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Biomedical subjects

Thomas Cox

Publications and source records attributed to Thomas Cox.

9 recordsLinked to original sources
PubMed2006

Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacologic considerations.

Most studies report the efficacy of only a single drug to achieve sedation in a broad age range of children. In clinical practice, a variety of sedative and anesthetic regimes are monitored by nurses and physicians. In this study we report the efficacy of a tiered approach to monitoring and sedation in infants. Two-hundred-fifty-eight infants who required magnetic resonance imaging (MRI) studies received either oral chloral hydrate (n = 102) or bolus doses of IV pentobarbital (n = 67) monitored by nurses or IV propofol infusion (n = 68) titrated by physicians. Fewer cardiorespiratory events were observed in the chloral hydrate group (2.9%) compared to pentobarbital (13.4%) and propofol groups (13.6%); P < 0.05, propofol versus chloral hydrate. Infants who received propofol were ready to begin MRI scanning earlier (mean 9.1 +/- 6.7 min) than infants who received oral chloral hydrate (mean 23.5 +/- 13.4 min; P < 0.05). The time to discharge was longest in the pentobarbital (mean 80.3 +/- 39.2 min) and shortest in the propofol group (mean 53.9 +/- 30.1 min; P < 0.05). Infants in the chloral hydrate group moved more frequently (22.5%) during MRI scanning (with four sedation failures of 102) compared to 12.2% in the pentobarbital group and 1.4% in the propofol group (P < 0.001).

Administration, Oral↗
PubMed2004

Acute care skills in anesthesia practice: a simulation-based resident performance assessment.

BACKGROUND: A recurring initiative in graduate education is to find more effective methods to assess specialists' skills. Life-sized simulators could be used to assess the more complex skills expected in specialty practice if a curriculum of relevant exercises were developed that could be simply and reliably scored. The purpose of this study was to develop simulation exercises and associated scoring methods and determine whether these scenarios could be used to evaluate acute anesthesia care skills. METHODS: Twenty-eight residents (12 junior and 16 senior) managed three intraoperative and three postoperative simulation exercises. Trainees were required to make a diagnosis and intervention in a simulation encounter designed to recreate an acute perioperative complication. The videotaped performances were scored by six raters. Three raters used a checklist scoring system. Three faculty raters measured when trainees performed three key diagnostic or therapeutic actions during each 5-min scenario. These faculty also provided a global score using a 10-cm line with scores from 0 (unsatisfactory) to 10 (outstanding). The scenarios included (1) intraoperative myocardial ischemia, (2) postoperative anaphylaxis, (3) intraoperative pneumothorax, (4) postoperative cerebral hemorrhage with intracranial hypertension, (5) intraoperative ventricular tachycardia, and (6) postoperative respiratory failure. RESULTS: The high correlation among all of the scoring systems and small variance among raters' scores indicated that all of the scoring systems measured similar performance domains. Scenarios varied in their overall difficulty. Even though trainees who performed well on one exercise were likely to perform well in subsequent scenarios, the authors found that there were considerable differences in case difficulty. CONCLUSION: This study suggests that simulation can be used to measure more complex skills expected in specialty training. Similar to other studies that assess a broad content domain, multiple encounters are needed to estimate skill effectively and accurately.

Acute Disease↗
PubMed2003

Theory and exemplars of advanced practice spiritual intervention.

Spirituality, defined consistently with the work of Martha E Rogers, is explored and application of spiritual interventions is described and discussed using two case studies that exemplify working with clients in a manner that blends environmental resources with personal needs. This paper illustrates how nurses can perform non-denominational spiritual interventions without compromising belief systems of client or nurse and without a great deal of material resources or time. Simple, time-limited interventions that respond to clients' minimal needs are well within the abilities of all nurses to perform, do not require excessive material or personnel resources and may reduce clients' anxieties, leading to reduced dissatisfactions with care and facilitating client recovery and rehabilitation.

Adult↗
PubMed2002

ATP-induced internalization of amphibian epithelial P2X receptors is linked to channel opening.

A family of ATP-gated, non-selective cation channels known as P2X receptors are involved in purinergic synaptic transmission and other, as yet poorly defined, functions. After repeated exposure to ATP some of these channels no longer respond, a phenomenon known as run-down. In some P2X receptor subtypes, run-down has been associated with endocytosis. Recently, we have cloned a P2X receptor from larval amphibian skin (fP2X5) that shows profound run-down. To visualize the receptor in the plasma membrane of Xenopus oocytes, it was fused to a green fluorescent protein (GFP). Localized membrane fluorescence was observed in fP2X5 GFP-injected oocytes. Typical voltage-clamp current run-down was observed in response to repeated ATP exposure, indicating that GFP did not alter channel function. Membrane fluorescence decreased after ATP exposure. The purinergic receptor antagonists suramin and pyridoxalphosphate-6-azophenyl-2',4'-disulfonic acid (PPADS) blocked ATP-induced membrane fluorescent decreases and voltage-clamp currents. A T18A-fP2X5 mutant showed no ATP-activated currents when expressed in oocytes. GFP fusion constructs of this mutant showed membrane fluorescence, indicating insertion of a non-functional channel. In contrast to the wild-type fP2X5, ATP caused no decrease in membrane fluorescence of the mutant channel. Taken together these data suggest that channel opening is necessary for receptor internalization.

Adenosine Triphosphate↗
PubMed2002

Benzobicyclooctanes as novel inhibitors of TNF-alpha signaling.

A novel series of TNF-alpha inhibitors based on a benzobicyclooctane scaffold is reported. The compounds display good potency in inhibiting TNF-alpha induced apoptosis and NF kappa B activation. Additionally, they are selective for TNF-alpha as they do not inhibit apoptosis induced by soluble Fas ligand. The compounds described here can act as leads for future medicinal chemistry efforts and may also be useful tools for elucidating the TNF-alpha signaling pathway.

Apoptosis↗
PubMedDate not supplied

A nurse-statistician reanalyzes data from the Rosa therapeutic touch study.

This article presents a reanalysis of data used to support the work of Emily Rosa's Therapeutic Touch (TT) science fair project published as an article in the Journal of the American Medical Association (JAMA) in 1998. The purpose of this article is to take a closer look at the assumptions, data, statistical procedures, and conclusions of the JAMA article. This is accomplished by focusing on (1) the conclusion that there was no overall effect of TT, (2) the conclusion that TT practitioners did not perform better depending on which hand was used, and (3) the assumptions about the capability of Rosa's experiment to validate an existing skill. Reanalysis of the Rosa data suggests contradictions to the authors' conclusions. Based on this reanalysis, the authors' recommendations against the use of TT can and should be challenged because of inappropriate design and analysis as well as incorrect statistical assumptions and conclusions.

Confidence Intervals↗