PubMed Health⌕ Search

Biomedical subjects

T W Whitley

Publications and source records attributed to T W Whitley.

At least 19 recordsLinked to original sources
PubMed1992

A study of occupational stress and depression among emergency physicians.

OBJECTIVE: To determine the level of stress and depression among emergency physicians and whether these variables were related to the emergency physician's decision to leave the specialty. STUDY DESIGN AND TYPE OF PARTICIPANTS: The study involved a random sample of 1,350 emergency physicians who received a questionnaire containing scales on depression and occupational stress as well as questions about their future plans for remaining in the specialty. RESULTS: Seven hundred sixty-three usable surveys (56.5%) were returned. Mean scores for the locus of control, Work-Related Strain Inventory, and the Center for Epidemiologic Studies--Depression Scale (CES-D) were within normal ranges. However, a disproportionate number, ie, more than 2.5% of the sample, scored more than two standard deviations from the mean. With the exception of the work satisfaction scale, there were no significant differences between the scores of fellows and nonfellows on measures of locus of control, stress, or depression. Of the population, 12.4% indicated that they were somewhat likely to very likely to leave the clinical practice of emergency medicine within the next year; 26.7% planned on leaving in the next five years, and less than half (42.9%) planned on seeing patients ten years from now. Older men, women, and those with high levels of stress and low job satisfaction were more likely to leave the specialty over the next ten years. CONCLUSION: While the vast majority of emergency physicians reported normal levels of stress, a disproportionate number reported high levels of stress and depression and plan on leaving the specialty of emergency medicine. The number of individuals planning to leave appeared to be greater than the number that will be replaced through residency training.

Career Mobility↗
PubMed1991

Inability to assess breath sounds during air medical transport by helicopter.

This study assessed the capabilities of a traditional and an amplified stethoscope used by flight nurses to assess breath sound during air medical transport in an MBB BO-105 helicopter. We developed a normal breath sound model using a prerecorded tape of breath sounds interspersed with segments without breath sounds; the recorder had been placed in the chest wall of a resuscitation training manikin. Flight nurses completed control listening sessions in a quiet environment and experimental sessions during flight using a traditional stethoscope for half of the sessions and an amplified stethoscope for the remaining half. In the quiet environment, flight nurses accurately reported the presence or absence of breath sounds in 110 (92%) of 120 trials. During helicopter flight, none of the flight nurses heard breath sounds during any of the recorded segments with either the traditional stethoscope or the amplified stethoscope. We conclude that flight nurses are unable to hear normal breath sounds using a traditional or amplified stethoscope during flight in a medically configured MBB BO-105 helicopter. Improved stethoscopes, innovative methods of listening, and reduction of aircraft noise are potential solutions to the problems of breath sound assessment during air medical transport.

Aircraft↗
PubMed1991

Work-related stress and depression among physicians pursuing postgraduate training in emergency medicine: an international study.

STUDY OBJECTIVE: To compare the levels of work-related stress and depression reported by physicians-in-training in emergency medicine in three survey sites and to determine the effects of gender and marital status on stress and depression among these physicians. DESIGN: Cross-sectional mail surveys. SETTING AND TYPE OF PARTICIPANTS: Physicians-in-training in the United States, United Kingdom, and Australasia. INTERVENTION: Questionnaires requesting demographic information and including scales assessing work-related stress and depression were administered. MEASUREMENTS AND RESULTS: A 3 x 2 x 2 multivariate analysis of variance in which survey site, gender, and marital status were independent variables and stress and depression scale scores were dependent variables revealed significant differences when stress and depression were analyzed simultaneously. Univariate analyses of variance revealed significant differences in stress by survey site and gender and in depression for all three independent variables. Comparison of adjusted means revealed that respondents from the United Kingdom reported significantly higher levels of stress than did respondents from the United States and that women reported significantly higher levels than men. Respondents from the United States reported significantly higher levels of depression than did respondents from the other countries, women reported higher levels than men, and unmarried respondents reported higher levels than married respondents. CONCLUSION: Despite limitations resulting from self-report bias, cross-sectional survey methodology, sampling error, and differences in training among the three survey sites, the respondents experienced similar levels of stress and depression attributable to anticipated sources.

Australia↗
PubMed1991

Reliability and validity of the Work-Related Strain Inventory among health professionals.

This article provides evidence from five samples of different health professionals (family physicians, emergency medical technicians, hospital nurses, flight nurses, and emergency medicine residents) for the reliability and validity of the Work-Related Strain Inventory (WRSI). The inventory consists of 18 items and was designed to measure perceptions of strain in occupational settings. Internal consistency reliability ranged from .85 to .90 and, as predicted, was correlated with the Maslach Burnout Inventory and measures of depression, role ambiguity, job satisfaction, and work-group functioning. When compared with different measures of depression symptoms (eg, Zung Self-Rating of Depression Scale, Center for Epidemiologic Studies Depression Scale), the Work-Related Strain Inventory was found to measure a different and independent construct. This inventory, a short, easily administered measure with good reliability, may be useful for appraising levels of work-related strain in behavioral and organizational models of the consequences of stress in different work environments.

Adult↗
PubMed1989

Transcutaneous oxygen tension measurements during hemorrhagic hypoperfusion using Trendelenburg and the pneumatic antishock garment.

Transcutaneous oxygen tension (PtCO2) was observed during hemorrhagic hypoperfusion using four therapeutic modalities: pneumatic antishock garment (PASG), 20 degrees Trendelenburg positioning, combined PASG-Trendelenburg, and whole blood infusion. Anesthetized mongrel dogs were mechanically ventilated. A heated transcutaneous oxygen sensor was applied to the skin overlying the sternum. Animals were bled over 10 min of 25% of their calculated blood volume. A therapeutic intervention was applied at the onset of hemorrhage (PASG, Trendelenburg, PASG-Trendelenburg or control). All animals were observed for 20 min, then during a 10-min shed blood reinfusion period, and for 20 min thereafter. PtCO2 was measured continuously and the following were measured serially: cardiac output, mean arterial pressure (MAP), mixed venous oxygen tension (MvO2), and arterial oxygen tension (PaO2). Cardiac index (CI) and the oxygen extraction ratio were calculated. PtCO2 decreased immediately after hemorrhage in all animals. Control values remained consistently below values for active interventions during this time. All groups regained baseline levels of PtCO2 after reinfusion of shed blood volume. PaO2 remained nearly constant during all experiments. MAP and CI fell in all groups following hemorrhage but did so less precipitously in the PASG group. The PASG and PASG-Trendelenburg groups showed the greatest increase in CI during reinfusion. These results suggest that when PtCO2 is relied upon as an indicator of adequacy of resuscitation during moderate hemorrhagic shock, that cutaneous perfusion may be improved by the PASG or Trendelenburg position, and that perfusion is most effectively restored by blood infusion.

Animals↗
PubMed1989

Helicopter use by rural emergency departments to transfer trauma victims: a study of time-to-request intervals.

To assess how soon rural emergency departments (EDs) call for helicopters to transport seriously injured patients, the records of all trauma victims (excluding isolated CNS trauma) transported by an emergency helicopter service from referring hospitals to a trauma center over an 18-month period were studied. Admission time to the referring ED was compared with the exact time a call for the helicopter was received and a time-to-request interval (TTR) was calculated. A total of 64 cases were studied. Fifty (78%) of the patients had blunt trauma; 14 (22%) had penetrating trauma. The average TTR for the helicopter was 69.8 minutes, with a range from 17 minutes before arrival at the referring ED to 337 minutes after arrival. Children (aged less than or equal to 16 years) had an average TTR of 34.1 minutes compared with 76.4 minutes for adults (aged greater than 16 years). Of the variables examined, patient age was the only factor significantly associated with TTR. These observations suggest that, except in children, there frequently is a lengthy time interval between the time trauma patients arrive at EDs in rural eastern North Carolina and the time an emergency helicopter service is called to transport them to a trauma center.

Adolescent↗
PubMed1989

A comparison of four methods of testing emergency medical technician triage skills.

Triage skills are requisite for all providers of prehospital care. Methods of assessing the acquisition of triage skills vary in complexity and expense. In this study, 61 prehospital care providers classified 20 cases, divided into four groups of five cases each: moulaged live trauma victims, nonmoulaged live trauma victims, nonmoulaged manikin trauma victims, and written scenarios. The providers were asked to classify the cases in each group by assigning triage tags to indicate injury severity and to rank the trauma victims in each group according to the urgency of care required. Analysis of variance revealed statistically significant differences among the four methods in both mean tagging scores (F3,235 = 8.63, P less than .0001) and mean ranking scores (F3,232 = 6.09, P less than .001). Multiple comparisons using Scheffe's test revealed that the mean tagging and ranking scores for moulaged live victims and written scenario methods were comparable and that both were significantly superior to the scores of the two other methods. However, a qualitative evaluation revealed that the providers greatly preferred triage of moulaged live victims to the other three methods.

Allied Health Personnel↗
PubMed1989

Factors associated with stress among emergency medicine residents.

A survey of members of the Emergency Medicine Residents Association was conducted to investigate the occupational stress and depression experienced by this group. The 488 respondents provided demographic information and completed measures of stress and depression. Multivariate analysis of variance revealed statistically significant differences in stress and depression by year of training (P less than .001), gender (P less than .01), and marital status (P less than .01). Univariate analyses of variance revealed overall differences in both stress and depression. Mean levels of stress and depression were higher for women residents, and unmarried residents reported more depressive symptomatology. The results indicate that women emergency medicine residents experience more stress and depression than men and that spouses can buffer some of the stress of residency training for men and women residents. No significant differences in stress or depression by year in training were revealed by univariate analysis of variance, which suggests that residents experience stress throughout the course of training. The similarities and differences in the occupational stress and depression experienced by emergency medicine residents in comparison with residents from other specialties suggest that additional study in emergency medicine is warranted.

Cross-Sectional Studies↗
PubMed1989

Pharyngeal tracheal lumen airway training: failure to discriminate between esophageal and endotracheal modes and failure to confirm ventilation.

The pharyngeal tracheal lumen (PTL) airway is a new airway control device for emergency medical technicians (EMTs) and paramedics and functions as either an esophageal obturator or an endotracheal tube. We developed a ten-step PTL airway training protocol that included proper airway insertion, patient ventilation, and confirmation of tube placement by auscultation. We then prospectively evaluated the effectiveness of training by testing the ability of 32 EMTs and paramedics to discriminate between esophageal and endotracheal mode placement. Training consisted of a group demonstration followed by supervised individual practice on a Laerdal Adult Intubation Model. All 70 insertion attempts resulted in esophageal obturator mode placement. As a result, trainees did not have an opportunity to practice discrimination between esophageal and endotracheal placement. Six weeks after initial training, 19 of the entry group were randomly and blindly assigned to ventilate each of two Laerdal models that had been previously intubated with the PTL, one in esophageal mode and the other in endotracheal mode. In the esophageal mode, 15 of 19 trainees (79%) correctly selected the esophageal port to ventilate, but four (21%) could not decide and abandoned the airway. In the tracheal mode, 16 of 19 trainees (84%) correctly selected the tracheal port to ventilate, one (5%) was unable to decide, and two (10.5%) selected the wrong tube and attempted ventilation with the esophageal port even though the tracheal balloon was completely occluding the airway. Ventilation was confirmed with auscultation in only 50% of the attempts (19 of 38). Our study indicates that the training protocol was inadequate to teach critical decision-making in the use of the PTL airway.(ABSTRACT TRUNCATED AT 250 WORDS)

Allied Health Personnel↗
PubMed1989

Prehospital care by EMTs and EMT-Is in a rural setting: prolongation of scene times by ALS procedures.

Because the initiation of IV lines by emergency medical technicians-Intermediates (EMT-Is) appeared to delay the patient's transport to the hospital, we undertook a retrospective study of 370 patients to compare prehospital care rendered by EMTs (EMT-A equivalent) and EMT-Is in a rural setting. Our study was limited to acute medical conditions in which protocols called for IV lines (124 patients with chest pain, 122 with acute respiratory distress, 99 with seizures, and only 25 with cardiac arrest) (the cardiac arrest cases were too few for statistical significance). We found that the difference in scene times for EMTs and EMT-Is not attempting IV lines was 6.1 and 6.9 minutes, respectively. The average scene time of EMT-Is attempting an IV line was 19.6 minutes (P less than .001) compared with EMT times, or times for EMT-Is not attempting an IV line. One hundred twenty-eight of 370 patients received IV medication within ten minutes of arrival in the emergency department, and ten of these patients had their IV lines initiated successfully in the field. Thirty-nine percent of patients with ED IV lines received IV medication within ten minutes of arrival, while only 21% of patients with a field IV line received medication in this period (P less than .05). We conclude that initiating a field IV line in this specific patient population significantly increased scene time and did not improve the chances of these patients receiving IV medication within ten minutes of arrival in the emergency department.

Allied Health Personnel↗
PubMed1988

Observation of head trauma patients at home: a prospective study of compliance in the rural south.

A prospective study was conducted to test the reliability of at-home observation of head trauma victims in the rural South among a population of low educational level. During a four-month period, 99 patients entered and 90 patients finished the study. In all cases, an individual was identified as willing to accept the responsibility of observing the patient. The observer received written and verbal instructions to stay with the patient for 24 hours and to wake the patient every four hours during that time. Patients then were contacted seven to nine days after their injury and questioned as to their present symptoms and observer compliance. For patients under 15 years of age (n = 34), the observer was questioned. Thirteen percent of the observers did not remain with the patient for 24 hours, 16% passed the responsibility of observation to another individual, and 71% awoke the patient as instructed. Observers who were not the patient's mother were significantly more likely to abandon the patient during the first 24-hour period. Observer compliance for patient awakening significantly decreased with the increase in patient age. When spouses and live-in friends were combined as a group of observers and compared with parents, the parents awoke the patient significantly more often. The authors conclude that in this population, at-home observation of head trauma patients, particularly those more than 25 years old, may not be reliable. Special attention should be directed toward the care of these patients.

Adolescent↗
PubMed1987

Specific occupational satisfaction and stresses that differentiate paid and volunteer EMTs.

A survey completed by 265 emergency medical technicians (EMTs) who provide emergency prehospital care in a rural area included a stress inventory for health professionals and a job satisfaction scale. Logistic regression indicated that the 118 paid EMTs were more likely to be dissatisfied with the freedom they have on the job than were the 147 volunteer EMTs. Paid EMTs also are less likely to be satisfied with the recognition they receive and more likely to cite work interference with family life and perceptions that others are trying to take advantage of them as sources of stress. Volunteer EMTs are more likely to be dissatisfied with the way their days off work are scheduled and to report stress attributable to work responsibilities different from those they had anticipated. Additional information about the demographic characteristics of EMTs from a rural area is provided.

Allied Health Personnel↗
PubMed1986

Histologic and endoscopic studies before and after gastric bypass surgery.

The purposes of this study were to establish a standardized multiparameter analysis system for histologic grading of gastritis and to compare histologic changes with endoscopic findings in the proximal and distal bypassed stomach in obese patients undergoing gastric bypass surgery. Three groups, comprising a total of 91 patients, were studied: a preoperative group (34 patients), a postoperative group at one year (33 patients), and a postoperative group at two years (24 patients). the biopsy specimens from the proximal and distal bypassed stomach were compared in all groups. Seventeen histologic variables were evaluated by three observers to classify the severity of gastritis. Forty percent of the patients in the postoperative group demonstrated histologic evidence of nonerosive, superficial gastritis, slightly more in the proximal stomach. Endoscopy showed significantly more bile reflux and inflammation in the distal stomach than the proximal stomach in nearly all patients. Our study demonstrates a significant discrepancy between bile reflux observed endoscopically and the histologic findings after gastric bypass surgery. No metaplastic or dysplastic changes were found up to two years postoperatively, but further studies are needed to determine the long-term endoscopic and histologic endoscopic and histologic sequelae of gastric bypass surgery.

Gastritis↗
PubMed1985

Comparison of EMT blood pressure measurements with an automated blood pressure monitor: on scene, during transport, and in the emergency department.

Auscultation or palpation of blood pressure in critically ill patients by emergency medical technicians (EMTs) can be difficult, if not impossible, because of ambient noise, motion artifact, limited access to patients, or weak pulses. Automated blood pressure monitors (ABPMs) have been designed to overcome these problems during field emergencies and patient transport. Our study compared blood pressure measurements taken by EMTs with measurements provided by a Lifestat ABPM. Measurements in emergency patients on scene, during transport, in the emergency department (ED), and in a controlled environment were compared. Measurements in the various sites were obtained from 57 patients, and provision was made for two measurements at each site. Comparison of on-scene systolic blood pressures yielded a mean absolute systolic difference of 10.46 +/- 1.42 mm Hg and a mean absolute diastolic difference of 9.33 +/- 1.32 mm Hg. During transport systolic pressures showed a mean absolute difference of 11.50 +/- 1.72 mm Hg, and diastolic pressures showed a mean absolute difference of 7.59 +/- 1.16 mm Hg. Mean absolute differences in the ED were 11.23 +/- 1.49 mm Hg systolic and 8.37 +/- 1.25 mm Hg diastolic. Ninety comparison measurements in a controlled environment yielded a mean absolute systolic difference of 8.74 +/- 0.87 mm Hg and a mean absolute diastolic difference of 7.97 +/- 0.72 mm Hg. Comparison of mean diastolic pressure differences between EMT and ABPM measurements in various settings revealed some small, but statistically significant, discrepancies that were not considered clinically relevant.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMedDate not supplied

Determination of prehospital blood glucose: a prospective, controlled study.

STUDY OBJECTIVE: To determine if emergency medical personnel can effectively rule out hypoglycemia in the prehospital setting. DESIGN: During a 10-week period, emergency medical personnel determined the fingerstick glucose on all prehospital patients with altered mental status using the Chemstrip bG. Statistical comparisons were made to serum glucose levels performed by hospital laboratory personnel on blood samples obtained prior to glucose administration. A serum glucose level less than 60 mg/dL was considered a positive test for hypoglycemia. PARTICIPANTS: 170 consecutive patients with altered mental status (AMS) ranging in age from 13 to 90 years were enrolled. MEASUREMENTS AND MAIN RESULTS: Of these patients, 158 were normal or hyperglycemic, 12 were hypoglycemic, and one patient was hypoglycemic but had only a borderline negative fingerstick test. Thus, a sensitivity of 91.7% and a negative predictive value of 99.3% were obtained. The specificity was 92.4%, and positive predictive value was 47.8%. CONCLUSION: The Chemstrip bG may be used safely in the prehospital setting to rule out hypoglycemia.

Adolescent↗