Treadmill exercise during adenosine infusion is safe, results in fewer adverse reactions, and improves myocardial perfusion image quality.

BACKGROUND: Combining low-level treadmill exercise with adenosine infusion may result in fewer bradyarrhythmic complications by increasing sympathetic tone and may improve myocardial perfusion image quality by decreasing background activity. METHODS: Patients referred for outpatient pharmacologic stress myocardial perfusion imaging performed simultaneous treadmill exercise (mean 2.2 metabolic equivalents) throughout 6-minute adenosine infusion (adenosine-exercise n = 507). Patients unable to exercise and those with left bundle branch block received adenosine infusion alone (adenosine-nonexercise n = 286). Adverse reaction data were collected on all patients and compared by sex. Background-to-target activity was calculated in a blinded fashion on 200 randomly selected patients. RESULTS: During the period from April 1996 to December 1998, 507 patients (64%) underwent adenosine-exercise testing, whereas 286 (36%) underwent adenosine-nonexercise testing. Hypotensive and arrhythmic (atrioventricular block, sinus bradycardia, and new onset atrial fibrillation or flutter) adverse reactions occurred less often during adenosine-exercise than during adenosine-nonexercise. Neither death nor myocardial infarction occurred in either group. In the adenosine-exercise group, 2.8% of patients experienced an adverse reaction versus 5.6% of the adenosine-nonexercise group (P = .04). The reduction in adverse reactions occurred in both men and women, although women had significantly more adverse reactions than men (5.7% vs 1.8%, P = .004). Liver/heart and gut/heart ratios were lower in the adenosine-exercise group (1.05+/-0.42 vs. 1.21+/-0.55 , P = .01; 0.61+/-0.21 vs. 0.69+/-0.24, P = .03, respectively). CONCLUSIONS: Compared with adenosine infusion alone, combining low-level treadmill exercise with adenosine in outpatients is safe, better tolerated, and improves image quality. Women were more likely to experience adverse reactions than men.

Perceptions, safety behaviors, and learning needs of parents of children brought to an emergency department.

INTRODUCTION: This study was conducted at a level II Pediatric Trauma Center to assess the perceptions, safety behaviors, and learning needs of parents who brought their children to the emergency department. METHODS: Surveys were distributed in the emergency department, and 412 parents/caretakers responded. A descriptive design provided the framework for data analysis. RESULTS: A profile of caretakers of children in three age groups (1 to 4, 5 to 12, and 13 to 15 years) emerged. Whereas most parents and older children knew how to call 911, only half of the parents knew child CPR. Parents tended to underestimate their children's risks for motor vehicle-related and immersion injuries and were more concerned about kidnapping and assault. Less than half of the parents believed that most injuries can be prevented. Learning needs were indicated by 34% of parents, and CPR was mentioned most frequently. Parents' desires for learning tended to focus on care after injuries happened. DISCUSSION: Health professionals need to spend more time teaching parents about the link between child development and risks for injury, to emphasize prevention. Interventions based on study results include the hospital Safety Helmet Discharge Plan.