Biomedical subjects
M S Nelson
Publications and source records attributed to M S Nelson.
Role-playing for teaching ethics in emergency medicine.
Ethical issues are becoming increasingly complicated. As with all specialties, emergency medicine has ethical dilemmas unique to the field. We describe a method for teaching students to identify and analyze ethical issues in emergency medicine. The course is designed for clinical medical students and house officers and is structured around various situations in which the students role-play. The course requires about 20 to 30 hours and covers a variety of topics from consent to treatment and confidentiality to teaching and education in the emergency department.
Theophylline levels in COPD exacerbations.
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A profile of BLS and ACLS instructors.
STUDY OBJECTIVE: To examine factors that motivate people to become and remain basic life support (BLS) and advanced cardiac life support (ACLS) instructors. DESIGN: A questionnaire was mailed to 967 BLS and ACLS instructors. SETTING: The study was performed in the San Francisco Bay Area. TYPE OF PARTICIPANTS: All BLS and ACLS instructors whose names were registered with the Santa Clara County Affiliate of the American Heart Association. RESULTS: Although there is room for improvement, 81% of the instructors were satisfied with their jobs. "Satisfaction in performing a valuable service" was the predominant reason they became instructors. "Lack of time" was the main factor causing people to stop teaching. CONCLUSION: The majority of BLS and ACLS instructors surveyed were quite happy. The current system appears to be working in that the teachers themselves are satisfied. An accurate portrait of BLS and ACLS instructors is crucial for organizations such as the American Heart Association if they wish to attract and retain instructors.
Academic professionals.
Faculty at medical schools form a unique group of people. While they are clearly academics many of them also serve in a dual role as professionals. There are some medical school faculty, however, who do not fit this role. This paper explores the definition of 'professional' and discusses some of the conflicts that may develop when academic professionals are mixed with academic non-professionals and with practitioners.
Models for teaching emergency medicine skills.
Teaching and retaining psychomotor skills presents problems in emergency medicine. A variety of models, including animals, plastic models, paid or unpaid volunteers, patients recently pronounced dead, and cadavers (the bodies of people who donate their bodies to science), have been developed to alleviate this problem. Practical and ethical concerns in using these models are discussed, with an emphasis on the cadaver model and on those procedures that are best taught on cadavers.
Frequency of inhaled metaproterenol in the treatment of acute asthma exacerbation.
Acute asthma exacerbations are common complaints in patients who present to the emergency department. A prospective, double-blinded study was designed to evaluate how frequency of dosing of an inhaled beta-agonist, metaproterenol (Alupent inhalation solution) would affect patient response, length of stay in the ED, and admission rates. Forty-one patients initially received a 0.3-mL dose of nebulized metaproterenol followed by two additional doses of either metaproterenol or saline every 20 minutes. While there was no difference in response (forced expiratory volume in one second) in patients at 30 minutes after their arrival, there was an improved response in the metaproterenol group at 60 and 120 minutes. The length of stay in the ED was approximately the same for both groups. There was no significant difference in admission rates. No increase in undesirable side effects (eg, nausea, tremor, palpitations) was seen in the metaproterenol-treated group. Frequent dosing of metaproterenol is useful in asthmatics having acute exacerbations and leads to rapid improvement without an increase in toxicity.
How medical school faculty regard educational research and make pedagogical decisions.
The authors studied a group of professors at a large school of medicine in the western United States to determine the extent to which they were aware of past or current educational research, their feelings about the enterprise of educational research, and how they made pedagogical decisions. The study emphasizes a qualitative analysis of the data by using in-depth, confidential interviews; many typical responses are quoted. The authors found little or no knowledge of past or current educational research even among those professors who thought such research to be valuable. The possible reasons for this finding are discussed.
Predicting matriculation.
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An integrated anatomy and cardiopulmonary resuscitation course.
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More practice with pediatric patients?
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Epinephrine dosage & arrest duration.
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Medical student retention of intubation skills.
Medical students are trained in airway management by endotracheal intubation in most medical schools. Unfortunately, little data exist examining retention, and no data exist that actually break down the steps of intubation to determine where students encounter problems. We studied 64 medical students trained to intubate as part of an American Heart Association advanced cardiac life support course and their performance two to three months after training. The rate of successful intubation (confirmed by visualization) was 70 +/- 12%. The most frequent errors during intubation were failure to check the light before intubation, use of the teeth as a fulcrum, and failure to check the cuff on the endotracheal tube. Knowledge of the most common errors will allow instructors to place greater emphasis on those areas during the initial instruction period with a focus on decreasing their occurrence in the future.
How quickly they forget.
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Clinical diagnosis of bacterial vaginosis.
Bacterial vaginosis (often called nonspecific vaginitis or gardnerella vaginitis) is an incompletely understood disease whose initial diagnosis is often one of exclusion made when no trichomonads, yeast, or evidence of cervicitis is found during the initial examination of a woman complaining of a vaginal discharge. To increase the accuracy of the initial diagnosis, specific criteria were used before the clinical diagnosis of bacterial vaginosis was made. The presence of three of the following four criteria was necessary: 1) vaginal pH greater than 4.5; 2) clue cells on the saline wet mount; 3) thin, homogeneous-appearing discharge; or 4) positive potassium hydroxide "whiff test." A study on 100 consecutive women presenting to the emergency department with vaginal symptoms was done. Of those women meeting the criteria, 93% (54/58) obtained relief of their symptoms by treatment with metronidazole. Of those women not meeting the criteria, only 24% (10/42) were cured (P less than .001). The sensitivity, specificity, and total error rates of these criteria were 84, 89, and 14%, respectively.
Comparison of acid phosphatase ACP1 variants by isoelectric focusing and conventional electrophoresis: identification of three new alleles, ACP1*N, ACP1*P and ACP1*S.
Three new alleles of human red cell acid phosphatase (ACP1) have been identified by comparison with previously reported variants using three different electrophoretic techniques. Family data are available on all the variants and show genetic transmission of the rare alleles ACP1*N, ACP1*P and ACP1*S. Further evidence of a rare allele demonstrating reversed 'A' activity is also described. The report documents the need to use several electrophoretic techniques to characterize new or rare variants.