American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The purposes of this article are to: identify gaps in the research literature on weaning adult patients from short-term mechanical ventilation, highlight the scientific base for practice guidelines, and suggest future research directions. Data bases from 1989 through June 1993 were reviewed, and relevant research articles were extracted, analyzed, and synthesized within the AACN Third National Study Group framework. ⋯ Despite considerable research on predictors and patient responses to weaning from short-term mechanical ventilation, few of the findings can be applied to clinical practice at this time. Less research is available on weaning modes and therapies that facilitate weaning from short-term mechanical ventilation; fruitful research in these areas depends in part on a better understanding of patient responses and accurate weaning predictors.
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Published reports indicate that survival rates of patients with adult respiratory distress syndrome have not improved dramatically since the first report of the condition in 1967. However, changes in ventilator strategies and improved critical care management may result in better survival rates in patients with well-defined, severe adult respiratory distress syndrome. ⋯ This survival rate exceeds most recently reported rates and thus supports the idea that improvement in treatment of adult respiratory distress syndrome is occurring.
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This literature review was done to explore the use of master's-prepared nurse practitioners to manage critically ill patients. Data-based, anecdotal, clinical, analytic, and position papers published over the past 10 years in the medical and nursing literature were reviewed. This article synthesizes findings on the use of nurse practitioners in clinical settings including primary and specialty care settings, describes favorable outcomes of advanced practice nurses, and identifies factors that must be addressed as these roles increase in use in critical care settings. ⋯ Additional federal support to ensure the preparation of these practitioners in adequate numbers is needed. Attention to issues of direct reimbursement, salaries, impact of changing role boundaries, malpractice coverage, and prescription privileges must be addressed. Research programs to examine the effect of nurse practitioners in specialized care should continue.
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Research in human coronary heart disease has been conducted primarily on males; however, investigators have begun to focus research efforts on female subjects as well. A literature review that identified studies on women and coronary heart disease was done to describe modifiable risk factors for coronary heart disease in women. Several modifiable risk factors such as smoking, hypertension, and disorders of lipid metabolism previously identified for men are also risk factors for women. ⋯ Moreover, women have additional risk factors related to menopause and, in some cases, the use of oral contraceptives. Significant initial information has been gained concerning women and coronary heart disease risk factors. However, gaps persist in information regarding the individual and synergistic effects of risk factors for CHD in women.
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Review Comparative Study
Drawing coagulation studies from arterial lines: an integrative literature review.
How much blood must be discarded from a heparinized arterial line to obtain accurate coagulation studies, specifically activated partial thromboplastin time? The published literature provides insight into the question and guidelines for practice in adult critical care. This article reviews and integrates findings from 14 research studies published from 1971 to 1993 on discarding blood from arterial lines for coagulation studies. ⋯ Studies have demonstrated that adequate discard volume for activated partial thromboplastin time is 6 times the catheter dead space. These results should not be generalized to systemically heparinized patients, pediatric patients, or other types of heparinized lines such as pulmonary artery, central venous, or Hickman catheters.