bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tobacco Dependence Curricula in Acute Care Nurse Practitioner Education
Authors: Heath Janie , Andrews Jeannette , Thomas Sue Ann , Kelley Frances J. , Friedman Erika 
Published: November 2019

• Background Tobacco dependence is the leading preventable cause of death in the United States, yet healthcare professionals are not adequately educated on how to help patients break the deadly cycle of tobacco dependence.• Objective To assess the content and extent of tobacco education in the curricula of acute care nurse practitioner programs in the United States.• Methods A survey with 13 multiple-choice items was distributed to the coordinators of 72 acute care nurse practitioner programs. The survey was replicated and modified from previous research on tobacco dependence curricula in undergraduate medical education.• Results Fifty programs (83%) responded to the survey. Overall, during an entire course of study, 70% of the respondents reported that only between 1 and 3 hours of content on tobacco dependence was covered. Seventy-eight percent reported that students were not required to teach smoking-cessation techniques to patients, and 94% did not provide opportunities for students to be certified as smoking-cessation counselors. Sixty percent reported that the national guidelines for smoking cessation were not used as a curriculum reference for tobacco content.• Conclusions The majority of acute care nurse practitioner programs include brief tobacco education. More in-depth coverage is required to reduce tobacco dependence. Acute care nurse practitioners are in a prime position to intervene with tobacco dependence, especially when patients are recovering from life-threatening events. National recommendations for core tobacco curricula and inclusion of tobacco questions on board examinations should be developed and implemented.
“Nurse, I Only Had a Couple of Beers”: Validity of Self-reported Drinking Before Serious Vehicular Injury
Authors: Sommers Marilyn Sawyer , Dyehouse Janice M. , Howe Steven R. , Wekselman Kathryn , Fleming Michael 
Published: November 2019

• Background Of the more than 40 000 Americans killed each year in vehicular crashes, 40% are involved in alcohol-related collisions. Although self-reported alcohol use has become an anchor for alcohol intervention after traffic crashes, clinicians are often skeptical about the truthfulness of self-reporting.
• Objective To determine the validity of self-reported alcohol consumption of vehicular occupants hospitalized for a serious, alcohol-related injury.
• Methods Non-alcohol–dependent subjects 18 years and older who were injured in motor vehicle crashes were interviewed. The self-reported number of standard drinks, time that drinking commenced, sex, and weight were used to calculate estimated blood alcohol concentration. This value was compared with the blood alcohol concentration measured at admission.
• Results Of the 181 subjects, 60% provided sufficient data to calculate the estimated concentration. Seven men with admission concentrations of 10 mg/dL or more denied drinking. Among the 113 subjects with estimated concentrations who acknowledged drinking (excluding the 7 who denied drinking), the mean concentration at admission was 158.67 mg/dL, and mean estimated concentration was 83.81 mg/dL. According to multiple regression analyses, weight and number of drinks accounted for 3% of the variance in alcohol concentration at admission for women (R =0.174, F2,40 = 0.623, P = .54) and for 29% of the variance in men (R=0.543, F2,128 =26.71, P&lt; .001).
• Conclusions Most persons who drink before vehicular injury acknowledge drinking. Self-reported data from men generally reflect the overall trend of alcohol consumption but with systematic underreporting. Reports from women are less predictable.
Bacterial Growth in Secretions and on Suctioning Equipment of Orally Intubated Patients: A Pilot Study
Authors: Sole Mary Lou , Poalillo F. Elizabeth , Byers Jacqueline F. , Ludy Jeffery E. 
Published: November 2019

• Background Contamination of equipment, colonization of the oropharynx, and microaspiration of secretions are causative factors for ventilator-associated pneumonia. Suctioning and airway management practices may influence the development of ventilator-associated pneumonia.
• Objectives To identify pathogens associated with ventilator-associated pneumonia in oral and endotracheal aspirates and to evaluate bacterial growth on oral and endotracheal suctioning equipment.
• Methods Specimens were collected from 20 subjects who were orally intubated for at least 24 hours and required mechanical ventilation. At baseline, oral and sputum specimens were obtained for culturing, and suctioning equipment was changed. Specimens from the mouth, sputum, and equipment for culturing were obtained at 24 hours (n = 18) and 48 hours (n = 10).
• Results After 24 hours, all subjects had potential pathogens in the mouth, and 67% had sputum cultures positive for pathogens. Suctioning devices were colonized with many of the same pathogens that were present in the mouth. Nearly all (94%) of tonsil suction devices were colonized within 24 hours. Most potential pathogens were gram-positive bacteria. Gram-negative bacteria and antibiotic-resistant organisms were also present in several samples.
• Conclusions The presence of pathogens in oral and sputum specimens in most patients supports the notion that microaspiration of secretions occurs. Colonization is a risk factor for ventilator-associated pneumonia. The equipment used for oral and endotracheal suctioning becomes colonized with potential pathogens within 24 hours. It is not known if reusable oral suction equipment contributes to colonization; however, because many bacteria are exogenous to patients’ normal flora, equipment may be a source of cross-contamination.
Recovering From Cardiac Surgery: What Patients Want You To Know
Authors: Doering Lynn V. , McGuire Anthony W. , Rourke Darlene 
Published: November 2019

• Background Care of cardiac surgery patients has changed substantially in the past decade, with an emphasis on streamlined procedures and shortened hospital stays. The few qualitative reports of patients’ perspectives of this experience focus primarily on physical complications and discomforts during the immediate postoperative period.
• Objective To examine patients’ perceptions of the quality of the nursing and medical care they received during their hospital stay after cardiac surgery.
• Methods Data were collected from a consecutive sample of 89 cardiac surgical patients who consented to participate in 2 telephone interviews at 1 week and 6 weeks after hospitalization. Patients responded to a single open-ended question: “What do you want your nurses and doctors to know to help them do a better job?” Thematic extraction analysis of patients’ responses was conducted by using commercially available statistical software. Extracted themes were applied to the structure-process-outcome framework of quality of care.
• Results Four major themes (and 12 subthemes) were identified: (1) being satisfied (having a positive experience, getting information), (2) not being cared for (feeling depersonalized, having expectations that did not match recovery experiences, not being listened to, experiencing unprofessional behavior by care providers, experiencing continued care needs after going home), (3) physical needs unmet (sleep, pain, complications, physical environment), and (4) informational needs unmet (needing more or different information).
• Conclusions Patients want nurses and doctors to provide a smooth transition to home, recognize the patients as individuals, prepare them honestly for their experiences with specific information, and manage pain and sleep.
Predictors of Quality of Life at 1 Month After Implantation of a Left Ventricular Assist Device
Authors: Grady Kathleen L. , Meyer Peter , Mattea Annette , Dressler Diane , Ormaza Sophia , White-Williams Connie , Chillcott Suzanne , Kaan Annemarie , Todd Barbara , Loo Alice , Klemme Annette L. , Piccione William , Costanzo Maria Rosa 
Published: November 2019

• Objectives To describe quality-of-life outcomes; determine relationships between quality of life and demographic, physical, psychosocial, and clinical variables; and identify predictors of quality of life at 1 month after implantation of a left ventricular assist device.
• Methods Patients who received either an implantable pneumatic (n = 38) or a vented electric (n = 54) left ventricular assist device as a bridge to heart transplantation between August 1, 1994, and August 31, 1999, completed 6 instruments used to measure quality of life and factors related to quality of life. Data were analyzed by using descriptive statistics, Pearson correlations, Mann-Whitney U tests, and forward, stepwise multiple regression.
• Results Overall satisfaction with quality of life was quite high as determined from the total score on the Quality of Life Index (mean = 0.69). Patients were very satisfied with the implantation and thought that they would do well after future heart transplant surgery. Patients had a moderate level of stress. Significant predictors of overall quality of life were psychological symptoms, stress, and race; these accounted for 46% of variance in quality of life.
• Conclusions Patients were satisfied with their quality of life at 1 month after implantation of a left ventricular assist device. However, they were least satisfied with their health and functioning and yet were optimistic about how well they thought they would do after heart transplantation. Psychological factors were the strongest predictors of satisfaction with overall quality of life.
Weaning Older Patients From Long-term Mechanical Ventilation: A Pilot Study
Authors: Epstein Carol Diane , El-Mokadem Naglaa , Peerless Joel R. 
Published: November 2019

• Background As older persons in the intensive care unit increasingly require long-term mechanical ventilation, accurate indications of readiness for weaning from ventilatory support are needed to avoid premature extubation.
• Objective To describe temporal changes in pulmonary and systemic variables in older adults receiving long-term mechanical ventilation.
• Methods After 3 days of unsuccessful attempts at weaning from ventilatory support, 10 trauma and surgical patients more than 60 years old were monitored daily. Previously reported predictors of the duration of mechanical ventilation and weaning outcome were measured, including hemodynamic and gas exchange variables, oxygen cost of breathing, and the score on the Burns Weaning Assessment Program.
• Results The 6 patients who could be weaned from ventilatory support were younger (median age, 71.5 years) than the 4 patients who could not be weaned (median age, 80 years). Patients who could be weaned were ready for weaning by day 11 of their stay in the intensive care unit and required an additional 5.5 days of mechanical ventilation; those who could not be weaned were not ready for weaning until day 17. All patients initially had increases in oxygen consumption during weaning; those who were successfully weaned had decreases before extubation. Respiratory rate, maximal inspiratory pressure, the ratio of Pao2 to fraction of inspired oxygen, and mean arterial pressure were higher in patients who could be weaned, and oxygen cost of breathing and central venous pressure were lower.
• Conclusion Further study of weaning in older adults is warranted.
Use of Intercostal Bupivacaine With Epinephrine After Surgery to Decrease Use of Narcotics and Duration of Intubation
Authors: Fox William J. , Hughes Thomas A. 
Published: November 2019

• Background Postoperative pain plays a significant part in the recovery of patients after open heart surgery.
• Objective To determine if the use of intercostal bupivacaine with epinephrine is associated with decreases in use of narcotics and intubation times after open heart surgery.
• Methods A randomly selected experimental group of 25 patients received injections of bupivacaine with epinephrine in the intercostal tissues before chest closure in open heart surgery. A control group of 22 patients received no bupivacaine, only standard care. Postoperative use of narcotics and intubation times were determined for both groups.
• Results Compared with the control group, the group given bupivacaine with epinephrine used significantly less narcotics (P = .008) and had significantly shorter intubation times (P = .003).
• Conclusion Injection of intercostal bupivacaine with epinephrine before chest closure in open heart surgery decreases use of narcotics and length of intubation postoperatively, thus speeding up recovery times.
An Educational Project to Improve Knowledge Related to Pulse Oximetry
Authors: Attin Mina , Cardin Suzette , Dee Vivien , Doering Lynn , Dunn Dieula , Ellstrom Kathi , Erickson Virginia , Etchepare Maria , Gawlinski Anna , Haley Theresa , Henneman Elizabeth , Keckeisen Maureen , Malmet Marcia , Olson Lisa 
Published: November 2019

• Background Pulse oximetry is a frequently used, noninvasive monitoring tool for assessing arterial blood oxygenation. Physicians, registered nurses, and respiratory therapists are responsible for the accurate interpretation of pulse oximetry data as part of the evaluation and management of acutely and critically ill patients.
• Objectives (1) To evaluate the extent of current knowledge about pulse oximetry and (2) to increase clinicians’ knowledge of research-based practices related to the appropriate use of pulse oximetry and interpretation of its results.
• Methods A test/survey of 17 true-false questions based on the research-based practice protocol of the American Association of Critical-Care Nurses was developed to evaluate current knowledge of pulse oximetry. A convenience sample of medical, nursing, and respiratory therapy staff was invited to complete the test/survey before and several months after an educational program to improve staff members’ knowledge of pulse oximetry. The program included educational forums, policy changes, competency checklists, and verification of inclusion of research-based principles in orientation programs.
• Results A total of 442 staff members completed the test/survey given before the educational program: 331 nurses, 82 physicians, and 29 respiratory therapists. The overall mean percentage of correct answers was 66%. Differences between disciplines were significant: respiratory therapists scored slightly higher (76%) than did nurses (64%) and physicians (66%) (P = .01). The scores on the test/survey given after the educational program increased significantly, from 66% to 82% (P &lt; .01).
• Conclusions This educational project improved staff members’ knowledge of pulse oximetry monitoring.
Incentive Spirometry in Postoperative Abdominal/Thoracic Surgery Patients
Authors: Rupp Michael , Miley Helen , Russell-Babin Kathleen 
Published: November 2019

Background:
Postoperative patients have higher incidences of respiratory complications. Patients undergoing abdominal or thoracic surgical procedures are at greater risk of having such complications. Incentive spirometry is an inhalation-based prophylactic technique that encourages patients to mimic a natural deep sigh to periodically increase lung volume. As this technique is the prophylactic method of choice for many hospitals, several studies have tested its efficacy.

Methods:
Five articles, including 4 systematic reviews and 1 clinical practice guideline, are analyzed and summarized. Each article was reviewed by a multidisciplinary team of health care providers and is discussed herein. A clinical recommendation for practice change is provided on the basis of the results.

Summary:
Incentive spirometry is only as effective as cough/deep-breathing regimens and other means of postoperative pulmonary prophylaxis. No single prophylactic technique clearly outperforms all others in preventing pulmonary complications. Future research is needed to determine the best method to prevent postoperative pulmonary complications.
LE AGENDE GLOBALI DI SVILUPPO DELLE NAZIONI UNITE
Authors: Chiappero Enrica 
Published: November 2019

In the last two decades the international community (or at least part of it) has shown an increasing awareness regarding the global challenges that either developed and developing countries are facing with: these challenges, which surely includes climate changes and international migrations, growing inequalities and persisting poverty, are raising serious concerns regarding the environmental, social and economic sustainability of the current model of development. On the basis of these arguments the UN system has promoted two main Agendas for development, in 2000 and 2015, setting goals and targets to be achieved. But do we really need an Agenda for development? What have we learnt from the MDGs and to what extent criticisms and weaknesses in the Agenda 2015 have been taken into account in designing the Agenda 2030? This short note is aimed to briefly touch some of these issues by comparing the two agendas.
Acting Through Inaction: The Distinction Between Leisure and Reverie in Jacques Rancière’s Conception of Emancipation
Authors: Ross Alison 
Published: November 2019

The classical distinction between leisure and work is often used to define features of the emancipated life. In Aristotle leisure is defined as time devoted to purposeful activity, and distinguished from the labour time expended merely to produce life’s necessities. In critical theory, this classical distinction has been adapted to provide an image of emancipated life, as purposively driven, fulfilling and meaningful activity. Aspects of this adapted definition undermine the classical leisure/work distinction to the extent that the demand for meaningful work, i.e., a leisure-work conjunction, is now used as a critical perspective on unfulfilling, oppressive labour. Rancière, however, is critical both of this idea of an extended franchise for leisure and of its dependence on craft and artisanal labour as the model of satisfying, skilled work. Instead of Aristotelian leisure, or ‘fulfilling’ work, Rancière identifies in the state of reverie an alternative marker for the emancipated life. The theme is consistent across the scattered archival, historiographical, philosophical, literary and aesthetic contexts his writing treats. But since reverie is defined as disengagement from action, the position raises a number of difficulties. This article examines how Rancière connects reverie to emancipation. It focuses on two questions: the nature of the relation between his definition of reverie and the classical, Aristotelian concept of action; and, whether, given the constitutive non-relation between reverie and action that he outlines, Rancière’s position can address the persistent problem in critical theory of the motivation for the emancipated life. It is argued that his highlighting of the potential communicative significance of modes and scenes of emancipated life is relevant to this problem. The key argument is that rather than developing a ‘theory’, his approach to emancipation focuses on and values communicable experiences of emancipation, and that states of reverie are one such type of valued experience.
Ontogénesis del pensamiento especulativo anselmiano
Authors: Corti Enrique Camilo 
Published: November 2019

De concordia, el último tratado escrito por Anselmo constituye un hito privilegiado en la ontogénesis de su pensamiento. Intentaré delinear en De concordia aquellos aspectos de su macroestructura que juzgo importantes y que pertenecen a ese proceso genético:
a) la obra se inscribe —junto con Monologion y Cur deus homo— en la ontogénesis del pensamiento anselmiano en tanto pensamiento especulativo;
b) este carácter especulativo está asociado íntimamente al lenguaje a través de la noción nihil;
c) la articulación entre libertad y necesidad cuanto el desdoblamiento del centro de DC (en centro textual y centro objetivo), son subsidiarios del antedicho carácter especulativo.
Effect of season and parity on water buffalo calving distribution throughout the year in Venezuela
Authors: Nava-Trujillo Héctor , Valeris-Chacin Robert , Hernandez Javier , Duran Nuñez Mariano , Morgado-Osorio Adriana , Caamaño Janeth , Quintero-Moreno Armando 
Published: November 2019

The aim of this study was to determine the effect of season and parity on water buffalo calving distribution throughout the year in Venezuela. A retrospective study analyzing records of 3,192 crossbred (Murrah/Mediterranean) buffaloes including 7,790 calvings was carried out in Venezuela. Two seasons were evaluated according to the length of the photoperiod: September-February (short photoperiod; autumn-winter) and March-August (long photoperiod; spring-summer). Parity order was categorized in parity 1, parity 2, parity 3, and parity 4. Photoperiod was shorter between September and February in comparison with March-August (11.81 ± 0.08 h/day and 12.42±0.08 h/day, respectively, p < 0.05). Percentage of calving varied between the two seasons (p < 0.05), and 63.7% (95% Confidence Interval (CI): 62.5%-64.9%) of calving occurred during the season of short photoperiod in comparison with that of the season of long photoperiod (36.3%, 95% CI: 35.1%-37.5%), and this effect was observed in all parities. The proportion of calvings during the short photoperiod season was greater as parity increased. The percentage of calving during the short photoperiod season was lower in primiparous water buffalo cows in comparison with that of multiparous water buffalo cows; conversely, the percentage of calving during the long photoperiod season was higher in primiparous water buffalo cows in comparison with that of multiparous water buffalo cows. Eight percent of water buffalo cows having their first calving in the long photoperiod season had the next calvings during this season. In conclusion, results confirm the seasonal reproductive behavior of water buffaloes with a concentration of calvings during the months with short photoperiod; this seasonality becomes stronger as parity increases; even though a small percentage of water buffalo cows has the ability of calving constantly during long photoperiod.