Biomedical subjects

J Blanton

Publications and source records attributed to J Blanton.

4 recordsLinked to original sources

PubMed1991

Prehospital diagnosis and treatment of acute myocardial infarction: a north-south perspective. The Cincinnati Heart Project and the Nashville Prehospital TPA Trial.

Intravenous thrombolytic therapy improves left ventricular function and reduces mortality in patients with acute myocardial infarction (AMI). In European and Middle Eastern trials, prehospital delivery of thrombolytic agents by physician-directed mobile intensive care units has been successful. This report describes two independently conceived and performed trials that used cellular telephone transmission of 12-lead ECGs to deliver recombinant tissue plasminogen activator (r-tPA) in the field to patients with AMI. In the Nashville Prehospital TPA Trial, 85 patients with chest pain were evaluated in the field for possible administration of r-tPA over a 6-month period. Three of 85 patients (3.5%) were found to be actual candidates for r-tPA treatment in the field. In phase II (dry-run phase) of the Cincinnati Heart Project, 374 patients were evaluated in the field with 14 documented cases of AMI (3.7%) before r-tPA was placed in ambulances for administration by paramedics. In phase III (active with r-TPA in ambulances), over a 1-year period 103 patients were evaluated with six (5.8%) documented cases of AMI. Three of five r-tPA field treatment decisions by emergency physicians using transmitted 12-lead ECGs were accurate (60%). When patients in phases II and III were combined, only 20 of 477 total patients (4.2%) were documented to have AMI. A decline in paramedic skills was noted because of the infrequent administration of the thrombolytic agent. Combining the Nashville and Cincinnati experiences, only 27 of 562 total patients with chest pain (4.8%) were candidates for prehospital thrombolysis. We conclude that few patients evaluated in the prehospital setting are actual candidates for thrombolytic therapy. Substantial allocation of financial and human resources for prehospital delivery of intravenous thrombolytic therapy does not appear warranted.

Adolescent↗

PubMed1988

Early identification of patients with acute myocardial infarction.

In conclusion, early identification of AMI requires the utilization of three main criteria: (1) History and physical examination; (2) 12-lead electrocardiography, and (3) serum protein markers of myocardial cell death. The history may indicate admission for AMI exclusion or unstable angina, although these data remain largely subjective. The physical examination provides few clues in subtle presentations of myocardial cell death, and instead identifies patients with left ventricular dysfunction, often with failure. The 12-lead ECG is an insensitive early indicator of AMI, often identifying 50% or fewer of these patients. Currently, thrombolytic therapy or invasive catheterization techniques such as PTCA are based on 12-lead depictions of acute injury patterns. Finally, serum markers of AMI, particularly myoglobin, CPK-MM isoforms, and new monoclonal antibody assays for CPK-MB may allow early identification of patients with AMI with nondiagnostic ECGs.

Creatine Kinase↗

PubMed1978

How evaluation findings can be integrated into program decision making.

The paper describes difficulties in integrating the findings of research and evaluation studies back into the ongoing process of decision making. The paper suggests how to present information in such a way as to improve its intellectual understandability and to decrease affective resistances to the acceptance of new information. The paper also describes common blocks that are met in the attempt to implement recommendations and describes methods to overcome them.

Affect↗

PubMed1976

A study of paraprofessionals in mental health.

This article summarizes data gathered on 15 paraprofessional training programs sponsored by the National Institute of Mental Health (NIMH). Data on the backgrounds of trainees working as paraprofessionals are presented along with a breakdown of the kinds of tasks in which they are employed, as well as characteristics linked with ratings of success and retention in the programs. Trainees tended to be employed in a wide variety of tasks, often at rather sophisticated levels. Analysis of the tasks indicates that projects are fulfilling the NIMH New Careers goal of contributing to greater community impact in mental health. Results corroborate earlier findings that para professionals have been accepted both by professionals and clients.

Adolescent↗