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T W Whitley

Publications and source records attributed to T W Whitley.

At least 19 recordsLinked to original sources
PubMed1997

Photograph documentation of motor vehicle damage by EMTs at the scene: a prospective multicenter study in the United States.

The purpose of this study was to determine if emergency medical service (EMS) personnel could take instant photographs of motor vehicle damage at crash scenes depicting the area and severity of damage of the crash under adverse weather conditions, in different lighting, and quickly enough so as not to interfere with patient care. This prospective multicenter trial involved 35 ambulances responding to motor vehicle crash scenes in rural, suburban, and urban areas in five centers in four states. Emergency medical technicians (EMTs) reported their experience implementing a protocol for use of an instant camera to photograph vehicle damage at crash scenes. Time reported by EMTs to take the photographs was 1 minute or less in 204 of 288 (70.9%) of motor vehicle crashes and 2 minutes or longer in 12 of 288 (4.2%) of motor vehicle crashes. From one EMS agency in the study, 48 scene times during which photographs were taken were, on average, 1.5 minutes shorter than 48 scene times immediately before implementation of on-scene crash photography. Photographs were taken in different weather and lighting conditions. EMTs reported they were able to determine both area and severity of damage in 260 of 290 (92.5%) crash photographs, but they were unable to determine area and severity of damage in only 2 of 290 (0.7%) crash photographs.

Accidents, Traffic↗
PubMed1997

Standardized examination performance and specialty choice.

BACKGROUND AND OBJECTIVES: It has been suggested that medical students who attend schools known for graduating prospective primary care physicians may enter primary care residencies, rather than non-primary care residencies, because they are unable to compete for subspecialty residencies due to poorer academic performance. This study determined if performance on standardized examinations conducted by the National Board of Medical Examiners (NBME) could differentiate between students who selected primary care and those who selected non-primary care specialties at a medical school in the southeastern United States committed to graduating primary care physicians. METHODS: We examined initial scores on NBME examinations and subsequent residency selections by 780 students over a 14-year period to determine if there were differences in the kind of residency placements of students who passed and those who failed the examinations. RESULTS: Data analysis indicated that medical students who entered primary care and non-primary care residencies were not distinguishable on the basis of standardized examination performance. CONCLUSIONS: These results may help to refute negative stereotypes about students who enter primary care residencies and about medical schools known for promoting careers in primary care.

Career Choice↗
PubMed1996

Patient and physician perception of need for emergency medical care: a prospective and retrospective analysis.

The purpose of this study was to examine patients' and physicians' perceptions of the urgency of need for emergency medical care, and why patients come to the emergency department (ED). Survey instruments were utilized at EDs at an academic tertiary care center and a community hospital. Physicians' prospective assessment indicated that 65.8% (921 of 1,400) of the patients seen needed attention within 12 hours, whereas the patients' perception was that 86.5% (957 of 1,106) needed care within 12 hours. Patients' and physicians' retrospective responses were compared; in 19.5% (152 of 781) of cases patients rated urgency of their condition lower than the physician. These results indicate that patients and the physicians who treat them, despite the passage of a decade since a previous report of a similar study and a vastly different patient and physician population, have similar perceptions of the need for emergency care. Additionally, patients presented to EDs for a multitude of reasons; however, in strikingly different patient populations, a number of reasons are identified consistently.

Attitude↗
PubMed1996

First-year medical students' knowledge of and attitudes toward primary care careers.

BACKGROUND AND OBJECTIVES: This study compared the knowledge of and attitudes toward primary care in relation to anticipated career choices of first-year medical students at two medical schools that differ significantly in production of primary care physicians. METHODS: A cross-sectional survey was conducted at a private, urban school in the Northeast where only a small percentage of students enter family practice residencies and a public, rural school in the Southeast where entry into family practice is among the highest in the country. The survey was conducted during the first semester of medical school. RESULTS: Ninety-six percent of students correctly identified general internal medicine, general pediatrics, and family practice as primary care fields; 51.8% identified these fields as "specialties." Statistically significant differences were seen between the percentages of students at the two schools who planned careers in primary care, suggesting that selection processes may differ between the two schools. There were no significant differences between students at the two schools in correctly identifying the characteristics of primary care practice. Only minor differences between the schools were found in assessments of the need for or importance of primary care. CONCLUSIONS: Although a significant difference in student interest in becoming primary care physicians was detected at the two schools, a surprising similarity was shown in their knowledge and attitudes about primary care. New attitudinal markers will need to be developed to help admissions committees select students most likely to enter primary care careers.

Adult↗
PubMed1995

Effect of acute ethanol ingestion on orthostatic vital signs.

STUDY OBJECTIVE: To determine the effect of acute ethanol intoxication on the results of orthostatic tilt testing. DESIGN: Prospective, randomized crossover study. Subjects received ethanol (1.1 gm/kg) or an equal volume of water added to nonalcoholic beer. Orthostatic vital signs, ethanol concentration, and relative volume status were checked initially and hourly for 8 hours. PARTICIPANTS: Twenty healthy human volunteers, 10 men, and 10 women. RESULTS: Peak ethanol concentration was 116 +/- 18 mg/dL (mean +/- SD) 1 hour after ingestion. ANOVA for repeated measures revealed a significant difference in orthostatic pulse change and relative volume deficit between the ethanol and placebo groups (P < .05). Post hoc testing revealed significant differences between the two groups at two, five, seven and eight hours post ingestion for pulse change, and two to eight hours for volume status (Bonferroni's corrected t test, P < .0055). At 2 and 5 to 8 hours, there were significantly more positive tilt tests (+/- 30 beat/minute increase) in the ethanol group than in the placebo group (P < .05). Starting at 2 hours, the ethanol group had a statistically significant relative fluid deficit averaging .5 L by 3 hours. There was no difference in postural blood pressure changes between the two groups. CONCLUSION: In healthy volunteers, ethanol intoxication resulted in exaggerated postural pulse changes and in a greater proportion of positive orthostatic tilt test results than in a placebo group. These changes were accompanied by significant relative fluid deficits.

Adult↗
PubMed1995

Is ambulance transport time with lights and siren faster than that without?

STUDY OBJECTIVE: To determine whether ambulance transport time from the scene to the emergency department is faster with warning lights and siren than that without. DESIGN: In a convenience sample, transport times and routes of ambulances using lights and sirens were recorded by an observer. The time also was recorded by a paramedic who drove an ambulance without lights and siren over identical routes during simulated transports at the same time of day and on the same day of the week as the corresponding lights-and-siren transport. SETTING: An emergency medical service system in a city with a population of 46,000. PARTICIPANTS: Emergency medical technicians and paramedics. RESULTS: Fifty transport times with lights and siren averaged 43.5 seconds faster than the transport times without lights and siren [t = 4.21, P = .0001]. CONCLUSION: In this setting, the 43.5-second mean time savings does not warrant the use of lights and siren during ambulance transport, except in rare situations or clinical circumstances.

Ambulances↗
PubMed1995

Accuracy of fingerstick glucose values in shock patients.

BACKGROUND: Fingerstick blood glucose measurement has become widespread in both hospital and prehospital settings. OBJECTIVE: To determine the accuracy of fingerstick blood glucose measurement in patients with poor peripheral perfusion (shock). METHOD: Results obtained during three methods of glucose analysis (fingerstick blood glucose measurement; bedside and laboratory glucose analysis) were examined prospectively on 38 patients from inpatient medical and surgical critical care units or the emergency department of a large tertiary care referral center. RESULTS: The means of the three glucose measurements were significantly different. Univariate analysis of the mean laboratory glucose value versus the mean fingerstick glucose value was significantly different. The mean venipuncture glucose measured by the bedside glucose meter versus the mean venous laboratory glucose was not significantly different. CONCLUSION: These results suggest that fingerstick blood samples should not be used for bedside glucose analysis in patients who may have inadequate tissue perfusion.

Adult↗
PubMed1994

Prehospital blood pressures: inaccuracies caused by ambulance noise?

Blood pressure measurements in a moving ambulance can be difficult to obtain. Sirens, engine noise, and road noise can all interfere with the accurate detection of a patient's blood pressure. This study was undertaken to determine the influence of ambulance noise and vibration on auscultated blood pressures. A model was developed that used dynamic pressures to simulate systolic Korotkoff sounds. Forty-nine emergency personnel were asked to obtain blood pressures using the model in both a quiet environment and in a moving ambulance. A total of 485 blood pressure measurements were obtained. Systolic pressures were randomized to two settings: 76 mm Hg and 138 mm Hg. Stationary readings were compared with moving readings using analysis of variance for repeated measures. Systolic blood pressure measurements obtained in the quiet environment averaged 133 +/- 5 mm Hg at the high setting, and 45 +/- 6 mm Hg at the low setting. Systolic blood pressure measurements obtained in a moving ambulance averaged 86 +/- 7 mm Hg at the high setting, and 41 +/- 7 mm Hg at the low setting. The average differences between quiet and moving measurements were 47 mm Hg at the "high" setting (P < .01) and 4 mm Hg at the "low" setting (P > .01). At physiological levels, blood pressures obtained in moving ambulances differ significantly from those obtained in a quiet environment, which may be caused by road noise and ambulance motion.

Ambulances↗
PubMed1994

Adverse lighting condition effects on the assessment of capillary refill.

In 1989, Champion et al recommended revising the Trauma Score to exclude capillary refill because it is "difficult to assess at night. . . ." However, a literature search produced no studies evaluating the effect of lighting conditions on the assessment of capillary refill. This study was undertaken to determine if any such effect exists. Three hundred nine participants at an emergency medical services (EMS) seminar were asked to assess each others' capillary refill in both light and dark environments. The participants were nurses, emergency medical technicians (EMTs), and paramedics who had been instructed in the assessment of capillary refill. In daylight conditions (partly cloudy day, lux meter = 15 to 16), capillary refill was reported as normal in 94.2% of the participants, delayed in 1.9% of the participants, and undetected in 3.9% of the participants. In dark conditions (moonlight or street lamp, lux meter = 4 to 6), capillary refill was reported as normal in 31.7% of the participants, delayed in 1.6% of the participants, and undetected in 66.7% of the participants. chi 2 analysis demonstrated a statistically significant difference between capillary refill assessment in light versus dark environments (P < .001).

Adolescent↗
PubMed1994

Intravenous versus rectal prochlorperazine in the treatment of benign vascular or tension headache: a randomized, prospective, double-blind trial.

STUDY OBJECTIVE: To compare the effectiveness of i.v. and PR prochlorperazine for treatment of acute benign vascular or tension headache. DESIGN: Prospective, randomized, double-blind trial. SETTING: University emergency department with 50,000 annual census. PARTICIPANTS: Forty-five adult patients enrolled on 46 visits. INTERVENTIONS: Patients received 10 mg prochlorperazine i.v. and placebo suppository or 25 mg prochlorperazine PR and placebo injection. Pain assessment was made using a 10-cm visual-analog scale; scores were analyzed using Wilcoxon/Kruskal-Wallis rank-sum tests (alpha of .01). RESULTS: Mean 60-minute pain scores for i.v. and PR groups were 0.6 and 3.5, respectively (P = .0002). Two patients (8.7%) in the i.v. group and six patients (26.1%) in the PR group required rescue analgesia (P = .12). CONCLUSION: i.v. prochlorperazine appears to provide more effective relief than PR prochlorperazine for benign vascular or tension headaches.

Acute Disease↗
PubMed1994

Work-related stress and depression among practicing emergency physicians: an international study.

STUDY OBJECTIVE: To compare the levels of work-related stress and depression reported by practicing emergency physicians in three survey sites and to determine the effects of gender and marital status on the stress and depression experienced by these physicians. DESIGN: Cross-sectional mail surveys. SETTING AND PARTICIPANTS: Seven hundred sixty-four practicing emergency physicians from the United States, 91 fellows in full-time practice from Australasia, and 154 consultants and 47 senior registrars from the United Kingdom. INTERVENTION: Administration of questionnaires requesting demographic information and including an inventory to assess work-related stress and a scale to measure depressive symptomatology. MEASUREMENTS AND MAIN RESULTS: A 3 x 2 x 2 multivariate analysis of variance performed to compare scores on the stress inventory and depression scale simultaneously by survey site, gender, and marital status revealed significant differences in stress and depression by survey site and marital status. Univariate analyses of variance revealed significant differences in both stress and depression among the three survey sites and in depression by marital status. Adjusted means indicated that physicians from the United Kingdom reported higher levels of stress and depression than physicians from the United States and Australasia. Physicians from the United States and Australasia did not differ with respect to stress or depression. Physicians who were not married reported higher levels of depression than married physicians. No large mean differences, actual or adjusted, were found for any of the grouping factors. CONCLUSION: Statistical differences among practicing emergency physicians from the United States, Australasia, and the United Kingdom were observed, but the actual levels of work-related stress and depression were similar and did not appear severe. Marriage was associated with lower levels of depressive symptomatology.

Analysis of Variance↗
PubMed1994

Adverse effect of helicopter flight on the ability to palpate carotid pulses.

STUDY OBJECTIVE: To determine if the air medical helicopter environment compromises the ability to palpate carotid pulses. DESIGN: Using a carotid pulse model, flight nurses were tested for their ability to palpate the simulated carotid pulse at normal (120/80 mm Hg) and low (80/60 mm Hg) blood pressures on the ground and during helicopter flight. SETTING: Palpation tests were performed during flight in an MBB BO-105 twin-turbine engine, single-rotor air medical helicopter; control palpation tests were performed on the ground. TYPE OF PARTICIPANTS: Ten flight nurses. MEASUREMENTS AND MAIN RESULTS: Tracings of pulsatile pressure from the carotid pulse model verified its ability to simulate a wide range of arterial pressures. Analyses of variance for repeated measures, including polynomial contrasts, were performed to compare the number of correct detections of the presence or absence of pulse pressures in flight with the number of correct detections in the two control conditions for both carotid pulse pressures. The mean in-flight number of correct detections was lower than both the preflight and postflight control tests, which were themselves nearly equal, at each simulated carotid pulse pressure. The quadratic terms for both the 120/80 mm Hg trial (F1,14 = 9.28; P = .0087) and the 80/60 mm Hg trial (F1,18 = 5.69; P = .0283) were statistically significant. CONCLUSION: Factors associated with transport of patients in an MBB BO-105 helicopter impair the ability of flight nurses to detect carotid pulses in a simulated physiologic model.

Aircraft↗
PubMed1993

Comparison of motor vehicle damage documentation in emergency medical services run reports compared with photographic documentation.

STUDY OBJECTIVE: To determine whether emergency medical services (EMS) run reports adequately document vehicle damage when compared with vehicle photographs by using a traffic accident scoring system. DESIGN: A prospective study consisting of three phases: photographing motor vehicle collisions and collecting their respective EMS run reports, traffic accident damage score development, and comparison of photographs to the run reports by emergency medical technicians using the traffic accident damage score. SETTING: Data were collected in North Carolina and Ohio from motor vehicle crashes to which nine different EMS squads responded during a three-year period. TYPE OF PARTICIPANTS: EMS squads ranged from basic to paramedic levels of training. MEASUREMENTS AND MAIN RESULTS: Three emergency medical technicians were unable to determine the area of vehicle damage in 48% and the severity of damage in 61% of the EMS run reports. In contrast, there were no instances in which all three emergency medical technicians were unable to determine both area and severity of damage from the photographs. CONCLUSION: Most EMS run reports do not document vehicle damage adequately.

Accidents, Traffic↗
PubMed1993

Organizational characteristics, perceived work stress, and depression in emergency medicine residents.

A structural equation analysis of data collected from 484 members of the Emergency Medicine Residents Association was used to test a model in which peer support and work-group cohesiveness predicted role ambiguity. Role ambiguity was then specified as a predictor of work-related stress. Stress was hypothesized to affect depression and work satisfaction. The analysis confirmed the direct relationship between stress and depression and indicated that support from peers and the work group reduces stress. This impact is influenced by the amount of role ambiguity perceived by residents. Peer support, role ambiguity, and stress explain 52% of the variance in depression reported by residents. Residents are more satisfied with their work when their peers are supportive and when levels of occupational stress and role ambiguity are not high. The model accounted for 47% of the variance in reported work satisfaction. The results suggest that role ambiguity leads to perceptions of stress. This perceived stress, in the absence of strong support groups, results in increased depressive symptomatology and decreased work satisfaction.

Adult↗
PubMed1993

Correlates of work-related stress among consultants and senior registrars in accident and emergency medicine.

A mail survey was conducted of consultants and senior registrars practising accident and emergency (A&E) medicine in the United Kingdom. The 201 respondents (72%) comprised 154 consultants (70.6%) and 47 senior registrars (77%), who provided demographic information and completed inventories measuring stress, depression, task and role clarity, work group functioning and overall satisfaction with work. The respondents did not report particularly high levels of stress or depression and generally evaluated aspects of their work environments favourably. Higher levels of stress were reported by consultants and respondents from district general hospitals. Levels of stress were similar to those reported by other groups of health care providers. Respondents generally considered tasks and roles to be clearly defined, work groups to be supportive, efficient units and work satisfying. There was no statistically significant correlation on the affective scales for the number of patient attendances, on call commitment or staffing numbers. Senior staff with more than 10 years experience in the specialty reported more satisfaction with work and work group functioning, and perceived their tasks and roles to be significantly clearer. Consultants over 45 evaluated their work groups favourably and were more likely to view them as cohesive, smoothly functioning units than senior registrars. The results probably reflect the ad hoc coping strategies adopted by a group of doctors, who have already demonstrated appropriate personality characteristics by completing a long training programme, with no realistic alternative late career opportunities. To prevent mid or late career attrition, however, A&E doctors should receive formal training in stress recognition and avoidance. Accessible counselling without stigma should be easily available. Senior A&E doctors have a role in detecting and managing stress amongst other staff in the department.

Adaptation, Psychological↗
PubMed1993

Predictors of work satisfaction among SHOs during accident and emergency medicine training.

The purpose of this study was to assess the ability of work-related stress, and other work environment characteristics that might affect stress, to predict work satisfaction among senior house officers (SHOs) during accident and emergency (A&E) training. Questionnaires were returned by 365 SHOs, who indicated their year in training, the number of hours worked per week, the type of training hospital, the number of new A&E attendances per year, the ratios of patients and consultants to SHOs at their training hospitals and their likelihood of specializing in A&E. They also completed inventories measuring work-related stress, task and role clarity, work group functioning and work satisfaction. Scores on the satisfaction scale served as the dependent variable in a multiple regression equation. Using an alpha level of 0.05, a significant relationship was detected between satisfaction and the 10 independent variables (P = 0.0001). Direct relationships between task and role clarity (P = 0.0001) and work group functioning (P = 0.0002) were significant, as were inverse relationships between stress (P = 0.0001) and the number of new attendances (P = 0.0321). Management practices, such as orientation sessions, that define tasks and roles, enhance work group cohesiveness and mitigate against stress, should result in increased satisfaction among SHOs.

Accidents↗
PubMed1992

A study of occupational stress and depression among emergency physicians.

OBJECTIVE: To determine the level of stress and depression among emergency physicians and whether these variables were related to the emergency physician's decision to leave the specialty. STUDY DESIGN AND TYPE OF PARTICIPANTS: The study involved a random sample of 1,350 emergency physicians who received a questionnaire containing scales on depression and occupational stress as well as questions about their future plans for remaining in the specialty. RESULTS: Seven hundred sixty-three usable surveys (56.5%) were returned. Mean scores for the locus of control, Work-Related Strain Inventory, and the Center for Epidemiologic Studies--Depression Scale (CES-D) were within normal ranges. However, a disproportionate number, ie, more than 2.5% of the sample, scored more than two standard deviations from the mean. With the exception of the work satisfaction scale, there were no significant differences between the scores of fellows and nonfellows on measures of locus of control, stress, or depression. Of the population, 12.4% indicated that they were somewhat likely to very likely to leave the clinical practice of emergency medicine within the next year; 26.7% planned on leaving in the next five years, and less than half (42.9%) planned on seeing patients ten years from now. Older men, women, and those with high levels of stress and low job satisfaction were more likely to leave the specialty over the next ten years. CONCLUSION: While the vast majority of emergency physicians reported normal levels of stress, a disproportionate number reported high levels of stress and depression and plan on leaving the specialty of emergency medicine. The number of individuals planning to leave appeared to be greater than the number that will be replaced through residency training.

Career Mobility↗