The "new team" triad.
Nurse managers develop new staffing patterns to increase the quality and cost-effectiveness of care. Ongoing evaluation and adjustments to the new patient-care delivery system are key.
Hospitals, Community↗
Biomedical subjects
R S Dennis
Publications and source records attributed to R S Dennis.
Situational leadership for collaboration in health care settings.
Explore the source record for details and available documents.
Administrative Personnel↗
Clinical use of pulse rates to determine daily energy expenditures in trauma and surgical patients.
This study was conducted to establish practical application by using pulse rates to determine resting energy expenditures in trauma and surgical patients. A continuous flow gas analyzer measured energy expenditures and a cardiotachometer/recorder determined pulse rates simultaneously. The study consisted of 18 normal subjects as controls, seven surgical patients (totaling 36 samples), a combination of the seven surgical and three trauma patients (totaling 23 samples). The group of seven surgical patients had a correlation coefficient of 0.531 when comparing pulse rate/min with kcal/m2/hr, and this was the best correlation among the group population studied. An attempt to establish a single regression line from individual patients showed no significant correlation, with the exception of two surgical patients. Of the total number of patient samples, we found no significant correlation between pulse rate and energy expenditures. Independently, Andrews (Am J Clin Nutr 24:1139-1147, 1971) and Payne (Am J Clin Nutr 24:1164-1170, 1971) suggested that there are multiple variables such as stroke volume, state of physical training, etc., that affect the outcome of such data. In this study, our variables were more extensive with respect to the severity of injuries and varying degrees of surgical procedures. The study concluded that there is no practical clinical use of pulse rates in determining daily resting energy expenditures of surgical or trauma patients.
Energy Metabolism↗
Energy requirements for cancer patients and the effect of total parenteral nutrition.
Limited data are available concerning resting metabolic expenditure (RME) in cancer patients and the effect of RME by varying glucose intake. This study describes the measurements on 21 patients with colorectal cancer while fasting and with incremental levels of standard TPN-glucose system by central vein. Following an overnight fast, the measured mean +/- SEM percent difference from the predicted RME for the male group was 4.13 +/- 1.67% and the female group, 2.09 +/- 2.09%. The overall mean percent difference of 2.95 +/- 1.45 suggests that colorectal cancer does not cause an increase in energy expenditure. Hepatic metastases in 11 of the patients did not influence RME. The data from the 21 patients indicate a statistically significant increase in RME with TPN compared to postabsorptive states in females of 37%, in males 21.88%, and combined of 29.88%. Progressively greater increases in RME were seen when calories provided incrementally exceeded the basal RME. Carbohydrate loading in excess of the patient's calorie need, as indicated by the respiratory quotient (RQ) greater than 1.0, results in fat synthesis and other energy-costing processes. The basal RME demonstrates that these cancer patients are not hypercatabolic, but do respond to high-level force-feeding with markedly increased metabolic expenditures.
Aged↗
Catabolic effect of dexamethasone in patients with major head injuries.
In the records of our extensive metabolic studies on trauma victims, we found 16 head injured patients who had no other major injuries. Among them, nine had been given dexamethasone for at least 6 days. The other seven had not received any corticosteroids. There was no significant difference in the Glasgow Coma Scales of the treated and untreated groups. Metabolic balance studies were carried out for at least 3 days, including the periods when the treated patients were receiving dexamethasone. Mean nitrogen balance was -0.296 +/- 0.03 g/kg/day for the treated group and -0.182 +/- 0.03 g/kg/day for the untreated group. This difference was significant (p = 0.02, t-test). Our metabolic data are also consistent with those of other published studies, which used other corticosteroids and somewhat different methodologies. Thus, it is clearly established that corticosteroids cause significant degrees of catabolism in head injured patients, beyond what would "normally" be expected in such patients if they did not receive these drugs.
Adolescent↗