Search PubMed⌕ Search

Biomedical subjects

W Kaye

Publications and source records attributed to W Kaye.

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

A reliable and valid method for evaluating cardiopulmonary resuscitation training outcomes.

In order to compare the quality of CPR performance after various training methods, training outcome assessment must provide meaningful data and do it in a way that is reliable. Few studies have provided details of their assessment procedures, and even fewer report on whether the measures to evaluate performance are reliable (yielding information consistently over multiple trials), or valid (measuring the outcome intended). Few studies have attempted to replicate assessment methods used by other authors. Conventional skill sheets have not been shown to assess compressions and ventilations reliably and validly. When using an instrumented manikin, skill checklists can be simplified by eliminating qualitative assessment of compressions and ventilations. Using a sample of 171 CPR trainees rated by trained evaluators, we provide details of agreement between two evaluators and use an established statistic (Cronbach's alpha) to assess the reliability of a 14-item simplified CPR checklist. The level of agreement between two raters was high (Pearson product-moment correlation = 0.87) as was the reliability estimate obtained by Cronbach's alpha (0.89). As criterion-related evidence of the validity of the CPR checklist to assess CPR performance, a correlation with a five-point subjective overall rating of CPR was estimated (Spearman correlation = 0.92). We urge standardized reporting of CPR training outcomes in order to achieve comparability across studies.

Adult↗
PubMed1996

Future directions for resuscitation research. III. External cardiopulmonary resuscitation advanced life support.

This discussion about advanced cardiac life support (ACLS) reflects disappointment with the over 50% of out-of-hospital cardiopulmonary resuscitation (CPR) attempts that fail to achieve restoration of spontaneous circulation (ROSC). Hospital discharge rates are equally poor for in-hospital CPR attempts outside special care units. Early bystander CPR and early defibrillation (manual, semi-automatic or automatic) are the most effective methods for achieving ROSC from ventricular fibrillation (VF). Automated external defibrillation (AED), which is effective in the hands of first responders in the out-of-hospital setting, should also be used and evaluated in hospitals, inside and outside of special care units. The first countershock is most important. Biphasic waveforms seem to have advantages over monophasic ones. Tracheal intubation has obvious efficacy when the airway is threatened. Scientific documentation of specific types, doses, and timing of drug treatments (epinephrine, bicarbonate, lidocaine, bretylium) are weak. Clinical trials have failed so far to document anything statistically but a breakthrough effect. Interactions between catecholamines and buffers need further exploration. A major cause of unsuccessful attempts at ROSC is the underlying disease, which present ACLS guidelines do not consider adequately. Early thrombolysis and early coronary revascularization procedures should also be considered for selected victims of sudden cardiac death. Emergency cardiopulmonary bypass (CPB) could be a breakthrough measure, but cannot be initiated rapidly enough in the field due to technical limitations. Open-chest CPR by ambulance physicians deserves further trials. In searches for causes of VF, neurocardiology gives clues for new directions. Fibrillation and defibrillation thresholds are influenced by the peripheral sympathetic and parasympathetic nervous systems and impulses from the frontal cerebral cortex. CPR for cardiac arrest of the mother in advanced pregnancy requires modifications and outcome data. Until more recognizable critical factors for ROSC are identified, titrated sequencing of ACLS measures, based on physiologic rationale and sound judgement, rather than rigid standards, gives the best chance for achieving survival with good cerebral function.

Animals↗
PubMed1996

Resuscitation training: a time for reassessment.

The goal of resuscitation education is to impart the knowledge and skills necessary to successfully resuscitate a victim of cardiopulmonary arrest. This goal can be accomplished only if the interactions among the instructor, learner, and curriculum are optimized. Instructors must have a clear understanding of educational theory and a thorough grasp of the program materials. Learners must be motivated and committed to developing and maintaining a high level of competence. The in-hospital chain of survival for the resuscitation response system must be reorganized to include determination of the appropriateness of resuscitation and provision of first-responder defibrillation capability. Using creativity and flexibility to meet these goals, nurses can improve the practice and potential outcome of resuscitation.

Adult↗
PubMed1996

The effect of cimetidine and ranitidine on cognitive function in postoperative cardiac surgical patients.

OBJECTIVE: To compare the incidence of delirium in postoperative cardiac surgical patients treated with either cimetidine or ranitidine. METHOD: Cardiac surgery patients were randomized to receive either cimetidine or ranitidine postoperatively. Each patient underwent three Mini-Mental Status Examinations (MMSE) and the medical record was reviewed for pertinent past medical history, laboratory data, and evidence of delirium on three occasions: one day preoperatively (before H-2 blocker was given), in the early postoperative period (while receiving the H-2 blocker); usually two days postoperatively on the day of hospital discharge (several days after the H2 blocker had been discontinued). RESULTS: Overall, both groups in the early postoperative period showed a significant decrease in the MMSE score (27.11 +/- 4.44 to 25.38 +/-2.87, mean +/- SD; t = 5.16, p < .0005), which resolved by the time of hospital discharge. There was no significant difference between cimetidine and ranitidine. Both age and preoperative MMSE score were strongly associated with the development of delirium. CONCLUSIONS: We found no significant difference between cimetidine's versus ranitidine's effect upon cognitive functioning in the postoperative cardiac surgical patient. This was true even when controlling for age and length of stay.

Adult↗
PubMed1995

Organizing and implementing a hospital-wide first-responder automated external defibrillation program: strengthening the in-hospital chain of survival.

First-responder automated external defibrillation (AED) in the hospital is consistent with the American Heart Association's (AHA) early defibrillation standard or care. With trained personnel and automated external defibrillators immediately available, early defibrillation should have a greater impact on survival than early cardiopulmonary resuscitation (CPR). Therefore, in our hospitals we modified basic life support to include automated external defibrillation (BLS-AED) for all personnel who are expected to respond to a cardiac arrest, with rapid defibrillation taking priority over CPR. We describe how we organized and implemented this hospital-wide first-responder BLS-AED program. Planning the process includes gaining support from key leaders who are responsible for resuscitation practice, and identifying the target audience of the training program. Hospital unit needs for AED or conventional defibrillation and equipment must be identified, the training program developed, and existing policies and procedures modified. Several barriers to implementation may exist. Education about the efficacy and safety of AED and experience once the BLS-AED program is in place can overcome attitudes and bias. Concerns about the cost of equipment and training must be addressed. Program evaluation may include patient issues such as measuring the time to the first defibrillation and patient outcome; as well as training and retention issues.

Adult↗
PubMed1995

Strengthening the in-hospital chain of survival with rapid defibrillation by first responders using automated external defibrillators: training and retention issues.

STUDY OBJECTIVE: To determine whether staff outside critical care areas who were proficient in basic life support (BLS) could be easily trained to use automated external defibrillators (AEDs) and whether they would retain these skills. DESIGN: Prospective, longitudinal cohort series. SETTING: Two university teaching hospitals. PARTICIPANTS: One hundred forty nurses who had previously learned BLS and constituted the staff from three medical/surgical nursing units from each study hospital. INTERVENTIONS: The nurses were taught how to use the Heartstart 1000s, a lightweight portable shock-advisory AED, in a 2-hour class with an instructor and manikin-to-student ratio of 1:5. The course emphasized hands-on practice of the BLS-AED algorithm on a computerized manikin. RESULTS: Using a similar scenario, each nurse was evaluated on the computerized manikin immediately after training (posttest). At 1 to 3, 4 to 6, and 7 to 9 months after the initial training, convenience samples of the cohort in three different groups were evaluated for retention. Satisfactory performance was defined as delivery of the first AED shock within 2 minutes of recognition of the arrest. At the posttest after training, 139 of 140 nurses (99%) demonstrated satisfactory performance. Of 77 nurses evaluated, 31 of 32 at 1 to 3 months, 18 of 18 at 4 to 6 months, and 24 of 27 at 7 to 9 months after initial training (95% overall) performed satisfactorily. CONCLUSION: As has been demonstrated with prehospital emergency personnel, nurses outside critical care areas who are proficient in BLS can easily learn and retain the knowledge and skills to use AEDs. Automated external defibrillation, a BLS skill, should be incorporated into BLS programs (BLS-AED) for all hospital personnel expected to respond to a patient in cardiac arrest, with rapid defibrillation taking priority over CPR.

Algorithms↗
PubMed1993

Are the eating disorders related to obsessive compulsive disorder?

The evidence supporting the idea that the eating disorders of anorexia and bulimia nervosa may be related to obsessive compulsive disorder is reviewed with respect to studies in phenomenology, comorbidity, neurotransmitters, central nervous system functional metabolism, and treatment and outcome. Although no definitive conclusion can be drawn, research generated from the idea has refined our thinking on the eating disorders.

Brain↗
PubMed1993

Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization.

OBJECTIVE: To gather data about occupancy, admission characteristics, patients' ages, and types of therapy utilized in ICUs in the United States. DESIGN AND SETTING: Survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals stating they had ICUs. MEASUREMENTS: Census questionnaires solicited information on occupancy, where the patients were admitted from, length of stay, therapies rendered, intensive care diagnoses, and resuscitation status, as well as other information. MAIN RESULTS: Data were obtained regarding 32,850 ICU beds, with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. The census response rate was 40% of the AHA hospitals that stated they had ICUs, with specific ICU data on 38.7% of the nation's ICUs. Overall, the responding units reported a mean occupancy rate of 84% of total bed capacity and 87% of available beds. As hospital size increased, so did ICU occupancy. Nearly 17% of all of the critical care patients had been in the units for > 14 days. More precisely, 49% of all responding units indicated that they had one or more "chronic" (> 14-day length of stay) patients. Most patients were admitted to the units from the emergency room (38%), operating room/postanesthesia care unit (22%), and the general hospital floor (16%). Neonatal units were exceptions to this observation, where most patients came from the delivery room (60%). Admission from other hospitals represented a significantly larger group of patients in the cardiac care, pediatric, and neonatal units. Respondents indicated that many of their current patients were elderly, with 43% of these patients aged 65 to 84 yrs and with 4% being > or = 85 yrs of age. The 47% of patients > or = 65 yrs of age increased to 58% when the neonatal and pediatric units were eliminated from the analyses. For all units responding to the survey, the leading primary admitting intensive care diagnoses were postoperative management, ischemic heart disorder, respiratory insufficiency/failure, and prematurity. Elimination of units predominantly treating children (pediatric and neonatal) from the analysis left "adult" units with three primary admitting diagnoses: ischemic heart disease, postoperative management, and respiratory insufficiency/failure with variation according to specific unit type. The leading diagnoses in pediatric units were respiratory insufficiency/failure, postoperative management, and congenital abnormalities. For neonatal units, prematurity was the primary admitting diagnosis, accounting for 59% of these units' patients. Respondents reported 5.3 +/- 10.9% of patients had received cardiopulmonary resuscitation (CPR) before admission into the critical care unit. Only 6.0 +/- 11.9% of patients in these critical care units had instructions that CPR not be performed while in the unit. CONCLUSIONS: This report should be viewed as the beginning step of an effort to improve both the information base available on critical care medicine and the performance of ICUs. Our survey findings provide an introduction into the everyday workings of critical care units throughout the United States. Research is required to determine which patients will benefit from intensive care and how to efficiently utilize the vast technology we have available for them in a world with limited financial resources, an aging population, and a multiplicity of societal and ethical concerns.

Adolescent↗
PubMed1992

A single-fluor approach to DNA sequence determination using high performance capillary electrophoresis.

The Tabor and Richardson strategy for enzymatic chain termination sequencing of DNA using relative peak intensity has been adapted to high performance capillary gel electrophoresis with laser induced fluorescence detection. This approach to DNA sequencing involves the use of only a single fluor and results in significant reduction in the time required to determine a DNA sequence without the use of highly complicated and expensive instrumentation. We present a modification of the Tabor and Richardson approach employing two reactions, each containing complementary mixtures of only three ddNTP's in the concentration ratio 4:2:1. The DNA sequence is determined by relative peak height and by assigning the missing ddNTP to "gaps" between the peaks. The use of only three terminators/reaction simplifies the software task of differentiating between the termination types and makes more efficient use of the available dynamic range. Both complementary mixes generate complete sequence information and the two data files are combined in order to make a more confident sequence call. This process helps to eliminate errors caused by occasional non-uniform incorporation of ddNTP's or false terminations and also alleviates some of the difficulty associated with reading through compressed regions of the electropherogram.

Base Sequence↗
PubMed1991

The problem of poor retention of cardiopulmonary resuscitation skills may lie with the instructor, not the learner or the curriculum.

Many studies (several even before American Heart Association recommended in 1973 that lay public be trained in cardiopulmonary resuscitation (CPR] have documented that retention of CPR skills is poor, unaffected by modifications in curriculum or whether the students are lay or professional. We chose to investigate what actually occurs during a CPR course, and gained the following insights: despite clearly defined curricula, we found that instructors did not teach in a standardized way. Practice time was limited and errors in performance were not corrected. Instructors consistently rated the students' overall performance as acceptable; at the same time, using the same checklist, we consistently rated performance as unacceptable. The checklist is an inaccurate tool for evaluating CPR performance. Despite the poor performance that we documented, students and instructors were satisfied with the courses and believed that the level of performance was high. As a result of these studies, we discovered that the problem of poor retention of CPR skills may lie not with the learner or the curriculum, but with the instructor. But, since lives are being saved with bystander CPR, does this documented poor retention matter? Perhaps the solution is not only to improve instructor training to make certain that students receive adequate practice time and accurate skill evaluation, but also to modify the criteria for correct performance when testing for retention. These criteria should be based on the minimum CPR skills that are required to sustain life for the critical 4-8 min before defibrillation and other advanced cardiac life support are delivered.

American Heart Association↗
PubMed1990

Measuring cardiopulmonary resuscitation performance: a comparison of the Heartsaver checklist to manikin strip.

Both checklists and recording manikin strips (strips) are used for evaluation of cardiopulmonary resuscitation (CPR) performance. To examine their relationship, we simultaneously evaluated single rescuer CPR of 255 subjects using both checklists and strips. For Group 1 (N = 192; general public tested in Heartsaver course) we compared the total number of initial ventilations and compressions judged to be correct by checklists with those judged to be correct by strips. For Group II (N = 63; physicians, nurses, general public tested in retention studies) we compared each subjects checklist with their own strip for evaluation of correct ventilations and compressions. In Group I, CPR was judged to be correct two to four times more frequently by checklists than by strips. In Group II, all correlations were poor. The most common disagreements were with performances evaluated as correct by checklist but not by strip. Therefore, the current checklist may be a poor instrument for measuring CPR. More accurate evaluation should improve learning and therefore improve outcome following cardiac arrest.

Educational Measurement↗
PubMed1990

Treatment of laxative abuse in a female with bulimia nervosa using an operant extinction paradigm.

Chronic laxative abuse was treated using an operant extinction paradigm in a 29-year-old woman with bulimia nervosa. Access to self-administration of laxative and placebo were alternated in an ABAB design. Outcome was measured by self-reported craving for laxatives and rates of drug self-administration. During baseline, the subject exhibited high rates of both craving and self-administration. During placebo phases, cravings and drug self-administration declined. Both measures increased when active drug was reinstated. The final return to placebo led to a decrease in craving and extinction of drug self-administration to zero doses per day. This paper introduces the concept of laxatives as reinforcers and provides a new approach to the treatment of laxative abuse in women with bulimia nervosa.

Adult↗