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Biomedical subjects

E C Wheeler

Publications and source records attributed to E C Wheeler.

7 recordsLinked to original sources
PubMed2000

The CNS's impact on process and outcome of patients with total knee replacement.

This study was designed to determine whether differences exist between patients with total knee replacement on hospital units with or without clinical nurse specialists (CNSs) in terms of selected process and outcome variables. The charts of 128 randomly chosen patients who had undergone total knee replacement were reviewed. Sixty-four patients were from orthopedic units with CNSs and 64 were from orthopedic units without CNSs. This study was based on Donabedian's framework for assessment of quality of care using structure, process, and outcome variables. Structural variables were collected on institutional and unit demographics. Data were gathered on nursing care interventions (process variables) using process instruments designed by the investigator. Length of stay, total length of stay, which included rehabilitation length of stay, and complications were the outcome variables used. Patients on units with CNSs had significantly higher process scores, shorter total length of stay, and fewer complications than patients on units without CNSs. In addition, significant negative correlations were found between process instrument scores and total length of stay. Higher scores on the process instruments (with CNS units) were correlated with shorter total length of stay. The number of complications was also negatively correlated to the process instrument scores.

Aged↗
PubMed1999

The effect of the clinical nurse specialist on patient outcomes.

The review of the literature shows a beginning body of evidence to support the positive effects of CNSs on patient outcomes. The most commonly examined patient outcomes were length of stay, complications, use of health care services, cost, and mortality rates. The study done by the author shows that patients with TKR operations on units with CNSs had better patient outcomes than patients on units without CNSs. Patients on units with CNSs had an overall shorter TLOS and fewer complications than did patients on units without CNSs, which is consistent with the literature. Health care providers are making continuing efforts to decrease operating costs. Because of economic pressures on health care administrators, a need to examine various job positions exists. Decisions regarding which positions are retained or eliminated should be based on well-designed research data. The effect of CNSs on patient outcomes can mean improved quality of care and cost reduction. As more research is conducted to show the effectiveness of CNSs on patient outcomes, health care administrators and consumers may become more convinced that such a person is a valuable member to have on the health care team.

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PubMed1995

Peripheral vascular anatomy, physiology, and pathophysiology.

The primary function of the circulatory system is to transport oxygen, nutrients, and waste products. Hemodynamics of the vessels are governed by a variety of physical properties and laws that explain blood flow through the vascular system. Blood flow is affected by pressure differences, radius of the vessel, length, and viscosity (Poiseuille's Law). Flow is directly proportional to the difference in pressure and inversely proportional to resistance. Any disturbance in blood flow in the arterial and venous system disrupts the delivery of oxygen and nutrients and the elimination of waste products. Disturbances of blood flow can be due to compression of the blood vessel (edema, hematoma, compartment syndrome), structural changes within the vessel (atherosclerosis), vasospasm (Raynaud's syndrome), vasodilatation (sepsis, distributive problems), or blood clot (thrombus or embolus). Decrease in perfusion will promote compensatory mechanisms such as vasodilatation, development of collateral vessels, and anaerobic metabolism. If compensatory mechanisms are unable to meet the oxygen demand by the tissues, ischemia develops, and eventually, tissue death occurs.

Blood Circulation↗