Current Search: Talbert, Steven (x)
View All Items
(1 - 7 of 7)
- Title
- PROTOCOL BASED SCREENING TOOLS TO IDENTIFY SEPSIS PATIENTS TRANSPORTED BY EMERGENCY MEDICAL SERVICES.
- Creator
-
Moser, Isaiah, Talbert, Steven, University of Central Florida
- Abstract / Description
-
Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in...
Show moreSepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients' outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.
Show less - Date Issued
- 2017
- Identifier
- CFH2000155, ucf:46061
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH2000155
- Title
- IDENTIFYING DRUG-SEEKING BEHAVIORS IN THE EMERGENCY DEPARTMENT.
- Creator
-
Bush-Burman, Randi, Talbert, Steven, University of Central Florida
- Abstract / Description
-
Pain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively...
Show morePain is the leading cause of Emergency Department (ED) visits making it one of the primary concerns of the emergency medical field. The experience of pain is subjective and unique to every individual making it difficult to effectively manage. As a result, the subjective nature of pain is also commonly associated with drug-seekers often claiming to have pain simply to receive narcotics to support their addiction. There have been numerous studies completed to determine how to effectively recognize drug-seeking. This integrative literature review will identify the common behaviors that have been seen as indicators of drug-seeking in the ED. The evidence collected from articles published between 2001 and 2011 examined the use of assessment tools, drug screening, and prescription monitoring programs for distinguishing drug-seekers. The evidence did not identify a specific evaluation tool used to recognize drug-seekers; however, the research did suggested that using these techniques can help to identify drug-seeking behavior allowing emergency medical staff to effectively manage pain in the ED.
Show less - Date Issued
- 2011
- Identifier
- CFH0004070, ucf:44802
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFH0004070
- Title
- Barriers to timely administration of thrombolytics in acute ischemic stroke patients.
- Creator
-
Joseph, Elizabeth, Talbert, Steven, Chase, Susan, Ullah, Saif, University of Central Florida
- Abstract / Description
-
Stroke is a leading cause of long term disability in the United States. The therapeutic benefits of intravenous thrombolytics is time dependent in an acute ischemic stroke patient and is an important determinant of 90 day and one year functional outcomes. This study investigated areas in the stroke alert process of a community based primary stroke care center that resulted in the delay of administration of thrombolytics within 60 minutes of an acute ischemic stroke patient's arrival to the...
Show moreStroke is a leading cause of long term disability in the United States. The therapeutic benefits of intravenous thrombolytics is time dependent in an acute ischemic stroke patient and is an important determinant of 90 day and one year functional outcomes. This study investigated areas in the stroke alert process of a community based primary stroke care center that resulted in the delay of administration of thrombolytics within 60 minutes of an acute ischemic stroke patient's arrival to the emergency room. A retrospective descriptive design was utilized and chart reviews were done on 40 patients that received thrombolytics in the emergency room. Patient characteristics and time variables associated with the various steps in the stroke alert process were extracted. Findings showed that only 7.5% of the patients received thrombolytics within the recommended 60 minutes, with the longest time interval associated with time from arrival to the emergency room to time of evaluation by teleneurologist. There were no significant differences in the characteristics of patients who received thrombolytics within 60 minutes and those patients that received thrombolytics after 60 minutes. Recommendations were made for changes in organizational and practice strategies to improve timely administration, and for future research involving the effects of quality improvement initiatives.
Show less - Date Issued
- 2012
- Identifier
- CFE0004390, ucf:49406
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004390
- Title
- Evaluation of Postoperative Air Leak and Chest Tube Drainage Systems after Pulmonary Resection.
- Creator
-
Jacobsen, Kristina, Talbert, Steven, Sole, Mary Lou, Guido-Sanz, Francisco, Bittner, Hartmuth, University of Central Florida
- Abstract / Description
-
Postoperative air leaks are the most common complication after a pulmonary resection. There is no data in the literature comparing the traditional and digital chest drainage system after a robotic-assisted pulmonary lobectomy. In 182 eligible patients, this retrospective study evaluated the association between digital and traditional drainage systems with postoperative chest tube days, hospital length of stay, chest tube reinsertion during hospitalization, and 30-day readmission for...
Show morePostoperative air leaks are the most common complication after a pulmonary resection. There is no data in the literature comparing the traditional and digital chest drainage system after a robotic-assisted pulmonary lobectomy. In 182 eligible patients, this retrospective study evaluated the association between digital and traditional drainage systems with postoperative chest tube days, hospital length of stay, chest tube reinsertion during hospitalization, and 30-day readmission for pneumothorax following a robotic-assisted lobectomy. The groups did not differ significantly in terms of age, gender, BMI, smoking, adhesions or neoadjuvant therapy. Patients with the digital drainage system had a mean chest tube duration of 2.07 days compared with 2.73 days for the traditional drainage system (p = 0.003). Hospital length of stay was also significantly reduced with the digital drainage system. Patients using the digital drainage system had a mean hospital length of stay of 4.02 days compared with 5.06 days with the traditional drainage system (p = 0.010). Although chest tube reinsertion occurred four times more frequently with traditional drainage system, the difference did not achieve the level of statistical significance (p = 0.059). The frequency of readmission due to pneumothorax was very low (1 patient per group), which prevented comparative statistical analysis. In the digital drainage system there are shorter chest tube days and hospital length of stay after a robotic-assisted lobectomy. The decision to remove chest tubes in the traditional drainage system is burdened with uncertainty. The digital drainage system reduces intraobserver variability allowing for improved decision making in chest tube removal.
Show less - Date Issued
- 2019
- Identifier
- CFE0007893, ucf:52771
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0007893
- Title
- Bleeding Control Using Multiple Amputee Trauma Trainer in Medical Simulation: Comparison of Movement Versus Non-Movement in Training.
- Creator
-
Allen, Christine, Kincaid, John, Schatz, Sarah, Allred, Kelly, Talbert, Steven, Sotomayor, Teresita, University of Central Florida
- Abstract / Description
-
Army first responders, specifically Combat Medics and Combat Lifesavers, provide medical intervention while in the field. Didactic as well as hands-on training helps to prepare these first responders, and one module they receive involves bleeding control. First responders are taught to use the Combat Application Tourniquet(&)#174; (CAT(&)#174;) to stop bleeding from limbs subjected to severe injury such as amputation, gunshot, or severe lacerations. A training aid like the Multiple Amputee...
Show moreArmy first responders, specifically Combat Medics and Combat Lifesavers, provide medical intervention while in the field. Didactic as well as hands-on training helps to prepare these first responders, and one module they receive involves bleeding control. First responders are taught to use the Combat Application Tourniquet(&)#174; (CAT(&)#174;) to stop bleeding from limbs subjected to severe injury such as amputation, gunshot, or severe lacerations. A training aid like the Multiple Amputee Trauma Trainer(TM) (MATT(TM)) simulator provides tourniquet training using a lifelike bilateral lower limb amputee. In addition, MATT(TM) combines movement and resistance while the first responder applies the tourniquet, mimicking conditions one would see in a real situation. This research describes tourniquet history, appropriate usage, field tourniquet review, surgical tourniquet, CAT(&)#174; bleeding intervention procedures, bleeding physiology and complications, prehospital tourniquet use in recent conflicts, medical simulation fidelity, and a review of the value of animatronic movement during tourniquet simulation-based training. I then evaluate the effectiveness of animatronic movement during tourniquet training using the Advanced MATT in an experiment using Army first responders. The control group experienced no movement while the experimental group experienced movement when applying a tourniquet during the lab-training. Each group then alternately experienced Advanced MATT movement during an immersive scenario along with fog, strobe lights, and battle sounds. It was hypothesized that 1) In the immersive scenario, the experimental groups (i.e., those who were trained on a moving simulator) would have a faster reaction time as compared to those participants who did not receive training on the moving Advanced MATT simulator; 2) In the lab-based training, the experimental groups would have a slower reaction time; 3) In the immersive scenario, the experimental groups would have a faster tourniquet application time when subjected to movement while in the lab-based training, but the experimental groups would also have a slower tourniquet application time when initially subjected to movement in the laboratory-based training; finally, 4, 5, and 6) Participants who completed lab-based tourniquet training on the Advanced MATT simulation with animatronic movement would report higher perceived realism scores than participants who complete the training on a static version of the Advanced MATT and participants who completed a tourniquet training immersive scenario on the Advanced MATT simulation with movement would report higher perceived realism, presence, and self-efficacy scores than participants who complete the training on a static version of the Advanced MATT. The empirical results show a significant overall training effect of the Advanced MATT simulator (with or without movement). For reaction time and tourniquet application time, involving simulator movement was significant over varying scenarios. A small reduction in reaction and tourniquet application time on the battlefield may be extremely beneficial on the battlefield. Participants who received movement generally gave more positive reactions than those who did not received movement, although these results failed to reach statistical significance. Participants who received movement, followed by a scenario without movement rated the subjective ratings the lowest, suggestive of the lack of movement. Furthermore, despite the order movement was received, no large drops in performance occurred in any condition, indicating that negative training was avoided.
Show less - Date Issued
- 2011
- Identifier
- CFE0004468, ucf:49316
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004468
- Title
- Ventilator-Associated Complications in the Mechanically Ventilated Veteran.
- Creator
-
Grano, Joan, Sole, Mary, Covelli, Maureen, Talbert, Steven, McGuirt, Aron, University of Central Florida
- Abstract / Description
-
Surveillance of ventilator-associated pneumonia (VAP) has been the common outcome measurement used for internal and external benchmarking for mechanically ventilated patients; and although not a clinical definition, it is commonly used as an outcome measurement for research studies. Criteria in the VAP definition include both subjective and objective components, leading to questions of validity. In addition, recent legislation has mandated the public reporting of healthcare-associated...
Show moreSurveillance of ventilator-associated pneumonia (VAP) has been the common outcome measurement used for internal and external benchmarking for mechanically ventilated patients; and although not a clinical definition, it is commonly used as an outcome measurement for research studies. Criteria in the VAP definition include both subjective and objective components, leading to questions of validity. In addition, recent legislation has mandated the public reporting of healthcare-associated infections, including VAP, in many states. Infectious disease experts have recently recommended monitoring a new outcome, ventilator-associated events (VAE), that contain specific objective criteria. The Centers for Disease Prevention and Control (CDC) have refined this definition and released a new VAE protocol and algorithm, replacing the VAP surveillance definition, as a result. The VAE protocol assesses for ventilator-associated conditions (VAC). The primary aims of this study were to determine the incidence of VAC; and to assess four predictors for VAC, including two VAP prevention strategies (use of the subglottic secretion drainage endotracheal-tube [SSD-ETT]), and daily sedation vacation); and two patient-related factors (alcohol withdrawal during mechanical ventilation, and history of COPD). In addition, the incidence for VAE, using a new national algorithm was determined. Using a retrospective study design, electronic medical records of 280 veterans were reviewed to identify cases of VAC using the VAE algorithm. The setting was two intensive care units (ICU) at a large Veterans Administration Healthcare System (VAHCS) from October 2009 to September 2011. In addition to demographic information, variables were collected to determine if cases met event criteria (VAC, infection-related ventilator-associated complication [IVAC], and possible or probable VAP). Incidence rates were calculated for VAC and IVAC. Comparative data between those with and without VAC were assessed with independent sample T-test or non-parametric equivalents. The study sample was predominantly male (97.1%), Caucasian (92.1%), non-Hispanic (90.7%); with a mean (SD) age of 67.2 (10.4) years. Twenty patients met the VAC definition resulting in a VAC incidence of 7.38 per 1000 ventilator days. There were no statistically significant differences in demographics or disease characteristics found between the two groups (patients with VAC and patients without VAC). Using logistic regression, the impact of the four predictors for VAC was assessed. None of the four explanatory variables were predictive of the occurrence of VAC. Secondary outcomes (e.g. mechanical ventilation days, ICU days, hospital days, and mortality) of veterans with VAC were compared to veterans without VAC. Results indicated that the VAC group was associated with a significantly longer duration of ICU stay, longer mechanical ventilation period, more likely to have a tracheostomy, and had a higher mortality during hospitalization. Expanding mechanical ventilation quality performance measures to include VAE/VAC provides a better representation of infectious and non-infectious ventilator-associated problems, and provides more accurate morbidity and mortality in this high-risk ICU population. Further research is necessary to explore patient characteristics and prevention strategies that impact the development of all VAC.
Show less - Date Issued
- 2013
- Identifier
- CFE0004853, ucf:49706
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0004853
- Title
- Impact of Interruption Frequency on Nurses' Performance, Satisfaction, and Cognition During Patient-Controlled Analgesia Use in the Simulated Setting.
- Creator
-
Campoe, Kristi, Talbert, Steven, Sole, Mary Lou, Andrews, Diane, Jentsch, Florian, University of Central Florida
- Abstract / Description
-
Problem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of...
Show moreProblem: Interruption during medication administration is a significant patient safety concern within health care, especially during the administration of high risk medications in nursing. Patient-controlled analgesia (PCA) devices are frequently associated with adverse events and have a four-fold increased risk of patient injury compared to non-PCA related adverse events. While the nature and frequency of interruptions have been established for nurses' medication processes, the impact of interruption frequency on nurses' PCA interaction has not been fully measured or described.Purpose: The purposes of this study were to quantify the impact of interruption frequency on registered nurses' (RN) performance, satisfaction, and cognitive workload during PCA interaction, and to determine nurses' perceptions of the impact of interruption frequency.Methods: This study employed a mixed-method design. First, an experimental repeated measures design was used to quantify the impact of interruption frequency on a purposive sample of nine medical-surgical RNs. The RNs completed PCA programming tasks in a simulated laboratory nursing environment for each of four conditions where interruption frequency was pre-determined. Four established human factors usability measures were completed for each of the four test conditions. The research questions were answered using repeated measures analysis of variance with (RM-ANOVA), McNamar's test, and Friedman's test. After each experiment, semi-structured interviews were used to collect data that were analyzed using inductive qualitative content analysis to determine RNs' perceptions of the impact of interruption frequency. Results: Results of the RM-ANOVA were significant for the main effect of interruption frequency on efficiency F(3,24)=9.592, p = .000. McNemar's test did not show significance for the impact of interruption frequency on effectiveness (accuracy). Friedman test showed participant satisfaction was significantly impacted by interruption frequency (x2=9.47, df=3, p=0.024). Friedman test showed no significance for the main effect of interruption frequency on cognitive workload scores by condition type (x2=1.88, df=3, p=0.599). Results of the qualitative content analysis revealed two main categories to describe nurses' perception of interruption frequency: the nature of interruptions and nurses' reaction to the interrupted work environment.Discussion/Implications: The results suggested that interruption frequency significantly affected task completion time and satisfaction for participants but not participant accuracy or cognitive workload. A high error rate during PCA programming tasks indicated the need to evaluate the conditions in which RNs complete PCA programming as each error presents potential risk of patient harm. RNs' described the impact of interruption frequency as having a negative impact on the work environment and subsequently implement compensating strategies to counterbalance interruptions. RNs' perceived that patient safety was negatively impacted by frequent interruption. RNs experienced negative intrapersonal consequences as a results of frequent interruption. Additional study is needed to better understand the impact of interruption frequency on RNs' performance accuracy and cognitive workload.
Show less - Date Issued
- 2015
- Identifier
- CFE0005770, ucf:50099
- Format
- Document (PDF)
- PURL
- http://purl.flvc.org/ucf/fd/CFE0005770
