Search PubMed⌕ Search

Biomedical subjects

D Tandberg

Publications and source records attributed to D Tandberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Triage: limitations in predicting need for emergent care and hospital admission.

STUDY OBJECTIVE: Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. METHODS: We used a crossover design in which each subject was subjected to nurse or computer-guided triage first, the other type of triage second, and physician triage last. Our null hypothesis: Triage methods will yield the same results. Our patients were a consecutive sample of patients at the ED of a university-affiliated county referral center. Critically ill patients were excluded. Triage categorization was examined for interobserver agreement (kappa-statistic) and prediction of admission (sensitivity, specificity, and predictive values). RESULTS: Of the 5,106 patients enrolled in the study, 289 (6.2%) were admitted. With regard to the agreement of triage categorizations, we found kappa-values of .452 and .185, respectively, for physician triage compared with nurse (SE +/- .012) and computer triage (SE +/- .012)(P = .001 for the difference between the kappa values). Sensitivity and specificity in predicting admission were 41.3 and 93.8, respectively, for nurses, 61.6 and 87.1, respectively, for physicians; and 68.2 and 73.6, respectively, for computer-aided triage. CONCLUSION: We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.

Adolescent↗
PubMed1996

The relationship between National Resident Match Program rank and perceived performance in an emergency medicine residency.

A nonconcurrent prospective cohort study was conducted to evaluate if National Resident Matching Program (NRMP) rank developed using multivariate regression followed by consensus group activity is associated with perceived general performance during emergency medicine residency. All residents graduating from a university hospital-based residency program between 1990 to 1993 were ranked by university faculty, private attendings, charge nurses, and a clerk. Each evaluator was asked to order (from the strongest to the weakest) a deck of cards that contained only each graduate's name and picture. NRMP ranks were scaled to adjust for differences in each year's match list length. Evaluators were unaware of the graduates NRMP ranks. Agreement among raters was analyzed using Kendall's coefficient of concordance. Perceived ranks were compared with actual NRMP ranks using the Spearman correlation procedure. Twenty graduates were evaluated by eight different individuals, yielding 160 pairs of ranks. There was moderately strong agreement among evaluators about the relative strength of the 20 residents (W = 0.67, P < .001). The association of perceived rank with NRMP rank was much greater than that expected by chance (r(s) = .35, P < .0001). Applicants with better NRMP ranks were perceived as stronger residents, which supports the strategy of using formal statistical modelling followed by consensus group activity as a method of generating NRMP rank lists.

Adult↗
PubMed1996

Effect of time of day and duration into shift on hazardous exposures to biological fluids.

OBJECTIVE: To determine whether hospital employee biological hazardous exposure rates varied with time of day or increased with time interval into shift. METHODS: This was a retrospective occurrence report review conducted at a university hospital with an emergency medicine residency program. Health care worker biological hazardous exposure data over a 30-month period were reviewed. Professional status, date, time, and type of exposure (needlestick, laceration, splash), time interval into shift of exposure, and hospital location of exposure were recorded. Hourly employee counts and risky procedure counts were matched by location with each reported exposure, to determine hourly rates of biological hazardous exposures. RESULTS: Analysis of 411 recorded exposures demonstrated that more people were exposed between 9:00 AM and 11:00 AM (p < 0.05), yet the exposure risk did not vary significantly when expressed as the number of exposures per worker or per procedure. Of the 393 exposures with data describing time interval into shift when the exposure occurred, significant numbers of exposures occurred during the first hour and at shift's end [when corrected for exposures per worker (p < 0.05) or exposures per procedure (p < 0.05)]. CONCLUSION: While the number of exposures are increased in the AM hours, the exposure rate (as a function of workers or procedures) does not vary with time of the day. However, the exposure rate is increased during the first hour and last 2 hours of a shift. Efforts to increase worker precautions at the beginning and end of shifts are warranted.

Blood-Borne Pathogens↗
PubMed1995

A controlled comparison of self-rated sleep complaints in acute and chronic nightmare sufferers.

A cross-sectional study was performed to retrospectively assess self-rated sleep complaints in three groups of subjects: controls without nightmares (N = 77), acute nightmares sufferers (< 6 months duration, N = 36), and chronic nightmare sufferers (> 6 months duration, N = 128). Four specific complaints of sleep disturbance were categorically measured to ascertain the presence or absence of the symptom: fear of going to sleep; awakenings from sleep; difficulty returning to sleep; and fitful, restless sleep. Each of the four separate sleep complaints were significantly more common in the acute (p < .0001) and chronic (p < .0001) nightmare groups compared with controls. A summed aggregate score of the four sleep complaints was also higher in both the acute (p < .0001) and chronic groups (p < .0001) compared with controls. Ninety-one percent of all subjects with nightmares reported at least one sleep complaint. Between-group assessments, comparing acute and chronic nightmare sufferers for any of the four variables and the aggregate, demonstrated no statistically significant findings, although a few trends were noted. A dose-response relationship was not observed for nightmare frequency or chronicity for any of the four sleep variables or their aggregate. The relationship between nightmares and disturbed sleep is discussed.

Adult↗
PubMed1995

Cerumen occlusion lowers infrared tympanic membrane temperature measurement.

OBJECTIVE: To examine the effect that cerumen occlusion of the ear canal has on infrared tympanic membrane temperature measurement. METHODS: A prospective, randomized, single-blind human study was carried out in a university hospital observation unit. The subjects were a convenience sample of human volunteers ages 18 years or older who did not have cerumen occlusion or scarred tympanic membranes. A paraffin-coated human cerumen plug was placed in one randomly chosen ear, and after 20 minutes of equilibration the temperature of each ear was measured with an infrared thermometer. Analysis of the difference in mean temperature between the occluded and nonoccluded ears was by Student's paired t-test. RESULTS: Infrared tympanic membrane temperatures were measured in 43 subjects aged 21 to 58 years. The mean temperature of the occluded ear canal was 0.3 degrees C lower than that of the opposite ear canal (p = 0.0001, 95% CI 0.16-0.45 degrees C). CONCLUSION: Cerumen occlusion of the ear canal causes underestimation of body temperature measure by infrared tympanic membrane thermometry.

Adult↗
PubMed1995

Dehydration and orthostatic vital signs in women with hyperemesis gravidarum.

OBJECTIVES: To assess the hydration status of women presenting to an ED with hyperemesis gravidarum and to determine whether clinically relevant changes in orthostatic vital signs occur. METHODS: A convenience sample of 23 pregnant women who had hyperemesis gravidarum, with each patient serving as her own control. The study took place in the ED observation unit of an urban teaching hospital. Women who had pregnancies of < or = 16 week's gestation who had been vomiting for at least 24 hours were included. Supine and standing pulse rates and blood pressures (BPs) were measured sequentially after 5 minutes in each position. Patient weight and urine specific gravity (SG) also were recorded. After 6 L of lactated Ringer's solution was infused over a 12-hour period, the same measurements were repeated. Pre- and posthydration changes were analyzed using the paired t-test. RESULTS: The mean treatment weight gain as a percentage of the total body weight was 5.6% +/- 2.2% (mean +/- SD). The urine SG decreased from 1.027 +/- 0.004 to 1.008 +/- 0.003 (p < 0.001). The mean change in systolic BP upon assuming the standing position was -8.3 +/- 12.7 mm Hg before hydration vs 2.9 +/- 7.8 mm Hg after hydration (p < 0.001). The corresponding change in mean diastolic BP was 3.7 +/- 10.9 mm Hg before hydration vs 8.6 +/- 10.9 mm Hg after hydration (p = 0.12). The mean change in pulse rate upon standing was 26.8 +/- 14.5 beats/min before hydration vs 14.5 +/- 10.1 beats/min after hydration (p = 0.002). CONCLUSIONS: Women who present to the ED with hyperemesis gravidarum are significantly dehydrated and experience measurable improvement in postural pulse rate and systolic BP changes with rehydration. However, the presenting orthostatic changes lack sufficient sensitivity to be effectively used as quantitative screening tests for dehydration.

Adolescent↗
PubMed1995

Time series forecasts of poison center call volume.

We tested the hypothesis that time series analysis can provide accurate predictions of future poison center telephone call volume by a prospective stochastic time series modeling of calls to a university-based regional poison center. All callers evaluated and managed during two sequential years had the time and date of the call recorded in a computer database. Time series variables were formed for poison center calls per hour. Prediction models were developed from the 1992 data and included four types: raw observations, moving average, means with moving average smoothing, and autoregressive integrated moving average. Forecasts from each model were tested against observations from the first 26 weeks of 1993. Each model's adequacy was tested on residuals by autocorrelation functions, integrated periodograms, linear regression, and differences among the variances. A total of 44,584 calls were received in 1992 and 24,781 in the first half of 1993. Large periodic variations in call volume with time of day were found (p < 0.001). The model based on arithmetic means of each hour of the week with three-point moving average smoothing yielded the most accurate forecasts and explained 58.5% of the variation observed in the 1993 test series (p < 0.001). Time series analysis can provide powerful, accurate short range forecasts of future poison center telephone call volume. Simpler, less expensive models performed best in this study.

Computers↗
PubMed1994

Observation unit impact on ED admission for asthma.

The hypothesis that the use of an observation unit (OU) in the emergency department (ED) results in monetary savings by lowering the hospital admission rate for asthma was studied in a retrospective comparative cohort at an urban university county hospital. All acute asthmatic patients seen in the ED during a 22-month period were included. Preobservation patients were seen before the OU opened (n = 834); postobservation patients were treated afterward (n = 390). Postobservation patients in the experimental group meeting standard criteria were admitted to the OU. Fisher's exact test and the binomial distribution were used to analyze proportions of patients admitted. Median charges were compared with the Mann-Whitney test. The difference between groups in hospital admission rate was only 2.7% and was not significant (P = .25). However, 5.3% less patients were admitted directly to the hospital (P = .01), and 6.7% less patients were discharged directly from the ED (P = .005). The OU produced no demonstrable cost savings. The use of an OU for asthmatic patients results in lower initial discharge rates from the ED and does not reduce eventual hospital admission appreciably.

Adolescent↗
PubMed1994

Floating nights: a 5-year experience with an innovative ED schedule.

An academic emergency group was surveyed to determine if scheduling night shifts in blocks ("floats") improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. Float physicians were surveyed for isolated and block nights. Faculty in the float group had poorer attitudes compared with the nonfloat group when both worked isolated nights (P = .0053). Working night floats eliminated these differences. Float physicians had more difficulty with sleep regardless of their schedule. They took longer to recover from an isolated night shift, drank more coffee, and used more postcall sedatives than their colleagues (P = .0108). The ideal night float was 2 to 4 weeks with shifts less than 10 hours, but careful attention to sleep hygiene remained essential. Physicians have different adaptability to night work. For some, concentrating night shifts is a useful strategy for improving shift work. This would require shorter shifts and larger groups than are now commonplace.

Attitude↗
PubMed1994

Time series forecasts of emergency department patient volume, length of stay, and acuity.

STUDY HYPOTHESIS: Time series analysis can provide accurate predictions of emergency department volume, length of stay, and acuity. DESIGN: Prospective stochastic time series modeling. SETTING: A university teaching hospital. INTERVENTIONS: All patients seen during two sequential years had time of arrival, discharge, and acuity recorded in a computer database. Time series variables were formed for patients arriving per hour, length of stay, and acuity. Prediction models were developed from the year 1 data and included five types: raw observations, moving averages, mean values with moving averages, seasonal indicators with moving averages, and autoregressive integrated moving averages. Forecasts from each model were compared with observations from the first 25 weeks of year 2. Model accuracy was tested on residuals by autocorrelation functions, periodograms, linear regression, and confidence intervals of the variance. RESULTS: There were 42,428 patients seen in year 1 and 44,926 in year 2. Large periodic variations in patient volume with time of day were found (P < .00001). The models based on arithmetic means or seasonal indices with a single moving average term gave the most accurate forecasts and explained up to 42% of the variation present in the year 2 test series. No time series model explained more that 1% of the variation in length of stay or acuity. CONCLUSION: Time series analysis can provide powerful, accurate short-range forecasts of future ED volume. Simpler models performed best in this study. Time series forecasts of length of stay and patient acuity are not likely to contribute additional useful information for staffing and resource allocation decisions.

Emergency Service, Hospital↗
PubMed1993

Chemical immobilization and killing of intra-aural roaches: an in vitro comparative study.

STUDY OBJECTIVE: The treatment of live insects in patients' ears is controversial. To determine which chemical agent is most effective for immobilizing and killing intra-aural cockroaches, we carried out the following investigation. DESIGN: An in vitro blinded comparative study. INTERVENTIONS: A model was developed in which live cockroaches were submerged in microscope immersion oil, 2% lidocaine, 4% lidocaine, or 2% viscous lidocaine in a glass beaker. Responses of cockroaches were recorded with a video-cassette recorder and evaluated later by a blinded observer. Measured variables were time to death and time-integrated activity before death. Analysis was by analysis of variance with Tukey's procedure. RESULTS: Four groups of 40 cockroaches each were exposed to each of the four agents. Microscope oil killed the insects most quickly (mean, 27.2 seconds; 95% confidence interval, 23.8 to 30.6). The other agents required more than 40 seconds and were inferior to oil (F = 15.5, P < .0001). Total activity was also least in the microscope oil group (F = 25.7, P < .0001). CONCLUSION: Microscope immersion oil is the most effective agent for immobilizing and killing intra-aural cockroaches.

Animals↗
PubMed1993

Selection of emergency medicine residents.

The selection of emergency medicine residents requires review of medical school performance and, usually, an interview in which applicants and program directors exchange important information. Computer technology is available to assist programs in the analysis of information about applicants. Ethnic diversity and minority recruitment should also be considered as 40% of all emergency medicine residencies have no minority residents. Suggestions for developing a valid, humane, and fair selection process are made.

Educational Status↗
PubMed1993

Fire fatalities among New Mexico children.

STUDY OBJECTIVE: To explore the relationship between social conditions and fire mortality rates among children. DESIGN: Retrospective analysis of fire fatalities in children 0 to 14 years old in New Mexico. SETTING: State Office of the Medical Investigator. TYPE OF PARTICIPANTS: All 57 New Mexico children 0 to 14 years old who died from fire-related injuries from 1981 through 1991. INTERVENTIONS: Medical investigator and autopsy records were reviewed and abstracted. Demographic and housing figures were obtained from US Census reports. Data were analyzed by chi 2 or by Fisher's exact test, with Bonferroni correction for multiple comparisons. RESULTS: Two thirds of decedents were male (P = .0014), and three fourths were less than 5 years old (P < .0001). Children living in mobile homes had triple the mortality rate of those in houses or apartments, and children in homes without plumbing (substandard) had more than ten times the mortality rate of those in houses or apartments (P < .0001). Two thirds of the victims in substandard homes were Native American (P < .0001). Errors or negligence of adults occurred in more than half of the deaths. Eighty-two percent of decedents died at the scene; only 11% reached a burn center. CONCLUSION: Substandard homes are associated with an increased fire mortality rate among children. Strategies to prevent childhood fire fatalities should address housing conditions and adult safety practices. Enhanced prehospital or burn unit care is unlikely to greatly affect childhood fire mortality rates.

Accidents, Home↗
PubMed1991

Cervical spine movement during airway management: cinefluoroscopic appraisal in human cadavers.

The objective of this study was to determine which airway maneuvers cause the least cervical spine movement. A controlled laboratory investigation was performed in a radiologic suite, using eight human traumatic arrest victims who were studied within 40 minutes of death. All subjects were ventilated by mask and intubated orally, over a lighted oral stylet and flexible laryngoscope, and nasally. Cinefluoroscopic measurement of maximum cervical displacement during each procedure was made with the subjects supine and secured by hard collar, backboard, and tape. The mean maximum cervical spine displacement was found to be 2.93 mm for mask ventilation, 1.51 mm for oral intubation, 1.65 mm for guided oral intubation, and 1.20 mm for nasal intubation. Ventilation by mask caused more cervical spine displacement than the other procedures studied (ANOVA: F = 9.298; P = .00004). It was concluded that mask ventilation moves the cervical spine more than any commonly used method of endotracheal intubation. Physicians should choose the intubation technique with which they have the greatest experience and skill.

Airway Obstruction↗
PubMed1991

The effect of pH buffering on reducing the pain associated with subcutaneous infiltration of bupivicaine.

The authors propose that pH buffering of bupivicaine with sodium bicarbonate reduces the pain associated with its local subcutaneous infiltration. In a double-blind, prospective study, 62 healthy adult volunteers received a 0.5 mL subcutaneous infiltration of 0.5% buffered bupivicaine into the dorsum of a randomly chosen hand. The pH was adjusted to 7.0 by adding 0.05 mL of sodium bicarbonate (1 mEq/L [corrected]) to 10 mL vials of commercially available bupivicaine (1:200 dilution). The control hand was injected with the same amount of unbuffered agent. Pain was scored after each infiltration using a nonsegmented visual analogue scale. Student's t-test for paired measurements was used to analyze intergroup pain score differences. Forty-three subjects (69%) reported less pain with buffered bupivicaine and only 17 (27%) noted a modest increase: two subjects (3%) reported no difference. The mean pain score for the buffered agent was 22 mm compared with 30 mm for the control. The mean difference (control-experimental) was 8 mm (t = 4.64, df = 61, P less than .001). The authors conclude that the addition of sodium bicarbonate to bupivicaine reduces the pain associated with its local infiltration.

Adult↗
PubMed1991

Systemic anaphylaxis after ingestion of a psyllium-containing breakfast cereal.

Allergic reactions have been described as an occupational hazard among nurses and pharmaceutical workers who handle psyllium-containing laxatives. This study reports the case of a 38-year-old female nurse who ingested a bowl of psyllium-containing Heartwise Cereal (Kelloggs, Battle Creek, MI) and 25 minutes later developed severe systemic anaphylaxis manifested by hypotension, a feeling of constriction in the throat, hoarseness, dyspnea, wheezing, generalized pruritus, urticaria, and vomiting. She was treated with epinephrine, normal saline, diphenhydramine, and methylprednisolone, and recovered completely. Subsequent IgE immunoblot assay was strongly reactive to psyllium. Ingestion of psyllium-containing breakfast foods by sensitized individuals can be associated with life-threatening systemic anaphylaxis.

Adult↗
PubMed1991

Magnetic resonance imaging in minor head injury.

STUDY OBJECTIVES: To investigate the role of cranial magnetic resonance (MR) imaging in evaluating patients discharged from the emergency department after minor head injury. DESIGN: A prospective blinded cohort study. SETTING: University hospital ED. TYPE OF PARTICIPANTS: Fifty-eight patients with minor head injury who were discharged from the ED with written head injury instructions. Patients admitted to the hospital were excluded. INTERVENTIONS: Ultra-low-field cranial MR scans were performed on patients within 24 hours of discharge. Scans were read blindly by two radiologists. MEASUREMENTS AND MAIN RESULTS: Fisher's exact test was used to compare symptoms in patients with abnormal and normal MR scans. There was no significant difference in symptoms between patients with abnormal and those with normal scans (P greater than .10). The proportion of abnormal MR scans was analyzed using the binomial distribution. Six of the 58 patients (10.3%) had traumatic intracranial abnormalities (proportion, 0.103; SD, 0.04; 95% CI, 0.04-0.21). Three had cortical contusions, and three had small subdural hematomas. Two of the six patients with abnormal MR scans, both with small subdural hematomas, had normal computed tomography scans. CONCLUSION: Ten percent of patients discharged from the ED after minor head injury had abnormal ultra-low-field cranial MR scans. Additional research is needed to establish the clinical importance of this unexpected observation.

Adolescent↗