Enhancing Nurses' Pain Assessment to Improve Patient Satisfaction.

Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement.

Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life.

Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described.

Perception of facial attractiveness following modification of the nose and teeth.

Objective: We investigated how laypeople perceive persons with straight teeth and nose, mild to moderate modification of the nose, and mild to moderate modification of the teeth. The objectives were to determine: (1) how modification of the nose or teeth affects others' perceptions of target persons' facial attractiveness, (2) whether these evaluations are affected by the target persons' or raters' gender, (3) whether the frontal view or three-quarter view has any effect on the ratings.

Materials And Methods: Survey data were collected from 226 college students at Seton Hill University (49% male, 51% female; age range, 18-25 years) who rated, on a 100mm VAS, photos of subjects with straight teeth and nose (control), mild to moderate modification of the nose, and mild to moderate modification of the teeth from the frontal and three-quarter views.

Effects of a video guided T'ai Chi group intervention on center of balance and falls efficacy: a pilot study.

This pilot study evaluated effects of a video-guided T'ai Chi group intervention on center of balance (COB) and falls efficacy, using a one arm, pre/post design. Thirty-two participants began the study, 17 completed pre- and post-testing and 15 were lost to follow-up. Outcomes were compared for the 17 participants who completed pre- and post-testing and subgroups based on session attendance.

Development and validation of the Dyspnea Index (DI): a severity index for upper airway-related dyspnea.

Objectives: To (1) develop and validate the Dyspnea Index (DI); (2) quantify severity of symptoms in upper airway dyspnea; and (3) validate the DI as an outcome measure.

Study Design: Survey development and validation.

Methods: Three hundred sixty-nine participants were recruited for different phases of the study.

Perceptions of midline deviations among different facial types.

Introduction: The correction of a deviated midline can involve complicated mechanics and a protracted treatment. The threshold below which midline deviations are considered acceptable might depend on multiple factors. The objective of this study was to evaluate the effect of facial type on laypersons' perceptions of various degrees of midline deviation.

Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway.

Objectives/hypothesis: To develop and validate a cough severity index (CSI) which quantifies patients' symptoms associated with upper airway chronic cough and to provide a tool for treatment outcome measures.

Methods: Two hundred patients who had a complaint of chronic cough and/or dyspnea were given a 49- item questionnaire developed through a clinical consensus of the most common symptoms of chronic cough of upper airway origin. The instrument was reduced to 10 questions using statistical methodology.

Quantifying component parts of indirect and direct voice therapy related to different voice disorders.

Voice therapy changes how people use and care for their voices. Speech-language pathologists (SLPs) have a multitude of choices from which to modify patient's vocal behaviors. Six SLPs performed 1461 voice therapy sessions and quantified the percentage of time spent in eight component parts of indirect and four component parts of direct voice therapy across five common voice disorders.

Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience.

Background: Chronically critically ill patients typically undergo an extended recovery after discharge from the intensive care unit, making involvement of family caregivers essential. Prior studies provide limited detail about specific ways this experience affects caregivers.

Objectives: To (1) describe lifestyle restrictions and distress among caregivers of chronically critically ill patients 1 and 6 months after discharge and (2) explore how caregivers' lifestyle restrictions and distress differ according to patients' and caregivers' characteristics.

Analysis of laryngeal framework surgery: 10-year follow-up to a national survey.

Objectives: Laryngeal framework surgery, including medialization laryngoplasty (ML) and arytenoid adduction (AA), are common treatments for vocal fold paralysis and glottal incompetence. Little information is known about the incidence of ML/AA surgery nationwide, in particular the success and complication rates.

Methods: A 25-item questionnaire was mailed to 6,644 Board-certified otolaryngologists.

Critical thinking skills in nursing students: comparison of simulation-based performance with metrics.

Aim: This paper is a report of an examination of the relationship between metrics of critical thinking skills and performance in simulated clinical scenarios.

Background: Paper and pencil assessments are commonly used to assess critical thinking but may not reflect simulated performance.

Methods: In 2007, a convenience sample of 36 nursing students participated in measurement of critical thinking skills and simulation-based performance using videotaped vignettes, high-fidelity human simulation, the California Critical Thinking Disposition Inventory and California Critical Thinking Skills Test.

Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners.

Background: Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center.

Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury.

Preliminary evidence suggests local brain tissue oxygenation (PbtO(2)) values of or=20 mm Hg to avoid hypoxia. This study tested the impact of a short (2 h) trial of normobaric hyperoxia on measures of oxidative stress.

Critical thinking ability of new graduate and experienced nurses.

Aim: This paper is a report of a study to identify critical thinking learning needs of new and experienced nurses.

Background: Concern for patient safety has grown worldwide as high rates of error and injury continue to be reported. In order to improve patient safety, nurses must be able to recognize changes in patient condition, perform independent nursing interventions, anticipate orders and prioritize.

Hemodynamic and molecular response to intermittent hypoxia (IH) versus continuous hypoxia (CH) in normal humans.

The hemodynamic response to hypoxia may be influenced by exposure pattern and inducible biological signals, such as nitric oxide synthase (iNOS) expression. The systemic blood pressure (BP) and heart rate (HR) response to intermittent and continuous hypoxia (IH and CH) were examined as was the relationship between these responses and iNOS expression in 10 normal subjects. BP and HR were recorded during exposure to IH or CH (total hypoxic time=60 min/dayx3 days for each exposure profile), whereas arterial oxygen saturation (SpO2) was maintained at 80-90%.

Comparison of 2 models for managing tracheotomized patients in a subacute medical intensive care unit.

Objective: To compare 2 models for managing patients admitted to a subacute medical intensive care unit (MICU) who required prolonged mechanical ventilation (> or = 7 d).

Methods: The subjects were 192 consecutive patients (mean +/- SD age 61.5 +/- 16.

Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit.

Background: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.

Objective: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.

Methods: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams.

Are symptom reports useful for differentiating between acute rejection and pulmonary infection after lung transplantation?

Background: Prompt treatment of acute rejection and pulmonary infection reduces morbidity and mortality in lung transplant recipients. Symptoms, spirometry, and bronchoscopy are used to detect these complications. Of these, symptom reporting is the least invasive, yet has received little critical examination.

Short-term complications and resource utilization in matched subjects after on-pump or off-pump primary isolated coronary artery bypass.

Background: Studies suggest that patients who undergo off-pump coronary artery bypass grafting (OPCABG) have fewer short-term complications and use fewer inpatient resources than do patients who undergo standard coronary artery bypass grafting (CABG) with extracorporeal circulation. However, dissimilarity between groups in risk factors for complications has hindered interpretation of results.

Objectives: To compare the prevalence of selected complications (atrial fibrillation, stroke, reoperation, and bleeding) and inpatient resource utilization (length of stay, discharge disposition, total charges) between subjects undergoing primary isolated CABG or OPCABG who were matched with respect to key risk factors.

Pattern and predictors of early rejection after lung transplantation.

Background: Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation.

Objectives: To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection.

Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.

Background: Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes.

Objective: To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients' care in a step-down medical intensive care unit.

Methods: Work sampling techniques were used to collect data when the nurse practitioner had 6 months' or less experience in the role (T1), after the nurse practitioner had 12 months' experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3).

Effect of tracheal gas insufflation during weaning from prolonged mechanical ventilation: a preliminary study.

Background: Tracheal gas insufflation reduces inspired tidal volume and minute ventilation in spontaneously breathing patients and may facilitate weaning from mechanical ventilation.

Objective: To determine if tracheal gas insufflation can reduce ventilatory demand during weaning trials in patients who require prolonged mechanical ventilation.

Methods: A reduction in ventilatory demand was defined as a relative decrease in tidal volume, minute ventilation, and mean inspiratory flow during trials with tracheal gas insufflation compared with the values during trials without this therapy.

Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli.

Study Objective: To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.

Design: Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.

Setting: Outpatient.

Early discharge following abdominal aortic aneurysm repair: Impact on patients and caregivers.

Although early discharge is common place, little is known about its impact after abdominal aortic aneurysm (AAA) surgery. We sought to prospectively describe patient outcomes and caregiving experience after early discharge following elective AAA repair using a standard or endovascular grafting system (EGS) procedure. Fifty-one patients (Standard, n=25; EGS, n=26) completed questionnaires on symptoms and health-related quality of life (HRQoL) while hospitalized and 1, 4, and 8 weeks after discharge.

Resource utilization related to atrial fibrillation after coronary artery bypass grafting.

Background: Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges.

Objective: To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting.

Methods: Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation.