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Biomedical subjects

N A Stotts

Publications and source records attributed to N A Stotts.

At least 37 records · Page 2Linked to original sources
PubMed1995

Effects of dynamic exercise on subcutaneous oxygen tension and temperature.

Exercise influences blood flow distribution and may thereby influence tissue oxygen. Given that experimental evidence suggests exercise improves wound healing, this study was undertaken to determine the effect of exercise on subcutaneous tissue oxygen tension (PscO2). Subjects performed a treadmill test to maximum oxygen consumption (VO2) while PscO2 and subcutaneous temperature (Tsc) were measured using a tonometer and optode/thermocouple system. There were no significant differences in PscO2 between measurement points. Mean Tsc had increased 4.8% at maximum VO2, and 6.3% as the cool-down period ended and differed significantly across the exercise period. Changes in PscO2 and Tsc were not correlated. Oxygen availability was neither enhanced nor significantly reduced by exercise. However, PscO2 did not increase as expected in relation to increases in Tsc. Further study will determine the purported beneficial effects of exercise and the mechanism by which it may affect wound healing.

Adult↗
PubMed1993

Daily physical activity levels in congestive heart failure.

To determine the level of daily physical activity routinely performed by patients with congestive heart failure (CHF) and the ability of clinical and laboratory assessments of function to predict peak daily activity levels, 45 patients with CHF were evaluated in the laboratory and during 2 days of usual activity. Subjects performed symptom-limited treadmill exercise tests with respiratory gas analysis and wore a Vitalog activity monitor with continuous measurement of heart rate and body motion. Mean maximal oxygen uptake for this sample was 16.8 ml/kg/min. Peak daily physical activity involved walking on a flat surface (44%), or general activities (housework/yardwork, 42%). Most subjects were asymptomatic (49%) during daily physical activity, 22% noted dyspnea, 16% fatigue and 13% sore muscles/joints. Perceived intensity of peak daily physical activity (mean = 4.19, SD = 2.21) was similar to perceived exertion (mean = 3.73, SD = 1.37) reported at ventilatory threshold measured during treadmill exercise testing. Subjects may control their peak daily physical activity to minimize symptoms experienced. It was further observed that current methods of assessing functional capacity in these patients were inadequate for estimating the peak level of daily activity. In conclusion, daily physical activity levels are low in patients with congestive heart failure and a gap exists between exercise capacity and actual performance of daily physical activity.

Aged↗
PubMed1993

Cost analysis for guideline implementation in prevention and early treatment of pressure ulcers.

One of the goals of the Agency for Health Care Policy and Research (AHCPR) is to improve the quality of medical care by developing and disseminating clinical practice guidelines. One indication of the effectiveness of a clinical guideline is the relationship between the costs of current practice and the costs of using the guideline. Using four model cases of patients at high risk for pressure ulcers, the costs of implementing the appropriate prevention and treatment procedures for each model were identified and compared to current practice costs. On the average, the overall cost of implementing the guideline is not much different from that of current practice.

Cost-Benefit Analysis↗
PubMed1993

Echocardiographic determination of valid zero reference levels in supine and lateral positions.

BACKGROUND: The phlebostatic axis--the junction of the fourth intercostal space and the midpoint of the anterior-posterior diameter--has been accepted as a reliable external reference point for the mid-right and mid-left atrium. Acceptance of this reference point is based upon research conducted in 1945 that measured venous pressures in the hands of subjects positioned with the head of the bed raised to different levels. The validity of this reference point for intracardiac pressure measurements in supine or laterally positioned patients has not been established. PURPOSE: To determine the validity of the phlebostatic axis in the supine and lateral positions. METHODS: To determine validity in the supine position, we compared the distance from the phlebostatic axis to a fixed external point (the bed surface) and the distance from the right and left atria in the supine position to this same fixed external point. The distances from the right and left atria to the bed surface were determined with echocardiography and were used as the standard for the proper position of external reference points. To determine the validity of the phlebostatic axis in lateral positions, we compared the distances from the right atrium and left atrium to the bed surface in the supine position with those distances in different lateral positions. RESULTS: We analyzed the data of 25 normal, healthy subjects. The study findings show that the phlebostatic axis is a valid reference point for the right atrium, and the phlebostatic axis and midanterior-posterior diameter are valid reference points for the left atrium in the supine position. However, neither is a valid external reference point in the lateral positions. Pressure measurements obtained when patients are in the lateral positions are not accurate. There remains a need to develop valid methods of accurate pressure measurements in various body positions.

Adult↗
PubMed1993

Wound care practices in the United States.

Wound management is a crucial aspect of patient care and the nurse often is faced with the question of which approaches to use to provide an environment that supports healing and prevents complications. Important questions include how different types of wounds should be dressed, what method of debridement to use, whether dressings should be changed using sterile versus unsterile technique, and which adjunctive therapies to select under given circumstances. These topics are of interest to clinicians as they represent actual clinical practice and some of the major debates among health care providers who are trying to determine which practices to use to optimize wound healing. While studies are available that compare specific products, no data are available at this time regarding the current wound care practices in the United States. If data documenting the existing wound care practices were available, they would increase understanding of how other professionals manage wound care and provide the basis for planning patient care as well as educational programs and research on wound care.

Adolescent↗
PubMed1990

Nutritional intake and status of clients in the home with open surgical wounds.

The purpose of this study was to determine (a) whether the nutritional intake of patients at home with wounds healing by secondary intention was adequate to support healing, and (b) the nutritional status of these patients. Nineteen subjects with a mean age of 65.3 years were accrued. Of the 17 subjects for whom nutritional intake data were available, 16 had insufficient caloric intake to support healing and over half had less than the Recommended Daily Allowance (RDA) of protein. Using the RDA as a conservative measure of vitamin and mineral need with injury, Vitamin C intake was decreased in approximately one third of the subjects, while all but one had decreased zinc intake. Over two thirds of the subjects reported a decrease from their usual weight and all the subjects measured had triceps skin fold (TSF) and mid-arm muscle circumference (MAMC) which were below the first and second Health and Nutrition Examination Surveys (HANES I & II) median. Mean serum albumin of the sample was below normal. The nutritional intake of these patients needs increased attention. Community health nurses (CHNs) need to assess nutritional status and monitor the intake of patients with wounds. Future research needs to address why intake is decreased and test strategies to increase oral intake.

Aged↗
PubMed1990

Physiology of wound healing and risk factors that impede the healing process.

In the critically ill patient, wound repair can be impeded by processes inherent to the illness, its treatment, and the critical care environment. This vulnerability to wound complications increases patient morbidity and mortality as well as length of stay, resource consumption, and hospital cost. The physiology of wound healing and factors that impede wound repair are discussed. Those factors commonly seen in critical illness include advanced age, diabetes mellitus, compromised immunocompetence, inadequate perfusion, and oxygenation, infection, malnutrition, obesity, and preoperative illness. Knowledge of management of the physiologic factors that affect wound healing enables the nurse to maximize tissue repair and prevent wound complications.

Critical Care↗
PubMed1990

Nutrition: a critical component of wound healing.

Nutrients are essential to wound healing and patients in critical care are often at risk for lack of sufficient nutrients that may result in impaired healing. Understanding the role of the various nutrients in healing provides the basis for assessment and therapy. Use of a practical and consistent nutritional assessment technique is an important part of care for critically ill patients with wounds. The health care team must provide care based on current knowledge of the effects of nutrition on wound healing and work collaboratively in doing nutritional assessment and providing nutritional support to optimize wound healing outcomes.

Critical Care↗
PubMed1988

Predicting pressure ulcer development in surgical patients.

The primary purpose of this study was to determine whether a modified Norton scale at admission to the hospital would predict which patients would develop pressure ulcers when hospitalized for surgery for a period of up to 3 weeks. The sample was composed of 387 adult patients admitted for elective cardiovascular surgery or neurosurgery. By regression analysis, no difference was found in the modified Norton scale scores for those who did and those who did not have pressure ulcers during hospitalization. Pressure ulcers developed in 67 subjects during hospitalization. The modified Norton scale was not more sensitive for older subjects than for younger subjects in this sample. The knee and lateral malleolus were the sites of the most severe pressure ulcers. Subjects who were hospitalized for longer periods had more severe ulcers. Future research is needed to more precisely determine which patients in the acute care setting are at risk for the development of pressure ulcers.

Adolescent↗
PubMed1987

Age-specific characteristics of patients who develop pressure ulcers in the tertiary-care setting.

This article explores whether age-specific characteristics of patients who develop pressure ulcers in the tertiary-care setting are present at hospital admission. Characteristics of interest were prescribed activity, diet, and oxygen therapy; weight change in the last 30 days; midarm muscle circumference; triceps skin fold; and total protein, serum albumin, white blood cell count, hematocrit, and hemoglobin. The sample was composed of 67 subjects who developed pressure ulcers when hospitalized electively and admitted to the cardiovascular or neurosurgical services of a tertiary-care hospital. Chi square and analysis of variance were used to analyze the data and showed no significant difference in the characteristics of the two groups. Data did indicate that length of hospitalization and severity of illness are more important determinants of ulcer development than age-specific characteristics in this sample.

Adult↗
PubMed1984

Retention of Basic Cardiac Life Support content: the effect of two teaching methods.

Does the method of instruction affect retention of Basic Cardiac Life Support (BCLS) knowledge and skill? This was the primary question addressed in a study conducted in a university school of nursing. The teaching methods studied were a lecture-demonstration-return demonstration method and a self-paced method. The sample consisted of 63 baccalaureate nursing students who were assigned to one of the two teaching methods. American Heart Association instructional materials and cognitive and performance tests were used with both treatment groups. Initial mastery and retention were tested during week two and eight respectively. Cognitive knowledge was retained at a mastery level by both groups at eight weeks. In addition, there was no difference in retention of performance skills based on teaching methods. However, neither group was able to demonstrate retention of performance skills at a mastery level. Additional data indicate the self-paced subjects spent less time in BCLS learning activities. While the self-paced instructional package was more costly on a one-time basis, repeated applications would decrease the cost/student.

Adult↗