bluuebunny/crossref_metadata_2025 huggingface dataset:
Routine Daily Chest Radiography in Patients with Pulmonary Artery Catheters
Authors: Houghton Douglas , Cohn Stephen , Schell Vaunne , Cohn Kelly , Varon Albert
Published: November 2019

• Background Pulmonary artery catheters are widely used invasive monitoring devices in critically ill patients. Clinicians disagree about whether daily chest radiographs are needed or clinical parameters alone are sufficient to verify catheter placement.

• Objectives To determine whether daily chest radiographs are needed to assess migration of pulmonary artery catheters.

• Methods One hundred consecutive patients with pulmonary artery catheters were prospectively evaluated. Clinical criteria for optimal position of the pulmonary artery catheters and findings on chest radiographs were compared. Optimal clinical criteria were (1) amount of air required to measure pulmonary capillary wedge pressure: 1.25 to 1.5 mL and (2) pulmonary artery catheter migrated 1 cm or less from initial position.

• Results Three hundred ninety comparisons of clinical criteria and radiographic findings were done. Chest radiographs indicated the catheter required repositioning in 15 (4%) of 390 instances but in only 4 (1%) of 310 instances in which bedside clinical findings indicated adequate catheter position. In 69 (18%) of the 390 cases, the clinical criteria for adequate catheter position were not met, but radiographs showed the catheter in an appropriate position. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of abnormal clinical criteria were 73%, 82%, 81%, 14%, and 99%, respectively.

• Conclusions Chest radiographs indicated that about 4% of catheters required repositioning. Catheter malposition can be reliably excluded (negative predictive value, 99%) by close observation of specific clinical criteria, so routine daily chest radiographs do not seem justified.
Association of Transient Myocardial Ischemia With Adverse In-Hospital Outcomes for Angina Patients Treated in a Telemetry Unit or a Coronary Care Unit
Authors: Pelter Michele M. , Adams Mary G. , Drew Barbara J.
Published: November 2019

• Background Little is known about the frequency or consequences of transient myocardial ischemia in patients admitted to a telemetry unit for treatment of angina.

• Objectives To compare the rate of transient myocardial ischemia in a group of patients with angina treated in a telemetry unit with the rate in a similar group treated in a coronary care unit and to determine if transient myocardial ischemia is associated with adverse in-hospital outcomes.

• Methods Continuous 12-lead electrocardiography was used to monitor changes in the ST segment in 186 patients in the coronary care unit (1994–1996) and 186 patients in the telemetry unit (1997–2000). Transient myocardial ischemia was defined as a change from baseline of 100 μV or more in the ST segment in 1 or more leads lasting 60 seconds or longer.

• Results The rate of transient myocardial ischemia was 15% for patients in the telemetry unit and 19% for patients in the coronary care unit. Regardless of hospital unit, patients with transient myocardial ischemia were more likely than those without this complication to experience death or acute myocardial infarction after hospital admission. Most patients did not experience signs or symptoms during transient myocardial ischemia: 71% of patients in the telemetry unit versus 58% of patients in the coronary care unit (P = .28).

• Conclusions Transient myocardial ischemia is common among patients with angina treated in a telemetry unit. ST-segment monitoring may be useful for detecting patients with ischemia who may benefit from more aggressive therapies aimed at abolishing ongoing ischemia.
Vasopressin in the Cardiac Surgery Intensive Care Unit
Authors: Albright Tracy N. , Zimmerman Michael A. , Selzman Craig H.
Published: November 2019

Although nearly 10% of patients experience profound vasodilatory shock after cardiopulmonary bypass, some patients remain refractory to traditional resuscitation. Among this subset are patients who have inappropriately low levels of endogenous vasopressin. Thus, vasopressin replacement is an intuitively attractive intervention. The purposes of this review are to outline the pathophysiology of vasodilatory shock after cardiopulmonary bypass, to discuss the physiological role of endogenous vasopressin, to explore the clinical basis for vasopressin replacement, and to review the pharmacology and dosing guidelines.
Oxidative Stress in Critically Ill Patients
Authors: Goodyear-Bruch Caryl , Pierce Janet D.
Published: November 2019

Oxygen-derived free radicals play an important role in the development of disease in critically ill patients. Normally, oxygen free radicals are neutralized by antioxidants such as vitamin E or enzymes such as superoxide dismutase. However, in patients who require intensive care, oxygen free radicals become a problem when either a decrease in the removal or an overproduction of the radicals occurs. This oxidative stress and the damage due to it have been implicated in many diseases in critically ill patients. Many drugs and treatments now being investigated are directed toward preventing the damage from oxidative stress. The formation of reactive oxygen species, the damage caused by them, and the body’s defense system against them are reviewed. New interventions are described that may be used in critically ill patients to prevent or treat oxidative damage.
Improvement of Glucose Control in the Intensive Care Unit: An Interdisciplinary Collaboration Study
Authors: Holzinger Ulrike , Feldbacher Monika , Bachlechner Adelbert , Kitzberger Reinhard , Fuhrmann Valentin , Madl Christian
Published: November 2019

Background Strict glycemic control in critically ill patients is challenging for both physicians and nurses.

Objectives To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol.

Methods A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of the protocol.

Results Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P < .001). The amounts of time when patients’ blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P<.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P<.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P < .001).

Conclusions Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.
Gas gangrene: certain diagnosis or certain death
Authors: Corry M , Montoya L
Published: November 2019

Clostridia are organisms which, in the right environment, can cause a rapidly spreading, fulminant myonecrosis. Early diagnosis and a combined management program are clearly paramount to a successful outcome. Knowledge of this disease and ongoing meticulous assessment are the tools that a nurse must use when dealing with patients who have gas gangrene or are at high risk of developing it. In the face of radical disfigurements that may follow therapeutic measures, the potential transfer to a distant center for treatment, and a deteriorating prognosis, the nurse must remain alert to patient and family psychologic needs.
Near drowning: a nursing challenge
Authors: McKinley MG
Published: November 2019

The victim of near drowning is one who presents multisystem problems for the critical care nurse. By understanding and recognizing the interrelationships of the problems that these individuals have, the nurse will be better able to meet the challenges presented.
Review and update of neuromuscular blocking agents
Authors: O'Brien DD
Published: November 2019

The patient arriving in the PACU or ICU following surgery requires vigilant and intelligent nursing care. The postanesthesia nurse or critical care nurse with an understanding of the neuromuscular blocking agents used in anesthesia care is best prepared to observe, evaluate, and care for this patient.
The immune system: implications for critical care nursing
Authors: Gurka AM
Published: November 2019

The immune system consists of a number of elements that work together in a complex manner to protect the body from foreign or invading organisms. Problems arise when the immune system malfunctions, or is suppressed by illness or other factors. Critical care nurses who incorporate assessment for the risk factors of immunocompromise into daily patient assessments and who plan interventions to prevent the effects of such immunocompromise, may prevent complications such as infection and achieve positive outcomes in patient care.
Care of the family of the ICU patient
Authors: Meijs CA
Published: November 2019

A nurse working in intensive care may easily forget the first impact this environment makes and therefore may unintentionally overlook a family's needs. It is hoped that this article will help nurses recognize the importance of easing stress within the family as well as provide the tools to meet the needs of each family whose loved one enters an intensive care unit.
Nursing care for patients with implantable defibrillators
Authors: McCrum AE , Tyndall A
Published: November 2019

Patients with implantable defibrillators are a new patient population that presents challenging issues and concerns. The size of this population will increase as the device's availability increases and design improvements are made that widen its applicability. These protocols have evolved during our first year with these patients and will doubtless change as we accrue experience in assisting patients to assume the role of being their own most important healthcare manager.
Alteration in gas exchange related to body position
Authors: Robichaud A
Published: November 2019

The diagnosis of alteration in gas exchange related to body position requires a deliberate evaluation of PaO2 responses. Body positions that improve V/Q matching and thus PaO2 need to be specified in patient care plans; individualized interventions are more useful than generic care plans that state, "turn q 2 h." Additionally, standard rotations for patients treated on mechanically rotating beds could be individualized according to gas exchange responses to the position changes. Routine documentation of patient body positions next to arterial blood gas results on flow sheets could prove valuable in the evaluation and treatment of hypoxemia in patients with pulmonary problems.
Intraosseous infusion
Authors: Miccolo MA
Published: November 2019

Intraosseous infusion has been documented for many decades to be a safe, fast, and effective method of fluid and medication administration. Complications are infrequent and the benefits generally far outweight the risks. Described in this article are: anatomic considerations, absorption, indications, complications, use in cardiopulmonary arrest, and insertion techniques.
Methemoglobinemia: the hidden diagnosis
Authors: Baker SA , Young DJ
Published: November 2019

Although methemoglobinemia is not commonly seen in the ER or the critical care setting, it can be life threatening if unrecognized and left untreated. A detailed case history illustrates the symptoms and some of the possible precipitating factors, and outlines treatment for a successful patient outcome.
Denial in myocardial infarction patients
Authors: Robinson KR
Published: November 2019

Since nurses are the health professionals who have the closest and most frequent contact with patients, they are in the best position to assist the MI patient with management of denial. It is important for nurses to recognize the manifestations of denial and then be able to assess the amount that denial accelerates or impedes the patient's progress toward regained health. With this increased awareness, nurses become the major influence in helping the MI patient recover psychologically as well as physically.
An epidural analgesia program: balancing risks and benefits
Authors: Rosen HF , Calio MM
Published: November 2019

An alternative to parenteral narcotic management is the administration of analgesics into the epidural space. The recognition and prevention of complications or side effects of epidural analgesia are prime concerns in planning nursing care for these patients.
Insulinoma: diagnosis and treatment
Authors: Walhout MF
Published: November 2019

A patient with an insulinoma, although rare, can be an interesting challenge to the critical care nurse. Recognition of signs and symptoms pointing to possible insulinoma is vital to prevent delays in appropriate treatment. Intensive nursing care is necessary in the preoperative, intraoperative, and postoperative stages of this condition.
The semi-prone position in ARDS: five case studies
Authors: Schmitz TM
Published: November 2019

Several studies have reported significant improvement in arterial blood oxygenation with use of the prone position in ARDS. This study, undertaken to examine the effect of the semi-prone position in patients with ARDS, resulted in several important considerations for clinical nursing practice.
Shock, a clinical syndrome: an update. Part 2. The stages of shock
Authors: Rice V
Published: November 2019

This is the second of the four-part series on Shock. It covers the four stages of shock. They include the initial stage, the compensatory stage, the progressive stage, and the refractory stage.
Use of the rubber dam after open heart surgery
Authors: Zellinger M , Lienberger TP
Published: November 2019

The presence of the rubber dam has specific implications for nursing practice. Advantages and complications of the rubber dam, as well as the implications, are discussed in this article.
Needs of families of critically ill patients: a literature review
Authors: Kleinpell RM
Published: November 2019

More research is needed to assess and address all areas of concern to family members. Options such as family discussion groups, patient-family or psychiatric liaison nurses, or clinical nurse specialist involvement might be used to improve family care and coping. Family perceptions of important needs warrant further research, and nursing interventions such as orientation-education programs, descriptive visitor pamphlets, nurse-family interaction sessions, and open or flexible visiting policies need additional investigation. It is only through continued assessment, evaluation, and intervention that critical care nurses can achieve total care for the ICU patient and family.
ICU nurses' coping measures: response to work-related stressors
Authors: Lewis DJ , Robinson JA
Published: November 2019

Stress is an integral part of every workplace. The environment of an intensive care unit exposes critical care nurses to a proportionately greater amount of work-related stress than most occupations. Several components contributing to stress as well as coping measures are discussed in this article.
A study of factors associated with CCU visiting policies
Authors: Hopping BL , Sickbert SF , Ruth J
Published: November 2019

There are many traditional beliefs about the need to restrict visitors on coronary care units (CCUs). Some hospitals, however, have modified their visiting policies. This article identifies factors related to the setting and control of visiting policies on CCUs.
Renal transplantation: a case study of the ideal
Authors: Blanford NL
Published: November 2019

Although renal transplantation has become a commonly accepted treatment for ESRD, it is anything but routine for the patient and family. Although JB's was a real case, his course represents the ideal. Seldom is a case this uneventful and benign. Follow-up care is complicated, critical and individual, and nursing plays a crucial role at each step of the transplant process.
The complicated elderly trauma patient: a case study analysis
Authors: Rauen C
Published: November 2019

SB validated many aspects of elderly trauma research and physiology. Although he had a prolonged length of stay and several complications, he survived multiple injuries and had a positive outcome. Exact causes for his complications and processes cannot be separated into degenerative or injury-related and are thus difficult to identify. With a review of aging physiology and SB's history, it is clear that his course and physiological responses to treatments were affected by his age and ability to respond to the demands placed on him. (See Table 5 for pertinent nursing diagnoses for SB.) There are physiological, psychological and sociological differences in caring for young and old trauma patients. Nursing, by virtue of its constant surveillance of patients, is in a unique position to help meet the special needs of the elderly trauma patient.
Neuroleptic malignant syndrome: critical factors
Authors: Staab WL
Published: November 2019

Although NMS is a rare complication of neuroleptic drug use, it is potentially fatal. Nursing care is directed at careful assessment, accurate treatment, and reduction of complications. Further studies should focus on prevention and treatment.
The near-death experience following multiple trauma
Authors: Sommers MS
Published: November 2019

The NDE is a fascinating but not uncommon phenomenon that some trauma victims experience during physical crises or periods of apparent clinical death. When critical care trauma nurses are familiar with the characteristics of the experience, they are able to assist trauma victims to understand available information about NDEs. More important, critical care nurses are able to assist victims and their families to understand the meanings of the NDE and how it affects their lives.
Creutzfeldt-Jakob disease: a family-centered approach
Authors: Belcaster A
Published: November 2019

Care of the patient with CJD requires particular attention to infection control and optimizing comfort. It also demands a great deal of consideration to family needs. Although none of these nursing interventions can change the final outcome for these patients, each may have an effect on the outcome for the family. A nurse with a finely tuned sense of ethics, who can prioritize the compassionate delivery of comfort, safety, and support, can make a great difference in the way a family copes with their loss.
Comfort issues in patients undergoing radiofrequency catheter ablation
Authors: Guaglianone DM , Tyndall A
Published: November 2019

The introduction of RFCA of accessory pathways offers an invasive yet safe cure for the potentially lethal arrhythmias associated with reentrant SVT. This lengthy procedure challenges nurses in providing patient comfort. It cannot be overemphasized how much these seemingly simple comfort measures can humanize an otherwise frighteningly "high-tech" atmosphere. Physical comfort as well as psychological well being will be enhanced with "high-touch" care. As RFCA becomes more common, further research must be directed toward maximizing comfort and minimizing complications.
Rupture of a splenic artery aneurysm in pregnancy
Authors: Simpson KR
Published: November 2019

Although ruptured splenic artery aneurysm in pregnancy is frequently fatal for mother and infant, prompt diagnosis and surgical treatment increase their chances for survival. Normal physiologic and hemodynamic changes of pregnancy may mask early symptoms of hypovolemic shock in pregnant women. The fetus is especially at risk, because maternal compensatory mechanisms activated during hemorrhage shunt blood from uteroplacental circulation to maternal central circulation. Collaboration between perinatal and critical care team members is essential.
Protocol for prevention of complications of endotracheal intubation
Authors: Chang VM
Published: November 2019

The care of patients with ETs is important, because pulmonary perfusion and oxygen ventilation play vital roles during the recovery process. Although several research studies have been conducted on various aspects of ET care, no standard of care on intubated patients has been developed based on results of these research studies. The value of the research findings should be recognized to ensure effective nursing interventions, minimize complications, and provide optimal nursing care.
Matching and mismatching ventilation and perfusion in the lung
Authors: Misasi RS , Keyes JL
Published: November 2019

Arterial blood-gas composition is determined by ventilation, pulmonary blood flow, and by how ventilation is matched to blood flow in the lungs. In healthy adults there are regional differences in both ventilation and blood flow in the lungs and the distribution of blood flow tends to parallel that of ventilation. Ventilation and blood flow can become mismatched in a variety of disease processes that affect the lungs. Mismatching of ventilation and perfusion causes decreased PaO2, may change PaCO2, and increases AaDO2 difference. Many different types of interventions are frequently necessary to treat mismatching of ventilation and perfusion.
Acute burn injury: a trauma case report
Authors: Byers JF , Flynn MB
Published: November 2019

Acute major burn injury provides the critical care nurse with a dynamic and complex patient care challenge. Understanding the physiological processes associated with acute major burn injury allows for proactive assessment and interventions. A thorough knowledge base regarding acute burn injury facilitates optimal patient care and improves the probability of a quality patient outcome.
Patient care conference: a coordinated, collaborative effort
Authors: Kallenbach AM , Meyer DS
Published: November 2019

The flow chart, guidelines, and document describe the mechanism for patient care conferences. Because the need, process, and documentation of patient care conferences have been clarified, care conferences are now more consistent, efficient, and effective. Documentation streamlined the process of setting up care conferences by recording the following information: who was notified, who would attend, specific issues to be discussed, conference scheduling summary of plans and decisions made. Task force satisfaction was high because of a short timeline, clear problem definition, clear goals, team sponsorship, and a good end product. Use of continuous quality improvement techniques added to the success of this project, because there was a methodology for starting with a variable, unclear process and ending with a creative, efficient process. All members of the healthcare team and patients and families were satisfied, because the patient care conference was available to discuss specific issues and reach consensus on decisions about the patient's treatment plan at critical points during the patient's hospital course.
Preoperative antioxidant and allopurinol therapy for reducing reperfusion-induced injury in patients undergoing cardiothoracic surgery
Authors: Simko LC , Walker JH
Published: November 2019

Administration of vitamin E, vitamin C, and allopurinol to reduce reperfusion-induced injury remains controversial. Clinical trials are being conducted, and the results are promising. No adverse side effects have been reported with the short-term use of these drugs. The cost of the pre-operative medication is approximately $5 per week, which favors its use. The ability of nurses to be effective advocates of patients receiving these drugs is vital. What appears to be a trivial medication regimen may save myocardial cells and promote an uncomplicated postoperative period.
Academic education. Creating a laboratory that simulates the critical care environment
Authors: Morton PG
Published: November 2019

Educating students and practicing nurses for the complexities and demands of critical care is a challenge. Training in a laboratory that simulates the critical care setting is an excellent teaching method that can be used to supplement lectures and clinical experiences. Developing such a laboratory is an exciting and rewarding process that will promote learning and ultimately benefit the care of critically ill patients.
Assisted suicide, recent judicial decisions, and implications for critical care nurses
Authors: Wlody GS
Published: November 2019

The passage of the Oregon Death With Dignity Act on November 8, 1994, heralded a wake-up call for healthcare professionals. Oregon, the first state to systematically "ration care" was thought to be a fertile ground for testing new and, some say, radical concepts in healthcare and government. Although the act was not implemented because it was tied up in legal action until February 1997, the fact that more than 50% of the voters in Oregon voted for it mandates that healthcare providers listen to their patients. Patients want more control of their pain, the way they die, and the resources spent on their care in the final days of their lives. Thoughts of future suffering engender great fear on the part of healthcare consumers. Concern exists that physician-assisted suicide in the ICU will affect not only physicians but also nurses, pharmacists, respiratory therapists, and other clinicians as terminally ill patients make requests for assisted suicide while in the acute and critical care setting of the hospital. Critical care nurses must examine their value systems, review the Code for Nurses, and make their own decisions about participation in deliberately ending lives of patients. With the impending Supreme Court decision due in July 1997, the court may leave these issues to the individual states, opening the door for assisted suicide to occur throughout the United States. Therefore, the possibility will remain that critical care nurses may be put in positions in which physicians are providing assistance to patients who wish to commit suicide and are requesting nurses' assistance to do so.
Management of children in status asthmaticus
Authors: Briening EP
Published: November 2019

Children admitted to the ICU with status asthmaticus require continuous nursing assessment of respiratory status and monitoring of the response to therapy. Nurses must be aware of the progression of respiratory distress and of the expected response to treatment and the side effects that can occur with each therapy. By assuming a greater responsibility in the care of the child with status asthmaticus, critical care nurses can improve the quality of care for these patients.
Tetanus: critical implications for nursing
Authors: Boyles CS , Mills MH , Trupiano P
Published: November 2019

In the United States today, tetanus is a rare disease. However, when it occurs, it can be a highly challenging situation for all members of the healthcare team. The majority of care during the course of the disease is supportive. The availability of personnel trained in managing cardiorespiratory emergencies and sustained mechanical ventilation in the ICU environment can have a beneficial effect on patients' outcomes. An awareness of the potential complications of tetanus can hasten recovery and maintain the patient's preexisting quality of life.
Cardiovascular chronobiology: implications for critical care nursing
Authors: Bridges EJ , Woods SL
Published: November 2019

Critical care clinicians must consider known expected circadian rhythms when interpreting fluctuations in patients' hemodynamic values. As noted in the case study, knowledge of circadian rhythmicity in cardiovascular variables may help clinicians anticipate hemodynamic changes and develop and evaluate chronobiologically sensitive interventions, including prescriptions for activity, modification of the timing of medications, and provision of protective interventions for patients with disrupted rhythms. Felver provides excellent guidelines for the systematic review of possible causes for overt changes in circadian patterns. This review highlights the need to evaluate (1) the effect of disease progression on temporal patterns, (2) the patient's underlying endogenous rhythms, (3) the zeitgebers that may entrain the patient's biological rhythms (e.g., light, social cues, and sleep-wake cycles), and (4) how the zeitgebers change in a critical care environment. The body of literature on the rhythmic fluctuation of cardiovascular variables in healthy, young subjects is extensive. During the past 10 years, research on the chronobiologic fluctuations of numerous physiological variables (cardiovascular, pulmonary, hematologic, and endocrine) in critical illness has increased. As information on the fluctuations in critically ill patients increases, critical care clinicians will be challenged to develop and evaluate a chronobiologically sensitive plan of care for these patients.
Improving the care of cardiothoracic surgery patients through advanced nursing skills
Authors: Zevola DR , Maier B
Published: November 2019

All the nurses in the cardiothoracic ICU are now certified in these advanced skills. The skills are reviewed with current staff members on a yearly basis during the annual evaluation. During their orientation to the cardiothoracic ICU, new staff nurses are certified by using the original process of attending an in-service training program and demonstrating the skill 3 times. The quality management department reviews medical records daily to detect complications. In addition, we (DRZ and MB) conducted a quality assurance review in which we monitored 20 patients being extubated and having PA catheters removed by nurses. No complications were noted during either review. The institution has seen improvements in quality of care and earlier discharge from the hospital. With earlier removal of endotracheal tubes and PA catheters, patients are more comfortable and their rehabilitation can be advanced sooner. Comparison of the mean length of stay for patients undergoing coronary artery bypass graft in March 1995 with the mean length of stay for such patients in March 1998 showed a 50.6% decrease, from 14.94 days to 7.38 days. These advanced skills have provided an increased autonomy for the nurses and have benefited the patients undergoing cardiac surgery in our institution.
Naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms
Authors: Iacono LA
Published: November 2019

The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. Critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. Critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.
Same-day transfer of patients to the cardiac telemetry unit after surgery: the Rapid after Bypass Back into Telemetry (RABBIT) program
Authors: Sakallaris BR , Halpin LS , Knapp M , Sheridan MJ
Published: November 2019

Early data from this project suggest that the RABBIT program fulfilled the process improvement goals of decreasing costs of cardiac surgery and maintaining high quality. Decreased cost was achieved by decreasing time to extubation and decreasing length of stay in the ICU and the total length of stay in the hospital. The cost savings were achieved without compromising the quality of care, which was assessed by measuring rates of readmission to the ICU and to the hospital and by surveying patients about their level of satisfaction. The success of the RABBIT program can be attributed to several factors. First, members of the cardiac surgery quality improvement team worked well together to solve problems and overcome obstacles, particularly after the pilot program. Second, naming the program helped to motivate staff, physicians, and patients. Outcome data was shared with the staff quarterly, and successes were celebrated. Finally, the use of a facilitator early in the process to establish the process with the surgeons and the staff was invaluable. Opportunities for continued improvement include resolving operational difficulties related to availability of beds and staffing, continuing work with physicians in changing practice patterns, increasing efficiency in scheduling operating rooms, and adjusting the preoperative education provided to patients and their families about the length of stay to expect. Quarterly outcome analysis continues, with reports to the cardiac surgery quality improvement team. The team continues to explore creative solutions to the aforementioned issues, as the goal of having 25% of patients who undergo cardiac surgery be transferred to the CTU on the day of surgery has remained elusive.
Ethics and practice in organ transplantation in patients infected with human immunodeficiency virus
Authors: Ricci-Murphy JA , Ress B , Axt C
Published: November 2019

In sum, much more needs to be known about the issue of transplantation in HIV-infected patients before the current state of extremely limited access to transplantation for these patients can be medically and ethically justified. Approaches to remedy this situation may include well-designed outcome studies; revision of existing local, regional, and national policies to better reflect the current state of knowledge; and education of clinicians, patients, and the public about this topic. Nurses can effect change in this area as informed clinicians, patients' advocates, researchers, and policy makers.
Messages of professional empowerment from the land of Oz
Authors: Caine RM , Lowenstein H
Published: November 2019

In the movie adaptation of Baum's book, Dorothy's whole adventure was a dream. But the movie told only a part of the original story. In the print version, Oz was a real place to which Dorothy eventually relocated after 3 more visits; Dorothy moved to Oz permanently in the sixth book (of 13 books) and became a princess. In many ways, critical care professionals are all living in a modern healthcare version of the story of Oz-facing tornadoes, wandering fields of intense expectations, traveling indistinct paths, manipulating wizardly technology, and confronting new enemies. To survive and thrive, we must have brains, heart, and courage. Despite everything that is going on around them, critical care professionals continue to have a sense of mission, a vision of continual improvement and professionalism, and a code of ethics that transcends the complex environment swirling around us. We can begin by creating a personal vision that we wish to achieve. This vision is not an academic exercise but rather a compelling statement that anticipates tomorrow without neglecting today. This vision will require commitment, teamwork, and involvement to make it a reality. Like the end of the original story of Oz, the end of this story is just the beginning. . . . Click your heels together 3 times and say, "It's a new century for critical care nurses!"
Self-scheduling and staff incentives: meeting patient care needs in a neonatal intensive care unit
Authors: Vetter E , Felice LD , Ingersoll GL
Published: November 2019

Nursing staff and leadership in a resource-intensive NICU identified an innovative process for covering the unit's scheduling needs. Early concerns about the feasibility of achieving self-scheduling with a large staff were unwarranted. The use of a unit-based committee and the support of the nurse manager allowed us to develop a process that met the needs of the staff members and maintained the staffing standards of the unit. Contributing to the success of the self-scheduling is a mechanism for recognizing and rewarding staff members who adjust their work schedules to meet the needs of the unit. Satisfaction among staff members with self-scheduling is high, and new employees cite the opportunity for self-scheduling as a contributing factor in their decisions to work in the NICU.
An easy method for interpreting the results of arterial blood gas analysis
Authors: Kirksey KM , Holt-Ashley M , Goodroad BK
Published: November 2019

Interpretation of acid-base disturbances is an essential skill for critical care nurses. Using the H model makes this process easy. When students and novice critical care nurses feel competent with certain skills, their confidence levels are greatly enhanced. One of us (K.M.K.) has been using the H model for many years to teach students how to interpret the results of arterial blood gas analysis. The students are often amazed at how easy and fun the model makes learning a subject many perceive as complex.
FORMAZIONE DEL CONSENSO E PANEGIRICI ALLâ€™EPOCA DELLâ€™IMPERATORE GIULIANO
Authors: Maranesi Alessandro
Published: November 2019

The text analyzes the role played by Mamertinusâ€™ gratiarum actio in trying to give political and cultural legitimation to the reign of Julian. It is intended to show that, against the apparent contradiction inherent in the concept of "new tradition", this panegyric reflects the attempt to conduct a real overturning of the concept of novitas, which assumes a meaning profoundly positive. In conclusion, we could note how the processes of urban renewal are examples of this trend.
PROPOSTA DI UNA FUNZIONE UTILITÃ€ DIPENDENTE DALLâ€™UTILITÃ€ ATTESA E DALLA DISPERSIONE DELLE UTILITÃ€
Authors: Frosini Vittorio B.
Published: November 2019

The author develops the properties and implications of a proposal, concerning a summary statistic of the random prospect of utilities. Following a suggestion of Maurice Allais, such a statistic is increasing with expected utility, and decreasing â€“ for most people, who are risk averse â€“ with the mean absolute deviation of utilities; a parameter multiplying this dispersion measure allows for risk averse or risk prone behaviour, according to its sign, and also for more or less departure from a certain prospect. It is demonstrated that this statistic (a) satisfies the first stochastic dominance, (b) satisfies the independence condition, (c) satisfies the so called â€œproblem of probabilistic insuranceâ€, (d) resolves the paradoxes of Allais, Ellsberg and Kahneman-Tversky (paradox of the substitution axiom), (e) the mean absolute deviation from the mean cannot be replaced by the standard deviation.
LATE ANTIQUE OR EARLY BYZANTINE? THE SHIFTING BEGINNINGS OF BYZANTINE LITERATURE
Authors: Agapitos Panagiotis A.
Published: November 2019

The aim of the paper is twofold. On the one hand, it examines the epistemological reasons behind the shifting beginnings of Byzantine literature, a shift that covers a period of four centuries (AD 300-700), as well as the methodological problems for the study of Byzantine literature resulting from the rise of Late Antiquity as a new historical period and a new field of studies. On the other hand, the paper proposes a series of four textually immanent criteria and seven internal operative principles by means of which a different methodological approach to the Â«beginningÂ» of Byzantine literature can be reached. For this purpose Eusebios of Caesarea and Lactantius will be used as the textual basis for establishing a structural break in literary production in the first two decades of the fourth century. For the purpose of controlling this proposal a comparison with an important but highly debated monument (the Arch of Constantine in Rome) will be made and some final conclusions as to the course of Greek literature in early Byzantine times will be made.
IL DIRITTO SOCIETARIO TRA DIRITTO COMPARATO E DIRITTO STRANIERO
Authors: Portale Giuseppe B.
Published: November 2019

The article tackles the issues related to the use of comparative law a source of substantive law in a specific legal system, with specific regard to corporate law. Expanding on previous studies on the general role of comparative law in the framework of sources of law (Â§ 1), the study argues that the comparative argument may be used to regulate purely domestic cases and as well as a play a crucial role in interpreting internal laws (Â§Â§ 1.1, 1.2) and analyzes the theoretical foundations of such process (Â§ 1.3) as well as the problems caused by the application of foreign law by a domestic judge (Â§ 2). Subsequently, two examples of such usage of the comparative legal argument are provided, drawn from the Italian corporate law experience (Â§ 3): on the one hand, the introduction of a specific regulation of a simplified private company (societÃ  a responsabilitÃ  limitata semplificata), representing a circulation of German (Unternehmergesellschaft- UG) and Belgian (sociÃ©tÃ© privÃ©e a responsabilitÃ© limitÃ©e starter) models (Â§ 3.1); on the other hand, the use of comparative law by in the interpretation of the organization structure in the Italian dualistic system (Â§ 3.2).
INFORMATION SYSTEM AND PRODUCTION PROCESS CONTROL
Authors: Zanella Angelo , Cascini Egidio
Published: November 2019

We start with the definition of experimental data. First place we consider the controllable variables, whose levels are established by technical production experts with regard to a theoretic â€œmodelâ€ defining the production components, their connections and working rules in sight of the envisaged achievements. Then, the responses or results of production activities, which typically show random variability. The controllable variables are used to regulate the means of their distributions and aspects of variability (Taguchi approach). An information system represents a data collection, which is directed to specific purposes like: financial control, accounting control, personnel control, business control, production control, framed around production programs, control of production lines and related maintenance, quality control, framed around control of nonconformities regarding some specification limits and ensuring product good quality over time. Qualitative guidelines for choosing the data for a quality control information system are that it must be as near as possible to a sufficient system which means that it is capable of explaining any nonconformity in a product characteristic, as well as being complete, that is, such that it is also capable of suggesting how to remove them. In a natural way quality control implies a dynamic approach based on a systematic improvement of production activities, starting from specific reference conditions. We consider two examples appropriated to explain the fundamentals of a methodology useful to cope with this complex subject. The first example refers to a real industrial application regarding the process control of polyvinyl chloride production, found in literature [9]. The second example concerns the distribution process of perishable goods, which is considered to be an innovation. In this case we suppose that there is a finite set of operating situations (points of sale) and that we can define an indicator Q=Q1 /c = Quality of a reference product/a corresponding economic quantity (cost or earning). In the case considered, by means of the ordering of the ratios total cost/total earning, we come to the most profitable situation.
PIERO SRAFFA: UN ECONOMISTA SCONOSCIUTO?
Authors: Porta Pier Luigi
Published: November 2019

This note outlines essential elements for reconstructing the intellectual route followed by Piero Sraffa on the basis of archival documents dating from the second half of the 1920s. These documents highlight Sraffaâ€™s interest in Marxâ€™s lack of success in linking his theoretical contribution to the reconstruction of its precedents in the history of political economy. Archival documents illustrate the formative phase of Sraffaâ€™s scientific programme and show his intention to build a new theory starting from its premises in the history of economic analysis. Sraffaâ€™s subsequent abandonment of the historical-analytical approach confirms Luigi Pasinettiâ€™s view that Sraffa had to shelve an initial programme of great vastity and ambition to reduce it within feasible limits, of which his â€˜equationsâ€™ are a characteristic feature.
SUL RITORNO DELLâ€™ECONOMIA POLITICA
Authors: Cardinale Ivano , Scazzieri Roberto
Published: November 2019

The transformations of political economy since its formative period in the late 16th-early 17th century (Bodin, Botero, Serra, Monthchrestien) defines its object as a field of possibilities. A dynamic (that is, historical) view of political economy is therefore a condition for identifying the relationship between different theoretical frameworks addressing the economic domain. The relationship between ends and means is central to the conceptual structuring of that domain and is at the root of the cleavages and overlaps that characterize the dynamics of economic theory. This essay highlights the central role of interdependencies in the construction of economic theory and highlights their importance both for identifying the internal structure of constraints in the economy and for assessing the relative weights of partial interests that are at the origin of collective actions. The essay also highlights the intertwining of material and social interdependencies in the dynamics of economic theory, and discusses the relationship between partial interests and forms of systemic interest. The latter relationship highlights the possible coexistence of coalitions and conflicts within the same system of interdependencies and makes such coexistence to depend on the internal, multi-level structure of interdependencies in the polity. This analytical framework is then applied to the assessment of multiple possible visualizations of systemic interest in the Eurozone.
LINGUA LOMBARDA?
Authors: Stella Angelo
Published: November 2019

The paper deals with the vivid concept of â€˜lingua lombardaâ€™ (often in between higher and lower cultures) as it is can be traced in a wide range of authors, from the first centuries to Dante, from Manzoni to 20th- and 21st-centuries scholars. It is in Italian dialectal areas where it is especially clear the cultural and methodological connection between (micro-)history and (micro-)geography for the long linguistic history of Italy. On the steps of a willing and yet perfectible regional law, scholars and academics (and the very Crusca too) should take actions in favour of these documentary and oral testimonies of â€˜local varietiesâ€™ in order to avoid their disappearance; they are an immaterial and now endangered treasure which was able, over the centuries, to give voice to so many â€˜vili e meccaniciâ€™. One important step in this direction could be a new (historically and geographically oriented) reading of the AIS maps.