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Biomedical subjects

R E O'Connor

Publications and source records attributed to R E O'Connor.

At least 19 recordsLinked to original sources
PubMed1999

Thrombolytic therapy for acute ischemic stroke: why the majority of patients remain ineligible for treatment.

STUDY OBJECTIVES: Thrombolytic therapy has been advocated as an effective treatment for acute ischemic stroke. In an attempt to promote maximum benefit while reducing the risk of hemorrhagic complications, numerous exclusions to the use of thrombolytic therapy for acute ischemic stroke have been promulgated. This study was conducted to identify the number of acute ischemic stroke patients eligible for thrombolytic therapy and to determine the reasons those deemed ineligible were excluded. METHODS: This observational study was conducted from September 15, 1996, to May 1, 1997, at an emergency department with an annual census of 70,000. Patients with a chief complaint suggestive of acute ischemic stroke were categorized as "eligible" if thrombolytic therapy was not contraindicated and could be initiated within 3 hours of symptom onset. Patients were deemed "ineligible" if the time to thrombolytic therapy would have exceeded 3 hours, or if other specific contraindications to thrombolytic therapy were present. For all categories, 95% confidence intervals (95% CI) were determined. RESULTS: Of the 214 patients with acute ischemic stroke who were screened, 6 (2.8%+/-2.2%) were eligible. Ninety-five patients (44%+/-7%) were excluded solely on the basis of the time interval from onset of symptoms to eligibility for thrombolytic therapy exceeding 3 hours. Other common reasons for exclusion included resolution of symptoms in 31 patients (14%+/-4%), intracranial hemorrhage as determined by head computed tomography in 22 (10%+/-4%), and minor symptoms in 20 (9%+/-4%). CONCLUSION: The majority of acute ischemic stroke patients do not meet accepted criteria for thrombolytic therapy. Most are ineligible because of delays in obtaining treatment. Strategies should be devised to reduce the time to treatment if thrombolytic therapy is to achieve widespread use in the treatment of acute ischemic stroke.

Acute Disease↗
PubMed1999

EMS systems: foundations for the future.

Emergency medical services (EMS) occupy a unique position in the continuum of emergency health care delivery. The role of EMS personnel is expanding beyond their traditional identity as out-of-hospital care providers, to include participation and active leadership in EMS administration, education, and research. With these roles come new challenges, as well as new responsibilities. This paper was developed by the SAEM EMS Task Force and provides a discussion of these new concepts as well as recommendations for the specialty of emergency medicine to foster the continued development of all of the potentials of EMS.

Emergency Medical Services↗
PubMed1998

Rating threat mitigators: faith in experts, governments, and individuals themselves to create a safer world.

This research explores public judgments about the threat-reducing potential of experts, individual behavior, and government spending. The data are responses of a national sample of 1225 to mail surveys that include measures of several dimensions of public judgments about violent crime, automobile accidents, hazardous chemical waste, air pollution, water pollution, global warming, AIDS, heart disease, and cancer. Beliefs about who can best mitigate threats are specific to classes of threats. In general, there is little faith that experts can do much about violent crime and automobile accidents, moderate faith in their ability to address problems of global warming, and greater expectations for expert solutions to the remaining threats. People judge individual behavior as effective in reducing the threats of violent crime, AIDS, heart disease, and automobile accidents but less so for the remaining threats. Faith in more government spending is highest for AIDS and the other two health items, lowest for the trio of violent crime, automobile accidents, and global warming, and moderate for the remaining threats. For most threats, people are not distributed at the extremes in judging mitigators. Strong attitudinal and demographic cleavages are also lacking, although some interesting relationships occur. This relative lack of sharp cleavages and the generally moderate opinion indicate ample opportunity for public education and risk communication.

Adult↗
PubMed1996

Impact of a two-tiered trauma response in the emergency department: promoting efficient resource utilization.

OBJECTIVE: The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. MATERIALS AND METHODS: At a Level I Trauma Center serving a suburban/urban population of approximately one million people, Emergency Department length of stay was tabulated for all consecutive Trauma Service admissions 6 months before and 6 months after implementation of a two-tiered trauma response protocol. This protocol, which uses specific triage criteria, consisted of the standard Surgery-supervised trauma code response and an additional Emergency Medicine-supervised trauma alert response. RESULTS: Trauma Service admissions numbered 532 in the pre-protocol period and 512 in the period after implementation of the protocol. In the first period, the Emergency Department length of stay was 289 minutes; in the second period, it was 241 minutes. Of the 512 patients in the post-protocol period, 183 were triaged to the new trauma alert group, reducing the number of Trauma Service consultations and decreasing Emergency Department length of stay by 139 minutes. The two levels of trauma response allowed accurate identification of the most seriously injured patients and improved the ability to predict those patients who would require direct disposition to the operating room or intensive care unit. CONCLUSIONS: Implementation of a two-tiered trauma response significantly decreased Emergency Department length of stay, allowed Emergency Medicine physicians to more rapidly identify, evaluate, and treat trauma patients requiring hospitalization, improved identification of patients requiring operating room or intensive care unit resources, and was time efficient and resource efficient.

Adult↗
PubMed1996

Reducing the rate of paramedic needlesticks in emergency medical services: the role of self-capping intravenous catheters.

OBJECTIVE: To determine whether the frequency of unintentional needlesticks can be reduced by replacing conventional i.v. catheters with self-capping ones. METHODS: Retrospective cohort, historically controlled study, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, for whom i.v. therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at i.v. access was examined during the 2 10-month periods, before and after introduction of a self-capping i.v. catheter. RESULTS: For the 2 periods, the percentage of patients for whom i.v. access was attempted remained constant at 65%. The success rate for i.v. access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new catheter, 44 injuries were reported overall. Of these, 15 were due to unintentional needlesticks, 11 associated with contaminated needles. Following the system-wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrapolated annual incidence of contaminated needlesticks decreased from 169 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 i.v.attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI; 132, 330) to 15 (95% CI; 0, 40) per 100,000 i.v. attempts. The absolute number of needlesticks and the proportion of injuries due to needlesticks decreased significantly (p < 0.005). CONCLUSION: The use of i.v. catheters with self-capping needles was associated with a significant reduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. The use of self-capping i.v. catheters was feasible and did not appear to be a deterrent to initiating i.v. therapy in the out-of-hospital environment.

Catheterization, Peripheral↗
PubMed1996

The rate of clinically significant plain radiograph misinterpretation by faculty in an emergency medicine residency program.

OBJECTIVE: To estimate the rate of clinically significant discrepancies between radiograph interpretations by attending radiologists and emergency medicine (EM) faculty in 2 academic EDs, using a unique scoring system. METHODS: A retrospective comparison of radiographic agreement between EM and radiology faculty members was performed. All plain films initially interpreted by EM faculty or by EM residents with immediate reinterpretation by EM faculty were subsequently reviewed by attending radiologists. All discrepancies between these readings were reported to the ED on the following day for review by an EM faculty member (usually different from the initial EM faculty reader) who determined the need for treatment or follow-up changes. A secondary chart review by a quality assurance faculty member determined whether radiographic findings not noted on the x-ray log were present on the ED record All discrepancies from February to June 1994 were reviewed. A severity score was assigned based on the following criteria. Q-0: There was no change in treatment or follow-up; or the initial interpretation by EM faculty was validated by repeat or additional views. Q-1: Discrepancy is minor. Q-2: Discrepancy is significant, with potential for injury or bad outcome. Q-3: Discrepancy is significant, with actual injury or bad outcome. RESULTS: Of 14,046 radiographic studies eligible for enrollment, there were 134 discrepancies (0.95%). Only 28 cases (0.2%) were found to be clinically significant. Of these, 25 were scored Q-1, 3 were scored Q-2, and 0 were scored Q-3. These clinically significant discrepancy rates were highest for the finger, skull, elbow, hand, and lumbar spine. CONCLUSION: Emergency medicine faculty provide highly accurate rates of plain radiograph interpretation, particularly when adjusted for clinical significance and actual impact on patient care.

Clinical Competence↗
PubMed1996

Drug release from a multiparticulate pellet system.

Multiparticulate pellet systems are used as both immediate and modified release dosage forms. Previous work has classified uncoated pellet systems prepared from microcrystalline cellulose as an inert matrix. The Higuchi square root of time equation, derived to describe drug release from a single planar system, is the accepted method to evaluate drug release from both planar and spherical heterogeneous inert granular matrices. A second equation of interest, the Higuchi cubic equation, was derived to describe drug release from a spherical pellet. Both equations predict a linear relationship between drug release and the square root of time or time. The purpose of the present study was to evaluate drug release from a multiparticulate pellet system using both equations and to study any differences when both equations are used to describe the same drug release data. By evaluating dissolution data from various pellet mesh cuts representing different bead radii and surface areas, changes in the slopes of both plots would be expected. Pellets were manufactured using extrusion/spheronization technology and consisted of 90% microcrystalline cellulose and 10% acetaminophen. Statistical comparison indicates that the Higuchi cubic equation seems to be more sensitive to changes in pellet size. While the square root of time equation describes the drug release data from granular, inert, spherical pellets, it may be better to utilize the Higuchi cubic equation because it is more sensitive to changes in particle size.

Algorithms↗
PubMed1996

Medicare HMOs: part of the solution or part of the problem in the struggle for cost containment?

The correct answer for salvage of the Medicare program while maintaining acceptable medical care is clearly not available today. Managed care programs for seniors have been an option in the last decade and plans are expanding rapidly into previously untapped areas. Some programs can indeed provide a multiplicity of services and thereby truly integrate and improve existing care plans. Others have less clear cut advantages. For any senior contemplating the options available for medical care under Medicare, HMOs and Medigap type instruments, the most salient advice is "buyer beware." A complete understanding of the options gained and lost by changing medical insurance coverage is essential.

Cost Control↗
PubMed1993

Respiratory arrest after local anesthesia for outpatient cataract surgery: a dramatic but transient complication.

Retrobulbar injection of anesthetic agents is common practice before ophthalmologic procedures. Rare but life-threatening complications of this procedure include respiratory depression and coma. We present the case of a woman with complete respiratory arrest and unresponsiveness who was brought into our emergency department from a local freestanding surgical center after preoperative retrobulbar anesthetic injection. Subsequently, the pathogenesis, clinical features, and supportive treatment for this dramatic but transient complication are discussed.

Aged↗
PubMed1993

Drug release mechanism from a microcrystalline cellulose pellet system.

A common form of modified release is the encapsulation of specially formulated or coated pellets. An important first step in the development of a multiparticulate coated dosage form is to characterize the uncoated pellet. In earlier work, an uncoated pellet system developed in these laboratories and prepared from microcrystalline cellulose (MCC) was investigated and found to exhibit both the physical characteristics of an inert matrix and varying degrees of in vitro modified release. The use and characterization of MCC as a spheronization matrix material forms the basis for this formulation study. The drug release mechanism has been verified by varying selected formulation factors and evaluating the resulting pellets according to the relationship developed by T. Higuchi for granular inert matrices. In all cases, this MCC pellet system adhered to the theoretical relationships and the drug release mechanism can, therefore, be classified as an inert matrix.

Cellulose↗
PubMed1993

Two approaches to reading instruction with children with disabilities: does program design make a difference?

This study examined the effects on reading achievement of variation in program design and tested the hypothesis this Distar Reading Mastery's (Engelmann & Bruner, 1988b) demonstrated effects with disadvantaged children in Project Follow Through can be generalized to children with disabilities. We compared the effects of two synthetic phonics reading programs, Direct Instruction (DI) Reading Mastery I and II and Addison Wesley's Meet the Superkids and The Superkids' Club, (Rowland, 1982a, 1982b) for 81 children in transitional kindergarten special education classes. No significant achievement differences were evident for the instructional program either at the end of the treatment year, or on follow-up testing 1 year later. However, among children who made advanced progress, the DI group showed larger reading gains.

Child↗
PubMed1993

Teaching phonological awareness to young children with learning disabilities.

This study examined the feasibility of teaching phonological manipulation skills to preschool children with disabilities. Forty-seven children, 4-6 years old, enrolled in a special education preschool, were randomly assigned to receive training in one of three categories of phonological tasks (rhyming, blending, and segmenting) or a control group. Results indicated that children were able to make significant progress in each experimental category, but that they demonstrated little or no generalization either within a category (e.g., from one type of blending task to another type of blending task) or between categories (e.g., from blending to segmenting). Although the children's level of cognitive development significantly predicted some learning outcomes, it did not appear to limit the learning of phonological tasks.

Awareness↗
PubMed1992

Delaware Emergency Medical Services System: cardiac resuscitation.

The Delaware EMS system has been in existence for 20 years. Initially begun as one paramedic unit serving New Castle County, it now comprises 15 units in a statewide system. The goal of this report is to detail the EMS system's impact on prehospital cardiac resuscitation and airway management. Emergency Medical Services (EMS) encompass all aspects of managing a sick or injured patient prior to arrival to the hospital. From the time a patient dials 911 until they arrive in the care of a doctor in an emergency room, the EMS system provides initial medical evaluation and care as well as transportation to the hospital. The components of Delaware's EMS system include: 1. Bystanders--the public is often called upon to perform CPR until trained rescuers arrive. 2. Medical Dispatchers--they receive incoming 911 calls and determine the personnel needed. 3. First responders--ambulance crews trained in basic life support (BLS). 4. Second responders--ambulance crews trained in advanced life support (ALS), paramedics. 5. Medical Control--doctors who are in radio contact with paramedics to provide medical advice.

Adult↗
PubMed1992

Cesarean section in a severely traumatized patient.

Massive trauma in a near-term pregnant patient challenges the emergency physician with very difficult treatment choices. We present the case of a severely traumatized pregnant female, near term, in whom the decision to proceed with a perimortem cesarean section in the Emergency Department produced a viable infant. We discuss the guidelines that are used in making such a decision and their rationale. The physiologic changes of pregnancy that may complicate maternal assessment and the effect of shock on the fetus are also discussed.

Adult↗
PubMed1992

The prehospital use of nebulized albuterol on patients with wheezing whose chief complaint is shortness of breath.

The use of prehospital nebulized beta-agonists has become widespread, and their safety and efficacy has been documented. Our purpose was to study their broadened use and determine their effectiveness in specific sub-sets of wheezing patients. We conducted a six and one-half month prospective study to determine the benefit of nebulized albuterol treatments on a variety of wheezing patients whose chief complaint to paramedics was shortness of breath. Sixty-two patients were enrolled in the study and were subdivided into four groups based on patient history; asthma, COPD, asthma & COPD (A/C), and non-Asthma/non-COPD (NANC). The effectiveness of the treatment was evaluated objectively by peak expiratory flow rates (PEFR) obtained before and immediately after treatment and subjectively by the patients' evaluation of their own dyspnea. Changes in PEFR were subjected to analysis by a paired T-test. Albuterol was effective in increasing the PEFR in patients with asthma, COPD and NANC. Patients with both asthma and COPD did not demonstrate increased PEFR after treatment. The majority of all patients were subjectively improved after nebulized albuterol treatments. We conclude that aerosolized albuterol is safe and effective in the prehospital treatment of patients complaining of dyspnea who are wheezing.

Adult↗