American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of patient-controlled analgesia on postoperative anxiety in elderly men.
To determine whether the use of patient-controlled analgesia vs intramuscular injections improves postoperative psychological parameters, particularly anxiety. ⋯ The use of patient-controlled analgesia does not significantly alter the measured psychological parameters, compared with intramuscular injections. Improved analgesia is the result of pharmacologic effects, independent of psychological factors.
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A preliminary investigation of opinions and behaviors regarding advance directives for medical care.
Advance directives are a means of promoting patient autonomy in end-of-life decisions but are used infrequently. A recent federal law requires healthcare organizations to provide information to patients about advance directives. This study explored attitudes and behaviors related to the use of advance directives in three areas: familiarity with advance directives, reasons for completing or not completing advance directives and preferences for receiving information about advance directives. ⋯ Advance directives are used infrequently to document treatment preferences. The success of programs to promote greater use of advance directives depends on a clearer understanding of the factors that influence both decision and action to execute an advance directive. Patients claim to be comfortable in discussing the topic and prefer that such discussions occur in the outpatient setting.
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Comparative Study
Room-temperature thermodilution cardiac output: proximal injectate lumen vs proximal infusion lumen.
To assess the accuracy of room-temperature thermodilution cardiac output measurements from the venous infusion port. ⋯ Room-temperature thermodilution cardiac output determinations from the venous infusion port can be used in place of central venous port cardiac outputs if the central venous port becomes nonfunctional.
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Case Reports
Case study: heart transplantation--increased incidence of acute rejection in female recipients.
Although the precise link between the increased incidence of allograft rejection in female heart transplant recipients remains uncertain, various gender-specific characteristics may predispose women to earlier rejection episodes. Critical care practitioners must be cognizant of the underlying immunologic factors that indicate higher risk in these recipients. Until the ideal treatment for cardiac rejection is discovered, identifying pertinent immunologic factors, attending to subtle symptoms, obtaining serial endomyocardial biopsies and initiating prompt, additional aggressive immunosuppressive protocols remain paramount in rendering quality patient care. Research must continue to elicit more specific tissue-typing antigens and more selective immunosuppressive agents that will ultimately result in prolonged survival of all heart transplant recipients.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Evaluation of the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines: the AACN Thunder Project. By the American Association of Critical-Care Nurses.
To evaluate the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines. ⋯ Chances for patency are greatest in men with long femoral lines who receive other anticoagulants or thrombolytics and heparinized flush solutions. Risks of nonpatency are greatest in women with short nonfemoral lines who do not receive other anticoagulants or thrombolytics and have nonheparinized flush solutions.