Transverse Aortic Arch to Descending Aorta Ratio: A New Echocardiographic Parameter for Management of Coarctation of the Aorta in the Infant

Objective. The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making. Methods. Echocardiograms of 47 patients <6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age‐matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA : DAO ratio) were calculated from the end‐systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm. Results. Both the proximal and distal TAA : DAO ratios were significantly lower in the study vs. control group (P= .001) and in patients who underwent patch reconstruction of the aorta vs. extended end‐to‐end anastomosis (P= .014; P= .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA : DAO <0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty‐six out of 47 patients were free from reintervention. Conclusion. The TAA : DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.     

Pearle Arnold Capwell (1885-1982), Pioneer Nurse

Nurse leaders who shaped our profession and those who continue to do so are well remembered and their histories are well documented. But there are uncelebrated nurses, who have contributed to the remarkable advances of nursing in the United States. They are the unsung heroines who made their mark as mothers, sisters, wives, citizens, and—not so incidentally—as nurses. Rarely did they write their memoirs and as a result there is little in the way of a record of "ordinary nurses providing daily nursing care" to the sick and injured many decades ago. We rarely have an opportunity to hear from those pioneers from early in the 20th century.     

Stress and Tobacco Addiction

Primary care providers are confronted on a daily basis with persons who are addicted to tobacco. Research studies have demonstrated an association between substance use and stress and coping. This paper discusses macro- and micro-level perspectives of stress that need to be considered in the management of tobacco addition. Lazarus's stress and coping paradigm is emphasized as a useful framework for managing addicted clients.     

The Shuler Nurse Practitioner Practice Model: A Theoretical Framework for Nurse Practitioner Clinicians, Educators, and Researchers, Part 1

Because nurse practitioners (NPs) have expanded their nursing knowledge and skills into medicine they need a model that reflects this expanded role. This article presents the Shuler Nurse Practitioner Practice Model, which is wellness-oriented and suggests how patient interaction, assessment, intervention, and evaluation should occur.     

Research Presentations: Disseminating Knowledge for Practice

The abstract should have a title and should include the purpose and the significance of the study to the target audience, the design and procedures used for data collection, a succinct summary of the most important findings, and a brief statement of conclusion (Table 1). Careful attention should be given when constructing a title. The title should be interesting, brief, representative of the focus of the study, and attract attention to the research. Most research titles include the type of study, the variables, and the population studied (Ryan, 1989).
It is important to identify whether there is a limitation on the number of words to be contained in the abstract. If there is not a limitation, follow the rule, "Never more than one typewritten page." The abstract that is sent with a query letter to an editor of a journal does not have a word limit, but the above rule generally applies. The limit for conferences can vary from 150 to 300 words, and will be indicated in the Call for Abstracts. Use of the word count feature in a word processing program will assist in the construction of an abstract that adheres to the word count stated in the Call for Abstracts (Plaut, 1982).
Specific references to the literature are included in rare instances. The language used in writing the abstract should not be highly technical. It should be clear and concise and should communicate to the reader the motive of the study, why and how the study was conducted, and what knowledge was gained from the study. Many conferences print the abstracts in the conference syllabus. A clear, concise, well-organized abstract has a greater probability of being accepted for presentation and is more likely to be well attended at a conference than one that is highly technical or disorganized.     

The Inside Story: A Simulation Game on Ethical, Legal, and Political Decision Making in Health Policy for Nurse Practitioners

This game can be conducted with as many as 50 and as few as 15 players. The optimum size includes 4-5 Board members and 4-6 participants in each of the four small-group scenarios. The game takes about 11/2-2 hours to play. This includes a break between Part I and Part II. Existing state and national laws and policies are used in the game so that participants may understand their effects and limitations. The game has no winners or losers. Everyone gains if the decision markers are able to consider the needs of the individuals and the needs of the public, though some individuals may or may not benefit as much as others. This, however, is reality and is inherent in the policy-making process. In primary care, nurse practitioners (NPs) have a crucial responsibility to weigh the impact of their decisions on their clients and the community. The "Inside Story" integrates recommended NP curriculum content such as ethical decision making and health policy into a creative and powerful educational experience. This simulation game could be adapted for other topics with ethical, legal, and political implications such as issues regarding allocation of scarce resources. It could be played among students or professionals from many disciplines as part of their curriculum or in a continuing education offering.