When is a nurse practicing medicine?
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Algorithms↗
Biomedical subjects
C G Bayne
Publications and source records attributed to C G Bayne.
Speak to me! An overview of patient communication systems.
One way to match professional expertise to the insatiable demand for patient information is to use new communication technologies. Patient communication systems and the opportunities they offer are explored. When using these emerging technologies, risks also should be addressed: not only must the information be accurate, but the systems must be secure.
Communication Barriers↗
Support systems for medical decision making.
The explosion of technological solutions and communications options makes a "wait-and-see" attitude prudent for the short term. Spending the large amount of computer cost and staff time developing global systems for each medical entity seems fraught with inefficiency at this time. No vendor has the correct product for our needs. How could they, when we don't even know what our needs are in this revolutionary environment? Any system you buy today will be obsolete tomorrow if it does not have a "meta" function for ongoing adjustment.
Decision Support Techniques↗
Using blood gases for the v.i.p..
UNLABELLED: We have tried to expand the routine analysis of blood gases to include some fine-tuning aspects of critical care. Test your understanding by answering the following question: A 70-year-old smoker falls into Lake Dillon (outside Denver) suffering a near-drowning episode. The pulse oximeter shows 93% on 6L nasal oxygen. His pulse and blood pressure are normal. Because you've read this article, you know that the patient's smoking habit and the city's elevation can affect the pulse oximeter's accuracy, leading one to underestimate the severity of the problem. So, you draw labs and note that his hemoglobin is 12, with blood gases showing PaO2 of 90, PaCO2 of 30 and a pH of 7.36. The lab forgot to calculate the base excess for you and his temperature is 89 degrees F rectally. A diagnosis of life-threatening inadequate oxygenation is supported by which of the following astute observations: a) An abnormal base deficit is proven by the borderline acidic pH and the low PaCO2. b) His anemia reduces both his buffer base and his oxygen carrying capacity. c) His hypothermia overstates his PO2 because the blood was heated up before measurement. d) His smoking makes a CO level likely, worsening his anemia and ignored by the pulse oximeter. e) The high level of supplemental oxygen has minimal effect on his arterial oxygen tension, showing severe pulmonary gas transfer problems (shunting). f) The measurement of his PaO2 is artificially high because he is at altitude. ANSWER: All of the following except (f). Measuring his oxygen tension at altitude actually works in his favor, since the barometric effect will be to reduce the PaO2 at a given level of sea level pathology. Now you are ready to give your patients the V.I.P. treatment!
Acid-Base Equilibrium↗
How sweet it is: glucose monitoring equipment and interpretation.
When monitoring blood glucose, a number of factors should be considered, e.g., the equipment and methods used to measure the levels. Teaching patients how to use this equipment is of paramount importance; outcomes depend on patient motivation and the proper use of the devices and strips. The significant advancements in glucose monitoring equipment and the lab monitoring methods are discussed.
Blood Glucose Self-Monitoring↗
A simple guide to nutritional support products.
In this day of cost-accounting methodologies of care, one must be as objective as possible in documenting weight loss as well as caloric need. To address the issues of nutritional need, a case study and the patient's assessment are presented.
Aged↗
Removing the confusion about infusion.
There is more to infusion technology than simply connecting the "pump-du-jour" to the central line. The purpose of infusion technology, its safety products and four categories of devices-elastomeric, mechanical, gas and membrane-are discussed.
Disposable Equipment↗
Patient information systems: unbiased information is key.
Successful patient information systems must have user-friendly services to transfer vast amounts of information. Whether it is preprinted discharge instructions for standard wound care, an algorithm-based triage discussion of one's chest pain, or simply a database to search out the current recommendations for flu shots or pediatric immunizations, the challenge for patient education in the communications revolution is high stakes indeed.
Humans↗
Vital signs: are we monitoring the right parameters?
Measuring vital signs began with simple observations by the great masters. New technologies are now used to correlate old theorems about cardiovascular efficiencies into accepted measured parameters. Measuring temperature, blood pressure and respiration has never been easier.
Blood Pressure Determination↗
How much protection is enough?
Infectious diseases are changing patient relations. Risk is a two-way street. Not only are health care providers at risk from patients, but patients also may be at risk from health care providers. Practical measures can be taken: identify the risks; determine how to reduce them; and educate others at risk.
Adolescent↗
Pocket-sized medicine. New POC technologies.
Newer miniature testing and monitoring machines are profoundly changing the delivery of health care. Blood gases, X-rays, electrocardiograms, all can be done within the privacy of the patient's home. Yet, government regulations are just beginning to catch up with this technologic revolution. These technologies and their effect on patients and the health care environment are discussed.
Equipment and Supplies↗
Technology assessment--who is getting stuck, anyway?
Some 13% to 62% of all injuries reported to hospital occupational health workers are traceable to phlebotomy procedures. However, the selection of a needleless system is complex. The informed manager seeks answers to the following questions: (1) Do needleless systems reduce the risk of seroconversion to bloodborne pathogens? (Answer yes.) (2) Does the use of a needleless system affect patients' risk of catheter sepsis? (Answer no.) and (3) What about chemical compatibility with the newer materials used in needleless systems? (New variables require more studies.) The author lists references, manufacturers and some of the chemicals to which some manufacturers have exposed their devices.
Blood Specimen Collection↗
Point of care testing: testing the system?
Point of care testing is changing for the better the way we practice medicine. Whether it is an anesthesiologist doing a blood gas in the operating room, a nurse measuring serum glucose in the home or on the unit, or an intensive care nurse testing by the bedside before calling an intensivist, newer instrumentation provides for a limited number of quality tests to instantly add value to the critical decision-making process of modern staff. This movement is a true paradigm shift that will reduce unnecessary testing, provide timely measurement of critical values and avoid unnecessary and catastrophic mistakes.
Costs and Cost Analysis↗
Falling: why and what to do about it.
Some 5% of all hospitalizations are due to falls--an average length of stay varies between 8 and 15 days. Some studies report the number one reason for admission to a skilled nursing facility is falls. Who is at risk and what can be done? Assessing the risk factors and introducing a "prosthetic environment" can reduce mobility limitations.
Accidental Falls↗
A mobile emergency room: a new option in comprehensive home care.
The marriage of all the emotional and convenience factors making preference for housecalls over space-age technology allows several processes to take shape. First, physicians can now be comfortable in having a complete database on which to make clinical decisions in the home. Secondly, continuity and quality of care questions can be laid to rest. Finally, given adequate volume, physician-owned services can generate sufficient revenues to entice more providers into the home care arena.
Aged↗
Doppler bubble detection and decompression sickness: a prospective clinical trial.
Decompression sickness in human beings exposed to high ambient pressure is thought to follow from gas bubble formation and growth in the body during return to low pressure. Detection of Doppler-shifted ultrasonic reflections in major blood vessels has been promoted as a noninvasive and sensitive indicator of the imminence of decompression sickness. We have conducted a double-blind, prospective clinical trial of Doppler ultrasonic bubble detection in simulated diving using 83 men, of whom 8 were stricken and treated for the clinical disease. Diagnosis based only on the Doppler signals had no correlation with clinical diagnosis. Bubble scores were only slightly higher in the stricken group. The Doppler technique does not appear to be of diagnostic value in the absence of other clinical information.
Clinical Trials as Topic↗
Reversal of inadequate cardiac output and perfusion during cardiopulmonary resuscitation by open-chest cardiac massage.
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Cardiac Output↗