Pharmacological Studies in Eating Disorders: A Historical Review

Eating disorders (EDs) are serious mental health conditions characterised by impaired eating behaviours and nutrition as well as disturbed body image, entailing considerable mortality and morbidity. Psychopharmacological medication is an important component in the treatment of EDs. In this review, we performed a historic analysis of pharmacotherapeutic research in EDs based on the scientific studies included in the recently published World Federation of Societies for Biological Psychiatry (WFSBP) guidelines for ED treatment. This analysis focuses on early approaches and trends in the methods of clinical pharmacological research in EDs, for example, the sample sizes of randomised controlled trials (RCTs). We found the development of psychopharmacological treatments for EDs followed advancements in psychiatric pharmacotherapy. However, the application of RCTs to the study of pharmacotherapy for EDs may be an impediment as limited participant numbers and inadequate research funding impede generalisability and statistical power. Moreover, current medication usage often deviates from guideline recommendations. In conclusion, the RCT model may not effectively capture the complexities of ED treatment, and funding limitations hinder research activity. Novel genetically/biologically based treatments are warranted. A more comprehensive understanding of EDs and individualised approaches should guide research and drug development for improved treatment outcomes.

[Therapy of Food Refusal and Anorexia Nervosa in German-Language Psychiatry Textbooks of the Past 200 Years]

The aim of this study was to describe how the therapy of anorexia nervosa (AN) and food refusal have been discussed in leading textbooks used in German-speaking academic psychiatry over the past 200 years. For this purpose, 18 textbooks of important school psychiatrists were selected. These were analyzed in a structured way to determine the content of the subject taught at universities in German-speaking countries at a given period. We found that AN was not taught as a distinct disorder until the end of the 20th century, although great attention had been paid to food refusal as a symptom and manifold therapeutic concepts had been developed much earlier. Whereas at the beginning of the 19th century forced feeding using feeding tubes was established, in the following years pharmacotherapies and special diets were developed. It is noteworthy that since the beginnings of academic psychiatry, some early forms of psychotherapy have been developed; for instance, special kinds of behavior were recommended when dealing with the patient, as the therapist was supposed to serve as a role model to encourage patients to eat. Treatment of food refusal by means of structured psychotherapeutic approaches were not established before AN was generally accepted as a distinct disease entity. The understanding of etiological factors that might lead to AN as well as potential psychotherapeutic interventions have changed fundamentally over the past decades.

Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803-2017

The most common eating disorders (EDs) according to DSM-5 are anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). These disorders have received increasing attention in psychiatry due to rising prevalence and high morbidity and mortality. The diagnostic category "anorexia nervosa," introduced by Ernest-Charles Lasègue and William Gull in 1873, first appears a century later in a German textbook of psychiatry, authored by Gerd Huber in 1974. However, disordered eating behavior has been described and discussed in German psychiatric textbooks throughout the past 200 years. We reviewed content regarding eating disorder diagnoses but also descriptions of disordered eating behavior in general. As material, we carefully selected eighteen German-language textbooks of psychiatry across the period 1803-2017. Previously, in German psychiatry, disordered eating behaviors were seen as symptoms of depressive disorders, bipolar disorder or schizophrenia, or as manifestations of historical diagnoses no longer used by the majority of psychiatrists such as neurasthenia, hypochondria and hysteria. Interestingly, 19th and early 20th century psychiatrists like Kraepelin, Bumke, Hoff, Bleuler, and Jaspers reported symptom clusters such as food refusal and vomiting under these outdated diagnostic categories, whereas nowadays they are listed as core criteria for specific eating disorder subtypes. A wide range of medical conditions such as endocrinopathies, intestinal or brain lesions were also cited as causes of abnormal food intake and body weight. An additional consideration in the delayed adoption of eating disorder diagnoses in German psychiatry is that people with EDs are commonly treated in the specialty discipline of psychosomatic medicine, introduced in Germany after World War II, rather than in psychiatry. Viewed from today's perspective, the classification of disorders associated with disordered eating is continuously evolving. Major depressive disorder, schizophrenia and physical diseases have been enduringly associated with abnormal eating behavior and are listed as important differential diagnoses of EDs in DSM-5. Moreover, there are overlaps regarding the neurobiological basis and psychological and psychopharmacological therapies applied to all of these disorders.

Statutory requirements for disclosure of breast cancer treatment alternatives

Therapeutic options for breast cancer, particularly for early-stage disease, and increased patient participation in medical decision-making have oriented state legislatures toward ensuring that women with breast cancer have adequate information about treatment alternatives. Currently, 18 states have enacted statutes regarding physician disclosure of treatment alternatives to breast cancer patients. This paper reviews these statutes in the context of the requirements imposed on the physician as health care provider and the content of medical information presented to the patient as a consequence of the laws. State statutes were identified through the National Cancer Institute's State Cancer Legislative Database, and the statutory requirements were analyzed. For statutes requiring development of a written summary of treatment alternatives, the most recent summary was obtained through the responsible state agency, and informational content was analyzed for relevance to treatment decisions in early-stage disease. As a group, these laws address informed consent for treatment, physician behavior within the patient-physician relationship, and the medical information upon which treatment decisions are based. Individual statutes vary in the scope of the issues addressed, particularly in the responsibility placed on physicians, and treatment option summaries developed in response to this legislation vary widely in content and scope. Despite broad implications of these statutes in oncology practice, little is known about their effects on breast cancer care. Additional research is needed to define the impact of these statutes on breast cancer care, as such legislation is considered by other states for this and other diseases.

Developing cancer control capacity in state and local public health agencies

In 1986, the National Cancer Institute began a major grant program to enhance the technical capabilities of public health departments in cancer prevention and control. This effort, commonly referred to as "capacity building" for cancer control, provided funding to support eight State and one local health department. The program focused on developing the knowledge and skills of health department personnel to implement intervention programs in such areas as smoking cessation, diet modification, and breast and cervical cancer screening. The grants ranged from 2 to 5 years in length, with funding of $125,000 to $1.6 million per grant. The total for the program was $7.4 million. While the priorities set for these grants were nominally similar, their capacity building activities in cancer prevention and control evolved into unique interventions reflecting the individual needs and priorities of each State or locality. Their experiences illustrate that technical development for planning, implementing, and evaluating cancer prevention and control programs is a complex process that must occur at multiple levels, regardless of overall approach. Factors found to contribute to successful implementation of technical development programs include* commitment of the organization's leadership to provide adequate support for staff and activities and to keep cancer prevention and control on the organizational agenda,* the existence of appropriate data to monitor and evaluate programs,* appropriately trained staff,* building linkages with State and community agencies and coalitions to guide community action,* an established plan or process for achieving cancer control objectives,* access to the advice of and participation of individual cancer and health experts,* an informed State legislature,* diffusion of cancer prevention and control efforts,and* the ability to obtain funds needed for future activities.

Health status of survivors of cardiac arrest and of myocardial infarction controls

We interviewed 308 survivors of out-of-hospital cardiac arrest and matched controls who had suffered a myocardial infarction. The Sickness Impact Profile (SIP) scores of controls were somewhat lower (better) than those of cases, but responses of cases and controls to additional questions about stair climbing, irritability and mood were virtually identical. Half as many (18 per cent) controls as cases (38 per cent) reported poorer memory function; nevertheless, 63 per cent of cases and 79 per cent of controls who had been working outside the home at the time of the event were employed at the time of the interview.

Emergency CPR instruction via telephone

We initiated a program of telephone CPR (cardiopulmonary resuscitation) instruction provided by emergency dispatchers to increase the percentage of bystander-initiated CPR for out-of-hospital cardiac arrest. Cardiac arrests in King County, Washington were studied for 20 months before and after the telephone CPR program began. Bystander-initiated CPR increased from 86 of 191 (45 per cent) cardiac arrests before the program to 143 of 255 (56 per cent) cardiac arrests after the program. During the after period, 58 patients received CPR as a result of telephone instruction, 12 of whom were discharged. We estimate that four lives may have been saved by the program. A review of hospital records revealed no excess morbidity in the group of patients receiving dispatcher-assisted CPR.

The potential use of automatic defibrillators in the home for management of cardiac arrest

Ventricular fibrillation, an abnormal cardiac rhythm, occurs in at least two-thirds of the 400,000 people who die out of the hospital from sudden cardiac arrest. This rhythm can be treated successfully by electric countershock, a procedure known as defibrillation. The survival rate following such cardiac arrest is directly related to the rapidity of response; the shorter the time from collapse to defibrillation, the more patients will survive. There are two basic options to shorten the time from collapse to defibrillatory shock. The first is to upgrade the emergency medical system. The second is to provide spouses and family members of potential cardiac arrest patients with automatic home defibrillators. This article considers the effectiveness of the second option, home defibrillation, compared with that of an equally costly upgrade in existing emergency medical service systems. The comparisons depend on the existing level of emergency medical service system, the cost of the home defibrillator, and the rate at which a home defibrillator would be used appropriately. The comparisons suggest that in many circumstances home defibrillation is an appropriate option to be considered.

Automatic external defibrillation: evaluations of its role in the home and in emergency medical services

Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. During the late 1970s the concept of early out-of-hospital defibrillation expanded as emergency medical technicians (EMTs) learned to defibrillate. Researchers in several settings confirmed the effectiveness of early defibrillation by EMTs. The automatic detection of ventricular fibrillation (VF) creates new opportunities for the early defibrillation concept. This includes both automatic implantable defibrillators and automatic external defibrillators (AED). The King County, Washington, EMS is conducting two projects to evaluate AEDs. One is a randomized, controlled crossover study in which EMTs use either an AED or a standard manual defibrillator. Outcome measurements include time to countershock, conversion rates, and survival rates. In the second project family members of patients who have survived out-of-hospital VF randomly receive an AED and cardiopulmonary resuscitation (CPR) instruction, or CPR instruction alone. This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.

Sensitivity, accuracy, and safety of an automatic external defibrillator

An automatic external defibrillator (AED) was used by paramedics to detect ventricular fibrillation and deliver countershocks in 39 people with out-of-hospital cardiac arrests. The AED identified and delivered at least 1 countershock to 13 of the 16 people in ventricular fibrillation (81% sensitivity). The AED responded correctly to all 21 of the non-ventricular-fibrillation rhythms (8 other electrical rhythms, 13 asystole) with no countershocks (100% specificity). In 2 patients the rhythm could not be assessed. The device caused no injuries to patients or personnel. The performance of the AED was also analysed by considering each 15 s segment of ventricular fibrillation as a separate challenge; the device delivered a countershock in 19 of 29 such segments (66%).

Survivors of out-of-hospital cardiac arrest: morbidity and long-term survival

Sudden cardiac death accounts for two thirds of death due to coronary artery disease. Advanced cardiac life support can now be brought directly to patients with out-of-hospital cardiac arrest, and in this country, as many as 30% of such patients can be discharged from the hospital annually. Certain clinical and resuscitation-related factors are predictive of mortality and morbidity. The best clinical predictors of long-term survival are absence of previous history of myocardial infarction, lack of congestive heart failure during hospitalization, and age less than 60 years. Resuscitation-related predictors of long-term survival are a short time collapse to cardiopulmonary resuscitation (CPR), and a short time from collapse to CPR combined with a short time to provision of definitive care. The majority of cardiac arrest survivors are able to resume previous levels of function.

Health status of survivors of out-of-hospital cardiac arrest six months later

The health status of long-term survivors of out-of-hospital cardiac arrest was studied six months after the event. Although Sickness Impact Profile scores for arrest survivors were higher (worse) than scores of enrollees in a prepaid closed panel health plan, in most cases problems of survivors were not incapacitating. Approximately three-fifths of survivors reported same or better memory function and stair climbing ability compared to that at time of arrest. Three-fifths of those who had been working continued to do so.

Treatment of ventricular fibrillation. Emergency medical technician defibrillation and paramedic services

We compared the effect of rapid defibrillation by emergency medical technicians (EMTs) combined with paramedic care with that of standard EMT and paramedic care on survival from 540 witnessed episodes of out-of-hospital cardiac arrest caused by ventricular fibrillation. More than 400 EMTs were trained in the recognition of ventricular fibrillation and operation of a defibrillator. For a portion of the three-year study, emergency care for 179 cases was randomized between the two types of services. For randomized cases, when the time interval between EMT and paramedic arrival was greater than four minutes there was significantly improved survival with EMT defibrillation and paramedic care (42%) compared with basic EMT and paramedic care (19%). Similar findings occurred when all cases were considered (38% v 18%). Defibrillation by EMTs combined with paramedic services can enhance survival from ventricular fibrillation, compared with basic EMT and paramedic care.

Service factors and health status of survivors of out-of-hospital cardiac arrest

To determine how emergency service factors affect the health status of survivors of out-of-hospital cardiac arrest, 424 survivors were studied six months later. The principal research tool was the Sickness Impact Profile (SIP), a behaviorally-based instrument for measuring sickness-related dysfunction. Time to initiation of care and time to definitive care were significantly related to dysfunction. The critical time intervals can be influenced by the manner in which communities provide emergency care.

Epidemiology of cardiac arrest and resuscitation in children

A surveillance system identified all out-of-hospital cardiac patients under the age of 18 who received emergency care in suburban King County, Washington. The etiology, cardiac rhythm, and outcome were identified for each case. During a 6 1/2-year period, 119 cardiac arrests occurred (annual incidence, 12.7/100,000 among individuals less than 18). Sudden infant death was the most common etiology (32%), and drowning was the second most common (22%). The most common rhythm was asystole, accounting for 66% of all rhythms. Six percent of patients treated with basic EMT care were discharged, compared with 7% of patients treated with EMT and paramedic care. In contrast to resuscitation from cardiac arrest in adults, the likelihood of successful resuscitation in children is very poor. This is due to different etiologies and the higher proportion of asystole seen in pediatric cardiac arrest as compared with adults.

The ACLS score. Predicting survival from out-of-hospital cardiac arrest

We developed a score predictive of survival following out-of-hospital cardiac arrest from an analysis of factors associated with 611 cases. The score is calculated from four pieces of information readily obtainable by emergency personnel directly at the scene. The four items are as follow: A, arrest witnessed; C, cardiac rhythm; L, lay bystander cardiopulmonary resuscitation (CPR); S, speed (response time of paramedic unit). Among 22 patients with favorable findings on all four predictive variables (witnessed arrest, ventricular fibrillation, bystander CPR, paramedic response time less than four minutes), 15 (70%) were discharged alive. The ACLS score for this group of patients was 70%. Among 97 patients with the most unfavorable findings (whose ACLS score was 0), one (1%) was discharged. We believe the score can provide emergency personnel with a realistic appraisal of the likelihood of successful resuscitation.

The costs of a suburban paramedic program in reducing deaths due to cardiac arrest

The marginal costs per averted death of a suburban paramedic program are estimated to be approximately $42,000, when program costs are attributed entirely to cardiac arrest cases due to underlying heart disease, and indirect costs attributable to episode-related hospitalization are included, It is suggested that at $42,000 per cardiac arrest death averted the program is cost-beneficial by two criteria. First, it compares favorably with an estimate obtained from the literature of the value to the average individual of saving the life of a myocardial infarction patient. Second, the people of King County passed a cost-commensurate Paramedic Program Property Tax Levy in 1979, revealing their willingness to support the program. Results of the study should be generalized in accordance with the facts that in King County 1) the population density averages approximately 1,300 per square mile; 2) a basic emergency medical system ensures a 4-minute average response time to initiation of cardiopulmonary resuscitation; 3) a citizen-training program in cardiopulmonary resuscitation further reduces average time to initiation of basic life support; and 4) the paramedic program is designed to ensure a 10-minute average time to definitive care.

Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians

The survival rate for patients with out-of-hospital cardiac arrest is low in communities where emergency service is provided solely by emergency medical technicians. We trained such technicians in a suburban community of 79,000 to recognize and treat out-of-hospital ventricular fibrillation with up to three defibrillatory shocks without the use of medications or special airway protection. Outcomes from cardiac arrest due to underlying heart disease were determined during two periods: two years with standard care by emergency medical technicians and one year with defibrillator-trained technicians. During the period with standard care, four of 100 patients with cardiac arrest were resuscitated and discharged alive from the hospital, as compared with 10 of 54 patients during the period with defibrillator-trained technicians (P less than 0.01). In 12 of 38 patients with ventricular fibrillation, a stable perfusing cardiac rhythm followed defibrillatory shocks given by defibrillator technicians. The enhanced survival after cardiac arrest is encouraging, and further trials of defibrillation by emergency medical technicians are warranted.

Out-of-hospital cardiac arrest: improved survival with paramedic services

Survival after out-of-hospital cardiac arrest was studied in a suburban community (population 304000) before and after addition of paramedic services. During period 1 emergency medical technicians provided basic emergency care (cardiopulmonary resuscitation at the scene of collapse and during the journey to hospital). In period 2 additional care was given at the scene of collapse by paramedics capable of advanced emergency care (defibrillation, endotracheal intubation, drugs). During the 3-yr study 585 patients with cardiac arrest caused by heart disease received prehospital emergency resuscitation. Paramedic services improved the rate of live admission to the coronary-care or intensive-care unit from 19% to 34% (p less than 0.001) and the rate of discharge from 7% to 17% (p less than 0.01). The mean time from collapse to delivery of advanced emergency care was 27.5 min during period 1 with technician services, and 7.7 min during period 2 with paramedic services. Ventricular fibrillation caused cardiac arrest in nearly all patients who survived; it occurred in 91 of the 160 (57%) patients during period 1 whose rhythms were determined and in 192 of the 343 (56%) patients during period 2. The decreased time from collapse to delivery of advanced emergency care accounted for the improved survival with paramedic services.

Management of out-of-hospital cardiac arrest. Failure of basic emergency medical technician services

Survival after out-of-hospital cardiac arrest treated by emergency medical technicians (EMTs) with basic life support was studied in four communities with a combined population of 380,000. During a two-year period, 18 (6%) of 321 patients with cardiac arrest were resuscitated and ultimately discharged from the hospital. This figure is compared with 55 (22%) of 253 discharged in adjacent suburban communities with paramedic services. The evident factor accounting for the difference in survival rates was the time from collapse to receiving definitive care (advanced cardiac life support)--26 minutes in the EMT area compared to 7.8 minutes in the paramedic area.

Out-of-hospital cardiac arrest: a review of major studies and a proposed uniform reporting system

The scientific literature from January 1970 to June 1979 was reviewed for articles reporting outcomes from out-of-hospital cardiac arrest treated by paramedic programs. Only articles appearing in refereed professional journals and reporting 25 or more attempted resuscitations were included. A total of 21 articles from 15 U.S. locations were found. Four separate case definitions were distinguished. Methods and reporting formats varied considerably. Few studies used an experimental or quasi-experimental design, or control or comparison groups. The range of attempted resuscitations varied from 26 to 1.106 patients. Patients admitted to hospital varied between 22 per cent and 65 per cent (mean 38 per cent, S.D. +/- 12.4 per cent). Patients discharged alive varied from 3.5 per cent to 31 per cent (mean 17.2 per cent, S.D. +/- 7.1 per cent). Post discharge survival was either not reported or reported in different formats. A simplified reporting format is proposed using factors known to be associated with successful resuscitation: 1) underlying heart disease etiology; 2) witnessed arrest; 3) cardiac rhythm of ventricular fibrillation/ventricular tachycardia; 4) hospital admission and discharge and, when possible, by time from collapse to initiation of CPR and definitive care. Uniform reporting of outcomes will improve comparability and accurate measurement of the impact of emergency programs on out-of-hospital cardiac arrest.

Evaluation of paramedic programs using outcomes of prehospital resuscitation for cardiac arrest

Two evaluation methods, one statistical and one comparative, were developed to assess the effectiveness of paramedic programs in King County, Washington. The outcome of hospital admission following prehospital cardiac arrest was used as a measure of effectiveness. In the statistical method, actual outcomes were compared with predicted outcomes. Predictive variables for admission were time from collapse to initiation of cardiopulmonary resuscitation and time from collapse to definitive care. Given knowledge of the predictive variables, the statistical evaluation enabled us to determine the probability of the outcome following cardiac arrest. In the comparative method, outcomes were compared with a standard in an adjacent community. Using this method, we identified program elements that could lead to improved outcome. Both evaluation methods are easily implemented.

Cardiac resuscitation in the community. Importance of rapid provision and implications for program planning

Several time-related variables involving resuscitation from out-of-hospital cardiac arrest were studied. Short time intervals from collapse to initiation of cardiopulmonary resuscitation (CPR) and to provision of definitive care were significantly associated with survival from cardiac arrest. The two times were jointly related, and one short time without the other was unlikely to result in survival. If CPR was initiated within four minutes and if definitive care was provided within eight minutes, 43% of patients survived. If either time was exceeded, the changes of survival fell dramatically. The time to initiation of CPR and definitive care are factors directly influenced by emergency medical service program decisions. A realistic option to improve time to initiation of CPR is widespread citizen CPR training. A possible option to improve the time to definitive care is the training of emergency medical technicians in defibrillation.

Evaluating emergency medical services: Quasi-experimental outcome studies

The need to evaluate expensive, dramatic, and politically sensitive emergency medical services programs when classical controlled trials are neither ethically nor practically possible can be satisfied by quasi-experimental designs. The sequential implementation of paramedic services in several suburban areas provided a natural experimental situation in which to evaluate whether addition of the service could significantly alter the outcome of cardiac emergencies compared to the basic emergency medical technician program previously available. Before measurements and after measurements were made in a study area plus two control areas: one with paramedic services in both time periods and the other with emergency medical technician service throughout. Preliminary results indicate successful resuscitation increased from 20% to 32% (p less than .05) and discharge from the hospital went from 8% to 18% (p less than .01). The implications for program and policy decisions are noted. Development of studies that evolved from this work are outlined.

Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation

As part of an evaluation of whether the addition of paramedic services can reduce mortality from out-of-hospital cardiac arrest compared to previously existing emergency medical technician (EMT) services, factors associated with successful resuscitation were studied. A surveillance system was established to identify cardiac arrest patients receiving emergency care and to collect pertinent information associated with the resuscitation. Outcomes (death, admission, and discharge) were compared in two areas with different types of prehospital emergency care (basic emergency medical technician services vs. paramedic services). During the period April 1976 through August 1977, 604 patients with out-of-hospital cardiac arrest received emergency resuscitation. Eighty-one per cent of these episodes were attributed to primary heart disease. Considered separately, four factors were found to have a significant association with higher admission and discharge rates :1) paramedic service, 2) rapid time to initiation of cardiopulmonary resuscitation (CPR), 3) rapid time to definitive care, and 4) bystander-initiated CPR. Using multivariate analysis, rapid time to initiation of CPA and rapid time to definitive care were most predictive of admission and discharge. Age was also weakly predictive of discharge. These findings suggest that if reduction in mortality is to be maximized, cardiac arrest patients must have CPR initiated within four minutes and definitive care provided within ten minutes.

Paramedic programs and out-of-hospital cardiac arrest: II. Impact on community mortality

Out-of-hospital cardiac arrest was studied in suburban King County, Washington in an attempt to determine the impact of paramedic services on community cardiac mortality. A portion of the study area received paramedic services and the remainder received basic emergency medical technician (EMT) services. A surveillance system identified all prehospital cardiac arrest incidents. The etiology and outcome were determined. Deaths due to primary heart disease (ICDA) codes 410-414) were compared to community cardiac mortality figures for the same period of time and in the paramedic and EMT areas. Between April 1, 1976 and August 31, 1977, 1,449 deaths due to primary heart disease occurred (annual rate of 19.2/10,000 in the EMT area and 13.4/10,000 in the paramedic area). For the same period, 487 patients with out-of-hospital cardiac arrest received emergency resuscitation. The annual incidence of out-of-hospital cardiac arrest was similar in the EMT and paramedic areas (5.6 and 6.0/10,000 respectively). Proportionately more lives of persons with cardiac arrest were saved in the paramedic area than in the MET area. During this 17 month period, the reduction in community cardiac mortality was 8.4 per cent in the paramedic area and 1.3 per cent in the EMT area. These findings suggest that paramedic services have a small but measurable effect on community cardiac mortality.

Epidemiology of cardiac arrest and resuscitation in a suburban community

A surveillance system identified all out-of-hospital victims of cardiac arrests who received emergency aid in King County, Washington, as well as the etiologic condition and cardiac rhythm causing each arrest. During an 18-month period, 649 cardiac arrests occurred (annual incidence 7.2/10,000). Primary heart disease was the cause in 81%. Ventricular fibrillation was the associated rhythm in 57% of cardiac arrests. Based upon the incidence of cardiac arrest in the community and the likelihood of resuscitation under optimal conditions, we estimate the maximum incidence of lives saved to be 2.0/10,000 annually.

Use of mobile unit to provide health care for preschoolers in rural King County, Washington

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Child-resistant medicine containers: experience in the home

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