bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGARUH KESEHATAN DAN KESELAMATAN KERJA TERHADAP KINERJA KARYAWAN BAGIAN PRODUKSI PT. PG RAJAWALI II UNIT PG JATITUJUH MAJALENGKA
Authors: Widyastuti Setyo Dwi , Fauzi Muhamad
Published: November 2019

Masalah keselamatan dan kecelakaan kerja di Indonesia masih sering diabaikan. Hal ini dapat dilihat dari masih tingginya angka kecelakaan kerja. Menurut data dari Jamsostek, jumlah kecelakaan kerja pada tahun 2012 sebanyak 9.056 kasus kecelakaan kerja. Dari jumlah tersebut, 2.419 kasus mengakibatkan kematian. Menurut Afdifar (2012), baru 2,1% dari 15.000 perusahaan besar yang menerapkan sistem manajemen K3. Sementara di perusahaan kecil dan menengah, implementasi dari penerapan sistem manajemen K3 juga masih jauh dari harapan. Berdasarkan pengukuran Indeks Pembangunan Ketenagakerjaan (IPK), Indonesia pada tahun 2012, indikator Kondisi Lingkungan Kerja hanya mencapai angka 3,71 (rendah) atau menurun dibanding 2011 yang mencapai angka indeks 5,02 (menengah-kebawah) (Ilfani, 2013). Dengan adanya pelaksanaan program kesehatan dan keselamatan kerja di perusahaan diharapkan dapat meningkatkan kualitas kinerja karyawan dan mampu mendukung pencapaian tujuan perusahaan secara optimal. Tujuan penelitian ini adalah untuk mengetahui pengaruh kesehatan dan keselamatan kerja terhadap kinerja karyawan bagian produksi PT. PG Rajawali II Unit PG Jatitujuh Majalengka. Jenis penelitian yang dilakukan adalah metode survey dengan pendekatan cross sectional. Populasi adalah seluruh karyawan bagian produksi II PT. PT. PG Rajawali II Unit PG Jatitujuh Majalengka sebanyak 600 orang. Pengambilan sampel dalam penelitian ini adalah dengan teknik kuota accidental sampling, yaitu sebanyak 87 orang. Instrumen yang digunakan dalam penelitian ini adalah lembar kuesioner dan dianalisis dengan menggunakan teknik analisis korelasi pearson. Berdasarkan hasil analisis data penelitian, dapat diketahui bahwa kesehatan dan keselamatan kerja (K3) berpengaruh terhadap Kinerja karyawan Bagian Produksi II PT. PG Rajawali II Unit PG Jatitujuh Kabupaten Majalengka. Penelitian ini hanya meneliti pengaruh kesehatan dan keselamatan kerja (K3) terhadap kinerja karyawan, oleh karena itu diharapkan peneliti selanjutnya dapat memperdalam penelitian ini dengan menambahkan faktor lain yang mungkin mempengaruhi kinerja karyawan
Carbazole-functionalized hyper-cross-linked polymers for CO2 uptake based on Friedel–Crafts polymerization on 9-phenylcarbazole
Authors: Fang Dandan , Li Xiaodong , Zou Meishuai , Guo Xiaoyan , Zhang Aijuan
Published: November 2019

To systematically explore the effects of the synthesis conditions on the porosity of hyper-cross-linked polymers (HCPs), a series of 9-phenylcarbazole (9-PCz) HCPs (P1–P11) has been made by changing the molar ratio of cross-linker to monomer, the reaction temperature T1, the used amount of catalyst and the concentration of reactants. Fourier transform infrared spectroscopy was utilized to characterize the structure of the obtained polymers. The TG analysis of the HCPs showed good thermal stability. More importantly, a comparative study on the porosity revealed that: the molar ratio of cross-linker to monomer was the main influence factor of the BET specific surface area. Increasing the reaction temperature T1 or changing the used amount of catalyst could improve the total pore volume greatly but sacrificed a part of the BET specific surface area. Fortunately changing the concentration of reactants could remedy this situation. Slightly changing the concentration of reactants could simultaneously obtain a high surface area and a high total pore volume. The BET specific surface areas of P3 was up to 769 m2 g−1 with narrow pore size distribution and the CO2 adsorption capacity of P11 was up to 52.4 cm3 g−1 (273 K/1.00 bar).
Facile synthesis and assessment of 2-alkoxy-4-(4-hydroxyphenyl)-6-arylnicotinonitrile derivatives as new inhibitors for C1018-steel corrosion in HCl: A combined theoretical and experiential investigations
Authors: Abd El-Lateef Hany , Abdelhamid Antar A , Mohamed Mounir A A , Moustafa Amr H
Published: November 2019

An effective and accessible synthesis of alkoxy arylnicotinonitriles was achieved via a four-component reaction of 4-hydroxybenzaldehyde, acetophenones, malononitrile in the presence of RONa. The synthesized alkoxy arylnicotinonitrile derivatives containing pyridine moiety were predestined as inhibitors for C1018-steel (CS) corrosion in 1.0 M HCl using potentiodynamic-polarization (PDP) and electrochemical impedance spectroscopy (EIS) methods. PDP plots were demonstrated that the arylnicotinonitriles behave as typical inhibitors of the mixed-type. They have also suppressed the CS corrosion at lower [inhibitor] and accomplished an inhibition capacity ranged from 87.6 to 98.2% in 0.7 mM. Their adsorption on the CS interface follows the isotherm model of Langmuir and they include both chemisorption and physisorption mechanisms, with a preference of chemisorption. The morphology of the CS surface was examined utilizing Fourier Transform Infrared Spectroscopy (FTIR) and field-emission scanning electron microscopy (FE-SEM). Moreover, Density Functional Theory (DFT) calculations confirm the empirical findings and the adsorption of arylnicotinonitrile derivatives on the CS interface.
Neutrino Emissions from Tidal Disruption Remnants
Authors: Hayasaki Kimitake , Yamazaki Ryo
Published: November 2019

We study high-energy neutrino emissions from tidal disruption remnants (TDRs) around supermassive black holes. The neutrinos are produced by the decay of charged pions originating in ultrarelativistic protons that are accelerated there. In the standard theory of tidal disruption events (TDEs), there are four distinct phases from the debris circularization of stellar debris to super- and sub-Eddington to radiatively inefficient accretion flows (RIAFs). In addition, we consider the magnetically arrested disk (MAD) state in both the super-Eddington accretion and RIAF phases. We find that there are three promising cases to produce neutrino emissions: the super-Eddington accretion phase of the MAD state and the RIAF phases of both the non-MAD and MAD states. In the super-Eddington MAD state, the enhanced magnetic field makes it possible to accelerate the protons to

with the other given appropriate parameters. The neutrino energy is then

at the peak of the energy spectrum. For M
bh ≳ 107.7
M
⊙, the neutrino light curve is proportional to

, while it follows the standard

decay rate for

. In both cases, the large luminosity and characteristic light curves diagnose the super-Eddington MAD state in TDEs. In the RIAF phase of the non-MAD state, we find

and

, and its light curve is proportional to

. This indicates that one can identify whether the existing RIAFs are the TDE origin or not. TDRs are potentially a population of hidden neutrino sources invisible in gamma-rays.
Characteristics of Magnetoacoustic Waves and Coronal Seismology
Authors: Karamimehr M. R. , Farahani S. Vasheghani , Ebadi H.
Published: November 2019

We model fast magnetohydrodynamic sausage and kink wave characteristics propagating in solar slab-like plasma structures. By implementing Cartesian coordinates, explicit expressions are provided governing the dependence of the frequency, damping, damping time, phase, and group speeds of fast sausage and kink waves on the wavenumber and density contrasts of solar slab-like plasmas. Explicit expressions are presented through equilibrium conditions and physical parameters controlling the plasma structure. Solutions of the explicit expressions are compared with numerical results. The overlap of curves proves adequate for the robustness of the explicit expressions. Kink modes possess higher frequencies compared to sausage modes in the leaky regime, while the sausage mode phase speed increases more rapidly compared to the kink speed. This explains the higher group speeds of sausage waves compared to kink waves around the cutoff. Sausage waves damp quicker compared with kink waves. The damping is inversely proportional to the mode number. As the damping time is directly proportional with the wavenumber, the damping time is much higher around the cutoff frequency compared to the long wavelength limit. The presented expressions prove adequate for coronal seismology, where, as the magnetoacoustic oscillations damp and disappear, the local and neighboring physical parameters and conditions could be estimated. As leaky kink modes live longer than sausage modes, they have a higher chance of being observed while transporting energy to a broader region. Sausage modes penetrate less due to fast damping providing higher heating rates in shorter ranges. Both modes contribute to coronal heating in various scales.
Risk of Lower Eyelids Malposition in Subciliary Compared to Transconjunctival Approach in Maxillofacial Fractures Management: A Systematic Review and Meta-Analysis
Authors: Sanjaya I Gusti Putu Hendra , Hamid Agus Roy Rusly Hariantana , Adnyana I Made Suka , Purwanthi I Gusti Ayu Putri , Magdalena Paulina , Mardhika Putu Eka
Published: November 2019

BACKGROUND: Both subciliary and transconjunctival approaches have been used for decades to visualise the site of the maxillofacial fracture. The most common complication following those procedures is lower eyelids malposition.
AIM: This meta-analysis will analyse which approach (subciliary and transconjunctival approaches) is more favourable to decrease lower eyelids malposition incidence.
METHOD: This meta-analysis was conducted based on PRISMA guidelines. The electronic search was conducted using keywords (“Lower Eyelids Malposition” OR “Complications” OR “Ectropion” OR “Entropion”) AND (Transconjunctival) AND (Subciliary) AND (Maxillofacial Fractures) in PubMed, The Cochrane Library, and Directory of Open Access Journal (DOAJ). This review included full-text studies (observational and randomised controlled trials) in English comparing subciliary and transconjunctival approach in patients with maxillofacial fractures in the last 10 years. The data collected were the type of fractures and approaches, ectropion and entropion incidence as well as follow-up duration. The risk of bias was assessed using Joanna Briggs Institute critical appraisal checklist. Statistical analysis was done using Review Manager 5.3 (Cochrane, Denmark).
RESULT: This study included 3 cohort studies and 2 Randomized Controlled Trial (RCT) studies from 2012 to 2017 with a total of 574 samples. Subciliary approach had a significant higher ectropion incidence when compared to transconjunctival approach (RR = 4.64, 95% CI: 1.68-12.81, p = 0.003). There was also a significant reduction of entropion incidence in patients with subciliary approach compared to transconjunctival approach (RR = 0.16, 95% CI: 0.04 – 0.69, p = 0.01).
CONCLUSION: There was no superiority between one procedure toward another since each procedure related to different lower eyelids malpositions.
Protective Effects of Propolis Extract in a Rat Model of Traumatic Brain Injury via Hsp70 Induction
Authors: Tandean Steven , Japardi Iskandar , Loe Michael Lumintang , Riawan Wibi , July Julius
Published: November 2019

BACKGROUND: Traumatic brain injury (TBI) is one of the major global health problems. Secondary brain injury is a complex inflammation cascades process that causes brain cell apoptosis. Propolis is a natural product that has neuroprotective property.
AIM: This study aimed to investigate the effect of propolis toward Hsp70 expression with apoptosis marker in brain tissue after TBI.
METHODS: Thirty-three Sprague Dawley rats were randomised into three treatments group, i.e. sham-operated controls, closed head injury (CHI), and CHI with propolis extract (treatment group). In the treatment group, propolis was given 200 mg/kg per oral for 7 days then harvested brain tissues after sacrificed by cervical dislocation at day 8. We investigated Hsp70, Caspase 3, apoptosis-inducing factor (AIF), and TUNEL assay expression using immunohistochemistry staining. Statistical test using one-way ANOVA test and Tukey HSD as post hoc test.
RESULTS: Mean of positive Hsp70 stained cells in group 1 was 6.82 ± 2.14, group 2 was 3.91 ± 2.26, and group 3 was 9.64 ± 3.53 with a significant difference of Hsp70 expression distribution within groups (p = 0.0001). Mean of positive caspase 3 stained cells in group 1 was 5.45 ± 2.30, group 2 was 13.82 ± 2.44, and group 3 was 7.03 ± 1.54 with a significant difference of caspase3 expression distribution within groups (p=0.0001). Mean of positive AIF stained cells in group 1 was 5.36 ± 2.11, group 2 was 12.82 ± 1.40, and group 3 was 8.09 ± 1.81 with a significant difference of AIF expression distribution within groups (p = 0.0001). Mean of positive TUNEL assay stained cells in group 1 was 4.82 ± 2.04, group 2 was 11.55 ± 1.51, and group 3 was 7.64 ± 1.96 with a significant difference of TUNEL test expression distribution within groups (p = 0.0001).
CONCLUSION: Propolis may protect brain cell from apoptosis after injury by maintaining Hsp70 expression in addition to antioxidant and anti-inflammatory.
Preparation and Evaluation of Sunscreen Nanoemulsions with Synergistic Efficacy on SPF by Combination of Soybean Oil, Avobenzone, and Octyl Methoxycinnamate
Authors: Arianto Anayanti , Cella Gra , Bangun Hakim
Published: November 2019

BACKGROUND: Soybean oil contains vitamin E and acts as a natural sunscreen which can absorb Ultra Violet (UV) B light and has antioxidant properties to reduce the photooxidative damage that results from UV-induced Reactive Oxygen Species production. The UV blocking from most natural oils is insufficient to obtain a high UV protection. The strategies for preparations of sunscreen products with high SPF can be done by nanoemulsion formulation and Ultra Violet filter combinations of Soybean Oil, Avobenzone and Octyl methoxycinnamate.
AIM: The purpose of this study was to prepare and in vitro efficacy evaluation of sunscreen nanoemulsion containing Soybean oil, Avobenzone and Octyl methoxycinnamate.
METHODS: The sunscreen nanoemulsions were prepared by the high energy emulsification method. The formulation uses a combination of 3% Avobenzone, 7.5% Octyl methoxycinnamate, with different ratio of Soybean oil and Liquid Paraffin. The nanoemulsion was evaluated for droplet sizes by using particle size analyzer, physical stability in room temperature (25 ± 2°C during experiment for 12 weeks of storage, physical stability (cycling test), phase separation by centrifugation at 3750 rpm for 5 hours, pH, viscosity, and Sun Protection Factor (SPF) value by UV spectrophotometric. The SPF value of sunscreen nanoemulsion was compared to sunscreen nanoemulsion without Soybean Oil and sunscreen emulsion. Particle morphology observation of nanoemulsion by using Transmission Electron Microscope.
RESULTS: The sunscreen nanoemulsion formulation containing a combination of 3% Avobenzone, 7.5% Octyl methoxycinnamate with a ratio of 2.73% Soybean Oil and 0.27% Paraffin Oil resulted in the smallest average droplet size of 68.47 nm. The sunscreen nanoemulsion without Soybean Oil had an average droplet size of 384.07 nm. The globules size was increased during the experiment for 12 weeks of storage at room temperature, but there was no phase separation after centrifugation. The formulation of sunscreen emulsion, phase separation was formed after centrifugation. The nanoemulsion had a pH value of 7.23 ± 0.06 and a viscosity value of 133.33 ± 7.22 cP. The sunscreen nanoemulsion containing a combination of 3% Avobenzone, 7.5% Octyl methoxycinnamate 2.73%, Soybean Oil, 2.73% and 0.27% Liquid Paraffin had SPF value (21.57 ± 1.21) higher than sunscreen nanoemulsion without Soybean Oil (16.52 ± 0.98) and sunscreen emulsion (15.10 ± 0.22). The TEM analysis of globules morphology showed that the sunscreen nanoemulsion formed a spherical globule.
CONCLUSION: The sunscreen nanoemulsion containing a combination of 3% Avobenzone, 7.5% Octyl Methoxycinnamate, 2.73% Soybean Oil and 0.27% Liquid Paraffin showed synergistic sunscreen efficacy on SPF. This sunscreen nanoemulsion is more stable than sunscreen emulsion formulation during the experiment for 12 weeks at room temperature.
Clinical Significance of Minimal Residual Disease at the End of Remission Induction Therapy in Childhood Acute Lymphoblastic Leukemia
Authors: Jovanovska Aleksandra , Martinova Kata , Kocheva Svetlana , Trajkova-Antevska Zorica , Coneska-Jovanova Biljana , Panovska-Stavridis Irina , Stankovikj Svetlana , Trajkova Sanja , Dimovski Aleksandar
Published: November 2019

BACKGROUND: Detection of minimal residual disease (MRD) in the early phase of therapy is the most powerful predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL).
AIM: We aimed to determine the significance of MRD at the end of remission induction therapy in the prediction of treatment outcome in children with ALL.
METHODS: Sixty-four consecutive patients aged 1-14 years with newly diagnosed ALL were enrolled in this study from January 2010 to October 2017. All patients were treated according to the ALL IC BFM 2002 protocol. MRD was detected at the end of remission induction therapy (day 33) by multiparameter 6-colour flow cytometry performed on bone marrow specimens with a sensitivity of 0.01%.
RESULTS: Overall, 42.2% of patients had detectable MRD on day 33 of therapy. MRD measurements were not significantly related to presenting characteristics but were associated with a poorer blast clearance on day 8 and 15 of remission induction therapy. Patients with negative MRD status on day 33 had a 5-year event-free survival of 94.6% compared with 76.1% for those with positive MRD status (P = 0.044).
CONCLUSION: MRD levels at the end of remission induction therapy measured by multiparameter flow cytometry have clinical significance in childhood ALL. High levels of MRD are strongly related to poor treatment outcome.
Surgeons Cannot Predict Pilon Fracture Outcomes Based on Initial Radiographs
Authors: Gage Mark J. , Mascarenhas Daniel , Marinos Dimitrius , Maceroli Michael A. , Wise Brent T. , Bhat Suneel B. , Potter G. David , Slobogean Gerard P. , Sciadini Marcus F. , Lebrun Christopher T. , Nascone Jason W. , Manson Theodore T. , O'Hara Nathan N. , O'Toole Robert V.
Published: November 2019

This study sought to determine (1) whether surgeons can accurately predict functional outcomes of operative fixation of pilon fractures based on injury and initial postoperative radiographs, (2) whether the surgeon's level of experience is associated with the ability to successfully predict outcome, and (3) the association between patients' demographic and clinical characteristics and surgeons' prediction scores. A blinded, randomized provider survey was conducted at a level I trauma center. Seven fellowship-trained orthopedic traumatologists and 4 orthopedic trauma fellows who were blinded to outcome reviewed data regarding 95 pilon fractures in random order. Injury ankle radiographs, initial postoperative fixation radiographs, and brief patient histories were assessed. Midterm follow-up functional outcome scores obtained a mean 4.9 years after surgery were available for all patients. Main outcome measures were Pearson correlation coefficient-assessed functional outcomes and surgeon-predicted outcomes. A mixed-effect model determined the association between patients' characteristics and surgeons' prediction scores. Minimal positive correlation was observed between functional outcomes and prediction scores. No difference was noted between the attending and fellow groups in prediction ability. When surgeons' prediction confidence level was greater than 1 SD above the mean confidence level, correlation between functional outcome and prediction improved, although poor correlation was still observed. AO/OTA type 43C fractures, high-energy mechanisms, and older patient age were characteristics associated with lower prediction scores. Surgeons had poor ability to predict functional outcomes of patients with pilon fractures based on injury and initial postoperative radiographs, and level of experience was not associated with ability to predict outcome. [
Orthopedics
. 2020; 43(1): e43–e46.]
Fluctuation in mixed venous oxygen saturation in critically ill medical patients: a pilot study
Authors: Noll ML , Fountain RL , Duncan CA , Weaver L , Osmanski VP , Halfmann S
Published: November 2019

OBJECTIVE: To determine fluctuation in mixed venous oxygen saturation in critically ill medical patients during a period of rest. DESIGN: Nonexperimental, descriptive. SETTING: The medical and coronary intensive care units in a large county hospital in south-central Texas. PATIENTS: Twenty critically ill patients, aged 19 to 85, who had placement of a pulmonary artery catheter capable of continuous monitoring of mixed venous oxygen saturation. The majority had a diagnosis of respiratory failure and required mechanical ventilation. METHODS: Mixed venous oxygen saturation was recorded each minute for a 2-hour period in either early morning or late afternoon hours. Minute-by-minute values obtained during a 30-minute period of rest were used to determine fluctuation. The lowest and highest mixed venous oxygen saturation values during the period were used to calculate percent changes from average values (fluctuation). RESULTS: The range of fluctuation was +/- 6% of the average mixed venous oxygen saturation value for 80% of the sample. Four patients had a greater range of fluctuation: however, their actual mixed venous oxygen saturation values were within a clinically acceptable range. No significant differences in percentage of low or high fluctuation were noted for the following variables: time of day, medication administration, oxygen delivery, oxygen consumption and average mixed venous oxygen saturation. The percentage of low fluctuation was significantly lower for four patients who were not mechanically ventilated. CONCLUSIONS: Knowledge of normal fluctuation enables the care giver to evaluate changes in mixed venous oxygen saturation in response to activities and/or treatments. Additional study of fluctuation in homogenous groups of critically ill patients is warranted.
Family-centered critical care: an option or obligation?
Authors: Marsden C
Published: November 2019

The patient was dying after undergoing aggressive treatment for a malignancy. Patient and family wanted "everything" to be done and the patient was transferred to the ICU for treatment of acute respiratory failure. The next day the patient's condition deteriorated further. The family decided against chest compressions or defibrillation; however, other aggressive treatment was continued. A "chemical code" was initiated and the patient was ventilated. The family was informed. As they stood in the hall outside the unit, the patient's wife asked if she could be with her husband. A nurse explained what she would see and accompanied her to the bedside. She stood at the head of the bed, stroked her husband's head and spoke softly in his ear. The patient's son came to the bedside and said his last words to his father. The wife was present when treatment was stopped and the patient was pronounced dead. She said to the nurse who had accompanied her, "You have given me the greatest gift possible--you allowed me to be with my husband at the end."
Preventing hypoxemia and hemodynamic compromise related to endotracheal suctioning
Authors: Mancinelli-Van Atta J , Beck SL
Published: November 2019

OBJECTIVE: To help the clinician bridge the gap between research and practice in determining ways to minimize side effects of endotracheal suctioning. DATA SOURCES: This article summarizes four previous reviews of research and studies published between 1984 and 1991 related to oxygenation techniques before, during and after endotracheal suctioning, and hemodynamic consequences of the suctioning procedure. STUDY SELECTION: Studies were reviewed by type of subject: animals, human subjects with normal lung function, and human subjects with abnormal lung function. Research of pediatric and head-injured populations was excluded from this review. DATA EXTRACTION: Oxygenation protocol, endotracheal suction characteristics, outcomes and measurement times, sample and setting, and findings were presented. CONCLUSIONS: Conclusions relate to the effectiveness of various endotracheal suction protocols on prevention of hypoxemia and hemodynamic compromise in intubated patients. DATA SYNTHESIS: An algorithm to guide clinical decision making is presented based on the conclusions of this review of the research.
An evaluation of interventions for meeting the information needs of families of critically ill patients
Authors: Henneman EA , McKenzie JB , Dewa CS
Published: November 2019

OBJECTIVE: To evaluate the effectiveness of two methods of meeting the information needs of families of critically ill patients: an open visiting hour policy and a family information booklet. SETTING: Medical intensive care unit of a university medical center. SUBJECTS: Family members (N = 147) of patients admitted to the medical intensive care unit. INTERVENTIONS: Implementation of an open visiting hour policy and information booklet. MEASUREMENTS AND MAIN RESULTS: Questionnaires were distributed to family members 24 to 48 hours after the patient's admission. The questionnaire addressed family satisfaction with having specific information needs met and posed questions that tested their knowledge of unit policies and personnel. The questionnaire was distributed to three groups: families who had restricted visiting hours and no booklet (group 1, n = 48), families who had open visiting hours but no booklet (group 2, n = 50), and families who had open visiting hours and an information booklet (Group 3, n = 49). Implementation of an open visiting hour policy increased family satisfaction. Families exposed to both the open visiting hours and the information booklet were more knowledgeable about specific details than were those exposed to only the open visiting hour policy. CONCLUSIONS: Flexible visiting hours and information booklets were two practical methods of meeting the information needs of families. Open visiting hours, as a singular intervention, significantly improved family satisfaction. The effectiveness of the booklet in assisting families to recall discrete pieces of information supports the further development and use of preprinted materials to assist in meeting family information needs.
Determining AACN's research priorities for the 90s
Authors: Lindquist R , Banasik J , Barnsteiner J , Beecroft PC , Prevost S , Riegel B , Sechrist K , Strzelecki C , Titler M
Published: November 2019

The American Association of Critical-Care Nurses completed a three-phased process of priority identification for critical care nursing research. In phase 1, a 78-item survey was generated following a comprehensive review of potential research topics. In phase 2, approximately 1000 critical care nurses rated each item on the survey for importance to critical care nursing. Based on these results, the AACN Research Committee formulated a clinical and a nonclinical (contextual) list of research topics. Each list contained 25 topics. In phase 3, topics were given final rankings at a 1-day Consensus Conference on Research Priorities. Both Likert-type and magnitude estimation scaling were used to determine priority ranking of items on each list. As a result, both clinical and contextual research priorities were established for AACN.
A preliminary investigation of opinions and behaviors regarding advance directives for medical care
Authors: Elpern EH , Yellen SB , Burton LA
Published: November 2019

BACKGROUND: Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. METHODS: A questionnaire was administered by personal interview to a nonrandomized convenience sample of 46 inpatients and 50 outpatients at a large, tertiary care, urban academic medical center in the summer of 1991. RESULTS: Most respondents (77%) had heard of either the living will or durable power of attorney for healthcare, but only 52% correctly understood the purpose of these documents. Twenty-nine percent of the sample had executed an advance directive. Those who had advance directives were older and considered themselves less healthy than did those without advance directives. Unfamiliarity with advance directives and procrastination were cited most often as reasons for not having an advance directive. Most subjects (65%) had spoken with someone, usually a family member or close friend, about preferences for treatment during a critical illness. Although they had rarely discussed advance directives, 83% anticipated that they would be comfortable doing so with a physician or a nurse. CONCLUSIONS: Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.
PTCA in elderly patients: hospital events
Authors: McGrath MA , Peet GI , Franke JG , Mildenberger RR , Morch JE , Mackenzie GW
Published: November 2019

BACKGROUND: Medical treatment of the elderly is changing to include the aggressive management of coronary artery disease with percutaneous transluminal coronary angioplasty. OBJECTIVE: The purpose of this study was to review major hospital events of patients aged 70 years or more, who underwent a first percutaneous transluminal coronary angioplasty. METHODS: A retrospective medical record review was done of 246 consecutive patients of 70 years or more, from January 1985 to December 1988, at a tertiary care community hospital. Adverse events and the factors that influenced outcome were identified. RESULTS: Of 246 patients (age range, 70-85 years, mean = 73.6), 19 died, 4 had a cerebral vascular accident, 11 had a transfusion and 11 underwent coronary artery bypass grafting. Sixteen patients had acute vessel closure and 8 died. Twenty-five patients had one event and 21 patients had more than one. DISCUSSION: The event rate after percutaneous transluminal coronary angioplasty in the elderly is high. CONCLUSIONS: Knowledge of the factors that influence adverse events (diagnostic category, success of procedure, degree of coronary artery disease and age) will assist the critical care team to plan and implement appropriate care.
The relationship of child acuity, maternal responses, nurse attitudes and contextual factors in the bone marrow transplant unit
Authors: Tomlinson PS , Kirschbaum M , Tomczyk B , Peterson J
Published: November 2019

PURPOSE: This study was designed to examine the relationships between maternal perceptions of an acutely ill child, nurse caregivers and contextual factors in a pediatric critical care unit. METHODS: Subjects were mothers of 20 children who had had their first bone marrow transplant and the primary nurse of each child. The study was conducted on a bone marrow transplant unit. Variables included the acuity of the child, maternal satisfaction with nursing care, maternal vigilance as measured by the time spent at the child's bedside, nurses' attitudes toward family involvement with care, nursing experience and bone marrow transplant unit variables (census, unit acuity and staffing deficit). RESULTS: Positive associations were observed between the child's acuity and maternal satisfaction with nursing care, and between maternal vigilance and staffing deficit. There was an inverse relationship between maternal vigilance and length of nursing experience of the primary nurse and between positive attitudes of nurses toward family participation and years of nursing experience. CONCLUSION: These results show the complex nature of parental perceptions and involvement in the hospitalized child's care. They suggest that maternal attitudes about caregiving are associated with the child's acuity and that maternal vigilance is related to nursing and environmental factors, principally critical care experience of the primary nurse.
ST segment monitoring for coronary artery reocclusion following thrombolytic therapy and coronary angioplasty: identification of optimal bedside monitoring leads
Authors: Drew BJ , Tisdale LA
Published: November 2019

BACKGROUND: Bedside ST segment monitors analyze only one precordial lead and one, two or three limb leads. The precordial lead V1 (or V6 if V1 is not feasible) has been recommended for bedside monitoring because of its value in diagnosing cardiac rhythms with a wide QRS complex. Thus, the remaining lead choices for ST monitoring are limited to the six limb leads. PURPOSE: To determine which of the limb leads in conjunction with V1 or V6 provides the greatest sensitivity for myocardial ischemia, a study was undertaken. METHOD: A total of 30 vessel-unique ischemic episodes were analyzed prospectively using continuous 12-lead electrocardiographic recordings in patients with acute myocardial infarction (n = 2) and patients undergoing coronary angioplasty (n = 25). RESULTS: Ischemic changes were evident in all cases using the full 12-lead electrocardiogram. Right coronary artery-related ischemia was detected in all cases using a single-lead III or aVF. In the group as a whole, the best combinations were: V1 + aVF, V1 + III, V6 + III, and V6 + aVF. Two patients developed sudden coronary artery reocclusion in the cardiac care unit after successful angioplasty. In both, leads identified in the cardiac catheterization laboratory as sensitive for recording ischemia were excellent choices for detection of reocclusion in the cardiac care unit. CONCLUSIONS: 12-lead electrocardiogram recordings during coronary angioplasty balloon inflation provide excellent guidance for postprocedure lead selection decisions. The most valuable limb leads for detecting ischemia due to abrupt artery closure are leads III and aVF, either of which is more sensitive than the routinely monitored lead II. The precordial leads valuable for arrhythmia monitoring, V1 and V6, are seldom sensitive in detecting ischemia in these patients.
The indirect patient care effect of a unit-based clinical nurse specialist on preventable pulmonary complications
Authors: Hanneman SK , Bines AS , Sajtar WS
Published: November 2019

PURPOSE: To examine the indirect effect of a unit-based expert nurse on the incidence of preventable pulmonary complications, which were defined as malpositioned endotracheal tube and inadvertent extubation. DESIGN: A nonequivalent control group/separate samples pretest/posttest design was used to test differences in the incidence of preventable pulmonary complications before and after a 6-month intervention by a unit-based expert nurse in the experimental unit. Retrospective medical record audits were used to collect data on all consecutive admissions to the experimental and control units in March and April of years 1 and 2. RESULTS: Estimated risk ratios demonstrated a significant reduction in preventable pulmonary complications in the experimental unit after the test, even though the acuity was significantly higher in posttest patients. It was concluded that indirect patient care by a unit-based clinical nurse specialist can reduce the incidence of preventable pulmonary complications.
Reviews and summaries of research related to AACN 1980 research priorities: clinical topics
Authors: Riegel B , Banasik JL , Barnsteiner J , Beecroft P , Kern L , Lindquist R , Prevost S , Titler M
Published: November 2019

This article reviews and summarizes the research conducted following publication of the 1980s American Association of Critical-Care Nurses' clinical research priorities. Original research conducted on the clinical priority topics between 1981 and 1991 was included. Review articles, doctoral dissertations, theses and abstracts were excluded unless judged to provide important information on the topic. Following the statement of each priority, progress in the area is summarized. Limitations and measurement issues are discussed as appropriate. Recommendations for future research are provided, and progress in the area is summarized.
Comparison of tidal volumes obtained by one-handed and two-handed ventilation techniques
Authors: McCabe SM , Smeltzer SC
Published: November 2019

OBJECTIVES: To compare tidal volumes delivered by one- vs two-handed compressions of a manual resuscitation bag and assess the effects of subject characteristics on those tidal volumes. DESIGN: Subjects (108 healthcare providers from a 500-bed teaching hospital) were assigned randomly to one of two procedures: one- followed by two-handed compression or two- followed by one-handed compression. A 1-liter resuscitation bag, lung performance analyzer and Wright spirometer were used to measure tidal volume. Data collection occurred in a simulated situation. RESULTS: There was a significant difference in tidal volume delivered by one-handed (mean = 694 mL, SD = 111) vs two-handed compressions (mean = 827 mL, SD = 113). Hand size, grip strength, height and weight were correlated with tidal volumes generated by one-handed and two-handed procedures. No other subject characteristics were correlated with tidal volumes. CONCLUSIONS: Tidal volumes delivered by healthcare providers using one- vs two-handed compressions were found to be significantly different, with those delivered by two hands significantly greater than those delivered by one hand. Strength of hand grip was the best predictor of volume delivered and was more strongly correlated with volumes delivered by one rather than two hands.
Radiofrequency catheter ablation for supraventricular tachycardias: Part I
Authors: Futterman LG , Lemberg L
Published: November 2019

Ablative therapy in the treatment of arrhythmias is an exciting development of the last decade. Although direct-current, high-energy shock can be effective treatment for many supraventricular tachycardias, clinicians are concerned about potential problems associated with its use. Drug therapy for arrhythmias has been inadequate, ineffective, poorly tolerated and fraught with toxic or proarrhythmic reactions. Because of its relative technical ease, high success rate and low complication rate, RFCA remains the therapeutic procedure of choice for patients with atrioventricular nodal reentrant supraventricular tachycardia. Other catheter ablation techniques such as laser, cryocatheter and microwave catheter are still being tested.
Injectate port selection affects accuracy and reproducibility of cardiac output measurements with multiport thermodilution pulmonary artery catheters
Authors: Renner LE , Meyer LT
Published: November 2019

OBJECTIVE: To compare the accuracy and reproducibility of thermodilution cardiac output measurements obtained from the injectate and infusion ports of a multilumen pulmonary artery catheter. The thermodilution results were compared with an independent measure of flow obtained from an electromagnetic flow meter. METHODS: In an experimental study conducted at an animal research laboratory of a health sciences university, two virgin western breed ewes were surgically instrumented with an inferior vena cava occluder, which reduced venous return and thus lowered cardiac output, and an ascending aortic electromagnetic flow probe, which provided an independent reference measure of cardiac output. On the day of study, a multilumen pulmonary artery catheter was inserted. Cardiac output was manipulated over a range of 2.9 to 12.1 L/min with i.v. isoproterenol or inferior vena cava occlusion. Approximately 30 simultaneous thermodilution and electromagnetic flow meter measurements of cardiac output were obtained from both the infusion and injectate ports in each of the two subjects. RESULTS: Correlation coefficients were lower and standard error of the estimates was higher for the infusion port (r = .83; SEE = 1.19 L/min) vs the injectate port (r = .94; SEE = .74 L/min), indicating reduced reproducibility with infusion port thermodilution cardiac output determinations. Accuracy was also adversely influenced in the infusion port results. The linear regression for the infusion port data intercepted the Y axis at +2.64 L/min, indicating significant overestimation of cardiac output at flows of less than 5 L/min and underestimation of flow when cardiac output exceeded 8 L/min. CONCLUSIONS: The use of the infusion port for the measurement of thermodilution cardiac output measurements may result in nonreproducible and inaccurate results.
Longitudinal recovery following sudden cardiac arrest and internal cardioverter defibrillator implantation: survivors and their families
Authors: Dougherty CM
Published: November 2019

OBJECTIVE: To describe psychological reactions, neurological sequelae, and family adjustment following sudden cardiac arrest during the first year of recovery. METHODS: 15 sudden cardiac arrest survivors and 1 member of each family were interviewed and completed questionnaires five times within the first year following sudden cardiac arrest (hospital discharge, 1, 3, 6, and 12 months). Psychological reactions assessed included anxiety, depression, anger, denial, and global stress. Neurological sequelae assessed included confusion and neurocognitive functioning. Family adjustment assessed included marital adjustment and family coping. All sudden cardiac arrest survivors suffered primary ventricular fibrillation outside the hospital and had an internal cardioverter defibrillator implanted during hospitalization. RESULTS: Anxiety, depression, anger, stress, and confusion were highest at hospital discharge and decreased over 1 year, with survivors reporting higher levels than spouses. Denial was high throughout the entire year in survivors. Memory and construction ability were impaired throughout the entire year in survivors. Family coping and dyadic satisfaction were highest at hospital discharge and decreased throughout 1 year. Spouses reported fewer coping strategies and lower dyadic satisfaction than survivors. Family social support was lower than previously established norms at all periods during the first year of recovery. CONCLUSION: To develop intervention programs to aid adjustment, healthcare providers need to take into account psychological reactions, neurological deficits, and family coping of sudden cardiac arrest survivors and their family members.
Sexual harassment of critical care nurses: a costly workplace issue
Authors: Kaye J , Donald CG , Merker S
Published: November 2019

BACKGROUND. Sexual harassment in the workplace is a prevalent form of impermissible sex discrimination in employment. The high profile of this issue in the media, together with laws prohibiting sexual harassment, have not prevented this problem for working nurses. OBJECTIVES. To describe and determine the extent of sexual harassment incidents experienced by nurses working in critical care areas, and to determine attitudes about, and presence of policies regarding, sexual harassment in hospitals. METHODS. For this descriptive study the federal government's definition of sexual harassment and a list of sexually harassing behaviors was mailed with a survey to 188 critical care nurses. RESULTS. Findings indicated that 46% of the respondents had been harassed. Offensive sexual remarks (56%), unwanted physical contact (53%), unwanted nonverbal attention (27%), requests for dates (16%), and sexual propositions (9%) were types of sexual harassment experienced. Sexual assault was experienced by one woman. Harassers were physicians (82%), coworkers (20%), or immediate supervisors (7%). A majority of the incidents (69%) were not reported. Most nurses (80%) had not received training, nor were there policies and procedures to follow in most cases for reporting harassment. CONCLUSIONS. These results suggest that many critical care nurses are harassed and that relatively few hospitals have sexual harassment policies known to employees. They also indicate that sexual harassment training, policies, and procedures are needed to provide a safe, healthy work environment for critical care nurses.
Weaning from short-term mechanical ventilation: a review
Authors: Hanneman SK , Ingersoll GL , Knebel AR , Shekleton ME , Burns SM , Clochesy JM
Published: November 2019

The purposes of this article are to: identify gaps in the research literature on weaning adult patients from short-term mechanical ventilation, highlight the scientific base for practice guidelines, and suggest future research directions. Data bases from 1989 through June 1993 were reviewed, and relevant research articles were extracted, analyzed, and synthesized within the AACN Third National Study Group framework. Seminal work and other supportive literature also were used in this review. Despite considerable research on predictors and patient responses to weaning from short-term mechanical ventilation, few of the findings can be applied to clinical practice at this time. Less research is available on weaning modes and therapies that facilitate weaning from short-term mechanical ventilation; fruitful research in these areas depends in part on a better understanding of patient responses and accurate weaning predictors.
Endotracheal saline and suction catheters: sources of lower airway contamination
Authors: Hagler DA , Traver GA
Published: November 2019

BACKGROUND. Normal saline instillation prior to endotracheal suctioning is a critical care ritual that persists despite a lack of demonstrated benefit. Saline instillation may dislodge viable bacteria from a colonized endotracheal tube into the lower airway, overwhelming the defense mechanism of immunocompromised patients. OBJECTIVE. To determine the extent to which normal saline irrigation and suction catheter insertion dislodge viable bacteria from endotracheal tubes. METHODS. Endotracheal tubes from 10 critical care patients intubated for at least 48 hours were obtained immediately after extubation. Each tube was used in random order for both saline instillation and suction catheter insertion. Dislodged material was cultured for quantitative analysis. RESULTS. Suction catheter insertion dislodged up to 60,000 viable bacterial colonies. A 5-mL saline instillation dislodged up to 310,000 viable bacterial colonies. CONCLUSIONS. The potential for infection caused by dislodging bacteria into the lower airway is additional evidence that routine use of saline during suctioning procedures should be abandoned.
Influence of expectations about symptoms on delay in seeking treatment during myocardial infarction
Authors: Johnson JA , King KB
Published: November 2019

BACKGROUND: Patients having cardiac symptoms often delay for hours before seeking treatment. Educational programs have had little impact on reducing this delay time. OBJECTIVES: To identify symptoms expected by a patient during a myocardial infarction and to examine whether a discrepancy between expectations and experience influenced delay in seeking treatment. METHODS: A retrospective, descriptive design was used. The setting was a large northeastern medical center. The convenience sample included 65 patients (mean age, 57; 74% men) after their first myocardial infarction. Data were collected with the Symptom Representation Questionnaire, a semi-structured interview guide that identified subjects' expectations about heart disease, actual symptom experience, and strategies used to manage the experience. RESULTS: The majority of subjects reported that they had expectations about the symptoms of heart disease that focused on location, intensity, associated symptoms, and quality. Expectations did not match the symptom experience of 74% of subjects. Subjects whose expectations did not match their experience delayed significantly longer before seeking treatment than subjects whose expectations did match their experience. CONCLUSIONS: Our results indicated that patients have expectations about symptoms of heart disease that may influence their behavior during a myocardial infarction.