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Issue 155 - 8 October 2010

Articles

1.  EDITORIAL
WEEKEND ADMISSIONS TO CRITICAL CARE WHY DO MORE OF THESE PATIENTS DIE?
By Alspach, JoAnn Grif. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p10-12
Abstract:
A recent issue of Chest included a report by Cavallazzi et al that systematically examined the literature for evidence of an association between off-hours (night or weekend) admission to an intensive care unit (ICU) and the patient’s risk of death. Based on previous research that suggested a link between these factors, the authors anticipated that their literature analysis of studies conducted in North America, Europe, and Asia would reveal that  patients who are admitted to an ICU during night or weekend hours would have a higher risk of death compared to patients admitted during daytime hours on weekdays.

2. Skilled Cardiac Monitoring at the Bedside: An Algorithm for Success.
By Evenson, Laura; Farnsworth, Monica. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p14-21
Abstract:
The American Association of Critical-Care Nurses (AACN) posted 2 practice alerts to address issues in cardiac monitoring in 2004 and updated them in April 2008.1, 2 The alerts addressed 2 main reasons for use of cardiac bedside monitoring. The first reason is to detect and provide early intervention for episodes of myocardial ischemia and injury.

3. Recent Advances in the Treatment of Hypertensive Emergencies.
By Smithburger, Pamela L.et al. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p24-31
Abstract:
Approximately 73.6 million people in theUnited States aged 20 years or older areaffected by hyper tension. Although significant improvements have been made with regard to awareness and treatment of hyper tension, approximately 30% o f adults are still unaware of their disease. 2 Up to 40% of people with hyper tension are not receiving treatment, and up to 67% of those treated are not achieving blood pressure control.

4. Continuous ST-Segment Monitoring in the Intensive Care Unit.
By Fox, Lisa et al. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p33-41
Abstract:
Cardiac monitoring of critically ill patients enables 3 basic features to be detected: rate abnormalities, rhythm disturbances, and ischemic patterns. When it was developed, continuous computerized ST-segment monitoring proved an invaluable resource for detecting ischemia in critically ill cardiac patients. Considered a technological bonus if instituted correctly, this essential device for detection of myocardial ischemia is underused in the United States.

5. Cardiac monitoring of critically ill patients enables 3 basic features to be detected: rate abnormalities, rhythm disturbances, and ischemic patterns.
Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p46-54
Abstract:
When it was developed, continuous computerized ST-segment monitoring proved an invaluable resource for detecting ischemia in critically ill cardiac patients. Considered a technological bonus if instituted correctly,this essential device for detection of myocardial ischemia is underused in the United States.

6. Prasugrel as Antiplatelet Therapy in Patients With Acute Coronary Syndromes or Undergoing Percutaneous Coronary Intervention.
By Fletcher, Barbara & Thalinger, Karen K. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p46-54
Abstract:
A cute coronary syndromes (ACSs) are among the leading causes of death in the developed world and are associated with annual costs of $300 million in the United States alone.1, 2 In 2005, approximately 1.5 million patients were discharged from the hospital with a primary or secondary diagnosis of ACS. 1 Overall, morbidity and mortality rates have
decreased in patients with ACS, but 25% of patients are still not receiving guideline-recommended care, a factor that causes substantial preventable in-hospital mortality.

7. Nursing Grand Rounds. A Guide to Developing Nursing Grand Rounds.
By Armola, Rochelle R.et al. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p55-62
Abstract:
With the evolution of nursing as a profession, nursing research and evidence-based practice have also advanced significantly. As many hospitals are in pursuit of or have ob tained Magnet accreditation, nursing grand rounds (NGRs) have seen a resurgence.

8. Pediatric Care. Basic Interpretation of Metabolic Acidosis.
By Jones, Melissa Beaudet. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p63-70
Abstract:
Accurate assessment of the relationship between abnormal blood gas findings and a patient’s overall clinical condition is a common challenge for pediatric critical care nurses. To meet this challenge, nurses must understand the mechanisms underlying acid-base balance and the common causes of acid-base imbalance.

9. ECGs and Pacemakers. Belhassen Ventricular Tachycardia: A Case Study.
By Weaver, Lauren et al. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p71-76
Abstract:
A patient who had experienced ventricular tachycardia was admitted to the coronary care unit (CCU) in normal sinus rhythm. According to the admitting physician’s notes, the dysrhythmia presumably was caused by myocardial ischemia. The dysrhythmia was described as paroxysmal sustained ventricular tachycardia with a left posterior fascicular block. After coronary artery disease was ruled out, an electrophysiologist diagnosed Belhassen ventricular tachycardia.

10. Ask the Experts. Use of Tissue Plasminogen Activator to Treat Acute Ischemic Stroke.
By Alexandrov, Anne W. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p77-78
Question:

I recently attended a class on acute stroke. One of the therapies, of
course, is tPA. I am wondering why previous stroke and acute
myocardial infarction (both less than 3 months earlier) are contraindications? Also why is history of either stroke or diabetes a concern when giving tPA?
Anne W. Alexandrov, RN, PhD, CCRN, replies:
Tissue plasminogen activator (tPA) was approved by the US Food
and Drug Administration in May 1996. The approval was based on
the results of the National Institutes of Neurologic Disorders (NINDS) tPA study,1 which showed significant benefit to ischemic stroke patients who received this drug within 3 hours of symptom onset. The prescribing information that was later approved by the Food and Drug Administration was based on the methods used in that trial. The concern about patients who have had a stroke within 3 months of a new stroke event relates to a potential risk for intracranial hemorrhage, in that unstable infarcted territories might possess vessels that could bleed.

11. In Our Unit. "Help, I Need Somebody..." A Collaborative Approach to Nurses Helping Nurses.
By Pasch, Vanessa L. et al. Critical Care Nurse, Oct 2010, Vol. 30 Issue 5: p79-80
Abstract:
In our unit, we have tackled head on the Act With Intention directive put forth by Beth Hammer, president of the American Association of Critical-Care Nurses (AACN). We never want a nurse to leave our unit because no one was available to help with patient care when the help was needed most. We never want a nurse to hesitate to ask a medication related question because of fear of retaliation. We never want a nurse to leave our unit because he/she felt as if no one was available to help with patient care when he/she needed it most. We never want a nurse to be afraid to ask for help.

Journals Table of Contents

12. From International Journal of Nursing Practice, Volume 16, Issue 5, October 2010
Clinical Paper

12A. Enhancing our clinical links and credibility: Nurse lecturers in clinical practice
Scholarly Paper
12B.
Symptom burden in inflammatory bowel disease: Rethinking conceptual and theoretical underpinnings
Research Papers
12C. Demands of immigration among Chinese immigrant nurses
12D. Effect of foot massage to decrease physiological lower leg oedema in late pregnancy: A randomized controlled trial in Turkey
12E. A randomized controlled trial to assess the impact of an Admission Service on patient and staff satisfaction
12F. How nurses address the burden of disease in remote or isolated areas in Queensland
12G. A quantitative study of Iranian nursing students' knowledge and attitudes towards pain: Implication for education
12H. Evaluation of the implementation of Assistant in Nursing workforce in haemodialysis units
12I. Knowledge of heart attack symptoms and risk factors among native Thais: A street-intercept survey method
12J. Physically restraining elder residents of long-term care facilities from a nurses' perspective
12K. Comparison between ambulatory infusion mode and inpatient infusion mode from the perspective of quality of life among colorectal cancer patients receiving chemotherapy
12L. The first Australian nurse practitioner census: A protocol to guide standardized collection of information about an emergent professional group Sandy Middleton, Glenn Gardner, Anne Gardner, Phillip Della, Michelle Gibb and Lynne Millar

13. Latest news from the Ministry of Health

7 Oct : Pandemic Influenza H1N1 2009 (swine flu) - Update 211
http://www.moh.govt.nz/moh.nsf/indexmh/influenza-a-h1n1-update-211-071010

1 Oct : Office of the Director of Mental Health- Annual Report 2009
http://www.moh.govt.nz/moh.nsf/indexmh/mental-health-office-annual-report-2009

1 Oct : Implementing the Clinical Guidelines for Weight Management in New Zealand: 2010/11
http://www.moh.govt.nz/moh.nsf/indexmh/implementing-the-clinical-guidelines-for-weight-management-in-nz-2010-11

28 Sep: New health connectivity standards for telecommunication networks
http://www.ithealthboard.health.nz/news/new-health-connectivity-standards-telecommunication-networks

News - National

14. Calls for more emphasis on lean thinking
Otago Daily Times - 8th Oct 2010
Calls for greater top-level emphasis on "lean thinking" in Dunedin Hospital were made at yesterday's Southern District Health Board meeting, but members were told change would cost money and could take up to five years.
http://www.odt.co.nz/news/dunedin/130478/calls-more-emphasis-lean-thinking

15. Diet more important than exercise
New Zealand Herald - 7th Oct 2010
New Zealanders' expanding waistlines have far more to do with overeating than with lack of exercise, a controversial new study contends.The international research has highlighted the disagreement over the causes of the obesity epidemic. Two-thirds of adults are overweight or obese. There are debates over the relative effects of overeating and reduced physical activity; and whether individuals' bad choices or an unhealthy environment -
such as super-sized fastfood and lack of safe cycleways - are most at fault.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10574374

16. Diabetes 'tsunami' predicted
Dominion Post - 8th Oct 2010
At least one in 10 Kiwi adults will have type 2 diabetes within 20 years in a "tsunami" of disease which could bankrupt the country, an expert says.
http://www.stuff.co.nz/dominion-post/national/4209719/Diabetes-tsunami-predicted

News - International

17. Health workers protest Qld wage offer Petrina Berry
AAP - October 7, 2010 - 3:39PM
About one thousand health workers have staged an angry protest outside Queensland's Parliament House for better pay, while inside, the health minister said they're the highest paid in the country. The health workers have rejected the state government's 2.5 per cent-a-year pay rise offer over three years. Health practitioners, including psychologists, physiotherapists, radiographers and scientists from Brisbane, Gold Coast, Sunshine Coast, Toowoomba and Dalby hospitals stopped work and rallied outside Parliament House at noon on Thursday.
http://news.brisbanetimes.com.au/breaking-news-national/health-workers-protest-qld-wage-offer-20101007-168jn.html

18. Hundreds of aspiring surgeons 'cannot get NHS training jobs'
The Telegraph - 7 October 2010
Hundreds of doctors cannot get training jobs to become consultant surgeons and are being left 'adrift', a medical journal has warned.
http://www.telegraph.co.uk/health/healthnews/8046197/Hundreds-of-aspiring-surgeons-cannot-get-NHS-training-jobs.html 

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