bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of a Critical Pathway on Patients’ Outcomes After Carotid Endarterectomy
Authors: Aragon Daleen , Burton Virginia , Byers Jacqueline F. , Cohen Michael 
Published: November 2019

• Background In 1996, an integrated plan of care was implemented to improve quality of care for patients undergoing elective carotid endarterectomy. Goals were to reduce length of stay, costs, number of preoperative and intensive care unit admissions, and use of diagnostic procedures yet maintain good outcomes.• Objectives To determine whether use of the integrated plan of care met the goals.• Methods Data on financial and process outcomes, use of angiographic diagnostic procedures, and demographics were retrieved from the hospital’s database for all patients who had elective carotid endarterectomy without cerebral infarction.• Results A total of 783 patients met inclusion criteria: 129 before implementation of the plan of care, 66 during the 6-month transition, and 588 after implementation. Preoperative angiography was done in 32% of patients before implementation, 11% during the transition, and 4% after implementation. Percentages of patients admitted to the intensive care unit were 77% before implementation, 24% during transition, and 9% after implementation. Mean lengths of stay were 2.93 days before implementation, 2.12 days during transition, and 1.68 days after implementation. Costs per case were $7798 before implementation, $5750 during transition, and $5387 after implementation. Analysis of variance revealed significant differences between groups in total length of stay (P=.001), preoperative length of stay (P&lt;.001), and costs (P&lt;.001).• Conclusion Use of the integrated plan of care reduced length of stay, costs, admissions to intensive care units, and use of cerebral angiography. Use of the plan improved resource utilization while maintaining quality of care.
Cognitive Impairment in Heart Failure: Issues of Measurement and Etiology
Authors: Riegel Barbara , Bennett Jill A. , Davis Andra , Carlson Beverly , Montague John , Robin Howard , Glaser Dale 
Published: November 2019

• Background Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment.
• Objectives To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment.
• Methods A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality &lt;269 mOsm/kg), and dehydration (serum osmolality ≥295 mOsm/kg).
• Results Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample.
• Conclusions Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.
Gastric Tonometry and Enteral Nutrition: a Possible Conflict in Critical Care Nursing Practice
Authors: Marshall Andrea P. , West Sandra H. 
Published: November 2019

• Background Gastric tonometry is used to assess gastrointestinal mucosal perfusion in critically ill patients. However, enteral feeding is withheld during monitoring with gastric tonometry because enteral feeding is thought to influence tonometric measurements.• Objectives To examine the effect of enteral feeding on the tonometric measurement of gastric mucosal carbon dioxide.• Methods Gastric tonometers were placed in 20 critically ill patients, and the Pco2 of the gastric mucosa was measured in both the full and the empty stomach during a 48-hour period.• Results The Pco2 measured by the tonometer increased after enteral feeding, and a significant difference in the Pco2 of the full versus the empty stomach was evident at 24 and 48 hours. Pco2 at 4, 24, and 48 hours differed significantly in the full stomach and in the empty stomach. However, the data did not reveal a significant difference in either the full stomach or the empty stomach between Pco2 at 24 hours and Pco2 at 48 hours.• Conclusion After 24 hours of feeding, the initial increase in Pco2 observed at 4 hours was not evident, suggesting stabilization of the intragastric environment. However, a higher Pco2 was evident in the empty stomach, indicating that the presence of the feeding solution may reduce the diffusion of carbon dioxide into the tonometer balloon. Consequently, measurements of intragastric Pco2 obtained after 24 hours of feeding may be reliable if the stomach is emptied by aspiration via the tonometer immediately before measurement.
Use of Physical Restraints in Adult Critical Care: A Bicultural Study
Authors: Martin Beth , Mathisen Lars 
Published: November 2019

• Background Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices.• Objectives To describe the relationship between patients’ characteristics, environment, and use of physical restraints in the United States and Norway.• Methods Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients’ acuity level.• Results Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P &lt; .001), patients were more sedated (P &lt; .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P &lt; .001). Seven incidents of unplanned device removal were reported in the US sample.• Conclusions Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
Withdrawal of Life-Sustaining Therapy After Sudden, Unexpected Life-Threatening Illness or Injury: Interactions Between Patients’ Families, Healthcare Providers, and the Healthcare System
Authors: Wiegand Debra Lynn-McHale 
Published: November 2019

• Background Withdrawal of life-sustaining therapy in intensive care units is increasing. Patients’ families are intimately involved in this process because the patients are usually unable to participate. Little is known about family members’ interactions with healthcare providers and the healthcare system during this process.• Objective To describe the interactions between patients’ family members, healthcare providers, and the healthcare system during withdrawal of life-sustaining therapy after a sudden, unexpected illness or injury.• Methods The investigation was part of a larger interpretative phenomenological study. Nineteen families (56 family members) who participated in the process of withdrawal of life-sustaining therapy for a family member were interviewed and observed. An inductive approach to data analysis was used to discover units of meaning, clusters, and categories.• Results The families’ experiences involved a variety of dimensions, including issues with healthcare providers (bonds and consistency with nurses and physicians, physicians’ presence, information, coordination of care, family meetings, sensitivity to time, and preparation for the dying process) and issues with the healthcare system (parking, struggles with finding privacy, and transfers of patients).• Conclusions Patients’ families need information, guidance, and support as the families participate in the process of withdrawal of life-sustaining therapy. The results of this study have important implications for clinical practice and future research.
Improving Nurse-Physician Communication and Satisfaction in the Intensive Care Unit With a Daily Goals Worksheet
Authors: Narasimhan Mangala , Eisen Lewis A. , Mahoney Christine D. , Acerra Frank L. , Rosen Mark J. 
Published: November 2019

• Objective To evaluate the effect of a standardized worksheet on physicians’ and nurses’ perceptions of their understanding of goals of care and on patients’ length of stay in an intensive care unit.• MethodsA worksheet was completed daily during multidisciplinary rounds and was posted at each bedside in the medical intensive care unit at Beth Israel Medical Center in New York. Information recorded included tests or procedures, medications, sedation, analgesia, catheters, consultations, nutrition, mobilization, family discussions, consents, and disposition. Attending physicians, residents, and nurses completed a questionnaire before implementation of the worksheet and 3 times afterwards. Responses were scored on a 5-point scale (1 = understand nothing, 5 = completely understand). Continuous variables were analyzed by using a t test; categorical variables, by using a χ2 test.• ResultsBefore the worksheet was implemented, scores for understanding goals were 3.9 for nurses and 4.6 for physicians. Scores increased to 4.8 for nurses (P = .001) and 4.9 for physicians (P = .03) 6 weeks later, an improvement that remained at 9 months. Both groups showed significant improvement in communication scores that lasted for 9 months. Most responders wanted to continue using the worksheet. During the study, the mean stay in the unit was 4.3 days, down from 6.4 days for the analogous 9-month period in the preceding year (P= .02).• Conclusion Nurses’ and physicians’ perceptions of their understanding of the goals of care and of communication between them were improved and stays in the unit were shortened when the worksheet was used.
Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation
Authors: Twibell Renee Samples , Siela Debra , Riwitis Cheryl , Wheatley Joe , Riegle Tina , Bousman Denise , Cable Sandra , Caudill Pam , Harrigan Sherry , Hollars Rick , Johnson Doreen , Neal Alexis 
Published: November 2019

Background Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.
Objectives To test 2 instruments used to measure nurses’ perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses’ self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.
Methods Nurses (n = 375) completed the Family Presence Risk-Benefit Scale and the Family Presence Self-confidence Scale.
Results Nurses’ perceptions of benefits, risks, and self-confidence were significantly and strongly interrelated. Nurses who invited family presence during resuscitation were significantly more self-confident in managing it and perceived more benefits and fewer risks (P &lt; .001). Perceptions of more benefits and fewer risks were related to membership in professional organizations, professional certification, and working in an emergency department (P &lt; .001). Data supported initial reliability and construct validity for the 2 scales.
Conclusions Nurses’ perceptions of the risks and benefits of family presence during resuscitation vary widely and are associated with how often the nurses invite family presence. After further testing, the 2 new scales may be suitable for measuring interventional outcomes, serve as self-assessment tools, and add to conceptual knowledge about family presence.
Obstructive sleep apnoea with co existent Kleine-Levine syndrome in a middle-aged man
Authors: Chawla Gopal , Niwas Ram , Dutt Naveen , Swamy Mukesh Kumar 
Published: November 2019

Hypersomnia is a symptom which is pathognomonic of patients with Kleine-Levin syndrome (KLS), but the cause of this finding remains undefined. Given the pervasive association between obstructive sleep apnoea (OSA) and excessive daytime sleepiness, there exists the possibility that OSA might contribute to the sleepiness exhibited by these patients. Here we report a middle age man who had excessive daytime sleepiness and diagnosed as OSA after polysomnography. Prescribing of continuous positive airway pressure (CPAP) lead to unmasking of episodes of increased sleepiness and other behavioural features of KLS.
Regulatory Delivery
Authors: Russell Graham , Hodges Christopher 
Published: November 2019

This ground-breaking book addresses the challenge of regulatory delivery, defined as the way that regulatory agencies operate in practice to achieve the intended outcomes of regulation.
Regulatory reform is moving beyond the design of regulation to address what good regulatory delivery looks like. The challenge in practice is to operate a regulatory regime that is both appropriate and effective. Questions of how regulations are received and applied by those whose behaviour they seek to control, and the way they are enforced, are vital in securing desired regulatory outcomes.
This book, written by and for practitioners of regulatory delivery, explains the Regulatory Delivery Model, developed by Graham Russell and his team at the UK Department for Business, Energy and Industrial Strategy. The model sets out a framework to steer improvements to regulatory delivery, comprising three prerequisites for regulatory agencies to be able to operate effectively (Governance Frameworks, Accountability and Culture) and three practices for regulatory agencies to be able to deliver societal outcomes (Outcome Measurement, Risk-based Prioritisation and Intervention Choices). These elements are explored by an international group of experts in regulatory delivery reform, with case studies from around the world.
Regulatory Delivery is the first product of members of the International Network for Delivery of Regulation.
Volume 10 in the series Civil Justice Systems
What to do with Adorno’s Aesthetic Theory? An Interview with Jacques Rancière
Authors: Allerkamp Andrea , Genel Katia , Hazoume Mariem 
Published: November 2019

What to do with Adorno’s Aesthetic Theory? An Interview with Jacques RancièreConducted by Andrea Allerkamp, Katia Genel, and Mariem HazoumeTranslated by Owen Glyn-WilliamsThis interview was originally published in French as “Que faire de la théorie esthétique d’Adorno ?”in Où en sommes-nousavec la Théorie esthétique d'Adorno ? (Pontcerq, 2018).
Zorgplicht: omgevingsrechtelijk instrument van de toekomst?
Authors: Tonnaer F.P.C.L. (Frans) 
Published: November 2019

Zorgplicht: omgevingsrechtelijk instrument van de toekomst? ‘Een goed gekozen zorgplicht leidt tot wetgeving die aanmerkelijk bestendiger is dan gedetailleerde regels …’
Dit artikel gaat in op enkele belangrijke aspecten van de zorgplicht in het omgevingsrecht, zoals handhaafbaarheid en toepasbaarheid van het instrument van de zorgplicht in de verschillende gedaanten onder de komende Omgevingswet en AMvB’s.
Tecnologías Digitales en el Aprendizaje-Servicio para la Formación Ciudadana del Nuevo Milenio
Authors: Sandia S. Beatriz Elena , Montilva C. Jonas Arturo 
Published: November 2019

La Sociedad Digital, caracterizada por la aceleración tecnológica, la producción de nuevos conocimientos, la disponibilidad y acceso a la información y la comunicación, interacción y colaboración a través de Internet, obliga a replantear la formación universitaria orientándola hacia el desarrollo de actitudes y competencias necesarias para una formación ciudadana adaptada a las necesidades de esta nueva sociedad. Este trabajo presenta los resultados de un análisis documental de las competencias, habilidades, valores y actitudes que caracterizan la ciudadanía del nuevo milenio; además de cómo el enfoque educativo de aprendizaje-servicio juega un papel preponderante en la formación ciudadana promoviendo aquellas competencias que son pertinentes y necesarias al proporcionar oportunidades para conectar el currículo con la comunidad y desarrollar habilidades y actitudes de participación cívica. Así mismo, se presenta un modelo de referencia para la comprensión de los espacios virtuales para el aprendizaje-servicio (EVApS). Este modelo fue elaborado usando un enfoque sistémico que concibe a este tipo de tecnologías como sistemas abiertos, intencionales, formados por conjuntos de componentes heterogéneos, los cuales se interrelacionan para proporcionar a sus usuarios una funcionalidad que apoya los procesos de enseñanza y aprendizaje orientados al aprendizaje-servicio. Este modelo ayuda a comprender y diseñar EVApS de manera integral y sistemática; así como a identificar el conjunto de tecnologías digitales que pueden ser utilizadas para apoyar el desarrollo de competencias propias del aprendizaje-servicio durante la formación de la ciudadanía del nuevo milenio.
Level of Knowledge on Prematurity and Its Complications in Women Seeking Care at Referral Hospitals in Mexico
Authors: Gutiérrez-Padilla José Alfonso , Monge-Diaz Julio César , Osorio-Euan Alejandro , Pacheco-Chi Karen Jacqueline , Leon Juan Carlos Barrera-de 
Published: November 2019

Objective: To determine the level of knowledge that women had on risk factors for and complications of prematurity at a referral hospital.
Materials and Methods: This was a comparative transverse study conducted in 2015, including women seeking care at a referral hospital, dividing this population into four groups: 1. Pregnant, n=108 (37%), 2. Not pregnant, n=85 (29%), 3. Women seeking an ophthalmological appointment for their prematurely born infant, n=13 (5%), and 4. Women with babies in Neonatal Intensive Care Units, n=85 (29%). Inferential statistics with chi-squared and Mann–Whitney U tests were applied using SPSS ver. 21.0 statistical software package.
Results: The population of women in its majority lived in a common-law marriage and had a secondary-school education. Knowledge of neonatal risk factors included smoking, n=239 (82%) alcoholism, n=236 (81%) diabetes, n=176 (61%), hypertension, n=210 (72%), and fever, n=123 (42%). Significant differences among this study groups were found in relation to the following risk factors for and complication of prematurity; alcoholism, p=0.001; diabetes, p=0.012; the infant’s eye problems, p=0.004; the infant’s language problems, p=0.036, and retinopathy of the premature infant, p=0.027. Differences were found on comparing adolescent with older mothers in terms of knowledge of risk factors, p=0.000 and knowledge of long-term prematurity complications, p=0.005.
Conclusion: The principal risk factors identified by mothers were smoking, alcoholism, and diabetes. The most frequently referred complications in the prematurely born infant were those that presented at the short term, mainly ocular and language problem complications.
Effects of Reflexology Strategy on the Mothers Breast Milk Volume and Their Premature Weight Gain
Authors: Allam Nehal A. 
Published: November 2019

Background: Reflexology means the application of the manual the pressure to specific points of the feet called "reflex points" that are believed to correspond to other parts of the body. The study aimed to assess the effect of reflexology strategy on the mother’s breast milk volume and their premature weight gain.
Design: An experimental design was used to conduct the study. A convenience sample of 120 Primiparous mothers and their preterm infants was chosen based on systematic simple random.
Methods: Three tools were designed by the researchers to collect the necessary data to implement the reflexology strategy framework. 1.Structured interview questionnaire sheet, 2. Assessment observational checklist sheet for Premature using 2 scales: A. Transitioning from tube feeds to oral feeds, B. The Preterm Infant Breastfeeding Behavior Scale, three Evaluation Phase observational checklist based on Mother-Infant- Breastfeeding Progress Tool (MIBPT):
Statistical Analysis: The collected data were coded, analyzed, figured and tabulated using frequencies and percentage, mean, standard deviation & chi-square tests.
Results: There were a statistically significant difference and marked improvement in reflexology group total scores of feeding performance (P < 0.001) after intervention for 6 weeks approved of reflexology strategy. Reflexology group majority (88.3%) demonstrated good breastfeeding as compared to (55.2%) in the study group.
Conclusion: The present study highlights the effect of reflexology strategy on the mother’s satisfaction, breast milk volume, and their premature weight gain. On the other hand, intervention accelerates the early transition of premature from the tube feeding to breastfeeding and discharge from the hospital.
Recommendation: In-service education program could be designed and implemented in the pediatric field to enable the nurses to apply reflexology strategy to improve empower early transitioning of the preterm from tube feeds to breastfeeding and early discharge. Reflexology strategy is non-pharmacological, simple, noninvasive and cheap technique would be welcomed by the nurses, physicians and mothers.
Effects of weather and hunting on wild reindeer population dynamics in Hardangervidda National Park
Authors: Bargmann Tessa , Wheatcroft Edward , Imperio Simona , Vetaas Ole R. 
Published: November 2019

AbstractWild reindeer have a range that extends across the circumpolar region. In the last few decades, however, populations of wild reindeer have been on the decline. The reasons for these declines are poorly understood, but are suggested to be linked to both local and global climatic factors, disease, and human interference. Hardangervidda plateau in Norway is home to the largest wild reindeer population in Europe, and is at the southern end of its European range. This population is therefore of particular importance, particularly in the light of climate change. We investigated how weather and hunting have affected the wild reindeer population in Hardangervidda over the last two decades. Our findings suggest that the wild reindeer population in Hardangervidda is most affected by winter temperature and hunting, where colder temperatures and lower harvest rates typically result in higher growth rates. We did not find significant evidence for linear density dependence. Our results show trends across Hardangervidda, and give an indication of how region‐wide weather and hunting pressure can affect the wild reindeer population. As new data emerge, future investigations should look into the existence and nature of density dependence and the influence of other weather and human disturbance related factors.