Clinical impact of advanced trauma life support

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee On Trauma (ACSCOT) presents a standardized method of initial trauma care. This study attempted to measure any changes in morbidity and mortality in trauma patients after the introduction of ATLS training. Over a 3-year period (May 1996 to September 1997-pre-ATLS period; December 1997 to April 1999-post-ATLS period), 63 trauma patients with an Injury Severity Scale (ISS) > or =16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community teaching hospitals. There was no significant difference in mortality rate between groups (48% [15 of 31] pre-ATLS vs. 30% [10 of 32] post-ATLS; P = .203, Fisher exact test). Mortality rates within the ISS range of 16 to 25 were 64% (nine of 14 pre-ATLS) versus 29% (five of 17 post-ATLS), and for the ISS 26 to 35 subgroup, 40% (four of 10 pre-ATLS) versus 25% (two of eight post-ATLS), and within the ISS 36 to 75 subgroup, 29% (two of seven pre-ATLS) versus 43% (three of seven post-ATLS). There was a significant difference in mortality during the first 60 minutes after admission: 0.0% post-ATLS versus 24.2% pre-ATLS (P = .002, Fisher exact test (95% confidence interval ranged from 12-45% in the pre-ATLS group and 0-11% in the post-ATLS group). According to the TRISS methodology (a worldwide-accepted mathematical method to calculate chances of survival through logistical regression),ATLS improved outcome from sub-"Major Trauma Outcome Study" (MTOS) standard results (z = -2.9 to a MTOS standard result z = -0.49). Our data demonstrate that introduction of the ATLS program significantly improved trauma patient outcome in the first hour after admission, as well as improvement from sub-MTOS standard to MTOS standard levels.     

Endoscopic repair of delayed stomach perforation caused by penetrating trauma: A case report

BACKGROUNDPrimary endoscopic closure of a perforated gastric wall during endoscopic procedures is mostly effective and well-tolerated; however, there are very few studies on the efficacy of endoscopic management of delayed traumatic gastric perforation. Herein, we report a novel case of a patient who was successfully treated for delayed traumatic stomach perforation using an alternative endoscopic modality.CASE SUMMARYA 39-year-old woman presented with multiple penetrating traumas in the back and left abdominal cavity. Initial imaging studies revealed left diaphragmatic disruption and peri-splenic hemorrhage without gastric perforation. An emergency primary repair of the disrupted diaphragm with omental reduction and suturing of the lacerated lung was performed; however, delayed free perforation of the gastric wall was noted on computed tomography after 3 d. Following an emergency abdominal surgery for the primary repair of the gastric wall, re-perforation was noted 15 d postoperatively. The high risk associated with re-surgery prompted an endoscopic intervention using 2 endoloops and 11 endoscopic clips using a novel modified purse-string suture technique. The free perforated gastric wall was successfully repaired without additional surgery or intervention. The patient was discharged after 46 d without any complications.CONCLUSIONEndoscopic closure with endoloops and clips can be a useful therapeutic alternative to re-surgery for delayed traumatic gastric perforation.     

Non‐medical prescribing in prostate cancer care: a case study reflection

There are approximately 54 000 nurse and midwife prescribers across the United Kingdom (UK), with 19 000 nurse independent and supplementary prescribers. Prostate cancer specialist nurses are ideally suited to implement advanced levels of practice in non‐medical prescribing, but little has been detailed in the literature about the prescribing practice in this clinical context. This paper set out to critically review evidence‐based recommendations for Prostate Cancer Specialist Nurses using a case study reflection to contextualize the role of non‐medical prescribing. A structured literature review was conducted in a range of electronic databases (DARE, Cochrane, MEDLINE, BNI, PsychINFO, EMBASE and CIHAHL), and a grey literature search in google, to identify studies employing a qualitative and/or quantitative methods. National (UK) and European clinical guidelines and legislative frameworks were also included. Methodological evaluation was conducted and evidence‐based recommendations were integrated into a narrative synthesis. A multidisciplinary and proactive approach to the management of men with metastatic prostate cancer ensures safe and effective prescribing practice, and optimizes supportive care delivery. A reflective case study has illuminated the key features necessary to maximize the success of non‐medical prescribing in prostate cancer care and captures the importance of good working relationships. While different practice models will emerge, the Prostate Cancer Model of Consultation may facilitate a structured framework for safe practice, embedded in effective communication strategies. Non‐medical prescribers must be committed to continual professional development, and prescribe safely within individual competencies and scope of professional practice. There is a pressing need for further research to evaluate prescribing practices with a particular focus on the nature of influencing factors on prescribing decisions, cost‐effectiveness and a more detailed understanding of how team working and inter‐team referral affects prescribing decisions between the Multidisciplinary Team (MDT) members.     

应用案例分析法提高低年资护士沟通能力

目的:应用案例分析法提高低年资护士沟通能力。方法:采用案例分析法对40名低年资护士进行为期3个月24课时的沟通能力培训,应用自行设计的沟通评价量表对培训前后进行比较。结果:培训后发现低年资护士积极性和主动性、发散性和批判性思维能力、沟通和健康教育能力、观察病情的能力、综合分析病情变化能力、表达能力、自信方面均得到了提高。结论:在低年资护士培训中运用案例分析法,能激发低年资护士学习兴趣,还能提高低年资护士分析与解决问题的能力,增强低年资护士的自信心,实现了理论知识、实践能力、个人素质的综合提高。     

Literature review of the impact of nurse practitioners in critical care services

Aims: The comprehensive review sought to examine the impact of Critical Care Nurse Practitioner models, roles, activities and outcomes. Method: The Medical Literature Analyses and Retrieval (MEDLINE), The Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMED; PROQUEST; ScienceDirect; and the Cochrane database were accessed for the review. Alternative search engines were also included. The search was conducted with the key words: critical care, intensive care, acute, adult, paediatric, trauma, disease management programs, disease management, case management, neonatal, cardiology, neurological, retrieval, transfer and combined with Nurse Practitioner. From the identified 1048 articles 47 studies were considered relevant. Results: Internationally, Critical Care Nurse Practitioners were located in all intensive care areas and services including post intensive care discharge follow‐up, intensive care patient retrieval and transfers and follow‐up outpatient services. The role focussed on direct patient management, assessment, diagnosis, monitoring and procedural activities. Critical Care Nurse Practitioners improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates. Studies also demonstrated positive financial outcomes with reduced intensive care unit length of stay, hospital length of stay and (re)admission rates. Conclusions: Internationally, Critical Care Nurse Practitioners are demonstrating substantial positive patient, service and nursing outcomes. Critical Care Nurse Practitioner models were cost effective, appropriate and efficient in the delivery of critical care services. Relevance to clinical practise: In Australia, there was minimal evidence of Critical Care Nurse Practitioner impact on adult, paediatric or neonatal intensive care units. The international evidence suggests that the contribution of the role needs to be strongly considered in light of future Australian service demands and workforce supply needs. In Australia, the Critical Care Nurse Practitioner role and range of activities falls well short of international evidence. Hence, it was necessary to scope the international literature to explore the potential for and impact of the Critical Care Nurse Practitioner role. The review leaves little doubt that the role offers significant potential for enhancing and contributing towards more equitable health services.     

创伤小组救治原则的临床研究

目的 研究急诊创伤小组抢救的救治原则。方法 应用录象技术,对来自急救部2002-07-2003-07治疗的重度创伤病人21例,按抢救的阶段划分采集时间,分析相关抢救步骤之间的先后关系,以缩短整体抢救阶段为目的,从而拟定创伤小组的抢救救治原则。结果 创伤小组抢救中的关键工作有:配血、呼吸支持、循环支持、神经系统支持、相关会诊五个部分,这五个部分按流程应该并行,不能串行;每个部分的流程要确立阶段完成时间并逐步标准化。结论 创伤小组的救治原则有:①组长指挥原则;②时间量化操作步骤原则;③抢救的站位原则;④合理排序和组合操作原则;⑤回顾讨论总结制度原则。     

The making of a nurse manager: the role of experiential learning in leadership development

cathcart e . b ., greenspan m . & quin m . (2010) Journal of Nursing Management 18, 440–447
The making of a nurse manager: the role of experiential learning in leadership development Aim To articulate the experientially acquired knowledge, skill and ethics embedded in nurse manager practice and describe the ways in which they were developed. Background The role of the nurse manager is usually described in lists of competencies, talents and traits which fail to capture the experience-based judgment and practical knowledge in this pivotal organizational role. Method Using Benner’s methodology of practice articulation, 32 nurse managers wrote and interpreted first person narratives of their practice. The experience level of the group ranged from new nurse managers to those with more than 10 years’ role tenure. The seminars were facilitated by a seasoned nurse executive and nurse manager with expertise in narrative interpretation. Results Interpretation of the paradigm case of one nurse manager suggests that complex leadership challenges can be a source of significant experiential learning for the individual and for the group. Conclusions Articulating and reflecting on experiential learning elucidates the skilled knowledge and judgment embedded in nurse manager practice which cannot be accessed in any other way. Implications for nursing management Articulating the practical knowledge which is necessary for effective nurse manager practice can hasten the development of role incumbents.     

Being an effective nurse consultant in the English National Health Service: what does it take? A study of consultants specializing in safeguarding

Aims This study established key attributes and perceived strengths, weaknesses, opportunities and threats (SWOT) of nurse consultants specializing in safeguarding children. Background The nurse consultant role in England spans four domains – clinical, leadership, education and research – and was intended to enable senior nurses to remain in clinical practice. Method Data identifying the time spent by the nurse consultants in the four domains was collated and a thematic content analysis of the SWOT of the role was ascertained from semi-structured interviews with nurse consultants (n = 4) and stakeholders (n = 6). Results Strengths and opportunities in clinical (consultancy), leadership and educational functions were identified but some weaknesses and threats in terms of nurse consultant’s contributions to research were also identified. The role was neither wholly strategic nor clinical. Role ambiguity meant that they were not always valued by managers, making the role potentially expendable. Conclusions Nurse consultants are pivotal within health-care organizations because they span clinical practice and leadership enabling them to support managers in strategic planning, commissioning and implementation of policy. Implications for nursing management Nurse consultants can support strategic practice development and influence quality and effectiveness service-wide. To succeed they must be understood, supported and nurtured by managers.     

1992年至2013年我国专科护士现状研究的文献分析

目的 探究我国在专科护士领域的研究现状,为培养和管理专科护理人才提供参考.方法 采用文献计量学方法,对收录在中国生物医学文献服务系统(SinoMed)、中文科技期刊数据库和中文科技期刊数据库中与专科护士有关的文献进行检索,对其文献数量、年度变化、文献类别、研究对象等进行分析.结果 共纳入符合标准的文献718篇,最早一篇为1992年综述类文献,而后文献数量逐年递增,文献以经验总结和综述类为主,ICU、手术室、急诊、糖尿病、肿瘤领域专科护士为研究热点.结论 我国关于专科护士的探索已在全国开展,但在定位、培训、认证、岗位管理等方面均缺少统一标准,亟待探索适合我国国情的专科护理人员发展之路.     

Current status of clinical nursing specialists and the demands of osteoporosis specialized nurses in Mainland China

The clinical nursing specialist (CNS) is an expert who applies an expanded range of practical, theoretical, and research-based competencies to the care of patients within in a specialty clinical area within the larger discipline of nursing. A large number of studies consistently conclude that the CNS is a valuable healthcare resource that provides high-quality clinical and evidence-based nursing practice and improves patient outcome. The CNS has been involved in healthcare practices for many years, with an increasingly diverse role. However, the training for the CNS in China is only in a preliminary developmental stage. The aim of this article is to review the history and development of the CNS role. Furthermore, the epidemiologic status of osteoporosis, as well as the feasibility and necessity of developing training programs in China for the osteoporosis CNS, will be discussed.     

急诊科护士对创伤患者低体温的认知调查分析

目的:了解急诊科护士对创伤患者低体温相关知识水平、对待创伤患者围术期体温监测和管理的态度,以期为以后的研究提供依据。方法:采用自行设计的调查问卷对我市3家三级甲等医院急诊科183名护士进行问卷调查。结果:63.39%的急诊科护士明确低体温的定义,91.26%的急诊科护士认为最接近体核温度的部位是直肠,急诊科护士能列出16种导致低体温的原因,10条复温注意事项。结论:急诊科护士对创伤患者低体温相关知识的掌握不够全面和深入,对体温监测和管理水平有待提高。     

Twenty-seven years of complication-free life with clean intermittent self-catheterization in a patient with spinal cord injury: A case report

Currently, clean intermittent self-catheterization (CISC) is the most prevalent method of bladder management in patients with spinal cord injury (SCI) at discharge from rehabilitation centers. However, half of the patients discontinue using CISC and change to other methods of bladder management several months postdischarge despite the fact that it the best way to prevent urinary tract complications. Few studies, however, report the long-term consequences of CISC. In this case, we present a woman in her early fifties who had sustained thoracic SCI and had continued using CISC for 27 years without developing any complications. The possible reasons for her success were absence of incontinence because of underactive and normal capacity bladder; normal upper-extremity functions and absence of marked spasticity of lower extremities that facilitated CISC technique; and absence of sociovocational problems, enabling her to keep proper intervals between catheterizations each day. This case indicates that CISC is useful for long-term bladder management in patients with SCI, even for 25 years or more. Long-term outcomes of CISC and factors leading to success need to be delineated in future studies with larger samples.     

Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM

ObjectiveTo describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization.MethodFollow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers.ResultsData from 835 patients with a mean age of 76.8 years (SD: 12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD: 2.5) and high dependence (Barthel 37.5, SD: 31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR: 1.41; 95% CI: 1.22-1.63), more telephone interventions by case managers (OR: 1.12; 95% CI: 1.02-1.24) and imaging tests (OR: 1.37; 95% CI: 1.17-1.60), together with greater caregiver burden (OR: 1.31; 95% CI: 1.08-1.59), the presence of medical devices at home (OR: 1.69; 95% CI: 1.00-2.87) and received less “Case Management” intervention.ConclusionsThe patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.