bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of nasogastric tube securing methods and tube types in medical intensive care patients
Authors: Burns SM , Martin M , Robbins V , Friday T , Coffindaffer M , Burns SC , Burns JE
Published: November 2019

BACKGROUND: Nasogastric tube displacement can result in serious complications such as aspiration and inadvertent migration of the tube into the lungs. Replacement of the tubes is costly, time- and effort-intensive, uncomfortable for the patients, and potentially dangerous. OBJECTIVE: To determine the best of three methods for securing nasogastric tubes in a medical intensive care population and to identify variables related to the failure of tube securing methods. METHODS: A convenience sample of 103 patients requiring duodenal or standard gastric tubes for feeding, medication delivery, or decompression were randomly assigned to one of three taping methods: pink tape, clear tape, or "butterfly," for a total of 264 taping episodes. Data collection included the mean time until failure of the securing methods as well as variables such as patient alertness and mobility. RESULTS: The mean time until failure was 100 hours with pink tape versus 56 hours with clear tape and 30 hours with the "butterfly." Differences were significant. Duodenal tubes stayed secured longer than standard sump tubes (mean time until failure was 86 vs 41 hours) for all taping methods, but not significant relationship was demonstrated between mean time until failure and variables such as alertness, sedation, confusion, mobility, and the use of restraints. CONCLUSION: Our results showed that the pink tape method was superior. Nasogastric tube securing methods in adult critical care patients vary in efficacy and should be selected carefully.
Early extubation: preliminary experience in the cardiothoracic patient population
Authors: Gross SB
Published: November 2019

BACKGROUND: Changing trends and economic forces that emphasize reduced length of stay and early discharge have commanded the need for redesign in the perioperative management of cardiovascular surgical patients. In an effort to explore alternative strategies a multidisciplinary group developed an early extubation program. OBJECTIVES: To determine the safety and efficacy of early extubation in terms of patient outcome, satisfaction and psychologic recovery, and cost and resource utilization. METHODS: A prospective analysis was conducted on patients who met eligibility criteria. Data were acquired from the medical record and through patient interviews. RESULTS: Forty-seven patients successfully participated in the early extubation program over a 10-month period; 15% were older than 70 years. The incidence of reintubation, cardiac arrest, or death was zero. The mean postoperative length of stay was 5.8 days. Two thirds of patients completed a one-step transfer model conferring a modest cost reduction and improved resource utilization. Findings also demonstrated reduced weight gain, earlier mobilization, and improved psychologic recovery. CONCLUSIONS: The preliminary findings demonstrate that early extubation is a safe and effective practice in selected cardiovascular surgical patients. Factors such as rising acuity, advanced age, and multisystem disease must be considered. Further research is warranted to validate the continued safety and efficacy of this practice to ensure positive patient outcomes.
Impact of aborted sudden cardiac death on survivors and their spouses: the phenomenon of different reference points
Authors: Doolittle ND , Sauve MJ
Published: November 2019

BACKGROUND: Although anecdotal data suggest that spouses of aborted sudden cardiac death survivors become enmeshed in the physical and emotional recovery of their mates, few longitudinal studies address the personal struggle of aborted sudden cardiac death survivors and their spouses during recovery. OBJECTIVE: To identify and explore phenomena experienced by aborted sudden cardiac death survivors and their spouses, and to determine implications for care. METHODS: This was a phenomenological study; qualitative interviews were conducted within 3 weeks of aborted sudden cardiac death and continued through 24 weeks after arrest at 6- to 8-week intervals. A total of 180 interviews were conducted with 40 survivors and 30 spouses. Interviews were tape-recorded, transcribed, and analyzed for recurrent themes. RESULTS: For the spouses the point of focus, or reference point, for future decision making was the arrest; for the survivors the reference point was prearrest life. These different reference points led to different concerns between spouses and survivors, from which spousal protectiveness and entrapment emerged. CONCLUSIONS: Acknowledgment of different reference points is essential in planning interventions for aborted sudden cardiac death survivors and their spouses. This population must be encouraged to express their questions, concerns, and fears early. Differences in perspectives should be identified to avoid troubled communication and conflicts.
Regression of coronary artery disease: the role of plaque biology
Authors: Valle BK , Valle GA , Lemberg L
Published: November 2019

Research has lead to a better understanding of the pathophysiology and history of atherosclerotic heart disease, which has reached epidemic proportions in industrialized countries in this century. Atherosclerosis should be seen as a chronic, protracted process that encompasses complex and dynamic interactions between cellular, biochemical, and biophysical factors in the microcosmos of the arterial vessel wall and blood circulation. In this context, the ultimate consequences of this disease process, namely coronary artery disease, must be seen as the "tip of the iceberg." The most dramatic manifestation of coronary artery disease, the acute coronary syndrome, usually occurs as the result of different forces and factors, which lead to abrupt plaque disruption, rupture, and vessel thrombosis. In contrast, the genesis of this atherosclerotic lesion is a slow process. Despite considerable experimental clinical evidence accrued during the past decade, atherosclerosis remains a complex pathophysiological process that is not fully understood. It is clear, however, that the interaction between the cellular elements of the vessel wall and the circulation are the determinants of atheroma formation. In this regard, the vascular endothelium appears to play a pivotal role because of its strategic location and metabolic activity. Antilipidemic therapy influences the outcome of coronary disease through a variety of mechanisms, including direct and indirect effects on the endothelium.
Cost containment in critical care
Authors: Hoppe B
Published: November 2019

Increasing emphasis will be placed on the efficient delivery of healthcare. This article concentrates on recommendations for cost containment including increased cost consciousness, elimination of waste, improved quality of care, and use of the team approach to cost containment. The resources over which bedside nurses and managers in critical care have direct or indirect control are the focus of this discussion.
Individual factors that influence sleep after cardiac surgery
Authors: Simpson T , Lee ER
Published: November 2019

BACKGROUND: Up to 50% of patients who undergo cardiac surgery report problems with sleep after cardiac surgery. Knowledge about which individual factors are associated with sleep problems after cardiac surgery would help nurses identify patients who are at greater risk for sleep problems during hospitalization. OBJECTIVE: To compare patients perceptions of sleep before and during hospitalization for cardiac surgery and identify and analyze individual factors in relation to patients perceptions of sleep. METHOD: A sample of 102 patients who underwent elective or emergent cardiac surgery were studied at a 300-bed teaching hospital in the northwestern United States. A few days before their anticipated discharge from the hospital, consenting patients completed questions about their sleep before hospitalization and the night before their interview. RESULTS: Patients reported that they slept fewer hours in the hospital than at home. No differences were found in patients perceived depth and sufficiency of sleep, or refreshment before and after surgery. Patients who slept poorly at home did not report any worse sleep after surgery than patients who slept well at home. Women's perceptions about the sufficiency, refreshment, and quality of sleep were consistent before and after surgery, but no relationships were found among men's ratings. The length of sleep at home was positively related to the length of sleep after surgery in older patients. CONCLUSIONS: Sleep length is related to patients perceptions of sleep after cardiac surgery. Gender and age are also related to qualitative aspects of sleep before and after surgery and can be instrumental in an individualized assessment of sleep patterns anticipated after cardiac surgery.
Smoking: a burden to patient and society
Authors: Keller KB , Lemberg L
Published: November 2019

Smoking prevalence had been steadily decreasing in the United States until 1993 when the rate stabilized. In 1993 there were 46 million adult smokers, which represented 25% of adults aged 18 years and older. Between 1983 and 1993, smoking prevalence among white men declined from 34% to 27% and from 41% to 32% in black men. Smoking prevalence among women declined from 30% to 27%. Currently, smoking prevalence is still higher for men than women, 28% and 23% respectively. More than 70% of adults began their daily habit of smoking by the age of 18 years. The frequency of this habit is highest among Native Americans/Native Alaskans (39%) compared with that of other ethnic groups. It is interesting that smoking prevalence is highest among men who are high-school dropouts (42%). Our role as healthcare providers is clear. We must protect our patients and society from the consequences of smoking. But healthcare professionals must first lead by example. Although the frequency of smokers is decreasing in this segment of society, it was still 18% for RNs and 27% for licensed practical nurses in 1991. Among physicians, the frequency of smokers has decreased from 19% in 1976 to 3% in 1991. With respect to effects on human health and the costs of tobacco use, our direction, responsibility, and duty to our patients and society are very clear.
Facilitating the recovery of open heart surgery patients through quality improvement efforts and CareMAP implementation
Authors: Griffith D , Hampton D , Switzer M , Daniels J
Published: November 2019

OBJECTIVE: To illustrate, using a literature review and CareMAPs, how care coordination and implementation of standard protocols can impact clinical outcomes for open heart surgery patients. METHODS: A CareMAP for open heart surgery patients was developed by a multidisciplinary team. To evaluate the effectiveness of CareMAP implementation and specific quality improvement efforts, a pilot study was done that focused on increasing activity levels, decreasing ventilator time, and decreasing the frequency of arterial blood gas sampling for a sample of 55 open heart surgery patients. A rapid recovery program was developed based on the results of this pilot study. A multidisciplinary continuous quality improvement team was developed to focus on three primary areas: ventilator weaning time, activity regimens, and early transfer to the open heart surgery step-down unit. Forty-nine open heart surgery patients were included in the initial program evaluation. RESULTS: The frequency of arterial blood gas sampling decreased from an average of 5.8 per patient to an average of 3.9 per patient. Postoperative length of stay also decreased by 1.3 days for diagnosis related group 106 patients, and 3.7 days for diagnosis related group 107 patients. Results of the pilot study demonstrated additional opportunities for improving the care of open heart surgery patients. Using the rapid recovery program, the average ventilator time decreased by 4.4 hours per patient. The average postoperative length of stay decreased to 4.7 days. CONCLUSIONS: Through the quality improvement process and through the use of CareMAPs and specific protocols, the recovery of open heart surgery patients was facilitated.
Critical care outcomes: linking structures, processes, and organizational and clinical outcomes
Authors: Mitchell PH , Shannon SE , Cain KC , Hegyvary ST
Published: November 2019

BACKGROUND: Organizational structure and process are thought to affect patient care outcomes beyond the effects of expert clinical care. OBJECTIVES: To test the hypothesis that a discretionary pattern of organizational structure and process factors is predictive of critical care unit performance, ie, desirable patient and organizational outcomes. METHODS: Quality-of-care patient and organizational outcomes were evaluated in 25 critical care units. A single value representing each critical care unit's euclidian distance from a theoretically ideal pattern of discretionary function was determined and correlated with unit-level measures of outcomes (standardized mortality ratio, severity-adjusted length of stay, patient satisfaction, quality of nursing care, and nursing retention). RESULTS: Distance from the ideal-type discretionary pattern predicted organizational but not clinical outcomes. Units closer to the ideal-type pattern had higher RN retention, and were viewed as better places to work, with higher-quality care by both nurses and physicians. Objectively measured quality of care, patient satisfaction, severity-adjusted mortality, and length of stay were not consistently related to better-structured units. CONCLUSIONS: With experienced critical care practitioners, unit-level structure and process factors were better predictors of organizational outcomes than of clinical outcomes.
Typical and atypical clinical signs and symptoms of myocardial infarction and delayed seeking of professional care among blacks
Authors: Lee HO
Published: November 2019

BACKGROUND: Despite the fact that the effectiveness of thrombolytic therapy for acute myocardial infarction is inversely related to the time between the onset of signs and symptoms and definitive therapy, long delays in seeking treatment have been reported consistently. A variety of reasons for the delays have been suggested. Because such delays are associated with longer hospital stays and higher mortality and morbidity, interventions that reduce delays are especially important. PURPOSE: To examine research on patients with myocardial infarction who delay seeking professional treatment and the factors related to the delay, and to review studies indicating that black patients have premonitory clinical signs and symptoms of myocardial infarction and changes in the structure and function of the cardiovascular system that are different from those in whites. METHODS: Studies were reviewed by using MEDLINE and by doing a manual search of relevant research journals in cardiovascular, nursing, and behavioral medicine published since 1970. Data published by the United States Department of Health and Human Services and the Agency for Health Care Policy and Research were also reviewed. RESULTS: Although the lengths of the delays have varied considerably, blacks have generally experienced longer delays than whites between acute onset of signs and symptoms of myocardial infarction and arrival at the emergency department. Studies show that black patients have a lower incidence of classic chest pain or discomfort but an increased incidence of dyspnea, whereas white patients are much more likely to complain of chest pain. CONCLUSION: Culturally sensitive public education about typical and atypical premonitory clinical signs and symptoms of myocardial infarction and the significance of early treatment of myocardial infarction in blacks is needed.
Control of infections caused by drug-resistant organisms in critical care
Authors: Hoppe B
Published: November 2019

The emergence of antibiotic-resistant pathogens has been an ongoing concern of infection-control and infectious disease practitioners. Infections caused by these organisms increase costs and may result in poorer outcomes for patients. Efforts to contain the problem of infections caused by drug-resistant organisms have two objectives: to optimize antibiotic use and to prevent transmission through effective infection-control practices.
Gut dysfunction in critically ill patients: a review of the literature
Authors: Stechmiller JK , Treloar D , Allen N
Published: November 2019

BACKGROUND: Critically ill patients are susceptible to injury of the intestinal mucosa, changes in gut permeability, and failure of intestinal defense mechanisms. These conditions put the patients at risk for infection and multiple organ dysfunction syndrome. Specific therapies are needed to prevent gut failure during critical illness. OBJECTIVE: The purpose of this literature review is to provide a better understanding of the normal defense mechanisms of the gut and alterations associated with ischemia-reperfusion injury, risk of infection, and the link to multiple organ dysfunction syndrome in critically ill patients. Implications for early enteral stimulation and nutrition are included. METHODS: Medical and nursing studies on the intestinal response to critical illness and on the implications for early enteral nutrition in critically ill patients were reviewed. RESULTS: Significant advances have been made in understanding the normal defense mechanisms of the gut, including barrier and immune functions. Translocation of bacteria, mediators of the inflammatory response, and the microcirculation play a role in the response to critical illness. Enteral nutrition that includes glutamine and arginine enhances gut function and improves patients' outcomes in some clinical states. DISCUSSION: Further research should focus on specific strategies to enhance gut function, prevent loss of gut integrity, and improve patients' outcomes. These strategies include maintaining mesenteric blood flow, using gastric tonometry to assess oxygenation, inhibiting inflammatory mediators, and using growth factors to modify the metabolic state in patients who are critically ill.
Amiodarone: a late comer
Authors: Futterman LG , Lemberg L
Published: November 2019

Amiodarone is useful in the treatment of patients with ventricular arrhythmias after acute myocardial infarction and was equally useful when these arrhythmias were associated with CHF. Amiodarone prolongs repolarization and lowers heart rate, actions that are beneficial in treating symptomatic arrhythmias. The absence of proarrhythmic effects distinguishes amiodarone from other antiarrhythmic agents. No excess mortality was seen in any of the amiodarone trials, and in fact, a definite trend toward a decrease in the number of sudden deaths was noted. For many years, amiodarone has been the antiarrhythmic drug of choice in Europe. Only in recent years has this drug gained respectability in the United States. Amiodarone is truly a late comer to our shores.
Health practices of critical care nurses: are these nurses good role models for patients?
Authors: Connolly MA , Gulanick M , Keough V , Holm K
Published: November 2019

BACKGROUND: Few studies have explored the health practices of critical care nurses. Critical care nurses routinely teach patients about using healthy practices such as low-fat diets, exercise, and routine screening examinations. However, it may be even more important that the nurses themselves have a healthy lifestyle, thus serving as role models for patients. Nurses are selling a product, and that product is health. The best salespersons are those who are genuinely committed to their product and model its benefits. Therefore, critical care nurses' healthful practices can have a profound effect on their patients. OBJECTIVES: The purpose of this descriptive exploratory study was to examine critical care nurses' responses to three questions about health practices in their daily lives: (1) What are critical care nurses doing currently to stay healthy? (2) Do they anticipate making any changes in their lifestyle in the future? (3) Would they recommend their lifestyle to their patients? METHODS: One hundred twenty-seven critical care nurses attending a midwestern critical care conference completed a two-part questionnaire designed to produce a health profile. In a man-on-the-street approach, 23 nurses participated in an interview via video camera. Descriptive statistics were used to analyze the data retrieved from the questionnaires. Interviews were transcribed verbatim and analyzed for themes with a constant comparative method. RESULTS: More than 70% of the critical care nurses who responded engage in exercise and follow a healthy, low-fat diet. Seventy-one percent said that they anticipate making a change in their lifestyle in the future, and 70% said that they would recommend their lifestyle to their patients. Five themes emerged from the videotaped interviews: (1) Heart-healthy practices predominated the responses. (2) Incorporating a healthy lifestyle was easy for some and a struggle for others. (3) Critical care nurses readily listed barriers to healthy living. (4) The nurses had a positive attitude about their healthy lifestyles and felt optimistic about being role models for their patients. (5) Future plans were either singular in focus or limited to maintenance of current health habits. CONCLUSIONS: The majority of the nurses reported practicing a healthy lifestyle and thought that they were good role models for patients.
SGOT, LDH, HBD, CPK, CK-MB, MB1MB2, cTnT, cTnC, cTnI
Authors: Futterman LG , Lemberg L
Published: November 2019

The troponin assay is the "new kid on the block." cTnI is currently the most sensitive, specific marker for cardiac damage and will replace the other less specific cardiac markers. This is a result of continued search for measures that provide the earliest diagnosis, which in turn ensures the greatest positive influence on morbidity and mortality in acute MI. Is the cTnI assay the ultimate marker for cardiac injury? It is doubtful. Only time will tell.
Lung volume reduction: surgical treatment for emphysema
Authors: Newsome EA , Ott BB
Published: November 2019

BACKGROUND: Lung volume reduction surgery is currently being investigated as a method of improving the respiratory function of patients with end-stage emphysema. PURPOSE: This article reviews the current literature on lung volume reduction surgery and proposes a multidisciplinary team approach to postoperative management. METHODS: We did a MEDLINE search and retrieved relevant articles. We selected and reviewed nine medical articles published in 1993, 1995, and 1996; one medical article from 1959; and one of four nursing articles. Overall, the articles describe the different techniques of median sternotomy and video-assisted thoracoscopic surgery and unilateral versus bilateral procedures. CONCLUSION: Lung volume reduction surgery is beneficial, but further investigation is required.
Nausea and vomiting in patients undergoing radiofrequency catheter ablation
Authors: Tyndall A , Nystrom KV , Funk M
Published: November 2019

BACKGROUND: Radiofrequency catheter ablation is a technique for curing cardiac arrhythmias by destroying tissue that is a critical part of the targeted electrical circuit. Nausea and vomiting have been observed after use of this technique, but no study to date has examined these complications. OBJECTIVES: To determine the incidence of nausea and vomiting after radiofrequency catheter ablation, determine factors related to nausea and vomiting, and evaluate the antiemetic efficacy of promethazine given during the procedure. METHODS: Medical records for 369 cases of radiofrequency catheter ablation performed in a 4-year period at a university medical center were reviewed. RESULTS: Nausea after the procedure was documented in 22% of cases. Logistic regression analysis based on variables significant in bivariate analysis revealed that younger age, female sex, and longer procedure duration were significantly and independently related to nausea. Vomiting after the procedure occurred in 13% of cases. Logistic regression revealed that younger age and longer procedure duration were significantly and independently related to vomiting. Further analysis showed that patients who received larger doses of promethazine relative to the dose of fentanyl had a significantly lower incidence of vomiting. CONCLUSIONS: Nausea and vomiting occurred in a considerable number of cases. Female sex, younger age, and longer procedure duration increased the risk of nausea, whereas only age and procedure duration were associated with vomiting. This study may guide clinicians to use a prophylactic antiemetic in patients undergoing radiofrequency catheter ablation, especially patients at increased risk for nausea and vomiting.
Placement of cardiac electrodes: written, simulated, and actual accuracy
Authors: Bupp JE , Dinger M , Lawrence C , Wingate S
Published: November 2019

BACKGROUND: Research has shown that critical care nurses show low accuracy on written tests of placement of electrodes, yet it is unknown how this low accuracy translates into placement of electrodes on actual patients. OBJECTIVES: To determine if accuracy scores differ between three methods (written knowledge, simulated clinical practice, actual clinical practice) of evaluating placement of continuous ECG electrodes by a group of cardiac care nurses. METHODS: A standardized scoring diagram was used with three different methods of measuring the accuracy of 44 nurses who worked on a telemetry unit or medical ICU in placing continuous ECG electrodes. The three methods were (1) written knowledge--placement of stickers on a diagram of a torso, (2) simulated clinical practice--placement of electrodes on a human model, and (3) actual clinical practice--placement of electrodes on an assigned patient. RESULTS: For the total diagram score (maximum score = 11), no significant differences among groups were found. For the V1 subscale score (maximum score = 4), a significant difference among groups was found: Scheffe's test showed that the significant difference was between simulated and actual clinical practice. Percentages of nurses achieving the maximum, or accurate, score were 18% for written knowledge, 25% for simulated clinical practice, and 9% for actual clinical practice. CONCLUSIONS: Although total scores did not differ among groups, the mean scores indicate that placement of electrodes was not accurate by any method. This finding has implications for how electrode placement is taught to nurses and for the accountability of nurses for placement of electrodes on their patients.
Quality of life 6 months after heart transplantation compared with indicators of illness severity before transplantation
Authors: Grady KL , Jalowiec A , White-Williams C
Published: November 2019

BACKGROUND: Quality of life is an important healthcare outcome to study. Quality of life after heart transplantation has not been compared with indicators of severity of illness before heart transplantation. OBJECTIVE: To compare differences in quality of life 6 months after heart transplantation with two preoperative indicators of severity of illness: New York Heart Association classification and United Network for Organ Sharing status. METHODS: Data were collected from a nonrandom sample of 219 adult patients who had received a heart transplant 6 months earlier. Patients were divided into groups on the basis of their New York Heart Association classification and United Network for Organ Sharing status immediately before transplantation. Instruments used were the Heart Transplant Symptom Checklist, Heart Transplant Stressor Scale, Rating Question Form, Quality of Life Index, Sickness Impact Profile, and Jalowiec Coping Scale. Data were analyzed with descriptive statistics, chi-square tests, and independent t tests. RESULTS: Quality of life 6 months after receiving a heart transplant varied with severity of illness before transplantation. These differences in quality of life were in the following domains: physical and occupational function, psychological state, and social interaction. Six months after receiving a heart transplant, patients who were more severely ill before transplantation were less satisfied with their lives, perceived that they were not doing as well, experienced more family-related stress, and used more negative coping strategies than did patients who were less severely ill preoperatively. CONCLUSIONS: These findings indicate the need for further study of quality of life in the transplant recipients who are the most critically ill in intensive care settings before surgery, to develop interventions to improve recipients' quality of life, and to evaluate effectiveness of those interventions longitudinally.
Converting i.v. nitroglycerin therapy to nitroglycerin ointment therapy: a comparison of two methods
Authors: Esposito GA , Dunham G , Granger BB , Tudor GE , Granger CB
Published: November 2019

BACKGROUND: Methods of converting treatment with i.v. nitroglycerin to treatment with nitroglycerin ointment 2% vary greatly and may affect the length of time patients remain in the ICU, nursing time, and possible recurrent angina. To date, no randomized, controlled studies have evaluated the methods used for conversion. OBJECTIVE: To evaluate two methods of conversion. METHODS: Two hundred patients receiving i.v. nitroglycerin at doses of 10 to 100 micrograms/min were randomized to two methods of conversion: (1) Apply nitroglycerin ointment and stop i.v. nitroglycerin 30 minutes later. (2) Decrease the dose of i.v. nitroglycerin by 10 micrograms/min every 15 minutes, apply one half the dose of nitroglycerin ointment when the original i.v. dose has been decreased by one half, and apply the full dose of the ointment when the i.v. nitroglycerin is stopped. The primary end point was the time patients remained in the ICU after the conversion. Secondary end points included time to hospital discharge, estimate of nursing time, and selected clinical end points. Kaplan-Meier and Cox regression analyses were used to evaluate time patients remained in the ICU and nursing time. Clinical outcomes were analyzed by using a chi-square test. RESULTS: Use of the first method reduced median time before transfer from the ICU by 23 minutes and median nursing time by 45 minutes. Analysis of all clinical outcomes showed no differences between the two methods. CONCLUSIONS: Use of the first method was associated with a reduction in the time patients remained in the ICU before transfer to another unit and savings in nursing time, but the two methods did not differ according to clinical outcomes.
Women and coronary disease: relationship between descriptors of signs and symptoms and diagnostic and treatment course
Authors: Penque S , Halm M , Smith M , Deutsch J , Van Roekel M , McLaughlin L , Dzubay S , Doll N , Beahrs M
Published: November 2019

BACKGROUND: Heart disease is the No. 1 killer among women in the United States. Differences in the clinical features of coronary heart disease among men and women have been reported, along with various approaches to the diagnostic workup and therapeutic interventions. PURPOSE: To explore the relationship between descriptors of signs and symptoms of coronary heart disease and follow-up care and to investigate any differences between male and female patients. METHODS: Structured interviews with patients and chart audits were used to assess initial signs and symptoms, associated cardiac-related signs and symptoms, and the diagnostic tests and interventions used for treatment. The sample consisted of 98 patients (51 women and 47 men) who were admitted with a medical diagnosis of myocardial infarction. RESULTS: Chest pain was the most common sign or symptom reported by both men and women. The 4 most common associated signs and symptoms were identical in men and women: fatigue, rest pain, shortness of breath, and weakness. However, significantly more women than men reported loss of appetite, paroxysmal nocturnal dyspnea, and back pain. Women were also less likely than men to have angiography and to receive i.v. nitroglycerin, heparin, and thrombolytic agents as part of acute management of myocardial infarction. CONCLUSION: Chest pain remains the initial symptom of acute myocardial infarction in both men and women. However, women may experience some different associated signs and symptoms than do men. Despite these similarities, men still are more likely than women to have angiography and to receive a number of therapies.
Treatment interference in acutely and critically ill adults
Authors: Happ MB
Published: November 2019

OBJECTIVES: To examine the state of knowledge of treatment interference, the self-removal of technological devices, in acutely or critically ill adults and to propose a multidisciplinary research agenda to further understanding of this clinical problem. METHOD: A combined computerized and hand search of the nursing and medical literature (MEDLINE, 1966 to June 1996; Cumulative Index to Nursing and Allied Health Literature, 1985 to June 1996; and holdings at the Center for the Study of Nursing History at the University of Pennsylvania) was conducted. Literature on specific technological devices and articles that contained the terms self-removal, withdrawal, devices, self-extubation, unplanned extubation, and involuntary treatment were searched. RESULTS: Literature on treatment interference was found in four main topic areas: (1) maintaining treatment, (2) unplanned extubation, (3) disruption or manipulation of a medical device, and (4) involuntary treatment. CONCLUSIONS: The results clearly establish the clinical importance of treatment interference and underscore the multidisciplinary and multifactorial nature of this perplexing, life-threatening clinical problem. Future research on treatment interference should emphasize systematically building an understanding of the processes involved, including patients' attributes, behavioral cues, and consequences, to develop appropriate multidisciplinary strategies to prevent patients' self-removal of technological devices.
Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization
Authors: Simon A , Bumgarner B , Clark K , Israel S
Published: November 2019

BACKGROUND: Most cardiac catheterizations are performed via femoral artery access. Reported rates of both peripheral vascular complications and success rates for the use of manual and mechanical compression techniques to achieve femoral artery hemostasis after cardiac catheterization vary. OBJECTIVE: To determine is use of a mechanical clamp is as effective as standard manual pressure for femoral artery hemostasis after cardiac catheterization. METHODS: Subjects consisted of 720 patients from 2 community hospitals who had elective diagnostic cardiac catheterization via the femoral artery. The control group (n=343) received manual compression for hemostasis; the study group (n=377) received mechanical compression. Standard protocols were used for the 2 compression techniques. Pressure was applied for a minimum of 10 minutes for 5F and 6F sheaths and catheters and for a minimum of 15 minutes for 7F and 8F sheaths and catheters. Prospective data were collected and analyzed for each patients, including sheath or catheter size, blood pressure, height, weight, age, time from administration of local anesthetic to successful cannulation of the femoral artery, anticoagulation status, total compression time, physician performing the catheterization procedure, nurse or technician who obtained hemostasis, and complications. In follow-up, patients were asked site-specific and functional status questions 1 to 2 days after the catheterization procedure and again 3 days after the catheterization procedure. RESULTS: Data were analyzed by using frequency distributions, measures of central tendency, and measures of variability. Only 1 difference between the 2 groups was significant: manual compression time was 14.93 +/- minutes, whereas mechanical compression time was 17.13 +/- minutes. CONCLUSION: Mechanical compression is as effective as manual compression for femoral artery hemostasis after cardiac catheterization.
Comparison of 2 methods of measuring the QT interval
Authors: Rimmer LK , Rimmer JD
Published: November 2019

BACKGROUND: Prolonged cardiac repolarization is associated with ventricular tachycardia and sudden cardiac death. Repolarization, represented by the QT interval, is usually measured on a 12-lead ECG recording. Measurements of the interval on bedside monitor ECG recordings have not been compared quantitatively with measurements on 12-lead ECG recordings. OBJECTIVE: To determine if QT intervals and QTc values obtained by using monitor recordings are as accurate as those obtained by using 12-lead ECG recordings. METHODS: For each of 50 subjects, 2 ECG recordings were obtained, 1 with a 12-lead ECG and 1 with the bedside monitor, and QT intervals were measured manually. The QT intervals on each type of recording were compared on a lead-by-lead basis, the maximum QT interval and the QTc maximum determined with each method were compared, and the "best single leads" for determining the QTc were ascertained for each method. RESULTS: QT intervals, on a lead-by-lead basis; maximum QT intervals; and QTc maximum values measured on the monitor recordings were consistently longer than those measured on the 12-lead ECG recordings. When the monitor ECG leads I or II and the 12-lead ECG QTc maximum were examined for simple agreement by using 460 milliseconds as a cutoff, agreement was found in 82% to 84% of the sample, and false negatives were 12% and 8%, respectively. CONCLUSION: Recordings from leads I or II on the bedside ECG monitor should be used to measure the QT interval. Once prolonged QT values are detected, recordings obtained with a 12-lead ECG can be used to confirm the analysis.
Thermodilution measurement of cardiac output in patients with low output: room-temperature versus iced injectate
Authors: Kiely M , Byers LA , Greenwood R , Carroll E , Carroll D
Published: November 2019

BACKGROUND: Measurements of cardiac output with the thermodilution technique add to data for clinical decision making and therefore must be valid and reliable. However, the results of studies on the accuracy of values obtained with room-temperature and iced injectates, especially in patients with high or low cardiac output, have been conflicting. OBJECTIVE: To determine the effect of the temperature of the injectate (iced or room temperature) on cardiac output values obtained with the thermodilution technique in critically ill adults with known low cardiac output. METHODS: A convenience sample of 50 subjects (41 men and 9 women) who had a cardiac index of less than 2.5 (calculated as cardiac output in liters per minute divided by body surface area in square meters) before the study had cardiac output measured by using a closed system and manual injections of room-temperature and iced injectates. RESULTS: A paired t test indicated no significant difference between iced and room-temperature injectates for cardiac output (iced, 3.62 L/min; room temperature, 3.71 L/min; t = 0.99; P = .327) and cardiac index (iced, 1.95; room temperature, 1.99; t = 0.71; P = .482). CONCLUSION: The findings support the practice of using room-temperature injectate to measure cardiac output in patients with low cardiac output.
Commotio cordis: sudden cardiac death in athletes
Authors: Futterman LG , Lemberg L
Published: November 2019

Commotio cordis due to blunt trauma to the precordium is a rare cause of death in young athletes, occurring less frequently than all of the other athletics-related deaths. Several measures, such as the use of safety baseballs and the use of chest protectors, can help protect young athletes from commotio cordis. In general, sudden cardiac death in athletes is receiving increasing attention from the public as a result of recent deaths of high-profile athletes. Sudden cardiac death, however, is rare, with an estimated 1 out of 200,000 high school athletes at risk each year. However, the personal, physiological, and cardiovascular benefits of athletics far outweigh the risks. Therefore, the message to parents is to allow their children to participate in athletics because the benefits far outweigh the risks.
Evolving trends in critical care nursing practice: results of a certification role delineation study
Authors: Biel M , Eastwood JA , Muenzen P , Greenberg S
Published: November 2019

BACKGROUND: In 1997, the AACN Certification Corporation, in conjunction with Professional Examination Service, undertook a role delineation study as 1 component of a large-scale, comprehensive, and systematic study of practice to update previous data. Focus groups made up of practicing critical care nurses were used to determine trends and changes in adult, pediatric, and neonatal critical care nursing practice. METHODS: Sixteen focus groups (6 adult, 5 pediatric, and 5 neonatal) used specially prepared protocols to guide discussions. Questions were designed to elicit descriptions of changes in critical care nursing practice in the preceding 5 years. Qualitative comments of the participants were analyzed across all the focus groups, rather than separately for the adult, pediatric, and neonatal focus groups. Then data for the focus groups for each patient-age range were aggregated and reviewed to abstract themes. RESULTS: Trends and changes in practice for adult, pediatric, and neonatal critical care nurses were determined. Common themes include ethical and legal issues, changes in the population of patients, psychosocial factors, and the impact of managed care. CONCLUSIONS: The results of these focus groups can be used to update the test blueprints that underlie the CCRN certification examination programs for adult, pediatric, and neonatal critical care nurses. Critical care nursing practice is changing. Specific knowledge of the changes is important for educators, managers, and clinicians. The results of this role delineation study can be used to teach, adapt systems, and validate practice.
Effects of position of chest drainage tube on volume drained and pressure
Authors: Schmelz JO , Johnson D , Norton JM , Andrews M , Gordon PA
Published: November 2019

BACKGROUND: The nursing practice of avoiding dependent loops in the tubing of chest drainage systems because such loops may impede drainage and alter the intrapleural pressure is not research based. OBJECTIVES: To determine if the volume of fluid drained and pressure vary when the chest drainage tubing is straight, coiled, has a dependent loop, or has a dependent loop that is periodically lifted and drained. METHODS: A repeated-measures design was used. For each tubing position, 500 mL of fluid was infused into the pleural space of 8 adult pigs during 45 minutes. The volume of fluid drained and the pressure at 2 locations within the drainage tubing were measured for 1 hour. RESULTS: After 60 minutes, significantly less fluid (least significant difference test, P = .03) was drained with the dependent-loop tubing position (65 mL) than with the other 3 positions. However, the amount of fluid drained was not significantly different among the lift and drain (250 mL), coiled (301 mL), or straight (337 mL) tubing positions. Throughout the entire study, pressure at the connection between the chest tube and the drainage tube was significantly higher (least significant difference test, P = .003) for the dependent loop with and without periodic lifting and draining. CONCLUSIONS: Straight and coiled tube positions are optimal for draining fluid from the pleural space. If a dependent loop cannot be avoided, lifting and draining it every 15 minutes will maintain adequate drainage.
Reliability of an intravenous intermittent access port (saline lock) for obtaining blood samples for coagulation studies
Authors: Arrants J , Willis ME , Stevens B , Gripkey L , Herman JA , Hernandez-Brooks L , Eaker JE
Published: November 2019

BACKGROUND: Patients admitted to rule out myocardial infarction often receive a heparin infusion that requires measurement of partial thromboplastin time every 6 to 8 hours until coagulation values stabilize. If the patient's acuity at admission does not necessitate placement of arterial or central catheters, insertion of an intermittent intravenous access port (saline lock) would decrease the need for frequent venipuncture. Many studies on obtaining blood samples via arterial and central catheters have been reported, but no reports have described the method of using a saline lock or the amount of blood discarded during that procedure. OBJECTIVE: To evaluate the efficacy of inserting a saline lock specifically for obtaining blood samples and to determine the amount of blood that must be discarded in order to obtain prothrombin and partial thromboplastin times that match the values from blood samples obtained via venipuncture. METHODS: Coagulation values determined with 2 consecutive blood samples obtained via the saline lock after the first 0.5 mL of blood withdrawn was discarded were compared with measurements determined with a blood sample obtained via venipuncture. RESULTS: Prothrombin and partial thromboplastin times were not significantly different among the 3 blood samples. CONCLUSION: The untoward effects of frequent venipunctures to obtain blood samples for measurement of prothrombin and partial thromboplastin times can be lessened by using an 18-gauge saline lock to obtain blood samples and discarding the first 0.5 mL of blood withdrawn before the samples for coagulation studies are collected.
The Framingham Heart Study: a pivotal legacy of the last millennium
Authors: Futterman LG , Lemberg L
Published: November 2019

The life span at birth in the Greco-Roman era (200-300 BC) was 27 years. The life span in 1900 was 47 years, representing a gain of 20 years in more than 2000 years, or an increase of 1 year per century. At the close of the 20th century, the average life span was 77 years. This is a 30-year gain in life expectancy in only 1 century, or an average of 3 years for every decade in the last century. Compare that with only 1 year gain in life expectancy per century for the previous 20 centuries. It must be quite evident from this brief review that in the last century the Framingham Heart Study played a pivotal role in influencing physicians and the public to place major emphasis on the prevention of CV disease. To be sure, the control of epidemics, cure of infections with antibiotics, universal vaccination, and establishing food and environmental safety standards in the last century were instrumental in extending the life span. Nevertheless, major and direct influences on the explosive expansion in longevity during our life time were the contributions of the Framingham Heart Study. To paraphrase W. B. Kannel, a chief investigator in the Framingham Heart Study, "A cardiovascular event should be regarded as a medical failure rather than the first indication for the need to treat."