Richard Hamilton - Academia.edu (original) (raw)

Papers by Richard Hamilton

Advances in Infectious Diseases, 2013

A characterization of the clinical demographic features of patients with infection caused Acineto... more A characterization of the clinical demographic features of patients with infection caused Acinetobacter baumannii, and the antibiotyping of the isolates recovered from these patients was undertaken, with a special reference to carbapenemresistant variants, and their risk factors. This study was conducted retrospectively from January 2010 to March 2011 at a 616-bed tertiary care university hospital. Sixty-four patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk and odds ratio. We identified 100 A. baumannii from 64 patients during 15 months period. Significant risk factors were working age (18-60 years), male gender, hospital stay (>1 week but <1 month), prior hospitalization, in a progressive care nursing units, respiratory/mechanical ventilation, polymicrobial infections and prior antibiotic therapy. Methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumoniae were the significant co-infecting agents. The antibiogram demonstrated multidrug resistance in a majority of the isolates. Relative risk associated with ventilator, diabetes, and surgery was higher in repeat isolates than in first isolates and were multidrug resistant. Repeat isolates were more resistant that the first isolates to most anti-acinetobacter agents, but the overall crude mortality was not significant during this study period, and couldn't correlated to the choice of treatment. In conclusion, a resistance against all clinically used carbapenems, and colistin is rapidly increasing in repeat isolates of A. baumannii; leaves narrow therapeutic options to treat multidrug-resistant and pandrug-resistant A. baumannii infection. For the first time we report rising incidence of colistin resistance by 20 percent in repeat isolates, and is worrisome for healthcare centers. A combination therapy should be adopted to treat such infection to avoid the emergence of colistin-resistant phenotypes in the United States.

Annals of Emergency Medicine, 2009

Study objective: To compare outcomes after acute acetaminophen poisoning in 2 large cohorts of pa... more Study objective: To compare outcomes after acute acetaminophen poisoning in 2 large cohorts of patients treated with either the 20-hour intravenous or 72-hour oral acetylcysteine protocol. Methods: We conducted a retrospective cohort study with historical control comparing patients treated with one of 2 acetylcysteine regimens. Data for the 20-hour group were obtained from a medical record review of patients on whom the 20-hour intravenous protocol was initiated in Canadian hospitals from 1980 to 2005. The 72-hour group consisted of a historical cohort of patients treated in US hospitals with the 72-hour oral protocol from 1976 to 1985. The primary outcome was hepatotoxicity (aminotransferase levels Ͼ1,000 IU/L). Results: Of the 4,048 patients analyzed, 2,086 were in the 20-hour group and 1,962 were in the 72-hour group. The incidence of hepatotoxicity was 13.9% in the 20-hour group and 15.8% in the 72-hour group (-1.9% absolute difference; 95% confidence interval [CI]-4.2 to 0.3). The relative risk of hepatotoxicity was lower in the 20-hour group when acetylcysteine was initiated within 12 hours of ingestion. The relative risk was lower in the 72-hour group when acetylcysteine was initiated later than 18 hours after ingestion. There was no significant risk difference between groups when acetylcysteine treatment was started 12 to 18 hours after ingestion. One patient in the 20-hour group received a liver transplant and died because of acetaminophen toxicity compared with no liver transplants and 3 deaths in the 72-hour group. Anaphylactoid reactions to intravenous acetylcysteine were reported in 148 of 2,086 patients (7.1%; 95% CI 6.1% to 8.3%). This study is limited by comparison of 2 separate data sets from different countries and study years. Conclusion: The risk of hepatotoxicity differed between the 20-hour and 72-hour protocols according to the time to initiation of acetylcysteine. It favored the 20-hour protocol for patients presenting early and favored the 72-hour protocol for patients presenting late after acute acetaminophen overdose. [

The numbering of technical project reports Issued by the Naval Air Development Center is arranged... more The numbering of technical project reports Issued by the Naval Air Development Center is arranged for specific Identification purposes. Each number consists of the Center acronym, the calendar year in which the number was assiqned. the sequence number of the report within the specific calendar year. and the official 2-digit corresponden'! code of the Command Officer or the Functional Department responsible for the report. For example: Report No. NADC-88020-60 Indicates the twentieth Center report for the year 1988 and prepared by the Air Vehicle and Crew Systems Tecnnology Department. The numerical codes are as follows:

The Journal of emergency medicine, 2017

Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydroc... more Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration. A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri." The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry t...

Http Www Libreriasaulamedica Com, 2010

Internal and emergency medicine, Jan 23, 2015

Residency training programs requirements state, "Residents should participate in scholarly a... more Residency training programs requirements state, "Residents should participate in scholarly activity." However, there is little consensus regarding how best to achieve these requirements. The objective of this study is to implement a resident research program that emphasizes resident participation in quantitative or qualitative empirical work. A three-step program "Think, Do, Write" roughly follows the 3 years of the residency. During the first phase, the resident chooses a topic, formulates a hypothesis, and completes standard research certifications. Phase 2 involves obtaining Institutional Review Board approval, and conducting the study. The final phase entails analyzing and interpreting the data, and writing an abstract to present during an annual research day. Residents are encouraged to submit their projects for presentation at scientific conferences and for publication. Multiple departmental resources are available, including a Resident Research Fund, and f...

Background: Acinetobacter baumannii (Ab) causes hospital- and community-acquired infections; furt... more Background: Acinetobacter baumannii (Ab) causes hospital- and community-acquired infections; furthermore, multidrug resistant (MDR) phenotypes are increasing globally. The carbapenems are often the last resort for treating MDRAb infections. We report analysis of patient demographics and characteristics of infection with carbapenem-resistant Ab. Methods: From June 2010 to Dec 2011, 100 Abpositive-cultures in 64 patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk, odds ratio, and 95% confidence interval. The analytical profile index was used to identify isolates, and an antibiogram for the first and repeat (second) isolates. Results: Of 100 samples, 49% were sputum samples from ventilated patients; 57% had an associated co-infection. Significant risk factors were working age (18-60 years), male gender, hospital stay more than 1 week but less than 1 month, prior hospitalization, progressive care nur...

Prehospital and disaster medicine

The smallpox vaccination emergency preparedness program has been unsuccessful in enrolling suffic... more The smallpox vaccination emergency preparedness program has been unsuccessful in enrolling sufficient numbers of healthcare workers. The objective of this study was to use game theory to analyze a pre-event vaccination versus post-event vaccination program using the example of a terrorist considering an attack with smallpox or a hoax. A three-person game (normal and extensive form), and an in-person game are played for pre-event and post-event vaccinations of healthcare workers facing the possibility of a smallpox attack or hoax. Full pre-event vaccinations of all targeted healthcare workers are not necessary to deter a terrorist attack. In addition, coordinating vaccinations among healthcare workers, individual healthcare worker risk aversion, and the degree to which terrorists make the last move based on specific information on the status of pre-event vaccination all greatly impact strategy selection for both sides. A Nash Equilibrium of pre- and post-event vaccination strategies ...

BMJ open, 2013

This article sought to define whether an alternative safety-engineered device (SED) could help pr... more This article sought to define whether an alternative safety-engineered device (SED) could help prevent needlestick injury (NSI) in healthcare workers (HCWs) who place central venous catheters (CVCs). The study involved three phases: (1) A retrospective analysis of deidentified occupational health records from our tertiary care urban US hospital to clearly identify NSI risk and rates to an HCW during invasive catheter placement; (2) 95 residents were surveyed regarding their knowledge and experience with NSIs and SEDs; (3) A random sample of six residents participated in a focus group session discussing barriers to the use of SED. A single urban US tertiary care teaching hospital. A retrospective analysis of NSI to HCWs in a tertiary care urban US hospital was conducted over a 4-year period (July 2007-June 2011). Ninety-five residents from specialties that often place CVC during training (surgery, surgical subspecialties, internal medicine, anaesthesia and emergency medicine) were su...

Veterinary and human toxicology, 1995

The leaves of Phytolacca americana (pokeweed), when ingested, typically produce a self-limited bu... more The leaves of Phytolacca americana (pokeweed), when ingested, typically produce a self-limited but severe gastroenteritis characterized by intense vomiting and frothy diarrhea. Although cardiac effects have been reported in previous cases of pokeweed ingestion, no cardiac toxin has ever been identified in pokeweed. We report the case of a family who ingested raw and/or cooked pokeweed leaves, and 1 member who developed a Mobitz type I heart block associated with vomiting which resolved after i.v. promethazine. This suggests the possibility that some cardiac effects of pokeweed are secondary to the increased vagal tone seen with severe gastrointestinal colic.

Aviation, space, and environmental medicine, 1991

Acceleration (+Gz) research and aircrew training using human centrifuges involves considerable st... more Acceleration (+Gz) research and aircrew training using human centrifuges involves considerable stress that can alter normal cardiovascular and neurologic function even in completely healthy individuals. It is clear that electrocardiographic rate, rhythm, and conduction disturbances are frequently associated with +Gz exposures. These cardiac changes can result in altered perfusion of the central nervous system (CNS) to an extent which exceeds that induced by the +Gz stress alone. Although centrifuge-based research and training have a proven record of overall safety, there is finite risk associated with such stressful exposures, and adverse events have been observed. It is, therefore, extremely important to continually develop improved avenues to enhance human safety during centrifuge exposure. We have implemented techniques that can be immediately employed by centrifuge medical personnel to reduce the potential for significant CNS embarrassment and possible injury. These include tech...

Aviation, space, and environmental medicine, 1991

As plans to bring the United States into the realm of continuously manned space operations are wr... more As plans to bring the United States into the realm of continuously manned space operations are written, questions concerning the medical support of those operations have been raised. A review of the simple, time-tested principles that guide military operational medicine can be applied to medical care in space. Based on this operational approach, I conclude that a successful medical team must understand the mission, identify medical resources, define medical evacuation capabilities, anticipate medical issues and plan solutions, and develop facility requirements. Once all this has been accomplished, appropriate selection and training of medical personnel completes the preparation.

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2009

This study compared ultrasonography-guided (USG) placement with anatomic placement during interna... more This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model. A prospective, randomized, crossover study of 28 fourth year medical students was conducted with institutional review board approval. Participants viewed an instructional material before participation, and supervision was standardized. Participants were randomly assigned to either USG or traditional landmark method first, and each group served as its own crossover comparison. Paired t tests and χ analysis were performed on matched-pair data. Fifty-four percent of participants had at least one arterial stick without USG compared with 0% when using USG. Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein: mean with USG = 1.5 advances (95% CI, 1.0-1.9), mean without USG = 10.4 advances (95% CI, 7.8-13), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; time to successful cannulation: mean with USG = 58 seconds (95% CI, 48-72 seconds), mean without USG = 338 seconds (95% CI, 286-390 seconds), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; and success rates: 100% with USG and 42.8% without USG (95% CI, 24.5%-61.1%). The number needed to treat to avoid an arterial stick by using USG during IJ insertion by novice practitioners is ∼2. The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.

Advances in Infectious Diseases, 2013

A characterization of the clinical demographic features of patients with infection caused Acineto... more A characterization of the clinical demographic features of patients with infection caused Acinetobacter baumannii, and the antibiotyping of the isolates recovered from these patients was undertaken, with a special reference to carbapenemresistant variants, and their risk factors. This study was conducted retrospectively from January 2010 to March 2011 at a 616-bed tertiary care university hospital. Sixty-four patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk and odds ratio. We identified 100 A. baumannii from 64 patients during 15 months period. Significant risk factors were working age (18-60 years), male gender, hospital stay (>1 week but <1 month), prior hospitalization, in a progressive care nursing units, respiratory/mechanical ventilation, polymicrobial infections and prior antibiotic therapy. Methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumoniae were the significant co-infecting agents. The antibiogram demonstrated multidrug resistance in a majority of the isolates. Relative risk associated with ventilator, diabetes, and surgery was higher in repeat isolates than in first isolates and were multidrug resistant. Repeat isolates were more resistant that the first isolates to most anti-acinetobacter agents, but the overall crude mortality was not significant during this study period, and couldn't correlated to the choice of treatment. In conclusion, a resistance against all clinically used carbapenems, and colistin is rapidly increasing in repeat isolates of A. baumannii; leaves narrow therapeutic options to treat multidrug-resistant and pandrug-resistant A. baumannii infection. For the first time we report rising incidence of colistin resistance by 20 percent in repeat isolates, and is worrisome for healthcare centers. A combination therapy should be adopted to treat such infection to avoid the emergence of colistin-resistant phenotypes in the United States.

Annals of Emergency Medicine, 2009

Study objective: To compare outcomes after acute acetaminophen poisoning in 2 large cohorts of pa... more Study objective: To compare outcomes after acute acetaminophen poisoning in 2 large cohorts of patients treated with either the 20-hour intravenous or 72-hour oral acetylcysteine protocol. Methods: We conducted a retrospective cohort study with historical control comparing patients treated with one of 2 acetylcysteine regimens. Data for the 20-hour group were obtained from a medical record review of patients on whom the 20-hour intravenous protocol was initiated in Canadian hospitals from 1980 to 2005. The 72-hour group consisted of a historical cohort of patients treated in US hospitals with the 72-hour oral protocol from 1976 to 1985. The primary outcome was hepatotoxicity (aminotransferase levels Ͼ1,000 IU/L). Results: Of the 4,048 patients analyzed, 2,086 were in the 20-hour group and 1,962 were in the 72-hour group. The incidence of hepatotoxicity was 13.9% in the 20-hour group and 15.8% in the 72-hour group (-1.9% absolute difference; 95% confidence interval [CI]-4.2 to 0.3). The relative risk of hepatotoxicity was lower in the 20-hour group when acetylcysteine was initiated within 12 hours of ingestion. The relative risk was lower in the 72-hour group when acetylcysteine was initiated later than 18 hours after ingestion. There was no significant risk difference between groups when acetylcysteine treatment was started 12 to 18 hours after ingestion. One patient in the 20-hour group received a liver transplant and died because of acetaminophen toxicity compared with no liver transplants and 3 deaths in the 72-hour group. Anaphylactoid reactions to intravenous acetylcysteine were reported in 148 of 2,086 patients (7.1%; 95% CI 6.1% to 8.3%). This study is limited by comparison of 2 separate data sets from different countries and study years. Conclusion: The risk of hepatotoxicity differed between the 20-hour and 72-hour protocols according to the time to initiation of acetylcysteine. It favored the 20-hour protocol for patients presenting early and favored the 72-hour protocol for patients presenting late after acute acetaminophen overdose. [

The numbering of technical project reports Issued by the Naval Air Development Center is arranged... more The numbering of technical project reports Issued by the Naval Air Development Center is arranged for specific Identification purposes. Each number consists of the Center acronym, the calendar year in which the number was assiqned. the sequence number of the report within the specific calendar year. and the official 2-digit corresponden'! code of the Command Officer or the Functional Department responsible for the report. For example: Report No. NADC-88020-60 Indicates the twentieth Center report for the year 1988 and prepared by the Air Vehicle and Crew Systems Tecnnology Department. The numerical codes are as follows:

The Journal of emergency medicine, 2017

Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydroc... more Synthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration. A 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled "Scooby Snax Limited Edition Blueberry Potpourri." The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry t...

Http Www Libreriasaulamedica Com, 2010

Internal and emergency medicine, Jan 23, 2015

Residency training programs requirements state, "Residents should participate in scholarly a... more Residency training programs requirements state, "Residents should participate in scholarly activity." However, there is little consensus regarding how best to achieve these requirements. The objective of this study is to implement a resident research program that emphasizes resident participation in quantitative or qualitative empirical work. A three-step program "Think, Do, Write" roughly follows the 3 years of the residency. During the first phase, the resident chooses a topic, formulates a hypothesis, and completes standard research certifications. Phase 2 involves obtaining Institutional Review Board approval, and conducting the study. The final phase entails analyzing and interpreting the data, and writing an abstract to present during an annual research day. Residents are encouraged to submit their projects for presentation at scientific conferences and for publication. Multiple departmental resources are available, including a Resident Research Fund, and f...

Background: Acinetobacter baumannii (Ab) causes hospital- and community-acquired infections; furt... more Background: Acinetobacter baumannii (Ab) causes hospital- and community-acquired infections; furthermore, multidrug resistant (MDR) phenotypes are increasing globally. The carbapenems are often the last resort for treating MDRAb infections. We report analysis of patient demographics and characteristics of infection with carbapenem-resistant Ab. Methods: From June 2010 to Dec 2011, 100 Abpositive-cultures in 64 patients were identified. Clinical and microbiological data were analyzed for risk factors and demographic features to derive relative risk, odds ratio, and 95% confidence interval. The analytical profile index was used to identify isolates, and an antibiogram for the first and repeat (second) isolates. Results: Of 100 samples, 49% were sputum samples from ventilated patients; 57% had an associated co-infection. Significant risk factors were working age (18-60 years), male gender, hospital stay more than 1 week but less than 1 month, prior hospitalization, progressive care nur...

Prehospital and disaster medicine

The smallpox vaccination emergency preparedness program has been unsuccessful in enrolling suffic... more The smallpox vaccination emergency preparedness program has been unsuccessful in enrolling sufficient numbers of healthcare workers. The objective of this study was to use game theory to analyze a pre-event vaccination versus post-event vaccination program using the example of a terrorist considering an attack with smallpox or a hoax. A three-person game (normal and extensive form), and an in-person game are played for pre-event and post-event vaccinations of healthcare workers facing the possibility of a smallpox attack or hoax. Full pre-event vaccinations of all targeted healthcare workers are not necessary to deter a terrorist attack. In addition, coordinating vaccinations among healthcare workers, individual healthcare worker risk aversion, and the degree to which terrorists make the last move based on specific information on the status of pre-event vaccination all greatly impact strategy selection for both sides. A Nash Equilibrium of pre- and post-event vaccination strategies ...

BMJ open, 2013

This article sought to define whether an alternative safety-engineered device (SED) could help pr... more This article sought to define whether an alternative safety-engineered device (SED) could help prevent needlestick injury (NSI) in healthcare workers (HCWs) who place central venous catheters (CVCs). The study involved three phases: (1) A retrospective analysis of deidentified occupational health records from our tertiary care urban US hospital to clearly identify NSI risk and rates to an HCW during invasive catheter placement; (2) 95 residents were surveyed regarding their knowledge and experience with NSIs and SEDs; (3) A random sample of six residents participated in a focus group session discussing barriers to the use of SED. A single urban US tertiary care teaching hospital. A retrospective analysis of NSI to HCWs in a tertiary care urban US hospital was conducted over a 4-year period (July 2007-June 2011). Ninety-five residents from specialties that often place CVC during training (surgery, surgical subspecialties, internal medicine, anaesthesia and emergency medicine) were su...

Veterinary and human toxicology, 1995

The leaves of Phytolacca americana (pokeweed), when ingested, typically produce a self-limited bu... more The leaves of Phytolacca americana (pokeweed), when ingested, typically produce a self-limited but severe gastroenteritis characterized by intense vomiting and frothy diarrhea. Although cardiac effects have been reported in previous cases of pokeweed ingestion, no cardiac toxin has ever been identified in pokeweed. We report the case of a family who ingested raw and/or cooked pokeweed leaves, and 1 member who developed a Mobitz type I heart block associated with vomiting which resolved after i.v. promethazine. This suggests the possibility that some cardiac effects of pokeweed are secondary to the increased vagal tone seen with severe gastrointestinal colic.

Aviation, space, and environmental medicine, 1991

Acceleration (+Gz) research and aircrew training using human centrifuges involves considerable st... more Acceleration (+Gz) research and aircrew training using human centrifuges involves considerable stress that can alter normal cardiovascular and neurologic function even in completely healthy individuals. It is clear that electrocardiographic rate, rhythm, and conduction disturbances are frequently associated with +Gz exposures. These cardiac changes can result in altered perfusion of the central nervous system (CNS) to an extent which exceeds that induced by the +Gz stress alone. Although centrifuge-based research and training have a proven record of overall safety, there is finite risk associated with such stressful exposures, and adverse events have been observed. It is, therefore, extremely important to continually develop improved avenues to enhance human safety during centrifuge exposure. We have implemented techniques that can be immediately employed by centrifuge medical personnel to reduce the potential for significant CNS embarrassment and possible injury. These include tech...

Aviation, space, and environmental medicine, 1991

As plans to bring the United States into the realm of continuously manned space operations are wr... more As plans to bring the United States into the realm of continuously manned space operations are written, questions concerning the medical support of those operations have been raised. A review of the simple, time-tested principles that guide military operational medicine can be applied to medical care in space. Based on this operational approach, I conclude that a successful medical team must understand the mission, identify medical resources, define medical evacuation capabilities, anticipate medical issues and plan solutions, and develop facility requirements. Once all this has been accomplished, appropriate selection and training of medical personnel completes the preparation.

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2009

This study compared ultrasonography-guided (USG) placement with anatomic placement during interna... more This study compared ultrasonography-guided (USG) placement with anatomic placement during internal jugular (IJ) central venous catheter (CVC) insertion by novice practitioners using a simulation model. A prospective, randomized, crossover study of 28 fourth year medical students was conducted with institutional review board approval. Participants viewed an instructional material before participation, and supervision was standardized. Participants were randomly assigned to either USG or traditional landmark method first, and each group served as its own crossover comparison. Paired t tests and χ analysis were performed on matched-pair data. Fifty-four percent of participants had at least one arterial stick without USG compared with 0% when using USG. Significant differences were shown in the USG versus no-USG groups in number of needle advances until successful cannulation of the vein: mean with USG = 1.5 advances (95% CI, 1.0-1.9), mean without USG = 10.4 advances (95% CI, 7.8-13), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; time to successful cannulation: mean with USG = 58 seconds (95% CI, 48-72 seconds), mean without USG = 338 seconds (95% CI, 286-390 seconds), P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; and success rates: 100% with USG and 42.8% without USG (95% CI, 24.5%-61.1%). The number needed to treat to avoid an arterial stick by using USG during IJ insertion by novice practitioners is ∼2. The USG during IJ CVC placement by novice practitioners is essential to improve patient safety. If these data are extrapolated to impact on patient care, an arterial stick may be avoided in one of every two IJ CVCs placed by novice practitioners. The USG technology should be made available to novice practitioners needing to place CVCs.