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  • Not Your Typical ST-Elevation Myocardial Infarction

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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.6318

    A man in his 80s with unknown medical history was brought to the emergency department after a cardiac arrest.

  • A Case of Chest Pain and Transient Cardiac Arrest

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    JAMA Intern Med. 2017; doi: 10.1001/jamainternmed.2017.5853
  • Patient Mortality During Unannounced Accreditation Surveys at US Hospitals

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    JAMA Intern Med. 2017; 177(5):693-700. doi: 10.1001/jamainternmed.2016.9685

    This study compares the mortality at hospitals during the time of accreditation review by The Joint Commission vs times when the hospitals are not under review.

  • A Patient With Hypertrophic Cardiomyopathy Presenting in Cardiac Arrest

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    JAMA Intern Med. 2017; 177(4):573-574. doi: 10.1001/jamainternmed.2016.8756
  • Partial Codes—A Symptom of a Larger Problem

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    JAMA Intern Med. 2016; 176(8):1058-1059. doi: 10.1001/jamainternmed.2016.2540
  • JAMA Internal Medicine June 1, 2016

    Figure: Regression-Adjusted Trends in the Likelihood of a Coding for High Anesthesia Risk by Comorbid Condition From 2005 to 2013

    Probabilities of being coded as being at high risk were predicted by holding patient-level characteristics (procedure type, insurance type, age, sex, service setting, and geographic region) at their means and controlling for comorbid conditions other than the specific condition of interest, including respiratory conditions (sleep apnea, chronic obstructive pulmonary disease [COPD], asthma, and cystic fibrosis), cardiovascular conditions (prior cardiac arrest, congestive heart failure, and coronary artery disease), and other chronic conditions (anemia, cancer, cerebrovascular diseases, dementia, diabetes mellitus, gastrointestinal bleeding, hepatobiliary diseases, human immunodeficiency virus, hypertension, inflammatory bowel disease, pancreatic disease, peripheral artery diseases, psychiatric disorder, renal failure, and other neurological diseases).
  • Potential of Missing Life-Threatening Arrhythmias After Limiting the Use of Cardiac Telemetry

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    JAMA Intern Med. 2015; 175(8):1416-1418. doi: 10.1001/jamainternmed.2015.2387

    This study used the current American Heart Association guidelines to determine whether telemetry alarms affect patient management and found that, even with the alarms designated as emergency, there were few episodes of clinically important arrhythmias and change in patient management was uncommon.

  • Risk for Clinically Relevant Adverse Cardiac Events in Patients With Chest Pain at Hospital Admission

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    JAMA Intern Med. 2015; 175(7):1207-1212. doi: 10.1001/jamainternmed.2015.1674

    This blinded data review of a prospectively collected database of adult patients admitted or observed with potentially ischemic chest pain found that the risk for a clinically relevant adverse cardiac event was rare and commonly iatrogenic.

  • JAMA Internal Medicine March 1, 2015

    Figure 1: Comparison of Risk Scores for Predicting RRT Activation and Cardiac Arrest or ICU Transfer, RRT Activation, and a Combined Adverse Outcome

    The accuracy of the Patient Acuity Rating (PAR), Modified Early Warning Score (MEWS), and the combined PAR-MEWS risk scores for predicting the (A) combined outcome of intensive care unit (ICU) transfer, cardiac arrest, or rapid response team (RRT) activation within 24 hours of an observation. For comparison, the individual outcomes of (B) ICU transfer or cardiac arrest, and (C) RRT activation within 24 hours are shown. Accuracy of each score is represented by the area under the receiver operator characteristic curve (AUC) with 95% confidence interval (error bars).
  • JAMA Internal Medicine March 1, 2015

    Figure 2: Impact of PAR Timing on Cardiac Arrest or ICU Transfer Prediction When Combined With MEWS

    The accuracy of Modified Early Warning Score (MEWS) vs the combined Patient Acuity Rating (PAR)-MEWS, for predicting cardiac arrest, intensive care unit (ICU) transfer, or rapid response team activation, using all the MEWS values available in the data set and carrying forward preceding PAR scores with decreasing allowable discrepancy in time between the 2 scores. Accuracy of each score is represented by the area under the receiver operator characteristic curve (AUC) with 95% confidence intervals (error bars).
  • Withholding and Withdrawal of Life-Sustaining Treatments in Intensive Care Units in Asia

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    JAMA Intern Med. 2015; 175(3):363-371. doi: 10.1001/jamainternmed.2014.7386

    This survey study found that whereas physicians in Asian intensive care units often withheld but seldom withdrew life-sustaining treatments at the end of life, attitudes and practice varied widely across countries and regions.

  • The Value of Clinical Judgment in the Detection of Clinical Deterioration

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    JAMA Intern Med. 2015; 175(3):456-458. doi: 10.1001/jamainternmed.2014.7119
  • JAMA Internal Medicine February 1, 2015

    Figure 1: Flowchart of Cardiac Arrest Sample Construction

    Codes refer to International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. ALS indicates advanced life support; BLS, basic life support.aPickup locations included residence, scene of accident or acute event, skilled nursing facility, and non–skilled nursing facility residential, domiciliary, custodial, or nursing home facility.bPresent on admission status for cardiac arrest is either no or unknown.cRural areas are defined as counties that do not meet the metropolitan or micropolitan criteria as defined by the US Bureau of the Census. Metropolitan counties have at least 1 urbanized area of 50 000 or more population, and micropolitan counties have at least 1 urban cluster of at least 10 000 but less than 50 000 population. Both types have adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.
  • JAMA Internal Medicine February 1, 2015

    Figure 2: Kaplan-Meier Analysis of Survival After Cardiac Arrest by Ambulance Service Level

    The main plot shows survival probability during the first 90 days, and the inset shows survival probability over the full observational period. Survival analysis was based on cardiac arrests that occurred between January 1, 2009, and October 2, 2011. Mortality was observed until December 31, 2011, when the data were censored; thus, there was follow-up to at least 90 days for each beneficiary. ALS indicates advanced life support; BLS, basic life support.
  • Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support

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    JAMA Intern Med. 2015; 175(2):196-204. doi: 10.1001/jamainternmed.2014.5420

    This observational cohort study demonstrates that patients with out-of-hospital cardiac arrest who received basic life support had higher survival at hospital discharge and 90 days compared with those who received advanced life support and were less likely to have poor neurological functioning.

  • Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

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    JAMA Intern Med. 2015; 175(2):237-244. doi: 10.1001/jamainternmed.2014.6781

    High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with acute myocardial infarction admitted to teaching hospitals during meetings were less likely to receive percutaneous coronary intervention , without any mortality effect.

  • Development and Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) Score to Predict Neurologically Intact Survival After In-Hospital Cardiopulmonary Resuscitation

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    JAMA Intern Med. 2013; 173(20):1872-1878. doi: 10.1001/jamainternmed.2013.10037

    Ebell et al developed a simple prearrest point score that can identify patients unlikely to survive in-hospital cardiac arrest neurologically intact or with minimal deficits. See the viewpoint by Berger and the editor’s note by Covinsky.

  • Evaluating Health System Processes With Randomized Controlled Trials

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    JAMA Intern Med. 2013; 173(14):1279-1280. doi: 10.1001/jamainternmed.2013.1044
  • Association Between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival

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    JAMA Intern Med. 2013; 173(13):1186-1195. doi: 10.1001/jamainternmed.2013.1026

    Chen and coauthors describe the association between inpatient cardiac arrest incidence and survival rates.