Clinical Use of the Volume-Time Curve for Endotracheal Tube Cuff Management

BACKGROUND: Previous investigation showed that the volume-time curve technique could be an alternative for endotracheal tube (ETT) cuff management. However, the clinical impact of the volume-time curve application has not been documented. the purpose of this study was to compare the occurrence and intensity of a sore throat, cough, thoracic pain, and pulmonary function between these 2 techniques for ETT cuff management: volume-time curve technique versus minimal occlusive volume (MOV) technique after coronary artery bypass grafting. METHODS: A total of 450 subjects were randomized into 2 groups for cuff management after intubation: MOV group (n = 222) and volume-time curve group (n = 228). We measured cuff pressure before extubation. We performed spirometry 24 h before and after surgery. We graded sore throat and cough according to a 4-point scale at 1, 24, 72, and 120 h after extubation and assessed thoracic pain at 24 h after extubation and quantified the level of pain by a 10-point scale. RESULTS: the volume-time curve group presented significantly lower cuff pressure (30.9 +/- 2.8 vs 37.7 +/- 3.4 cm H2O), less incidence and intensity of sore throat (1 h, 23.7 vs 51.4%; and 24 h, 18.9 vs 40.5%, P < .001), cough (1 h, 19.3 vs 48.6%; and 24 h, 18.4 vs 42.3%, P < .001), thoracic pain (5.2 +/- 1.8 vs 7.1 +/- 1.7), better preservation of FVC (49.5 +/- 9.9 vs 41.8 +/- 12.9%, P = .005), and FEV1, (46.6 +/- 1.8 vs 38.6 +/- 1.4%, P = .005) compared with the MOV group. CONCLUSIONS: the subjects who received the volume-time curve technique for ETT cuff management presented a significantly lower incidence and severity of sore throat and cough, less thoracic pain, and minimally impaired pulmonary function than those subjects who received the MOV technique during the first 24 h after coronary artery bypass grafting.

Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

Advanced interatrial block: A well-defined electrocardiographic pattern with clinical arrhythmological implications

3.050 JCR (2013) Q2, 44/125 Cardiac & cardiovascular systems

Evaluating the contribution of the clinical librarian to a multidisciplinary team

Urquhart, C., Turner, J., Durbin, J. & Ryan, J. (2006). Evaluating the contribution of the clinical librarian to a multidisciplinary team. Library and Information Research, 30(94), 30-43. Sponsorship: NHS Trusts in North Wales

Evaluating SWICE-R (South West Information for Clinical Effectiveness - Rural). Final report for South West Workforce Development Confederations (Knowledge Resources Development Unit)

Yeoman, A., Durbin, J. & Urquhart, C. (2004). Evaluating SWICE-R (South West Information for Clinical Effectiveness - Rural). Final report for South West Workforce Development Confederations, (Knowledge Resources Development Unit). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: South West WDCs (NHS)

Changes in information behavior in clinical teams after introduction of a clinical librarian service

Urquhart, C., Turner, J., Durbin, J. & Ryan, J. (2007). Changes in information behavior in clinical teams after introduction of a clinical librarian service. Journal of the Medical Library Association, 95(1), 14-22. Available via PubMed central Sponsorship: North Wales NHS Trusts

Developing a toolkit for assessing the impact of health library services on patient care

Urquhart,C., Spink, S., Thomas, R. & Weightman, A. (2007). Developing a toolkit for assessing the impact of health library services on patient care. Report to LKDN (Libraries and Knowledge Development Network). Aberystwyth: Department of Information Studies, Aberystwyth University. Sponsorship: Libraries and Knowledge Development Network/ NHS

Ethics and Foreign Policy: The Antinomies of New Labour's 'Third Way' in Sub-Saharan Africa

Abrahamsen, Rita, Williams, Paul, 'Ethics and Foreign Policy: The Antinomies of New Labour's 'Third Way' in Sub-Saharan Africa', Political Studies (2002) 49(2) pp.249-264 RAE2008

The Poetics of the Limit : Ethics and Politics in Modern and Contemporary American Poetry

Woods, Timothy, The Poetics of the Limit (New York: Palgrave Macmillan, 2003) RAE2008

Troublesome Amateurs: Theatre, ethics and the labour of mimesis

Kear, A. 'Troublesome Amateurs: Theatre, ethics and the labour of mimesis', Performance Research (2005) 10 (1), 26-46 RAE2008

Metaphorizing the Holocaust: The Ethics for Comparison

This paper focuses on the ethics of metaphor and other forms of comparison that invoke National Socialism and the Holocaust. It seeks to answer the question: Are there criteria on the basis of which we can judge whether metaphors and associated tropes “use” the Holocaust appropriately? In analyzing the thrust and workings of such comparisons, the paper also seeks to identify and clarify the terminology and concepts that allow productive discussion. In line with its conception of metaphor that is also rhetorical praxis, the paper focuses on specific controversies involving the metaphorization of the Holocaust, primarily in Germany and Austria. The paper develops its argument through the following process. First, it examines the rhetorical/political contexts in which claims of the Holocaust’s comparability (or incomparability) have been raised. Second, it presents a review (and view) of the nature of metaphor, metonymy, and synecdoche. It applies this framework to (a) comparisons of Saddam Hussein with Hitler in Germany in 1991; (b) the controversies surrounding the 2004 poster exhibition “The Holocaust on Your Plate” in Germany and Austria, with particular emphasis on the arguments and decisions in cases before the courts in those countries; and (c) the invocation of “Auschwitz” as metonym and synecdoche. These examples provide the basis for a discussion of the ethics of comparison. In its third and final section the paper argues that metaphor is by nature duplicitous, but that ethical practice involving Holocaust comparisons is possible if one is self-aware and sensitive to the necessity of seeing the “other” as oneself. The ethical framework proposed by the paper provides the basis for evaluationg the specific cases adduced.

Ethics of war / by al-Hajj Khwaja Kamal-ud-din.

http://www.archive.org/details/ethicsofwarbyalh00kamauoft

Non-clinical outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

The impacts of antiretroviral therapy on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of antiretroviral therapy (ART) on these non-clinical indicators in developing countries and assess the state of research on these topics. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 12 full-length articles, 7 abstracts, and 1 presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reported so far. Studies from developing countries have not yet assessed non-clinical outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, both positive and adverse non-clinical outcomes need to be empirically measured and qualitatively explored in order to support patient adherence and maximize treatment benefits.