Ventilatory support and predictors of hospital stay in neonates

: Ventilatory support in neonatal intensive care units (NICU) and related care modalities have profound lifelong benefits for neonates. : Ventilatory support and predictors of hospital stay were prospectively examined in 262 neonates and their mothers who were admitted to a NICU. A mixed-model, generalized estimating equation approach was used for prediction analysis, accounting for the dependencies of multiple births (26.3% of sample). : Predictors for hospital stay included gestational age, congenital defects, birth weight, days requiring ventilator support, and oxygen support. Cubic curves present the best-fit model for the relationships between maturity (gestational age and birth weight) and length of hospital stay; along with days requiring oxygen support, ventilator support, and central arterial and venous access lines. : Ventilatory support and associated care modalities are important resources for high-risk neonates during hospital stay. Future studies need to determine the best care course for neonatal ventilatory support to prevent complications.     

Evaluating the efficacy of the infection control liaison nurse in the hospital

The infection control liaison nurse (ICLN) is a nurse in the ward, appointed to participate in education for infection control, and to liaise between the ward and the infection control nurse (ICN). The efficacy of ICLNs was evaluated when a guideline on urinary catheter care was introduced in a 1000-bed hospital in Hong Kong. The 27 public wards were divided randomly into a test (24 wards) and control group (three wards), and ICLNs were appointed in the test group by the nursing administration. For education, the ICN conducted in-service lectures for both groups, while in the test group, the ICLNs also conducted tutorials for all ward nurses. Before and after the education programme, prevalence surveys were conducted to detect incorrect practices on urinary catheter care. Three practices were evaluated: the securing of catheters, presence of kinking and the use of urinary bags with a drainage spigot. Before education, the percentage of incorrect practices in the test groups was 63%, which was comparable to the 68% of the control group (P = 0.40, chi 2 = 0.71). After education, the percentage of incorrect practices in the test group (36%) was significantly lower than the 48% in the control group (P less than 0.05, chi 2 = 4.25). This indicates that ICLNs can indeed enhance the education programme for infection control.     

Management of pain during abortion

The purpose of this study was to determine the effects of three cognitive behavioural strategies in the management of abortion pain. The interventions were drawn from the multidimensional model of pain suggested by the gate control theory. Forty patients undergoing abortion with local anaesthesia were instructed in one of four interventions: relaxation, pleasant imagery, analgesic imagery, and a pain discussion (attention control) group. Pain was measured using Johnson's two-dimensional graphic rating scales labelled sensation and distress. Speed of recovery and analgesic use were included as objective dependent measures. No significant differences were found among the four groups on any dependent measures although subjects receiving the pleasant imagery intervention reported the lowest subjective ratings of pain sensation and distress. Findings are discussed in terms of past research and implications for the management of acute pain experienced during abortion.     

Autonomic and Cardiovascular Responses of Preschool Children to Television Programs

This exploratory study examined the heart rates (HR) and skin temperatures (ST) of 18 preschool children while they viewed two clips of everyday children's television (TV) programming. The measurements were made in a day care setting, in a naturalistic environment designed to mimic the real world of children's TV viewing. The purpose of the study was to determine whether cardiovascular and autonomic arousal to TV programming might occur in some children. Since a large body of psychosocial literature addresses the affects of TV violence on children, HR and ST were examined during exposure to scenes from Mr. Roger's Neighborhood and G.I. Joe cartoons. The Mr. Roger's clip was slow, rhythmic, prosocial, and nonviolent, while the G.I. Joe clip was fast-paced, staccato, colorful, and full of verbal and action violence. The study found a significant effect of exposure to the cartoon violence on HR, with HR increasing. ST decreased, but not significantly, and there was a significant effect of time on the ST, due possibly to habituation. This finding has relevance to nursing assessment, intervention, and education of parents and children, since TV viewing is a pervasive cultural phenomenon. The possibility of excessive or inappropriate autonomic and cardiovascular responsiveness in some children to TV must be considered.     

Factors Affecting the Risk of Blood Bank Specimen Hemolysis

OBJECTIVES: To evaluate simultaneously several possible risk factors for blood bank specimen hemolysis. METHODS: This was a prospective cohort study of emergency department and labor and delivery patients to estimate the effect of various factors on the risk of blood bank specimen hemolysis. Study variables included patient demographics, type and gauge of needle or catheter, anatomic location of venipuncture, and patient care area. Hemolysis was determined by blood bank laboratory technicians. Cox proportional hazards multivariate regression modeling was performed to estimate the adjusted relative risks for hemolysis. RESULTS: Of the 605 subjects with complete data, 194 (32.1%) subjects had blood specimens drawn directly with a steel needle, and 411 (69.1%) had specimens drawn through a Vialon (BD Medical Systems, Inc., Sandy, UT) intravenous (IV) angiocatheter. The overall risk of hemolysis for all was 7%, 10% for Vialon IV angiocatheters and 1.5% for steel needles. In the multivariate analysis, the factors most closely associated with hemolysis were the use of Vialon IV catheters and sampling from an anatomic site other than the antecubital area. CONCLUSIONS: Blood bank specimens drawn from Vialon IV catheters (particularly smaller gauge catheters) and from veins outside the antecubital area are at significantly increased risk to hemolyze.