Accuracy of arrhythmia recognition in paramedic treatment of paroxysmal supraventricular tachycardia: : A ten-year review

Objectives

To examine trends in paramedic rhythm misidentification rates in the use of adenosine for presumed paroxysmal supraventricular tachycardia (PSVT) over a ten-year period, and to determine variables associated with rhythm misidentification.

Methods

The authors conducted a retrospective analysis of all cases in which paramedics treated presumed PSVT with adenosine from 1993 to 2002. Rhythm strips were categorized as narrow or wide-complex and regular or irregular. Appropriate use of adenosine was defined as narrow-complex regular tachycardia with no visible P waves and rate greater than 140 beats/min.

Results

The authors studied 224 patients with a mean age of 60 years (range, 15-94 years); 157 (70%) were female and predominantly white. The majority (54%) of patients had initial heart rates of 161-200 beats/min. Forty-nine percent of the patients had a previous history of PSVT. Inappropriate use of adenosine occurred in 45 (20%) cases. Misidentification rates per year ranged from 9% to 31% with the lowest rate occurring after a targeted education program on tachydysrhythmias. An initial heart rate of <160 beats/min (χ² = 14.81, p<0.001) and absence of a medical history of either fast heart rate or palpitations (χ² = 11.35, p = 0.001) were associated with inappropriate use of adenosine.

Conclusion

Paramedics in this emergency medical services system are more likely to use adenosine appropriately for patients with initial heart rates of >160 beats/min and a history of rapid heart rate or palpitations. Further studies are required to identify factors associated with rhythm interpretation errors in the prehospital setting as well as to evaluate error reduction strategies.     

An Eating Disorders Prevention Program

PROBLEM. To develop, implement, and evaluate a school personnel training program on eating disorders.
METHODS. The pretest-posttest control group design zuas used to examine effects of this training with 117 high school personnel. Both experimental ( n = 85) and control ( n = 32) groups were given a pretest and a posttest on knowledge and attitudes. The experimental group participated in a training program. Both groups zuere asked to keep a 3-month count of students at risk for eating disorders.
FINDINGS. Results included a significant difference in knowledge between the experimental and control groups. School personnel in the experimental group were more likely to identify students at risk for developing eating disorders.
CONCLUSIONS. Training school personnel to identify students at risk for eating disorders holds promise as a strategy for dealing with this disease. All at-risk students for eating disorders should be further evaluated and additional treatment initiated as needed.     

Concept Analysis of Pain: Implications Related to Nursing Diagnoses

Pain is a phenomenon that has an impact on clients in a variety of settings. Nurses have many responsibilities related to assessment, diagnosis, intervention, and evaluation when caring for the person experiencing pain. The phenomenon of pain is described through a concept analysis, which is guided by the research tradition of phenomenology. A review of both medical and nonmedical literature provides a broad base of definitions from which the attributes, antecedents, and consequences are derived. The analysis includes the construction of various cases and identification of empirical referents in the phenomenologic tradition. Suggestions for future development and implementation of the concept into clinical nursing practice and clinical nursing research are included.     

The last post? Defending nursing against the postmodernist maze

Is postmodernism in many ways the empiricist-liberal tradition at the inevitable end of its intellectual and political tether? Or is postmodernism the ‘laughter of genius’ that art and argument in their traditional forms are dead? Can postmodernism be applied to social and economic issues whilst carrying a denial of the manner by which Western thought has shaped these issues? Can postmodernism provide moral pathways to help us with contemporary ethical issues? How can postmodernist thought encompass the activities of nurses, particularly in the area of psychiatric care? Can nurses afford postmodernist suppositions in the face of suffering and pain? If postmodernism exists, does it exist everywhere (as does nursing) or is it a more localized event?     

Evaluation of a program on self‐esteem and ego‐identity for Korean nursing students

Nursing students with high levels of self‐esteem and a strong ego‐identity maintain a level of self‐integrity that enables them to participate successfully in shared group values and interests while simultaneously meeting their own needs. Self‐esteem and ego‐identity are associated with academic achievement, major (area of study) satisfaction, and life satisfaction in undergraduate students. This study evaluated a brief group program for Korean nursing students that focused on promoting positive self‐esteem and ego‐identity development. Twenty‐three Korean nursing school students participated. Changes in the students' ego‐identity and self‐esteem were quantitatively examined. Scores for ego‐identity and self‐esteem increased significantly for the students who participated in the group, while scores in the control group remained the same. The program is judged as an effective method for nursing educators or college mental health providers to utilize in order to promote affirmative ego‐identity and self‐esteem in nursing students. Additionally, the program contributes to helping students achieve developmental goals during their college life.     

Association of cardiovascular emerging risk factors with acute coronary syndrome and stroke: A case‐control study

In this study, we estimated the risk of acute coronary syndrome and stroke associated with several emerging cardiovascular risk factors. This was a case‐control study, where an age ‐ and sex‐matched acute coronary syndrome group and stroke group were compared with controls. Demographic and clinical data were collected through patient interviews, and blood samples were taken for analysis. In the bivariate analysis, all cardiovascular risk factors analyzed showed as predictors of acute coronary syndrome and stroke, except total cholesterol and smoking. In the multivariate logistic regression model for acute coronary syndrome, hypertension and body mass index, N‐terminal section brain natriuretic peptide and pregnancy‐associated plasma protein‐A were independent predictors. For stroke, the predictors were hypertension, diabetes mellitus, body mass index, and N‐terminal section brain natriuretic peptide. Controlling for age, sex, and classical cardiovascular risk factors, N‐terminal section brain natriuretic peptide and pregnancy‐associated plasma protein‐A were independent emerging cardiovascular risk factors for acute coronary syndrome, but pregnancy‐associated plasma protein‐A was not for stroke. High levels of cardiovascular risk factors in individuals with no episodes of cardiovascular disease requires the implementation of prevention programs, given that at least half of them are modifiable.