Establishing biennial paramedic experience benchmarks

Objective. Since stroke symptoms are often vague, and acute therapies for stroke are more recently available, it has been hypothesized that stroke patients may not be treated with the same urgency as myocardial infarction (MI) patients by emergency medical services (EMS). To examine this hypothesis, EMS transport times were examined for both stroke and MI patients who used a paramedic-level, county-based EMS system for transportation to a single hospital during 1999. Methods. Patients were first identified by their hospital discharge diagnosis as stroke (ICD-9 430–436, n = 50) or MI (ICD-9 410, n = 55). Trip sheets with corresponding transport times were retrospectively obtained from the 911 center. A separate analysis was performed on patients identified by dispatchers with a chief complaint of stroke (n = 85) or MI (n = 372). Results. Comparing stroke and MI patients identified by ICD-9 codes, mean EMS transport times in minutes did not meaningfully differ with respect to dispatch to scene arrival time (8.3 vs 8.9, p = 0.61), scene time (19.5 vs 21.4, p = 0.23), and transport time (13.7 vs 16.2, p = 0.10). Mean total call times in minutes from dispatch to hospital arrival were similar between stroke and MI patients (41.5 vs 46.4, p = 0.22). Results were similar when comparing patients identified by dispatchers with a chief complaint indicative of stroke or MI. Conclusion. In this single county, EMS response times were not different between stroke and MI patients. Replication in other EMS settings is needed to confirm these findings.     

A Cardiovascular Pharmacotherapy Elective Course to Enhance Pharmacy Students�� Literature Evaluation Skills and Ability to Apply Clinical Evidence

Objectives. To design and implement a cardiovascular pharmacotherapy elective course to enhance pharmacy students’ ability to evaluate medical literature and apply clinical evidence.Design. In weekly class sessions, students were provided an overview of the important literature supporting therapeutic guidelines for the management of major cardiovascular diseases. Students worked in groups to complete outside-of-class assignments involving a patient case and then discussed the case in class. During the semester, each student also independently completed a literature search on an assigned topic, summarized the studies found in table format, and presented 1 of the studies to the class.Assessment. Students’ grades on weekly patient case assignments steadily increased over the semester. Also, the average grade on the final examination was higher than the grade on the midterm take-home examination. On the course evaluation, students rated the course favorably in terms of improvement of confidence in evaluating the primary literature and applying it to practice.Conclusion. Completion of the cardiovascular pharmacotherapy elective increased pharmacy students’ level of confidence in evaluating literature and applying clinical evidence in making patient care decisions.     

Optimal Disinfection Times for Needleless Intravenous Connectors

BackgroundElimination of catheter-related bloodstream infections is a major focus in health care. According to the Centers for Disease Control and Prevention and the Infusion Nurses Society, the optimal time for needleless connector disinfection has not yet been empirically established.MethodsUsing experimental design and established lab procedure, a 0.5 MacFarland suspension was used to inoculate 172 needleless connectors with bacteria (Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa) and allowed to dry for 18 hours. Five groups of connectors (n = 27 per group) were disinfected using 70% isopropyl alcohol with friction for 5, 8, 10, 12, and 15 seconds, and flushed with 0.5 mL nonbacteriostatic sterile normal saline onto sheep-blood agar plates for incubation at 35°C for 48 hours. Bacterial growth (1 colony) was noted on 2 negative controls; therefore, a second sample (n = 172) was tested as above using additional precautions of masking, gloving, and gowning. A third group of connectors was tested using a 0.5 MacFarland suspension containing yeast (Candida albicans).ResultsGroup 1 showed significant (χ²₄ = 37.93; P = .00) and strong (Cramér's V = 0.53; P = .00) associations between scrub time and growth status. Although not statistically significant, Groups 2 and 3 demonstrated clinically significant associations between these factors.ConclusionsAlthough additional research is warranted, our study showed that disinfection times of 5 and 8 seconds were inadequate for reducing bacterial transfer. However, disinfection times of 10, 12, and 15 seconds resulted in comparable, decreased rates of bacterial migration.     

A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism

Some individuals with autism engage in physical aggression to an extent that interferes with not only their quality of life, but also that of their parents and siblings. Behavioral and psychopharmacological treatments have been the mainstay of treatments for aggression in children and adolescents with autism. We evaluated the effectiveness of a mindfulness-based procedure, Meditation on the Soles of the Feet, in helping three adolescents to manage their physical aggression. This procedure required the adolescents to rapidly shift the focus of their attention from the aggression-triggering event to a neutral place on their body, the soles of their feet. Incidents of aggression across the three adolescents ranged from a mean of 14–20 per week during baseline, 4–6 per week during mindfulness training, including zero rates during the last 4 weeks of intervention. Aggression occurred a rate of about 1 per year during a 3-year follow-up. Our results suggest adolescents with autism can learn, and effectively use, a mindfulness-based procedure to self-manage their physical aggression over several years.     

Comparison of coronary stenting versus conventional balloon angioplasty on five-year mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Little is known about the influence of stenting versus balloon angioplasty on long-term outcomes (particularly mortality) after primary percutaneous coronary intervention (PCI). We evaluated 2,087 patients with ST-elevation myocardial infarction enrolled in various Primary Angioplasty in Myocardial Infarction (PAMI) trials in the United States, who underwent primary PCI. The main outcome was all-cause mortality at 5 years, obtained through the National Death Index. Of the 2,087 patients, stenting was performed in 692 (33%). The absolute difference in the hospital (2.2% vs 3.3%), 1-year (3.3% vs 5.2%), and 5-year (10% vs 13%) mortality rates favored patients receiving a stent versus conventional balloon therapy, with the difference increasing with time. A multivariate Cox model identified stent use (vs balloon alone) as an independent correlate of lower 5-year mortality (hazard ratio 0.60, 95% confidence interval 0.42 to 0.85). The absolute reduction in mortality was greatest in the highest risk group. In conclusion, compared with balloon angioplasty, stenting during primary PCI not only resulted in better angiographic and short-term outcomes, but also in a sustained beneficial effect on mortality at 5 years. These data support the routine use of coronary stenting in most patients undergoing primary PCI, when feasible.