Peripheral intravenous catheters started in prehospital and emergency department settings.

The purpose of this study was to determine the rates of phlebitis in trauma patients according to where the peripheral intravenous catheter (PIVC) was inserted in a prehospital setting or in an emergency department setting. Variables investigated also included where the catheter was anatomically placed, the gauge of the catheter, and the patients' Injury Severity Score. The overall phlebitis rate was 5.

Chamber advances for delivery of hyperbaric oxygen therapy.

In this edition of the Watch, Dr. Robins has provided a review of hyperbaric chamber therapy, with particular discussion of new monoplace chambers and their expanded role in emergency medicine.

Unilateral neglect: assessment in nursing practice.

The North American Nursing Diagnosis Association has recognized unilateral neglect (UN) as a nursing diagnosis for more than 2 decades. Such a designation implies that nurses primarily are responsible for assessing, treating, and researching the disorder. However, nurses have made few documented contributions toward this responsibility.

Motor learning and Parkinson disease: Refinement of movement velocity and endpoint excursion in a limits of stability balance task.

Objective: To investigate the effects of practice on performance and retention of a balance task in persons with Parkinson disease (PD).

Methods: Ten persons with PD and 10 age and gender-matched healthy control subjects were tested on an anticipatory, static base of support, limits of stability (LOS) balance task on a force plate. The motor learning paradigm utilized for all subjects included an acquisition phase and retention tests at 24 h and 1 week after acquisition.

A pilot study of the effect of inhaled buffered reduced glutathione on the clinical status of patients with cystic fibrosis.

Study Objectives: To assess the impact of inhaled, buffered reduced glutathione (GSH) on clinical indicators of cystic fibrosis (CF) pathophysiology.

Design And Patients: A randomized, double-blind, placebo-controlled pilot study was conducted over an 8-week period. Nineteen subjects, age 6 to 19 years, with CF status documented by positive sweat chloride test results (> 60 mEq/L) were recruited for the trial.

Treatment of neonatal pain without a gold standard: the case for caregiving interventions and sucrose administration.

Although many different neonatal pain assessment scales are used in clinical research, no gold-standard instrument exists. The multitude of pain assessment scales used has, in fact, threatened the validity of many studies and confused the construct of pain. This integrative review of the neonatal pain literature provides the recommendations from practice guidelines and the current evidence for modifying the pain response prior to and during common painful procedures.

Evaluation of a new real-time blood continuous glucose monitoring system in pregnant women without gestational diabetes. A pilot study.

The incidence of gestational diabetes mellitus (GDM) has reached epidemic proportions in the United States, affecting 200,000 pregnant women annually. Controversies exist regarding whether the glucose levels used to diagnose GDM in pregnancy should be lowered since similar fetal complications are seen in women with GDM as well as in nondiabetic women. Although GDM has been extensively studied, the effects of the earlier stage of glucose intolerance are not well understood.

Pityriasis rosea.

Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis rosea typically affects children and young adults.

Common hair loss disorders.

Hair loss (alopecia) affects men and women of all ages and often significantly affects social and psychologic well-being. Although alopecia has several causes, a careful history, dose attention to the appearance of the hair loss, and a few simple studies can quickly narrow the potential diagnoses. Androgenetic alopecia, one of the most common forms of hair loss, usually has a specific pattern of temporal-frontal loss in men and central thinning in women.

Radiofrequency ablation of accessory pathways guided by the location of the ligament of Marshall.

Introduction: In humans, complex muscle connections are present near the junction between the coronary sinus (CS) and the ligament of Marshall. We hypothesize that these complex muscle connections participate in accessory pathway conduction.

Methods And Results: Electrophysiologic studies and radiofrequency ablation were performed in four patients with refractory AV reciprocating tachycardia.

Operational evaluation of pulse oximetry in NICU patients with arterial access.

Objective: To investigate pulse oximetry in neonates who require arterial access as represented by the clinical data recorded to manage their care.

Study Design: Analysis of simultaneous SpO(2) and SaO(2) from: 7-year historical NICU data (N=31905); 4-month prospective NICU data (N=566); verification data using two hemoximeters (N=52); and NICU data from two collaborating centers (N=95 and 168). The bias function (SpO(2)-SaO(2)) was regressed against the measured "gold" standard, SaO(2).

Childhood outcome after early high-frequency oscillatory ventilation for neonatal respiratory distress syndrome.

Objective: In a previous multicenter controlled clinical trial, we randomly assigned surfactant-treated premature newborns with moderate to severe respiratory distress syndrome to early treatment with high-frequency oscillatory ventilation (HFOV) or to conventional ventilation (CV). Compared with control infants who were treated with CV, neonates who were treated with HFOV using a strategy designed to recruit and maintain lung volume and minimize oxygen exposure had clinical evidence of improved pulmonary outcome and less lung injury. We report a follow-up study designed to determine whether clinical differences persisted between these study groups.

Implementing differentiated practice: personal values and work satisfaction among hospital staff nurses.

This project was part of a collaborative model for nursing staff development and student education. Personal values and work satisfaction of 49 staff nurses working on three hospital units were compared. One of the units employed differentiated practice.

Vein of marshall cannulation for the analysis of electrical activity in patients with focal atrial fibrillation.

Background: Whether or not the muscle bundle within the ligament of Marshall (LOM) can serve as the origin of focal atrial fibrillation (AF) is unknown.

Methods And Results: A total of 28 consecutive patients with paroxysmal AF underwent balloon-occlusion coronary sinus angiograms to identify the vein of Marshall (VOM). Attempts were then made to advance a 1.

Idiopathic paroxysmal atrial fibrillation induced by a focal discharge mechanism in the left superior pulmonary vein: possible roles of the ligament of Marshall.

Introduction: The origin of double potentials inside the left superior pulmonary vein and their relation to the mechanisms of idiopathic paroxysmal focal atrial fibrillation (AF) are unclear.

Methods And Results: A total of 40 patients were studied. Group I included 15 patients who underwent radiofrequency catheter ablation of accessory pathway.

A comparison of the use of tympanic, axillary, and rectal thermometers in infants.

This study examined the relationship between three instruments used in measuring tympanic, axillary, and rectal temperatures in infants less than 1 year of age. Temperatures were measured by Oto-temp Pedi Q tympanic thermometers, Becton Dickinson axillary thermometer, and rectal thermometers. A convenience sample of 5 infants less than 90 day and 54 greater than 90 days with fever, as well as 34 infants less than 90 days and 27 infants greater than 90 days without fever were studied.

Elderly patients' perceptions of care in the emergency department.

Objective: Patients' perceptions and satisfaction are areas of growing concern in health care research, but little has been reported from the perspective of elderly persons. The purpose of this study was to describe elderly patients' perceptions of care in the emergency department.

Methods: A qualitative, descriptive study design was used.

How to resolve stool retention in a child. Underwear soiling is not a behavior problem.

Many parents do not realize their child has stool retention when they bring him or her for an office visit. Some complaints that may be a tip-off and should prompt questioning about stool frequency and underwear soiling are vague abdominal pain, urinary incontinence, and stools so large they plug the toilet. A rectal examination is usually adequate to confirm the diagnosis.

A simultaneous comparison of three neonatal pain scales during common NICU procedures.

Objective: This study evaluated neonatal pain scales during procedures commonly performed in a neonatal intensive care unit.

Design: Evaluated were the Neonatal Infant Pain Scale (NIPS), the Comfort scale, and a new scale known as the Scale for Use in Newborns (SUN). Four procedures were scored: intubation, intravenous catheter insertion, endotracheal tube suctioning, and diaper changes.

Dermatitis of the feet.

Most rashes that occur on the feet are due to eczema, infections, or shoe dermatitis. But which are which? Fortunately, distinguishing among these common skin diseases requires just a little basic knowledge of dermatology and familiarity with two simple diagnostic tests. Two case reports illustrate the authors' approach to diagnosis, treatment, and patient education.

The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome.

Objective: To compare the hospital course and clinical outcome of preterm infants with respiratory distress syndrome treated with surfactant and managed with high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CV) as their primary mode of ventilator support.

Design: A prospective randomized clinical trial.

Setting: Three community-based level III neonatal intensive care units.