Biomedical subjects
J F Byers
Publications and source records attributed to J F Byers.
Quality control recording methods in microbiology.
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Usefulness of measures of Svo2, Spo2, vital signs, and derived dual oximetry parameters as indicators of arterial blood gas variables during weaning of cardiac surgery patients from mechanical ventilation.
OBJECTIVES: To determine whether combined use of the parameters of mixed venous oxygen saturation, arterial oxygen saturation obtained by pulse oximetry (Spo2), and vital signs correlated with arterial blood gas variables (ABGs) better than each individual variable during weaning of postoperative cardiac surgery patients from mechanical ventilation; and to evaluate the relationship of derived parameters: oxygen extraction index and ventilation/perfusion index (VQI), and ABGs. DESIGN: Secondary analysis of previous correlational study. SETTING: The cardiac care unit in a large medical center in central Florida. PATIENTS: Thirty postoperative coronary artery bypass graft patients being weaned from mechanical ventilation. METHODS: After a change in ventilator settings during systematic weaning towards extubation, measurements of variables were taken during a 30-minute period. At 30 minutes, an ABG was drawn for comparison. Data were collected after two ventilator changes. A total of 57 data sets were used for analysis. RESULTS: By use of multiple regression analyses, statistically significant (p < 0.01) independent variables predicting pH and partial pressure of carbon dioxide were Spo2 and respiratory rate. The independent variable contributing to the model versus partial pressure of oxygen was Spo2. The oxygen extraction index did not correlate with ABGs; however, the VQI correlated significantly with all ABG variables except bicarbonate. CONCLUSIONS: The use of multiple parameters was no more useful in predicting ABGs than individual variables of Spo2 and respiratory rate. The derived VQI parameter correlated with ABGs. The use of VQI in conjunction with Spo2 and respiratory rate may assist in patient monitoring during weaning and reduce the number of ABGs needed.
Mandatory HIV testing: a timely controversy.
Incidence of infection with the human immunodeficiency virus (HIV) has increased to epidemic proportions. Strategies are needed to prevent transmission of the virus. One strategy, mandatory HIV testing of nurses, is controversial. Both sides of this issue are debated in this article.
Application of a transactional model of stress and coping with critically ill patients.
Critically ill patients are exposed to many physiologic and environmental stressors, which can result in deleterious physiological and psychological effects. Stress and coping within Lazarus and Folkman's transactional model is used as a basis for describing patient responses in critical care. The authors propose specific strategies to reduce stress and maximize coping in the critically ill patient.
Burn patients' pain and anxiety experiences.
The purpose of this study was to examine burn patients' pain and anxiety experiences during resting conditions and procedures. The relationship of contextual factors and interventions to pain and anxiety were also explored. Procedural pain was significantly higher than resting pain (P = .02); however, there were no significant differences in anxiety between resting conditions and procedures (P = .16). There was a significant difference between burn patients' acceptable level of pain, resting pain, and procedural pain (P = .01). Resting pain was significantly lower than patients' acceptable level of pain (P = < .01). Procedural pain was slightly lower than patients' acceptable level of pain, but these results were not statistically significant (P = .37). Percent of total body surface burned was associated with increased procedural anxiety (P = .022). Family presence correlated with decreased procedural pain (P = .011) and midazolam use (P = .047). Prior experience with the procedure was associated with increased morphine(P = .003) and midazolam use (P = .029). These findings support the multifactorial nature of burn pain and anxiety and provide guidance for practice.
Knowledge, skills, and attributes needed for nurse and non-nurse executives.
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Critical appraisal tools facilitate the work of the quality professional.
Quality management activities involve the application of scientific principles to performance improvement activities. With the plethora of available information, a systematic approach to evaluating the quality and usefulness of sources is necessary. One approach is critical appraisal, which is used to search for the best evidence or integrate evidence with clinical expertise. Two critical appraisal tools (CATs) are presented here, the first for any original clinical or health services research study and the second for research synthesis. The CAT scoring system and summaries of reviewed references facilitate understanding of the "state of the science" in the areas of interest.
Noninvasive positive-pressure ventilation: averting intubation of the heart failure patient.
Mechanically ventilating patients with heart failure who have respiratory distress can increase hospital costs, complications, and mortality. A few studies have evaluated the use of noninvasive positive-pressure ventilation (NPPV) as an alternative treatment for these patients. This article describes NPPV and reviews its use in managing an acute exacerbation of heart failure.
Family discussion groups, a way to meet the needs of the ICU patient's family.
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