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J R Graves

Publications and source records attributed to J R Graves.

36 records · Page 2Linked to original sources
PubMed1992

Transcutaneous cardiac pacing in the treatment of out-of-hospital pediatric cardiac arrests.

STUDY OBJECTIVE: To evaluate the effectiveness of transcutaneous cardiac pacing in out-of-hospital treatment of cardiac arrests in pediatric patients. DESIGN: We describe the outcome of patients treated during a prospective trial of transcutaneous cardiac pacing in the field. We compare their outcome with that of out-of-hospital arrests in submersion patients who were not paced. We identified patients from Seattle and King County Emergency Medical Services reports, hospitals, and medical examiner's registries. MEASUREMENTS AND MAIN RESULTS: Nine patients in cardiac arrest caused by drowning (six) and sudden infant death syndrome (three) were paced in the field. All were less than 6 years old. The one survivor was severely neurologically impaired and died six months later. Transcutaneous cardiac pacing produced electrical capture in two patients but no detectable pulse or blood pressure. Ten submersion patients less than 6 years old in cardiac arrest were not paced. One survived, with mild neurologic impairment at hospital discharge. CONCLUSION: Transcutaneous cardiac pacing was not effective and was not associated with improved survival.

Cardiac Pacing, Artificial↗
PubMed1990

Near-fatal yew berry intoxication treated with external cardiac pacing and digoxin-specific FAB antibody fragments.

The case of a 5-year-old girl who survived a near-fatal ingestion of yew plant leaves after treatment with CPR, transcutaneous pacing, and digoxin-specific FAB antibody fragments is presented. Multiple rhythm disturbances, including profound bradycardia, occurred. She required endotracheal intubation, external chest compressions, and application of a transcutaneous pacemaker. Paced cardiac contractions produced a dramatic improvement in her blood pressure and clinical condition. Two empiric injections of digoxin-specific FAB antibody fragments were administered, after which cardiac function and rhythm gradually improved. She was discharged in her normal state of health three days later. Yew leaves and berries contain several alkaloids that can produce fatal conduction disturbances. Transcutaneous cardiac pacemakers may be lifesaving for patients with transient cardiac toxicity from drug or toxin ingestions. In addition, cross-reactivity between digoxin-specific FAB antibodies and the alkaloids in the yew plant may exist and may have therapeutic importance, although this mechanism was unlikely to have helped our patient.

Bradycardia↗
PubMed1990

A research-knowledge system (ARKS) for storing, managing, and modeling knowledge from the scientific literature.

Nursing knowledge and nursing data are the foundation for nursing practice. Domain knowledge that is stored in the literature of nursing and related disciplines, if not in memory, needs to be available to nurses during the process of clinical decision making. Although the electromechanical technology for delivering knowledge is available, conceptual technology lags far behind. An informatics solution to the conceptual problem is provided by knowledge engineering, the branch of informatics that addresses such problems by developing methods for restructuring knowledge from one form into a form that is more useful. The purpose of this article is to describe a research program for engineering nursing knowledge that has resulted in the development of such a tool, a prototype computer system for storing, managing, and modeling research-knowledge. The system is called ARKS, acronym for A Research-Knowledge System.

Computer Simulation↗
PubMed1989

The study of nursing informatics.

A framework for organizing the study of nursing informatics is presented. The management and processing of nursing data, information science and nursing science is proposed as an area for study. The premises for such study and the key concepts and relationships are discussed. Nursing informatics would support the practice of nursing and delivery of nursing care.

Education, Nursing↗
PubMed1988

An innovative approach to medical control: semiautomatic defibrillators with solid-state memory modules for recording cardiac arrest events.

We evaluated the use of microprocessor-based memory modules incorporated into automatic external defibrillators. These solid-state modules store information about each clinical use, including selected segments of the ECG rhythm and notations on defibrillator operation. A playback unit provides annotated printouts of the recorded information. The purpose of our evaluation was to determine whether this memory module could adequately support medical control "run-reviews" when compared with dualfunction (voice and ECG) tape recordings. A total of 41 resuscitation attempts by emergency medical technicians trained to defibrillate (EMT-Ds) were evaluated in five preselected performance areas: defibrillation skills, command and communication at the scene, patient assessment and support, safety, and speed. When performance was reviewed using the tape recordings, the average EMT-D performance score was 16.2 (maximum, 20); when reviewed using the printouts from the medical control modules, the average score, 7.2, was significantly lower (P less than .01). The lower scores with the medical control module occurred because not all five areas of skill could be evaluated adequately by the memory module approach. Assessment of the areas of communication/command at the scene, patient assessment/support, and safety required verbal tape recordings. The medical control module appeared superior to the tape recordings at providing a quick, convenient, and accurate evaluation of rhythm assessment, shock decisions, time intervals, and defibrillator performance. They make several features of medical control review easier and more convenient, and may encourage implementation of early defibrillation programs. We conclude, however, that medical control modules cannot replace on-scene tape recordings for adequate medical control of EMT-D programs.

Automation↗
PubMed1987

Automatic external defibrillators used by emergency medical technicians. A controlled clinical trial.

In a randomized controlled clinical trial, the effectiveness of emergency medical technician (EMT) use of automatic external defibrillators (AEDs) was compared with EMT use of standard defibrillators for patients in cardiac arrest. A total of 321 cardiac arrest patients were treated during the study: 116 were treated by EMTs using the AED (AUTO group), 158 were treated by EMTs using the standard defibrillators (standard group), and 47 were treated by EMTs using the standard defibrillator when they were assigned to use the AED. There was no significant differences in hospital admission or discharge rates between the AUTO group (54% admitted, 28% discharged) and the standard group (52% admitted, 23% discharged) for patients in ventricular fibrillation (VF), for patients in non-VF rhythms, or for all patients combined. The only significant difference observed was in the time from power ON to first shock: 1.1 minutes average AUTO group and 2.0 minutes average standard group. The treatment groups did not differ significantly in sensitivity for VF (78% AED, 76% standard), specificity for non-VF rhythms (100% AED, 95% standard), or rates of defibrillation to a non-VF rhythm (62% AED, 57% standard). We conclude that in clinical outcomes and device performance, AEDs are comparable with standard defibrillators and should be considered an acceptable alternative. Automatic external defibrillators appear to have advantages over standard defibrillators in training, skill retention, and faster operation. Such devices can make early defibrillation available for a much larger portion of the population. They are a major innovation for the prehospital care of cardiac arrest patients.

Analysis of Variance↗
PubMed1986

Ventilation skills of emergency medical technicians: A teaching challenge for emergency medicine.

We assessed the ability of 64 emergency medical technicians (EMTs) to ventilate a resuscitation manikin with a bag valve mask and with a pocket face mask to determine if their skill levels met the American Heart Association standard of 12 ventilations per minute, each with a tidal volume of 800 mL or more. All ventilation attempts were made during ongoing chest compressions (60 per minute). A successful ventilation was defined as a tidal volume of 800 mL +/- 40 mL. In a preliminary skills assessment, EMTs averaged 4.8 attempts with the bag valve mask and 2.9 attempts with the pocket face mask before a successful ventilation (P less than .01). In a formal skills assessment that lasted two minutes, successful ventilations per minute averaged 8.3 with the bag value mask and 9.9 with the pocket face mask (P less than 0.1). EMTs passed if they averaged ten or more successful ventilations per minute; 67% passed with the bag valve mask and 77% with the pocket face mask (NS). During a ten-minute extended skill assessment the EMTs averaged 9.6 ventilations per minute with the bag valve mask and 9.5 with the pocket face mask (NS). EMTs achieved initial success and maintained continued success better with the pocket face mask, but a reasonably high percentage (67%) met an objective standard when using the bag valve mask. We propose that objective standards be used to test the skills of EMTs for any ventilatory adjunct that they are permitted to use.

Allied Health Personnel↗
PubMed1985

What is a "save"?: Outcome measures in clinical evaluations of automatic external defibrillators.

Automatic external defibrillators (AEDs) represent an important technologic innovation in the management of out-of-hospital cardiac arrest. We propose the following concept: AEDs are machines with the limited task of ventricular fibrillation (VF) identification, countershock delivery, and defibrillation. They cannot be expected to produce "saves" independently. This study tested this concept by using the same AED in two different emergency medical systems: outcomes dependent upon the device should be the same in both groups, whereas outcomes dependent upon patient and system factors should be different. Paramedics, with the AED as their initial monitor/defibrillator, treated 16 cardiac arrest patients in VF; EMTs (emergency medical technicians), with the same AED, treated 17 patients in VF. There were no significant differences in the outcomes proposed to be machine-dependent: sensitivity, defined as the percentage of VF rhythm segments shocked; specificity, defined as the percentage of non-VF rhythms not shocked; and defibrillation of segments of VF to non-VF rhythms. There were, however, differences in the outcomes dependent on patient and system factors (paramedic group presented first): percent converted to a perfusing rhythm (23% vs 69%; p less than 0.05); percent admitted to the hospital (19% vs 65%; p less than 0.025); and percent discharged from the hospital (6% vs 29%; p = N.S.). We conclude that AEDs should be compared and evaluated on device-dependent outcomes and not on the basis of producing "saves".

Aged↗
PubMed1985

Automatic external defibrillators: clinical, training, psychological, and public health issues.

Automatic external defibrillators (AEDs) will be used by spouses, family members, emergency first-responders, and the citizenry at large. Such use, however, raises a number of clinical, training, psychological, and public health issues. Clinical issues: Is cardiac arrest to be verified by the operator or the AED? Second verification systems, such as breath detectors, produce errors of omission, but greatly expand the pool of potential users. The relative merits of high sensitivity and low specificity in arrest verification must be defined by clinicians relative to the setting and the potential users. AEDs require cessation of basic CPR during their assessment periods; clinicians must determine the tradeoff between long interruption of basic life support and much earlier delivery of countershocks. Training issues: Criteria for those to be trained include consideration of who the patient will be and who the AED operator might be. AEDs pose a familiar adult education problem, that is, acquisition of a new psychomotor skill and retention of that skill for long periods before performance. What are the best teaching techniques? Currently available AEDs have different designs for device-operator interaction. Which design is most likely to assure proper performance during an actual arrest? Psychological issues: What are the psychological effects of learning about, living with, and eventually using an AED? The development of the automatic external defibrillator constitutes the most recent attempt to achieve early defibrillation of patients in cardiac arrest. The potential public health effect of such devices is enormous.

Electric Countershock↗
PubMedDate not supplied

Embedded structures and representation of nursing knowledge.

Nursing Vocabulary Summit participants were challenged to consider whether reference terminology and information models might be a way to move toward better capture of data in electronic medical records. A requirement of such reference models is fidelity to representations of domain knowledge. This article discusses embedded structures in three different approaches to organizing domain knowledge: scientific reasoning, expertise, and standardized nursing languages. The concept of pressure ulcer is presented as an example of the various ways lexical elements used in relation to a specific concept are organized across systems. Different approaches to structuring information-the clinical information system, minimum data sets, and standardized messaging formats-are similarly discussed. Recommendations include identification of the polyhierarchies and categorical structures required within a reference terminology, systematic evaluations of the extent to which structured information accurately and completely represents domain knowledge, and modifications or extensions to existing multidisciplinary efforts.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Mapping out the road to quality.

Through the experiences of 12 long-term care organizations, we learn how to successfully create total quality management programs. Commitment, leadership, time, money and ongoing education and training are major components of TQM efforts.

Health Services Research↗
PubMedDate not supplied

Researcher's Workbench.

The Researcher's Workbench, developed at the University of Utah College of Nursing, is a computer toolkit for nurse researchers. Workbench includes a set of software tools, most of which are commercially available, to support each stage of the research process. The tools reside on a Macintosh II desk-top computer (Apple Computer, Cupertino, CA) that houses processors to run both Macintosh and MS-DOS (Microsoft Corporation) software. The Workbench is available to all College of Nursing faculty, research associates, and graduate students. This article describes the purpose, methods, design, and implementation of the Workbench. The article assumes familiarity with personal computer terminology.

Computers↗
PubMedDate not supplied

Description of a graduate program in clinical nursing informatics.

This article describes the history and development of the Clinical Nursing Informatics Program at the University of Utah College of Nursing. Program philosophy and curriculum are discussed in the context of the conceptual framework. Courses and student projects are described. The authors reflect on the ensuing stage of program development.

Computer Systems↗