bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior Approach Total Shoulder Arthroplasty: A Retrospective Analysis of Short-term Results
Authors: Greiwe R. Michael , Hill Misti A. , Boyle Maxwell S. , Nolan Joseph
Published: November 2019

Subscapularis dysfunction and failure are the leading causes of complications of total shoulder arthroplasty (TSA). An approach to shoulder arthroplasty has been described that may improve exposure to the retroverted glenoid and spare the rotator cuff. This article details the 6-month clinical outcomes of the first 26 patients who underwent TSA using a posterior approach. Thirty-one patients who underwent TSA using a posterior approach between September 2016 and October 2017 were identified retrospectively. Patients were assessed for American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, range of motion, complications, radiographic outcomes, and patient satisfaction. Statistical models were used to compare the means for each outcome variable over time. Of the initial 31 patients, 26 patients were available for follow-up at a minimum of 6 months; the remaining 5 patients did not return for follow-up at 6 months. Significant improvement in each outcome variable from baseline was noted by 6 weeks postoperatively. Further improvement was observed at 3 months for SST and external rotation, and at 6 months for ASES function and forward flexion. All outcome variables demonstrated some improvement from one time point to the next. Posterior TSA is a safe and efficacious procedure at 6 months. Compared with traditional TSA, posterior cuff-sparing approaches may improve posterior joint access, posterior soft tissue balancing, and long-term rotator cuff issues. [
Orthopedics
. 2020; 43(1):e15–e20.]
Armamento y hombres de armas en la navegación comercial del Cantábrico oriental (1480-1550)
Authors: González Arce José Damián
Published: November 2019

Este trabajo tiene como objetivo analizar cómo fueron armados los barcos mercantes, y su tripulación, que comerciaron entre el Cantábrico oriental y el norte de Europa a finales del siglo XV y primera mitad de XVI. Para explicar de este modo el éxito de estas expediciones, que, cuando fueron organizadas por la Universidad de mercaderes de Burgos, apenas sufrieron asaltos con pérdidas. Para ello se han extraído los datos que aportan los contratos de fletamento conservados para el período, y se han contrastado con lo ocurrido en otras rutas comerciales, como la americana, o en otras regiones, como los Países Bajos. Para llegar a la conclusión de que el mayor armamento y gentes de armas, que por derecho consuetudinario debían llevar los navíos comerciales castellanos para su protección, y la navegación en conserva o en pequeñas flotas conjuntas, no solo les sirvió para sufrir pocos abordajes, sino que fueron el ejemplo a seguir por otros países.
Fundar para defender: fortificación y geoestrategia en Saint-Domingue entre 1665 y 1748
Authors: López Hernández Ignacio J.
Published: November 2019

La colonia de Saint-Domingue se constituyó poco después de su ocupación como la principal posesión francesa en las Antillas bajo la que la Corona se organizó comercial y militarmente en el Caribe. A pesar de ello, hasta no hace mucho, las cuestiones relativas a su defensa han pasado desapercibidas por la historiografía. Este trabajo pretende documentar el proceso de fortificación de la colonia entre 1665 y 1748, a partir del estudio de un importante corpus cartográfico conservado, en su mayoría, en los Archives Nationales d’Outre Mer de Aix-en-Provence. En base a ello, se aspira a definir el plan defensivo implementado por la administración francesa en relación con los factores geoestratégicos que encuadraron este periodo y, más especialmente, la guerra que enfrentó al bloque hispanofrancés con el británico durante la década de 1740.
Lanzas, escopetas, machetes y mazas de dominadores y subalternos en el Tucumán (Jujuy, 1736-1795)
Authors: Normando Cruz Enrique , Soler Lizarazo Luisa Consuelo
Published: November 2019

El artículo identifica las armas utilizadas por españoles, indios y criollos durante el siglo XVIII en el Tucumán (Jujuy). Desde una perspectiva de historia cultural se examinan diversos tipos de documentos para indagar sobre los instrumentos de la microfísica del poder y el contradictorio monopolio de la violencia.
Repenser la frontière
Authors: Aubès Françoise , Olivier Florence
Published: November 2019

Cet article d’introduction rend compte d’une réflexion menée depuis 1991 au fil de quatre numéros de la revue (8, 13, 39, 53). Pensés et écrits avec les outils méthodologiques de l’époque et avant les grands événements qui reconfigureront la géographie mondiale – chute du mur de Berlin, disparition de l’URSS, etc. –, ces premiers numéros abordent la question de la frontière territoriale de manière encore binaire et frontale, la frontière mexicaine restant le paradigme par excellence, tandis qu’au niveau littéraire, sa représentation reste dans la lignée des innovations du boom. En 2010 América. Cahiers du CRICCAL publiait Transamériques. Les échanges culturels et continentaux. On y lisait comment la notion de frontière était devenue une notion plus fluide, synonyme de passage, transnationalisation, décentrement, mouvement diasporique à l’aune de nouvelles réalités et de nouvelles théories : le sujet migrant devenant protagoniste. Le présent numéro aborde ces réflexions dans le contexte de travaux récents sous l’effet d’évolutions de l’Amérique latine.
Histoire et mémoire dans la littérature de frontières
Authors: Calderón Le Joliff Tatiana
Published: November 2019

La frontière constitue un concept aporétique, entre clôture et passage. L’ayant d’abord considérée dans sa relation au territoire et à l’espace historique, social et politique, je m’intéresse plus particulièrement à sa traduction symbolique dans la littérature et aux significations culturelles qu’elle revêt dans diverses aires linguistiques. Cet article synthétise les résultats de deux projets de recherche successifs qui abordent la représentation de la frontière dans la littérature hispano-américaine, sud-africaine et française et son rapport avec l’élaboration du discours historique et des récits de mémoire.
Grupos transfronterizos e identidades étnicas
Authors: Paz Frayre Miguel Ángel
Published: November 2019

La frontera entre México y Estados Unidos es una construcción histórica a la vez que un paradigma sociocultural, si bien es cierto divide a dos estados nación, también brinda la posibilidad para resignificar la idea que los tohono o´otham de Sonora y de Arizona tienen sobre su pasado y los referentes simbólicos que lo constituyen: el concepto de territorio, la importancia de la tradición, las particularidades de la lengua y los fundamentos de su mitología. Al respecto, es posible acudir a las palabras Frontier y Border para identificar aspectos históricos y sociales que aluden a procesos de diferente naturaleza. Así, Frontier nos lleva al conjunto de significados culturales y de mecanismos que se encuentran operando y que marcan una clara diferencia entre el salvaje y el civilizado, se trata de una compleja relación de exclusión que se encuentra anclada a prácticas sociales. Border alude a un ámbito político y geográfico, desde esta perspectiva, concebimos a la frontera como un límite que divide dos naciones con particularidades propias. De este modo, es de vital importancia el hacer un análisis detallado desde la antropología sobre el impacto que esta frontera tiene sobre la vida cotidiana de los o´otham de Sonora para quienes este hecho geopolítico es un claro referente.
New nurses, new spaces: a preview of the AACN History Study
Authors: Lynaugh JE , Fairman J
Published: November 2019

This article previews selected findings of the American Association of Critical-Care Nurses History Project that is being conducted under the auspices of the Center for the Study of the History of Nursing at the University of Pennsylvania. Using methods of social history research, we reviewed pertinent literature, studied documents of institutions and organizations, and interviewed a broad array of participants. Analysis of this evidence resulted in a history of the evolution of nursing and hospital care for patients with life-threatening illnesses during the 40-year period since 1950. We explored the effects of changing public and professional ideas about the nature of critical illness, the effects of technology, and the historical dimensions of critical care nursing. Special attention was given to the events and circumstances that led to the development of AACN and the reciprocal relationships between AACN and the care of critically ill people.
Cardiopulmonary support in the intensive care unit
Authors: Cone M , Hoffman M , Jessen D , Posa P , Dailey C , Rybowiak L
Published: November 2019

The cardiopulmonary support system is an extracorporeal device that allows for rapid cardiopulmonary support of the critically ill patient in the intensive care unit. It provides immediate and complete support of cardiac and pulmonary functions to maintain perfusion to vital organs in patients who are severely physiologically compromised (eg, in cardiogenic shock, adult respiratory distress syndrome or pulmonary edema). Successful cardiopulmonary support requires systemic anticoagulation, percutaneous venous and arterial cannulation and careful monitoring by the critical care team to maintain adequate tissue perfusion and oxygenation. Although patient mortality can occur secondary to bleeding, embolism or sepsis, this technique provides life-sustaining circulatory and respiratory support until definitive treatment can be initiated.
Pheochromocytoma in the pregnant patient: a case study
Authors: DCJr Howard
Published: November 2019

This is a case study of a patient 32 weeks pregnant who presented with multiple endocrine neoplasia type IIa, with severe pheochromocytoma complicated by adult respiratory distress syndrome. The patient's blood pressure was labile, with systolic variations from 50 to 230 mm Hg and tachycardia ranging from 150 to 180 beats per minute. The patient was treated with a variety of alpha- and beta-blockers whose efficacy is compared. Hemodynamic measures are compared with the clinical presentation. The importance of fluid replacement is discussed.
Long-term follow-up of ICU patients
Authors: Friedman BC , Boyce W , Bekes CE
Published: November 2019

Critical care medicine programs must provide outpatient experience for their fellowship trainees. We have developed an unusual follow-up plan allowing critical care fellows to contact their patients months after their intensive care unit stay. We evaluated responses of 46 patients after a mean interval of 8.6 months since their initial intensive care unit stay. Patients were stratified by severity of disease by using the APACHE scoring system. Diagnostically, the patients represented the typical medical-surgical intensive care unit population. Patients were asked 11 questions concerning their health and socio-emotional status as it related to their hospitalization and intensive care unit stay. Our results established a practical method of providing outpatient follow-up that may fulfill residency review requirements for critical care fellowships, confirmed previously speculative ideas about ICU experiences, and suggested future research opportunities to study intensive care unit patients following discharge.
Coronary artery bypass graft surgery in older women and men
Authors: King KB , Clark PC , Norsen LH , GLJr Hicks
Published: November 2019

OBJECTIVE: To compare women and men younger than 70 years of age and 70 years or older undergoing coronary artery bypass surgery. DESIGN: Retrospective chart review, case-control series. SETTING: University medical center. PATIENTS: All women (n = 465) having first-time isolated coronary artery bypass surgery between 1983 and 1988, and 465 men matched for age and year of surgery. Predominantly white; 33% were 70 years or older. MEASURES: Medical record data: demographics, preoperative comorbidities, perioperative and postoperative complications, mortality, length of stay. RESULTS: Preoperatively, women 70 years of age or older had a higher incidence of congestive heart failure, renal disease and hypertension, and a lower incidence of smoking history compared with women less than 70 years old. Men 70 years or older had a higher incidence of congestive heart failure and renal disease, and a lower incidence of smoking history compared with men less than 70 years old. There was no difference in mortality between older and younger women, whereas the mortality rate for older men was higher than that for younger men. There were fewer differences between women younger than 70 and those 70 years or older in incidence of postoperative complications than between men of those same age groups. Among patients 70 years or older, incidence of postoperative congestive heart failure was greater in women than in men. There were no other differences between women and men younger than 70 and those 70 years or older in incidence of postoperative complications. Controlling for the influence of postoperative complications, age was related to length of stay for women and men. CONCLUSIONS: Older women were at no greater risk of mortality or the occurrence of postoperative complications compared with younger women or older men. A functional component influencing recovery and length of hospital stay needs to be considered to provide optimal nursing care after surgery.
Job stress and burnout in acute and nonacute pediatric nurses
Authors: Oehler JM , Davidson MG
Published: November 2019

OBJECTIVE: To identify predictors of burnout in pediatric nurses and to compare the incidence of burnout, job stress, anxiety and perceived social support in acute and nonacute care pediatric nurses. DESIGN: Prospective correlational-descriptive methodology was used to predict high, moderate or low burnout from length of work experience, perceived work stress and social support and anxiety. SUBJECTS AND SETTING: Registered nurses (n = 121) employed full-time in neonatal and pediatric intensive care units and pediatric intermediate care units. MEASUREMENTS AND RESULTS: Measures of job stress, anxiety, experience, social support and burnout were compared in acute and nonacute care pediatric nurses. The overall mean incidence of burnout was in a moderate range for both acute and nonacute care pediatric nurses for the emotional exhaustion and depersonalization subscales and in the high range of personal accomplishment subscales of the Maslach Burnout Inventory. Analysis of variance revealed no differences between groups. However, when nurses were grouped by high, moderate and low burnout scores, chi-square analysis revealed significant differences. More acute care nurses reported high burnout and more nonacute care nurses reported low burnout. Discriminant function analysis revealed that job stress was the strongest significant predictor of burnout, followed by state anxiety, coworker support, trait anxiety and experience on the unit. CONCLUSIONS: Even though high burnout levels are more frequent in acute care pediatric nurses, burnout is a problem in both acute and nonacute care pediatric nurses. The pattern of results suggests that efforts directed toward reducing anxiety and job stress and increasing coworker support, particularly for less experienced nurses, might reduce burnout.
When weaning from mechanical ventilation fails
Authors: Knebel AR
Published: November 2019

OBJECTIVE: To describe the etiologies and indicators of weaning failure and to provide a framework for planning interventions to facilitate weaning of long-term ventilation patients. DATA SOURCE: A Medline search of human studies in English on weaning from mechanical ventilation. ARTICLE SELECTION: Articles were selected if they pertained to the assessment and management of weaning failure. Both research and review articles were included. DATA EXTRACTION: All pertinent articles were described, along with their limitations. DATA SYNTHESIS: Weaning from mechanical ventilation is an emerging science. Caring for patients who are difficult to wean requires expert clinical decision making so patients do not feel defeated and have the best chances for success. Combining the limited research on weaning intervention with clinical expertise helps to build a scientific basis for care and can assist clinicians in tailoring interventions to specific problems that precipitate weaning failure. CONCLUSION: A scientific approach to care may promote weaning in difficult cases and provide directions for future research into the etiologies of weaning failure.
Job satisfaction among critical care nurses
Authors: Stechmiller JK , Yarandi HN
Published: November 2019

OBJECTIVE: To develop a conceptual path model to explain the effects of a set of personal and work-related independent variables and the dependent variables of situational stress, job stress and job motivation on job satisfaction among critical care nurses. DESIGN: A prospective descriptive study using a conceptual path model. SETTING: Nine hospitals licensed for at least 250 beds in the northeastern, northwestern, northcentral, and southern regions of Florida. SAMPLE: Three hundred female critical care nurses employed in the nine hospitals who had worked full-time for at least 3 months. MEASUREMENTS: Subjects were administered a demographic and work survey questionnaire, Daily Hassles Instrument, Psychological Hardiness Test and the Job Diagnostic Inventory. MAIN OUTCOME MEASURES: A conceptual path model was constructed to illustrate the effects of a set of personal and work-related independent variables and the dependent variables of situational stress, job stress and job motivation on job satisfaction. MAIN RESULTS: Path analysis of a job satisfaction model resulted in a causal progression of situational stress leading to either job stress or job motivation, both affecting job satisfaction. The results showed that job stress, job motivation, job expectations, meaningful work, knowledge of work results, commitment to career, health difficulties, task identity, supervision, dealing with others at work, opportunity for advancement, pay and job security had a significant effect on job satisfaction. CONCLUSION: Thirteen variables had a significant effect on job satisfaction and explained 63% of the variance. The four most significant effects on job satisfaction were opportunities for advancement, meaningfulness of work, pay and supervision. Commitment to the career, task identity and job security had a modest effect on job satisfaction.
Effects of a closed tracheal suction system on ventilatory and cardiovascular parameters
Authors: Harshbarger SA , Hoffman LA , Zullo TG , Pinsky MR
Published: November 2019

OBJECTIVE: To determine whether patients ventilated in the assist-control mode experienced a change in oxygenation, respiratory rate, inspiratory:expiratory ratio, heart rate, blood pressure or acid-base balance when suctioned with a closed tracheal suction system. DESIGN: A quasi-experimental, within-subject, repeated-measures design was used. SUBJECTS: 18 patients ventilated on a fraction of inspired oxygen of 0.47 +/- 0.17 and 2.3 +/- 5.0 cm H2O positive end-expiratory pressure. INTERVENTIONS: Two suction passes were performed, with measurements at baseline, immediately after the first suction pass, immediately before the second suction pass, immediately after the second suction pass, 2 minutes after the second suction pass and 5 minutes after the second suction pass. No hyperoxygenation was used. RESULTS: Significant differences were seen over time for arterial oxygen saturation, respiratory rate and inspiratory:expiratory ratio. Arterial oxygen saturation decreased to less than 90% in four subjects (range 88% to 89%), with a maximum fall of 9%. No significant differences were seen for heart rate, blood pressure, partial pressure of carbon dioxide, bicarbonate, time to nadir (lowest arterial oxygen saturation) or recovery time. CONCLUSIONS: Subjects ventilated in the assist-control mode and suctioned with a closed tracheal suction system did not experience significant changes in cardiovascular or acid-base parameters when suctioned without hyperoxygenation. Although most subjects did not become desaturated, four subjects experienced desaturation at one or more intervals. To prevent desaturation, hyperoxygenation should be used before and after suctioning with a closed tracheal suction system.
Accuracy of drawing coagulation samples from heparinized arterial lines
Authors: Templin K , Shively M , Riley J
Published: November 2019

OBJECTIVE: To determine the accuracy of activated partial thromboplastin time and prothrombin time studies when samples are drawn through heparinized arterial lines. METHODS: A total sample of 90 grouped blood samples (from 30 subjects) was used. Patients were all male, with a mean age of 65 and were studied within 24 hours of percutaneous transluminal coronary angioplasty. Each patient had three venous control and arterial line sample sets (a total of 90 blood samples) drawn when routinely ordered for monitoring therapy. For the arterial line sample, a discard volume of the deadspace, deadspace + 2 mL, or deadspace + 4 mL was randomly assigned for each sample. The venous control volumes were the same for all three sample sets. RESULTS: A 2 x 3 repeated measures analysis of variance was used to analyze the results. The independent variables were the source of the sample (venous vs arterial) and the discard volume of arterial blood (deadspace, deadspace + 2 mL, deadspace + 4 mL). The dependent variables were the activated partial thromboplastin time and prothrombin time values. Mean arterial activated partial thromboplastin time values were significantly higher than the corresponding venous values. Mean activated partial thromboplastin time values were not significantly different among the discard volumes of blood drawn. However, there was a significant source by volume interaction. Tukey post-hoc comparisons of venous-arterial activated partial thromboplastin time differences among the three volumes showed significant differences between deadspace volume and deadspace + 2 mL, and deadspace volume and deadspace + 4 mL. There was no significant difference between deadspace + 2 mL and deadspace + 4 mL volumes. CONCLUSION: Results indicated that the minimal amount of discard volume for accurate activated partial thromboplastin time values in this population of percutaneous transluminal coronary angioplasty patients was the catheter deadspace volume plus 2 mL (total 3.6 mL).
Nurses' beliefs and attitudes toward visiting in adult critical care settings
Authors: Kirchhoff KT , Pugh E , Calame RM , Reynolds N
Published: November 2019

OBJECTIVE: To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. DESIGN: Both interviews and questionnaires were used to gather data on nurses' attitudes and beliefs about visiting and open visiting according to the format of Ajzen and Fishbein's Theory of Reasoned Action. SETTING: Five Utah intensive care units and three Ohio intensive care units. SAMPLE: Critical care nurses in Utah (N = 29) and Ohio (N = 41) were interviewed to assess their beliefs about the effects of visiting on patients, families, nurses and nursing care delivery. RESULTS: Nurses believed the consequence of visiting was more positive for the patient from a psychological perspective than from a physiological perspective but that the effects might differ depending on the patient, the visitor and the circumstances. They believed that visiting had negative consequences for families, because they became exhausted, and that visiting was disruptive for nursing care delivery. Their attitudes about effects of visiting on nursing staff were consistently more negative than were attitudes about the effects on the patient and the family. CONCLUSION: To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.
Severe anemia in the Jehovah's Witness: case report and discussion
Authors: Collins SL , Timberlake GA
Published: November 2019

Major blood loss following trauma is common, but severe anemia is generally not life-threatening when managed with the administration of blood and blood products. Severe anemia becomes particularly challenging and potentially lethal when the patient is a Jehovah's Witness, for whom receiving a transfusion is contrary to religious principles. This case report describes the management and hospital course of a Jehovah's Witness who was seriously injured in an airplane crash.
Effects of a bedbath on mixed venous oxygen saturation and heart rate in coronary artery bypass graft patients
Authors: Atkins PJ , Hapshe E , Riegel B
Published: November 2019

OBJECTIVE: To determine the physiologic effects of a bedbath on critically ill patients. METHODS: Thirty hemodynamically stable coronary artery bypass graft patients were studied less than 24 hours after surgery in a repeated measures, quasi-experimental design. Study sites were the medical/surgical and coronary intensive care units of a large community hospital in the south-central United States. Two bedbaths consisting of bathing and turning phases were given to subjects early (mean, 3.6 hours) and late (mean, 18.5 hours) in the immediate postoperative period. Mixed venous oxygen saturation (Svo2) and heart rate were recorded at 1-minute intervals before, during, and for 5 minutes after each bedbath. RESULTS: Mean Svo2 decreased from baseline during the bathing phase of early and late bedbaths 1.6% and 1.9%, respectively, whereas mean heart rate increased from baseline 3.2% and 1%, respectively. During the turning phase, mean Svo2 decreased from baseline 9.2% and 12.1%, respectively, whereas mean heart rate increased from baseline 5.2% and 1.8%, respectively. Svo2 declined to less than 53% in 10 (33%) subjects during both early and late bedbaths. The most severe decreases in Svo2 occurred during early bedbaths and were usually associated with coughing, shivering, and/or agitation. CONCLUSIONS: Early bedbaths caused more dramatic declines in Svo2 than late bedbaths. Coughing, shivering, and agitation accentuated Svo2 declines and could be prevented by waiting to bathe coronary artery bypass graft patients until 1 day postoperatively. Routine bathing, at least in the early postoperative period, should be reconsidered.
A survey of pain assessment and management practices among critical care nurses
Authors: Gujol MC
Published: November 2019

BACKGROUND: Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. PURPOSES: To explore the relationship between two variables in pain assessment (length of time after surgery and ventilator status) and medication decisions made by critical care nurses, and to identify nurses' concerns about opioid use. METHODS: A convenience sample of 71 critical care nurses participated in the survey. RESULTS: Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.
Intensive care at two teaching hospitals: an organizational case study
Authors: Zimmerman JE , Rousseau DM , Duffy J , Devers K , Gillies RR , Wagner DP , Draper EA , Shortell SM , Knaus WA
Published: November 2019

OBJECTIVE: To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival. METHODS: We performed on-site organizational analysis in two ICUs at two major teaching hospitals. Our main outcome measures were interviews and direct observations by a team of clinical and organizational researchers; demographic, clinical, and survival data for 888 ICU admissions; and questionnaire responses from 70 nurses and 42 physicians on ICU structure and organization. ICU performance was measured using risk-adjusted survival and the ratios of actual to predicted ICU length of stay and resource use. RESULTS: Structural and organizational questionnaires, self-evaluation by staff members, and the research team's implicit judgments following detailed on-site analysis failed to distinguish units with higher and lower risk-adjusted survival. Both units exhibited practices to emulate and practices to avoid. CONCLUSIONS: The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.
Latex hypersensitivity: an iatrogenic and occupational risk
Authors: Mendyka BE , Clochesy JM , Workman ML
Published: November 2019

BACKGROUND Immediate hypersensitivity reactions to natural rubber and latex products were first reported in 1979 by Nutter, who identified contact urticaria to latex gloves. Since that time, numerous cases of immediate and delayed reactions to latex have been reported. Because latex products are ubiquitous, especially in the critical care environment, there is increasing risk of hypersensitivity among patients and healthcare workers. METHOD Literature review. OBJECTIVES To review the types of allergic reaction to latex and to inform healthcare providers of the risks to patients and themselves of acquiring latex hypersensitivity. CONCLUSION Immediate hypersensitivity reactions to natural rubber and latex products pose a significant threat to patients, healthcare workers, and the general population. Medical history alone is inadequate to identify all persons at risk. Numerous proteins doubtless exist in latex that may be the link to allergenicity. Further research is needed to address demographic, behavioral, environmental, and biogenetic factors including gender differences, ethnicity and race.
Developing a critical pathway for orientation
Authors: Evers C , Odom S , Latulip-Gardner J , Paul S
Published: November 2019

A direct correlation exists between job satisfaction and employee retention with an organized and compassionate orientation process for new employees on a nursing unit. It is generally recognized that preceptorship/mentoring is the most desirable orientation modality; however, situations occasionally require orientees to work with several preceptors with varying levels of proficiency. A program based upon a framework designated "critical pathway" was established in a coronary care unit and a cardiac progressive care unit to organize orientation information into weekly segments, with each week's content building upon the previous week's information. Because the critical pathway clearly delineates the orientation content, all necessary information is imparted to the orientee in an organized fashion without omitting pertinent details. Problems with orientation are documented as variances on the critical pathway, and are discussed between the preceptor and orientee during weekly evaluation sessions. This article reports the procedure for developing a critical pathway for orientation using the critical pathway concept, which is adapted from the nursing case management practice model.
Critical care nurse practitioners: evolution of the advanced practice nursing role
Authors: Keane A , Richmond T , Kaiser L
Published: November 2019

This literature review was done to explore the use of master's-prepared nurse practitioners to manage critically ill patients. Data-based, anecdotal, clinical, analytic, and position papers published over the past 10 years in the medical and nursing literature were reviewed. This article synthesizes findings on the use of nurse practitioners in clinical settings including primary and specialty care settings, describes favorable outcomes of advanced practice nurses, and identifies factors that must be addressed as these roles increase in use in critical care settings. Nurse practitioners' movement into critical care settings should be undertaken. Additional federal support to ensure the preparation of these practitioners in adequate numbers is needed. Attention to issues of direct reimbursement, salaries, impact of changing role boundaries, malpractice coverage, and prescription privileges must be addressed. Research programs to examine the effect of nurse practitioners in specialized care should continue.
Controlled trial of backrest elevation after coronary angiography
Authors: Coyne C , Baier W , Perra B , Sherer BK
Published: November 2019

BACKGROUND: Protocol at most centers requires keeping the head of the bed flat for at least 5.5 hours after coronary angiography. OBJECTIVE: To determine the effect of head of bed elevation after diagnostic coronary angiography on patient comfort and on the incidence and timing of postprocedural complications. METHODS: A convenience sample of 120 adult patients on the short-stay special procedures nursing unit of a university teaching hospital was used. Patients who had undergone elective diagnostic coronary angiography via the femoral artery were randomly assigned to a control or experimental group. The control group had the head of bed maintained at 15 degrees or less for 5.5 hours after the procedure. The experimental group had the head of bed gradually elevated from 15 degrees to 60 degrees over the 5.5 hours. Both groups dangled and ambulated after 5.5 hours. All other aspects of the procedure were identical. Outcome was measured by incidence and timing of dizziness, hypotension, bleeding, hematoma, and diminished foot pulses. Level of pain was assessed on a scale of 0 to 10. RESULTS: No statistically significant differences were noted between groups in the incidence of complications. The incidence of back pain at a level of more than 3 on a scale of 0 to 10 was less for the experimental group than for the control group. CONCLUSIONS: Elevation of the head of the bed after coronary angiography decreases discomfort with no increase in complications. Replication of this study is needed for verification.
Perceptions of collaborative practice between Navy nurses and physicians in the ICU setting
Authors: King L , Lee JL
Published: November 2019

BACKGROUND: Despite strong evidence for the benefits of collaborative practice between nurses and physicians, this model remains the exception rather than the rule. OBJECTIVES: To examine the extent to which Navy nurses and physicians perceive that collaborative practice exists in the ICU, and to examine the difference in perceived use of collaborative practice by Navy nurses and physicians in the ICU. METHODS: Ninety nurses and 49 physicians working in ICUs at the Navy's four teaching hospitals and aboard the Navy's two hospital ships deployed in Southwest Asia were surveyed using the Collaborative Behavior Scale-Part I and the Collaborative Practice Scales. RESULTS: There was a significant difference between nurses' and physicians' perceptions of collaborative practice behavior. Physicians reported that collaborative practice behavior existed to a greater extent than did nurses in the study. There was no significant difference between nurses' and physicians' perceived use of collaborative practice behavior. CONCLUSIONS: Navy ICU nurses and physicians perceived that they were involved in collaborative practice behavior at a moderate level. Physicians, however, reported perceiving collaborative practice to a greater extent than did nurses. Further research, in different populations, is required to test the theorized constructs of the instruments used to measure perceptions of collaborative practice behavior in this study.
Patients' reactions to angioplasty: realistic or not?
Authors: Gulanick M , Naito A
Published: November 2019

BACKGROUND: A major problem limiting the success of angioplasty is the high restenosis rate. In addition, coronary artery disease is an ongoing process requiring lifestyle changes to prevent disease progression. OBJECTIVE: To examine patient concerns and risk factor modification behaviors during early recovery from angioplasty. Specific attention was directed to: (1) expectation of restenosis, (2) occurrence of angina, (3) achievement of expected benefits, (4) tension/anxiety levels, (5) self-efficacy for and actual performance of needed lifestyle changes. METHODS: For this descriptive study the Self-Report of Recovery (a project-derived questionnaire) and the Profile of Mood States were mailed to 54 patients at 1, 6, and 12 weeks of recovery. The study group comprised 37 men and 17 women (mean age, 57 years) who had undergone first-time successful angioplasty at a midwestern medical center. At 12 weeks 78% remained. RESULTS: A majority of patients did not expect restenosis to occur. At 3 months 83% reported that they were angina-free, 90% reported that they would repeat the procedure if needed, all scores on the tension/anxiety scale were normal, and 86% had achieved some benefits they had expected. Most expressed high confidence in their ability to reduce risk factors, with 90% reporting initiation of at least one lifestyle change. CONCLUSION: We concluded that patients had positive feelings about their angioplasty experience and were not overly concerned about restenosis.
Heart rate variability: prognostic implications
Authors: Futterman LG , Lemberg L
Published: November 2019

HRV offers information about sympathetic and parasympathetic autonomic function and thus can serve as a measure of risk stratification for serious cardiac arrhythmias and sudden cardiac death. HRV appears to be altered in patients with acute myocardial infarction or diabetic neuropathy and is affected by other physiologic and pathophysiologic processes. Use of HRV measurements requires continued investigation to determine optimal methods and tools by which HRV indices and its variables are analyzed. Long-term studies are required to help correct for differences in values pertaining to age and disease process. Also, studies are needed to determine how patient management strategies will be affected by knowledge gained through HRV analysis and to determine which patient populations should be monitored for HRV analysis and to identify those at risk for sudden cardiac death.
Nursing-based protocol for treatment of alcohol withdrawal in the intensive care unit
Authors: Watling SM , Fleming C , Casey P , Yanos J
Published: November 2019

Inappropriate benzodiazepine dosing in patients exhibiting signs of alcohol withdrawal cause staff and patient safety problems. Our primary goal was to develop an alcohol withdrawal protocol based on objective measures, and then to coordinate benzodiazepine dosing with those measures and improve care of the patient withdrawing from alcohol. A secondary goal was to give the primary care nurse the flexibility to administer benzodiazepine doses as needed to improve patient and staff safety. We developed and implemented a modified version of a published withdrawal symptomatology scale; a corresponding scale was developed for benzodiazepine dosing by observing the usual lorazepam doses needed to control withdrawal symptoms. Both scales and care guidelines for the patient withdrawing from alcohol were organized in the form of preprinted orders. Since implementation of the alcohol withdrawal protocol, complaints regarding patient and staff safety have decreased. Other patient care units are beginning to use the protocol. A hospital-wide task force is developing patient care plans based on the protocol for all patients withdrawing from alcohol.
Stressors perceived by cardiac surgical patients in the intensive care unit
Authors: Soehren P
Published: November 2019

BACKGROUND: Few studies have documented stressors experienced by patients recovering from cardiac surgery in the intensive care unit. Furthermore, research has indicated that nurses' predictions of stressors often are not accurate. Stressors frequently experienced by cardiac surgical patients in the intensive care unit must be clearly identified to enable nurses to predict them, plan interventions to minimize them, and help patients cope. OBJECTIVE: To determine what stressors are perceived by cardiac surgical patients while in the intensive care unit. METHODS: A descriptive survey design, employing the Intensive Care Unit Environmental Stressor Scale, was used. Patients completed the instrument while on a telemetry unit after transfer from the cardiac intensive care unit at a large regional hospital in the northwestern United States. A nonprobability convenience sample of 43 postoperative first-time cardiac surgical patients was used. RESULTS: Presence of oral and nasal tubes was rated as the primary stressor. Loss of control and missing one's spouse were the highest-rated psychological stressors. Overall mean scores for stressor items were low. CONCLUSIONS: Our results suggest that interventions reducing stressors enhance the recovery process for cardiac surgical patients.
Psychophysiologic responses of mechanically ventilated patients to music: a pilot study
Authors: Chlan LL
Published: November 2019

BACKGROUND: Although mechanically ventilated patients experience numerous stressors, they have not been included in music therapy stress reduction and relaxation studies. OBJECTIVE: To examine selected psychophysiologic responses of mechanically ventilated patients to music. METHODS: A two-group experimental design with pretest, posttest, and repeated measures was used. Twenty mechanically ventilated patients were randomized to a music-listening group or a nonmusic (headphones only) group. Physiologic dependent measures--heart rate and rhythm, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and airway pressure--were collected at timed intervals. Psychologic data were collected before and after intervention using the Profile of Mood States. RESULTS: Using repeated measures analysis of variance, results for heart rate and respiratory rate over time and over time between groups were significant. Between-group differences were significant for respiratory rate. Significant differences were found via t test for the music group's Profile of Mood States scores. No adverse cardiovascular responses were noted for either group. CONCLUSIONS: Data indicated that music listening decreased heart rate, respiratory rate, and Profile of Mood States scores, indicating relaxation and mood improvement.
Research review: use of activated clotting time to monitor heparin therapy in coronary patients
Authors: Noureddine SN
Published: November 2019

Successful management of patients after coronary angioplasty requires careful monitoring of the coagulation status in order to titrate heparin therapy and prevent thrombosis or bleeding. Traditionally, the activated partial thromboplastin time was used to monitor heparin therapy. Recently, however, use of activated clotting time is gaining more support because it can be performed at the bedside and is cost-effective. This article reviews the research on the use of activated clotting time in titrating heparin therapy in angioplasty patients. Although the literature supports the use of activated clotting time in angioplasty, limitations of the studies and the different methodologies used preclude generalization of results. More research is needed to confirm the efficiency and effectiveness of the activated clotting time in monitoring heparin therapy.
Comparison of three methods of measurement of pulmonary artery catheter readings in critically ill patients
Authors: Johnson MK , Schumann L
Published: November 2019

BACKGROUND: Pulmonary artery catheter readings are critical for clinical decision making and therapeutic intervention in critically ill patients. Research data of digital display versus graphic strip chart recording of hemodynamic pressures during spontaneous breathing and mechanical ventilation are inconclusive. OBJECTIVES: To compare three methods of measurement of hemodynamic pressure readings from the pulmonary artery catheter in critically ill patients during mechanical ventilation and spontaneous breathing. METHODS: A nonrandomized, repeated-measures design was used to compare hemodynamic pressures (right atrial, systolic, diastolic, and wedge pressures) from the pulmonary artery catheter in cardiovascular patients during mechanical ventilation (n = 25) and again during spontaneous breathing (n = 19). RESULTS: Using repeated measures analysis of variance, statistically significant differences were noted in the pulmonary artery diastolic, wedge, and right atrial pressure during mechanical ventilation. During spontaneous breathing, significant differences occurred in pulmonary artery systolic and wedge pressures only. No statistically significant difference occurred in the systolic pressure during mechanical ventilation, or the pulmonary artery diastolic and right atrial pressures during spontaneous breathing. CONCLUSIONS: The results of this study indicate that graphic recording is the most reliable means of measuring hemodynamic pressure at end-expiration. Further research is needed to validate these findings with other models of monitoring equipment and other patient populations.
An additional imaging sign preceding spontaneous fragmentation and embolization of an implanted subclavian vein catheter
Authors: Abulafia O , Sherer DM , Fultz PJ
Published: November 2019

Analysis of chest roentgenograms performed before spontaneous fragmentation and distal embolization of an implanted subclavian vein catheter revealed discontinuity of the catheter's radiopaque marker in addition to kinking of the area proximal to the breakage point. To the authors' knowledge the case presented in this article is the first report of this imaging sign before catheter fragmentation. Lateral catheter placement and early recognition of subtle imaging signs may assist in decreasing the incidence of this significant complication.
Frequency requirements for zeroing transducers in hemodynamic monitoring
Authors: Ahrens T , Penick JC , Tucker MK
Published: November 2019

BACKGROUND: Accurate hemodynamic monitoring information can be obtained only if the transducer/amplifier system is used correctly. One major component of correct use is zeroing the transducer to provide a relative reference point on which to measure hemodynamic pressures. However, nursing requirements for frequency of zeroing are inconsistent. In addition, the concepts of leveling and zeroing are frequently confused. OBJECTIVE: To determine whether transducers drift from zero (+/- 2 mm Hg), and if they do not drift from zero, how long they hold a zero value. METHODS: The study, conducted in four midwestern hospitals, was carried out in two parts: an initial 10-day bench test of 50 transducers and an evaluation of 388 transducers attached to patients for 1 to 5 days. Transducers were monitored over time after being consistently leveled. RESULTS: Bench testing indicated that 100% of transducers did not drift +/- 2 mm Hg from zero during the study period. In the clinical study, only 1.3% of transducers drifted from zero. Five transducers drifted +/- 2 mm Hg from zero, with a range of -5 to 3 mm Hg. CONCLUSIONS: We conclude that transducers used for hemodynamic monitoring require zeroing only on initial setup and disconnection from the amplifier.
Managing agitation in critically ill patients
Authors: Harvey MA
Published: November 2019

Managing agitation in critically ill patients is challenging and complex. Advances in the field of critical care impose strains on patients that can lead to disorientation and agitation, especially as more severe illnesses are treated successfully. Although the adverse effects of agitation are well-known, their impact on morbidity, mortality, length of stay, and cost are only beginning to be addressed. Meeting these challenges requires an understanding of the potential adverse effects of agitation, its causes and contributing factors, the advantages and limitations of available pharmacologic agents, and the role of nonpharmacologic interventions. This article reviews each of these issues, with a focus on clinical applications and strategies.