bluuebunny/crossref_metadata_2025 huggingface dataset:
Epilepsy: a review of seizure types, etiologies, diagnosis, treatment, and nursing implications
Authors: Long L , McAuley JW
Published: November 2019

Critical care nurses must be able to adequately identify and document seizure activity, perform appropriate interventions, and recognize signs of AED toxicity. Critical care nurses not only share the responsibility of taking care of epilepsy patients, but also must help in valuable patient and family education as it relates to long-term management. Becoming better informed of the plan of care for epilepsy patients helps optimize expected outcomes and enables patients and families to manage this illness better.
Acute renal failure in the newborn
Authors: McCourt M
Published: November 2019

Newborns at risk for acute renal failure require immediate diagnosis and treatment. Supportive care must be provided while the kidney heals and begins functioning again. The critical care nurse plays a vital role in early recognition and treatment of signs and symptoms of acute renal failure. As technology improves, a greater number of acutely ill newborns are surviving. The critical care nurse is managing more neonates with acute renal failure. Expertise in caring for these infants has also improved. Quality nursing care plays a crucial role in preventing complications and improving the prognosis of neonates with renal failure.
ECG interpretation of chamber enlargement
Authors: Magdic KS , Saul LM
Published: November 2019

In this age of cost containment, it is important for healthcare providers to deliver quality care in a cost-effective manner. Once an ECG has been ordered, it is important to maximize its contribution to patients' care by evaluating the characteristics of the ECG and the problems that could alter it.
A volunteers in participatory sampling survey of weaning practices. The Third National Study Group on Weaning from Mechanical Ventilation
Authors: Clochesy JM , Burns SM , Shekleton ME , Hanneman SK , Knebel AR , Ingersoll GL
Published: November 2019

The survey results of the VIPs membership described in this article add qualitative information to the growing body of scientific knowledge on weaning patients off ventilators. Clearly, quantitative studies exploring the efficacy of different weaning practices across the continuum must be done if we are to accurately compare practices and prescribe the "when" and "how" of weaning. To this end, the Third National Study Group is revising the proposed weaning model and model in order to further elucidate the state of the art and science of weaning.
Inhaled nitric oxide in the ICU
Authors: Kalweit S
Published: November 2019

Inhaled nitric oxide is a pulmonary vasodilator that enhances gas exchange in compromised lungs. Treatment with nitric oxide may benefit adults who have severe pulmonary disease. As more knowledge is gained and clinical experiences with this therapy increase, patients' outcomes most likely will show significant improvement, with increases in survival rates.
Chronic disease management: an outpatient approach
Authors: Paladichuk A
Published: November 2019

The current climate of managed care has sparked efforts to reduce costs in patient care. In many cases, this has resulted in more efficient methods of patient management: chronic disease management in an outpatient setting appears to be one such success story. For critical care nurses interested in working beyond the boundaries of a traditional ICU, chronic disease management clinics represent an alternative environment in which they may apply their skills. Nancy Brass-Mynderse, RN, MSN, CCRN, a clinical nurse specialist (CNS) with 18 years of experience in critical care, was instrumental in development of the Scripps Health Chronic Disease Clinic at Green Hospital of Scripps Clinic, San Diego, Calif. Brass-Mynderse currently supervises the operation of the clinic, along with Omana Kaliangara, RN, MSN, CFNP, a nurse practitioner. Brass-Mynderse received her bachelor's degree from the University of Arizona, Tucson, Ariz, and her master's degree from San Diego State University. She recently obtained her family nurse practitioner certificate from California State University, Dominguez Hills, Calif. Kaliangara received her bachelor's degree from San Jose State University, San Jose, Calif, and her nurse practitioner certificate from the University of California, San Francisco, Calif. After working in family medicine and a diabetic clinic, Kaliangara developed an interest in the management of chronic diseases. In an interview with CRITICAL CARE NURSE in September, Brass-Mynderse and Kaliangara took time to discuss the development and operation of the clinic, and to recount some of their success stories.
Xenotransplantation: the potential and the challenges
Authors: Bloom ET , Moulton AD , McCoy J , Chapman LE , Patterson AP
Published: November 2019

Clinical use of xenotransplants is a potential way to provide care for a population of seriously ill patients and alleviate the demand for human organs. However, xenotransplantation also presents a spectrum of concerns, not only for individual patients but also for the public health, that must be discussed and dealt with in a science-based and public manner. Such discussions should take place on a national level and should include scientists, physicians, and policy makers from all countries in which the clinical use of xenografts is being considered.
Epoprostenol therapy for primary pulmonary hypertension
Authors: Cheever KH , Kitzes B , Genthner D
Published: November 2019

Although a rare disease, PPH is deadly. Until recently, patients had little hope for remission of this disease. Originally viewed as a "bridge to transplantation," new research findings suggest that epoprostenol significantly improves PPH so that transplantation may not be necessary. Treatment with epoprostenol is difficult to manage, however, because it requires continuous central infusion. Nurses have a key role in ensuring that patients safely and effectively manage this therapy.
Frequency of ischemia during intracoronary ultrasound in women with and without coronary artery disease
Authors: Lau KY , Wung SF , Adams MG , Zellner C , Drew BJ
Published: November 2019

Myocardial ischemia is common during ICUS imaging in women with and without CAD. Although no long-term adverse effects occurred in our small sample, a larger sample of women is required to confirm our observations and to determine the precise mechanisms of ischemia. Such studies may determine whether the smaller diameter of coronary vessels in women makes the women more vulnerable than men to the occurrence of chest pain and ischemia during ICUS. Although ICUS is valuable in guiding coronary interventions, disposable catheters are costly. Studies are required to assess the cost-benefit ratio of incorporating ICUS with coronary interventional procedures. Until more is known, we recommend that nurses educate patients about ICUS, monitor them closely for ischemia and arrhythmias during the procedure, and consider obtaining 12-lead ECGs when patients undergo and ICUS procedure.
Blunt chest trauma: case report
Authors: Flynn MB , Bonini S
Published: November 2019

Care of patients with blunt cardiac trauma is challenging for bedside nurses because of the potentially elusive and subtle nature of clinical findings associated with such trauma. An understanding of the forces exerted during the trauma episode will assist nurses in the assessment and search for hidden injuries. A high index of suspicion and continued cautious assessment and attention to subtle changes in the patient's physical condition are essential. Keen attention to changes in the patient's vital signs, cardiac output, ECG findings, pulses, and fluid volume status alert nurses to potential injuries associated with blunt cardiac trauma ranging from myocardial contusion to cardiac tamponade, aortic tears, and cardiac rupture. Survival of patients with blunt cardiac trauma depends on early intervention.
Managing pulmonary hypertension in heart transplantation: meeting the challenge
Authors: Coe PF
Published: November 2019

The most common measurements of pulmonary hypertension include systolic and mean pulmonary artery pressures, PVR, and transpulmonary gradient. Pulmonary artery pressures greater than 50 mm Hg, PVR greater than 6 Woods units, and transpulmonary gradient greater than 15 mm Hg that are unresponsive to optimal vasodilators are contraindications to orthotopic heart transplantation. Therapies used to reduce PVR in the cardiac catheterization laboratory include high-flow oxygen; sublingual nitroglycerin; and intravenous inotropic agents, vasodilators, and selective pulmonary vasodilators. Systemic hypotension may be an undesirable side effect of vasodilators. Inhaled agents such as nitric oxide and prostacyclin are specific to the pulmonary vasculature and reduce PVR without causing systemic hypotension. All pharmacological therapies used to optimize pulmonary hemodynamics before transplantation can be used during transplantation in patients who are at high risk for acute right ventricular failure and death after orthotopic heart transplantation because of elevated pulmonary hemodynamic values. Use of larger donor hearts for patients with elevated PVR and referral for heart-lung transplantation are potential treatment options. A heterotopic heart transplantation might also be attempted. However, because of the poor success with heterotopic transplantation, other options such as treatment with inhaled pulmonary vasodilators show much more promise and are associated with long-term survival after transplantation. Finally, nursing knowledge and implementation of transplantation protocols are essential for continued assessment and management of candidates for heart transplantation who are cared for in the intensive care or coronary care unit.
Overdoses of tricyclic antidepressants: grandchildren and grandparents
Authors: Lewis-Abney K
Published: November 2019

TCAs are an extremely toxic source of poisoning in young children. Overdoses of TCAs can cause coma, seizures, hypotension, cardiac arrhythmias, and cardiac arrest. Treatment is directed at rapid assessment, monitoring, support of vital functions, halting drug absorption, and treating CNS and cardiac toxic effects. All children should be monitored for a minimum of 6 hours, and many require admission to a critical care unit. The mainstay of therapy is alkalinization. Intravenous administration of sodium bicarbonate is the preferred treatment for hypotension, shock, and arrhythmias. Blood pH should be monitored and should be maintained between 7.45 and 7.55. More specific drug therapy, cardioversion, or artificial pacing may be required for refractory arrhythmias. Before the child is discharged from the hospital, strategies to reduce the risk of future poisonings should be discussed with the child's family.
Bloodless medicine and surgery for patients having cardiac surgery
Authors: Reger TB , Roditski D
Published: November 2019

Changes in patients' care mandate that nursing care be amenable to change. With the advent of new technology, systems of care delivery are evolving. Blood transfusion practices that were once considered standards are being reexamined and redefined. Nurses, in their roles as patients' advocates and educators, must be cognizant of changes in practice and be prepared to deliver competent care. The effectiveness of techniques of bloodless medicine and surgery originally designed to serve the needs of Jehovah's Witnesses is accepted today, and other groups of patients are choosing this type of care. Furthermore, as blood conservation strategies are refined and perfected, they most likely will be used by a greater number of patients undergoing cardiac surgery. Specific guidelines have been developed for point-of-care service for patients undergoing bloodless cardiac surgery. Nursing care throughout the hospital stay, from preadmission to discharge, is tailored to meet these patients' emotional and physical needs. Quality comprehensive nursing care is required to make bloodless medicine and surgery programs successful.
Understanding the neonatal immune system: high risk for infection
Authors: McKenney WM
Published: November 2019

Neonates are vulnerable to infection from prenatal and postnatal exposure to microorganisms. The immaturity of the immune system in neonates and illness and/or prematurity place these infants at significant risk for bacterial invasion and systemic infection. Long-term sequelae include, but are not limited to, prolonged hospital stays and increased risk of neurodevelopmental problems. Nurses must understand the function of the immune system and the disadvantages unique to newborn infants to be able to provide education to others and appreciate the need for vigilant monitoring and protection of these infants.
Ketorolac as an Analgesic Agent for Infants and Children After Cardiac Surgery
Authors: Jalkut Meredith K.
Published: November 2019

Ketorolac has been used safely as an analgesic agent for children following cardiac surgery in selected populations. Controversy exists among institutions about the risks involved with this medication in this patient group. This article reviews the current literature regarding the safety of ketorolac for postoperative pain management in children after cardiac surgery. Specifically, concerns about renal dysfunction and increased bleeding risk are addressed. Additionally, the article details pharmacokinetics and potential benefits of ketorolac, such as its opioidsparing effect. The literature reflects that the use of this medication is not well studied in certain pediatric cardiac patients such as neonates and those with single-ventricle physiology, and the safety of this medication in regards to these special populations is reviewed. In conclusion, ketorolac can be used in specific pediatric patients after cardiac surgery with minimal risk of bleeding or renal dysfunction with appropriate dosing and duration of use.
Fever in Acute and Critical Care
Authors: Munro Nancy
Published: November 2019

Determining the underlying cause of a fever can be a daunting task. Multiple reasons have been found for a patient to have a fever, but the use of an organized approach will assist clinicians in reaching a correct diagnosis. The first step in this process is a complete assessment, including a thorough physical assessment and an evaluation of the history of present illness as well as a detailed review of all the patient’s medications. Infection should always be a primary consideration for the cause of a fever. Evaluating each body system can match symptoms with a possible cause for fever, and proper testing and imaging can be pursued. Noninfectious causes of fever need to be included in the differential diagnostic process. This article provides an analytic approach to fever in adult patients in the acute and critical care environment.
Advanced Chest Imaging Interpretation of Acute Pulmonary Disorders
Authors: Siela Debra
Published: November 2019

Bedside and advanced practice nurses in acute and critical care often view chest radiologic images of their patients. Correlation of findings on chest radiologic images with results of physical and other diagnostic assessments can provide information for making appropriate clinical judgments. Radiologic images of the chest available for acutely ill patients now include frontal/lateral chest radiographs and computed tomography (CT) scans. The purpose of this article is for the reader to review basic skills for interpreting chest radiographs, gain skill in reviewing CT scans of the chest, and be able to apply more advanced interpretation skills for both chest radiographs and chest CT scans. Several chest images are included for review.
Breaking Bad News and Discussing Goals of Care in the Intensive Care Unit
Authors: Hollyday Sheryl L. , Buonocore Denise
Published: November 2019

The intensive care unit is a high-stakes environment in which nurses, including advanced practice registered nurses (APRNs), often assist patients and families to navigate life and death situations. These high-stakes situations often require discussions that include bad news and discussions about goals of care or limiting aggressive care, and APRNs must develop expertise and techniques to be skilled communicators for conducting these crucial conversations. This article explores the art of communication, the learned skill of delivering bad news in the health care setting, and the incorporation of this news into a discussion about goals of care for patients. As APRNs learn to incorporate effective communication skills into practice, patient care and communication will ultimately be enhanced.
Improving End-of-Life Care Prognostic Discussions
Authors: Kalowes Peggy
Published: November 2019

Research has validated the desire of patients and families for ongoing prognostic information; however, few conversations occur before patients reach the advanced stages of their disease trajectory. Physician hesitance and delay in discussing unfavorable prognoses deny patients and families optimal time to prepare for critical decision making. Advanced practice registered nurses can play a crucial, complementary role with the critical care interdisciplinary team to implement strategies to improve communication about prognosis and end of life with patients and families. Clinicians should discuss deterioration in disease-specific characteristics and changes (decline) in functional status. Functional status can serve as an accurate guide for forecasting prognosis, particularly in patients with heart failure, stroke, chronic lung disease, and end-stage renal disease. This article provides an overview of effective intensive care unit prognostic systems and discusses barriers and opportunities for nurses to use evidence-based knowledge related to disease trajectory and prognosis to improve communication and the quality of palliative and end-of-life care for patients.
Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life
Authors: Gura Melanie T.
Published: November 2019

Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations.
Current Technology to Maximize Cardiac Resynchronization Therapy Benefit for Patients With Symptomatic Heart Failure
Authors: Huntsinger Mary Eng , Rabara Roselou , Peralta Irene , Doshi Rahul N.
Published: November 2019

The incidence of heart failure (HF) continues to increase, affecting millions of people in the United States each year. Cardiac resynchronization therapy (CRT) has been used and studied for patients with symptomatic HF for more than 20 years. The purpose of this article is to review technologies and developments to help maximize CRT for patients with symptomatic HF. Although most interventions to optimize CRT are physician directed, nurses also have an important role in the care and education of patients with symptomatic HF and can affect clinical outcomes. Therefore, nurses’ understanding of CRT and measures to maximize this lifesaving therapy is critical in HF management.
Let’s Get Certified
Authors: Altman Marian
Published: November 2019

Certification benefits nurses, patients and their families, and hospitals. Nurses become certified for various reasons: personal challenge; self-improvement; advancement of knowledge and education; demonstration of mastery of skills, knowledge, and abilities; and commitment to lifelong learning and career growth. However, there are also barriers to certification. Fear of test taking or failure and lack of resources or organization recognition are reasons many nurses cite for not becoming certified. Nurse leaders play a pivotal role in supporting nurses to obtain and maintain specialty nursing certification. Nurse leaders may promote certification, support nurses who are on their certification journey, and reward and recognize those staff that become certified. This article will share practices to increase the number of specialty certified nurses in your unit or organization.
Promoting Certification
Authors: Staul LuAnn
Published: November 2019

The mission of the American Association of Critical-Care Nurses focuses on providing nurses with expert knowledge to promote delivery of excellent, safe, quality care to acutely and critically ill patients and their families. Chapters consist of professional leaders in a community who carry on the mission work of the American Association of Critical-Care Nurses at the local level. Chapters can emphasize the value of certification and continuing education, because they offer a wide spectrum of opportunities to meet the learning and developmental needs of nurses as they advance in their professional careers. This article will highlight strategies that can be implemented by local chapters to facilitate and promote certification.
Sleep Disturbances and Fatigue in Critically Ill Patients
Authors: Matthews Ellyn E.
Published: November 2019

Sleep disturbances and fatigue are significant problems for critically ill patients. Existing sleep disorders, underlying medical/surgical conditions, environmental factors, stress, medications, and other treatments all contribute to a patient’s inability to sleep. Sleep disturbance and debilitating fatigue that originate during acute illness may continue months after discharge from intensive care units (ICUs). If these issues are unrecognized, lack of treatment may contribute to chronic sleep problems, impaired quality of life, and incomplete rehabilitation. A multidisciplinary approach that incorporates assessment of sleep disturbances and fatigue, environmental controls, appropriate pharmacologic management, and educational and behavioral interventions is necessary to reduce the impact of sleep disturbances and fatigue in ICU patients. Nurses are well positioned to identify issues in their own units that prevent effective patient sleep. This article will discuss the literature related to the occurrence, etiology, and risk factors of sleep disturbance and fatigue and describe assessment and management options in critically ill adults.
Pain in Critically Ill Patients With Substance Use Disorder or Long-term Opioid Use for Chronic Pain
Authors: Drew Debra J. , St. Marie Barbara J.
Published: November 2019

Opioid tolerance resulting from long-term opioid consumption for chronic pain or from substance use disorder adds a layer of complexity to managing pain in the critical care setting. This article discusses similarities and differences of these 2 conditions. The phenomenon of tolerance and opioid-induced hyperalgesia are presented. Prevention of opioid withdrawal, when patients are on methadone or buprenorphine, is described. An overview of the neurophysiology of pain and substance use disorder is presented. Practical clinical suggestions are given to assist the critical care nurse in caring for these complex patients.
Advancing Nursing Research Through a Mentorship Program for Staff Nurses
Authors: Gawlinski Anna , Miller Pamela S.
Published: November 2019

This article describes a unique model of implementing unit-based research teams to provide staff nurses with knowledge, skills, and mentoring. The essential elements of designing and conducting a research study are emphasized in an effort to improve nursing practice and the quality of patient care. The research education and practicum are incorporated into team meetings. This unique model provides greater efficiency and effectiveness of resources and allows for more interactive education than occurs in traditional models. Unit-based nursing teams learn together to design research studies, test hypotheses, and answer clinically relevant research questions, using the scientific process.
Ventricular Assist Devices
Authors: O’Shea Genevieve
Published: November 2019

Patients with advanced heart failure have limited treatment options despite advances in medical management. Ventricular assist devices represent a surgical option that offers improved end-organ function, survival, and quality of life. Postoperative nursing management involves the most complicated aspects of care following cardiac surgery as well as issues unique to advanced heart failure and mechanical circulatory support. Despite growing numbers of ventricular assist device implants, literature about the challenging care of patients following ventricular assist device implantation is limited. This article focuses on the physiological basis for postoperative nursing management strategies and the most important complications of which critical care nurses need to be aware.
Fever Management in Patients With Brain Injury
Authors: Mcilvoy Laura
Published: November 2019

Elevated temperature in patients with brain injury has been linked to increased hospital and intensive care unit lengths of stay, increased morbidity, greater disability, and higher mortality. The prevailing medical opinion is that maintaining normothermia in patients with acute brain injury is beneficial. However, little evidence exists to support this recommendation. Nurses are responsible for diagnosing and treating fever, but evidence-based guidelines that would govern fever management for these patients do not exist. This article discusses what evidence is available to support the management of fever in patients with brain injury and in what areas evidence is lacking.
Partnership for a Healthy Work Environment
Authors: Goran Susan F. , Mullen-Fortino Margaret
Published: November 2019

The tele–intensive care unit (ICU) provides a remote monitoring system that adds an additional layer of support for critically ill patients. However, to optimize contributions, the bedside team must incorporate this resource into the patient’s plan of care. Using the American Association of Critical-Care Nurses’ Healthy Work Environment Standards as a platform, we can create and nurture a new partnership model. Strategies that embrace the standards of skilled communication, true collaboration, and effective decision making become mutual goals for improving patient safety and outcomes. Joint communication guidelines facilitate timely and meaningful communication. Trust and the desire to cooperate encourage provider engagement to strengthen collaboration. The use of tele-ICU technology can assist in the interpretation and transformation of data to affect decision making at all levels to influence patient care. Through the lens of the healthy work environment, the tele-ICU/ICU partnership provides enhanced opportunities for improved patient care and team satisfaction.
High-Frequency Percussive Ventilation Using the VDR-4 Ventilator
Authors: Kunugiyama Sujen K. , Schulman Christine S.
Published: November 2019

High-frequency percussive ventilation (HFPV) has been used for patients with severe respiratory compromise refractory to conventional mechanical ventilation. It frequently results in equivalent or improved oxygenation and ventilation at lower peak pressures than conventional ventilation, thus minimizing secondary ventilator-associated lung injury. The only ventilator currently available that delivers HFPV is the volume diffusive respirator (VDR-4; Percussionaire Corp, Sandpoint, Idaho). High-frequency percussive ventilation is delivered via a pneumatically powered, pressure-limited, time-cycled, high-frequency flow interrupter and provides small tidal volumes with 300 to 700 oscillations per minute. Following transition to HFPV, respiratory status often stabilizes or improves within a few hours. The unique gas flow mobilizes significant volumes of pulmonary secretions, further facilitating gas exchange. This article reviews the operating principles of HFPV, the functional components of the VDR-4, and the special nursing care considerations to include sedation, hemodynamic assessment, skin and oral care, nutrition, and weaning from ventilation.
Early Metabolic/Cellular-Level Resuscitation Following Terminal Brain Stem Herniation
Authors: Arbour Richard B.
Published: November 2019

Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor’s organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.
Writing an Employer-Focused Resume for Advanced Practice Nurses
Authors: Welton Robert H.
Published: November 2019

The most important new trend in resumes is the employer-focused resume. Writing one is not difficult, but it requires a change in focus. The focus of this type of resume is on the needs of prospective employers. This new resume format allows applicants to describe to prospective employers what they can provide related to the employer’s needs as opposed to a simple listing of their academic and work experiences without relation to the prospective new job. This article provides advanced practice nurses with sources to guide construction of informative text about their advanced practice nursing skills and competencies using language familiar to employers. Resumes and curriculum vitae formats are compared, and advice is provided on developing content for either format. Guidelines are provided about listing credentials, identifying clinical proficiencies from student clinical practicum, using qualification summaries rather than an objective statement, choosing references, and including essential components in a cover letter.
Multiple Endocrine Neoplasia
Authors: Manchester Carol S.
Published: November 2019

Multiple endocrine neoplasia (MEN) is an array of tumors found in various endocrine glands throughout the human body. A wide spectrum of clinical manifestations accompanies this syndrome. The complexities of the glandular function and subtle development of symptoms can cause the diagnosis to be missed, and individuals with MEN can be an enigma to the care team. Appropriate differential diagnosis and assessment are critical for these individuals to receive optimal care. An interprofessional team of health care providers, including an endocrinologist and an advanced practice endocrine nurse, must work in concert to orchestrate a plan of care across the continuum. Those specialized nurses who encounter individuals with MEN in a critical care setting are positioned to support the patient, the family, and the care team through this maze of multiple endocrinopathies and tumors.
Medication Errors in the Intensive Care Unit
Authors: Frith Karen H.
Published: November 2019

Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
Alarm Fatigue
Authors: Sendelbach Sue , Funk Marjorie
Published: November 2019

Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. Patient deaths have been attributed to alarm fatigue. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety.
Lâ€™INTERREGNUM FUORI DI ROMA: ORIGINE E FUNZIONI DELLâ€™ISTITUTO NELLE CITTÃ€ ITALICHE
Authors: Bianchi Edoardo
Published: November 2019

The extraordinary magistracy of the interregnum is attested by inscriptions from some communities of Roman Italy: Beneventum, Ostia, Fundi, Formiae and Cumae. The A. analyses all the available evidence in order to detect the origins and functions of the local interreges and their relationship with the Roman interrex.
IL LUNGO CAMMINO DEI MERCANTI DI SAPIENZA. LE ORIGINI DELLâ€™UNIVERSITÃ€ DI PAVIA NELLA STORIOGRAFIA DAL XIV AL XX SECOLO
Authors: Mantovani Dario
Published: November 2019

This paper offers a contribution to the history of historiography on the University of Pavia. The Author takes into account both the treaties explicitly dealing (since the 18th Century) with the history of the University, but also all the evidence of a historical consciousness about the origins and history of the University; such a historical consciousness started to appear in 1361, when the Visconti Family officially founded the University. Particular attention is paid to the three interpretations about the foundation (origo), which has been attributed to the Lombard Kings, to Charlemagne and to Lothair I. For a long time there was a widespread belief in Europe that the University of Pavia had been founded by Charlemagne, simultaneously with the University of Paris; the creator of this tradition (based on the history of Charlemagne written by Notker the Stammerer) was BarthÃ©lemy de Chasseneuz, in 1525. The attribution of the founding to Lothair in 825 is only a recent idea, which has been nourished, with different intentions, by the 19th Century German legal historians who discovered a school of Lombard Law in Pavia (attested since at least the 10th Century) and by the Celebrations held in Pavia in 1925.
UN MEDICO DISTRATTO: Â«RESPONSABILITAâ€™ POLITICAÂ» E Â«GIUDIZIO AMMINISTRATIVOÂ» NEL LOMBARDO-VENETO
Authors: Rossi Filippo
Published: November 2019

A slip of the pen when prescribing an antipyretic. A story of medical malpractice makes a deep breakthrough in several legal profiles of liability under the second part of the Austrian penal code of 1803, and also over the dismissal of the public official of the Lombardy-Venetia kingdom: reflections on some issues for future research.
NEL SECONDO CENTENARIO DEL â€œCODICE AUSTRIACOâ€
Authors: Gandolfi Giuseppe
Published: November 2019

Il â€œcodice civile austriacoâ€ Ã¨ entrato in vigore il 1Â° giugno 1811 ed ha quindi compiuto duecento anni. Eâ€™ stato il codice civile dellâ€™Impero dellâ€™oriente europeo (Ã–sterreich). Attualmente Ã¨ in vigore in Austria e nel Principato del Lichtenstein. Si tratta di un codice eccellente, che ha una chiara impronta illuministica e giusnaturalistica. Questi suoi caratteri risultano dalla comparazione con altri codici europei in tema di: rendita fondiaria, vendita e trasferimento della proprietÃ , conversione del contratto nullo, errore nel contratto, fatto dannoso imputabile a piÃ¹ persone. Nel corso dellâ€™Ottocento questo codice Ã¨ stato in vigore in Italia nel Regno Lombardo-Veneto e in altre regioni dellâ€™Italia del Nord sino alla prima guerra mondiale. Invocando il codice austriaco Giuseppe Garibaldi ha chiesto e ottenuto nel 1880 lâ€™annullamento del suo matrimonio rato e non consumato con la marchesina sedicenne Giuseppina Raimondi.
UMM-EL-BREIGÃ‚T (TEBTYNIS): CAMPAGNA DI SCAVO DELLâ€™ANNO 2012
Authors: Gallazzi Claudio
Published: November 2019

Pendant sa campagne de 2012, la Mission franco-italienne de lâ€™Institut franÃ§ais dâ€™archÃ©ologie orientale du Caire et de lâ€™UniversitÃ© de Milan a poursuivi ses activitÃ©s sur le kÃ´m de Umm-el-BreigÃ¢t, dans les vestiges de lâ€™ancienne Tebtynis, en Ã©tendant la fouille dans les zones oÃ¹ elle avait dÃ©jÃ  travaillÃ© en 2010. Au nord-ouest du temple de Soknebtynis, la Mission a mis au jour plusieurs bÃ¢timents utilisÃ©s aussi bien comme habitations que comme magasins. Ces constructions ont permis de suivre lâ€™Ã©volution du secteur du dÃ©but du IIIe s. av. J.-C., lorsque lâ€™endroit fut urbanisÃ©, jusquâ€™au IIIe s. apr. J.-C., quand il fut envahi par le dÃ©sert. Ã€ lâ€™est du temple, la Mission a continuÃ© la fouille systÃ©matique du dÃ©potoir repÃ©rÃ© en 1994, en rÃ©cupÃ©rant des objets rares et des centaines dâ€™ostraka, dipinti sur amphores et papyrus Ã©crits en hiÃ©ratique, dÃ©motique et grec, qui datent de la pÃ©riode hellÃ©nistique et qui concernent souvent le sanctuaire situÃ© Ã  proximitÃ©.
RODOLFO BENINI: ALCUNI SUOI CONTRIBUTI ALLA STATISTICA IN OCCASIONE DEI 150 ANNI DALLA NASCITA
Authors: Mira Antonietta
Published: November 2019

For the first time in Italy, thanks to the contributions of Rodolfo Benini, Statistics became an autonomous discipline, finally released from economical, demographical and social sciences to which was still assimilated. The rigor and the technical refinement of his analysis justify the importance attributed to his statistical contributions, and support the fact that he has been recognised by Corrado Gini as the first round Italian statistician. Starting from the interpretation by Marcello Boldrini of his Â«tre mirabili opere di sistemazioneÂ», I will deepen three of the main themes linked to the statistical methodology addressed by Benini: multiple linear regression, indexes of attraction and repulsion and the distribution of economical variables. I will conclude discussing his relationship with Pareto, whose law Benini first verified on income and later extended to other economical variables.
EUROBONDS E CRISI DELLâ€™EUROZONA (A proposito di un recente volume)
Authors: Beretta Silvio
Published: November 2019

The paper connects the eurobonds issue to the political aspects of the current eurozone crisis. It firstly emphasizes that the possible future issuance of Eurobonds, or the refusal to do so, represent signs of the emergence of cooperative or, alternatively, non-cooperative behaviors among eurozone countries. Such a dichotomy, in turn, appears as a clear proof of the political roots of the crisis. Accordingly to this perspective, the persistent demand for a full European political integration as the decisive step out of the crisis is reviewed by analyzing a list of works, particularly the conclusions of the Reflection Group on the future of the European Union and the concluding remarks of the Governor of the Bank of Italy.
LO STATUTO DEL COLLEGIO DEI DOCTORES ARTIUM ET MEDICINAE DELLâ€™UNIVERSITAâ€™ DI PAVIA DEL 1409: LA COPIA COMPLETA RITROVATA
Authors: Mantovani Dario
Published: November 2019

This paper describes the copy of the Statuta Collegii doctorum Artium et Medicinae issued for the University of Pavia in 1409, recently rediscovered at the Pavia University History Museum. The most ancient part of the manuscript, which dates to 16th century, witnesses the complete text of the 15th century Statuta, whereas the copy previously known, which dates to 18th century, lacks of ten chapters. The manuscript also contains subsequent amendments and most of the names of the members of the Collegium from 1409 to 1762. Particular attention is paid, in this presentation, to the institutional framework implied by the Statuta; with that aim, its formula of approval (dated February 1409) and the chapter which lists the books on which doctoral examinations in Pavia were based are transcribed.
ANALISI STATISTICA COMPARATIVA DEGLI INFORTUNI SUL LUOGO DI LAVORO NELLâ€™UNIONE EUROPEA
Authors: Zanella Angelo , Facchinetti Danya , Bramante Riccardo
Published: November 2019

Protection and prevention with regard to the accidents at work have become important aspects of Quality control, which evolved in the direction - from being mere technological - to a system which considers all production performance aspects linked to the quality of goods and services. The physical and psychological security of the workers represent an essential element of human resources to ensure the quality and qualification of a Company. The purpose of this paper is the application to work-accidents in 14 states of EU of the concentration that is typically used for the study of income, through the discrete function of Lorenz and the corresponding Gini Index. This method opens the need to obtain more sure elements for the analysis among companies of different sizes and would also allow an accurate comparison of the international situation facing to clarify why manufacturing and transport sectors in Italy show more relative work-accidents changes than variations of the active population. It also follows a framework of great utility for personal choices and investments abroad.
DELIO TESSA STUDENTE ALLâ€™UNIVERSITÃ€ DI PAVIA
Authors: Pisani Mario
Published: November 2019

Delio Tessa (1886-1939), the writer and dialect poet of Milan has accomplished his studies at the University of Pavia, attending the Faculty of Law. His career as a student was not particularly brilliant and, as it results from his prose writings, published after his death, his recollections of that town remained only sentimental and a source of poetic inspiration.
RIFLESSIONI SUL TESTO DELLA COMMEDIA DANTESCA
Authors: Pasquini Emilio
Published: November 2019

After a brief overview of the national edition of Danteâ€™s works and the essential critical bibliography concerning the poemâ€™s text, the author focuses on Petrocchiâ€™s edition of the â€˜antica vulgata,â€™ on the subsequent attempts by Lanza and Sanguineti (based on BÃ©dierâ€™s method), and the generous experiment by Paolo Trovato (based on Lachmannâ€™s method). These proposals can be integrated with the idea (supported by Padoan, Pasquini, and Veglia) of a diffusion by groups of cantos characterised, from the outset, by the interference of oral transmission. The article also examines a number of supposedly indifferent variants (taken from Petrocchiâ€™s critical apparatus), where one of the two alternatives can be recognised as the copyistâ€™s initiative, so as to exclude any doubt that it provides an authorial variant.
HANS FRANK E Lâ€™ISTITUZIONALIZZAZIONE DI UN REGIME
Authors: Vitti Emiliano
Published: November 2019

At the end of September 1939 Polish Campaign opened the Second World War and Germans took control of their portion of territory, according to the German-Soviet agrements of August-September 1939, giving it a juridical, institutional and socialeconomic structure subject to the Reich, with specific functions and aims, as the reorganization of the administrative system through the institution of the General Government of Poland. Nevertheless, every historiographical reflection cannot be separated from the survey of Governor Hans Frankâ€™s role. His position was in fact relevant owing to his cultural and professional education, his loyalty to Hitler, his personal uncertainties, his role of First Reichâ€™s Jurist and private Hitlerâ€™s lawyer, before becoming Governor of Poland. The need of a management of Poland with SS caused frictions and jurisdiction conflicts, both at the political-institutional and on a personal level with some of the main responsible officials on behalf of Heinrich Himmler. The analisys of these atypical territorial entity through an approach which was technically correct before humanitarian is basic to understand inner workings and to try to produce a framework of the system as complete as possible about the administration of these sui generis â€œStateâ€.
LA NARRATIVA Dâ€™AMORE E LA CENSURA A BISANZIO
Authors: Conca Fabrizio
Published: November 2019

In his Bibliotheca, the Byzantine patriach Photius is very critical about Achilles Tatiusâ€™ novel, expressing a very harsh judgment because of the obscenity of the content and the indecency of the language. In the present paper this is confirmed by the analysis of significant passages, which demonstrate how licentious themes are not absent from the Libesroman. Despite of Photiusâ€™ censorship, the novel enjoyed a remarkable popularity during the Byzantine age, that was also legitimized by the assumption of the Suida Lexicon that Achilles Tatius became a Christian and a bishop towards the end of his life.
UMM-EL-BREIGÃ‚T (TEBTYNIS) 2015: LE DUE CANTINE DEI PAPIRI E I DUE TEMPLI DI SOKNEBTYNIS
Authors: Gallazzi Claudio
Published: November 2019

Juste avant dâ€™entreprendre sa campagne 2015 Ã  Tebtynis, la Mission archÃ©ologique franco-italienne, qui est Ã  lâ€™oeuvre sur le site depuis 1988, a eu Ã  sa disposition le cahier de fouille de Carlo Anti concernant les travaux rÃ©alisÃ©s sur les lieux de 1930 Ã  1932. GrÃ¢ce aux indications du cahier, la Mission a pu repÃ©rer Ã  lâ€™intÃ©rieur du sanctuaire de Soknebtynis les deux caves dans lesquelles une quantitÃ© trÃ¨s importante de papyrus fut rÃ©coltÃ©e en 1931 et dont lâ€™emplacement Ã©tait demeurÃ© inconnu. Ensuite, lâ€™Ã©quipe a dÃ©couvert le temple Ã©rigÃ© Ã  lâ€™Ã©poque de PtolÃ©mÃ©e Soter sous les vestiges du sanctuaire retrouvÃ© en 1899 et dÃ©gagÃ© en 1931-1933, qui doit Ãªtre datÃ© du Ier s. av. J.-C. et non, comme tout le monde le pensait, du dÃ©but de lâ€™Ã©poque ptolÃ©maÃ¯que.