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Biomedical subjects

A J Giuliano

Publications and source records attributed to A J Giuliano.

6 recordsLinked to original sources
PubMed2000

Temperature measurement in critically ill adults: a comparison of tympanic and oral methods.

BACKGROUND: Despite increasing use of tympanic thermometers in critically ill patients who do not have a pulmonary artery catheter in place, variations in measurements obtained with the thermometers are still a problem. OBJECTIVE: To compare the range of variability between tympanic and oral electronic thermometers. METHODS: Subjects were a convenience sample of 72 patients admitted to a 24-bed adult medical-surgical intensive care unit. For each patient, temperatures were measured concurrently (within a 1-minute period) with an oral (Sure Temp 678) thermometer, a pulmonary artery catheter (Baxter VIP Swan-Ganz Catheter), and 2 tympanic (FirstTemp Genius II and ThermoScan Ear Pro-1) thermometers. Each subject was used up to 3 times for data collection. Measurements obtained with the oral and tympanic thermometers were compared with those obtained with the pulmonary artery catheter. Nonparametric analysis of data was used. RESULTS: The magnitude of error for the ThermoScan tympanic thermometer differed significantly from that of the Genius II tympanic thermometer and the SureTemp oral thermometer (P < .001). Application of the Bland and Altman method to frame the data on the basis of an accuracy tolerance zone of +/-0.5 degrees C indicated variability with both the oral and tympanic methods. The overall degree of variability was lower for the oral thermometer. CONCLUSIONS: Oral thermometers provide less variable measurements than do tympanic thermometers. Use of oral thermometry is recommended as the best practice method for temperature evaluation in critical care patients when measurement of core temperature via a pulmonary artery catheter is not possible.

Adult↗
PubMed2000

Families first.

Family support can have positive effects on critically ill patients, so limiting visitation in critical care units may not be in their best interest. This study examined the outcomes of increasing visitation using a quality-improvement model.

Attitude of Health Personnel↗
PubMed1999

Temperature measurement in critically ill orally intubated adults: a comparison of pulmonary artery core, tympanic, and oral methods.

OBJECTIVE: Core temperature measurement using a pulmonary artery (PA) catheter is considered the gold standard for measuring temperatures in critically ill patients. The objective of this study was to compare oral and tympanic temperature measurements (in both the oral and core equivalence modes) against PA core temperature measurements to determine which method was the most accurate and reliable in the absence of a PA catheter. DESIGN: Prospective, descriptive comparative analysis. PATIENTS: Convenience sample of 102 critically ill orally intubated patients with a PA catheter in place. SETTING: A 24-bed medical/surgical/trauma intensive care unit in a university-affiliated medical center. INTERVENTIONS: Four experienced intensive care unit nurses were trained in the use of temperature measurement with the oral, tympanic (both core and oral equivalence modes were used), and PA core methods. Simultaneous temperature measurements were then taken once in each subject using each method. The potential covariates that were analyzed were mean blood pressure, patient acuity using the Simplified Acute Physiology Score II, age, sex, ambient room temperature, and ventilator circuit temperature. MEASUREMENTS AND MAIN RESULTS: The training period indicated that it took more time to train experienced nurses in the use of tympanic thermometry than oral thermometry. Descriptive statistics were the following: core, x = 37.33 (SD = 0.89); oral, x = 37.18 (SD = 0.92); tympanic oral, x = 36.80 (SD = 0.93); and tympanic core, x = 37.12 (SD = 1.0). Bias averages were calculated and were significantly different from 0 for all three methods (oral-PA core, -0.15 [SD = 0.36]; tympanic core-PA core, -0.11 [SD = 0.57], tympanic oral-PA core, -0.52 [SD = 0.53]), indicating that there is some degree of decreased accuracy associated with each method when compared with PA core. However, scatter plots using the Bland and Altman methodology (Altman DG, Bland JM: Practical Statistics for Medical Research. London, Chapman and Hall, 1991) illustrate that the greatest variability is associated with the tympanic method. CONCLUSIONS: Temperature measurement is an important piece of clinical data in a critically ill patient population. We found oral thermometry to be the most accurate and reproducible method when a PA core measurement was not available.

APACHE↗
PubMed1995

Folstein vs modified Mini-Mental State Examination in geriatric stroke. Stability, validity, and screening utility.

OBJECTIVE: Two studies were conducted with the Folstein Mini-Mental State Examination (MMS) and the Modified Mini-Mental State Examination (3MS) to examine whether the expanded version is a more useful screening tool in stroke populations. DESIGN: Clinical utility of screening tests (MMS and 3MS) was evaluated in reference to neuropsychological performance and functional outcome in rehabilitation. SETTING: Medical rehabilitation unit of university-affiliated hospital. PATIENTS: Two groups (n = 77, and n = 70) of patients who were admitted consecutively. MAIN OUTCOME MEASURES: Neuropsychological performance and functional outcome (functional independence measure). RESULTS: The reliability, stability, and validity of the 3MS were established in the stroke population. Classification accuracy did not differ between the MMS and 3MS, although the 3MS had higher sensitivity. In detecting cognitive impairment when compared with the extended neuropsychological battery, both instruments were adequate in patients with left-sided cerebrovascular accidents and were ineffective in patients with right-sided cerebrovascular accidents. The 3MS correlated with some cognitive domains missed by the MMS, thus adding useful clinical information. Finally, the 3MS was a significantly better predictor of functional outcome than the MMS. CONCLUSIONS: The 3MS was found to be a reliable, valid, and stable cognitive screening instrument in the stroke population. Classification accuracy indicates that both screening instruments are not strong in their ability to detect cognitive impairment in patients with stroke, especially in right-sided cerebrovascular accidents. The 3MS does have some advantages over the MMS; the expanded version of the screen not only provides additional cognitive information but also allows for better predicting of functional outcome.

Aged↗
PubMed1992

Emotional dysfunction in a geriatric population: staff observations and patients' reports.

This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗