bluuebunny/crossref_metadata_2025 huggingface dataset:
Attribution of injury to alcohol involvement in young adults seriously injured in alcohol-related motor vehicle crashes
Authors: Sommers MS , Dyehouse JM , Howe SR , Lemmink J , Davis K , McCarthy M , Russell AC
Published: November 2019

BACKGROUND: Approximately 40% of all traffic fatalities are associated with the use of alcohol. Hospitalization for serious injury after a motor vehicle crash related to use of alcohol may be an opportunity to change drinking behaviors in non-alcohol-dependent drinkers, thereby reducing the risk for future disability and death. OBJECTIVES: To determine the degree to which non-alcohol-dependent adults aged 18 to 45 years with alcohol-related vehicular trauma attributed their injury to use of alcohol. METHODS: During hospitalization, 132 subjects involved in alcohol-related motor vehicle crashes were interviewed. The interviews included the question, "To what extent do you believe your alcohol consumption was responsible for this injury?" Responses were measured on a 7-point scale ranging from 1 (not at all) to 7 (totally). RESULTS: In response to the question about attribution of injury to alcohol, 37.8% of subjects responded "not at all," 24.3 responded "somewhat," and 37.9% responded "mostly" or "totally." Spearman rank correlation between attribution of injury to alcohol involvement and blood alcohol content at admission was r = 0.440 (P < .001). CONCLUSIONS: More than 60% of patients injured in alcohol-related motor vehicle crashes attributed their injury partly or totally to use of alcohol. When alcohol-free, hospitalized patients with higher blood levels of alcohol on admission were more likely than those with lower levels to attribute their injury to alcohol. Hospitalization for a motor vehicle crash related to use of alcohol provides an opportunity for interventions to decrease drinking.
Health status, perceptions of coping, and social support immediately after discharge of survivors of acute myocardial infarction
Authors: Daly J , Elliott D , Cameron-Traub E , Salamonson Y , Davidson P , Jackson D , Chin C , Wade V
Published: November 2019

BACKGROUND: The period immediately after discharge from the hospital after an acute myocardial infarction is a stressful and vulnerable time about which little is known. OBJECTIVE: To explore health status, perceptions of coping, and social support among survivors of a recent myocardial infarction in the first 3 weeks after discharge from hospitals in southwestern Sydney, Australia. METHODS: A descriptive, exploratory approach with a triangulated methodology was used to assess the experiences of 38 survivors, detect patterns in these experiences, explore the health-support needs of survivors, and determine changes in health status in the first 3 weeks after discharge. Quantitative data were collected with the Medical Outcomes Study SF-36, New York Heart Association classification, Canadian Cardiovascular Society Angina Scale, and the Jalowiec Coping Scale. A semistructured interview schedule provided additional qualitative data about the experiences of the survivors. RESULTS: The health status of participants was relatively stable during the 3-week period; most had no activity limitation due to dyspnea or angina. However, the subjects' health status was considerably lower than that of their age-matched population. The most common and most effective coping strategies adopted during this period were confrontation, optimism, and self-reliance. In addition, the subjects experienced anxiety, depression, ambiguity and uncertainty, fear of recurrence of the infarction and of deterioration in health, of boredom and of inertia. CONCLUSION: These findings can help nurses in hospital and community settings assist survivors of acute myocardial infarction to prepare for and deal effectively with experiences during convalescence.
Hibernating myocardium, stunning, ischemic preconditioning: clinical relevance
Authors: Futterman LG , Lemberg L
Published: November 2019

Hibernation is a chronic condition that can be due to either chronic low perfusion or repetitive stunning. When oxygen demands increase, prolonged periods of ischemia occur, resulting in multiple episodes of stunning. Because hibernation may play a significant role in refractory failure, the diagnosis of hibernation followed by reperfusion can be life saving. Myocardium that has sustained a transient sublethal injury but has the potential for recovery with time is referred to as stunned myocardium. Myocardial stunning is commonly seen after coronary artery bypass surgery: variable periods of myocardial ischemia are sustained during coronary artery bypass graft surgery, and when these patients return to the intensive care unit, their ventricular function is severely impaired because of the prolonged anoxia during bypass. With the support of artificial assist devices, counterpulsation or temporary use of catecholamines, these patients improve and have a favorable prognosis. Similarly, recovery occurs with time in stunning that follows AMI or cardiac transplantation because in either case the heart had been temporarily anoxic. Clinical observations of ischemic preconditioning include the following: (1) first-effort angina or "warm-up phenomenon," i.e., angina with exercise early, but similar or greater effort the rest of the day does not cause any angina and (2) mortality of AMI is lower in patients with a history of angina preceding AMI. Angina 1 to 2 hours before AMI is the most effective time window for ischemic preconditioning. A less potent "second window" is observed when angina occurs during the second to fourth day before AMI. Adenosine possesses marked cardioprotective properties and has been used to pharmacologically induce ischemic preconditioning with some success. Work is still in progress.
Survey of use of ST-segment monitoring in patients with acute coronary syndromes
Authors: Patton JA , Funk M
Published: November 2019

BACKGROUND: Although effective for assessing ongoing myocardial ischemia, ST-segment monitoring may be underused. OBJECTIVES: To determine the proportion of cardiac units in the United States that use ST-segment monitoring, hospital and unit characteristics associated with its use, how units use such monitoring with respect to research recommendations, if units that use ST-segment monitoring find it clinically useful and easy to use, and why some units are not using this type of monitoring. METHODS: A survey on ST-segment monitoring was mailed to a random sample of 500 cardiac nurse managers and clinical nurse specialists. RESULTS: Of the final 192 respondents, 104 (54.2%) reported that they were using ST-segment monitoring. Monitor brand was the only characteristic associated with use of this monitoring (P = .03). On units that used ST-segment monitoring, patients were monitored if they had myocardial infarction (81%), unstable angina (79.6%), or possible myocardial infarction (78.6%) and after percutaneous transluminal coronary angioplasty (47.6%). Leads were chosen according to unit protocol (60.2%) and 12-lead electrocardiographic findings (48.5%); leads II (95.0%) and V1 (75.2%) were used most often. The majority of units that use ST-segment monitoring agreed that it is clinically useful (83%) and easy to use (56%). Among the units not using ST-segment monitoring, the most common reason was that physicians were not interested (27.1%). CONCLUSIONS: ST-segment monitoring is not routinely used; when it is, research recommendations are often not followed. Increased awareness is needed among cardiac nurses and physicians of the clinical usefulness and proper use of ST-segment monitoring.
Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units
Authors: O'Brien JL , Moser DK , Riegel B , Frazier SK , Garvin BJ , Kim KA
Published: November 2019

BACKGROUND: Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels. OBJECTIVES: To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments. METHODS: In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record. RESULTS: Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05). CONCLUSIONS: Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.
End-of-life care in the intensive care unit: a challenge for nurses
Authors: Miller PA , Forbes S , Boyle DK
Published: November 2019

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.
Nurse-physician collaboration in an intensive care unit
Authors: Miller PA
Published: November 2019

BACKGROUND: Collaborative interaction between nurses and physicians on critical care units is significantly related to mortality rates and length of stay in the units. For this reason, collaborative interaction should be an integral part of quality improvement programs. OBJECTIVES: To examine perspectives of nurses and physicians on collaborative interaction in an intensive care unit, to examine differences between groups in perceptions of collaborative interaction in the unit, and to compare this unit with units examined in a national study. METHODS: A modification of the ICU Nurse-Physician Questionnaire was used to collect data from 35 nurses and 45 physicians. Descriptive statistics and analysis of variance were used to determine group scores and to examine differences between groups. RESULTS: The level of collaborative interaction in the unit was high. However, nurses and physicians and all other staff groups examined except one had significant differences in perceptions of collaborative interaction. The high level of collaborative interaction was confirmed by a comparison of the results with the results from a national sample. CONCLUSIONS: Critical care units can use this example to incorporate an assessment of the level of collaborative interaction into their quality improvement program.
Herbal or complementary medicine: fact or fiction?
Authors: Keller KB , Lemberg L
Published: November 2019

Although herbal medications have been used in medical therapy since the dawn of civilization, they have not undergone careful scientific assessment. Some herbal derivations are exceptional and have become standard therapy in cardiovascular disease; eg, digitalis, reserpine, and aspirin. The high prevalence of herbal use around the world and in the United States today may have a negative impact on patient care when herbal preparations are used in combination with medications ordered by healthcare providers who are not advised of the patient's use of herbs. Healthcare providers need to be familiar with all herbal medications in order to prevent potentially serious reactions between conventional and herbal medications. They should be asking patients about herbal use when first obtaining a medical history. Patients who use alternative therapies do not tell their healthcare providers about such use.
The Vortex: Families’ Experiences With Death in the Intensive Care Unit
Authors: Kirchhoff Karin T. , Walker Lee , Hutton Ann , Spuhler Vicki , Cole Beth Vaughan , Clemmer Terry
Published: November 2019

• Background Lack of communication from healthcare providers contributes to the anxiety and distress reported by patients’ families after a patient’s death in the intensive care unit.

• Objective To obtain a detailed picture of the experiences of family members during the hospitalization and death of a loved one in the intensive care unit.

• Methods A qualitative study with 4 focus groups was used. All eligible family members from 8 intensive care units were contacted by telephone; 8 members agreed to participate.

• Results The experiences of the family members resembled a vortex: a downward spiral of prognoses, difficult decisions, feelings of inadequacy, and eventual loss despite the members’ best efforts, and perhaps no good-byes. Communication, or its lack, was a consistent theme. The participants relied on nurses to keep informed about the patients’ condition and reactions. Although some participants were satisfied with this information, they wished for more detailed explanations of procedures and consequences. Those family members who thought that the best possible outcome had been achieved had had a physician available to them, options for treatment presented and discussed, and family decisions honored.

• Conclusions Uncertainty about the prognosis of the patient, decisions that families make before a terminal condition, what to expect during dying, and the extent of a patient’s suffering pervade families’ end-of-life experiences in the intensive care unit. Families’ information about the patient is often lacking or inadequate. The best antidote for families’ uncertainty is effective communication.
The Effect of a Critical Pathway on Patients’ Outcomes After Carotid Endarterectomy
Authors: Aragon Daleen , Burton Virginia , Byers Jacqueline F. , Cohen Michael
Published: November 2019

• Background In 1996, an integrated plan of care was implemented to improve quality of care for patients undergoing elective carotid endarterectomy. Goals were to reduce length of stay, costs, number of preoperative and intensive care unit admissions, and use of diagnostic procedures yet maintain good outcomes.

• Objectives To determine whether use of the integrated plan of care met the goals.

• Methods Data on financial and process outcomes, use of angiographic diagnostic procedures, and demographics were retrieved from the hospital’s database for all patients who had elective carotid endarterectomy without cerebral infarction.

• Results A total of 783 patients met inclusion criteria: 129 before implementation of the plan of care, 66 during the 6-month transition, and 588 after implementation. Preoperative angiography was done in 32% of patients before implementation, 11% during the transition, and 4% after implementation. Percentages of patients admitted to the intensive care unit were 77% before implementation, 24% during transition, and 9% after implementation. Mean lengths of stay were 2.93 days before implementation, 2.12 days during transition, and 1.68 days after implementation. Costs per case were $7798 before implementation, $5750 during transition, and $5387 after implementation. Analysis of variance revealed significant differences between groups in total length of stay (P=.001), preoperative length of stay (P<.001), and costs (P<.001).

• Conclusion Use of the integrated plan of care reduced length of stay, costs, admissions to intensive care units, and use of cerebral angiography. Use of the plan improved resource utilization while maintaining quality of care.
The Synergy Model and the Role of Clinical Nurse Specialists in a Multihospital System
Authors: Cohen Sharon Saunderson , Crego Nancy , Cuming Richard G. , Smyth Melinda
Published: November 2019

The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses’ responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients’ outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients’ outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.
Cognitive Impairment in Heart Failure: Issues of Measurement and Etiology
Authors: Riegel Barbara , Bennett Jill A. , Davis Andra , Carlson Beverly , Montague John , Robin Howard , Glaser Dale
Published: November 2019

• Background Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment.

• Objectives To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment.

• Methods A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality <269 mOsm/kg), and dehydration (serum osmolality ≥295 mOsm/kg).

• Results Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample.

• Conclusions Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.
Advances in the Understanding of Clinical Manifestations and Therapy of Severe Sepsis: An Update for Critical Care Nurses
Authors: Ely E. Wesley , Kleinpell Ruth M. , Goyette Richert E.
Published: November 2019

Severe sepsis is a major public health concern and a burden on the healthcare system. Despite improvements in efforts to control the source of infection and increased recognition by healthcare providers of patients with the disease, the mortality rate remains unacceptably high, from 30% to 50%. The systemic inflammatory response syndrome criteria are used as diagnostic indicators of sepsis when they occur in patients with known or suspected infection. The outcome of a patient with severe sepsis is often related to the occurrence of sepsis-induced multiple organ dysfunction syndrome. Multiple organ dysfunction syndrome appears to result from a cascade of organism-related factors, inflammatory mediators, endothelial injury, disturbed hemostasis, and microcirculatory abnormalities. In patients with severe sepsis, derangements of inflammation and coagulation are tightly linked. Although numerous clinical trials focused on interventions in one or the other of the inflammatory and coagulation systems failed to show reduced mortality due to sepsis, a member of a new class of drugs called “cogins” was effective. In its active form, protein C has anti-inflammatory, antithrombotic, and profibrinolytic properties that can reduce organ injury associated with severe sepsis. A recombinant form of activated protein C, drotrecogin alfa (activated), significantly reduces 28-day mortality due to all causes in patients with severe sepsis and has an acceptable safety profile. This review provides an overview of severe sepsis, highlighting recent advances in treatment of the disease and the role of critical care nurses.
Do-Not-Resuscitate and Stratification-of-Care Forms in Rhode Island
Authors: DePalo Vera A. , Iacobucci Rhonda , Crausman Robert S.
Published: November 2019

Congress passed the Patient Self-Determination Act of 1990 to ensure that patients are informed of their rights to express healthcare preferences in advance of loss of capacity. Thus, a patient may elect to forgo cardiopulmonary resuscitation in favor of a treatment approach that favors comfort over survival. Do-not-resuscitate and stratification-of-care forms provide a means for expression of healthcare preferences in hospitals. These forms can often guide the important discussion of healthcare preferences. Unfortunately, no clear standard exists for what should be included in do-not-resuscitate or stratification-of-care forms that institutions seeking to improve in this vital area of practice could use for guidance. Existing forms in use at adult general hospitals throughout Rhode Island were reviewed.
Gastric Tonometry and Enteral Nutrition: a Possible Conflict in Critical Care Nursing Practice
Authors: Marshall Andrea P. , West Sandra H.
Published: November 2019

• Background Gastric tonometry is used to assess gastrointestinal mucosal perfusion in critically ill patients. However, enteral feeding is withheld during monitoring with gastric tonometry because enteral feeding is thought to influence tonometric measurements.

• Objectives To examine the effect of enteral feeding on the tonometric measurement of gastric mucosal carbon dioxide.

• Methods Gastric tonometers were placed in 20 critically ill patients, and the Pco2 of the gastric mucosa was measured in both the full and the empty stomach during a 48-hour period.

• Results The Pco2 measured by the tonometer increased after enteral feeding, and a significant difference in the Pco2 of the full versus the empty stomach was evident at 24 and 48 hours. Pco2 at 4, 24, and 48 hours differed significantly in the full stomach and in the empty stomach. However, the data did not reveal a significant difference in either the full stomach or the empty stomach between Pco2 at 24 hours and Pco2 at 48 hours.

• Conclusion After 24 hours of feeding, the initial increase in Pco2 observed at 4 hours was not evident, suggesting stabilization of the intragastric environment. However, a higher Pco2 was evident in the empty stomach, indicating that the presence of the feeding solution may reduce the diffusion of carbon dioxide into the tonometer balloon. Consequently, measurements of intragastric Pco2 obtained after 24 hours of feeding may be reliable if the stomach is emptied by aspiration via the tonometer immediately before measurement.
Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment
Authors: Hamlin Shannan K. , Villars Penelope S. , Kanusky Joseph T. , Shaw Andrew D.
Published: November 2019

Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.
Use of Physical Restraints in Adult Critical Care: A Bicultural Study
Authors: Martin Beth , Mathisen Lars
Published: November 2019

• Background Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices.

• Objectives To describe the relationship between patients’ characteristics, environment, and use of physical restraints in the United States and Norway.

• Methods Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients’ acuity level.

• Results Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample.

• Conclusions Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
Withdrawal of Life-Sustaining Therapy After Sudden, Unexpected Life-Threatening Illness or Injury: Interactions Between Patients’ Families, Healthcare Providers, and the Healthcare System
Authors: Wiegand Debra Lynn-McHale
Published: November 2019

• Background Withdrawal of life-sustaining therapy in intensive care units is increasing. Patients’ families are intimately involved in this process because the patients are usually unable to participate. Little is known about family members’ interactions with healthcare providers and the healthcare system during this process.

• Objective To describe the interactions between patients’ family members, healthcare providers, and the healthcare system during withdrawal of life-sustaining therapy after a sudden, unexpected illness or injury.

• Methods The investigation was part of a larger interpretative phenomenological study. Nineteen families (56 family members) who participated in the process of withdrawal of life-sustaining therapy for a family member were interviewed and observed. An inductive approach to data analysis was used to discover units of meaning, clusters, and categories.

• Results The families’ experiences involved a variety of dimensions, including issues with healthcare providers (bonds and consistency with nurses and physicians, physicians’ presence, information, coordination of care, family meetings, sensitivity to time, and preparation for the dying process) and issues with the healthcare system (parking, struggles with finding privacy, and transfers of patients).

• Conclusions Patients’ families need information, guidance, and support as the families participate in the process of withdrawal of life-sustaining therapy. The results of this study have important implications for clinical practice and future research.
Improving Nurse-Physician Communication and Satisfaction in the Intensive Care Unit With a Daily Goals Worksheet
Authors: Narasimhan Mangala , Eisen Lewis A. , Mahoney Christine D. , Acerra Frank L. , Rosen Mark J.
Published: November 2019

• Objective To evaluate the effect of a standardized worksheet on physicians’ and nurses’ perceptions of their understanding of goals of care and on patients’ length of stay in an intensive care unit.

• MethodsA worksheet was completed daily during multidisciplinary rounds and was posted at each bedside in the medical intensive care unit at Beth Israel Medical Center in New York. Information recorded included tests or procedures, medications, sedation, analgesia, catheters, consultations, nutrition, mobilization, family discussions, consents, and disposition. Attending physicians, residents, and nurses completed a questionnaire before implementation of the worksheet and 3 times afterwards. Responses were scored on a 5-point scale (1 = understand nothing, 5 = completely understand). Continuous variables were analyzed by using a t test; categorical variables, by using a χ2 test.

• ResultsBefore the worksheet was implemented, scores for understanding goals were 3.9 for nurses and 4.6 for physicians. Scores increased to 4.8 for nurses (P = .001) and 4.9 for physicians (P = .03) 6 weeks later, an improvement that remained at 9 months. Both groups showed significant improvement in communication scores that lasted for 9 months. Most responders wanted to continue using the worksheet. During the study, the mean stay in the unit was 4.3 days, down from 6.4 days for the analogous 9-month period in the preceding year (P= .02).

• Conclusion Nurses’ and physicians’ perceptions of their understanding of the goals of care and of communication between them were improved and stays in the unit were shortened when the worksheet was used.
Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation
Authors: Twibell Renee Samples , Siela Debra , Riwitis Cheryl , Wheatley Joe , Riegle Tina , Bousman Denise , Cable Sandra , Caudill Pam , Harrigan Sherry , Hollars Rick , Johnson Doreen , Neal Alexis
Published: November 2019

Background Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.

Objectives To test 2 instruments used to measure nurses’ perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses’ self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.

Methods Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale.

Results Nurses’ perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P < .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P < .001). Data supported initial reliability and construct validity for the 2 scales.

Conclusions Nurses’ perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.
The basics of building a presentation
Authors: Thomassy CS
Published: November 2019

To prepare a presentation, the critical care staff member must be willing to invest time and effort. Time and effort combined with an organized approach to the development process should result in a quality presentation.
To treat or not to treat: the controversy of handicapped newborns
Authors: Carr MW
Published: November 2019

When dealing with the prospects of treating, not treating, or delaying treatment for handicapped newborns, there is no room for error. Since that is an impossible premise, one must make the best possible treatment plan for the newborn. The parents and members of the health care team should be included in the decision making. Those involved must also remember that no decisions are final; if the infant's physical condition changes, the treatment plan may be reevaluated. Any errors must be made by promoting the best interests of the infant in question, by keeping the infant alive longer than necessary rather than providing a premature death. Never, under any circumstances, should an infant be starved, dehydrated, or outright killed; to do so is to violate the rights of the infant. The infant's rights to life without constant pain are also violated by the senseless prolongation of his life and the promotion of wrongful life through the excessive use of modern technology.
DIC: the insidious killer
Authors: Young LM
Published: November 2019

Disseminated intravascular coagulation (DIC) is not a disease but an abnormal syndrome that is always secondary to another process. Because its symptomatology is varied and subtle, frequent assessments of body systems must be conducted. This article and its plan of care are designed to assist the nurse in the effective management of the DIC patient.
Trauma care strategies for changing economic forces
Authors: Flynn MB , Luchsinger J
Published: November 2019

Nurses have expertise in wellness, health promotion, delivery of acute care, and rehabilitation. As the venture into healthcare reform deepens, nurses must take a more proactive role in redirecting the delivery of trauma care in such a way that optimal provision of healthcare services is maintained while costs of providing care are reduced across the continuum of care. Efforts must focus on preventing traumatic injuries, restructuring healthcare delivery systems to meet the needs of patients with traumatic injuries, and reducing healthcare expenditures. Table 3 outlines strategies used by our facility to decrease cost without compromising patients' care. The current era is fraught with rapid changes that necessitate a creative, rational, and organized approach to making decisions about the delivery system for patient-focused care. Nurses are in an optimal position to develop and implement interdisciplinary, creative strategies that will maximize the delivery of trauma care services to the community. Each institution must evaluate the processes involved in its delivery of trauma care services. Strategies to contain costs must focus on processes implemented to achieve optimal outcomes of patients' care. The economic marketplace will evaluate care on the basis of outcome statistics and cost analysis. Thus, nurses must continue to be critical evaluators of nursing practice, always striving for the best healthcare delivery system possible during these turbulent economic times.
Heparin-associated thrombocytopenia: nursing implications
Authors: Jerdee AL
Published: November 2019

Because of the potential severity of the associated complications, nurses have an essential role in the care of patients with HAT. Bedside nurses have the opportunity to report information that may indicate a change in a patient's condition after administration of heparin. This information could lead to diagnosis of heparin sensitivity and prompt treatment to decrease the associated thrombotic complications. Once HAT is diagnosed, a variety of resources are available as the patient's condition evolves. Primary concerns include determining effective strategies to provide appropriate skin care, educating the patient and the patient's family members, and providing effective continuity of care. Continuity of care is essential to maintain the patient's physical and emotional status and should be provided by a multidisciplinary team that includes physical and occupational therapists, skin care specialists, and clinical nurse specialists. Future topics for nursing research on HAT include the education of nurses, patients, and families about HAT; the most effective nursing interventions; and appropriate treatment for ischemic extremities. By knowing how to respond safely and effectively to a patient's sensitivity to heparin, critical care nurses can have a beneficial impact on the patient's care.
LA GLOBALIZZAZIONE DELLA DISEGUAGLIANZA. ASPETTI TEORICI, EMPIRICI E DI POLICY
Authors: Targetti Lenti Renata
Published: November 2019

Since the beginning of the 90’s inequality, once again, become one of the central issues of the economic debate from different perspectives: theoretical, applied and of policy. Not only increased the attention toward the inequality within countries, but also toward the global one, that is the inequality between countries and between citizens of the world as they belong to a single community. The effects of globalization on inequality are still very controversial. According to some authors international integration has produced not only instability and recurring crises, but also a growing inequality within and between countries. For other authors, instead, inequality and poverty decreased with the globalization. This paper will analyze the issue of global inequality mainly from an empirical standpoint. First of all, however, it will be discussed some issues related to the definition of the phenomenon with reference to the theoretical as well to the normative aspects. The empirical analysis will be undertaken by distinguishing the weight of the inequality between countries from that within countries on global inequality. Changes of synthetic indexes will be calculated, but also the differences in income’s distribution in each country will be analyzed. This kind of analysis, innovative with respect to the traditional ones, will allow to observe how the differences in the income’s distribution of industrialized and of developing countries can justify phenomena of the global economy such as, for example, migratory flows.
IL CARTEGGIO TRA GAETANO CATTANEO, FREDERIK MÜNTER E PIETRO TAMBURINI. FRA NUMISMATICA E GIANSENISMO
Authors: Zuliani Federico
Published: November 2019

Cet essai examine la correspondance établie entre Gaetano Cattaneo et le savant danois Frederik Münter, dont douze lettres, datées des années 1815-1825, ont été conservées à la Bibliothèque Royale de Copenhague. Commencé pour des raisons strictement numismatiques, l’échange épistolaire permet toutefois de reconstruire une partie significative des rapports que Münter a entretenus avec l’Italie avant et après son retour dans sa patrie, survenu en 1787 au terme de quatre ans passés entre Naples et Rome. Cette correspondance apporte d’un côté diverses informations permettant de mieux retracer les liens de Münter avec la Lombardie où il résida quelques semaines lors du retour en Danemark, et où il fréquenta les milieux latomistes et se lia d’amitié avec entre autres Luigi Bossi, Gian Rinaldo Carli, Carlo Innocenzo Isimbardi et le comte Wilzeck. D’un autre côté, elle nous renseigne en détail sur la profonde estime unissant Münter aux théologiens jansénistes de l’Université de Pavie, Pietro Tamburini et Giuseppe Zola en premier lieu. Enfin, cet essai illustre comment Münter, proche des conceptions historico-théologiques des prélats jansénistes italiens, s’efforça d’en faire connaître la pensée au public cultivé de l’Europe du Nord.
Relazione
Authors: Bearzot Cinzia , Cordano Federica , Troiani Lucio
Published: November 2019

Non disponibile.
Obstructive sleep apnoea with co existent Kleine-Levine syndrome in a middle-aged man
Authors: Chawla Gopal , Niwas Ram , Dutt Naveen , Swamy Mukesh Kumar
Published: November 2019

Hypersomnia is a symptom which is pathognomonic of patients with Kleine-Levin syndrome (KLS), but the cause of this finding remains undefined. Given the pervasive association between obstructive sleep apnoea (OSA) and excessive daytime sleepiness, there exists the possibility that OSA might contribute to the sleepiness exhibited by these patients. Here we report a middle age man who had excessive daytime sleepiness and diagnosed as OSA after polysomnography. Prescribing of continuous positive airway pressure (CPAP) lead to unmasking of episodes of increased sleepiness and other behavioural features of KLS.
White garment churches (Vapositori) and ZANU-PF party politics in Zimbabwe: True marriage or marriage of convenience during and post-Mugabe era
Authors: Musoni Phillip
Published: November 2019

The white garment churches’ (Vapositori) involvement in party politics, particularly in favour of ZANU-PF, continued to flourish in Zimbabwe even after the demise of Mugabe. Robert Gabriel Mugabe ruled Zimbabwe from 1980 until he was deposed by the Zimbabwean Army on 21 November 2017. Unlike other Christian boards in Zimbabwe, the Vapositori churches played a significant role in authenticating and validating the continuation of ZANU-PF holding onto power from 1980 till the present even after the removal of Mugabe. This article describes the relationship between ZANU-PF and Vapositori analogically as a marriage. This article posited that this marriage between Vapositori and the ruling ZANU-PF political party did not end with Mugabe. President Emmerson Dambudzo Mnangagwa and his vice president, Constantino Kuvheya Chiwenga, are seen masquerading Vapositori by attending and addressing Vapositori church gatherings. Thus, this article interrogates whether the marriage between Vapositori and ZANU-PF was borne out of real love or is just a marriage of convenience. Moreover, if it’s a marriage of convenience then who controls whom and why? These and other related questions require a critical investigation to deepen our understanding of the ‘Church and politics’ in Zimbabwe during and after the Mugabe era.
The Throne of God as a prototype of primacy in the Church and in creation
Authors: Birzu Vasile
Published: November 2019

This study emphasises the cosmic dimensions of the Church understood as the Throne of God, analysing its understanding in this way by the great writers and thinkers of the ancient world, for example, Philo the Alexandrine, Saint Dionysius the Areopagite and Saint Irene of Lyon. The reconstitution of all the cosmological contexts and understanding of the Throne of God inspired by the texts of the ancient authors is opening a very interesting perspective over the existence of the Church as a cosmic Throne of God and reassembling of all the heavenly and intelligible creations sustained and vivified by the primal light of God transmitted in this way towards the lower degrees of the heavenly angelic and churchly hierarchy. Thus, the real source of primacy in the Church is originated, as Saint Dionysius pointed out, in the primal light of God poured over the Church. The Church as the Throne of God helps to discover the real cosmic and heavenly perspective over the heavenly power and authority, the bishops of the Churches are called frankly by God from the beginning (Rv 3:21).
SA Journal of Industrial Psychology: Annual editorial overview 2019
Authors: Coetzee Melinde
Published: November 2019

This article is intended to provide an overview of the publication themes of the 45th edition of the SA Journal of Industrial Psychology (SAJIP) (2019). Guidelines and suggestions for improving future editorial matters are also provided.
A novel technique for stent-assisted coil embolization of intracranial aneurysms: The wireless trans-cell approach
Authors: Ohshima Tomotaka , Kawaguchi Reo , Maejima Ryuya , Matsuo Naoki , Miyachi Shigeru
Published: November 2019

Background: When inserting coils under stent deployment, a jailed microcatheter technique is typically applied as a first line approach. However, the trans cell approach might be required to achieve satisfactory complete occlusion. The trans cell approach occasionally ends in failure because the catheter cannot safely follow a proceeding guidewire into the aneurysm. Here, we report the new wireless trans cell approach (WTA), which allows feasible and safe catheter navigation through the stent strut into the aneurysm, without a proceeding guidewire. Methods: A straight tip microcatheter was used, and the tip was shaped as a very small bend of approximately 45°. The side aspect of the catheter tip exhibited a right angled edge, while the front aspect showed a round curve in the advancing direction. We compared the 45° microcatheter with a straight tip microcatheter using a silicon vascular model and then applied the WTA in a case of an unruptured basilar apex aneurysm. Results: Catheter navigation through the stent strut was smoother with the WTA than the conventional wire assisted approach. Our case of a basilar apex aneurysm was successfully treated with the dual catheter technique, which involved a jailed catheter and navigation using the WTA. After stent deployment from the right posterior cerebral artery to the basilar artery through the 45° microcatheter, the WTA was applied using the same catheter. No stress was detected during catheter navigation through the stent strut into the aneurysm. Conclusions: The WTA is associated with smoother catheter navigation compared with the conventional wire assisted approach in cases of a terminal type aneurysm.