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Background: Hospital procedures have been associated with cognitive change in older patients. This study aimed to document the prevalence of mild cognitive impairment in individuals undergoing left heart catheterization (LHC) before the procedure and the incidence of cognitive decline to 3 months afterwards., Methods and Results: We conducted a prospective, observational, clinical investigation of elderly participants undergoing elective LHC. Cognition was assessed using a battery of written tests and a computerized cognitive battery before the LHC and then at 3 months afterwards. The computerized tests were also administered at 24 hours (or discharge) and 7 days after LHC. A control group of 51 community participants was recruited to calculate cognitive decline using the Reliable Change Index. Of 437 participants, mild cognitive impairment was identified in 226 (51.7%) before the procedure. Computerized tests detected an incidence of cognitive decline of 10.0% at 24 hours and 7.5% at 7 days. At 3 months, written tests detected an incidence of cognitive decline of 13.1% and computerized tests detected an incidence of 8.5%. Cognitive decline at 3 months using written tests was associated with increasing age, whereas computerized tests showed cognitive decline was associated with baseline amnestic mild cognitive impairment, diabetes mellitus, and prior coronary stenting., Conclusions: More than half the patients aged >60 years presenting for LHC have mild cognitive impairment. LHC is followed by cognitive decline in 8% to 13% of individuals at 3 months after the procedure. Subtle cognitive decline both before and after LHC is common and may have important clinical implications., Clinical Trial Registration Information: URL: www.anzctr.org.au. Unique identifier: ACTRN12607000051448., (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)

Aims: The outcome of in-hospital resuscitation following cardiac arrest depends on many factors related to the patient, the environment and the extent of resuscitation efforts. The aim of the present study was to determine predictors of successful resuscitation and survival to -hospital discharge following in-hospital cardiac arrest and to assess functional outcomes of survivors (cerebral performance scores)., Methods: Medical records of adult patients sustaining in-hospital cardiac arrest between June 2001 and January 2003 were reviewed. Successful resuscitation was defined as the return of spontaneous circulation at the completion of resuscitative efforts, irrespective of degree of inotropic/vasopressor support. Thirty demographic and clinical variables were analysed to determine predictors of successful resuscitation and in-hospital survival., Results: In 105 patients with cardiac arrest, 46 patients (44%) were successfully resuscitated and 22 (21%) survived to hospital discharge. Predictors of successful resuscitation included a primary cardiac admission diagnosis, monitoring at the time of the arrest, a longer duration of resuscitation and the absence of the need for endotracheal intubation. Patients with ventricular tachycardia/fibrillation were more likely to survive to hospital discharge than those with asystolic or pulseless electrical activity (45 vs 12 vs 20%, P = 0.01). The sole independent predictor of survival to hospital discharge was the absence of the need for endotracheal intubation (odds ratio 0.14, 95% confidence interval 0.02-0.88, P < 0.01). The majority of survivors (73%) had normal cerebral performance scores., Conclusions: Identification of predictors of successful resuscitation following cardiac arrest is important for risk stratification. Ongoing appraisal of in-hospital cardiac arrests through a multicentre registry could improve clinical outcomes.

Aim: ADHD-CT and anxiety has been associated with increased diastolic BP in controlled trials of single dosage studies of methylphenidate, although parent and child reports of anxiety have not been considered separately. Therefore, we tested the hypothesis that primary school-age children with ADHD-CT and anxiety have increased diastolic BP from a sitting to a standing position compared to children with ADHD-CT without anxiety, whether defined from a parent or child perspective., Method: Thirty-eight medication naive children with ADHD-CT were studied. Four groups were formed from parent and child reports of anxiety, using categorical and continuous measures of anxiety. The groups were compared using one-way ANOVA. Where omnibus F was significant, the post hoc SNK procedure (p < 0.05) was used to determine the source of this significance., Results: Primary school-age children with ADHD-CT and anxiety, defined from the child's report alone, had significantly increased diastolic BP from a sitting to a standing position than children with ADHD-CT without anxiety., Conclusions: The recognition of anxiety and its management in primary school-age children with ADHD-CT is generally poorly understood. In this particular group of children, only the child's report of anxiety was associated with significantly increased diastolic BP from a sitting to a standing position. Therefore, careful and thorough assessment of the child's perspective is required. The characteristics of this anxiety and its association with postural BP require further careful longitudinal study. Biological implications are noted.

This study assesses the impact of early percutaneous coronary intervention in patients presenting with cardiogenic shock after acute myocardial infarction. Predictors of in-hospital death include the need for intubation, cardiopulmonary resuscitation, and angiographic failure; long-term outcomes at 2 years in hospital survivors are favorable.