Biomedical subjects

D Elliott

Publications and source records attributed to D Elliott.

184 records · Page 11Linked to original sources

PubMedDate not supplied

Reproducibility of central venous pressures in supine and lateral positions: a pilot evaluation of the phlebostatic axis in critically ill patients.

OBJECTIVE: To determine if the phlebostatic axis (PA) can be used to obtain reproducible central venous pressures (CVP) in laterally positioned critically ill patients. DESIGN: A quasi-experimental study design was used. The outcome variable was central venous pressure. The explanatory variables were position (supine, 30 degrees right lateral, 30 degrees left lateral) and transducer leveling procedure (supine PA, upper PA, dependent PA). Each subject was used as his or her own control. SETTING: General intensive care unit of a 929 bed metropolitan teaching hospital in New South Wales, Australia. SUBJECTS: A convenience sample of 25 critically ill patients (15 men and 10 women) with an average age of 59.6 years +/- 15.2. METHOD: Each subject's baseline CVP range was collected over a 25-minute period in a supine position. CVP measurements were then obtained in the left and right lateral positions (initial lateral position alternated for each subsequent subject). When the subject was lateral, three CVP readings corresponding to the three transducer leveling procedures were taken. DATA ANALYSIS: One-way repeated measures analysis of variance (one for each leveling procedure) were performed. Clinical significance was deemed evident when the lateral CVP measurement exceeded the baseline range. RESULTS: Statistically significant changes were associated with the upper PA (p < 0.001) and the dependent PA (p < 0.001). Only the supine PA yielded statistically nonsignificant changes in CVP (p = 0.073). However, power analysis indicated that the results were not conclusive (power = 0.520). Clinical significance was determined in 100% and 92% of subjects in the left lateral and right lateral positions, respectively, when using the upper PA whereas the dependent PA yielded clinical significance in all (100%) subjects. Clinical significance was seen in 46% and 42% of subjects for the left lateral and right lateral positions, respectively, when the supine PA was used. CONCLUSION: Of the three leveling procedures, the supine PA yielded the most reproducible CVP measures. However, further studies are required before the supine PA can be recommended as a valid and reliable transducer position for CVP measurement in laterally positioned patients.

Adult↗

PubMedDate not supplied

The effects of music and muscle relaxation on patient anxiety in a coronary care unit.

OBJECTIVE: To test the efficacy of music and muscle relaxation techniques in reducing the anxiety of patients admitted to a coronary care unit with ischemic heart disease. DESIGN: Randomized, controlled trial. SETTING: Seven-bed coronary care unit of an Australian tertiary care hospital. PATIENTS: Fifty-six patients admitted to a coronary care unit with unstable angina pectoris or acute myocardial infarction. OUTCOME MEASURES: Psychologic (State Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Linear Analogue Anxiety Scale) and physiologic (systolic and diastolic blood pressure and heart rate) variables were measured as indicators of anxiety. INTERVENTION: Two or three 30-minute sessions of audiotape interventions were conducted with portable tape players with headphones. The two intervention tapes consisted of light classical music and verbal instructions for muscle relaxation. RESULTS: With analysis of variance procedures, the null hypotheses were supported. No significant differences (p < 0.05) between groups were demonstrated for the psychologic or physiologic variables; that is, no significant reductions in anxiety were achieved for patients using music or muscle relaxation interventions when compared with the control group. The effect size of the interventions on the outcome measures was 0.19 to 0.22, indicating a small effect. Resultant power was at a low level. CONCLUSIONS: These results differ from those of similar studies but may be related to the high probability of a type II error. Further investigation with longer intervention sessions and larger sample sizes is indicated. Similar studies should incorporate power analysis when reporting their results.

Angina, Unstable↗

PubMedDate not supplied

Attitudes of Australian nurses toward the implementation of a clinical information system.

A computerized clinical information system (CIS) used for the majority of patient charting and medical records was installed in six of 15 beds in the intensive care unit (ICU) of a large Australian hospital in November 1993. Staff acceptance was identified as integral to the success of the system. A survey was issued to all nursing staff of the ICU to identify factors that affected attitude toward computers in the critical care environment. Factors resulting in negative attitudes then could be targeted through training and support for users. The factors considered that potentially could influence attitudes were age, nursing experience, intensive care nursing experience, and education. The study showed that nursing experience had a statistically significant effect on motivation to use computers. A strong relation was evident between the concepts of beliefs, attitudes, and motivation. A less apparent association was present between knowledge and the other concepts. Orientation and in-service education programs should provide appropriate and applied information to optimize the motivation, beliefs, and computer literacy of nurses using CIS frameworks.

Adult↗

PubMedDate not supplied

A comparison of nursing activities associated with manual and automated documentation in an Australian intensive care unit.

This article describes a comparative study that examined the frequencies of nursing activities, when using a clinical information system (CIS) and a paper-based documentation system in an Australian intensive care unit. The study unit had half the beds equipped with a CIS, and the remaining beds used paper documentation. Work sampling methodology was used to observe nurses working with both systems. Though there were differences for all activities between the environments and the directions of the differences were logical, none were statistically significant using a chi-square test (P = .11-0.65), probably because of the small sample size. This study established that work sampling methodology using a random timer is a valid and relatively easy method to capture work activity in the clinical area. Although this article does not provide definitive information regarding the benefits of a CIS over manual documentation, a number of important methodological issues are discussed, including the study design, procedure, use of dedicated observers, and the distinction between basic versus fully optioned systems. Future research should evaluate the efficiency, impact on patient outcomes and nursing practice, and cost effectiveness of fully optioned systems.

Australia↗