Internal medicine residents' perceptions of the balance between service and education in their night-call activities.

PURPOSE: To quantify the workload of residents on night call and to determine the residents' perceptions of the balance between service and education in their night-call activities. METHOD: Twenty-two internal medicine residents--nine first-year residents and 13 senior residents (i.e., in their second, third, or fourth year)--kept logs of their night-call activities for two periods of 16 days each in 1991-92, at a 772-bed teaching hospital affiliated with Wright State University School of Medicine. The residents used the following five-point scale to rate each activity: 1, strictly service; 3, even balance; 5, strictly education. They also recorded the total times spent on various activities. Data were analyzed by using the independent and paired t-tests. RESULTS: Ninety-eight percent of the logs were returned. The first-year and senior residents did not differ significantly in times spent on logged events. Both the first-year and the senior residents perceived many night-call activities to be weighted toward education, especially those involving evaluation of acutely ill patients being considered for hospital admission (overall mean rating of 3.3). There was no striking difference between the first-year and senior residents' perceptions of the balance between service and education in their activities. CONCLUSION: The residents' perceptions of the relationship between service and education indicate that there was an even balance between the two. The educational aspects of night-call duties can and should remain an integral part of residents' training.

Modified head-up tilt test for orthostatic challenge of critically ill patients.

The purpose of this study was to assess the cardiovascular response to a modified head-up tilt test for use with the bedridden, critically ill patient. The cardiovascular responses of seven normals and ten critically ill patients to 45 degrees head-up tilt with the legs horizontal (0 degrees) were analyzed. Stroke volume index (SI) and cardiac index (CI) were measured with thoracic electric bioimpedance (TEB). The baseline TEB (Z0) was measured to monitor fluid shift out of the thorax during tilt. BP was measured and systemic vascular resistance index (SVRI) was calculated. Normals responded to the modified head-up tilt with a decreased SI (59 to 44 ml/m2 and CI (3.7 to 2.8 L/min.m2), and an increased SVRI and Z0 (25.5 to 27.9). As a group, the patients showed no significant change with tilt. However, individual analysis revealed a heterogeneous response by the patients. Those patients who demonstrated a caudal shift of blood (increased Z0) had decreased SI. Those with no indication of a caudal shift of blood, presumably due to decreased venous compliance, did not change SI. Thus, this type of modified head-up tilt can be used in the ICU to study more intensely cardiovascular function and control in the bedridden subject.

Comparison of two impedance cardiographic techniques for measuring cardiac output in critically ill patients.

The purpose of the present study was to compare cardiac output (Q) values obtained by both the Kubicek (MIC) and Sramek (NCCOM3) impedance cardiographic techniques with thermodilution (TD) in critically ill patients. The two impedance techniques were also compared in normal subjects. Seven healthy subjects and ten ICU patients were enlisted in the study. Three Q measurements were made in each subject. In the ICU patients, there were no significant differences in Q values as measured by TD (6.6 L/min), MIC (6.3 L/min), and NCCOM3 (6.4 L/min). Both MIC and NCCOM3 Q values were comparable to TD in patients. In normals, however, the NCCOM3 estimated larger values for Q than did the MIC (NCCOM3, 9.2 L/min; MIC, 6.2 L/min). Q values obtained with MIC in normals were comparable with published values for supine normals. Thus, the two techniques agreed in the patients but not in the normals. The reasons for these results are not obvious from the data, but are attributable to the measurements by the NCCOM3. Because of this, caution is suggested when interpreting absolute Q values obtained by the NCCOM3.

Comparison of two impedance cardiographic techniques for measuring cardiac output.

The purpose of the present study was to compare cardiac outputs obtained by both the Kubicek (MIC) and Sramek (NCCOM3) impedance cardiographic techniques with thermodilution (TD) in critically ill patients. The two impedance techniques were also compared in normal subjects. Seven healthy subjects and ten patients in the intensive care unit were enlisted in the study. Only those subjects with successful measurements by all three methods were used in the data analysis. Three measurements of cardiac output were made in each subject. In patients, there were no significant differences in cardiac outputs as measured by TD (6.61/min), MIC (6.3 1/min), NCCOM3 (6.4 1/min). MIC and NCCOM3 cardiac outputs were correlated and approximated the line of identify when compared to TD. In normals, however, the NCCOM3 overestimated the cardiac output (NCCOM3, 9.2 1/min; MIC, 6.2 1/min). Because of these inconsistent results, caution is urged when interpreting the values obtained by the NCCOM3. In contrast, the use of the MIC in both populations has been reaffirmed.