The purpose of this study was to compare the performance of a nurse resident crew (N/R) to that of the usual nurse/nurse (N/N) crew in a helicopter transport service using scene time as a measure of overall teamwork. It was designed as a retrospective case control study carried out by a university-based helicopter emergency transport service. Emergency Medicine second-year residents who volunteered to be assigned to the helicopter transport service for 1 month rotations flew with an experienced flight nurse. This nurse/resident (N/R) team was compared to the usual nurse/nurse (N/N) team in scene trauma flights. The average ground time for the N/N crew (10.5 minutes, n = 43) was not significantly different from that of the N/R crew (10.3 minutes, n = 43). This study suggests that an emergency medicine resident can be incorporated into a flight crew without adversely affecting scene time.

Adolescent↗

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Intubation quality assurance thresholds.

INTRODUCTION: Quality assurance (QA) and continuous quality improvement (CQI) are valued activities within health-care organizations. Quality assurance indicators as guidelines for quality practice usually are established intuitively. The purpose of this study was to determine an appropriate threshold for successful intubation in patients transported by air and to examine factors impacting this success rate. SETTING: Fifteen rotor-wing programs from across the United States participated. METHOD: The study was a prospective descriptive design. A total of 369 flight crew members agreed to participate, and intubations were attempted on 862 patients during the 12-month study. RESULTS: Intubations were attempted on 862 patients and were successful in 788 (91.4%) of the patients. Of the patients not successfully intubated, 14 received supplemental oxygen only, 25 were supported with bag-valve-mask, 26 received a surgical cricothyroidotomy and for nine patients it was unknown what form of airway support was provided. CONCLUSION: Factors impacting successful intubation include cardiac arrest, use of neuromuscular blockade, use of sedatives and facial trauma. Data from the study support a threshold for successful intubation of between 90% and 95%.

Air Ambulances↗

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Lead toxicosis in 2 horses: similarity to equine degenerative lower motor neuron disease.

Explore the source record for details and available documents.

Animals↗

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Community activation and health promotion: identification of key organizations.

PURPOSE: The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. DESIGN: Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. SETTING: This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. SUBJECTS: Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. MEASURES: Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. RESULTS: Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants).(ABSTRACT TRUNCATED AT 250 WORDS)

Health Education↗

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Motivating change.

Effective health behaviour change consultations demand a high level of skill and well-practised strategies used in a patient-centred way of working.

Attitude to Health↗

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Use of an automated pharmacy system and patient registries to recruit HMO enrollees for an influenza campaign.

OBJECTIVE: To develop methods to identify, recruit, and vaccinate HMO enrollees at increased risk for influenza-related complications as part of a comprehensive influenza campaign. SETTING: Group Health Cooperative (GHC) is a large, membership-governed, managed care organization that serves 395,000 members in the Puget Sound area. APPROACH: An automated pharmacy system and patient data registries were used to identify enrollees with chronic illness. Enrollees with chronic illness and all enrollees 65 years of age and older were considered "high-risk" enrollees to be recruited for vaccination. Postcard reminders coupled with a publicity and education campaign were used to recruit high-risk enrollees to special influenza clinics. RESULTS: Our approach identified 2.5% of children (persons < 18 years of age) and 10.5% of adults (persons 18 to 65 years of age) as chronically ill and thus at high risk for influenza-related complications. Most high-risk children were identified through prescriptions for steroids, autonomic inhalers, or both or because they were enrolled in the asthma registry. Most high-risk adults were identified because of prescriptions for steroids, insulin, or oral hypoglycemic agents; because they had received pneumococcal vaccine; or because they were enrolled in the diabetes registry. Influenza coverage rates for all seniors (persons > or = 65 years of age) increased from 34% in 1984 to more than 72% in the 1996-1997 campaign year. Coverage rates were much lower for high-risk children (36%) and adults (46%). CONCLUSIONS: Influenza coverage rates can still be substantially improved for adults younger than 65 years of age and children at high risk for influenza-related complications.

Adolescent↗

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A community-based approach to preventing alcohol use among adolescents on an American Indian reservation.

This paper examines the effectiveness of a 5-year community-based health promotion program to reduce the rate of substance use, particularly alcohol, by adolescents on a Plains State American Indian reservation. The program was part of the Kaiser Family Foundation Community Health Promotion Grants Program. Since a reservation control group was not available, adolescents serving as control groups for other Community Health Promotion Grants Program communities, including a small sample of rural American Indians, were used as a basis for comparison. School-based surveys of 9th and 12th graders were carried out on the reservation and in five relevant California control communities--two suburban, three rural--in 1988, 1990, and 1992. The results showed that the use of both alcohol and marijuana declined substantially among American Indian adolescents living on the reservation. Binge drinking (five or more drinks on an occasion) declined from 46 percent to 30 percent, and marijuana use (in the past month) declined from 46 percent to 29 percent over the 4-year period. However, there were similar, if smaller, declines in alcohol use in the comparison groups. Since there was no evidence of a relative increase in exposure to alcohol and drug programs on the reservation, the authors are cautious in attributing the significant and heartening declines in substance use among adolescents on the reservation to the community-based program.

Adolescent↗

PubMedDate not supplied

Relationship between socioeconomic status, health status, and lifestyle practices of American Indians: evidence from a Plains reservation population.

This paper presents information on the prevalence of a variety of health behaviors and health conditions on an American Indian reservation in the Plains region of the western United States. In addition, data from two non-Indian comparison groups were used to examine the extent to which differences in health status and health behaviors between Indians and non-Indians could be explained by differences in socioeconomic status. The American Indian data were from a survey conducted in 1988 during an evaluation of a local community-based health promotion program, part of the Kaiser Family Foundation's Community Health Promotion Grants Program. The comparison groups were 12 communities in California surveyed in evaluating the Community Health Promotion Grants Program and three Plains States participating in the Behavioral Risk Factor Surveillance Survey. The results show that the higher prevalences of risk-taking behavior among Indians and their poorer self-reported health status remained after adjustment for socioeconomic status. Also, among Indians, higher levels of income and education were not associated with improved self-reported health status and lower prevalence of tobacco use, as was the case with the comparison groups. The higher prevalences of risk-taking behaviors and ill health among American Indians residing on one reservation, even among those with higher socioeconomic status, suggests a need for the investigation of other social and environmental influences.

Adolescent↗