, 118 were excluded from the study for etiological reasons and 137 were included for an endoscopic sphincterotomy within 72 hours from their admission. There were nine technical failures and 128 endoscopic sphincterotomies were performed. Sixty-five eligible patients were not included for logistic problems or patients' refusal; they can be considered as a "control group". RESULTS: The mortality rate of endoscopic sphincterotomy was 0 and the morbidity rate 2.1%. The mortality rate of acute pancreatitis was 3.1% in the sphincterotomy group vs 7.6% in the control group (P = 0.1) (NS) and the morbidity rate 25% versus 32% (P > or = 0.1) (NS). CONCLUSION: These results suggest that endoscopic sphincterotomy could be beneficial in acute biliary or idiopathic pancreatitis but they are not statistically significant. Endoscopic sphincterotomy does not increase the severity of acute pancreatitis and can be considered particularly in cases of gallstone pancreatitis but it should be performed less than 48 hours after the onset of acute pancreatitis.     

"Stunned myocardium"--laboratory curiosity or clinically relevant phenomenon of myocardial failure?

Reversible contractile dysfunction ("myocardial stunning") now is recognized in laboratory animals as well as in the clinic. The precise mechanism(s) responsible for this transient decrease in myocardial contractility is at present unknown. However substantial body of experimental evidence suggest failure in calcium homeostasis due to free radicals injury and calcium overload in ischemic/reperfused myocardium.     

Choice-supportive source monitoring: Do our decisions seem better to us as we age?

Participants were given several 2-option choices and then asked to review how they felt about their decisions, to review the details of their decisions, or to do an unrelated task. When later asked to attribute features to the previous options, in each condition older adults (64–83 years) attributed significantly more positive and fewer negative features to their chosen options than to foregone options. Younger adults' (18–22 years) attributions were as choice-supportive as those of older adults in the affective review condition but were less so in the other conditions. The age difference was present even when older and younger adults were equated for source identification and recognition accuracy. This study suggests that as people age, their tendency to distort memory in favor of the options they chose increases. In addition, it suggests that affectively reviewing choices increases younger adults' tendency toward choice-supportive memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do haphazard reviews provide sound directions for dissemination efforts?

Comments on The dissemination and implementation of evidence-based psychological treatments: A review of current efforts (see record 2010-02208-010) by Kathryn R. McHugh and David H. Barlow. The lead article in the February–March issue by McHugh and Barlow (2010) emphasized the need for “dissemination and implementation of evidence-based psychological treatments.” The authors identified a number of intervention programs as evidence based and in need of dissemination. One is multisystemic therapy (MST). They claimed that this program is among “the most successful dissemination efforts . . . pursued by treatment developers” (p. 79). McHugh and Barlow’s (2010) discussion of the implementation of MST in Hawaii is troubling, because it neglected to mention concerns about the perceived lack of cultural sensitivity of the MST program in that state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do expectancies for reinforcement from smoking change after smoking initiation?

Expectancies are important predictors of smoking behavior. Recent research suggests that expectancies are not stable and vary across internal and external states and levels of cigarette consumption. Expectancies may also vary between individuals as a function of temperamental characteristics such as behavioral undercontrol (BU). Although pre-initiation expectancies have been linked to subsequent smoking behaviors, no study has assessed the effect of smoking initiation on expectancies. The present study was designed to test the hypotheses that both positive (PRE) and negative (NRE) reinforcement expectancies would increase following initiation, and that these changes would be moderated by BU. College students were interviewed 12–15 months apart. Those who initiated smoking between assessments (n = 69) were included in the present study. Linear mixed models showed a significant increase in PRE but not NRE from pre- to postinitiation. The relationship between NRE and time was moderated by BU, such that higher BU was associated with significantly larger post-initiation increases in NRE. Findings suggest that PRE and NRE change significantly following experience with smoking. Furthermore, undercontrolled, impulsive individuals may be particularly vulnerable to smoking with the intention of alleviating aversive states. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Do reef fish, variola louti and scarus niger, perform amodal completion? Evidence from a field study.

In terms of visual perception, coral reefs are structurally complex habitats. Therefore, visual stimuli that invoke territorial behavior in fish, causing them to respond to potential intruders and competitors, may be fragmented. Amodal completion was recently shown in a fish species. Here, we presented a mirror covered by occluders, with different squared openings arranged in a vertical or a horizontal broken line or a checkerboard formation, within their natural territories in the reef. Single small openings in the occluders did not trigger an attack on the reflected image, while specific configurations of them did so, suggesting that fish recognized an intruder in the fragmented image. The results suggest the use of amodal completion by fish although other possibilities cannot be rejected. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Chronic and acute stressors among military personnel: Do coping styles buffer their negative impact on health?

This study examined the moderating impact of positive and negative coping styles on the relationship of acute and chronic job stressors with self-reported health symptoms of 521 military personnel. The number of acute work-related events was associated with a high frequency of self-reported symptoms. Similarly, role ambiguity, overload, and lack of job stimulation were associated with increased symptoms. Only the negative coping styles (i.e., venting of negative emotions and denial/disengagement) were uniquely associated with symptoms. Only 5 of the 13 proposed Stressor?×?Coping interactions were significant, and they all involved the negative coping styles. That is, instead of alleviating the negative outcomes of work stressors, these coping styles were associated with high strain, regardless of the amount of stressor, and, in some cases, these coping styles exacerbated the negative effect of the stressor on the strain outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do pigeons (Columba livia) study for a test?

In 4 experiments, the authors asked whether pigeons (Columba livia) would show metamemory by choosing to study a sample stimulus before taking a memory test. In Experiments 1a–1c, pigeons chose between cues that led either to exposure to a sample stimulus or directly to the comparison test stimuli without seeing the sample in a delayed matching-to-sample task. The same choice was used in Experiment 2 to see whether pigeons would take a reminder when memory of the sample was weak. In Experiments 3 and 4, pigeons’ responses led to either a choice between red and green side keys with a sample present to guide the choice or a choice with no sample present. The findings of all of these experiments suggest the absence of metamemory in pigeons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do the kidneys play an important role in the pathogenesis of "essential" hypertension?

The Prague Hypertensive Rat (PHR) is a model of genetic hypertension derived from the Wistar strain, in which a normotensive parallel, the Prague Normotensive Rat (PNR), was also bred from the same parent pair. Thus, it is possible to transfer organs between both parallels without signs of rejection and without the use of immunosuppressive drugs. Unilateral nephrectomy and transplantation of one kidney within the PHR and PNR groups did not affect the systolic blood pressure (SBP). Transplantation of one kidney from PNR to a bilateral nephrectomized (BNX) PHR normalized the high SBP; and transplantation of one kidney from PHR to BNX PNR led to an elevation of SBP: hypertension "travels" with the kidney. When the development of high SBP in PHR was prevented for 2 months after weaning by antihypertensive drugs, transplantation of one kidney from these rats to BNX PNR always induced a sustained hypertension in the recipient. If a PHR was left with one original kidney in situ after transplantation of a "normotensive" kidney, the high blood pressure persisted until the original "hypertensive" kidney was removed. These results support the view that the kidney of PHR produces a "hypertensinogenic" substance, the secretion of which is genetically determined and is not influenced by the magnitude of the SBP.     

Do adherence variables predict outcome in an online program for the prevention of eating disorders?

Unlike traditional interventions, Internet interventions allow for objective tracking and examination of the usage of program components. Student Bodies (SB), an online eating disorder (ED) prevention program, significantly reduced ED attitudes/behaviors in college-aged women with high body image concerns, and reduced the development of EDs in some higher risk subgroups. The authors investigated how adherence measures were associated with ED attitudes and behaviors after treatment. Female SB participants (n = 209) completed the Eating Disorders Examination-Questionnaire (EDE-Q; C. G. Fairburn & S. J. Beglin, 1994) at baseline, posttreatment, and 1-year follow-up. Total weeks participation and frequency of utilizing the online Web pages/journals predicted pre- to posttreatment changes in EDE-Q Restraint but not in other ED symptoms. In participants with some compensatory behaviors, discussion board and booster session use were associated with increased weight/shape concerns during follow-up. In overweight participants, higher online Web page/journal use was related to decreased EDE-Q Eating Concern scores during follow-up. This is the first study to investigate the relationship between adherence to specific program components and outcome in a successful Internet-based intervention. Results can be used to inform future development and tailoring of prevention interventions to maximize effectiveness and facilitate dissemination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do procedures for verbal reporting of thinking have to be reactive? A meta-analysis and recommendations for best reporting methods.

Since its establishment, psychology has struggled to find valid methods for studying thoughts and subjective experiences. Thirty years ago, Ericsson and Simon (1980) proposed that participants can give concurrent verbal expression to their thoughts (think aloud) while completing tasks without changing objectively measurable performance (accuracy). In contrast, directed requests for concurrent verbal reports, such as explanations or directions to describe particular kinds of information, were predicted to change thought processes as a consequence of the need to generate this information, thus altering performance. By comparing performance of concurrent verbal reporting conditions with their matching silent control condition, Ericsson and Simon found several studies demonstrating that directed verbalization was associated with changes in performance. In contrast, the lack of effects of thinking aloud was merely suggested by a handful of experimental studies. In this article, Ericsson and Simon's model is tested by a meta-analysis of 94 studies comparing performance while giving concurrent verbalizations to a matching condition without verbalization. Findings based on nearly 3,500 participants show that the “think-aloud” effect size is indistinguishable from zero (r = –.03) and that this procedure remains nonreactive even after statistically controlling additional factors such as task type (primarily visual or nonvisual). In contrast, procedures that entail describing or explaining thoughts and actions are significantly reactive, leading to higher performance than silent control conditions. All verbal reporting procedures tend to increase times to complete tasks. These results suggest that think-aloud should be distinguished from other methods in future studies. Theoretical and practical implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Do neurocognitive ability and personality traits account for different aspects of psychosocial outcome after traumatic brain injury?

Objective: To examine the contributions of demographic, injury, cognitive, and personality characteristics to psychosocial outcome 8 years after traumatic brain injury (TBI). Design: Multiple regression analyses were used to estimate the variance explained by putative "predictors" of psychosocial outcome. Participants: Thirty-nine TBI survivors and 39 family member informants. On the basis of Glasgow Coma Scale scores and Accident Injury Severity (head) ratings, the patients' brain injuries ranged from mild to critical in severity. Main Outcome Measures: One self-report measure combined putative markers of social role engagement, such as marital status and earned income. Another, based on informant ratings using the Katz Adjustment Scale, was conceptualized as reflecting behavioral adjustment. Results: Whereas cognitive functioning explained significant unique variation in social role engagement, it did not account for variance in behavioral adjustment. Conversely, whereas 3 personality trait ratings explained significant incremental variance in behavioral stability, only 1 did the same with respect to social role engagement. Conclusions: Social role engagement and behavioral adjustment appear to represent 2 related but distinguishable aspects of TBI outcome that are associated with different patient characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is there a "non-MAO" macromolecular target for L-deprenyl?: Studies on MAOB mutant mice

Several irreversible inhibitors of monoamine oxidase B, can promote survival of damaged neurons in several animal models of cerebral injury. Today it is evident that this effect is not a consequence of monoamine inhibition. Instead it has been proposed that L-deprenyl may act via an unrelated non-monoamine oxidase type- of binding site. In the present study we have investigated if brain tissue from MAOB knockout mice contain such "non-MAO" binding sites for radiolabelled deprenyl. Interestingly, no binding of L-deprenyl was observed indicating that the mother compound does not act directly via a macromolecular target. This is enticing since several alternative mechanisms of action have been proposed in the literature.     

The dynamic hip screw with support plate--a reliable osteosynthesis for highly unstable "reverse" trochanteric fractures?

ORIF management of unstable trochanteric fractures of type A3 of the A0 classification is difficult because of lateral dislocation of the proximal fractured segments, particularly when only the sliding hip-screw is used for fixation. A connectable butt-press plate was recently developed in order to prevent this type of dislocation. We review the results with this fixation technique in 22 elderly patients with an average age of 76 years who presented with highly unstable trochanteric fracture of the A3 type. Three patients died of diseases unrelated to the trauma or operation before the fractures had healed. The other 19 were followed prospectively until fracture healing had occurred. Complaints, leg shortening and changes in the CCD angle were recorded. Furthermore, the mobility score was determined. Although the patients were able to bear full weight after the operation, no lateral dislocation of fragments was observed. Only 1 patient had a varus dislocation of 5 degrees until the fracture had consolidated. This was due to severe osteopenia and subsequent dislocation of the screw within the femoral head. No pseudarthrosis, osteitis or rotational malalignment was noted. Five of the surviving patients had a lower mobility score after fracture healing as compared to the status before the fracture was sustained. On the basis of this review, we recommend the use of this new connectable buttress plate with sliding hip screws because it provides sufficient fixation of highly unstable fractures of type A3.     

Do you two know each other? Transitivity, homophily, and the need for (network) closure.

The authors investigate whether need for closure affects how people seek order in judging social relations. In Study 1, the authors find that people who have a high need for closure (NFC) were more likely to assume their social contacts were connected to each other (i.e., transitivity) when this was not the case. In Studies 2 and 3, the authors examine another form of order in network relations—racial homophily—and find that high-NFC participants were more inclined to believe that 2 individuals from the same racial category (e.g., African American) were friends than two racially dissimilar individuals. Furthermore, high-NFC individuals were more likely to make errors when judging a racially mixed group of people; specifically, they recalled more racial homophily (racially similar people sitting closer together) than had actually appeared. (PsycINFO Database Record (c) 2010 APA, all rights reserved)