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Biomedical subjects

C G Cayten

Publications and source records attributed to C G Cayten.

At least 55 records · Page 3Linked to original sources
PubMed1981

Impact of prehospital cardiac algorithms on ventricular fibrillation survival rates.

To determine the value of algorithms in the field, a set of cardiac clinical algorithms was developed for and tested by the City of Philadelphia paramedics. A controlled test was carried out by revising the narrative standard operating procedure to reflect algorithm content and giving the algorithms, in pocket-size booklet form, to half the Fire Rescue platoons (43 men). Baseline data included paramedics' characteristics, arrhythmia recognition and management test scores, and data on the number of patients who were discharged alive from the hospital following successful treatment of ventricular fibrillation in the field. Platoons with and without the algorithms served identical areas of the city, did not differ in response times, and were treated similarly with regard to continuing education during the study period. Paramedics who received the algorithms were encouraged, but not required, to use them. Platoons using the algorithms experienced an increase in their ventricular fibrillation patient survival rates from 10.6% to 14.5%; those platoons not using the algorithms had a decrease in patient survival rates from 11.8% to 7.0% (P = 0.0732). There was no statistically significant difference in the paramedics' scores on arrhythmia recognition and management tests given before and after use of the algorithms. Only 39% of the paramedics used the algorithms during actual patient care, but 83% used them as a study guide or for reference between runs. The data suggest that algorithm use may minimize the rate of knowledge and skill decay.

Allied Health Personnel↗
PubMed1981

Determining the generalizability of rating scales in clinical settings.

Traditional approaches to interrater reliability presuppose that reliability is diminished only by undifferentiated random measurement errors. Generalizability theory offers a more comprehensive and appropriate framework for viewing problems associated with assessments derived from multiple raters. A study involving the use of the Functional Limitation Scale (FLS) by three physicians to assess patient status at five points in time illustrates this new approach. Data were analyzed in a multi-way factorial ANOVA design with the levels of raters (3), occasions (5), and patients (15). Examination of the variance components and associated generalizability coefficients revealed that the raters along or in interaction with other factors contributed little variance, while the greatest proportion of variance was attributable to the difference measurement occasions and the patients or these factors in interaction. The FLS was found to be capable of differentiating between patients and the effect of time on patient status, regardless of the physician rater(s). This study illustrates how one multi-faceted design can answer questions that formerly required several separate data sets.

Analysis of Variance↗
PubMed1980

Interobserver and intraobserver reliability in the collection of emergency medical services data.

The collection of data by abstraction from patient records is a widely used method of research, evaluation, and registry. Since valid conclusions depend on the accuracy of the abstracted data, it is essential to examine the abstracting procedures. In this paper, we report on a study of patient data abstracted from emergency department records by nurses trained by project personnel. Twenty-five charts were selected at each of five hospitals. To test interobserver reliability, the nurses were asked to abstract all of the charts at each hospital; to test intraobserver reliability, four of the nurses each reabstracted a set of charts. The results show that even with highly trained, well motivated abstractors, there are considerable differences in the accuracy with which the variables are abstracted. Disposition from the hospital, quantitative vital signs, and blood gas values tend to be abstracted with higher reliability; whereas variables requiring judgment, such as character of vital signs or history of disease, tend to have low reliability. To improve the quality of abstracted data, we propose improved retrieval methods for hospital records, monitoring of data collection procedures, cooperation of all medical personnel providing the raw data, and careful selection of variables.

Emergency Service, Hospital↗
PubMed1979

Severity indices and their implications for emergency medical services research and evaluation.

The present paper explores the rationale for the development of severity indices and the role such indices can play in various research and evaluation situations. Concrete examples from Emergency Medical Services research and evaluation settings are used to illustrate the potential shortcomings of designs that fail to incorporate measures of severity. A short critical review of existing indices is presented, and the ways that the indices can be refined and improved, and better used to evaluate emergency care, are summarized.

Emergency Medical Services↗
PubMed1978

Paramedic services: nationwide distribution and management structure.

A paramedic clearinghouse to provide information on the status of advanced life support systems in the United States is being established at the Center for the Study of Emergency Health Services, University of Pennsylvania. Philadelphia. As the first phase of this project a list of paramedic services categorized by location, population of area served, and management structure was compiled. A total of 310 paramedic services was identified, the majority fairly evenly distributed through midpopulation ranges, the largest number in the 50,000 to 100,000 range. Paramedic services operated by fire departments were most common. As the second phase, a survey of the operation, paramedic certification and education, and the organization of financing of these services is planned. Six services, each representing a different management or educational approach, were selected to test the survey instrument.

Allied Health Personnel↗
PubMed1978

Assessing the validity of EMS data.

Variation in the assessment of basic clinical data gathered by emergency medical technicians and emergency department nurses was studied. Prior to testing, precise definitions, categories and procedures were developed and tolerance limits for the quantitative variables were created. Each participant evaluated four consecutive patients simultaneously with another evaluator setting the standard. The results indicate that the error rate is low to moderate for the different variables. For the quantitative variables, the error rate is over 20% and, when an error does occur, it is often very large. This indicates a need for ongoing emphasis on accurate measurement and, in cases where highly accurate data is essential, the use of multiple observers.

Data Collection↗
PubMed1977

Prehospital cardiac care: illusion of consensus.

To judge standard practice for managing arrhythmias, what an EMT should be able to do in the field, drugs of choice, the success of EMT training, and the quality of EMT performance, clinical algorithms were developed. Branching logic, forcing yes/no decisions and delineating actions for all contingencies helped formalize and systematize EMT management of urgent and emergency cases. The algorithm set was sent to 19 consultants for review of content, sequence, drug dosage, and drug usage. The results indicated lack of consensus on appropriate prehospital cardiac care, but the approval of the algorithm approach.

Allied Health Personnel↗
PubMed1976

Auditing the quality of care in emergency departments.

A methodology for evaluating the quality of emergency department care in the form of a retrospective process audit for emergent and urgent cases was developed and tested in the Philadelphia General Hospital Emergency Department. A physician panel develped criteria against which the management of six "chief complaints," as indicated on the medical record, was measured. Then nonphysician auditors examined records retrospectively for a three-week period, covering every day and shift for a total sample of 389 cases. The physician panel made an implicit review of those records that varied from the criteria. The results of the review in four diagnostic areas showed that for chest pain 51% (36) did not meet the provisional standards; for abdominal pain 35% (35) did not; for wounds 51% (51) did not, and for sore throats 43% (22) did not. These results were presented to the ED staff and charts were re-audited after one month. The results of this second audit are being tabulated though preliminary findings indicate an improvement in the percentage of cases meeting the criteria.

Blue Cross Blue Shield Insurance Plans↗
PubMed1976

Emergency medical technician-paramedic training.

With a nationally standardized emergency medical technician-paramedic training program soon to be adopted, certain factors in the planning of training programs should be emphasized. (1) The facilities should provide an opportunity for the paramedics to gain clinical experience in intensive care units and emergency departments. Teaching must be appropriate to the students' educational background. (2) The course content should include advanced life-support. (3) Full-time and part-time programs must be developed, possibly using a modular format. (4) The operating procedure should conform to local medical and legal practice. (5) Mechanisms for evaluation and recertification must be developed. (6) Continuing education, as important or more important than the original training, should be included in program planning.

Allied Health Personnel↗
PubMedDate not supplied

Predicting survival of victims of motor vehicle crashes in New York state.

This study assesses the relative ability of three different models to predict in-hospital mortality for victims of motor vehicle crashes. The first two models, the trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT), are models that have been used in many earlier studies and have been quoted extensively in the literature. The third model, which is developed in this study, uses essentially the same risk factors as the other two studies, but employs them in a different manner. In order to provide a fair comparison, new (logistic regression) model coefficients are fit to the first two models using the study data. The models are compared with respect to typical criteria for assessing the fit of logistic regression models as well as their ability to predict mortality for various subsets of seriously injured patients. The study concludes that the new model provides a substantially more accurate prediction of mortality, and that it may be wise for regions attempting to assess relative outcomes in their subregions to develop statistical models that are tailored to their own patients.

Accidents, Traffic↗
PubMedDate not supplied

Early predictors of sepsis in the motor-vehicle crash trauma victim.

INTRODUCTION: Sepsis is a major cause of late morbidity and mortality in the victim of trauma. Currently, there is no method that is clinically practical and accurate for predicting the occurrence of sepsis in trauma victims. METHODS: Data were collected on 3,759 motor-vehicle crash victims from 16 hospitals during a 4 1/2 year period. Retrospective analysis was done to examine the relationship of patient and injury factors known within the first 24 hours of admission on the development of sepsis. RESULTS: Sepsis developed in 154 patients (4.1%) who had a mortality rate of 17.5%. Significant early predictors of sepsis included: 1) certain pre-existing conditions; 2) blood transfusion required; 3) seven or more injuries; 4) Glasgow Coma Scale score <10 and hypotension [corrected]; 5) major blood vessel injury; 6) head trauma; 7) internal injury of the chest or abdomen; 8) spinal-cord injury; and 9) certain fracture types. CONCLUSIONS: These predictors might help target high-risk patients and, thus, promote earlier and more effective treatment for those patients.

Accidents, Traffic↗
PubMedDate not supplied

A new pressure ulcer risk assessment scale for individuals with spinal cord injury.

Each year, one-fourth of the 200,000 individuals with spinal cord injury in the United States develop pressure ulcers. No method currently exists, however, to accurately identify which of these individuals are at increased risk for development of pressure ulcers. We studied 219 spinal cord-injured patients, seen at a Veterans Affairs Medical Center, during a 6-yr period. Our goal was to develop a pressure ulcer risk assessment scale, specifically for persons with SCI. Each risk factor had to meet four criteria: (1) statistical association with pressure ulcer development; (2) biologically plausible mechanism; (3) literature support; (4) improved prediction. Among the 219 spinal cord-injured patients evaluated, 176 (80.4 percent) had a history of one or more pressure ulcers. Fifteen risk factors met the four criteria for inclusion into the risk assessment scale. They were as follows: restricted activity level, degree of immobility, complete spinal cord injury, urinary disease, impaired cognitive function, diabetes, cigarette smoking, residence in a nursing home or hospital, hypoalbuminemia, and anemia. Compared with the more general scales available, for quantifying the risk of pressure ulcer development, preliminary results suggest that this new scale is a significant improvement for the spinal cord-disabled.

Adolescent↗