Staff nurse perceptions of the contributions of students to clinical agencies

This study is a replication and extension of Grindel and associates' 2001 study of the perceptions of staff nurses (psychiatric, perinatal, and medical/surgical) regarding the benefits of having students from a baccalaureate nursing program work in clinical agencies. Using the Nursing Students' Contributions to Clinical Agencies tool, the overall perception of students' contributions ranged from -4 to +5, with a mean of 2.50. The two highest ranked items were "allows opportunities for mentoring" and "threatens professional role development," indicating the ambivalence staff nurses feel toward nursing students. Qualitative data also demonstrated the benefits and challenges of working with students. Recommendations are made for the creation of a positive, nurturing learning environment through closer collaboration between nursing education and service.     

The effect of an intermediate care unit on the demographics and outcomes of a surgical intensive care unit population

HYPOTHESIS: Many surgical intensive care units (SICUs) face bed shortages for acutely ill patients that may result from a large proportion of bed occupation by chronically ill patients. We hypothesized that the introduction of a new intermediate care or step-down unit (SDU) managed by surgically trained intensivists would allow the admission of more acutely ill patients while maintaining satisfactory outcomes. DESIGN: Prospective retrospective comparison of SICU patient populations before and after the introduction of an SDU. SETTING: The SICU of New York-Presbyterian Hospital, New York Weill Cornell Center, a university hospital containing a level I trauma center. PATIENTS AND INTERVENTIONS: All patients in the SICU admitted from August 1, 1996, through June 30, 1997, were SICU patients prior to the introduction of the SDU. Patients admitted from August 1, 1997, through June 30, 1998, were SICU post-SDU patients, and SDU patients included those admitted to the SDU from August 1, 1997, through July 1, 1998. MAIN OUTCOME MEASURES: For each of the 2 eras, patients were compared for age, sources of admission, Acute Physiology and Chronic Health Evaluation (APACHE) II and III scores, unit length of stay, and mortality. Other data collected included origin of admission, nature of admission, and diagnosis. RESULTS: Six hundred sixty-six patients were admitted during the pre-SDU era, while a total of 1117 patients (619 SICU and 498 SDU patients) were admitted in the post-SDU era. After the introduction of the SDU, the mean (standard deviation) APACHE II scores of the SICU and SDU patients increased (14.2 vs 13.4, P =.04) without affecting mortality (6.0% in the post-SDU era vs 8.2% in the pre-SDU era, P =.07). The post-SDU era had a higher proportion of emergency admissions (42.3% vs 48.6%, P<.05) and interhospital transfers (7% vs 1%). CONCLUSIONS: Opening an SDU resulted in a significant increase in the overall severity of the SICU population. Creation of an SDU managed by surgically trained intensivists may optimize the use of a hospital's resources, permit the expansion of emergency or tertiary care services, and improve outcomes for critically ill surgical patients.     

Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series

STUDY DESIGN: A case series. OBJECTIVES: The purpose of this case series was to assess the effect of high-intensity neuromuscular electrical stimulation (NMES) on quadriceps strength and voluntary activation following total knee arthroplasty (TKA). BACKGROUND: Following TKA, patients exhibit long-term weakness of the quadriceps and diminished functional capacity compared to age-matched healthy controls. The pain and swelling that results from surgery may contribute to quadriceps weakness. The use of high-intensity NMES has previously been shown to be effective in quickly restoring quadriceps strength in patients with weakness after surgery. METHODS AND MEASURES: All patients were treated for 6 weeks, 2 to 3 visits per week, in outpatient rehabilitation. Five patients (NMES group) participated in a voluntary exercise program for both knees and NMES for the weaker knee. Three patients (exercise group) participated in a voluntary exercise program for both knees without NMES. For each treatment session, 10 isometric electrically elicited muscle contractions were administered at maximally tolerated doses to the initially weaker leg of the NMES group. Quadriceps strength and muscle activation were repeatedly assessed up to 6 months after surgery using burst superimposition techniques. RESULTS: At 6 months, the weak NMES-treated legs of 4 of 5 patients in the NMES group had surpassed the strength of the contralateral leg. In contrast, none of the weak legs in the exercise group were stronger than the contralateral leg at 6 months. Changes in quadriceps muscle activation mirrored the changes exhibited in strength. CONCLUSION: When NMES was added to a voluntary exercise program, deficits in quadriceps muscle strength and activation resolved quickly after TKA.     

The effect of aprotinin on hypoxia-reoxygenation-induced changes in neutrophil and endothelial function

BACKGROUND AND OBJECTIVE: An acute inflammatory response associated with cerebral ischaemia-reperfusion contributes to the development of brain injury. Aprotinin has potential, though unexplained, neuroprotective effects in patients undergoing cardiac surgery. METHODS: Human neutrophil CD11 b/CD18, endothelial cell intercellular adhesion molecule-1 (ICAM-1) expression and endothelial interleukin (IL)-1beta supernatant concentrations in response to in vitro hypoxia-reoxygenation was studied in the presence or absence of aprotinin (1600 KIU mL(-1)). Adhesion molecule expression was quantified using flow cytometry and IL-1beta concentrations by enzyme-linked immunosorbent assay. Data were analysed using ANOVA and post hoc Student-Newman-Keuls test as appropriate. RESULTS: Exposure to 60-min hypoxia increased neutrophil CD11b expression compared to normoxia (170+/-46% vs. 91+/-27%, P = 0.001) (percent intensity of fluorescence compared to time 0) (n = 8). Hypoxia (60 min) produced greater upregulation of CD11b expression in controls compared to aprotinin-treated neutrophils [(170+/-46% vs. 129+/-40%) (P = 0.04)] (n = 8). Hypoxia-reoxygenation increased endothelial cell ICAM-1 expression (155+/-3.7 vs. 43+/-21 mean channel fluorescence, P = 0.0003) and IL-1beta supernatant concentrations compared to normoxia (3.4+/-0.4 vs. 2.6+/-0.2, P = 0.02) (n = 3). Hypoxia-reoxygenation produced greater upregulation of ICAM- 1 expression [(155+/-3.3 vs. 116+/-0.7) (P = 0.001)] and IL-1beta supernatant concentrations [(3.4+/-0.3 vs. 2.6+/-0.1) (P = 0.01)] in controls compared to aprotinin-treated endothelial cell preparation (n = 3). CONCLUSIONS: Hypoxia-reoxygenation-induced upregulation of neutrophil CD11b, endothelial cell ICAM-1 expression and IL-1beta concentrations is decreased by aprotinin at clinically relevant concentrations.     

The effect of lidocaine on neutrophil CD11b/CD18 and endothelial ICAM-1 expression and IL-1beta concentrations induced by hypoxia-reoxygenation

BACKGROUND: Lidocaine has actions potentially of benefit during ischaemia-reperfusion. Neutrophils and endothelial cells have an important role in ischaemia-reperfusion injury. METHODS: Isolated human neutrophil CD11b and CD18, and human umbilical vein endothelial cell (HUVEC) ICAM-1 expression and supernatant IL-1beta concentrations in response to hypoxia-reoxygenation were studied in the presence or absence of different concentrations of lidocaine (0.005, 0.05 and 0.5 mg mL(-1)). Adhesion molecule expression was quantified by flow cytometry and IL- 1beta concentrations by ELISA. Differences were assessed with analysis of variance and Student-Newman-Keuls as appropriate. Data are presented as mean+/-SD. RESULTS: Exposure to hypoxia-reoxygenation increased neutrophil CD11b (94.33+/-40.65 vs. 34.32+/-6.83 mean channel fluorescence (MCF), P = 0.02), CD18 (109.84+/-35.44 vs. 59.05+/-6.71 MCF, P = 0.03) and endothelial ICAM-1 (146.62+/-16.78 vs. 47.29+/-9.85 MCF, P < 0.001) expression compared to normoxia. Neutrophil CD18 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (71.07+/-10.14 vs. 109.84+/-35.44 MCF, P = 0.03). Endothelial ICAM-1 expression on exposure to hypoxia-reoxygenation was less in lidocaine (0.005 mg mL(-1)) treated cells compared to control (133.25+/-16.05 vs. 146.62+/-16.78 MCF, P = 0.03). Hypoxia-reoxygenation increased HUVEC supernatant IL-1beta concentrations compared to normoxia (3.41+/-0.36 vs. 2.65+/-0.21 pg mL(-1), P = 0.02). Endothelial supernatant IL-1beta concentrations in lidocaine-treated HUVECs were similar to controls. CONCLUSIONS: Lidocaine at clinically relevant concentrations decreased neutrophil CD18 and endothelial ICAM-1 expression but not endothelial IL-1beta concentrations.     

Altered quadriceps control in people with anterior cruciate ligament deficiency

PURPOSE: The purpose of this study was to determine whether similar patterns of quadriceps dysfunction are observed when people with anterior cruciate ligament (ACL) deficiency perform static and dynamic tasks. METHODS: EMG data were collected from 15 subjects with an ACL deficient knee and 15 uninjured subjects as they performed static and dynamic tasks that were isolated to the knee and presented no threat to joint stability. The dynamic task was cyclic flexion and extension in the terminal 30 degrees of knee extension; the static task was an established isometric target-matching protocol. The muscle activity patterns observed during the tasks were evaluated and compared. RESULTS: The subjects with ACL deficiency exhibited quadriceps muscle control strategies that were significantly different from those of the uninjured subjects. This was true in both the dynamic and the static tasks. The findings were most noteworthy in the vastus lateralis muscle. Good agreement (r = -0.73 to -0.75) was observed in subjects' static and dynamic VL results; more moderate agreement was observed in results of the other quadriceps muscles. CONCLUSION: Diminished quadriceps control was observed when people with ACL deficiency performed static and dynamic tasks. The most striking feature of this impaired control was failure to turn the quadriceps "off" when performing flexion tasks in which the knee extensors are usually "silent." Our findings suggest that quadriceps dyskinesia after ACL injury is relatively global. Changes in neural function and muscle physiology after ACL injury are put forth as the most likely source of the observed dyskinesia.     

Modafinil's effects on simulator performance and mood in pilots during 37 h without sleep

INTRODUCTION: Modafinil is a relatively new alertness-enhancing compound of interest to the military aviation community. Although modafinil has been well-tested in clinical settings, additional studies are required to establish its safety and efficacy for use in pilots. OBJECTIVE: The purpose of this study was to determine whether modafinil (100 mg after 17, 22, and 27 h without sleep) would attenuate the effects of fatigue on fighter-pilot mood and performance during 37 h of continuous wakefulness. METHODS: A quasi-experimental, single-blind, counterbalanced design tested the effects of modafinil in 10 Air Force F-117 pilots. RESULTS: Modafinil attenuated flight performance decrements on six of eight simulator maneuvers. Overall, modafinil maintained flight accuracy within approximately 15-30% of baseline levels, whereas performance under the no-treatment/placebo condition declined by as much as 60-100%. Modafinil decreased self-ratings of depression and anger, while improving ratings of vigor, alertness, and confidence. Benefits were most noticeable after 24 to 32 h of continuous wakefulness. One potential drawback of modafinil was that, at least at the 100-mg dose level, the drug's effects were not subjectively salient. Since this may lead personnel to escalate the dose without flight surgeon approval, personnel should be cautioned regarding this particular drug characteristic. CONCLUSION: Although modafinil did not sustain performance at predeprivation levels, the present study suggests that modafinil should be considered for the military's armament of short-term fatigue countermeasures. Future research will evaluate whether 200-mg doses are more beneficial than the 100-mg doses used here.     

Oral contrast agents for CT of abdominal trauma in pediatric patients: a comparison of dilute hypaque and water

OBJECTIVE: Dilute Hypaque Sodium is generally well accepted as an oral contrast agent for CT of pediatric patients who have experienced recent blunt abdominal trauma. However, Hypaque can cause complications. Using water as a substitute contrast agent eliminates these potential complications. The purpose of our study was to compare the performance of water with that of dilute Hypaque as an oral contrast agent. Our hypothesis was that we would find no significant difference in performance between the two agents in defining anatomic details of the hollow gastrointestinal tract. MATERIALS AND METHODS: We performed a retrospective review of 74 CT scans obtained in infants and children who had received blunt abdominal trauma, scoring the quality of visualization of bowel structures, the presence of non-bowel-related findings, and the confidence level in making each assessment. The date range of the scans reviewed overlapped with the period in which the oral contrast material used for scanning such patients was switched from dilute Hypaque to water. Of the 74 CT scans that we reviewed, 53 were obtained with dilute Hypaque and 21 were obtained with water. The sex distribution between the two groups was compared using a chi-square test, whereas the mean age was compared using a two-sample two-sided Student's t test. A two-sample one-sided Student's t test of equivalence was used to analyze the data. RESULTS: Sex distribution for the two groups of patients was not significantly different (69.81% of the group who received dilute Hypaque were boys; 68.18% of the group who received water were boys). Furthermore, the difference in the mean age for the two groups was not statistically significantly (dilute Hypaque group, 8.86 years; water group, 10.18 years). No statistically significant difference in performance of the contrast agents was found with respect to the detection of intraabdominal abnormality. As an oral contrast material, water performed as well as dilute Hypaque in facilitating visualization of all intraabdominal anatomic structures. CONCLUSION: In defining anatomic details of the hollow gastrointestinal tract, water is as effective as dilute Hypaque as an oral contrast agent for CT in the setting of acute blunt abdominal trauma in pediatric patients.