Prospective study of manikin-only versus manikin and human subject endotracheal intubation training of paramedics.

STUDY OBJECTIVES: To determine the effect of manikin-only training on field success of endotracheal intubation by paramedics. DESIGN: Prospective evaluation of individual field endotracheal intubation success rates for paramedics after they participated in a manikin-only or a manikin-plus-cadaver training program. TYPES OF PARTICIPANTS: Paramedics responding to emergency calls involving adult medical or trauma victims. INTERVENTIONS: All participants were trained using a controlled manikin training program; then, half were randomly selected for additional instruction using fresh human cadavers. MEASUREMENTS AND MAIN RESULTS: Individuals trained using only the manikin program had mean +/- SD individual success rates of 82 +/- 32%, and individuals who received additional cadaver training had mean individual success rates of 83 +/- 31%. Overall success rates for the two groups were 86% for the manikin-only group and 85% for the manikin-plus-cadaver-trained group. The sample size was not adequate to allow rejection of the null hypothesis. CONCLUSION: Paramedics trained in endotracheal intubation using a systematic manikin-only teaching program can attain acceptable individual success rates in the actual field setting.     

Have hospital inpatient cost containment programs contributed to the growth in outpatient expenditures? Analysis of the substitution effect associated with hospital utilization review

The rapid increase in outpatient expenditures has been the focus of growing attention in recent years. This increase has corresponded with public and private efforts to contain hospital inpatient costs, prompting some analysts to suggest that outpatient expenditure growth is the result of a substitution effect; that is, the substitution of outpatient for inpatient care associated with hospital cost containment programs. Claims data on 43 privately insured groups that adopted utilization review (UR) during the latter part of 1984 or early 1985 were analyzed, comparing outpatient expenditures before and after adoption of hospital inpatient UR to quantify the substitution effect associated with UR. UR was not associated with higher physician office expenditures nor with higher outpatient diagnostic expenditures. UR was related to significantly higher hospital outpatient department expenditures. On average, these expenditures were approximately 20% higher (P = 0.01) after the adoption of UR. However, outpatient department expenditures of the groups analyzed represented a fairly small percentage of total medical expenditures; hence, the absolute expenditure increase was quite modest, on the order of $9 per insured person per year. This analysis, admittedly limited in scope, suggests that UR is associated with a measurable substitution effect. It is likely that inpatient hospital cost containment programs have resulted in some substitution of outpatient for inpatient care and thus have played a role in fostering outpatient expenditure growth during recent years.     

Technology: a strategic factor in hospital planning

Hospital administrators cannot afford to sit back, amazed at technological progress. They must be able to assess technology--both currently available and planned for the future--and they must be willing to adapt to rapid change. Assessing and planning for technology are essential for future survival.     

Organ system radiology. Instruction of sophomore medical students

During a six-year period we have evolved a method of teaching organ system radiology to sophomore medical students. This involves didactic and clinical sessions with small group discussions and activities central to the program. The course is designed to present a bridging course between the basic medical sciences and the clinical sciences and to better prepare students for their patient care responsibilities.     

Phase I trial of multiple large doses of murine monoclonal antibody CO17-1A. I. Clinical aspects

Twenty-five patients with metastatic gastrointestinal adenocarcinoma received one to four infusions (400 mg) of murine monoclonal antibody CO17-1A. Eleven patients had mild gastrointestinal symptoms, and one had a transient flushing episode. Two of five who received three weekly infusions had readily reversible anaphylactic reactions at the time of the third infusion (day 15). There were no other toxic effects. One patient had a complete remission and is surviving at greater than 104 weeks, and four had stable disease. The median survival for the whole group was 57 weeks. In general, the antibody infusions were well tolerated but had modest antitumor effects.     

Sphincteric action of the pelvicalyceal junction and pacemaker activity in human kidney

The effect of elevation of renal pelvic pressure on pacemaker activity was examined in 5 isolated human kidneys. Pressure fluctuations transmitted from renal pelvic contractions first appeared in pressure tracings from the upper renal calyx as renal pelvic pressure exceeded 25 cm H2O. This finding suggests that the pelvicalyceal junction acts as a sphincter which can withstand pelvic pressures of about 25 cm H2O. The upper renal calyx contracted rhythmically at a rate of 10 times per minute when the pelvic pressure was low. At high pelvic pressures, upper calyceal contraction frequency decreased although its rhythm remained regular. As renal pelvic pressure increased, the frequency of renal pelvic contractions increased to a level that corresponded in a 1:1 ratio with contractions of the upper calyx.     

Interdisciplinary service learning and substance abuse screening in free clinic settings.

Interdisciplinary groups of students learned screening tools for substance use and practiced skills of brief intervention while serving needs of a local free clinic.