Health-related workplace productivity measurement: adding to the list.
Explore the source record for details and available documents.
Absenteeism↗
Biomedical subjects
Brian Schwartz
Publications and source records attributed to Brian Schwartz.
Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.
BACKGROUND: Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks. We performed a randomized trial comparing intravenous lidocaine with intravenous amiodarone as an adjunct to defibrillation in victims of out-of-hospital cardiac arrest. METHODS: Patients were enrolled if they had out-of-hospital ventricular fibrillation resistant to three shocks, intravenous epinephrine, and a further shock; or if they had recurrent ventricular fibrillation after initially successful defibrillation. They were randomly assigned in a double-blind manner to receive intravenous amiodarone plus lidocaine placebo or intravenous lidocaine plus amiodarone placebo. The primary end point was the proportion of patients who survived to be admitted to the hospital. RESULTS: In total, 347 patients (mean [+/-SD] age, 67+/-14 years) were enrolled. The mean interval between the time at which paramedics were dispatched to the scene of the cardiac arrest and the time of their arrival was 7+/-3 minutes, and the mean interval from dispatch to drug administration was 25+/-8 minutes. After treatment with amiodarone, 22.8 percent of 180 patients survived to hospital admission, as compared with 12.0 percent of 167 patients treated with lidocaine (P=0.009; odds ratio, 2.17; 95 percent confidence interval, 1.21 to 3.83). Among patients for whom the time from dispatch to the administration of the drug was equal to or less than the median time (24 minutes), 27.7 percent of those given amiodarone and 15.3 percent of those given lidocaine survived to hospital admission (P=0.05). CONCLUSIONS: As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation.
Aged↗
Development of a medical examination program for former workers at a Department of Energy national laboratory.
BACKGROUND: As a part of the U.S. Department of Energy (DOE) Former Workers' Medical Surveillance Program, a Needs Assessment was conducted at Los Alamos National Laboratory (LANL). The objective was to identify former LANL employees who may be at significant risk for occupational disease and determine whether a medical examination program could reduce morbidity or mortality. We describe the needs assessment approach used at LANL. METHODS: An algorithm was developed to make needs determinations. Information on factors including exposure, health impacts, size of exposed populations, and LANL worker concerns and recommendations were obtained. Each of these factors was scored from 1 to 3. The resulting factor sum was then multiplied by a binary (1 or 0) intervention suitability factor which was 1 if both of the following were available: (1) a screening test with acceptable sensitivity and specificity for the health outcome of concern; and (2) an intervention that decreases morbidity or mortality. This resulted in an Intervention Needs Score that was used to set priorities for the medical examination program for the estimated 35,000 former LANL workers. RESULTS: Analysis of the algorithm output suggested that six exposure categories be recommended for consideration in a medical examination program. Beryllium, asbestos, and noise clearly warranted inclusion. Lead and ionizing radiation required careful consideration regarding availability of screening tests. Solvents were problematic due to the lack of screening tests and suitable intervention in formerly exposed workers. CONCLUSIONS: The algorithm approach to the needs assessment at LANL documented that six chemical and physical agents should be considered as candidates for inclusion in a medical examination program for former workers.
Aged↗
Gallium nitrate accelerates partial thickness wound repair and alters keratinocyte integrin expression to favor a motile phenotype.
The nitrate form of the Group III transitional element gallium (GN) increases expression of specific structural components of the provisional wound matrix (i.e., collagen type I, fibronectin) in human dermal fibroblasts. To evaluate the potential of GN as a therapeutic option in management of cutaneous trauma, GN-treated partial thickness porcine wounds and experimentally "injured" human keratinocyte (NHK) monolayer cultures were compared with mirror image control (i.e., saline-treated) sites. GN suppressed cell proliferation in both models, as determined by reduced Ki-67 reactivity and significant lengthening of keratinocyte cell cycle transit times, while effectively promoting reepithelialization. The primary effect of GN was apparently to promote cell migration, as neither epidermal thickness nor epidermal differentiation was altered as a result of GN exposure in vivo or in vitro. Significantly enhanced epidermal reepithelialization was associated with alterations in expression of several keratinocyte integrin subunits. GN induced a significant increase in alpha5 expression. alpha5beta1 switching is a characteristic of the motile phenotype in the setting of cutaneous injury. Concomitantly, GN treatment also induced a dramatic (70%) decrease in the expression of the alpha3 subunit; alpha3beta1 binds laminin 5 and is associated with hemidesmosome formation and reestablishment of a nonmotile phenotype. Taken together, the GN-induced changes in integrin expression favor acellular migration. While the molecular mechanism of GN action on resident cells of the skin remains to be defined, these data suggest that GN administration which represses MMP activity in the wound and increases matrix synthesis also accelerates NHK motility and, thereby, may be a useful therapeutic agent for wound repair.
Animals↗
Half-a-million strong: the emergency medical services response to a single-day, mass-gathering event.
INTRODUCTION: Emergency medical services (EMS) responses to mass gatherings have been described frequently, but there are few reports describing the response to a single-day gathering of large magnitude. OBJECTIVE: This report describes the EMS response to the largest single-day, ticketed concert held in North America: the 2003 "Toronto Rocks!" Rolling Stones Concert. METHODS: Medical care was provided by paramedics, physicians, and nurses. Care sites included ambulances, medically equipped, all-terrain vehicles, bicycle paramedic units, first-aid tents, and a 124-bed medical facility that included a field hospital and a rehydration unit. Records from the first-aid tents, ambulances, paramedic teams, and rehydration unit were obtained. Data abstracted included patient demographics, chief complaint, time of incident, treatment, and disposition. RESULTS: More than 450,000 people attended the concert and 1,870 sought medical care (42/10,000 attendees). No record was kept for the 665 attendees simply requesting water, sunscreen, or bandages. Of the remaining 1,205 patients, the average of the ages was 28 +/- 11 years, and 61% were female. Seven-hundred, ninety-five patients (66%) were cared for at one of the first-aid tents. Physicians at the tents assisted in patient management and disposition when crowds restricted ambulance movement. Common complaints included headache (321 patients; 27%), heat-related complaints (148; 12%), nausea or vomiting (91; 7.6%), musculoskeletal complaints (83; 6.9%), and breathing problems (79; 6.6%). Peak activity occurred between 14:00 and 19:00 hours, when 102 patients per hour sought medical attention. Twenty-four patients (0.5/10,000) were transferred to off-site hospitals. CONCLUSIONS: This report on the EMS response, outcomes, and role of the physicians at a large single-day mass gathering may assist EMS planners at future events.
Adolescent↗
Measuring the EMS patient access time interval and the impact of responding to high-rise buildings.
OBJECTIVES: To measure the patient access time interval and characterize its contribution to the total emergency medical services (EMS) response time interval; to compare the patient access time intervals for patients located three or more floors above ground with those less than three floors above or below ground, and specifically in the apartment subgroup; and to identify barriers that significantly impede EMS access to patients in high-rise apartments. METHODS: An observational study of all patients treated by an emergency medical technician paramedics (EMT-P) crew was conducted using a trained independent observer to collect time intervals and identify potential barriers to access. RESULTS: Of 118 observed calls, 25 (21%) originated from patients three or more floors above ground. The overall median and 90th percentile (95% confidence interval) patient access time intervals were 1.61 (1.27, 1.91) and 3.47 (3.08, 4.05) minutes, respectively. The median interval was 2.73 (2.22, 3.03) minutes among calls from patients located three or more stories above ground compared with 1.25 (1.07, 1.55) minutes among those at lower levels. The patient access time interval represented 23.5% of the total EMS response time interval among calls originating less than three floors above or below ground and 32.2% of those located three or more stories above ground. The most frequently encountered barriers to access included security code entry requirements, lack of directional signs, and inability to fit the stretcher into the elevator. CONCLUSIONS: The patient access time interval is significantly long and represents a substantial component of the total EMS response time interval, especially among ambulance calls originating three or more floors above ground. A number of barriers appear to contribute to delayed paramedic access.
Ambulances↗
Use of treat-and-release medical directives for paramedics at a mass gathering.
INTRODUCTION: Paramedics provide a substantial proportion of care at mass gatherings but do not typically release patients without physician assessment. OBJECTIVE: To evaluate treat-and-release medical directives implemented at a large single-day summer rock concert. METHODS: Medical directives allowed paramedics to administer acetaminophen, dimenhydrinate, diphenhydramine, or polymyxin B ointment for common complaints without evidence of serious illness on history or examination. After treatment, patients were released or transferred to a medical facility according to predefined criteria. Patient demographics, chief complaint, treatment, and disposition were obtained from paramedic records. To determine whether any patients released by paramedic subsequently required ambulance transport, all ambulance records were searched for a period of eight hours before to 24 hours after the event. RESULTS: More than 450,000 people attended the concert, with 1,870 presenting for medical attention. Four hundred seven patients received medications under the directives. No disposition was recorded in 13 cases. Two hundred ninety-nine patients were treated with acetaminophen, of whom 269 (90.0%) were released and 23 (7.7%) required additional care. Sixty-two patients received dimenhydrinate, 44 (71%) were released, and 14 (23%) required transport. Thirty-six patients received diphenhydramine, and 34 (94%) were released. Ten patients received polymyxin B and were released. No patient released by paramedics was found to have later required ambulance transport. CONCLUSIONS: Treat-and-release medical directives for paramedics at mass gatherings may help divert patients from requiring care at a medical facility. Future research is needed to determine the safety (morbidity and mortality) of these directives.
Adolescent↗