bluuebunny/crossref_metadata_2025 huggingface dataset:
O papel da mulher no meio pentecostal: novíssimas relações de Gênero nas Assembleias de Deus
Authors: Barduzzi Rodrigues da Costa Otávio , Barduzzi Rodrigues da Costa Otávio
Published: November 2019

A intenção deste artigo é mostrar as mudanças de gênero ocorridas no cenário Pentecostal Tradicional Brasileiro. Houve a preocupação em escrever acerca disso uma vez que os clássicos acerca do tema não mais alcançam as constantes mudanças pelas quais esse grupo religioso passou nos últimos cinco anos. Para ser mais especifico há de se mostrar aqui as mudanças diversas relacionadas aos costumes, teologia, ética e rituais que as Assembleias de Deus e algumas igrejas que se espelham nelas estão passando sobretudo em relação ao gênero que tradicionalmente se pauta por uma relação machista. A metodologia utilizada é a observação participante decorrente anos de pesquisa entre as Assembleias de Deus. Conclui-se que estão ocorrendo varias mudanças no que se refere as relações de gênero, rituais, teologias e costume dentro desse tipo de pertença religiosa. Aqui há de se enfocar as mudanças em relação ao gênero.
The Use of Cold Compression Dressings After Total Knee Replacement: A Randomized Controlled Trial
Authors: Webb J M , Williams D , Ivory J P , Day S , Williamson D M
Published: November 2019

ABSTRACT

This prospective, controlled study compared cold compressive dressings with wool and crepe in the postoperative management of patients undergoing total knee replacement (TKR). Forty TKR patients were assessed for blood loss, pain, swelling, and range of motion. Patients in the cold compression group had less blood loss through suction drainage (982 ml versus 768 ml). A higher proportion of patients in the treatment group did not require blood transfusion postoperatively. Mean opiate requirements were lower in the cold compression group (0.57 versus 0.71 mg/kg/48 hours). The cold compression device appeared to reduce blood loss and pain following TKR.
Nimuendajú, a Senhorita Doutora e os ‘etnógrafos berlineses’: rede de conhecimento e espaços de circulaçâo na configuraçâo da etnologia alemâ na Amazônia no início do século XX
Authors: Sanjad Nelson
Published: November 2019

[pt] O artigo analisa a participação da zoóloga alemã Emília Snethlage (1868-1929), pesquisadora e depois diretora do Museu Goeldi, em Belém, Brasil, na rede de conhecimento que se estabeleceu no início do século XX na região amazônica, destinada à investigação etnológica e à coleta de artefatos indígenas, e que teve, entre seus mais conhecidos atores, os alemães Theodor Koch-Grünberg (1872-1924) e Curt Nimuendajú (1883-1945). Ambos são reconhecidos pelo trabalho em prol dos povos indígenas do Brasil e pelo legado científico nos campos da antropologia, arqueologia e linguística. Menos conhecida, Snethlage teve, entretanto, decisiva participação na inserção de Nimuendajú no meio científico. A partir de uma extensa pesquisa em fontes documentais localizadas no Brasil e na Alemanha, demonstra-se que, no primeiro período em que Nimuendajú esteve vinculado ao Museu Goeldi, entre 1913 e 1921, Snethlage viabilizou suas primeiras expedições e publicações científicas, além de articular suas relações com museus e etnólogos alemães, incluindo aquele que viria a ser seu dileto amigo e interlocutor, Koch-Grünberg, de maneira a lhe permitir trabalhar também como coletor profissional.
Ciencia en el Madrid del “No Pasarán”. La protección de las colecciones de Historia Natural y el Instituto Nacional de Ciencias Naturales durante la Guerra Civil
Authors: Pelayo Francisco
Published: November 2019

Los edificios culturales y científicos de Madrid se vieron muy perjudicados por la guerra civil española (1936-1939). Madrid fue una ciudad asediada y bombardeada por los sublevados. En la capital se encontraban los más importantes museos, la Biblioteca Nacional y las principales instituciones científicas y de humanidades, en donde trabajaban los más relevantes investigadores de la época. A comienzos de la guerra tuvo lugar la incautación de bibliotecas y colecciones de ciencias naturales en palacios y edificios pertenecientes a aristócratas, financieros, personas contrarias a la República y colegios de religiosos. Los naturalistas del Instituto Nacional de Ciencias Naturales organizaron la conservación y protección de las colecciones biológicas, mientras que bombas y obuses impactaban en las instituciones científicas de la zona republicana.
Científicos e intelectuales, una nueva cultura política: José Cuatrecasas y las colecciones de flora tropical
Authors: López Sánchez José María
Published: November 2019

Este trabajo quiere mostrar una faceta del papel desempeñado por el coleccionismo y las colecciones científicas en la formación de los naturalistas durante la Edad de Plata de la ciencia española. El objetivo es evidenciar que la Junta para Ampliación de Estudios, principal institución que impulsó ese proyecto, aspiraba a crear intelectuales con capacidad de participar en la gobernanza del país (una nueva cultura política). La JAE encarnó un proyecto científico racionalista que se oponía a las visiones más conservadoras, defensoras de una ciencia católica, en una lucha que no se restringía a la ciencia, sino que alcanzaba lo social, lo político y lo cultural. Para ello recurrimos a la biografía del botánico José Cuatrecasas partiendo del enfoque de una historia sociocultural de la ciencia y una historia de las ideas.
A Survey
Authors: Baheti Reshma Radheshamjee , Kinariwala Supriya
Published: November 2019

Recently, human stress is rapidly increasing. The school-college students, job professionals, and many people those work under pressure. In last few decades, research is going on how to predict people under pressure or feeling relax with his/her duty. In survey it is evaluated, sentiment analysis will work to find emotions or feelings about their daily life. By analyzing social media network like Facebook, Twitter, and other networking sites where user can share personal feelings like happy, angry, stressed, relaxed, or any other emotion to express human life events or views regarding any topic. On social networking sites, a huge number of informal messages are posted every day, also blogs or discussion forums are also available. Emotions appear to be frequently vital in these texts for expressing friendship, and the presentation of social support as a part of opinions or view. In this article, a survey is done on existing techniques which are working to find sentiment analysis of textual data. In the textual data, the positive and negative sentences have to be found to check the emotions of the user. The survey also finds the natural language processing, the lexical parser, sentiment analysis, the classifier algorithm and some different kinds of Twitter datasets. It is found that 85% work completed on sentiment analysis and categorized the sentences as positive or negative.
An Empirical Evaluation of Assorted Risk Management Models and Frameworks in Software Development
Authors: Aggarwal Alankrita , Dhindsa Kanwalvir Singh , Suri P. K.
Published: November 2019

Software risk management is one the key factors in software project management with the goal to improve quality as avoid vulnerabilities. The term defect refers to an imperfection that may arise because of reasons including programmers' skills, lack of suitable testing strategies, and many others. When actual results are different from expected result or meeting wrong requirement, it is called defect and it forms the basis of risk escalation in a software project which is obviously not accepted in any type of deployment. Making a reliable software should be risk free from any vulnerability. Along with reliability another issue arises is software quality which is a factor with software risk management. The quality of software is to reduce the occurrence of risks and defects with the objective to produce an effectual value software which is key point of consideration. In this article, is underlined the present assorted risk management strategies proposed and projected by a number of researchers and academicians on the different parameters using benchmark datasets from renowned sources of research.
Survival of New Institutional Sociology Theory
Authors: Yassin Mohamed , Ali Salah A.
Published: November 2019

This study explores the extent to which institutional pressures influence the adoption of environmental management accounting (EMA) within the Egyptian manufacturing companies through an institutional perspective that relies on the new institutional sociology theory. The study has conducted interviews with staff members in 18 Egyptian manufacturing companies (organizational level), and with other different actors (organizational-field level), influencing the adoption of EMA in Egyptian companies. The study finds that there is some influence of institutional pressures on EMA's adoption in Egyptian manufacturing companies. The study finds that coercive pressure has more influence on companies to adopt EMA than normative and mimetic pressures. The poor influence of Egyptian accounting professional associations and environmental institutions has weakened the impact of normative pressures. More investigation is needed regarding the political and socio-economic factors surrounding the adoption of EMA in Egyptian context through the multi-levels institutional perspective.
Multi-Objective Optimization Methods for Transportation Network Problems
Authors: Mnif Mouna Gargouri , Bouamama Sadok
Published: November 2019

This article recapitulates literature research solving transportation problems and these variants, notably the multimodal transportation problems variants. Moreover, the existing optimization methods critiqued and synthesized their efficiency to solve the transportation problem. This problem can be identified by various criteria and objectives functions that distinguished according to the case study. Based on the existing literature research, a taxonomy is proposed to distinguish different factors and criteria that perform and influence the multi-objective optimization on the transportation network planning problems. The transportation problems are cited according to these objective functions, and the variant of the problem by referring to the previous studies. In this article, the authors have focused their attention on a recent multi-objective mathematical model to solve the planning network of the multimodal transportation problem.
Gender Sensitivity of Adult Education Activities of Community-Based Organizations in Ghana
Authors: Kutame Louis Caleb , Aryeh-Adjei Abigail
Published: November 2019

Gender and gender-related issues have threatened to disrupt the perceived community developmental outcomes community-based organizations (CBOs) strive to achieve. This is because women are viewed as ‘second class' citizens of most patriarchal African communities. To understand how CBOs are transforming the uniqueness of women in development in Ghana, a field study was conducted with fifty-seven (57) CBO heads and twenty (20) heads of beneficiary groups to investigate the gender sensitivity of Adult Education (AE) activities of CBOs in the Akuapem North District and how these activities help in empowering women in various community activities. The issue of inclusion of women in AE activities by CBOs is generally agreed on in principle in the communities. It was agreed the AE activities empowered women to have self-confidence to take part in development work among others. Recommendations are that CBO policies to ensure gender equity in AE activities should be critically looked at and necessary changes be made to actively involve more women in community development and education work.
Use of Purpose and Role Based Access Control Mechanisms to Protect Data Within RDBMS
Authors: Patil Suraj Krishna , Sagare Sandipkumar Chandrakant , Shelar Alankar Shantaram
Published: November 2019

Privacy is the key factor to handle personal and sensitive data, which in large chunks, is stored by database management systems (DBMS). It provides tools and mechanisms to access and analyze data within it. Privacy preservation converts original data into some unknown form, thus protecting personal and sensitive information. Different access control mechanisms such as discretionary access control, mandatory access control is used in DBMS. However, they hardly consider purpose and role-based access control in DBMS, which incorporates policy specification and enforcement. The role based access control (RBAC) regulates the access to resources based on the roles of individual users. Purpose based access control (PuBAC) regulates the access to resources based on purpose for which data can be accessed. It regulates execution of queries based on purpose. The PuRBAC system uses the policies of both, i.e. PuBAC and RBAC, to enforce within RDBMS.
Capstone Course
Authors: Galeshi Roofia , Choi Jung-ah
Published: November 2019

Capstone courses are uniquely positioned in higher education programs. A capstone course in teacher education programs provides an opportunity for preservice teachers to synthesize their undergraduate learning. A capstone course builds and connects a bridge between college learning and workplace environment to ease preservice teachers' transition into the workplace. In this transition process, faculty helps preservice teachers elicit, reflect, and interpret their own understanding of their content area and relate it to their teaching practices. This article draws upon a series of semi-structured interviews with capstone instructors across the United States. It explores the experiences of faculty, teaching capstone courses and provides rich accounts of how capstone courses serve preservice teachers. It offers an insight into the challenges faculty face while teaching capstone courses. The findings provide an overview of mathematics education capstone instructors' pedagogical approach and their belief about the role capstone courses within teacher education programs.
Levels of Aspiration to Use Digital Tools and Performance in an Educational Technology Course
Authors: Bello Lukuman Kolapo , Hamzat Lateefat Folake
Published: November 2019

This study examined pre-service teachers' level of aspiration to use educational technology experience, and level of aspiration to use digital tools to engage learners in class activities and their performance in an educational technology course. The study adopted the research survey design and was carried out with 261 pre-service teachers. The results revealed that the level of aspiration to use experience from educational technology course and digital tool training was high. The result showed a significant positive relationship of R= 0.03 between pre-service teachers' level of aspiration to use educational technology experience and their performance. Also, there was a positive relationship of R= 0.66 between prospective teachers' level of aspiration to use digital tools and their performance. It was, therefore, recommended that pre-service teachers need to be encouraged with adequate instructional facilities to have positive aspiration to use technology now and in the future.
Clinical comparison of two- and three-wavelength systems for continuous measurement of venous oxygen saturation
Authors: Chulay M , Palmer J , Neblett J , Nancherla AR , Tripodi D , Caden D
Published: November 2019

OBJECTIVE: To evaluate clinically the accuracy of continuous SvO2 systems to reflect reference SvO2 values over a 24-hour period. DESIGN: Randomized clinical trial. SETTING: Six-bed cardiac surgical intensive care unit of a 540-bed federal facility. POPULATION: Sixty postoperative cardiac patients. INTERVENTIONS: Random assignment to a two- or three-wavelength continuous SvO2 catheter for postoperative SvO2 monitoring. At 4-hour intervals over a 24-hour period, mixed venous blood samples were analyzed with a reference cooximeter and compared with the monitor value of the SvO2 catheter. MAIN OUTCOME MEASURES: A reference cooximeter method to measure SvO2 in mixed venous blood; SvO2 as measured by the in-line, SvO2 catheter system. RESULTS: SvO2 measured by the three-wavelength system did not differ significantly from the reference SvO2 measurement. In contrast, SvO2 measured by the two-wavelength system was significantly lower than the reference SvO2 measurement within 4 hours of admission to the critical care unit and remained significantly lower throughout the 24-hour study period. CONCLUSIONS: The results of this clinical study confirmed a previous study in dogs, showing that SvO2 is measured more accurately by the three-wavelength continuous monitoring system.
Coronary rotational ablation: an overview with related nursing interventions
Authors: Deelstra MH
Published: November 2019

The treatment of coronary artery disease has changed significantly over the last decade. It is estimated that more than 300,000 percutaneous transluminal coronary angioplasty procedures were performed in 1990. Despite advances in angioplasty technique and increased immediate success rates, limitations to treatment remain and have prompted a continuing search for a more effective revascularization device. Rotational ablation performed with a high-speed burr covered with diamond microcrystals has been proven safe and effective in treating coronary lesions. At high speeds the burr preferentially ablates plaque. The particles produced during the procedure are smaller than red blood cells and are readily disposed of by the reticuloendothelial system. This article is an overview of the rotational ablation procedure and related nursing care of the patient.
Effects of bathing, passive range-of-motion exercises, and turning on oxygen consumption in healthy men and women
Authors: Verderber A , Gallagher KJ
Published: November 2019

BACKGROUND: Baseline data are needed to provide a foundation for future studies investigating the effects of various nursing interventions on the oxygen requirements of critically ill patients. OBJECTIVES: To establish reference values for the oxygen requirements of adults in response to three common patient events: a nurse-administered bed bath, passive range-of-motion exercises, and turning from side to side; and to determine whether the order in which the interventions were administered had an effect on oxygen consumption. METHODS: A convenience sample of 30 healthy men and women were randomly assigned to one of three treatment groups, for which the order in which interventions were to be administered had previously been designated. Data were analyzed using analysis of variance with repeated measures. RESULTS: There was a significant difference in the mean oxygen consumption among activities, as well as between men and women, with men having a significantly higher mean oxygen consumption than that of the women. For both men and women, the mean oxygen consumption during unassisted turning and back care was significantly higher than at baseline. The oxygen consumption for men averaged 4.25 mL/kg per minute, SD = .71 at baseline, 5.08 mL/kg per minute, SD = .98 for turning, and 4.72 mL/kg per minute, SD = .90 during back care. Women averaged 3.74 mL/kg per minute, SD = .49 at baseline, 4.48 mL/kg per minute, SD = .85 for turning, and 3.89 mL/kg per minute, SD = 1.15 during back care. Changes in oxygen consumption for other interventions were nonsignificant and negligible. Oxygen consumption returned to near baseline within 15 minutes of cessation of activity. The order in which interventions were administered did not have a significant effect on oxygen consumption. CONCLUSIONS: The anterior bath and passive range of motion exercises have minimal effect on oxygen consumption. Turning and back care significantly increase oxygen consumption from the baseline value. The order in which interventions are administered does not have any appreciable effect on oxygen consumption.
Procedures nurses use to remove central venous catheters and complications they observe: a pilot study
Authors: Dumont CP
Published: November 2019

BACKGROUND: Removal of internal jugular and subclavian central venous catheters is a common nursing intervention. Venous air embolism is a serious complication of catheter removal. Although some procedures have been recommended to prevent venous air embolism, whether nurses use these procedures and what complications patients experience are unknown. OBJECTIVES: The purposes of this pilot study were (1) to determine what procedures nurses use to remove internal jugular and subclavian central venous catheters, (2) to find out what complications patients are experiencing, (3) to find out if complications experienced are related to the procedures used, and (4) to develop a questionnaire about central venous catheters. METHODS: A descriptive and correlational design was used. The subjects were 29 nurses whose job description included removal of internal jugular and subclavian central venous catheters. Two questionnaires were used: a demographics questionnaire and the questionnaire about central venous catheters. RESULTS: Descriptive statistics were used to analyze the sample, to determine the percentage of nurses sampled who use the recommended procedures, and to describe the frequency of complications observed. The sample size was not sufficient for observed complications to be correlated with procedures. CONCLUSIONS: None of the nurses sampled had venous air embolism diagnosed in their patients. They reported observing dyspnea, pain, bleeding from the insertion site, and arrhythmias. Many of the nurses reported that they did not always use all the recommended procedures; only 9 nurses (31%) reported always using all the recommended procedures.
Sedating critically ill patients: factors affecting nurses' delivery of sedative therapy
Authors: Weinert CR , Chlan L , Gross C
Published: November 2019

BACKGROUND: Critical care nurses often have wide discretion in managing the sedative therapy of patients receiving mechanical ventilation. Little is known about the factors and processes that influence sedative practice. OBJECTIVES: To determine if nurses' personal beliefs about and attitudes toward critical illness and their goals for sedation influence the nurses' sedative practice, to discover whether social factors influence sedative therapy, and to describe the processes that nurses use to assess patients' need for sedative therapy. METHODS: Audiotapes of focus group interviews with 5 groups of 34 experienced medical and surgical intensive care unit nurses from 2 hospitals were transcribed verbatim. Two investigators independently analyzed the verbatim text, and a sample of the participants validated the category summaries and interpretations. RESULTS: Patients' family members can affect sedative practice directly or indirectly, and demands for efficient delivery of care can influence sedative therapy. Primary indications for sedation included patients' comfort and amnesia and prevention of patients' self-injurious behaviors. Conflicts between physicians and nurses arose when explicit and shared goals for sedation were lacking. Participants noted that numerous factors impede routine use of sedation protocols even though use of the protocols may improve communication and promote uniformity of sedative practice. CONCLUSION: Social, personal, and professional factors influence sedative therapy. Future research should establish the relative importance of these factors and determine whether their impact is attenuated when sedation protocols are implemented.
Comparison of outcome predictions made by physicians, by nurses, and by using the Mortality Prediction Model
Authors: Copeland-Fields L , Griffin T , Jenkins T , Buckley M , Wise LC
Published: November 2019

BACKGROUND: Critical care nurses must collaborate with physicians, patients, and patients' families when making decisions about aggressiveness of care. However, few studies address nurses' ability to predict outcomes. OBJECTIVES: To compare predictions of survival outcomes made by nurses, by physicians, and by using the Mortality Prediction Model. METHODS: Predictions of survival and function and attitudes toward aggressiveness of care based on the predictions were recorded on questionnaires in the emergency department by emergency and intensive care unit physicians and by intensive care unit nurses at the time of admission to the unit between February and September 1995 for 235 consecutive adult nontrauma patients. Scores on the Mortality Prediction Model were calculated on admission. Data on 85 of the 235 patients were analyzed by using descriptive, chi 2, and correlational statistics. Nurses' predictions of function were compared with patients' actual outcomes 6 months after admission. RESULTS: Nurses' predictions of survival were comparable to those of emergency physicians and superior to those obtained by using the objective tool. Years of nursing experience had no relationship to attitudes toward aggressiveness of care. Nurses accurately predicted functional outcomes in 52% of the followed-up cases. Intensive care physicians were more accurate than nurses and emergency physicians in predicting survival. All predictions made by clinicians were superior to those obtained by using the model. CONCLUSIONS: Nurses can predict survival outcomes as accurately as physicians do. Greater sensitivity and specificity are necessary before clinical judgment or predictive tools can be considered as screens for determining aggressiveness of care.
Exposure of Intensive Care Unit Nurses to Nitric Oxide and Nitrogen Dioxide During Therapeutic Use of Inhaled Nitric Oxide in Adults With Acute Respiratory Distress Syndrome
Authors: Qureshi Mohammed A. , Shah Nipurn J. , Hemmen Carol W. , Thill Mary C. , Kruse James A.
Published: November 2019

• Background Although low concentrations of inhaled nitric oxide may by therapeutic, both nitric oxide and its oxidation product nitrogen dioxide are potentially toxic. The threshold limits for time-weighted average concentrations of nitric oxide and nitrogen dioxide issued by the American Conference of Governmental Industrial Hygienists are 25 and 3 ppm, respectively. The concentrations of these gases in the breathing space of hospital personnel during administration of nitric oxide to adult patients have not been reported.

• Methods Air was sampled from the breathing zone of intensive care unit nurses via collar-mounted tubes during the nurses’ routine duties attending patients who were receiving inhaled nitric oxide at 5 or 20 ppm. The exhaust ports of the mechanical ventilators were left open to the room. Nitric oxide and nitrogen dioxide were chemically assayed as nitrite from sorbent tubes by using spectrophotometry. Ambient nitric oxide levels were measured at sequential distances from the ventilator by using chemiluminescence.

• Results The time-weighted average concentrations of inspired gas for nurses during inhaled nitric oxide treatment were 0.45 ppm or less for nitric oxide and less than 0.29 ppm for nitrogen dioxide. Nitric oxide levels at the ventilator during delivery at 20 ppm were 9.2 ppm, but dropped off markedly beyond 0.6 m (2 ft), to a mean of about 30 ppb.

• Conclusion Inhaled nitric oxide therapy at doses up to 20 ppm does not appear to pose a risk of excessive occupational exposure to nitric oxide or nitrogen dioxide to nurses during routine delivery of critical care.
Pain Assessment and Management in the Critically Ill: Wizardry or Science?
Authors: Puntillo Kathleen
Published: November 2019

Assessment and management of patients’ pain across practice settings have recently received the increased attention of providers, patients, patients’ families, and regulatory agencies. Scientific advances in understanding pain mechanisms, multidimensional methods of pain assessment, and analgesic pharmacology have aided in the improvement of pain management practices. However, pain assessment and management for critical care patients, especially those with communication barriers, continue to present challenges to clinicians and researchers. The state of nursing science of pain in critically ill patients, including development and testing of pain assessment methods and clinical trials of pharmacological interventions, is described. Special emphasis is placed on results from the Thunder Project II, a major multisite investigation of procedural pain.
Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use
Authors: Ahrens Tom , Yancey Valerie , Kollef Marin
Published: November 2019

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.

• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.

• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.

• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.

• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.
Risk of Colonization of Central Venous Catheters: Catheters for Total Parenteral Nutrition Vs Other Catheters
Authors: Dimick Justin B. , Swoboda Sandra , Talamini Mark A. , Pelz Robert K. , Hendrix Craig W. , Lipsett Pamela A.
Published: November 2019

• Background Infected central venous catheters cause morbidity and mortality.

• Objective To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes.

• Methods Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Single-lumen catheters used solely for total parenteral nutrition were inserted into the subclavian vein and cared for by a dedicated team. Catheters for other purposes were placed and cared for by other staff. Catheters were cultured if clinical findings suggested infection.

• Results Of 854 central venous catheters, 61 (7%) were used for total parenteral nutrition. During 4712 catheter days of observation, 89 catheters of all types were colonized. Risk factors for colonization included duration of catheterization (P < .001), having 3 or more lumens (hazard ratio, 1.7; 95% CI, 1.1–2.6), pulmonary artery catheterization (hazard ratio, 1.7; 95% CI, 1.1–2.7), and placement in the internal jugular vein (hazard ratio, 1.6; 95% CI, 1.1–2.5). Catheters used for total parenteral nutrition (hazard ratio, 0.14; 95% CI, 0.04–0.57) and those in the subclavian vein (hazard ratio, 0.51; 95% CI, 0.3–0.8) were at lower risk of colonization. In a multivariate Cox model, the only significant factor was a 5-fold lower risk of infection for catheters used for total parenteral nutrition (hazard ratio, 0.19; 95% CI, 0.04–0.83).

• Conclusion Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients’ care.
Evaluation of Chemical Dot Thermometers for Measuring Body Temperature of Orally Intubated Patients
Authors: Potter Patricia , Schallom Marilyn , Davis Susan , Sona Carrie , McSweeney Maryellen
Published: November 2019

• Background Recent research indicates that oral measurement of body temperature is a reliable option in orally intubated patients. In situations such as protective isolation, where dedicated electronic thermometers are not available, are single-use chemical dot thermometers an acceptable alternative?

• Objective To determine the accuracy of single-use chemical dot thermometers in orally intubated adult patients.

• Methods Subjects included a convenience sample of 85 adult patients admitted to 1 of 2 intensive care units (surgical trauma and neuroscience). For each patient, oral temperatures were measured concurrently (within 5 minutes) with a chemical dot thermometer and an electronic thermometer. The sequence of temperature measurements was alternated with each subsequent patient. Both thermometers were placed in the same posterior sublingual pocket opposite the side of the endotracheal tube.

• Results Measurements obtained with electronic and single-use chemical dot thermometers correlated strongly (r = 0.937). With the chemical dot thermometer, body temperature was overestimated in 11.8% of the measurements and underestimated in 10.8% of the measurements by 0.4°C or more. The difference between oral temperatures measured with the 2 different thermometers was not related to the patient’s age, sex, or sublingual pocket location or to the order of thermometer use.

• Conclusion The chemical dot thermometer is useful and reliable for measuring body temperature of orally intubated patients. When measurements of body temperature have important consequences for decisions about treatment, clinicians should use an electronic thermometer to confirm measurements made with a chemical dot thermometer.
Paramedic and Emergency Department Care of Stroke: Baseline Data From a Citywide Performance Improvement Study
Authors: Wojner Anne W. , Morgenstern Lewis , Alexandrov Andrei V. , Rodriguez Diana , Persse David , Grotta James C.
Published: November 2019

• Background Rapid diagnosis and transport by paramedics and efficient, effective emergency management are essential to improving care of acute stroke patients.

• Objectives To measure the performance of paramedics and emergency departments providing care for patients with suspected acute stroke.

• Methods Two stroke centers and 4 other hospitals where most patients with acute stroke in Houston, Tex, are admitted participated. Hospital and paramedic performance data were collected prospectively on 446 patients with suspected acute stroke transported by paramedics between September 1999 and February 2000.

• Results Paramedics had a sensitivity of 66%, specificity of 98%, and overall accuracy of 72% in diagnosing stroke. For patients with suspected stroke, 58.5% arrived in the emergency department within 120 minutes of symptom onset; in confirmed cases, that percentage was 67%. Mean total transport time was 42.2 minutes and was significantly longer (P < .001) to inner-city hospitals (44 minutes) than to suburban, community-based centers (39 minutes). Door to computed tomography times were significantly (P < .001) shorter for the 2 stroke centers than the other hospitals. Overall thrombolysis treatment rate among patients with confirmed ischemic stroke was 7.4% (range, 0–19.4%); treatment rates at the 2 stroke centers were 5.9% and 19.4%.

• Conclusions More than half of patients with suspected stroke arrive at hospitals while thrombolytic treatment is still feasible. Although the current rate for thrombolytic treatment in Houston exceeds the national rate, performance of paramedics and hospitals in treating acute stroke can be improved by increasing efficiency and standardizing medical practices.
Management of Patients in the Intensive Care Unit: Comparison Via Work Sampling Analysis of an Acute Care Nurse Practitioner and Physicians in Training
Authors: Hoffman Leslie A. , Tasota Frederick J. , Scharfenberg Carmella , Zullo Thomas G. , Donahoe Michael P.
Published: November 2019

• Background Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients’ outcomes.

• Objective To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients’ care in a step-down medical intensive care unit.

• Methods Work sampling techniques were used to collect data when the nurse practitioner had 6 months’ or less experience in the role (T1), after the nurse practitioner had 12 months’ experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities.

• Results Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001).

• Conclusion The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients’ families and collaborating with health team members.
Comparison of 3 Methods of Detecting Acute Respiratory Distress Syndrome: Clinical Screening, Chart Review, and Diagnostic Coding
Authors: Howard April E. , Courtney-Shapiro Carrie , Kelso Lynn A. , Goltz Michele , Morris Peter E.
Published: November 2019

• Background Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases.

• Methods For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians’ progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85).

• Results Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician’s notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria.

• Conclusions The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians’ notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.
Nocturnal Care Interactions with Patients in Critical Care Units
Authors: Tamburri Linda M. , DiBrienza Roseann , Zozula Rochelle , Redeker Nancy S.
Published: November 2019

• Background Sleep deprivation is common in critically ill patients and may have long-term effects on health outcomes and patients’ morbidity. Clustering nocturnal care has been recommended to improve patients’ sleep.

• Objectives To (1) examine the frequency, pattern, and types of nocturnal care interactions with patients in 4 critical care units; (2) analyze the relationships among these interactions and patients’ variables (age, sex, acuity) and site of admission to the intensive care unit; and (3) analyze the differences in patterns of nocturnal care activities among the 4 units.

• Methods A randomized retrospective review of the medical records of 50 patients was used to record care activities from 7 PM to 7 AM in 4 critical care units.

• Results Data consisted of interactions during 147 nights. The mean number of care interactions per night was 42.6 (SD 11.3). Interactions were most frequent at midnight and least frequent at 3 AM. Only 9 uninterrupted periods of 2 to 3 hours were available for sleep (6% of 147 nights studied). Frequency of interactions correlated significantly with patients’ acuity scores (r = 0.32, all Ps < .05). A sleep-promoting intervention was documented for only 1 of the 147 nights, and 62% of routine daily baths were provided between 9 PM and 6 AM.

• Conclusions The high frequency of nocturnal care interactions left patients few uninterrupted periods for sleep. Interventions to expand the period around 3 AM when interactions are least common could increase opportunities for sleep.
Pain Levels Experienced With Activities After Cardiac Surgery
Authors: Milgrom Lesley B. , Brooks Jo Ann , Qi Rong , Bunnell Karen , Wuestefeld Susie , Beckman Daniel
Published: November 2019

• Background Acute pain is common after cardiac surgery and can keep patients from participating in activities that prevent postoperative complications. Accurate assessment and understanding of pain are vital for providing satisfactory pain control and optimizing recovery.

• Objectives To describe pain levels for 5 activities expected of patients after cardiac surgery on postoperative days 1 to 6 and changes in pain levels after chest tube removal and extubation.

• Methods Adults who underwent cardiac surgery were asked to rate the pain associated with various types of activities on postoperative days 1 to 6. Pain levels were compared by postoperative day, activity, and type of cardiac surgery. Pain scores before and after chest tube removal and extubation also were analyzed.

• Results Pain scores were higher on earlier postoperative days. The order of overall pain scores among activities (P < .01) from highest to lowest was coughing, moving or turning in bed, getting up, deep breathing or using the incentive spirometer, and resting. Changes in pain reported with coughing (P=.03) and deep breathing or using the incentive spirometer (P = .005) differed significantly over time between surgery groups. After chest tubes were discontinued, patients had lower pain levels at rest (P = .01), with coughing (P=.05), and when getting up (P=.03).

• Conclusions Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain.
Appropriately Timed Analgesics Control Pain Due to Chest Tube Removal
Authors: Puntillo Kathleen , Ley S. Jill
Published: November 2019

• Background Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain.

• Objective To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients.

• Methods Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later. Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time.

• Results Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered.

• Conclusions If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.
Comparison of Cardiac Output Determined by Bioimpedance, Thermodilution, and the Fick Method
Authors: Engoren Milo , Barbee Daniel
Published: November 2019

• Background Cardiac output can be determined by using a variety of methods.

• Objectives To determine the precision and bias between 3 methods for determining cardiac output: bioimpedance, thermodilution, and the Fick method.

• Methods Cardiac output was determined by using bioimpedance via neck and thorax patches and thermodilution via pulmonary artery catheter in 46 patients in the intensive care unit. A subset of 15 patients also had cardiac output determined by using the Fick method.

• Results Mean (SD) cardiac output in all patients was 6.3 (2.2) L/min by thermodilution and 5.6 (2.0) L/min by bioimpedance. In the 15 patients in whom all 3 methods were used, mean cardiac output was 6.0 (1.7) L/min by thermodilution, 5.3 (1.7) L/min by bioimpedance, and 8.6 (4.5) L/min by the Fick method. Bias and precision (mean difference ± 2 SDs) were 0.7 ± 2.9 L/min between thermodilution and bioimpedance, 1.7 ± 3.8 L/min between the Fick method and thermodilution, and 2.4 ± 4.7 L/min between the Fick method and bioimpedance.

• Conclusion Bioimpedance, thermodilution, and Fick determinations of cardiac outputs are not interchangeable in a heterogenous population of critically ill patients.
Effect of a Multidisciplinary Intervention on Communication and Collaboration Among Physicians and Nurses
Authors: Vazirani Sondra , Hays Ron D. , Shapiro Martin F. , Cowan Marie
Published: November 2019

• Background Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients’ satisfaction and quality of care.

• Objective To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit.

• Methods During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually.

• Results Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P < .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P < .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported similar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P < .001).

• Conclusions The multidisciplinary intervention resulted in better communication and collaboration among the participants.