Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximerry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximerry were reviewed. These studies revealed significant knowledge deficits about pulse oximerry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximerry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximerry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximerry is maintained in order to ensure that patient outcomes are not compromised.

Assessment methods in social work education: a review of the literature

Student assessment is an important component of social work education, and consumes considerable effort on behalf of both students and staff members. Social work educators in higher education face the challenge of constructing assessment methods, which encourage the development of reflective and critical learning, as well as enabling students to demonstrate acquisition of required knowledge and/or skills. While there is now a substantial literature on field education, the assessment of classroom-based units has warranted less attention. This paper examines the range of assessment methods reported in the social work education literature, the evidence which supports the use of these methods and issues associated with the identified assessment methods.

Selenium content of Australian foods: a review of literature values

The aim of this study was to review the published literature values for the selenium content of Australian foods. A secondary aim was to compare the results for Australian foods with food composition data from international sources to investigate the extent of geographical variation. Published food composition data sources for the selenium content in Australian foods were identified and assessed for data quality using established criteria. The selenium content is available for 148 individual food items. The highest values found are for fish (12.0–63.2 μg/100 g), meats (4.75–37.9 μg/100 g) and eggs (9.00–41.4 μg/100 g), followed by cereals (1.00–20.3 μg/100 g). Moderate levels are seen in dairy products (2.00–7.89 μg/100 g) while most fruits and vegetables have low levels (trace—3.27 μg/100 g). High selenium foods show the greatest level of geographical variation, with foods from the United States generally having higher selenium levels than Australian foods and foods from the United Kingdom and New Zealand having lower levels. This is the first attempt to review the available literature for selenium composition of Australian foods. These data serve as an interim measure for the assessment of selenium intake for use in epidemiological studies of diet–disease relationships.

Conceptualising the requirements of CRM from an organisational perspective : a review of the literature

For an organisation to undertake a Customer Relationship Management (CRM) implementation program it needs to consider a multitude of requirements. Some authors have hinted at viewing CRM within a wider perspective than just  customer centric perspectives. The aim of this paper is to discuss the domain and conceptualise some of the requirements of CRM from an organisation’s point of view. However, CRM needs to be identified as the whole organisation, including its internal and external environments. Undertaking CRM in any organisation needs to be preceded by a sequence of stages. An organization needs to develop a roadmap outlining the path to become CRM centric. Therefore an organisation should address, or at least consider, a list of those factors at every stage of a CRM implementation program, for an implementation program to be effective. The main focus of literature in CRM has been customer centric. This paper, being the first stage of much wider research, will focus on the organisation and the internal environment. This paper will identify three information systems (IS) and information technology (IT) requirements in organisations that are integral parts of CRM. These need to achieve a level of synergy for successful CRM. To understand these three requirements (front-end systems, back-end systems, and datahandling technologies) in a CRM project is too great in magnitude at this early stage of the research. This paper begins to draw together the tenuous links between the three requirements of information systems (IS) and information technology (IT) systems. Writing this paper and shifting its focus towards requirements engineering, the author has realised that a whole area of literature has to be explored, because CRM is another IS implementation.

Research methods in sales ethics: a review of the empirical literature

From a review of the empirical sales ethics literature, this paper reports findings about some of the research methods used to investigate the decision-making of sales practitioners under ethical conditions. The review identifies that several of the methodological deficiencies raised by previous reviewers of the literature have not been adequately addressed by subsequent researchers. The paper primarily reviews quantitative research studies because of their prevalence in the empirical sales ethics literature, and because studies similar to these have contributed much to marketing ethics theory. This discussion also focuses on sampling and data collection methods, the treatment of respondent and non-response bias, the use of instruments and scales, and the application of the scenario technique. Some suggestions are made that would improve the research methods in each of these areas.

Three strategic dimensions of information security in ecommerce : a literature review based conceptual model

Important eCommerce requirements are a robust and secure technical infrastructure, and the ability to ensuring the security of information, and to satisfying certain related legal requirements. In this paper, based on a literature review, we present a high-level conceptual model of information security in eCommerce, consisting of three strategic dimensions: protecting organizations' information, satisfying certain legal requirements, and enabling trusted and secure electronic transactions. Our conceptual model can be used by eCommerce managers as a tool in the strategic planning and management process, to better understand and communicate the inter-dependencies between business and legal requirements. The model can also be used for devising the goals and objectives relevant to their specific organization, for designing the policies that are needed, and deciding how technology will be managed and what training is required.

Consumer construction of sport consumption experiences through role play : a literature review

Evidence exists in the literature that many traditional consumer behaviours have fundamentally different meanings when considered in an experiential context. This paper posits that voicing during the experiential consumption of sport may in fact be a factor of experiential consumption rather than an expression of dissatisfaction as in the traditional complaint behaviour model. This is significant in the interpretation of experiential sport consumption where vocalising appears to serve purposes other than complaining. This paper revises the traditional complaint behaviour literature for explanations about vocalising and then offers some alternate conceptual propositions using experiential consumption literature.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

Extent of heart failure self-care as an endpoint to patient education: a literature review

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status.
Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours.
Design/method: bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected.
Results: Ten randomized controlled trials were selected that used education as an intervention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported signifi cant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care.
Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review

Background. Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions.

Aim. To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge.

Methods. A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge.

Findings. Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people.

Conclusion. Further research is necessary to explore how episodic care is integrated into the on-going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.

The Asia Pacific literature review on internal auditing

Purpose – By conducting the 2006 global Common Body of Knowledge (CBOK) study, The Institute of Internal Auditors (IIA) attempts to better understand the expanding scope of internal auditing practice throughout the world. The purpose of this review of recent internal auditing literature in Asia Pacific is to document how the internal audit function is changing in response to the shifts in global business practices.
Design/methodology/approach – The literature in Asia Pacific is reviewed with a focus on developments that have implications for the expanded scope of internal auditing and the changing skill sets of internal auditors. This focus has implications for CBOK 2006.
Findings – The literature indicates a paradigm shift in the activities performed by internal auditors. The increasing complexity of business transactions, a more dynamic regulatory environment in Asia Pacific, and significant advances in information technology have resulted in opportunities and challenges for internal auditors. Although in 2004, The IIA responded to the changing organizational environment by updating the professional practices framework, more work needs to be done to prepare internal auditors for the expanded set of skills and knowledge required to perform audits of the future.
Originality/value – By presenting an overview of past literature in Asia Pacific and discussing the shifting demands on internal audit services, the researchers hope to motivate further research in the field.

Sedation and analgesia management for mechanically ventilated adults: literature review, case study and recommentations for practice.

The quality of sedation management in mechanically ventilated patients has been a source of concern in recent years. This paper summarises the literature on the principles of optimal sedation, discusses the consequences of over and undersedation, highlighting the importance of appropriate pain management, and presents a case study using the results of an audit of 48 mechanically ventilated adults. As a result of the review and audit, we are implementing changes to practice.

The most important recommendations from the literature are the use of a sedation scale, setting of a goal sedation score, appropriate pain management and implementation of a nurse initiated sedation algorithm. Other recommendations include use of bolus rather than continuous sedative infusions and recommencing regular medications for anxiety, depression and other phychiatric disorders as soon as possible. A recommendation arising from our audit was the need to identify patients at high risk of oversedation and undersedation and adopt a proactive rather than reactive approach to management. The practice goal is to provide adequate and appropriate analgesia and anxiolysis for patients. This will improve patient comfort while reducing length of mechanical ventilation and minimising risk of complications.

Herb-drug interactions: a literature review

Herbs are often administered in combination with therapeutic drugs, raising the potential of herb-drug interactions. An extensive review of the literature identified reported herb-drug interactions with clinical significance, many of which are from case reports and limited clinical observations.
Cases have been published reporting enhanced anticoagulation and bleeding when patients on long-term warfarin therapy also took Salvia miltiorrhiza (danshen). Allium sativum (garlic) decreased the area under the plasma concentration-time curve (AUC) and maximum plasma concentration of saquinavir, but not ritonavir and paracetamol (acetaminophen), in volunteers. A. sativum increased the clotting time and international normalised ratio of warfarin and caused hypoglycaemia when taken with chlorpropamide. Ginkgo biloba (ginkgo) caused bleeding when combined with warfarin or aspirin (acetylsalicylic acid), raised blood pressure when combined with a thiazide diuretic and even caused coma when combined with trazodone in patients. Panax ginseng (ginseng) reduced the blood concentrations of alcohol (ethanol) and warfarin, and induced mania when used concomitantly with phenelzine, but ginseng increased the efficacy of influenza vaccination. Scutellaria baicalensis (huangqin) ameliorated irinotecan-induced gastrointestinal toxicity in cancer patients.
Piper methysticum (kava) increased the 'off' periods in patients with parkinsonism taking levodopa and induced a semicomatose state when given concomitantly with alprazolam. Kava enhanced the hypnotic effect of alcohol in mice, but this was not observed in humans. Silybum marianum (milk thistle) decreased the trough concentrations of indinavir in humans. Piperine from black (Piper nigrum Linn) and long (P. longum Linn) peppers increased the AUC of phenytoin, propranolol and theophylline in healthy volunteers and plasma concentrations of rifamipicin (rifampin) in patients with pulmonary tuberculosis. Eleutheroccus senticosus (Siberian ginseng) increased the serum concentration of digoxin, but did not alter the pharmacokinetics of dextromethorphan and alprazolam in humans. Hypericum perforatum (hypericum; St John's wort) decreased the blood concentrations of ciclosporin (cyclosporin), midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline, but did not alter the pharmacokinetics of carbamazepine, pravastatin, mycophenolate mofetil and dextromethorphan. Cases have been reported where decreased ciclosporin concentrations led to organ rejection. Hypericum also caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when used in combination with selective serotonin reuptake inhibitors (e.g. sertraline and paroxetine).
In conclusion, interactions between herbal medicines and prescribed drugs can occur and may lead to serious clinical consequences. There are other theoretical interactions indicated by preclinical data. Both pharmacokinetic and/or pharmacodynamic mechanisms have been considered to play a role in these interactions, although the underlying mechanisms for the altered drug effects and/or concentrations by concomitant herbal medicines are yet to be determined. The clinical importance of herb-drug interactions depends on many factors associated with the particular herb, drug and patient. Herbs should be appropriately labeled to alert consumers to potential interactions when concomitantly used with drugs, and to recommend a consultation with their general practitioners and other medical carers.

Healthy parks, healthy people : the health benefits of contact with nature in a park context : a review of current literature

This review identifies significant research that has not previously been compiled. It will provide key information for decision making by park managers, forming the basis of a program of future research to overcome the limited knowledge in this area. It is part of stage two of this project, funded by the International Park Strategic Partners Group. It builds on an earlier review (completed early in 2002 with funding provided by Parks Victoria) by addressing the health and wellbeing benefits of contact with nature in a parks context, at an individual and community level.