Publications by authors named "Thomas F O"

10 Publications

  • Page 1 of 1

The measure of treatment agreement between portable and laboratory blood gas measurements in guiding protocol-driven ventilator management.

J Trauma 2009 Aug;67(2):303-13; discussion 313-4

Department of Internal Medicine, Pulmonary/Critical Care Division, Intermountain Medical Center, University of Utah, Salt Lake City, Utah, USA.

Background: Portable blood gas analyzer and monitor devices are increasingly being used to direct ventilator therapy. The purpose of this study was to evaluate the "measure of treatment agreement" between portable and laboratory blood gas measurements used in guiding protocol-driven ventilator management.

Materials And Methods: Using National Institutes of Health Acute Respiratory Distress Syndrome network ventilator management guidelines to manage patient care, measurements taken from the Nonin 8500 M pulse oximeter (SpO2), the Novametrix-610 end-tidal CO2 (ETCO2) detector, and the i-STAT 1 (SaO2, PO2, pH, PCO2) were compared with the recommended treatment from paired laboratory ABL-725 (SaCO2, PO2, pH, PCO2) measurements.

Results: Four hundred forty-six intubated adult intensive care unit patients were studied prospectively. Except for the ETCO2 (R2 = 0.460), correlation coefficients between portable and laboratory measurements were high (R2 > or = 0.755). Testing for equivalence, the Nonin-SpO2, iSTAT-PO2, iSTAT-pH, and iSTAT-PCO2 were deemed "equivalent" surrogates to paired ABL measurements. Testing for the limits of agreement found only the iSTAT-PCO2 to be an acceptable surrogate measurement. The measure of treatment agreement between the portable and paired laboratory blood gas measurements were Nonin-SpO2 (68%), iSTAT-SaO2 (73%), iSTAT-PO2 (97%), iSTAT-pH (88%), iSTAT-PCO2 (95%), and Novametrix-ETCO2 (60%). Only the iSTAT-PO2 and the iSTAT-PCO2 achieved the > or =95% treatment agreement threshold to be considered as acceptable surrogates to laboratory measurements.

Conclusions: : The iSTAT-PO2 and -PCO2 were portable device measurements acceptable as surrogates to standard clinical laboratory blood gas measurements in guiding protocol-directed ventilator management. The "measure of treatment agreement," based on standardized decisions and measurement thresholds of a protocol, provides a simple method for assessing clinical validity of surrogate measurements.
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http://dx.doi.org/10.1097/TA.0b013e3181a5f055DOI Listing
August 2009

Hyperbaric oxygen for acute carbon monoxide poisoning.

N Engl J Med 2002 Oct;347(14):1057-67

Department of Internal Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, Utah 84143, USA.

Background: Patients with acute carbon monoxide poisoning commonly have cognitive sequelae. We conducted a double-blind, randomized trial to evaluate the effect of hyperbaric-oxygen treatment on such cognitive sequelae.

Methods: We randomly assigned patients with symptomatic acute carbon monoxide poisoning in equal proportions to three chamber sessions within a 24-hour period, consisting of either three hyperbaric-oxygen treatments or one normobaric-oxygen treatment plus two sessions of exposure to normobaric room air. Oxygen treatments were administered from a high-flow reservoir through a face mask that prevented rebreathing or by endotracheal tube. Neuropsychological tests were administered immediately after chamber sessions 1 and 3, and 2 weeks, 6 weeks, 6 months, and 12 months after enrollment. The primary outcome was cognitive sequelae six weeks after carbon monoxide poisoning.

Results: The trial was stopped after the third of four scheduled interim analyses, at which point there were 76 patients in each group. Cognitive sequelae at six weeks were less frequent in the hyperbaric-oxygen group (19 of 76 [25.0 percent]) than in the normobaric-oxygen group (35 of 76 [46.1 percent], P=0.007), even after adjustment for cerebellar dysfunction and for stratification variables (adjusted odds ratio, 0.45 [95 percent confidence interval, 0.22 to 0.92]; P=0.03). The presence of cerebellar dysfunction before treatment was associated with the occurrence of cognitive sequelae (odds ratio, 5.71 [95 percent confidence interval, 1.69 to 19.31]; P=0.005) and was more frequent in the normobaric-oxygen group (15 percent vs. 4 percent, P=0.03). Cognitive sequelae were less frequent in the hyperbaric-oxygen group at 12 months, according to the intention-to-treat analysis (P=0.04).

Conclusions: Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning.
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http://dx.doi.org/10.1056/NEJMoa013121DOI Listing
October 2002

Scoring acuity hours and costs of nursing for trauma care.

Am J Crit Care 1993 Nov;2(6):436-43

Brigham Young University, Provo, UT 84602.

Objective: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems.

Methods: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients.

Results: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively.

Conclusions: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.
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November 1993

Hypothermia in the sepsis syndrome and clinical outcome. The Methylprednisolone Severe Sepsis Study Group.

Crit Care Med 1992 Oct;20(10):1395-401

Division of Critical Care Medicine, LDS Hospital, Salt Lake City, UT.

Objective: To evaluate the consequences of clinical hypothermia associated with sepsis syndrome and septic shock.

Design: Analysis of data from a multi-institutional, randomized, placebo-controlled, prospective study with predetermined end-point analysis of development of shock, recovery from shock, hospital length of stay, and death.

Setting: Multi-institutional medical and surgical ICUs.

Patients: Patients meeting predetermined criteria for severe sepsis syndrome.

Interventions: Appropriate sepsis and shock care with 50% of patients receiving methylprednisolone and 50% receiving placebo.

Measurements And Main Results: The occurrence rate of hypothermia (< 35.5 degrees C) is 9% in this population. When compared with febrile patients, hypothermic patients had a higher frequency of central nervous system dysfunction (88% vs. 60%), increased serum bilirubin concentration (35% vs. 15%), prolonged prothrombin times (50% vs. 23%), shock (94% vs. 61%), failure to recover from shock (66% vs. 26%), and death (62% vs. 26%). The hypothermic patients were also more likely to be classified as having a rapidly or ultimately fatal disease upon study admission.

Conclusions: This prospective study confirms that hypothermia associated with sepsis syndrome has a significant relationship to outcome manifest by increased frequency of shock and death from shock. This finding is in sharp contrast to the protective effects of induced hypothermia in septic animals and perhaps man.
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http://dx.doi.org/10.1097/00003246-199210000-00006DOI Listing
October 1992

A comparison of emergency medical helicopter accident rates in the United States and the Federal Republic of Germany.

Aviat Space Environ Med 1990 Aug;61(8):750-2

Division of Emergency Medicine, University of California Davis Medical Center, Sacramento 95817.

The purpose of this study was to compare accident rates of helicopter emergency medical services (USA-HEMS) to domestic air taxi service (USA-Taxi) and helicopter emergency medical services in the Federal Republic of Germany (FRG-HEMS). Contingency tables compared the total hours flown to the number of fatal and non-fatal accidents for USA-HEMS (1982-7) vs. USA-Taxi (1980-5) and USA-HEMS (1982-7) vs. FRG-HEMS (1982-7). The overall accident rate for USA-HEMS was 11.7/100,000 h, with the fatal accident rate being 4.7/100,000 h. This was significantly different from the USA-Taxi overall accident rate of 6.7/100,000 h and the fatal accident rate of 1.6/100,000 h (chi 2 = 20.441, p = 0.0001). The USA-HEMS overall and fatal accident rates were not significantly different than the FRG-HEMS overall (10.9/100,000 h) and fatal (4.1/100,000 h) accident rate (chi 2 = 0.061, p = 0.97). These data suggest that emergency air transport is inherently more risky than routine air taxi services.
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August 1990

Impact of Medicare prospective reimbursement system on nutritional support service patients: the importance of pass throughs.

JPEN J Parenter Enteral Nutr 1989 Jan-Feb;13(1):71-6

Nutritional Support Service, LDS Hospital, Salt Lake City, UT 84143.

The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass-through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because of the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non-Medicare patients. When data from all Medicare patients (which includes both NSS and non-NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass-through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements.
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http://dx.doi.org/10.1177/014860718901300171DOI Listing
May 1989

Outcome of critically injured patients treated at Level I trauma centers versus full-service community hospitals.

Crit Care Med 1985 Oct;13(10):861-3

Critically injured patients were identified by a CRAMS (circulation, respiration, abdomen, motor, speech) score of 6 or less while still in the field. They were prospectively followed as they received their care at the nearest medical facility according to the then-existing district Emergency Medical Services protocols. Those cared for by Level I trauma centers had a significantly reduced mortality rate compared to those treated at the other large full-service community hospitals. The commitment to Level I trauma care improves outcome of the critically injured, and field triage of the critically injured patient to these centers is indicated.
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http://dx.doi.org/10.1097/00003246-198510000-00019DOI Listing
October 1985

Simultaneous determination of cellular mutagenesis and transformation by chemical carcinogens in Fischer rat embryo cells.

J Toxicol Environ Health 1978 Jan;4(1):79-91

Thirteen chemicals, eight carcinogenic and five closely related noncarcinogenic analogues, were tested to establish the validity of a simultaneous procedure for the in vitro assay of potential carcinogens and mutagens. The assay utilizes Fischer rat embryo (FRE) cells infected with Rauscher leukemia virus and simultaneously measures the induction of cellular transformation (growth in soft agar) and mutagenesis (ouabain resistance) by chemicals. An activation procedure for the metabolic conversion of the procarcinogens and promutagens to biologically active forms is described. All chemicals that produced transformation in the FRE system also induced a significant increase in ouabain resistance. The significance and the potential uses of this assay are discussed.
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http://dx.doi.org/10.1080/15287397809529646DOI Listing
January 1978

Chemical-viral co-carcinogenesis: requirement for leukemia virus expression in accelerated transformation.

Int J Cancer 1976 Dec;18(6):852-8

The essential role of Rauscher leukemia virus (RLV) multiplication in viral-chemical co-carcinogenesis was investigated by the use of ethidium bromide (EtBr) as an inhibitor of viral complementary DNA (cDNA) integration in the host genome. EtBr inhibited co-carcinogenic transformation when present at the time of RLV inoculation but was ineffective when added to preinfected cells. Inhibitors of protein synthesis, puromycin and cyclohexamide also inhibited co-carcinogenic transformation of chronically infected cells. Purified rat interferon used at a concentration which inhibited 85% of RLV production did not modify the course of co-carcinogenic transformation. The implications of these observations in terms of the possible role of the virus-specific protein (s) in the co-carcinogenic process are discussed.
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http://dx.doi.org/10.1002/ijc.2910180618DOI Listing
December 1976
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