Prehospital trauma care: what do we really know?

PURPOSE OF REVIEW: The prehospital care of injured patients has been surrounded with much controversy over the years. This controversy exists regarding the specific interventions used on-scene and en-route to definitive care centers, regarding the overall approach to the care of these patients (advanced life support versus basic life support) and with regards to who should be providing this care. This section of the journal aims to review the most current literature concerning these topics as well as highlight some important and relevant literature preceding it. RECENT FINDINGS: Studies examining overall prehospital care in terms of morbidity, mortality and cost have been published over the last year and important points from these studies are highlighted in the text. Unfortunately, there have not been any recent, appropriately powered, prospective studies that help in clarifying this controversy. An international study of prehospital care has recently been completed and is summarized. Recent studies looking at specific aspects of prehospital care (endotracheal intubation, intravenous access and therapy, rural trauma) are also outlined in the text. SUMMARY: There is no convincing evidence that prehospital advanced life support in the urban setting provides any benefit to injured patients in terms of either morbidity or mortality.     

Nursing and the aging workforce: myths and reality, what do we really know?

Not unlike the general population, the population of nurses is aging. This trend is problematic for the nursing workforce in the light of a predicted shortage yet the extent of the effect of the aging population is unknown. What should individuals older than 45 years know to mitigate the effects of aging both physically and professionally? This article describes the magnitude of the aging nursing workforce issue, explores the myths and realities related to the aging process, discusses evidence-based strategies supporting healthy aging and retention of experienced nurses in one Magnet hospital, and introduces recommendations for further study.     

Clinical supervision: what do we know and what do we need to know? A review and commentary

AIMS: This study is addressed to nurses but the issues are of equal concern to both midwives and health visitors. Clinical supervision ideally both challenges nurses as well as help their practice. There is need to identify critical elements that help professional practice and understand more clearly the changing nature of supervisory relationships. BACKGROUND: Clinical supervision in nursing is over a decade old in the UK and yet emerging nursing literature suggests that many ideas remain unfamiliar to nursing practice. The resistance shown by nurse towards clinical supervising remains perplexing. Moreover, ideas concerning clinical supervision have been applied without a substantive evidence base. METHODS: The discussion draws on varied ideas concerning supervision, including those outside of nursing, to ask what do we know and still need to know about clinical supervision. This study suggests that, a single approach to clinical supervision could be unhelpful to nursing. FINDINGS AND CONCLUSION: Nursing knowledge concerning many aspects of clinical supervision is increasing because of research. Much of the literature suggests that clinical supervision is scholarly activity requiring much the same attention to relationships as the therapeutic activities it supports. This discussion concludes with the idea that clinical supervision might work at its best as a quiet activity allowing nurses to think about nursing work in ways that suit individual learning styles.     

Fluoroquinolone-induced tendinopathy: what do we know?

Fluoroquinolones are relatively safe, effective antibiotics. As their use becomes more frequent, so will the adverse side effects. I highlight a rare but debilitating adverse reaction-fluoroquinolone-induced tendinopathy. Case reports and letters from 1987 to 1998 were identified by using Grateful Med and PubMed Internet accesses to the National Library of Medicine. Articles were reviewed for clinical practicality. There are few articles on fluoroquinolone-induced tendinopathy in the US literature targeting primary care physicians. This entity has been described in many case reports, but little has been done to isolate the causative agents. Incidence of this side effect is difficult to estimate, since no prospective studies are available for review or calculation of risk. Fluoroquinolone-induced tendinopathy appears more commonly in tendons under high stress. The cause is probably multifactorial. Risk factors for the development of fluoroquinolone-induced tendinopathy are age, renal failure, corticosteroid use, and previous tendinopathy from fluoroquinolones.     

Ventilating patients with acute severe asthma: what do we really know?

The goal of mechanical ventilation for patients with acute severe asthma is to ensure adequate oxygenation, ventilation, and gas exchange while simultaneously preventing hyperinflation, auto-positive end expiratory pressure, and subsequent barotrauma. Though existing evidence on the topic is relatively scarce, the application of current knowledge may guide our practice and prevent iatrogenic complications. To that end, this article describes selected ventilatory management strategies for the patient with acute severe asthma, such as the limitation of tidal volume size and respiratory rate, selection of specific inspiratory and expiratory ratios, the use of positive end expiratory pressure, and the application of helium-oxygen mixtures.     

Suicide among Asian Americans: what do we know? What do we need to know?

The current review begins with an acknowledgment of the diversity within the Asian American population as well as the scarcity of information on suicide among this particular racial/ethnic minority group. In analyzing what is known and what still needs to be learned about suicide among Asian Americans, the current article provides a critical review of significant factors such as age, gender, religious and spirituality issues, acculturation, social support, familial dynamics, social integration as well as gay/lesbian/bisexual orientations. In examining these factors, recommendations related to interventions and the existing research gaps are also discussed.     

Do patients and their families expect what we really offer them?

Frequently we evaluate user satisfaction for the treatment procedures provided (quality perceived), but we do not study the prior expectations (quality desired). Our objective is to discover what these patient and their family expectations are about treatment procedures and nurses' role so that we can make improvements and contribute to maximizing the quality of treatment provided. The aspects which cause greatest concern so that a patient's hospital stay is comfortable are the interpersonal relationships with family members, room mate, and professionals. Furthermore, the authors evaluate the treatment with nurses as a primary aspect in quality treatment.