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Saway B, Seidel L, Dane FC, Sood N, Wattsman T. Corrigendum to "Mindfulness in the OR: A Pilot Study Investigating the Efficacy of an Abbreviated Mindfulness Intervention on Improving Performance in the Operating Room." Journal of Surgical Education. Volume 78, Issue 5 (2021), Pages 1611-1617. J Surg Educ 2022; 79:837. [PMID: 35115268 DOI: 10.1016/j.jsurg.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Brian Saway
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Laurie Seidel
- Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia
| | | | - Nikki Sood
- Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia
| | - Terri Wattsman
- Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virginia
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Parish DC, Goyal H, James E, Dane FC. Pulseless Electrical Activity: Echocardiographic Explanation of a Perplexing Phenomenon. Front Cardiovasc Med 2021; 8:747857. [PMID: 37528947 PMCID: PMC10390303 DOI: 10.3389/fcvm.2021.747857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/12/2021] [Indexed: 08/03/2023] Open
Abstract
Pulseless electrical activity (PEA) is considered an enigmatic phenomenon in resuscitation research and practice. Finding individuals with no consciousness or pulse but with continued electrocardiographic (EKG) complexes obviously raises the question of how they got there. The development of monitors that can display the underlying rhythm has allowed us to differentiate between VF, asystole, and PEA. Lack of clear understanding of the emergence of PEA has limited the research and development of interventions that might improve the low rates of survival typically associated with PEA. Over 30 years of studying and practicing resuscitation have allowed the authors to see a substantial rise in PEA with variable survival rates, based on the patients' illness spectrum and intensity of monitoring. This paper presents a small case series of individuals with brain death whose family members consented to the echocardiographic observation of the dying process after disconnection from life support. The observation from these cases confirms that PEA is a late phase in the clinical dying process. Echocardiographic images delineate the stages of pseudo-PEA with ineffective contractions, PEA, and then asystole. The process is contiuous with none of the sudden phase shifts seen in dysrhythmic events such as VF, VT or SVT. The implications of these findings are that PEA is a common manifestation of tissue hypoxia and metabolic substrate depletion. Our findings offer prospects for studies of the development of interventions to improve PEA survival.
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Affiliation(s)
- David C. Parish
- Department of Medicine, Mercer University School of Medicine, Macon, GA, United States
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, United States
- Mercer University School of Medicine, Macon, GA, United States
| | - Erskine James
- Department of Internal Medicine, Atrium Health Navicent, Macon, GA, United States
| | - Francis C. Dane
- Department of Psychology, Radford University, Radford, VA, United States
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Uchakin PN, Sakhalkar VS, Dane FC, Uchakina ON, Sheed JN, Uphouse WT, Sakhalkar OV. Azithromycin Reduces Markers of Vascular Damage in Pediatric Patients With Sickle Cell Disease. J Hematol 2021; 10:178-186. [PMID: 34527114 PMCID: PMC8425801 DOI: 10.14740/jh827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Immunomodulatory effects of macrolides in chronic inflammation are well known. In this study, we tested our hypothesis that azithromycin (AZT) can decrease inflammation in pediatric patients with sickle cell disease (SCD). Methods The use of AZT as an anti-inflammatory agent was evaluated in double-blind, placebo-controlled, cross-over study for 8 weeks of treatment with 8 weeks of washout. Blood samples were collected before (PRE) and after (POST) each 8-week treatment period. Repeated measures analysis of variance (ANOVA) with post hoc multiple comparison procedures and Chi-square test were used for statistical analysis of the data. Complete blood count, distribution of the lymphocyte subsets, and plasma levels of markers of vascular damage were analyzed. Results A significant decrease in the number of leucocytes and granulocytes was observed in AZT group following treatment. An opposite dynamic was observed in placebo group; numbers of granulocytes significantly increased at POST interval. All markers of vascular damage were reduced in AZT group at POST interval with overall significance (P = 0.026). The most prominent significant changes were observed in levels of myeloid-related protein 8/14 (MRP8/14), lipocalin A (NGAL), matrix metalloproteinases (MMP) 9, and insulin-like growth factor-binding protein (IGFBP) 4. Plasma level of C-reactive protein (CRP) was significantly decreased in AZT group as well. Conclusions Data suggested that AZT may be beneficial in management of microvascular injury in SCD.
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Affiliation(s)
- Peter N Uchakin
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA 31207, USA.,Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
| | - Vishwas S Sakhalkar
- Division of Pediatric Hematology/Oncology, Mercer University School of Medicine, Beverly Knight Olson Children's Hospital and HOPE Clinic at Atrium Health-Navicent, Macon, GA 31201, USA
| | - Francis C Dane
- Department of Psychology, Radford University, Roanoke, VA 24013, USA
| | - Olga N Uchakina
- Department of Biomedical Sciences, Mercer University School of Medicine, Macon, GA 31207, USA
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Saway BF, Seidel LW, Dane FC, Wattsman T. Mindfulness in the OR: A Pilot Study Investigating the Efficacy of an Abbreviated Mindfulness Intervention on Improving Performance in the Operating Room. J Surg Educ 2021; 78:1611-1617. [PMID: 33849789 DOI: 10.1016/j.jsurg.2021.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Surgery requires operating room physicians to succumb to unpredictable schedules, long hours, and involved operations, which have led many to acquire maladaptive habits to attain focus in the OR. Research on mindfulness in the medical community has shown positive results on stress, burnout, and quality of life. However, due to the seemingly subjective nature of the benefits of mindfulness as well as the lengthy time requirement by participants, researchers have had difficulty conducting experiments with adequate sample sizes and controls in operating room specialties. OBJECTIVE We assessed the hypotheses that a brief mindfulness intervention on physicians, residents, and anesthesiologists can improve mindfulness, focus, and perceived stress in the operating room. Additionally, we hypothesized that the improvement in scores are independent of level of training and physician type. METHODS As part of a 3 (Physician Type) X 3 (Case) X 2(Timing) factorial design, 33 surgeons, anesthesiologists, and surgical residents completed a pre- and postintervention Mindfulness Awareness and Attention Scales (MAAS) survey. Three categories of surgery cases, routine-elective, complex-elective, and add-on, were completed pre- and postintervention, along with measures addressing focus and perceived stress. The intervention included a 25-minute mindfulness training on the benefits of mindfulness and how to utilize a brief, 4-minute mindfulness skill employed prior to each postintervention surgery. RESULTS The mindfulness intervention was associated with a significant increase in mindfulness (p = 0.006) and flow state (p = 0.009) and a significant decrease in perceived stress (p = 0.033), particularly during the complex routine cases (p = 0.024). CONCLUSIONS We have developed a brief mindfulness intervention that is compatible with the busy workflow of operating room physicians and can increase the mindful state of participants as well as improve factors that are associated with burnout and distractions.
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Affiliation(s)
- Brian F Saway
- Medical University of South Carolina, Department of Neurosurgery, Charleston, South Carolina.
| | - Laurie W Seidel
- Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virgina
| | | | - Terri Wattsman
- Virginia Tech Carilion School of Medicine and Fralin Biomedical Research Institute, Roanoke, Virgina
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Carvalho H, Dane FC, Whicker SA. Conceptions of Learning and Teaching for Faculty Who Teach Basic Science. Med Sci Educ 2021; 31:745-751. [PMID: 34457923 PMCID: PMC8368879 DOI: 10.1007/s40670-021-01264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Conceptions of learning and teaching refer to what faculty think about teaching effectiveness. Approaches to teaching refer to the methods they use to teach. Both conceptions and approaches range from student-centered/learning-focused (active learner engagement) to teaching-centered/content-focused (passive learner engagement). This study explored how faculty teaching experience influenced faculty conceptions and their approaches to teaching. The authors hypothesized that more experienced educators appreciate and apply active learning approaches. METHODS The authors used a cross-sectional survey to collect anonymous data from the Basic Science faculty at Virginia Tech Carilion School of Medicine (VTCSOM). The survey included the Conceptions of Learning and Teaching scale (COLT; Jacobs et al. 2012) and demographic information. They assessed instrument reliability with Cronbach's alpha and examined relationships between variables with correlation and chi-square and group differences with ANOVA. RESULTS Thirty-eight percent (50/130) of faculty responded to the survey. COLT scores for student-centered (4.06 ± 0.41) were significantly higher (p < 0.001) than teacher-centered (3.12 ± 0.6). Teacher-centered scores were lower (p < 0.05) for younger (30-39, 2.65 ± 0.48) than older faculty (50-59, 3.57 ± 0.71) and were negatively correlated with using multiple teaching methods (p = 0.022). However, 83% (39/50) reported using both traditional lectures and active approaches. DISCUSSION Faculty conceptions about teaching showed appreciation for active learning, but a tendency to use traditional teaching methods interspersed with student-centered ones. Teaching experience was not related to faculty conceptions but was related to their teaching approaches. The amount of time dedicated to teaching was related to the appreciation of active learning, and young teachers were more student-oriented. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01264-4.
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Affiliation(s)
- Helena Carvalho
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA USA
| | - Francis C. Dane
- Department of Psychology, Radford University, Roanoke, VA USA
| | - Shari A. Whicker
- Office of Continuing Professional Development, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA USA
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Bolling K, Long T, Jennings CD, Dane FC, Carter KF. Bras for Breast Support After Sternotomy: Patient Satisfaction and Wear Compliance. Am J Crit Care 2021; 30:21-26. [PMID: 33385198 DOI: 10.4037/ajcc2021687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND For women undergoing median sternotomy, especially those with a bra cup size C or larger, breast support can reduce pain, wound breakdown, and infection. This study addressed a gap in research, identifying the best bra after sternotomy in terms of patient satisfaction and wear compliance. OBJECTIVES To evaluate larger-breasted women's satisfaction and compliance with wearing 3 commercially available front-closure bras-with a hook-loop closure (the hospital's standard of care), a zipper closure, or a hook-eye closure-after cardiac surgery. METHODS This study used a posttest-only, 3-group randomized controlled design. A convenience sample of participants were sized and randomly assigned a product that was placed immediately postoperatively. Participants agreed to wear the bra at least 20 h/d until the provider cleared them for less wear. At inpatient day 5 or discharge, and at the follow-up outpatient visit, subjects completed investigator-developed surveys. Data were analyzed from 60 participants by using the χ2 test and Kruskal-Wallis analysis of variance; also, patterns were identified within written comments. RESULTS Participants were most satisfied with the hook-eye front-closure product before (P = .05) and after (P = .02) discharge. Participants recommended the hook-eye and zipper products over the hook-loop bra (H = 8.39, P = .02). Wear compliance was strongest in the group wearing the hook-eye bra. CONCLUSIONS The hook-eye closure product had the most satisfaction and greatest wear compliance, and it received the highest recommendation. A practice change was made to fit and place the hook-eye bra in the operating room immediately after surgery.
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Affiliation(s)
- Kimberly Bolling
- Kimberly Bolling is a registered nurse in the cardiac surgery intensive care unit, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Takako Long
- Takako Long is a registered nurse in the cardiovascular progressive care unit, Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Cathy D. Jennings
- Cathy D. Jennings is a clinical nurse specialist, Carilion Roanoke Memorial Hospital
| | - Francis C. Dane
- Francis C. Dane is a professor of psychology, Radford University, Radford, Virginia, and a professor of interprofessionalism, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Kimberly Ferren Carter
- Kimberly Ferren Carter is senior director, nursing research, Carilion Clinic, Roanoke, Virginia
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Carvalho H, Dane FC, Whicker SA. Basic Science Faculty Conception of Learning and Teaching. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.766.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Helena Carvalho
- Department of Basic Science EducationVirginia Tech UniversityRoanokeVA
| | - Francis C Dane
- Department of Arts & SciencesJefferson College of Health SciencesRoanokeVA
| | - Shari A Whicker
- Office of Continuing Professional DevelopmentVirginia Tech Carilion School of MedicineRoanokeVA
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Affiliation(s)
- David C Parish
- Mercer University School of Medicine, Macon, GA 31201, USA
| | - Hemant Goyal
- Mercer University School of Medicine, Macon, GA 31201, USA
| | - Francis C Dane
- Jefferson College of Health Sciences, Roanoke, VA 24013, USA
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Abstract
Research based on registry studies involves significant ethical issues. Using detailed information about one registry concerning in-hospital resuscitation, we present issues concerning informed consent, access to identifiable medical information, and benefit for participants. In addition, multiple methodological difficulties have indirect implications for the ethical conduct of registry research, including consensus about variable definitions, validity and reliability for clinical decisions, sample sizes, and sources of data. Both direct and indirect ethical issues are examined from the viewpoint of accepted regulations and codes regarding ethical conduct of research; specific examples of more or less ethical solutions to the problems are presented from published research.
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Abstract
A criminal trial was presented to male and female undergraduates in one of four modes: videotape, audiotape, transcript, or summary. Significant differences in verdicts and in perceptions of the effectiveness of attorneys' presentations were observed across modes, but no differences in perceptions of witnesses were noted.
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Patel D, Devereaux RS, Teaford G, Dane FC, Parish DC, Waring ME, Kiefe CI. Abstract 159: Medication Adherence Improves Shortly After Acute Coronary Syndrome Admission and Then Declines Over One Year: Findings from TRACE-CORE. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Incomplete medication adherence is common, results in poor outcomes, and remains resistant to change in patients with acute coronary syndromes (ACS). However, few studies, if any, have reported patterns of adherence at multiple time points during patients’ transition from the hospital to their community.
Objective:
To describe patterns of self-reported medication adherence at admission and over a post-discharge transitional period of 12 months.
Methods:
Adult patients (n=2187) hospitalized for ACS enrolled in the “Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education” (TRACE-CORE) cohort from GA and MA completed the 8-item Morisky Medication Adherence Scale (range: 0-8) in person during hospitalization and via telephone interviews at 1-, 3-, 6-, and 12- month(s) after discharge. High, medium, and low adherence were defined as scale scores of 8, 6-7 and 0-5, respectively and analyzed. Repeated measures ANOVA was used to test for differences in mean adherence across the assessment periods.
Results:
Participants were 66% male, 16% non-Hispanic black, 81% non-Hispanic white, and aged 61.3 ± 11.34 years. High adherence was reported by 25% at baseline, increased to 50.9% at 1-month, and subsequently dropped to 46%, 45%, and 44% by 3,6, and 12 months, respectively (table). Mean adherence scores (n=906) increased from 6.15(SD=1.78) at baseline to 7.05 (1.23) at 1-month then slightly decreased and leveled off [6.95(1.31), 6.93(1.31), 6.89(1.36); p<0.001 for changes over time]. Baseline differed from all other scores and 1-month scores differed from baseline, 6-, and 12-months.
Conclusion:
A major increase in high adherence from baseline to 1-month was followed by a slight decline from 3 to 12 months post discharge. The improvement in adherence from baseline may have been prompted by the “teachable moment” resulting from an ACS. Further research may delineate interventional factors during this transition period that may improve long-term adherence.
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Elliott RL, Chowdhury M, Wilson L, Dane FC, Williams S. Does religion affect medical students' attitudes toward ethical dilemmas? J Med Assoc Ga 2012; 101:22-23. [PMID: 22872972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Dane FC. Type II errors in 'Nurses' prediction of volume status after aneurysmal subarachnoid hemorrhage: a prospective cohort study'. Crit Care 2009; 13:402. [PMID: 19239723 PMCID: PMC2688125 DOI: 10.1186/cc7705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dane FC, Parish DC. Survival patterns with in-hospital cardiac arrest. JAMA 2008; 299:2625-6; author reply 2626-7. [PMID: 18544718 DOI: 10.1001/jama.299.22.2625-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Julka K, Smith BE, Paris DC, Patel RM, Dane FC. DAILY, MONTHLY AND SEASONAL VARIATION OF IN-HOSPITAL RESUSCITATION FREQUENCY AND OUTCOME. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.543c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jones-Crawford JL, Parish DC, Smith BE, Dane FC. Resuscitation in the hospital: circadian variation of cardiopulmonary arrest. Am J Med 2007; 120:158-64. [PMID: 17275457 DOI: 10.1016/j.amjmed.2006.06.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 05/26/2006] [Accepted: 06/08/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Over 25 reports have found outpatient frequency of sudden cardiac death peaks between 6 am and noon; few studies, with inconsistent results, have examined circadian variation of death in hospitalized patients. This study assesses circadian variation in cardiopulmonary arrest of in-hospital patients across patient, hospital, and event variables and its effect on survival to discharge. METHODS A retrospective, single institution registry included all admissions to the Medical Center of Central Georgia in which resuscitation was attempted between January 1987 and December 2000. The registry included 4692 admissions; only the first attempt was reported. Analyses of 1-, 2-, 4-, and 8-hour intervals were performed; 1- and 4-hour intervals are presented. RESULTS Significant circadian variation was found at 1 hour (P=.01), but not at 4-hour intervals. Significant circadian variation was found for initial rhythms that were perfusing (P=.03) and asystole (P=.01). A significantly higher percentage of unwitnessed events were found as asystole during the overnight hours (P=.002). Using simple logistic regression, time in 4-hour intervals and rhythm were each significantly related to patient survival until hospital discharge (P=.003 and P <.0001). In multivariate analysis, only rhythm remained significant. CONCLUSIONS Circadian variation of cardiopulmonary arrest in this hospital has several temporal versions and is related to survival. Late night variation in witnessed events and rhythm suggests a delay between onset of clinical death and discovery, which contributes to poorer outcomes.
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Affiliation(s)
- Jennifer L Jones-Crawford
- Department of Internal Medicine, Mercer University School of Medicine/Medical Center of Central Georgia, Macon, Ga, USA
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Parish DC, Dinesh Chandra KM, Dane FC. Success changes the problem: why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it. Resuscitation 2003; 58:31-5. [PMID: 12867307 DOI: 10.1016/s0300-9572(03)00104-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Programs for research and practice in resuscitation have focused on identification and reversal of ventricular fibrillation (VF). While substantial progress has been achieved, evidence is accumulating that clinical death is less likely to be caused by fibrillation now than in the 1960s and 1970s. Pulseless electrical activity (PEA) has emerged as the most common rhythm found in arrests in the hospital and is rapidly rising in pre-hospital reports. PURPOSE To identify the magnitude of changes occurring, search for potential explanations from population and clinical epidemiology and present the data available regarding etiology and treatment of PEA. DATA SOURCES Synthesis of material from population epidemiology, clinical epidemiology, animal and human research on VF and PEA. CONCLUSIONS VF is a manifestation of severe, undiagnosed coronary artery disease (CAD). Rates of death from CAD increased from rare in 1930 to become the most common cause of death in the US. CAD death rates peaked in the early 1960s and had declined over 50% by the late 1990s. Primary and secondary prevention, early diagnosis and aggressive, successful treatment have contributed to this decline. PEA is a brief phase in clinical death that occurs after losses in consciousness, ventilatory drive and circulation but before decay to asystole; survival rates are poor. PEA is a common stage in clinical death from any of a variety of tissue hypoxic/anoxic insults. Research on PEA is needed; 50 years of attention to CAD and VF have resulted in improved survival and changed the disease spectrum. Similar attention to animal and clinical research on PEA may have the potential to improve survival.
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Affiliation(s)
- David C Parish
- Department of Internal Medicine, The Medical Center of Central Georgia, 707 Pine Street, Macon, GA, USA.
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Abstract
PURPOSE Studies have shown that medical students become more cynical and less altruistic as they advance in training. However, these studies were conducted in traditional medical schools, and many used unvalidated tools. This study examined students' attitudes in a problem-based learning (PBL) curriculum using reliable and valid measures. METHOD Medical students and PGY-1 residents at Mercer University School of Medicine in Macon, Georgia, completed Wrightsman's Philosophies of Human Natures Scale (PHNS) in 1999 and 2000. Chronbach's alpha assessed internal reliability among subscales, and test-retest reliability coefficients confirmed acceptable reliability. For 114 students who completed both surveys, changes in PHNS scores were analyzed, with particular attention to the subscales of trustworthiness, altruism, and cynicism. RESULTS Students assessed at the beginning of their second year increased the extent to which they believed people are trustworthy and increased their beliefs in how altruistic people are. They also showed a significant decrease in cynicism. There was not a significant change in trustworthiness, altruism, or cynicism among the participants beyond first year. In general, female students held less cynical views about others and believed people to be more trustworthy. CONCLUSIONS Contrary to prior reports, this study found that more advanced trainees were not more cynical or less altruistic than their more junior counterparts. Indeed, a significant and positive change of attitudes among the participants during their first year of medical school refuted earlier reports. Thus, results of earlier studies and the effect of a PBL curriculum on attitudes of medical students need to be re-examined.
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Affiliation(s)
- W Patrick Roche
- Department of Family Medicine, Mercer University School of Medicine, Macon, Georgia 31207, USA.
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Katner HP, Durham HL, Patel NA, Dane FC, Weerasuriya L, Harvey H, Durham M, Cook D, Patel D, Stephens J. The epidemic of HIV/AIDS in middle Georgia. J Med Assoc Ga 2002; 91:35-8. [PMID: 12189964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Harold P Katner
- Section of Infectious Diseases, Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA
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Elliott RL, Dane FC. Is one selective serotonin reuptake inhibitor better than another? JAMA 2002; 287:1935; author reply 1937-8. [PMID: 11960525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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van Walraven C, Forster AJ, Parish DC, Dane FC, Chandra KM, Durham MD, Whaley C, Stiell I. Validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations. JAMA 2001; 285:1602-6. [PMID: 11268268 DOI: 10.1001/jama.285.12.1602] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Most patients undergoing in-hospital cardiac resuscitation do not survive to hospital discharge. In a previous study, we developed a clinical decision aid for identifying all patients undergoing resuscitation who survived to hospital discharge. OBJECTIVE To validate our previously derived clinical decision aid. DESIGN, SETTING, AND PARTICIPANTS Data from a large registry of in-hospital resuscitations at a community teaching hospital in Georgia were analyzed to determine whether patients would be predicted to survive to hospital discharge (ie, whether their arrest was witnessed or their initial cardiac rhythm was either ventricular tachycardia or ventricular fibrillation or they regained a pulse during the first 10 minutes of chest compressions). Data from 2181 in-hospital cardiac resuscitation attempts in 1987-1996 involving 1884 pulseless patients were analyzed. MAIN OUTCOME MEASURE Comparison of predictions based on the decision aid with whether patients were actually discharged alive from the hospital. RESULTS For 327 resuscitations (15.0%), the patient survived to hospital discharge. For 324 of these resuscitations, the patients were predicted to survive to hospital discharge (sensitivity = 99.1%, 95% confidence interval, 97.1%-99.8%). In 269 resuscitations, patients did not satisfy the decision aid and were predicted to have no chance of being discharged from the hospital. Only 3 of these patients (1.1%) were discharged from the hospital (negative predictive value = 98.9%), none of whom were able to live independently following discharge from the hospital. CONCLUSION This decision aid can be used to help physicians identify patients who are extremely unlikely to benefit from continued resuscitative efforts.
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Affiliation(s)
- C van Walraven
- Department of Medicine, University of Ottawa, Ontario, Canada.
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Abstract
OBJECTIVE determine the frequency of initial rhythms in in-hospital resuscitation and examine its relationship to survival. Assess changes in outcome over time. METHODS retrospective cohort (registry) including all admissions to the Medical Center of Central Georgia in which a resuscitation was attempted between 1 January, 1987 and 31 December, 1996. RESULTS the registry includes 3327 admissions in which 3926 resuscitations were attempted. Only the first event is reported. There were 961 hospital survivors. Survival increased from 24.2% in 1987 to 33.4% in 1996 (chi(2)=39.0, df=1, P<0.0001). Survival was affected strongly by initial rhythm (chi(2)=420.0, df=1, P<0.0001) and decreased from 63.2% for supraventricular tachycardia (SVT) to 55.3% for ventricular tachycardia (VT), 51.0% for perfusing rhythms (PER), 34.8% for ventricular fibrillation (VF), 14.3% for pulseless electrical activity (PEA) and 10.0% for asystole (ASYS). PEA was the most frequent rhythm (1180 cases) followed by perfusing (963), asystole (580), VF (459), VT (94) and SVT (38). DISCUSSION the powerful effect of initial rhythm on survival has been reported in pre-hospital and in-hospital resuscitation. VF is considered the dominant rhythm and generally accounts for the most survivors. We report good outcome for each; however, VF represents only 13.8% of events and 16.7% of survivors. PEA accounts for more survivors (169) than does VF (160). Our improved outcome is partially explained by changes in rhythms, but other institutional variables need to be identified to fully explain the results. Further studies are needed to see if our findings can be sustained or replicated.
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Affiliation(s)
- D C Parish
- Department of Internal Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201, USA.
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Abstract
CONTEXT No data have been published on the relationship between advanced cardiac life support (ACLS) training of the individual who initiates resuscitation efforts and survival to discharge. OBJECTIVE To determine whether patients whose arrests were discovered by nurses trained in ACLS had survival rates different from those discovered by nurses not trained in ACLS. DESIGN Cohort case-comparison. SETTING A 550-bed, tertiary care center in central Georgia. SUBJECTS Patients whose cardiopulmonary arrest was discovered by a nurse who activated the in-hospital resuscitation mechanism. MAIN OUTCOME MEASURE Patient survival to discharge. RESULTS Initial rhythm was strongly related to survival to discharge and individually associated with 57% of the variability in survival. Nurse's training in advanced cardiac life support was also strongly related to survival and individually associated with 29% of the variability. Combining both the variables determined 62% of the variability in survival to discharge. Patients discovered by an ACLS-trained nurse (n=88) were about four times more likely to survive (33 survivors, 38%) than were patients, discovered by a nurse without training in ACLS (n=29, three survivors, 10%). CONCLUSION Arrest discovery by nurses trained in ACLS is significantly and dramatically associated with higher survival-to-discharge rates.
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Affiliation(s)
- F C Dane
- Departments of Psychology and Internal Medicine, Medical Center of Central Georgia, Mercer University, 707 Pine Street, Macon, GA 31201, USA.
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Smith MU, Dane FC, Archer ME, Devereaux RS, Katner HP. Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south. AIDS Educ Prev 2000; 12:49-70. [PMID: 10749386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Twenty-one 10th graders selected as opinion leaders by their peers in a rural county in a southern state participated in a 36-hour peer-educator training program Students Together Against Negative Decisions (STAND) based on diffusion of innovations theory and the transtheoretical model. Comparison subjects received either a 22-hour leadership training course (n = 20) or no intervention (n = 45). STAND and comparison subjects completed a 154-item written knowledge, attitude, and behavior survey at the beginning of the training (Time 1), at the end of the training (Time 2), and again 8 months later (Time 3). One hundred and sixty-seven other 9th and 10th graders in the intervention county and 74 in the comparison county completed an abbreviated telephone interview at Time 1 and Time 3. At Time 3 STAND-trained peer educators reported significantly greater increases in AIDS Risk Behavior Knowledge (more than 4 times comparison groups), frequency of conversations with peers about birth control/condoms (+180% vs. +12%) and sexually transmitted diseases (STDs; +282% vs. -33%), condom use self efficacy (+16% vs. -1%), and consistent condom use (+28% vs. +15%). STAND teens also reported substantial favorable trends at Time 3, including increased condom use (+213% vs. +31%) and decreased unprotected intercourse (-30% vs. +29%). At Time 3 teens in the intervention county reported significantly greater increases in the number of people who talked with friends in the preceding 3 months about STDs (+39% vs. -19%) or with a parent/adult about sex (+6% vs. -37%). Intervention county teens also reported a substantial but nonsignificant 2.6-fold greater increase in condom use at last intercourse (+64% vs. +25%) but unfavorable changes in other risk behaviors. The STAND peer-educator training program appears to be an effective method for improving selected sexual knowledge, attitudes, and behaviors among participant teenagers in the rural South.
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Affiliation(s)
- M U Smith
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA 31201, USA.
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Abstract
OBJECTIVE Assess the frequency and outcome of inhospital resuscitation and determine the relationship between patient age and survival and whether it is affected by initial rhythm. DESIGN Retrospective, single-institution, registry study of inhospital resuscitation. SETTING A 550-bed, tertiary-care, teaching hospital in Macon, GA. PATIENTS All admissions for which a resuscitation was attempted in the Medical Center of Central Georgia during the period of January 1, 1987 through December 31, 1993. The registry sample included 2,394 admissions, for which 2,813 resuscitation attempts were made; only the first resuscitation attempt during an admission was analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Rates of survival to discharge steadily increased from 24.4% in 1987 to 38.6% in 1993; the overall survival rate was 26.8%. Age, used as a continuous variable, was strongly related to survival (odds ratio = 0.984; p < .0001). Categorically, overall survival rates for pediatric, adult, and geriatric patients were 56.4%, 29.0%, and 24.0%, respectively. Survival rates also varied significantly (odds ratio = 0.469; p < .0001) among initial rhythms, i.e., supraventricular tachycardia (60.7%), ventricular tachycardia (57.6%), perfusing rhythms (49.84%), ventricular fibrillation (32.0%), pulseless electrical activity (14.6%), and asystole (9.1%). The relationship between age and survival did not change across the years included in the study, but did vary as a function of initial rhythm (p < .0001). Age was positively related to survival when initial rhythm was supraventricular tachycardia (p = .04), negatively related to survival when the initial rhythm was perfusing (p < .0001) or pulseless electrical activity (p = .0002), and not related to survival when the initial rhythm was ventricular tachycardia (p = .98), ventricular fibrillation (p = .14), or asystole (p = .21). CONCLUSIONS The relationship between patient age and a successful resuscitation attempt is not as simple as reported earlier. Whether age is related to increased or decreased survival, or is unrelated to survival, depends on the rhythm extant when resuscitation attempts begin. Survival rates were higher than most reported elsewhere and improved significantly over time. Multicentered studies are needed to determine whether these results are unique to the institution studied.
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Affiliation(s)
- D C Parish
- Department of Internal Medicine, Medical Center of Central Georgia and Mercer University School of Medicine, Macon, USA
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Abstract
To determine the incidence of arteriographically proven coronary artery disease in black men evaluated for chest pain, we retrospectively reviewed the charts of 208 black men, aged 20 to 60, who had coronary arteriography at the Medical Center of Central Georgia (MCCG) from 1985 through January 1990. Age, type of chest pain, and risk factors commonly accepted as associated with coronary disease (hypertension, family history, left ventricular hypertrophy, diabetes, smoking, and hypercholesterolemia) were identified for each patient. Patients were categorized by previous evidence of coronary disease: 145 were studied to evaluate suspected disease and 63 to evaluate previously proven (prior catheterization) or presumptive (prior myocardial infarction) disease. Chest pain groups (typical and atypical angina) were analyzed by Pearson chi-square goodness of fit using the Diamond and Forrester age and chest pain tables as a model. Risk factors were analyzed using a maximum likelihood chi-square test. Coronary artery disease was common in the study group (48.6% of all patients) but significantly less than predicted by the Diamond and Forrester tables. Risk factors were highly prevalent, but only age and smoking were associated with catheterization-proven coronary artery disease in this group. We conclude that coronary artery disease is common in black men evaluated for chest pain but less frequent than would be expected from comparison with findings in white men presenting similar clinical features. Risk factors other than age and smoking were not associated with increased incidence of disease. A prospective study is needed to delineate a more effective means of evaluating black male patients with chest pain.
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Affiliation(s)
- D C Parish
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA
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