The functional disability caused by IBM reduces QoL, but psychosocial factors such as mood affect QoL directly and by influencing the degree to which disease severity reduces QoL. Further study should follow the effects of IBM on QoL over time and look at the influence of other psychosocial factors. Such studies may point to psychosocial interventions that may help improve QoL in IBM even if the disease itself cannot be treated.

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Alarms with self-reset capabilities may result in an excess number of audible alarms and clinical alarm fatigue. By eliminating self-resetting alarms, the volume of audible alarms and associated clinical alarm fatigue can be significantly reduced without requiring additional resources or technology or compromising patient safety and lead to improvement in both staff and patient satisfaction.

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Background-The benefit of primary percutaneous coronary interventions (P-PCI) for patients with ST-elevation myocardial infarction (STEMI) has been well documented. However, controversy still exists as to whether PCI should be expanded to hospitals without coronary artery bypass graft surgery. Methods and Results-Patients who were discharged after PCI for STEMI between January 1, 2003, andDecember 12, 2006, in P-PCI centers (hospitals with no coronary artery bypass graft surgery, and PCI only for patients with STEMI) were propensity matched with patients in full service centers, and mortality and subsequent revascularization rates were compared. For patients undergoing PCI, there were no differences for in-hospital/30-day mortality (2.3% for P-PCI centers versus 1.9% for full service centers [Pϭ0.40]), emergency coronary artery bypass graft surgery immediately after PCI (0.06% versus 0.35%, Pϭ0.06), 3-year mortality (7.1% versus 5.9%, Pϭ0.07), or 3-year subsequent revascularization (23.8% versus 21.5%, Pϭ0.52). P-PCI centers had a lower same/next day coronary artery bypass graft rate (0.23% versus 0.69%, Pϭ0.046) and higher repeat target vessel PCI rates (12.1% versus 9.0%, Pϭ0.003). For patients with STEMI who did not undergo PCI, P-PCI centers had higher in-hospital mortality (28.5% versus 22.3%; adjusted odds ratio, 1.38; 95% CI, 1.10 to 1.75). Conclusions-No differences between P-PCI centers and full service centers were found in in-hospital/30-day mortality, the need for emergency surgery, 3-year mortality or subsequent revascularization, but P-PCI centers had higher repeat target vessel PCI rates and higher mortality rates for patients who did not undergo PCI. P-PCI centers should be monitored closely, including the monitoring of patients with STEMI who did not undergo PCI. (Circ Cardiovasc Interv. 2009;2:519-527.)

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