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Biomedical subjects

B M Thompson

Publications and source records attributed to B M Thompson.

At least 19 recordsLinked to original sources
PubMed1999

1998-1999 SAEM emergency medicine faculty salary and benefits survey.

OBJECTIVES: The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefits survey for all 1998 residency review committee (RRC)-EM-accredited programs using the SAEM fourth-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. METHODS: Blinded program and individual faculty data were entered into a customized version of FileMaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by program region, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to the American Association of Medical Colleges (AAMC). Demographic data were analyzed with regard to numerous criteria, including department staffing levels, ED volumes, ED length of stay, department income sources, salary incentive components, and specific type and value of fringe benefits offered. Data were compared with those from previous SAEM studies. RESULTS: Seventy-three of 120 (61%) accredited programs responded, yielding usable data for 70 programs and 965 full-time faculty among the four AAMC regions. Mean salaries were reported as follows: all faculty, $167,478; first-year faculty, $140,616; programs reporting data to the AAMC, $161,794; programs not reporting data to the AAMC, $165,724. Mean salaries as reported by AAMC region: northeast, $167,876; south, $160,586; midwest, $190,957; west, $148,977. CONCLUSIONS: Reported salaries for full-time EM residency faculty continue to rise. Significant regional differences in salaries have been present in all four SAEM surveys. Nonclinical hours are compensated at approximately one-half the rate paid for clinical hours. The demographic data indicate that EM residency faculty are working at the upper extremes of numbers of patient encounters per physician, patient acuity levels, and department lengths of stay.

Certification↗
PubMed1998

1995-1996 SAEM emergency medicine faculty salary/benefits survey.

OBJECTIVE: The Society for Academic Emergency Medicine (SAEM) commissioned an emergency medicine (EM) faculty salary and benefit survey for all 1995 Residency Review Committee in Emergency Medicine (RRC-EM)-accredited programs using the SAEM third-generation survey instrument. Responses were collected by SAEM and blinded from the investigators. POPULATION: Seventy-six of 112 (68%) accredited programs responded, yielding data for 1,032 full-time faculty among the four Association of American Medical Colleges (AAMC) regions. METHODS: Blinded program and individual faculty data were entered into a customized version of Filemaker Pro, a relational database program with a built-in statistical package. Salary data were sorted by 115 separate criteria such as program regions, faculty title, American Board of Emergency Medicine (ABEM) certification, academic rank, years postresidency, program size, and whether data were reported to AAMC. Demographic data from 132 categories were analyzed and included number of staff and residents per shift, number of intensive care unit (ICU) beds, obstacles to hiring new staff, and specific type and value of fringe benefits offered. Data were compared with those from the 1990 and 1992 SAEM and the 1995-96 AAMC studies. RESULTS: Mean salaries were reported as follows: all faculty, $158,100; first-year faculty, $131,074; programs reporting data to AAMC, $152,198; programs not reporting data to AAMC, $169,251. Mean salaries as reported by AAMC region: northeast, $155,909; south, $155,403; midwest, $172,260; west, $139,930. Mean salaries as reported by program financial source: community, $175,599; university, $152,878; municipal, $141,566. CONCLUSIONS: Reported salaries for full-time EM residency faculty continue to rise. Salaries in programs reporting data to the AAMC are considerably lower than those not reporting. The gap between ABEM-certified and non-ABEM-certified faculty continues to widen. Residency-trained faculty are now shown to earn more than non-residency-trained faculty. Significant regional differences in salaries have been present in all three SAEM surveys.

Emergency Medicine↗
PubMed1997

Selenium regulation of selenium-dependent glutathione peroxidases in animals and transfected CHO cells.

Glutathione peroxidase (GPX1) was the first identified selenium-dependent enzyme, and this enzyme has been most useful as a biochemical indicator of selenium (Se) status and the parameter of choice for determining Se requirements. We have continued to study Se regulation of GPX1 to better understand the underlying mechanism and to gain insight into how cells themselves regulate nutrient status. In progressive Se deficiency in rats, GPX1 activity, protein and mRNA all decrease in a dramatic, coordinated and exponential fashion such that Se-deficient GPX1 mRNA levels are 6-15% of Se-adequate levels. mRNA levels for other Se-dependent proteins are far less decreased in the same animals. The mRNA levels for a second Se-dependent peroxidase, phospholipid hydroperoxide glutathione peroxidase (GPX4), are little affected by Se deficiency, demonstrating that Se regulation of GPX1 is unique. Se regulation of GPX1 activity in growing male and female rats shows that the Se requirement is 100 ng/g diet, based on liver GPX1 activity; use of GPX1 mRNA as the parameter indicates that the Se requirement is nearer to 50 ng Se/g diet in both male and female rats. This approach will readily detect an altered dietary Se requirement, as shown by the incremental increases in dietary Se requirement by 150, 100 or 50 ng Se/g diet in Se-deficient rat pups repleted with Se for 3, 7 or 14 d, respectively. Studies with CHO cells stably transfected with recombinant GPX1 also show that overexpression of GPX1 does not alter the minimum level of media Se necessary for Se-adequate levels of GPX1 activity or mRNA. We hypothesize that classical GPX1 has an integral biological role in the mechanism used by cells to regulate Se status, making GPX1 an especially useful and effective parameter for determining Se requirements in animals.

Animals↗
PubMed1995

Western Nebraska family (family D) with autosomal dominant parkinsonism.

The etiology of Parkinson's disease (PD) remains uncertain. Environmental influences may have an important role, but genetic factors have been firmly implicated in several recently reported kindreds. We studied a family (family D) whose ancestors probably immigrated to the United States from England. The pedigree contains 188 individuals spanning six generations with 18 affected members. Autosomal dominant inheritance is present. Typical levodopa-responsive PD with bradykinesia, rigidity, resting tremor, and impaired postural reflexes develops. Eye movement abnormalities, pyramidal and cerebellar signs, sensory disturbances, and orthostatic blood pressure changes do not occur. Disease progression is slow. PET with [18F]-6-fluoro-L-dopa (FD) performed on an affected individual revealed decreased uptake of FD in a pattern consistent with PD. Autopsy performed on another affected individual demonstrated neuronal and pigmentary loss, gliosis, and Lewy bodies in the substantia nigra pars compacta. This large kindred appears to represent a neurodegenerative disorder closely resembling, if not identical to, idiopathic PD.

Aged↗
PubMed1989

Iontophoretic treatment of herpetic whitlow.

Herpetic whitlow can be a vector for spread of infection, especially among health care professionals. Until now, treatment has been inadequate. In two patients with documented herpetic infections of the finger, the antiviral drug idoxuridine was applied to the lesions by cathodal iontophoresis. Results were characterized by rapid relief of discomfort and swelling, rapid appearance and coalescence of vesicles, and rapid healing, with reduced pain and little or no paresthesia. No recurrences have been noted in the two patients after 42 and 38 months. The positive beneficial results indicate that aggressive iontophoretic treatment for herpetic whitlow is useful and justified.

Adult↗
PubMed1987

Digoxin levels in prehospital sudden-death syndrome.

Digitalis toxicity is common and has been associated with ventricular dysrhythmias. Digoxin levels in patients who suffer prehospital sudden death have never been studied. This study measured digoxin levels in a population of sudden-death patients. During the 15-week study period, 252 patients in cardiac arrest were seen by an urban paramedic system. During daytime hours, paramedics were requested to obtain a blood sample from sudden-death patients; the samples were subsequently analyzed for digoxin by means of radioimmunoassay. Thirty-nine patients had measured digoxin levels drawn; 28 (71.8%) were in the therapeutic range (0.5-2.1 ng/mL), and four (10.2%) were in the toxic range (greater than 2.1 ng/mL). The patients with toxic dogoxin levels and those with nontoxic levels had similar resuscitation rates (50.0% vs. 34.3%, P = NS), but none were found in ventricular fibrillation. Emergency medical services personnel should consider digoxin toxicity as a potential etiology of arrest.

Aged↗
PubMed1987

Development of a staff training program at the Wesley Hospital.

This paper reports the development of a staff training program at The Wesley Hospital in response to perceived needs. A training needs analysis identified priorities for training. Three courses have been run: decision making workshops, stress management workshops, and an assertion seminar. The design of these courses, and staff responses are discussed. Future developments in the training program are proposed.

Hospital Bed Capacity, 300 to 499↗
PubMed1986

Decision making in prehospital sudden cardiac arrest.

Many studies of prehospital resuscitation report on selected populations. We examined a series of 445 unselected nontraumatic cardiac arrests. Emergency cardiac care (ECC) was not initiated in 126 (28%). ECC was begun in 319 (78%), but was terminated in 132 (33%). Ninety-four (21%) were admitted to the hospital with palpable pulses and organized rhythm (successful resuscitation/save rate for patients presenting in ventricular fibrillation was 50%/25%. Multivariate regression analysis was used to identify the relative importance of significant variables in predicting survival, and the analysis identified the presence of ventricular fibrillation, short paramedic response times, and short paramedic treatment times.

Aged↗
PubMed1986

Rib radiographs for trauma: useful or wasteful?

In trauma to the chest, the clinical impression and the physical findings of rib fractures are nonspecific. Fractures often are not seen on initial films. The principal diagnostic goal should be the detection of significant complications (pneumothorax, hemothorax, major vascular injury, or pulmonary contusion) requiring admission. The therapeutic effort should be to provide pain relief and prevent the delayed development of atelectasis or pneumonia in patients with painful chest wall injuries, whether or not a fracture is detected initially. An upright posteroanterior chest radiograph has the greatest yield in detecting fractures and complications resulting from them. Tomograms and expiratory, oblique, and "coned-down" views should not be done routinely. The use of these more specific examinations may be indicated, however, in such cases as trauma to ribs 1 to 3 or 9 to 12. Their selective use in isolated cases (trauma to ribs 1 to 3 or 9 to 12) and suspected child abuse may indicate the need for these more specific examinations. Because detection of pulmonary complications of chest trauma is most important, a delayed or repeat upright posteroanterior chest radiograph may be the most cost-effective second radiograph. Significant medical care cost savings may be appreciated by limiting the use of specific rib views to instances in which it might influence the patient's therapy.

Adolescent↗
PubMed1986

Prophylactic lidocaine in the prehospital patient with chest pain of suspected cardiac origin.

The prophylactic use of lidocaine in the patient with cardiac chest pain has been reported to reduce the incidence of sudden death from ventricular dysrhythmias in the hospital setting, but few studies have been done in the early prehospital phase. We conducted a randomized, prospective study comparing the effects of lidocaine versus no lidocaine in stable patients presenting with chest pain to a paramedic system. In a one-year period, 446 patients qualified for the study; 222 received lidocaine and 224 did not. The overall hospital mortality of the two groups was 8.1% and 6.7%, respectively (P = .35). Four patients in each group developed sudden death in the prehospital and emergency department settings with ventricular dysrhythmia as the precipitating rhythm. One hundred twenty-nine (29%) had an acute myocardial infarction. The lidocaine and control group contained 68 and 61 of the patients, respectively, with an overall mortality rate of 14.7% and 13.1% (P = .45). The development of significant dysrhythmias (frequent premature ventricular contractions, ventricular tachycardia, bradycardia, second- and third-degree heart blocks) after initiation into the study was similar in both groups of patients. The use of lidocaine was a factor in decreasing systolic blood pressure (P less than 0.03) but did not appear to be clinically significant. For stable patients presenting with chest pain of suspected cardiac origin, prophylactic lidocaine in the prehospital setting was not effective in preventing life-threatening dysrhythmias, but clinically significant side effects were not noted either.

Adult↗
PubMed1986

Calcium: limited indications, some danger.

Calcium chloride has been advocated since the 1920s for the resuscitation of asystole, electromechanical dissociation (EMD), and ventricular fibrillation. Reports of side effects and complications have been numerous. Studies of calcium assays following American Heart Association recommended dosages have shown dangerously elevated serum levels. Large retrospective clinical studies in Milwaukee and Tampa have found no evidence of improved survival with calcium chloride in asystole and EMD. A prospective randomized double-blind study comparing calcium chloride and saline controls in the Milwaukee Paramedic system for asystole and EMD using standard AHA protocols showed no statistically significant difference in resuscitation rates or long-term survival between the calcium and no-calcium groups for the rhythm of asystole. Although patients with EMD had statistically improved resuscitation rates when calcium chloride was given, only one of the patients survived to hospital discharge. Because of the low rates of resuscitation and long-term survival in patients presenting in asystole and EMD, proving that calcium chloride does not enhance survival would require large multicenter trials. However, since no controlled study has ever documented significant benefit, its routine use in asystole and EMD cannot be supported. Calcium has long been used in medical treatment of hypocalcemic and hyperkalemic states and should be administered in moribund patients who have the proper clinical history and clinical signs of hypocalcemia.

Animals↗
PubMed1985

Pre-hospital IAC-CPR versus standard CPR: paramedic resuscitation of cardiac arrests.

Recent studies evaluating interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) have demonstrated a significant increase in cardiac output, mean arterial pressure, and cerebral perfusion, as compared with standard CPR. A clinical evaluation of IAC-CPR effectiveness on resuscitation outcome has not been reported. A prospective randomized study comparing IAC-CRP with standard CPR for resuscitation of prehospital cardiopulmonary arrest was undertaken using the Milwaukee County Paramedic System. The patients were randomized following endotracheal intubation into IAC-CPR and standard CPR groups. Since October 1983, 291 patients have qualified for the study group. Of these, 146 patients had standard CPR, and 45 (31%) were successfully resuscitated. Of the 145 patients treated with IAC-CPR, 40 (28%) were successfully resuscitated. Chi-square analysis reveals no significant difference between these groups. To determine whether abdominal compression increases regurgitation, the frequency of emesis before and after intubation was analyzed. No significant difference was found between the IAC-CPR and standard CPR groups. Thus, IAC-CPR applied by paramedics in the field to patients following intubation does not improve cardiac resuscitation rates.

Abdomen↗
PubMed1985

Effects of high infusion pressure and large-bore tubing on intravenous flow rates.

An in vitro study was conducted to determine the maximum flow rates that can be obtained with commercially available intravenous (IV) catheters, when infusion pressure and IV tubing size are modified. Standard tubing (3.2 mm ID) and two sizes of experimental large-bore tubing (5.0 mm and 6.4 mm ID) were tested with tap water and diluted packed cells (hematocrit 45) at 600 mm Hg, 300 mm Hg, and gravity flow infusion pressure. The maximum flow rate obtained was 3,158 ml/min for tap water and 3,000 ml/min for diluted packed cells. The increases in flow rates from gravity to 300 mm Hg and from gravity to 600 mm Hg are significant (P less than 0.05) and provide up to 197% and 341% increases, respectively, for all catheter/tubing combinations tested. Large-bore tubing is most effective when used in conjunction with large-bore catheters. For the 8.5 French catheter, a change from standard (3.2 mm ID) to large-bore (6.4 mm ID) tubing resulted in a statistically significant (P less than 0.05) increase in flow rate of more than 200% regardless of infusion pressure.

Fluid Therapy↗
PubMed1985

Comparison of clinical CPR studies in Milwaukee and elsewhere in the United States.

As we mark the 25th anniversary of the clinical application of closed-chest cardiopulmonary resuscitation (SCPR), it is time to look back and analyze the progress we have made in the resuscitation of sudden death syndrome. Recent studies of SCPR's effectiveness have yielded mixed results, in comparison to early studies that were universally favorable. The continued toll of neurologic injury following SCPR resuscitation, and reinforcement of the importance of defibrillation in resuscitation, stimulate us to find improved forms of SCPR and improved methods of resuscitation delivery in emergency medical systems.

Electric Countershock↗