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Biomedical subjects

S Ross

Publications and source records attributed to S Ross.

315 records · Page 18Linked to original sources
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Evaluating the competence of clinical nurses from beginning to advanced practitioner.

Frequently, clinically competent nurses leave direct patient care for non-clinical positions or other careers to achieve greater professional advancement and recognition. The drain of clinical nursing expertise away from the patient prompted the development and evaluation of a clinical promotion program to appraise and recognize clinical nursing competence. At the beginning of the evaluation period, 205 nurses were appraised for clinical competence and categorized as: Level 1--a beginning practitioner or a nurse returning to service; Level 2--a skilled clinical practitioner; and Level 3--an advanced clinical practitioner. Nurses volunteered information related to demographic characteristics, education, clinical experience, and attitudes to their work and work environment. Reassessments were completed after one year. Evaluation of the program employed a longitudinal comparative design. The major finding shows significant shift in clinical nurses' competence over time with a greater percentage of nurses at higher levels of ability. Further evaluation of the program is in process.

Adult↗
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Management prerogative.

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Decision Making, Organizational↗
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Comparison of ampicillin-sulbactam and ticarcillin-clavulanic acid in patients with chronic renal failure: effects of differential pharmacokinetics on serum bactericidal activity.

STUDY OBJECTIVES: To evaluate the pharmacodynamic antibacterial activity of ticarcillin-clavulanic acid (T-C) and ampicillin-sulbactam (A-S) combinations against reference bacterial strains in patients with end-stage renal disease maintained on long-term hemodialysis. DESIGN: Randomized, crossover, controlled study. SETTING: National Institutes of Health-funded general clinical research unit in a Veterans Administration Medical Center. PATIENTS: Nine adult men with end-stage renal disease maintained on long-term hemodialysis. Two subjects did not complete the study due to problems of vascular access, and another withdrew for personal reasons. INTERVENTIONS: On a nondialysis day, each subject was randomly administered either T-C 3.1 g or A-S 3 g as a slow intravenous infusion over 30 minutes. Serial blood samples were collected for measurement of antibiotic serum concentrations and determination of serum bactericidal titers. Following a washout period, the study was repeated with the alternative antibiotic combination. MEASUREMENTS AND MAIN RESULTS: The mean observed apparent beta-half-life of clavulanic acid was substantially shorter than that for the other three drugs. The bactericidal activity of both A-S and T-C against non-beta-lactamase-producing (N beta-LP) strains of S. aureus and E. coli was consistently high, as indicated by geometric mean SBTs of at least 1:5 at 24 hours. Against beta-lactamase-producing (beta-LP) S. aureus, the geometric mean SBTs for A-S were at least 1:25 throughout the study period, while the geometric mean SBTs for T-C decreased over 24 hours from 1:29 to 1:6. Against beta-LP E. coli, the bactericidal activities for both A-S and T-C were poor, with geometric mean peak SBTs of only 1:6 and 1:3, respectively. The geometric mean SBT for T-C against this E. coli strain had declined to 1:1 at 6 hrs. CONCLUSION: Increasing the dosing interval for T-C in patients with end-stage renal disease may lead to periods of insufficient clavulanic acid to protect ticarcillin from beta-lactamase degradation.

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Mapping the future of hospital information systems: priorities for nursing applications.

The purpose of this study was to determine the value of computerized applications to nurse users in a large acute-care university-affiliated hospital. A hospital information system has been in place since 1983. A convenience sample of 77 staff nurses and 33 nurse managers from various clinical areas rated the benefits for decision making and patient care of approximately 19 existing automated applications, and prioritized for future acquisition, approximately 40 applications not currently available. Results of the study revealed that of the applications currently automated, respondents ranked the applications of results reporting, order entry, nursing station census, and message switching as most useful for decision making and patient care. Applications identified as high priorities for future acquisition were on-line charting, automated medication record, and enhanced results reporting.

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