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Frank Thomas

Publications and source records attributed to Frank Thomas.

13 recordsLinked to original sources
PubMed2004

Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial.

Fatigue is a frequent problem after surgical treatment of solid tumours. Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients. Therefore, we compared the effect of the two therapies on fatigue in a randomised controlled study. Seventy-two patients who underwent surgery for lung (n=27) or gastrointestinal tumours (n=42) were assigned to an aerobic exercise group (stationary biking 30 min five times weekly) or a progressive relaxation training group (45 min three times per week). Both interventions were carried out for 3 weeks. At the beginning and the end of the study, we evaluated physical, cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC-QLQ-30) questionnaire, and maximal physical performance with an ergometric stress test. Physical performance of the training group improved significantly during the programme (9.4+/-20 watts, p=0.01) but remained unchanged in the relaxation group (1.5+/-14.8 watts, p=0.37). Fatigue and global health scores improved in both groups during the intervention (fatigue: training group 21%, relaxation group 19%; global health of both groups 19%, p for all < or =0.01); however, there was no significant difference between changes in the scores of both groups (p=0.67). We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours. However, exercise is not better than progressive relaxation training for the treatment of fatigue in this setting.

Adult↗
PubMedDate not supplied

The 2003 Air Medical Leadership Congress: findings and recommendations.

To address important concerns facing the air medical community, 149 air medical transport leaders, providers, consultants, and experts met September 4-6, 2003, in Salt Lake City, Utah, for a 3-day summit-the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community. Using data from a Web-based survey, top air medical transport issues were identified in four core areas: safety, medical care, cost/benefit, and regulatory/compliance. This report reviews the findings of previous congresses and summarizes the discussions, findings, recommendations, and proposed industry actions to address these issues as set forth by the 2003 congress participants.

Air Ambulances↗
PubMedDate not supplied

Medical helicopters in wilderness search and rescue operations.

Medical helicopters may be asked to assist in wilderness search and rescue (SAR) operations to quickly reach patients in remote areas and provide medical care and transport of sick or injured persons. The number 1 priority for any medical helicopter involved in an SAR operation is safety, which is considered at each decision point. The involvement of a medical helicopter service begins with a request from a local agency for support. Obtaining key information about the SAR operation from the local agency is essential for deciding whether to accept the mission and for making appropriate preparations for the mission. While en route to the SAR location, the medical crew can review the information regarding location and patient status. Once on location, the crew can survey the scene from the air before landing at the command post to brief with SAR personnel regarding the mission. An initial survey of the scene from the air is important for identifying landing zones and evaluating the terrain where the rescue will occur. A face-to-face briefing with SAR personnel is preferable to learn specifically what type of mission is requested. The medical helicopter crew is empowered to decline the mission for safety reasons at any step. The actual rescue may be done by inserting the helicopter at the scene in nontechnical terrain or by having SAR personnel extricate the patient and deliver him or her to the medical helicopter crew at the nearest safe landing zone. Medical care and transport of the patient as indicated by injuries or illness then occurs. Finally, a postmission debriefing is essential for identifying problems that occurred during the mission and implementing corrections for improvement.

Air Ambulances↗
PubMedDate not supplied

Transport of winter resort injuries to regional trauma centers.

INTRODUCTION: This study examined the epidemiology of winter resort injuries presenting to regional trauma centers by helicopter (HEMS) or ground (GEMS) ambulance. METHODS: Five hundred seventy-five patients (GEMS 289; HEMS 286) were identified from trauma registries and HEMS transport records. Demographic data, hospital interventions, and discharge status were examined. RESULTS: HEMS patients had a significantly lower Glasgow coma score (GCS) and trauma score (TS), longer intensive care unit (ICU) length of stay (LOS), and more deaths than did GEMS patients (P < 0.05). Despite this, significantly more HEMS patients were discharged home from the emergency department (24.5% vs. 4.8%; P < 0.001). HEMS patients had more isolated head/facial injuries and multiple injuries, with less isolated extremity injuries than did GEMS patients (P < 0.05). Regardless of transport mode, patients with multiple injuries, thoracoabdominal injuries, or head injuries with a GCS < or = 13 were more likely to require immediate interventions (intubation, chest tube, blood products). Patients with isolated extremity injuries rarely needed immediate care. CONCLUSION: HEMS patients had a higher acuity and different injury pattern when compared to GEMS patients. Approximately 24.5% of HEMS patients were discharged home from the ED. This reflects significant overtriage of patients to HEMS. A prospective study examining the initial triage of patients injured at winter resorts would help to determine which subset of patients are best served by HEMS transport.

Adolescent↗
PubMedDate not supplied

AMTC presentations.

Explore the source record for details and available documents.

Air Ambulances↗
PubMedDate not supplied

Sleep and cognitive performance of flight nurses after 12-hour evening versus 18-hour shifts.

BACKGROUND: Inadequate rest can result in disastrous medical and aviation errors. Using a prospective within-subjects design, this study compared the amount of daily sleep and the cognitive performance in flight nurses working 12-hour evening versus 18-hour shifts during a 72-hour duty schedule. METHODS: Ten flight nurses who worked two different duty schedules participated in the study. The first duty schedule consisted of three back-to-back 12-hour (7:00 pm to 7:00 am) evening shifts. The second duty schedule consisted of two 18-hour (7:00 am to 1:00 am) shifts separated by a 24-hour rest period. Pre- and duty sleep times were monitored using actigraphy. The flight nurses were tested using a battery of neuropsychological tests before and immediately after completing 12- and 18-hour duty schedules. After the conclusion of both duty schedules, nurses were asked to rate the 12- versus 18-hour duty schedules via questionnaire. RESULTS: Daily sleep times for the 12- versus 18-hour were not different for the pre-duty schedule (8.9 +/- 2.3 vs. 9.0 +/- 2.3 hours) or during duty schedule (7.0 +/- 1.4 vs. 6.9 +/- 1.3 hours). A significant decline was seen in the amount of pre- versus duty sleep for both the 12-hour (8.9 +/- 2.3 vs. 7.0 +/- 1.4 hours; P < .05) and the 18-hour (9.0 +/- 2.3 vs. 6.9 +/- 1.3 hours; P = .04) duty schedules. During the 72-hour duty schedule, the 12-hour vs. 18-hour duty schedules, the nurses had less pre-shift sleep (3.2 +/- 1.2 vs. 6.2 +/- 0.6; P = .001) and more on-shift (4.4 +/- 1.7 vs. 2.1 +/- 0.8; P = .002) sleep. Despite the decline in daily sleep during both duty schedules, no significant decline in the before versus after cognitive test scores were observed for either the 12- or 18-hour duty schedule. A questionnaire given to the 10 nurses indicated that the 18-hour duty schedule was more compatible with their non-work lifestyle (P = .04). CONCLUSIONS: Provided adequate daily sleep (at least 7 hours/day) is obtained, we found no difference or decline in the cognitive function of flight nurses working either a 12-hour evening or 18-hour shift during a 72-hour duty schedule. Eighteen-hour duty shifts may be a practical economical means of expanding the period of helicopter site coverage without adversely affecting cognitive performance in medical crewmembers. Actigraphy may be a useful tool for air medical programs that want to objectively assess whether adequate sleep is occurring in individuals working extended (>12 hours) or unusual duty shifts.

Air Ambulances↗
PubMedDate not supplied

The Air Medical Leadership Congress: setting the health care agenda for the air medical community.

BACKGROUND: Emergency air medical transport provides the means for critically ill or injured patients to rapidly access sophisticated medical flight teams and medical centers. However, issues such as surging emergency medical services helicopter accidents, expected pilot and nurse shortages, falling reimbursements, and new compliance regulations are now threatening these important but expensive transport services. Unless an industry strategy can be developed to address these and other threats, many medical flight programs may be forced to curtail the availability of these lifesaving services. PURPOSE: On September 4-6, 2003, air medical leaders, experts, program managers, providers, and users of emergency air medical services gathered in Salt Lake City, Utah, to discuss and formulate recommendations to address the top issues that threaten the future of air medical transport services. This congress was open to anyone engaged in the field of air medical transport. This historic meeting resulted in a plan to enhance transport safety, foster appropriate utilization, improve in-flight medical care, maximize cost and reimbursement effectiveness, and develop strategies to reduce the adverse effects of new regulatory and compliance mandates. OBJECTIVES: This article describes the significance of the Air Medical Leadership Congress and the 10-Point Plan method used to develop it.

Air Ambulances↗
PubMedDate not supplied

Scene transport of pediatric patients injured at winter resorts.

OBJECTIVE: To examine the characteristics of pediatric patients (age =16 years) injured at winter resort scenes and transported by helicopter emergency medical services (HEMS) or ground EMS (GEMS) ambulance services to regional trauma centers. METHODS: Between 1997 and 2001, a total of 119 patients (GEMS = 69; HEMS = 50) were identified from trauma registries and HEMS transport records. Demographic data, initial vital signs, hospital interventions, and discharge status of the two groups were examined. RESULTS: The distributions of gender, initial vital signs, Injury Severity Score (ISS; either = or > 15), intensive care unit (ICU) length of stay (LOS), total hospital LOS, and home discharge status were similar between the two groups (p = 0.05). Patients transported by HEMS were older (14 +/- 2 vs. 10 +/- 4, p < 0.001), less likely to be admitted to the hospital (73% vs. 98.5%; p < 0.001), and more likely to have multiple injuries [13 (27%) vs. 8 (11.6%), p = 0.032]. The GEMS patients had a higher rate of isolated extremity [33 (80.5%) vs. 8 (19.5%)] and thoracoabdominal [11 (73.3%) vs. 4 (26.7%)] injuries. The high orthopedic injury rate in the GEMS patients contributed to a higher rate of surgery in this group (45% vs. 24%, p = 0.028). Regardless of transport mode, patients requiring immediate interventions (intubation, chest tube placement, or blood product administration) had either a depressed level of consciousness (GCS = 12) on emergency department arrival or thoracoabdominal injuries. No deaths were recorded. CONCLUSIONS: Patients transported by HEMS and GEMS had similar hospital characteristics but different injury patterns. A prospective study examining the initial triage of pediatric patients injured at winter resorts would help to determine which subset of patients are best served by HEMS transport.

Adolescent↗
PubMedDate not supplied

Carbon Monoxide Research Group, LDS Hospital, Utah in reply to Scheinkestel et al. and Emerson: the role of hyperbaric oxygen in carbon monoxide poisoning.

UNLABELLED: This comprehensive response was invited by the Editor of Emergency Medicine Australasia to allow our Group from Salt Lake City, Utah to review the two articles 'Where to now with carbon monoxide poisoning?' by Scheinkestel et al. and the accompanying COMMENTARY: 'The dilemma of managing carbon monoxide poisoning' by Emerson published in the April issue of Emergency Medicine Australasia.

Carbon Monoxide Poisoning↗
PubMedDate not supplied

Capnography: beyond the numbers.

Detecting end-tidal pressure of carbon dioxide (PetCO2) is becoming increasingly common in the emergency transport setting. Several CO2 detection devices are suitable for emergency transport, including colorimetry, capnometry, and capnography. Capnography is the only device that displays a waveform of CO2 levels throughout the respiratory cycle. Analysis of this waveform is key to avoiding therapeutic errors. End-tidal PCO2 is best used for verifying endotracheal and nasal gastric tube placement and assessing the effectiveness of CPR. The use of capnography as a means of guiding manual or mechanical ventilatory therapy is unreliable in unstable, critically ill, or injured patients.

Capnography↗