Drug use in women with bulimia and anorexia nervosa.
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Adult↗
Biomedical subjects
W Kaye
Publications and source records attributed to W Kaye.
An advanced resuscitation training course for preregistration house officers.
Preregistration house officers need to be able to manage the first 5-10 minutes of a cardiac arrest. A course has been designed based on the recommendations of the Resuscitation Council UK 1984 and the format of the American Heart Association advanced cardiac life support course. Fifty-nine newly qualified doctors from the same medical school class were studied in two consecutive groups: Group 1 (n = 31) were commencing their first post and Group 2 (n = 28), whose first preregistration post had been at other hospitals without practical resuscitation training, were commencing their second post. They were pretested and taught in three 2-hour sessions. Five months later they were tested to measure retention of knowledge and skills. Before training there was no difference in knowledge between the two groups but Group 1 were more skilled. The knowledge and skills of both groups immediately after training were significantly improved and at 5 months skills were subject to modest decay only. Experience of managing cardiac arrests was not a substitute for formal practical training.
Educational Measurement↗
The effects of smoking deprivation on caloric consumption in women with bulimia nervosa.
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Adult↗
Access for drug administration during cardiopulmonary resuscitation.
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Animals↗
Educational issues in basic and advanced cardiac life support.
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Clinical Competence↗
Arsenic exposure in children living near a former copper smelter.
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Arsenic↗
Advanced cardiac life support refresher course using standardized objective-based Mega Code testing.
The American Heart Association (AHA) recommends that those whose daily work requires knowledge and skills in advanced cardiac life support (ACLS) not only be trained in ACLS, but also be given a refresher training at least every 2 yr. However, AMA offers no recommended course for retraining; no systematic studies of retraining have been conducted on which to base these recommendations. In this paper we review and present our recommendation for a standardized approach to refresher training. Using the goals and objectives of the ACLS training program as evaluation criteria, we tested with the Mega Code a sample population who had previously been trained in ACLS. The results revealed deficiencies in ACLS knowledge and skills in the areas of assessment, defibrillation, drug therapy, and determining the cause of an abnormal blood gas value. We combined this information with our knowledge of other deficiencies identified during actual resuscitation attempts and other basic life-support and ACLS teaching experiences. We then designed a refresher course which was consistent with the overall goals and objectives of the ACLS training program, but which placed emphasis on the deficiencies identified in the pretesting. We taught our newly designed refresher course in three sessions, which included basic life support, endotracheal intubation, arrhythmia recognition and therapeutic modalities, defibrillation, and Mega Code practice. In a fourth session, using Mega Code testing, we evaluated knowledge and skill learning immediately after training. We similarly tested retention 2 to 4 months later. Performance immediately after refresher training showed improvement in all areas where performance had been weak.(ABSTRACT TRUNCATED AT 250 WORDS)
Critical Care↗
Abnormal hypothalamic-pituitary-adrenal function in anorexia nervosa. Pathophysiologic mechanisms in underweight and weight-corrected patients.
To study the pathophysiology of hypercortisolism in patients with anorexia nervosa, we examined plasma ACTH and cortisol responses to ovine corticotropin-releasing hormone before and after correction of weight loss. We also studied patients with bulimia whose weight was normal, since this disorder has been suspected to be a variant of anorexia nervosa. Before their weight loss was corrected, the anorexic patients had marked hypercortisolism but normal basal plasma ACTH. The hypercortisolism was associated with a marked reduction in the plasma ACTH response to corticotropin-releasing hormone. When these patients were studied three to four weeks after their body weight had been restored to normal, the hypercortisolism had resolved but the abnormal response to corticotropin-releasing hormone remained unchanged. On the other hand, at least six months after correction of weight loss their responses were normal. The bulimic patients whose weight was normal also had a normal response to corticotropin-releasing hormone. We conclude that in underweight anorexics, the pituitary responds appropriately to corticotropin-releasing hormone, being restrained in its response by the elevated levels of cortisol. This suggests that hypercortisolism in anorexics reflects a defect at or above the hypothalamus. The return to eucortisolism soon after correction of the weight loss indicates resolution of this central defect despite persistence of abnormalities in adrenal function.
Adrenocorticotropic Hormone↗
Use of the Mega Code to evaluate team leader performance during advanced cardiac life support.
The Mega Code is a simulated cardiac arrest during which students practice as members of a team and learn to integrate the knowledge and skills of advanced cardiac life support (ACLS). This study used the Mega Code and American Heart Association (AHA) standards to evaluate 32 medical residents (MDs) and nine critical care nurses (RNs) in the role of ACLS team leader. All had been previously trained in ACLS. The testing sequence included ventricular fibrillation (VF) refractory to initial countershock (defib), asystole after second defib, recurrent VF after drug therapy, and finally sinus rhythm after third defib. A blood gas report indicated respiratory acidosis and hypoxemia. Assessment of patient status was poor in both groups, although MDs did significantly (p = .001) better than RNs. Other problem areas were drug therapy and trouble-shooting are not adequately stressed in the AHA ACLS curriculum; moreover, there is no lecture that specifically addresses the team approach to resuscitation and the role of team leader. We found that the Mega Code effectively evaluated individual and group performance. Results of objective-based Mega Code testing can be used both to improve ACLS curriculum and to indicate areas to be stressed during refresher training.
Cardiology↗
Retention of cardiopulmonary resuscitation skills by physicians, registered nurses, and the general public.
To evaluate retention of CPR skills by medical residents (MDs), registered nurses (RNs), we tested single-rescuer CPR skills of 21 MDs, 17 RNs, and 21 laypersons using recording manikin and American Heart Association criteria. All study participants had been trained from 4 to 12 months before testing. No MD or RN and only one layperson performed each step correctly and in proper sequence. If calls for assistance were eliminated, one additional layperson, two MDs, and two RNs performed correctly. There were no significant differences between the MDs and RNs. MDs and RNs did better (p less than .01) in assessment compared to laypersons, but some individuals in each group initiated ventilations and compressions without assessing need. There was no difference in the ability to perform ventilations; all three groups did poorly. MDs and RNs performed compression skills better than laypersons (p less than .01), but all had difficulty with rate and depth of compressions. Moreover, only one-third of the general public demonstrated correct hand placement. Despite more training and experience, MD and RN performance was comparable to layperson performance. These data suggest that improving basic life-support skills could save more lives.
Clinical Competence↗
Cognitive processing in anorexia nervosa. A disturbance in automatic information processing.
Anorexia nervosa patients were found to perform as well or better than control subjects on cognitive tasks that both require considerable cognitive effort and 'direct' the subject to the information that will be tested, but do more poorly than controls on tests that assess automatic or incidental processing of information. The implications of this particular pattern of cognitive alterations for theories concerning the etiology of anorexia nervosa are discussed.
Adult↗
The effect of time since training on house officers' retention of cardiopulmonary resuscitation skills.
Currently, the American Heart Association (AHA) recommends that physicians be certified in cardiopulmonary resuscitation (CPR) every two years. This study was undertaken to determine the effects of time since training on retention of CPR skills of physicians and to identify at what point performance deteriorates to a level requiring retraining with supervised practice. The physicians' performance of CPR one year or less after training was compared with that of more than one year after training. Thirty-three medical residents who had been taught CPR by the same instructor were tested without warning for one-person CPR on a recording mannikin. Performance was evaluated according to AHA Heartsaver criteria. The data were analyzed by organizing all CPR steps or behavioral objectives into three categories: assessment, skills (which included ventilation and compression), and sequence (which included calls for assistance). The data suggest that the knowledge of CPR sequence remains stable and that assessment improves while skill performance deteriorates after one year. This apparent contradiction in overall CPR performance may relate to the effect of experience. Assessment may improve because of involvement in actual resuscitations in the hospital. Deterioration of skills may reflect the fact that senior residents do not actually perform CPR, but become team leaders and thereby lose their skills, or that poor performance is not corrected in actual "code" situations. If a two-year certification standard is maintained, CPR skill testing at least every 12 months should be considered. If skills have deteriorated, hands-on-practice should be undertaken at that time.
Certification↗
Can better basic and advanced cardiac life support improve outcome from cardiac arrest?
The effect of basic and advanced cardiac life support (BLS and ACLS) on long-term survival is dependent upon both the response time and the quality of intervention. Retention research using the results of classroom testing as indirect indicators has shown that performance of BLS and ACLS skills is poor. This suggests that BLS and ACLS courses do not teach the knowledge and skills well, the information is too difficult to retain, testing procedures are faulty, and/or the performance standards are unrealistic. To maximize the likelihood of successful resuscitation from cardiac arrest, we propose the following: (a) simplify the BLS procedures; (b) simplify the BLS and ACLS curricula; (c) simplify teaching strategies; (d) simplify testing based on what steps are required to sustain life; (e) define objective criteria for knowledge acquisition and skill performance; (f) base refresher training on diagnosed deficiencies and evaluate innovative ways to improve retention; (g) develop a resuscitation record to provide accurate documentation of patient status, dysrhythmias, therapy, and responses to therapy; (h) develop a process evaluation tool to evaluate individual and group performances during actual resuscitation; and (i) form an international consortium of BLS and ACLS investigators.
Animals↗
Clinical findings in patients with anorexia nervosa and affective illness in their relatives.
The most prevalent psychiatric disorders in the families of patients with anorexia nervosa are bipolar and unipolar major affective disorder. The presence of affective disorder, self-induced vomiting, or bulimia in the patient is not predictive of affective illness in the relatives. Thus these features do not define genetic heterogeneity within anorexia nervosa. There may be genetic factors shared between anorexia nervosa and affective disorders.
Adult↗
Problems in delivering desired oxygen concentrations from jet nebulizers to patients via face tents.
We compared the actual oxygen concentration reaching the airway of 10 patients with the preset oxygen concentration delivered from single and double jet nebulizers to face tents. We measured hypopharyngeal oxygen concentration (FHO2), which closely approximates tracheal fractional inspired oxygen concentration (FIO2), using the Nasal Oxygen Sampler we have previously described. All nebulizers were powered by 12-14 L/min of 100% oxygen, and nebulizer settings were varied between 40% and 100% oxygen. The FHO2 never closely approximated the oxygen concentrations delivered from the nebulizer to the face tent. There was no significant difference in FHO2 between single- and double-nebulizer systems.
Oxygen Inhalation Therapy↗
Pharmacologic treatment of eating disorders.
Increased research focusing on the eating disorders has put the clinician on firmer ground when choosing appropriate psychopharmacologic treatments. Recent studies of patients with bulimia demonstrate that treatment with antidepressant medications may substantially reduce symptoms of bingeing and vomiting. The efficacy of pharmacologic approaches to anorexia nervosa is more uncertain, in part because of the limited availability of long-term follow-up studies. The judicious use of appetite suppressant medications, as reviewed in the text, is helpful for mild to moderate obesity. In treating these disorders, the clinician needs to integrate medication treatment with psychotherapeutic and behavioral treatment approaches.
Anorexia Nervosa↗
Forms of memory failure.
Memory may fail in a variety of ways. Patients with Korsakoff's syndrome demonstrate global memory deficits similar to those seen in patients with early progressive dementia. Korsakoff's patients, however, may recall rules and principles for organizing information and can gain access to their previously acquired knowledge (semantic memory), whereas recent memory may be grossly impaired. In contrast, dementia patients may have little access to previously acquired knowledge and therefore have great difficulty in organizing and encoding ongoing events. These contrasting forms of memory failure have implications for understanding the structure and mechanisms of memory and learning, particularly the relationship between episodic and semantic memory, as well as the development of therapeutic strategies for cognitive impairments.
Alcohol Amnestic Disorder↗
Abnormalities in plasma and cerebrospinal-fluid arginine vasopressin in patients with anorexia nervosa.
Previous studies have indicated that many patients with anorexia nervosa have defects in urinary concentration or dilution suggestive of abnormal secretion of the antidiuretic hormone arginine vasopressin. To explore this possibility, we examined the response of plasma vasopressin to intravenous hypertonic saline in anorexic patients before and after correction of their weight loss. We also measured basal levels of the hormone in the cerebrospinal fluid. In all four subjects studied before correction of weight loss, the response to hypertonic saline was abnormal: in one, the plasma level of arginine vasopressin increased subnormally relative to the plasma sodium level; in the other three, it fluctuated erratically, with no relation to plasma sodium. These defects persisted in the three patients studied three to four weeks after recovery of body weight. In two patients who were initially studied when they were underweight, the defects were gone six months after recovery; in five of seven other patients studied at least six months after recovery but not while they were underweight, the response was normal. Abnormalities in the osmoregulation of plasma arginine vasopressin were not accounted for by nonosmotic stimuli and were almost always associated with an absolute increase in the level of arginine vasopressin in the cerebrospinal fluid or a reversal of the normal (less than 1.0) cerebrospinal fluid/plasma ratio of arginine vasopressin. These results indicate that most if not all patients with anorexia nervosa have abnormal levels of arginine vasopressin in their plasma and cerebrospinal fluid that are corrected very slowly with weight gain. The cause and consequences of these abnormalities remain to be determined.
Adult↗