Immobilization and extrication of trauma patients by untrained personnel.
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Results for “Untrained Personnel”
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Observations on blood-gas changes, relative cost and suitability of simple anaesthetic apparatus and techniques used by untrained personnel.
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Anesthesia, Inhalation↗
Faulty design, untrained personnel contribute to environmental hazards in smaller hospitals.
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Accreditation↗
Ankle brachial index measurements in critical leg ischaemia--the influence of experience on reproducibility.
BACKGROUND AND AIMS: While the use of ankle brachial indices (ABI) in the screening for peripheral arterial obstructive disease is widely accepted, the applicability of ABI in the identification of critical leg ischaemia (CLI) is far from settled. The aim was to assess inter-observer variability of ABI measurements in patients with CLI. MATERIAL AND METHODS: The study was conducted in two parts. In both parts a hand-held 9.5 MHz Doppler device was used. PART A: ABI was measured by 7 measurers with variable measurement experience in 22 limbs of patients admitted to the surgical ward because of CLI. The agreement between the measurements was assessed. PART B: Inter-observer agreement in measuring ABI was assessed between 2 trained vascular technicians measuring 33 limbs in patients with CLI on the vascular outpatient clinic. RESULTS AND CONCLUSIONS: Part A: 16% of the ABI-values differed 0.15 or more from the median and the mean coefficient of variation was 56.1. Part B: The difference between measurements did not exceed 0.14 with a mean coefficient of variation of 3.2. To obtain reproducible and quantitative measurement values the measurements have to be performed by trained personnel. Measurements performed by untrained personnel can only be regarded as qualitative.
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[Intra-osseous infusion--a simple, rapid and lifesaving method].
One of the major challenges in the initial treatment of critically ill or injured patients is the establishment of a well functioning intravenous access. This can be very difficult in patients with circulatory collapse, and almost impossible in infants. Central venous cannulation is time-consuming and requires skill. Nor can intratracheal and rectal administration of drugs and fluids fully replace the intravascular route. In such situations the old but forgotten technique of intraosseous infusion represents an elegant and easy way of gaining rapid intravascular access. The method is simple, safe and almost foolproof, and can easily be performed under field conditions, e.g. by paramedical personnel. Very few contra indications exist, and the success rate even by untrained personnel is high. In this review the physiological aspects and the technique itself is discussed and illustrated by case reports.
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[Newborn resuscitation in the delivery room: evaluation of a regional training program conducted in 1990 in the Centre region].
OBJECTIVE: To evaluate the regional programme designed to train personnel for resuscitation of the neonate in the delivery room and organized in the district of Centre, France in 1990. STUDY: Transversal study. SITE: The different maternities of the district. POPULATION: 31 maternities, 156 persons in charge of neonates in the delivery room including medical personnel (doctors, mid-wives) and paramedics, with or without any special training in 1990. METHOD: A single evaluator visited each maternity and met the personnel involved. The modalities of the evaluation were not given in advance and included a census of the personnel who had participated in the training programme and changes in material. The success of the training programme was evaluated on a theoretical and practical basis for the personnel and on the number of severe meconium aspirations observed. RESULTS: The training programme had reached 53% of the personnel involved. It had a wide impact both in terms of changed material and in neonatal resuscitation rates compared with untrained personnel. The number of severe meconium aspirations fell from 3 in 1989 to 0 in 1990.
Cross-Sectional Studies↗
Training bar personnel to prevent drunken driving: a field evaluation.
The potential of a server intervention program to decrease the likelihood that a bar patron will leave a bar intoxicated was evaluated. Research assistants posing as regular patrons ("pseudopatrons") visited two bars where about half of the servers had received server intervention training. Pseudopatrons set the occasion for server intervention to occur by drinking six alcoholic beverages in two hours. The blood-alcohol concentration (BAC) of the pseudopatrons was measured after they left the bar. Results revealed that trained servers initiated more server interventions than did untrained personnel. Moreover, pseudopatrons served by trained personnel reached substantially lower BACs than those served by untrained servers. These results suggest that, if implemented on a large scale, server intervention programs have the potential of reducing drunken driving by helping to decrease the exit BACs of bar patrons.
Accidents, Traffic↗
Prediction of future serum concentrations with Bayesian fitted pharmacokinetic models: results with data collected by nurses versus trained pharmacy residents.
Recording the times of dosage administration and serum sampling by trained personnel resulted in significantly greater adherence to the protocol of therapeutic drug monitoring and in significantly greater precision in the achievement of desired serum concentration goals of aminoglycoside therapy than when relatively untrained personnel recorded it as a comparatively unemphasized part of their job. This was true even when only data of peak and trough serum concentrations were used. This study demonstrates that thoughtful data collection by appropriately trained nursing, pharmacy, or other clinical personnel is an essential part of therapeutic drug monitoring and plays a significant role in the optimal individualization of drug dosage regimens for patient care.
Aged↗
Use of the intubating laryngeal mask airway by medical and nonmedical personnel.
The intubating laryngeal mask airway (ILMA) is a newly available device designed to allow for blind endotracheal intubation and treatment of patients with difficult airways. We studied the intubation success rates and speed with initial use of this device on an intubation manikin to determine whether this device might be easily used by trained and untrained personnel. Rapid and successful intubation with a device requiring limited or no training could have widespread implications for both health care providers and laypersons. The study consisted of 2 parts. In part 1, health care providers with intubation experience, health care providers without prior intubation experience, and nonmedical personnel were instructed to enter a room and intubate a manikin using the ILMA. A single page set of schematic directions was provided within the ILMA setup. The main outcomes were the intubation success rate and the time required for successful ventilation and intubation. In part 2, participants were retested after a standardized <60 second device demonstration. The 111 participants in the study included 44 emergency physicians (40%), 21 anesthesiologists (19%), and 46 other medical or nonmedical personnel (41%). On first attempted use of the device, and with no prior training, 59% of all participants successfully intubated the manikin. Attending and resident physicians had an 83% initial success rate. The median time to ventilation was 47 seconds, and the median time from ventilation until intubation was 29 seconds. Following the <60 second demonstration, 108 of 111 (97%) participants achieved success, with the median time to ventilation 18 seconds, and the median time from ventilation until intubation 17 seconds. All attending and resident physicians succeeded in intubation following the demonstration. Success rates on first attempt correlated with level of training, prior intubation experience, and prior LMA use (all P < .001). After a <60 second demonstration, medical and nonmedical personnel with and without prior intubation training can successfully use the ILMA to rapidly establish an airway in a manikin model. The ILMA should be further studied to determine if it may permit endotracheal intubation by first responders, paramedical personnel, and other medical staff with limited or no laryngoscopy skills.
Clinical Competence↗
Speech assessment of patients using three types of indwelling tracheo-oesophageal voice prostheses.
A multidisciplinary prospective study compared speech acceptability between three types of indwelling tracheo-oesophageal voice prostheses. Twenty male laryngectomees took part over five years, using 42 prostheses. Speech was assessed on a discrete scale by trained and untrained personnel. The majority scored in the mid-range for each assessor. The kappa coefficient was used to test similarity between assessors, and for all pairings agreement was significant (p < 0.05). The speech and language therapist tended to give higher scores and the patient lower. A relationship was found between patients' ages categorized by decade and the surgeon's score alone. This relationship held for Groningen high resistance and Provox prostheses individually too (p < 0.05). The untrained assessed similarly to the professionals--humans are all voice listeners. The analysis suggests surgeons find tracheo-oesophageal speech in older patients better than in younger ones; or make more allowances for the elderly. There was a trend for Provox prostheses to produce the best scores.
Age Factors↗
Use of a mechanical simulator for training in applying cricoid pressure.
Using an airway management training model, we have assessed anaesthesia personnel in their use of correct cricoid force and ability to retain this skill after a short training programme. A perspex device, working on a hydraulic principle, was used to measure cricoid pressure when applied to the model. After initial assessment at two levels of cricoid force (20 and 40 N), participants undertook additional training on 3 consecutive days. Thereafter, available participants underwent reassessment at 14-21 days. Forty-nine anaesthetic assistants and anaesthetists underwent initial assessment and 18 completed the full training and reassessment. Untrained, the majority (63%) of participants applied inadequate cricoid force with a wide variation (mean 16.8 (SD 9.3) (range 4.5-43.0) at 20 N and 32.9 (13.3) (14.9-74) at 40 N). After a single training session there was a marked improvement in application of cricoid force. Two additional training sessions did not provide further improvement. After 14-21 days the ability of participants to apply correct cricoid force was retained by 72% of subjects. Those who applied inadequate cricoid force initially were more likely to do so even after training. Most subjects applied too great a cricoid force in the first 5 s of application followed by a progressive loss of force during the next 20 s. This trend improved after training. We conclude that the majority of untrained personnel apply inadequate cricoid force, placing patients at risk of aspiration of gastric contents. While a simple training programme improved application of cricoid force, retained for up to 3 weeks, there was often a substantial decrease in the force applied to the cricoid during a single application, even after training.
Anesthesiology↗
Versatile unit for filling gelatin capsules with drugs or chemicals.
A new, inexpensive device was developed for making individually prepared capsules that can be administered to experimental animals. The device was designed for accurate and rapid production of large numbers of various capsule sizes and drug dosages. During 12 months of usage, 21 capsules were prepared weekly for each of 44 dogs (924 total capsules) in approximately 2.5 work-hours/week. Each capsule contained a precise amount of drug to administer a specific dosage to each individual dog. No difficulties were encountered in the manufacture or utilization of this device, and it can be operated by untrained personnel.
Animals↗
Technical considerations in evaluating the endothelial integrity of rat aortic preparations with silver staining.
Assessment of endothelial integrity is an obligatory step in many pharmacological studies. Integrity of endothelium is affected by manipulations performed during the removal and cleaning of the vessel and by some of the silver-staining techniques utilized for demonstrating interendothelial junctions. When aortas were cleaned of periadventitial tissue in cold Tris-saline (once separated from the animal) by untrained personnel, only 45% of the endothelium was preserved. When cleaning was performed in situ by trained personnel while flushing with cold Krebs-Ringer-6% albumin, over 95% was left intact. AgNO3-staining performed before fixation produced a 50% loss of endothelium when using NH4Br and (NH4)2S as developers. AgNO3-staining performed after fixation produced over 95% recuperation of endothelium when 2% glutaraldehyde, 150 mM NaCl, 40 mM phosphate buffer, pH 7.4, were utilized as initial fixative, NH4Br and (NH4)2S being equally effective as developers. Chloride ions were necessary to intensify silver lines. Several patterns of deendothelization were produced by mechanical and chemical injury with saponin, NH4Br and (NH4)2S. In all cases, hematoxylin staining was employed as an auxiliary technique to interpret images of injured endothelium. Presence of albumin protected the endothelium from mechanical damage.
Animals↗
Sentinel node detection in malignant melanoma patients: radiation safety considerations.
BACKGROUND: The surgical management of malignant melanoma necessitates correct sentinel lymph node localization. The highest reported sensitivities are those of lymphoscintigraphy and intraoperative gamma-probe detection combined with a vital blue dye technique. OBJECTIVE: Control of the radiation doses experienced by surgical personnel untrained in the use of unsealed radioactive materials. METHODS: Sentinel lymph nodes were localized, and biopsies were performed in 25 patients with malignant melanoma. Radiation doses during surgery were determined with energy-compensated silicon pin diode detectors and LiF thermoluminescent ring dosimeters. RESULTS: In 21 cases (24%), the measured doses were less than 1 microSv, but in 4 operations (16%), 1 to 4.5 microSv was received. The equivalent dose rate was generally less than 1 microSv/h. The finger-absorbed doses for the surgeon and the assistant surgeon were (mean+/-SD) 159+/-23 and 48+/-17 microGy per intervention, respectively. CONCLUSION: Personal dosimetric survey and limitation of the number of surgical interventions do not appear to be essential.
Anesthesiology↗
Female genital mutilation: an analysis of 522 cases in South-Western Nigeria.
This study was conducted at three teaching hospitals in South-Western Nigeria. Paturients were examined to find out if they had had female genital mutilation. Those who did were given a self-administered questionnaire. Results show that all the patients had either Type I (69%) or Type II (31%) mutilation (using WHO classification). The average age at which the procedure was performed was 6.9+/-2.9 years, with 4% of women having the procedure performed in pregnancy. The majority of the procedures were performed by medically untrained personnel (89%). Up to 67% of the women reported complications following the procedure. Severe pain and bleeding were the most common (69%) of the complications reported. The most common reason given for the procedure is cultural/traditional (63%). About a fifth of the women want their female child to undergo female genital mutilation. This study highlights the need for further interventions aimed at discouraging the practice of female genital mutilation.
Adult↗
Bedside determination of bicarbonate and base excess, blood oxygen saturation and content, VD/VT, and P50 using a programmable calculator.
Assessing and modifying oxygen transport are major parts of ICU patient management. Determination of base excess, blood oxygen saturation and content, dead space ventilation, and P50 helps in this management. A program is described for determining these variables using a T1 59 programmable calculator and PC 100A printer. Each variable can be independently calculated without running the whole program. The calculator-printer's small size, low cost, and hard copy printout make it a valuable and versatile tool for calculating physiological variables. The program is easily entered by an stored on magnetic card, and prompts the user to enter the appropriate variables, making is easy to run by untrained personnel.
Acid-Base Equilibrium↗
Stability of salivary concentrations of the newer antiepileptic drugs in the postal system.
Saliva antiepileptic drug (AED) concentrations strongly correlate with serum concentrations. Saliva collection is painless and noninvasive, and untrained personnel can easily be taught the collection process. Remote patients could mail saliva samples to a laboratory for monitoring, and samples could be obtained in the immediate postictal state to provide a "real-time" concentration. The objectives of this study were to assess the stability of saliva lamotrigine (LMT), levetiracetam (LEV), oxcarbazepine (OXC), topiramate (TPM), and zonsiamide (ZNS) concentrations sent through the United States Postal Service (USPS) and to quantify the amount of time needed for patients and the USPS to return samples to clinic. Saliva samples were obtained from patients currently taking 1 of the targeted AEDs. Samples were split into 2 storage vials. One sample was sealed in an addressed envelope, which the patient mailed from home, whereas the other sample was frozen immediately. Postmark date and day returned were collected for mailed samples. Saliva concentrations were determined using HPLC. Wilcoxon rank sum tests were used to compare the immediately-frozen and mailed sample means. Correlations were determined by the Spearman test. Thirty-seven patients were enrolled in the study. The median time between collection and postmark was 1 day (range 0-6 days); and between collection and receipt was 4 days (range 1-160 days). The mean concentrations for mailed and immediately frozen samples were similar for each AED (P > 0.15). Spearman rank order correlations between mailed and immediately frozen aliquots were strong (LMT rs = 1, LEV rs = 1, OXC rs = 0.964, TPM rs = 0.90, and ZNS rs = 1). Saliva samples mailed by patients maintain stability and can be returned in a reasonable length of time. Further studies are needed to assess patient/caretaker capability of obtaining an adequate sample.
Adolescent↗
Management of clinical data in urology. Experience with integrated personal computers and a relational database.
The use of microcomputers in medicine is rapidly increasing. To handle clinical data and to facilitate clinical research, a system based on several personal computers that can be linked together was developed. Commercially available software was used, consisting of a powerful relational database complemented by programs for statistics, graphics and desk top publishing. The low cost, modular and flexible system was handled by untrained personnel; computer specialists were not needed. Data on more than 1100 patients have been entered so far and data retrieval can be done by the physician "on the spot" using standard prefabricated reports. Data can then be analysed statistically and processed to graphics and publications.
Computers↗