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Biomedical subjects

H M O'Connor

Publications and source records attributed to H M O'Connor.

9 recordsLinked to original sources
PubMed1999

The use of computer simulation as a strategic decision-making tool: a case study of an emergency department application.

Computer simulation is a recognized decision support tool, one which has been used in many healthcare applications. Simulation offers the benefit of constructing and analyzing multiple "what if" scenarios without disrupting patient care or incurring significant cost. This article describes the successful use of computer simulation in the evaluation of multiple restructuring options in the emergency departments of a health sciences centre. Healthcare executives require timely and meaningful information to assist with strategic choices, and computer simulation can play a significant role in decision support.

Computer Simulation↗
PubMed1999

Standardized patients in the early acquisition of clinical skills.

OBJECTIVES: Facing dramatic reductions of inpatient beds and fewer faculty tutors, the Queen's University medical school has had to consider alternatives to the traditional inpatient encounter for the early acquisition of clinical skills. The purpose of this study was to investigate the feasibility and impact on students of a model for a first-year clinical skills course, using exclusively standardized patients in place of inpatients, and using a smaller ratio of faculty to students. DESIGN: Twenty volunteers were selected from the first-year class of 75 students to participate as the experimental group. The remaining 55 students formed the control group. SETTING: Queen's University medical school, Ontario, Canada. SUBJECTS: First-year medical students. RESULTS: In measures of student satisfaction with the amount of performance feedback received during the course, there was a non-significant trend towards greater satisfaction among the experimental group compared to the control group. This occurred despite a tutor to student ratio of 1.5:10 in the experimental group compared to 3:10 in the control group. In the student evaluation of their tutors, mean scores for the two groups were 4.28 for the experimental group and 4. 06 for the control group (P = 0.10). The mean OSCE scores for the two groups were 76.4 for the experimental group and 76.5 for the control group (P = 0.93). There is no practical or statistical difference in either of these two scores. CONCLUSIONS: We conclude that this new model is feasible, was well received by the students and that the reduced tutor to student ratio and lack of inpatient encounters did not appear to adversely affect their learning.

Adult↗
PubMed1997

Running an objective structured clinical examination on a shoestring budget.

BACKGROUND: A major obstacle in the wide implementation of objective clinical structured examinations (OSCEs) is their high cost, averaging $200 to $300 (Canadian dollars, CDN) per candidate and estimated at up to CDN$900 per candidate if all "hidden" administrative costs are included. METHODS: A detailed cost analysis of preparing and administering OSCEs at 1 institution was undertaken over 2 years. An 18-station, 6-minute-per-station OSCE was given to a 72-student third-year medical class. RESULTS: The total cost of the OSCE was CDN$5,010, or $70 per student. The key factors in reaching this significantly lower per-student OSCE cost included: judicious use of standardized patients, use of academic faculty for preparing and marking the stations, and decreased secretarial and other administrative costs. CONCLUSIONS: Data suggest that OSCEs can be set up with reasonable cost and limited resources even in smaller institutions. Cost should not be considered a major obstacle in implementing this excellent examination type in undergraduate medical education.

Canada↗
PubMed1997

Clinical skills training: developing objective assessment instruments.

The purpose of this study was to develop objective assessment instruments for use in psychomotor skill training and to test the instruments for interobserver reliability. Two checklist style instruments, one for suturing and one for endotracheal intubation, were developed through a process of review of standard texts, consultation with local experts and field testing. Following development they were used by paired examiners in an Objective Structured Clinical Examination (OSCE) setting to test the instruments for interobserver reliability. A total of 88 final year medical students were recruited from the five Ontario medical schools to participate as examinees. The checklists worked well within the practical constraints of a 10 minute OSCE station and demonstrated a high level of interobserver reliability with Kappa scores of 0.65 for the suturing checklist and 0.71 for the intubation checklist Furthermore, the Kappa scores for individual checklist items served to identify items which demonstrated poor interobserver reliability and thus highlighted them for review.

Clinical Competence↗
PubMed1992

Cardiac arrest in Ontario: circumstances, community response, role of prehospital defibrillation and predictors of survival.

OBJECTIVES: To describe the patient characteristics, circumstances and community response in cases of out-of-hospital cardiac arrest; to evaluate the effect on survival of the introduction of prehospital defibrillation; and to identify factors that predict survival. DESIGN: Population-based before-and-after clinical trial. SETTING: Five Ontario communities: London, Sudbury, the Greater Niagara region, Kingston and Ottawa. PATIENTS: A consecutive sample of 1510 primary cardiac arrest patients who were transported to hospital by ambulance over 2 years. INTERVENTION: The use of defibrillators by ambulance attendants. MAIN OUTCOME MEASURES: Patient characteristics (sex and age), circumstances of arrest (place, whether arrest was witnessed and cardiac rhythm), citizen response (whether cardiopulmonary resuscitation [CPR] was started by a bystander, time to access to emergency medical services and time to initiation of CPR), emergency medical services response (ambulance response time, time to initiation of CPR and time to rhythm analysis with defibrillator) and survival rates. MAIN RESULTS: A total of 92.1% of the patients were 50 years of age or older, and 68.3% were men. Overall, 79.6% of the arrests occurred in the home. The average ambulance response time for witnessed cases was 7.8 minutes. The overall survival rate was 2.5%. The survival rates before and after defibrillators were introduced were similar, and the general functional outcome of the survivors did not differ significantly between the two phases. Factors predicting survival included patient's age, ambulance response time and whether CPR was started before the ambulance arrived. CONCLUSIONS: The survival rate was lower than expected. The availability of prehospital defibrillation did not affect survival. To improve survival rates after cardiac arrest ambulance response times must be reduced and the frequency of bystander-initiated CPR increased. Once these changes are in place a beneficial effect from advanced manoeuvres such as prehospital defibrillation may be seen.

Adult↗
PubMed1987

Treatment of migraine with intramuscular chlorpromazine.

We undertook a prospective, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of intramuscular parenteral chlorpromazine (CPZ) in the treatment of the acute migraine attack. Thirty-six patients who presented to the emergency department with migraine headache were given either CPZ (1 mg/kg) or a saline placebo and were observed for one hour. Of those receiving CPZ, nine of 19 (47.4%) had sufficient relief from their headache to carry on with their activities of daily living, compared with four of 17 (23.5%) of the control group. This difference was not statistically significant. However, the drug was more often effective than a placebo in giving some relief from the headache (P less than .005) and in relieving nausea significantly more often than placebo (P less than .001). The only significant side effects were drowsiness (P less than .01), and an asymptomatic drop in blood pressure (10 mm Hg systolic) (P less than .05). This controlled study demonstrates that CPZ is a safe medication that provides some relief from migraine headaches, but it is less efficacious than suggested in earlier reports.

Adult↗
PubMed1985

Review of traumatic injuries in regional federal penitentiaries.

The incidence of major injuries in inmates of Canadian prisons has steadily increased in recent years. The medical records of the emergency department serving virtually all prisoners at federal penitentiaries in the Kingston, Ont. area were reviewed for cases of traumatic injury. In the 30-month period ending Mar. 1, 1984 there were 353 visits to the emergency department, of which 140 were for accidental injuries and 213 for injuries resulting from violence. Of the injuries caused by violence 75 (35%) were self-inflicted and 138 (65%) were inflicted by others. Of the 75 inmates with self-inflicted injuries 17 required admission to hospital, and 12 of these underwent surgery. Of the 138 inmates injured by others 50 were admitted to hospital, and 6 of these were transferred to the neurosurgical or cardiothoracic department at Kingston General Hospital; 31 of the 50 underwent surgery, and 4 died in hospital as a result of their injuries.

Accidents↗