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Biomedical subjects

M L Sole

Publications and source records attributed to M L Sole.

12 recordsLinked to original sources
PubMed2001

Comprehensive trauma patient care by nonphysician providers.

Nonphysician providers are being increasingly used to care for trauma patients. As these complex patients recover, they require meticulous medical management and time-consuming psychosocial care. A retrospective evaluation of a unique patient care service staffed by nonphysician providers is presented. The Intermediate Care Service is designed to facilitate the management and long-term placement of trauma patients who no longer require intensive care while recovering from their injuries. The new diagnoses, physician order changes, and disposition of 93 patients cared for during a 6-month period are described. Most patients were admitted with neurologic injury. The most common new diagnosis was constipation; the most frequent new orders related to medications, including bowel management, and rehabilitation consultations. All patients were discharged from the hospital. The Intermediate Care Service represents a unique and valuable model for the collaborative management of complex trauma patients.

Adolescent↗
PubMed2001

Assessing the female sexual assault survivor.

Because sexual assault survivors often seek treatment in primary care settings, clinicians must be prepared to evaluate these patients in a nonjudgmental manner. The initial evaluation includes a medical and assault history. During the physical examination, physical injuries are noted and forensic evidence is collected. Treatment includes prophylaxis for pregnancy and sexually transmitted infections and counseling referrals. This article focuses on care of the adult female sexual assault survivor. Psychosocial support, physical examination, collection of evidence, treatment, and documentation are discussed.

Contraceptives, Postcoital↗
PubMed2000

Variables influencing patients' outcomes after elective aortic reconstruction surgery.

BACKGROUND: Aortic reconstruction surgery for aneurysmal and occlusive disease is associated with significant morbidity and mortality. OBJECTIVES: To determine what variables influence patients' outcomes after elective aortic reconstruction surgery so that an evidence-based best-practice initiative can be developed for these patients. METHODS: A descriptive, comparative study of all patients undergoing elective aortic reconstruction from October 1997 through December 1998 was used. Retrospective chart review was used to collect demographic and clinical data on the first 48 subjects, who had been discharged from the hospital. Data on the other 63 subjects were collected prospectively. RESULTS: The typical subject was a 65-year-old man with a history of cardiovascular disease, hypertension, and smoking. Subjects were grouped by type of surgery and by outcome (survived without complications vs died or survived with major complications). Outcomes were not significantly different in patients undergoing different types of surgery. Variables associated with poor outcomes included history of cardiovascular disease, elevated preoperative levels of serum urea nitrogen and creatinine, high volumes of salvaged autologous blood administered intraoperatively, and early postoperative hypotension that required treatment. Pulmonary complications were the most common; next most common were cardiac complications. History of cardiovascular disease and hypotension were significant predictors of outcome. CONCLUSION: The variables associated with poor outcomes can be used to design a best-practice initiative for patients undergoing elective aortic reconstruction.

Aged↗
PubMed2000

Analysis of factors related to the development of ventilator-associated pneumonia: use of existing databases.

OBJECTIVE: To investigate factors related to ventilator-associated pneumonia to assist in the development and implementation of prevention strategies. METHODS: A retrospective, descriptive design was used. Power analysis determined sample size. A consecutive sample of 120 patients admitted to the critical care units of a level I trauma center who were receiving mechanical ventilation was used. Data were obtained from clinical and financial databases. Variables included demographic data, causative organism of the pneumonia, medications, comorbid conditions, complications, duration of therapies, length of stay, and cost per case. RESULTS: The average patient was a 49-year-old man. The sample was 54.9% trauma patients, and the prevalence of ventilator-associated pneumonia was 16.7%. Significant factors included duration of intubation (r = 0.28, P = .005), mechanical ventilation (r = 0.26, P = .005), and tube feeding (r = 0.30, P = .001); trauma (phi = 0.24, P = .009); and use of histamine2 receptor antagonists (phi = -0.25, P = .006). The only variable that significantly increased the odds ratio for ventilator-associated pneumonia was trauma. The only variable that significantly decreased the odds ratio was use of histamine2 receptor antagonists. Patients in whom ventilator-associated pneumonia developed had a 16-day increase in length of stay (t = -2.68, P = .008), and a $29,369 increase in cost per case (t = -3.649, P = .000). CONCLUSIONS: These findings provide a baseline for discussions about potential changes in practice to help prevent ventilator-associated pneumonia.

Adolescent↗
PubMed1999

Application of trauma concepts in the medical-surgical client.

Concepts related to fluid administration, hemodynamic monitoring, bladder pressure monitoring, acid-base status, and temperature management are applicable in all clients, not just those with traumatic injury. Two case studies are illustrated showing how trauma care concepts are also relevant to the acutely ill client. Nurses are challenged to identify how the content presented in this symposium can be used for all clients.

Aged↗
PubMed1998

Nursing strategies to prevent ventilator-associated pneumonia.

Critically ill patients who require mechanical ventilation are at high risk for development of pneumonia during the course of treatment. Ventilator-associated pneumonia leads to higher rates of mortality and morbidity, increased length of hospital stay, and higher hospital costs. The intubation that is necessary for mechanical ventilation impairs the patient's normal defense mechanisms for fighting infection. Impaired defenses, along with such risk factors as age of the patient, equipment used, and failure of the staff to wash hands increase the likelihood of colonization of the lower airways. Colonization and subsequent pneumonia commonly occurs from microaspiration of secretions from the oropharynx and gastrointestinal tract. In this article, the mechanism of microaspiration, diagnosis of ventilator-associated pneumonia, and nursing strategies to reduce the incidence of pneumonia are described.

Adult↗
PubMedDate not supplied

Enhancing traditional, televised, and videotaped courses with Web-based technologies: a comparison of student satisfaction.

BACKGROUND: Varied distance learning strategies can be used to deliver nursing courses, including interactive television, videotape, and Web-based approaches. PURPOSES: (1) To assess student assess student satisfaction with a critical care elective course offered simultaneously via traditional and distance learning formats in which Web-based strategies were added, and (2) to compare satisfaction of students taking the traditional course versus those taking the class via distance technology. METHODS: Students (n = 113) who took the course during the spring 1998 and 1999 semesters completed a teacher-constructed evaluation at the end of the semester. FINDINGS: Mean ratings on the evaluation were positive. Ratings of interaction, communication with instructor, and facilitation of learning were higher from students who took the traditional course. CONCLUSIONS: The application of Web-based technologies may be one factor for the overall course satisfaction. However, it is important to continue to evaluate strategies that work best for students taking courses via distance technology.

Consumer Behavior↗
PubMedDate not supplied

Designing and facilitating class discussion in an Internet class.

Designing a replacement for face-to-face classroom discussion is a major consideration in the development of an Internet course, whether the course is completely new or a redesign of an existing course. The experiences of four faculty members who were involved in developing courses for a baccalaureate completion program for RNs taught entirely on the Internet will be used to illustrate key issues in designing andfacilitating on-line discussion.

Communication↗
PubMedDate not supplied

Noninvasive positive-pressure ventilation: averting intubation of the heart failure patient.

Mechanically ventilating patients with heart failure who have respiratory distress can increase hospital costs, complications, and mortality. A few studies have evaluated the use of noninvasive positive-pressure ventilation (NPPV) as an alternative treatment for these patients. This article describes NPPV and reviews its use in managing an acute exacerbation of heart failure.

Critical Illness↗