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Jeffrey B Riley

Publications and source records attributed to Jeffrey B Riley.

8 recordsLinked to original sources
PubMed2006

Successful use of a competency step exam in a perfusion education program.

The perfusion education program at The Ohio State University uses a step exam to rank students and identify incompetent students in regard to the program learning objectives. The step exam determines student progress from the didactic to the clinical phase. Each student must pass the competency step exam to gain entry to the clinical rotations. The development, use, and results of the step exam are reported. The design and knowledge matrix establish the content validity of the exam. Single test question discrimination and difficulty statistics identify valid exam items. Examples of the exam's predictive ability are presented. The step exam is a 200-question exam using multiple choice items. The exam is modeled after several health-related national certification exam processes. The exam has content validity based on the published, written objectives for the education program. Each item on the exam has a history of use and meets criteria for difficulty, discrimination, and distraction. The use of a high-stake competency exam in clinical science and medical education programs is controversial and technically challenging. A step exam to have high-stake consequences must be reliable, meet requirements for content validity, and hopefully exhibit predictive validity.

Allied Health Occupations↗
PubMed2006

In vitro evaluation of the air separation ability of four cardiovascular manufacturer extracorporeal circuit designs.

Neurologic impairment is a common complication of adult cardiac surgery. Cerebral gaseous microemboli (GME) detected during cardiopulmonary bypass has been associated with cognitive impairment after adult cardiac surgery. Several previous studies have shown that components comprising the extracorporeal circuit (ECC) can affect the ability of the ECC to eliminate air. The differences in the air separation ability of four manufacturer's commonly used ECCs were studied. The air-separating ability of Cobe Cardiovascular, Gish Biomedical, Medtronic, and Terumo Cardiovascular Systems Corp. ECCs were studied in vitro under clinically relevant conditions. Bolus and continuous venous air were introduced and output GME patterns by size, time, and count were measured (using an embolus detection device) and statistically analyzed. Graphic representations depicting elapsed time, GME size, and bubble count helped to visually rank the air-handling performance of the ECCs. There are significant air-handling differences between the ECCs tested. Overall, the blinded results reveal that ECC A and ECC C removed significantly (p < 0.001) more suspended GME than ECC B and ECC D. In the 50-mL venous room-air bolus and the 100 mL/min pulsed air challenges, ECC B and ECC D allowed significantly more GME to pass (p < 0.001) compared with ECC A and ECC C. For example, in a 2-hour pump run ECC C would deliver 480 potential high-intensity transient signals (HITS) compared with the 9600 from the ECC B during venous room air entrainment at 100 mL/min. There are substantial and significant air-handling differences between the ECCs from the four different manufacturers. The results from this work allow for objective characterization of ECCs air-separating ability. This additional information provides an opportunity for clinicians to potentially minimize the risks of arterial air embolization and its associated deleterious neurologic effects, while allowing clinicians to make better-informed consumer decisions.

Analysis of Variance↗
PubMed2005

Quantifying platelet gel coagulation using Sonoclot and Thrombelastograph hemostasis analyzer.

Little in vitro research exists discussing platelet gel composition and the resulting strength and degradation characteristics using point-of-care technologies. There must be a quantifiable way of determining the structural integrity of the resulting formed platelet gel thrombus. The Thrombelastograph Hemostasis Analyzer (TEG) and Sonoclot measure the elasticity of a clot as it forms and subsequently degrades naturally. The objective of this study was to determine the application of TEG and Sonoclot technologies as point-of-care devices for technicians using platelet gel therapy. The collected bovine blood was anticoagulated with CPD and processed using a previously published plasma sequestration protocol, using normal saline as a wash solution. The resulting platelet-rich plasma was stored in a sequestration bag in a water bath to maintain the blood temperature at 37 degrees C. Sequestered bovine platelet-rich plasma was made into platelet gel using three different thrombin concentrations. A total of 30 experiments were performed on the platelet gel product using both the TEG and the Sonoclot. We discovered that 6 of the Sonoclot tests and 15 of the TEG tests were valid. None of the TEG clot signatures and nine of the Sonoclot signatures were discovered to be invalid. A chi2 test was performed on the resultant data. The value of the chi2 test was calculated to be 12.86, which translated into a p value of less than 0.001. Despite the vast use and growing popularity of platelet gels, a method in which to quantify platelet gels has yet to be reported. There remains a possibility that gels formed with different concentrations of components may prove useful in different areas of surgery or their uses may expand to a broader spectrum of medicine. However, technology to quantify platelet gels must first be standardized. On the basis of the data collected in this study, it was determined that the TEG and the Sonoclot are not equally capable of analyzing platelet gel clots. The TEG is a valid means for analysis, whereas the Sonoclot provided unreliable analysis based on a Chi-squared test.

Animals↗
PubMed2005

Thrombelastograph (TEG) analysis of platelet gel formed with different thrombin concentrations.

Autologous blood transfusion is the safest and most successful way to decrease transfusion-related risks such as postoperative infections, allo-immunization, and short- and long-term immunosuppression. In addition, these fibrin sealants are known to provide coagulation support at the surgical site and act as an adjunct to the control of postoperative bleeding. The physical formation of autologous platelet fibrin gel clot is dependent on both the common pathway of the coagulation cascade and platelet activation. Platelet gel can help provide control of intraoperative and postoperative bleeding. The Thrombelastograph Hemostasis Analyzer (TEG) measures the viscoelastic properties of a clot as it forms. Based on the information that the TEG provides, it promises to be a good choice for point of care measurement of the integrity of thrombus formed by platelet gels. Bovine blood from a single donor was sequestered into platelet-rich plasma and was made into platelet gel using calcium and three different concentrations of thrombin. The platelet gel samples were then analyzed with the TEG analyzer. The results for MA, tMA, CI, and angle were recorded and statistical analysis was performed to accept or reject the null hypothesis, which is: There is no difference between TEG parameters when analyzing platelet gels formed with calcium chloride, platelet-rich plasma and three different concentrations of thrombin A one-way analysis of variance test was performed between thrombin concentrations for MA (p = 0.19), tMA (p = 0.443), CI (p = 0.257), and angle (p = 0.323). The results showed that thrombin concentration did not affect the MA, tMA, CI, or angle as measured by the TEG analyzer. The null hypothesis was accepted. Based on a one-way analysis of variance test for MA, tMA, CI, and angle there was no significant statistical difference for the TEG samples in this experiment as reported with a 95% confidence interval.

Animals↗
PubMed2004

Internet-based virtual classroom and educational management software enhance students' didactic and clinical experiences in perfusion education programs.

A challenge faced by many university-based perfusion education (PE) programs is the need for student clinical rotations at hospital locations that are geographically disparate from the main educational campus. The problem has been addressed through the employment of distance-learning environments. The purpose of this educational study is to evaluate the effectiveness of this teaching model as it is applied to PE. Web-based virtual classroom (VC) environments and educational management system (EMS) software were implemented independently and as adjuncts to live, interactive Internet-based audio/video transmission from classroom to classroom in multiple university-based PE programs. These Internet environments have been used in a variety of ways including: 1) forum for communication between the university faculty, students, and preceptors at clinical sites, 2) didactic lectures from expert clinicians to students assigned to distant clinical sites, 3) small group problem-based-learning modules designed to enhance students analytical skills, and 4) conversion of traditional face-to-face lectures to asynchronous learning modules. Hypotheses and measures of student and faculty satisfaction, clinical experience, and learning outcomes are proposed, and some early student feedback was collected. For curricula that emphasize both didactic and clinical education, the use of Internet-based VC and EMS software provides significant advancements over traditional models. Recognized advantages include: 1) improved communications between the college faculty and the students and clinical preceptors, 2) enhanced access to a national network of clinical experts in specialized techniques, 3) expanded opportunity for student distant clinical rotations with continued didactic course work, and 4) improved continuity and consistency of clinical experiences between students through implementation of asynchronous learning modules. Students recognize the learning efficiency of on-line information presentation but still prefer the traditional face-to-face classroom environment. Traditional paradigms impose limitations that are rooted in dependence upon the students and instructors being physically located in the same place at the same time. These represents significant impediments for PE programs that use geographically separate clinical sites to provide clinical experience. Historically this has led to a disintegration of the presentation of theory, and a reduction in the quantity or quality of clinical experience opportunities. New PE models help to eliminate limitations and improve the quality of education especially in the face of economic challenges. Perfusion education students and faculty will have to work together to find computer-based offerings that are equivalent to traditional classroom methods.

Allied Health Personnel↗
PubMed2004

A failure mode effect analysis on extracorporeal circuits for cardiopulmonary bypass.

Although many refinements in perfusion methodology and devices have been made, extracorporeal circulation remains a contributor to neurological complications, bleeding coagulopathies, use of blood products, as well as systemic inflammatory response. With the exposure of these adverse effects of cardiopulmonary bypass, the necessity to re-examine the safety of extracorporeal circuits is vital. A failure mode effect analysis (FMEA) is a proven proactive technique developed to evaluate system effect or equipment failure. FMEA was used to evaluate the six different types of extracorporeal circuits based on feedback from five clinical experts. Cardiovascular device manufacturers, the Veteran's Administration National Center for Patient Safety, and the Joint Commission on Accreditation of Healthcare Organizations recommend the use of FMEA to assess and manage risks in current and developing technologies and therapies. This analysis investigates the safety of six types of extracorporeal circuits used in coronary revascularization, including the newer miniaturized extracorporeal circuits. The FMEA lists and ranks the hazards associated with the use of each cardiopulmonary bypass extracorporeal circuit type. To increase the safety of extracorporeal circuits and minimize the effects associated with cardiopulmonary bypass, perfusionists must incorporate FMEA into their clinical practice.

Equipment Failure Analysis↗
PubMed2002

Designing an integrated extracorporeal therapy service quality system.

Reorganization in clinical operations of a national service provider organization, Fresenius Medical Care Extracorporeal Alliance (FMC-EA), provided the opportunity to overhaul and integrate quality systems. Under the new structure, the management of acute dialysis, apheresis, open-heart perfusion, and intraoperative autotransfusion services were combined into an integrated service portfolio supported by a multidisciplinary team of nurses, perfusionists, and technicians. This communication is intended to be a concise review of the literature that establishes the foundation for the new quality system as well as a discussion of the five clinical policies and clinical procedure guidelines that govern clinical behavior in mobile, point of care, acute extracorporeal therapy services. The clinical policy standards are based on recognized essentials and guidelines published by professional organizations, federal and state government agencies, and accreditation groups. The standards list the essential behaviors that clinicians should exhibit during the provision of extracorporeal therapy procedures such as acute therapeutic apheresis. Compliance with the redesigned procedure guidelines and policies will provide the clinical practice platform for continuous quality improvement (CQI) activities, benchmarking, and self-improvement. These practices can lead to improvements in the quality of care, a decrease in medical errors, and a reduction in overall health care costs.

Blood Component Removal↗