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Biomedical subjects

M H Ackerman

Publications and source records attributed to M H Ackerman.

17 recordsLinked to original sources
PubMed1997

Neutralizing ageism in critical care via outcomes research.

Ageism, as a mind-set, amplifies a belief that intensive care for the elderly is ineffectual. However, there are little data to support the notion that advanced chronological age alone predicts unfavorable outcomes in response to intensive care. A lack of outcome data, combined with ageism, may place older patients at risk for rationing of intensive care. Currently, neither public policy nor cultural norms directly support a limitation in services to the elderly. However, as pressure to reduce health care costs increases, critically ill elderly patients may be targeted for rationing. In this context, outcomes research involving elderly populations is crucial. The purpose of this report is to explicate the risk of ageism in the delivery of intensive care and to describe methods for implementing outcomes assessment for critically ill elderly patients as an essential element in a continuum of care.

Aged↗
PubMed1996

Development of a model of advanced practice.

BACKGROUND: The acute care nurse practitioner role is relatively new and not yet clearly defined. Our institution is in the first phase of a role delineation study that includes model development, validity testing, model revision, and dissemination. OBJECTIVES: To identify domains of practice, activities within each domain of practice, and common conceptual strands that cut across each domain, and to synthesize this information into a usable format to guide practice and role development. METHODS: A nonexperimental study design was used, including review of literature, expert consultation, brainstorming, and review of practice. RESULTS: The patient is central to the model. The identified domains of practice include direct comprehensive care, support of systems, education, research, and publication, and professional leadership. The conceptual strands include empowerment, collaboration, and scholarship. A continuum of experience from novice to expert was also identified within each domain. CONCLUSIONS: The development of the model is the first and most important phase in the role-delineation process. We believe that the model is accurate but still in need of testing. Nevertheless, our model can be used to guide institutions and individual practitioners.

Critical Care↗
PubMed1995

An educational model for the acute care nurse practitioner.

As new opportunities for acute care nurse practitioners (ACNP) evolve, there is increasing recognition of the need to distinguish between the knowledge base and the role functions generic to all advanced practice nurses, and the knowledge base specific to different areas of clinical specialization. This necessitates differentiating between converging core curriculum elements and merging the roles of advanced practice nurses. This article presents an educational model for the ACNP.

Acute Disease↗
PubMed1994

A review of disease-specific formulas.

Critical illness frequently leads to organ dysfunction. Nutritional support of individual organ function is an evolving area of nutritional support. Within the past several years, there was an increase in the number of nutritional products reported to improve organ function. In this article, the authors review disease/organ-specific nutritional support, including the theory behind therapy and the empiric data supporting or refuting these theories. It is hoped that this article will aid practitioners in their nutritional management of patients with organ dysfunction.

Enteral Nutrition↗
PubMed1994

The systemic inflammatory response, sepsis, and multiple organ dysfunction: new definitions for an old problem.

Sepsis is one of the leading causes of morbidity and mortality in the United States. Until recently, there was much variation in the definition and descriptions of sepsis. This article outlines the report of the consensus conference between the Society of Critical Care Medicine and the American College of Chest Physicians, which established recommendations for the terminology to be used when describing sepsis. An overview of the epidemiology of sepsis and the current state-of-the-art therapy are also provided.

Critical Care↗
PubMed1994

Systemic inflammatory response syndrome, sepsis, and nutritional support.

This article reviews the metabolic alterations that occur in SIRS and sepsis and the management of these patients nutritionally. Practical clinical assessment parameters that can be used by the critical care nurse to determine the nutritional and metabolic needs of the patient are presented. Issues related to enteral and parenteral routes of delivery are presented, and a discussion of disease-specific nutritional formulas is included. An understanding of the determination of metabolic and nutrition needs and the provision of adequate support to meet those needs are vital to the care of the hypermetabolic septic patient.

Energy Metabolism↗
PubMed1993

The effect of saline lavage prior to suctioning.

OBJECTIVE: To determine the effect on oxygen saturation of instilling a saline bolus into artificial airways prior to suctioning, as measured by pulse oximeter. DESIGN: Quasi-experimental, single-case, counterbalanced design. SETTING: The surgical, medical and coronary intensive care units of a federal, teaching medical center. SUBJECTS: Subjects were 40 men, more than 40 years old, in need of intensive care nursing and mechanical ventilation. INTERVENTIONS: Subjects were suctioned as needed for 24 hours. A 5-mL saline bolus was instilled every other time the subject was suctioned. Outcome measurements were done immediately before and after suctioning and at 1-minute intervals for 5 minutes after suctioning. MAIN OUTCOME MEASURES: Noninvasive oxygen saturation values. RESULTS: The instillation of a saline bolus was found to have an adverse effect on oxygen saturation that worsened over time. Significant changes in oxygen saturation as a result of saline bolus instillation were found at 2,3,4 and 5 minutes after instillation. CONCLUSIONS: These results indicate that instilling saline prior to suctioning has an adverse effect on oxygen saturation. These results support the recommendation that the practice of instilling saline prior to suctioning should be abandoned as a routine procedure. More study is needed to investigate whether a specific group of patients may actually benefit from this procedure.

Aged↗
PubMed1983

Synthesis and anticonvulsant activity of some tetracyclic indole derivatives.

Several related series of cycloalkyl[4,5]pyrrolo[3,2,1-ij]quinolines 7a-g, 8a-c, 10a-3, and 16a-f and indolo[3,2,1-hi]indoles 22a-c and 23a,b were synthesized and tested for anticonvulsant activity. The key preparative step, a Fischer indole reaction between a bicyclic hydrazine and a cyclic ketone, gave the compounds in 34-96% yield. The products were tested in rat maximal electroshock for anticonvulsant activity. Several compounds showed good activity, with 6-[(dimethylamino)methyl]-4,5,6,8,9,10-hexahydrocyclopenta[4,5]pyrrolo[3,2,1-ij]quinoline (7d) and N-methyl-4,5,6,8,9,10,11,12-octahydrocyclohepta[4,5]pyrrolo[3,2,1-ij]quinoline- 6-carboxamide (10c) having ED50's of 12.5 and 12.9 mg/kg po, respectively.

Animals↗
PubMed1983

Angiotensin converting enzyme inhibitors: N-substituted monocyclic and bicyclic amino acid derivatives.

The synthesis of N-(3-mercaptopropionyl)-N-arylglycines (14a-x),- N-arylalanines (15a,b),-N-cycloalkylglycines (16a-k), and -1,2,3,4-tetrahydroisoquinoline-3-carboxylic acids (17a-d), -1,2,3,4-tetrahydroquinoline-2-carboxylic acids (18a-f), and -indoline-2-carboxylic acids (19a-k) is described. In vitro inhibition of angiotensin converting enzyme (ACE) is reported for each compound, and the structure--activity relationship for each series is discussed. The in vivo inhibition of ACE and antihypertensive effects of representative compounds from each series are discussed. The most potent compound, 19d, had an in vitro ACE IC50 of 2.6 X 10(-9) M and lowered blood pressure in spontaneous hypertensive rats 85 mm at a dose of 10 mg/kg po.

Amino Acids↗
PubMedDate not supplied

A review of normal saline instillation: implications for practice.

Nurses commonly use normal saline instillation (NSI) as a component of the suctioning procedure. The current research on NSI has not clearly identified many positive aspects of the procedure. Much of the research suggests it may actually be harmful. There has been little investigation into the reasons NSI is used. It is presumed that NSI is used to increase secretion removal when patients have thick endotracheal secretions due to inadequate humidity to the airway. Nurses need to be aware of the potential negative effects of routine NSI as well as alternative methods for maintaining adequate airway humidification.

Clinical Nursing Research↗
PubMedDate not supplied

Humor won, humor too: a model to incorporate humor into the healthcare setting.

The benefits of using humor in health care include stress reduction and improved psychological well-being for patients and the nursing staff. The authors discuss model to incorporate humor into a specific health-care setting, and include a detailed description of two humor programs: the Chuckle Wagon and Nursing Humor Resource Center.

Humans↗
PubMedDate not supplied

Humor won, humor too: a model to incorporate humor into the healthcare setting (revised)

The benefits of using humor in health care include stress reduction and improved psychological well-being for patients and the nursing staff. The authors discuss a model to incorporate humor into a specific healthcare setting, and include a detailed description of two humor programs: the Chuckle Wagon and Nursing Humor Resource Center.

Humans↗