Pre-hospital body surface potential mapping improves early diagnosis of acute coronary artery occlusion in patients with ventricular fibrillation and cardiac arrest

Aims: To determine whether 80-lead body surface potential mapping (BSPM) improves detection of acute coronary artery occlusion in patients presenting with out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) and who survived to reach hospital. Methods and results: Of 645 consecutive patients with OHCA who were attended by the mobile coronary care unit, VF was the initial rhythm in 168 patients. Eighty patients survived initial resuscitation, 59 of these having had BSPM and 12-lead ECG post-return of spontaneous circulation (ROSC) and in 35 patients (age 69±13 yrs; 60% male) coronary angiography performed within 24. h post-ROSC. Of these, 26 (74%) patients had an acutely occluded coronary artery (TIMI flow grade [TFG] 0/1) at angiography. Twelve-lead ECG criteria showed ST-segment elevation (STE) myocardial infarction (STEMI) using Minnesota 9-2 criteria - sensitivity 19%, specificity 100%; ST-segment depression (STD) =0.05. mV in =2 contiguous leads - sensitivity 23%, specificity 89%; and, combination of STEMI or STD criteria - sensitivity 46%, specificity 100%. BSPM STE occurred in 23 (66%) patients. For the diagnosis of TFG 0/1 in a main coronary artery, BSPM STE had sensitivity 88% and specificity 100% (c-statistic 0.94), with STE occurring most commonly in either the posterior, right ventricular or high right anterior territories. Conclusion: Among OHCA patients presenting with VF and who survived resuscitation to reach hospital, post-resuscitation BSPM STE identifies acute coronary occlusion with sensitivity 88% and specificity 100% (c-statistic 0.94). © 2012 Elsevier Ireland Ltd.

Exploring the mobile structural assessment tool: Concept maps for learning website: Concept Maps for Learning Website

In this paper, we describe how the pathfinder algorithm converts relatedness ratings of concept pairs to concept maps; we also present how this algorithm has been used to develop the Concept Maps for Learning website (www.conceptmapsforlearning.com) based on the principles of effective formative assessment. The pathfinder networks, one of the network representation tools, claim to help more students memorize and recall the relations between concepts than spatial representation tools (such as Multi- Dimensional Scaling). Therefore, the pathfinder networks have been used in various studies on knowledge structures, including identifying students’ misconceptions. To accomplish this, each student’s knowledge map and the expert knowledge map are compared via the pathfinder software, and the differences between these maps are highlighted. After misconceptions are identified, the pathfinder software fails to provide any feedback on these misconceptions. To overcome this weakness, we have been developing a mobile-based concept mapping tool providing visual, textual and remedial feedback (ex. videos, website links and applets) on the concept relations. This information is then placed on the expert concept map, but not on the student’s concept map. Additionally, students are asked to note what they understand from given feedback, and given the opportunity to revise their knowledge maps after receiving various types of feedback.