Adherence to Best Practice Advice for Diagnosis of Pulmonary Embolism

PURPOSE

This study evaluated clinician adherence to the American College of Physicians Best Practice Advice for diagnosis of pulmonary embolism.

DESIGN

A prospective, single-center, descriptive design was utilized.

METHODS

A heterogeneous sample of 111 hemodynamically stable adult inpatients with a computed tomography pulmonary angiogram ordered was consented. Electronic medical records were reviewed for demographic and clinical variables to determine adherence. The 6 individual best practice statements and the overall adherence were evaluated by taking the sum of "yes" answers divided by the sample size.

RESULTS

Overall adherence was 0%. Partial adherence was observed with clinician-recorded clinical decisions rules and obtaining d-dimer (3.6% [4/111] and 10.2% [9/88], respectively) of low/intermediate probability scorers. Age adjustment of d-dimer was not recorded. Computed tomography pulmonary angiogram was the first diagnostic test in 89.7% (79/88) in low/intermediate probability patients.

CONCLUSION

In hemodynamically stable, hospitalized adults, adherence to best practice guidelines for diagnosis of pulmonary embolism was minimal. Clinical utility of the guidelines in hospitalized adults needs further evaluation. Systems problems (eg, lack of standardized orders, age-adjusted d-dimer values, information technology support) likely contributed to poor guideline adherence.

Foot Care Self-Management in Non-Diabetic Older Adults: A Pilot Controlled Trial

Self-management can mitigate common foot problems; however, community-dwelling older adults without diabetes rarely receive foot care self-management training. This two-group pilot study examined feasibility and preliminary efficacy of the novel, nurse-led 2 Feet 4 Life intervention. Twenty-nine adults (M age 76 years ± 6.6 years) from two senior centers completed the study (90.6% retention rate). Intervention dosage was one hour/week for four consecutive weeks. Study procedures were safe and feasible. Intervention group participants found the intervention acceptable and valuable. Observed between-group effect sizes were the following: knowledge (4.339), self-efficacy (3.652), behaviors (3.403), pain (0.375) and foot health (0.376). Large effect sizes were observed within-groups and within their interaction for knowledge (1.316), behaviors (8.430), pain (9.796), and foot health (3.778). Effect sizes suggest the intervention impacted foot care outcomes between groups and within individuals over seven months' time. Fully powered studies are indicated to test the intervention in diverse samples with more complex foot problems.

Excluding Pulmonary Embolism with End-tidal Carbon Dioxide: Accuracy, Cost, and Harm Avoidance

A non-randomized single center prospective, descriptive, correlational design was used to determine what end-tidal carbon dioxide (EtCO₂) level provided the best sensitivity, specificity, and negative predictive value to exclude pulmonary embolism (PE) diagnosis in hemodynamically stable hospitalized adults (n = 111). The financial impact and harm avoidance of adding EtCO₂ to the PE diagnostic process also were examined. PE diagnosis was determined by computed tomography pulmonary angiography (CTPA). PE prevalence was 18.9%. Mean±SD EtCO₂ was lower for PE positive than negative participants (28 ± 7.8 to 33 ± 8.1 mmHg respectively 95% CI: 1.22-8.96; P = .01). For PE exclusion, an EtCO₂ cutoff ≥42 mmHg yielded 100% sensitivity, 12.2% specificity, and 100% negative predictive value. For every six inpatients assessed with EtCO₂, one could be saved from unnecessary CTPA. Eliminating unnecessary CTPA removes the potential harm associated with radiation and intravenous contrast exposure. Additionally, an EtCO₂ cutoff ≥42 mmHg could eliminate ~$88,000/year in healthcare waste at this institution.

Diagnosis of pulmonary embolism: Following the evidence from suspicion to certainty

Accurate, timely and cost-effective identification of pulmonary embolism remains a diagnostic challenge. This article reviews the pulmonary embolism diagnostic process with a focus on the best practice advice from the American College of Physicians. Benefits and risks of each diagnostic step are discussed. Emerging diagnostic tools, not included in the algorithm, are briefly reviewed.

Analysis of qualitative interviews about the impact of information technology on pressure ulcer prevention programs: implications for the wound, ostomy and continence nurse

PURPOSE

The purpose of this study was to compare pressure ulcer prevention programs in 2 long-term care (LTC) facilities with diverse Information Technology Sophistication (ITS), one with high sophistication and one with low sophistication, and to identify implications for the WOC nurse.

DESIGN

Secondary analysis of narrative data obtained from a mixed-methods study.

SUBJECTS AND SETTING

The study setting was 2 LTC facilities in the Midwestern United States. The sample comprised 39 staff from 2 facilities, including 26 from a high-ITS facility and 13 from the low-ITS facility. Respondents included certified nurse assistants, certified medical technicians, restorative medical technicians, social workers, RNs, licensed practical nurses, information technology staff, administrators, and directors.

METHODS

This study is a secondary analysis of interviews regarding communication and education strategies in 2 LTC agencies. This analysis focused on focus group interviews, which included both direct and nondirect care providers.

RESULTS

Eight themes (codes) were identified in the analysis. Three themes are presented individually with exemplars of communication and education strategies. The analysis revealed specific differences between the high-ITS and low-ITS facilities in regard to education and communication involving pressure ulcer prevention. These differences have direct implications for WOC nurses consulting in the LTC setting.

CONCLUSIONS

Findings from this study suggest that effective strategies for staff education and communication regarding PU prevention differ based on the level of ITS within a given facility. Specific strategies for education and communication are suggested for agencies with high ITS and agencies with low ITS.

Impact of the Health Insurance Portability and Accountability Act on participant recruitment and retention

Recruiting and retaining an adequate sample is critical to the success of any research project involving humans. Recent reports indicate that the Health Insurance Portability and Accountability Act (HIPAA) privacy rule has adversely affected research. Few resources are available to help researchers navigate the challenges to recruitment and retention after HIPAA privacy rule implementation. This article addresses obstacles to recruitment in prospective clinical research studies related to the HIPAA privacy rule, as well as HIPAA-compliant strategies to enhance recruitment and retention. Recruitment challenges discussed include evolving interpretations of the HIPAA regulations, inability to directly contact potential participants, complexity of HIPAA-required documents, increased costs of recruitment, and an expanding administrative burden. Among the strategies addressed are preparatory research reviews, using clinical collaborators and staff liaisons, prescreening potential participants, minimizing participant burden during the consent process, enhancing participant follow-up, facilitating recruitment for future studies, and streamlining compliance training for staff.

Effect of oral hydration on skin microcirculation in healthy young and midlife and older adults

Clinically undetected underhydration lowers subcutaneous tissue oxygen, impairs healing and increases wound infection. This study examined the effect of supplemental oral hydration on noninvasive measures of skin temperature (T(s)), transcutaneous skin O(2) (PtcO(2)), and CO(2) (PtcCO(2)), and skin blood flow (laser Doppler fluxmetry [Flux]=concentration of moving blood cells [CMBC] x Velocity) in healthy adults. Nineteen Control and 18 Test (Hydrated) subjects participated. Ad libitum fluid intake was allowed before the experiment. Sensors were placed on the chest, lower legs, and feet. Time 1 resting supine T(s), PtcO(2)/PtcCO(2), and Flux/CMBC/Velocity were obtained. Then, the Test group ingested 500 mL of H(2)O. Time 2 measures were obtained 30 minutes later. Data were analyzed using ANOVA. Change in T(s), PtcO(2), PtcCO(2), and Velocity did not differ between groups. Flux increased more in the Test than in the Control group (p<0.01). The Flux change was explained by a CMBC increase (p<0.05). For midlife/older subjects only, the CMBC change was greater in the Test than in the Control group (p<0.01). Flux may be sufficiently sensitive to detect microvascular changes in response to supplemental oral hydration. These data also suggest that subtle levels of hypoperfusion due to underhydration may exist in community-dwelling healthy midlife/older adults in their natural state.

Impact of Pain on Outcomes in Long-Term Care Residents with and without Multiple Sclerosis

OBJECTIVES

To compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine the impact of MS and pain on outcomes 90 and 180 days after LTC admission.

DESIGN

Retrospective analysis of a large data set.

SETTING

LTC facilities in Missouri.

PARTICIPANTS

Residents admitted to non-hospital-based LTC facilities.

MEASUREMENTS

Minimum Data Set/Resident Assessment Instrument, Version 2.0; Activities of Daily Living Scale; Cognitive Performance Scale.

RESULTS

Residents with and without MS had similar pain prevalence and intensity after admission, with daily pain more frequent in residents with MS (P=.03). On admission, residents with MS had more physical disability (P<.001) and a greater prevalence of pressure ulcers (P=.004) and depression (P<.001) than residents without MS. In all LTC residents, initial pain status was associated with physical disability (P<.001), pressure ulcers (P<.001), depression (P<.001), and cognitive performance (P<.001) 90 and 180 days after admission. A diagnosis of MS was associated with physical disability (P<.001) 90 and 180 days after admission and pressure ulcer development 180 days after admission (P=.02).

CONCLUSION

Residents with MS were more physically disabled and had more frequent pain and a higher prevalence of pressure ulcers and depression on admission than residents without MS. Pain, or lack thereof, in residents with and without MS on admission may warn of problems that could occur within 6 months after admission to a LTC facility.

Elevated sacral skin temperature (Ts): a risk factor for pressure ulcer development in hospitalized neurologically impaired Thai patients

Pressure ulcer incidence and sacral skin temperature (T(s)) were measured in hospitalized neurologically impaired Thai patients ( n = 17) positioned supine and then laterally. Pressure ulcer incidence within 2 weeks of admission was 47%. Regardless of reclining position, mean sacral T(s) in subjects who developed a pressure ulcer was higher ( p < .01) than those who did not develop an ulcer. The data suggest that T(s) may increase at least 1.2 degrees C 24-96 hr before sacral pressure ulcer development. Sacral T(s) may be an objective predictor of sacral pressure ulcer development in hospitalized neurologically impaired Thai patients.

Nursing Home Quality and Pressure Ulcer Prevention and Management Practices

OBJECTIVES

To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs).

DESIGN

Retrospective analysis of a large data set and comparative survey.

SETTING

LTCFs in Missouri.

PARTICIPANTS

Three hundred sixty-two LTCFs participated in the survey. Three hundred twenty-one facilities had pressure ulcer QI scores between April 1 and September 30, 1999.

MEASUREMENTS

Pressure ulcer QI scores, Pressure Ulcer Prevention & Treatment Practices Survey.

RESULTS

The mean+/-standard deviation pressure ulcer QI score was 10.9+/-6.2%, with a risk-adjusted score of 15.7+/-8.9% for high-risk residents and 3.1+/-3.6% for low-risk residents. Minimizing head-of-bed elevation to less than 30 degrees was used by fewer than 20% of facilities. More than 40% of facilities used a risk assessment tool that was not evidence based. Fewer than 13% of facilities used the Agency for Health Care Policy and Research pressure ulcer prevention and treatment guidelines. No relationship was found between the number of prevention strategies (P=.892) or the number of treatment strategies (P=.921) and the pressure ulcer QI scores.

CONCLUSION

Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment guidelines appear to be rarely implemented. This study provides a basis for developing educational and quality improvement programs and future research related to pressure ulcer prevention and treatment in LTCFs.

Skin assessment and pressure ulcer care in hospital-based skilled nursing facilities

The Minimum Data Set, a comprehensive assessment tool for nursing home residents, is used for clinical decision-making, research, quality improvement, and Medicare and Medicaid reimbursement. Within the Minimum Data Set, pressure ulcers and skin condition are evaluated. Because information about pressure ulcer prevalence and care in hospital-based skilled nursing facilities is sparse, a study was conducted to: a) determine pressure ulcer prevalence upon admission to hospital-based skilled nursing facilities in the state of Missouri, and b) ascertain methods of assessment, treatment, and documentation of skin and pressure ulcer care in these facilities. Prevalence data were obtained from analysis of the Minimum Data Set data, and a survey was conducted to obtain skin care practices. The vast majority of residents (96%) were admitted from acute care facilities, and pressure ulcer prevalence on admission was 18.4% +/- 8.0%. Seventy-seven percent (77%) of the 88 surveys mailed were returned. The Braden or Norton Scale for risk assessment is reportedly used by 55% of facilities; whereas, 35% use a facility-developed tool. Commonly reported pressure ulcer prevention/treatment interventions used include: dietitian referral, use of barrier ointments, and a written repositioning schedule. Incontinence management and minimizing the head of bed elevation were infrequently used. Nearly one-half (47%) of facilities reported daily reassessment and documentation of wound status, suggesting less-than-optimal, time-consuming wound care practices. Despite the limitations inherent in survey designs and the use of databases such as the Minimum Data Set, the results of this study suggest that pressure ulcers are a common problem in acute care and hospital-based skilled nursing facilities and research-based risk assessment, prevention, and wound assessment strategies have not been widely implemented. The results of this study provide a basis for developing educational programs and a guide for future research.

Why older adults with light care needs enter and remain in nursing homes

Many patients in nursing homes receive limited services. In 1996, approximately 17% of the 1.6 million nursing home residents received assistance with two or less activities of daily living (ADL). This descriptive study addressed this issue by investigating why residents with light care needs enter and remain in nursing homes. Residents with light care needs (N = 20) identified by directors of nursing were interviewed to elicit why they entered and remain in nursing homes. Their care level was estimated using the Minimum Data Set (MDS) and Resource Utilization Groups, Version III (RUG-III). In this study, older adults with light care needs who decide to enter and remain in nursing homes were found to be influenced by a prior hospitalization or a health event; the perceived inability to manage instrumental ADLs (IADLs), ADLs, or health monitoring at home; and lack of knowledge about alternatives to nursing home care. This study demonstrates the vital role nurse case managers can play in both acute care settings and nursing homes. They can help older adults with light care needs to make informed decisions about long-term care, seek out community options, and set in place assistive care systems that can help them age in the community.

Factors associated with unplanned readmissions following cardiac surgery

Cardiac surgery patients are at risk for unplanned readmissions due to the various complications they may experience following surgery. The purpose of this report is to critically review the literature related to predictors of unplanned readmissions of cardiac surgery patients following discharge from the hospital. A literature review was conducted from 1989 to 1999 using MEDLINE and CINAHL, with the following key words: cardiac surgery, coronary artery bypass surgery, recovery, and readmission. The literature revealed that gender and race do have an effect on how well a patient will recover following cardiac surgery. It was also found that patients with longer lengths of stay due to complications were at greater risk for readmission following discharge from the hospital. There was no evidence that decreased length of stay for this patient group led to a greater number of readmissions. Implications for nurses include the need for improved coordination of patient care and implementation of effective discharge planning in high-risk patients. Additional research is needed to develop interventions to decrease readmissions of women and African Americans and other racial groups specific to their particular risk factors for readmission following cardiac surgery.

Designing effective nursing interventions

The purpose of this article is to present issues scientists must consider to design effective experimental interventions. The efforts of nurse-researchers to test diverse interventions are consistent with the central role of interventions for the nursing discipline. Despite the importance of interventions, limited literature has addressed the actual design of these interventions. Many experimental interventions lack content validity, and others are inadequate to affect outcomes. Eight issues to consider in the development of interventions are discussed, including the conceptual basis of the intervention, descriptive research linking key concepts to the proposed outcome, previous intervention literature testing similar or related interventions, the intervention target, intervention specificity/generality, single or bundled interventions, intervention delivery, and intervention dose. Strategies are recommended for designing effective experimental interventions.

Randomized clinical trial of a quality improvement intervention in nursing homes

PURPOSE

The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed.

DESIGN AND METHODS

Nursing facilities (n = 113) were randomly assigned to one of three groups: workshop and feedback reports only, workshop and feedback reports with clinical consultation, and control. Minimum Data Set (MDS) Quality Indicator (QI) feedback reports were prepared and sent quarterly to each facility in intervention groups for a year. Clinical consultation by a gerontological clinical nurse specialist (GCNS) was offered to those in the second group.

RESULTS

With the exception of MDS QI 27 (little or no activity), no significant differences in resident assessment measures were detected between the groups of facilities. However, outcomes of residents in nursing homes that actually took advantage of the clinical consultation of the GCNS demonstrated trends in improvements in QIs measuring falls, behavioral symptoms, little or no activity, and pressure ulcers (overall and for low-risk residents).

IMPLICATIONS

Simply providing comparative performance feedback is not enough to improve resident outcomes. It appears that only those nursing homes that sought the additional intensive support of the GCNS were able to effect enough change in clinical practice to improve resident outcomes significantly.

Prevalence, incidence, management, and predictors of venous ulcers in the long-term-care population using the MDS

OBJECTIVE

To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998.

MAIN OUTCOME MEASURES

Version 2.0 of the Minimum Data Set was utilized. Assessment items included selected measures from background information, disease diagnoses, physical functioning and structural problems, health conditions, oral/nutritional status, and skin condition.

MAIN RESULTS

Venous ulcer prevalence on admission was 2.5%. The incidence of venous ulcer development for long-term-care residents admitted without an ulcer at 90, 180, 270, and 365 days after admission was 1.0%, 1.3%, 1.8%, and 2.2%, respectively. The most frequent skin treatments for residents with a venous ulcer were ulcer care, dressings, and ointments. Factors associated with venous ulcer development within a year of admission were diabetes mellitus, peripheral vascular disease, and edema.

CONCLUSION

Venous ulcer prevalence and incidence are greater in the long-term-care population than in the community at-large. Residents with a venous ulcer are likely to have comorbid conditions such as diabetes mellitus, peripheral vascular disease, congestive heart failure, edema, wound infection, and pain. Based on these data, risk factors such as history of leg ulcers, recent edema, diabetes mellitus, congestive heart failure, or peripheral vascular disease should prompt clinicians to carefully plan care that will manage a resident's risk for venous ulcer development.

Initial field testing of an instrument to measure: observable indicators of nursing home care quality

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were tested in 109 Missouri and 11 Icelandic nursing homes. Content validity was established using experts. Concurrent and known groups validity was evaluated using Minimum Data Set quality indicators, survey citations, and a process of care measure. Interrater and test-retest reliabilities were calculated as well as coefficient alpha. The "Observable Indicators of Nursing Home Care Quality" instrument is a new measure that can be used by researchers, and potentially by regulators, consumers, or providers, to observe and score specific indicators of quality care following a 20- to 30-minute inspection of a nursing home.

Effect of dressings on saphenous vein harvest incision pain, distress and cosmetic result

Little research has examined the healing and pain associated with saphenous vein (SV) harvest incisions, and no literature has addressed the associated distress and cosmetic result. The purpose of this study was to determine whether dry sterile gauze dressings, transparent film dressings or no dressings were more effective in hospitalized patients undergoing coronary artery bypass graft (CABG), in terms of minimizing leg incisional pain, minimizing the distress of a leg scar and improving the cosmetic appearance of the leg incision scar. Patients were randomized to dressing type on postoperative day (POD) 1, completed a pain and distress visual analogue scale (VAS) on PODs 1, 3 and 5, and a cosmetic result VAS upon discharge. Overall, leg incisional pain decreased over time (p < 0.05). Females reported decreasing pain between PODs 1 and 3, while males reported increasing pain between PODs 1 and 3 (p < 0.05). The film-dressing group reported decreasing pain from PODs 1 to 3, while the no-dressing and gauze-dressing groups reported increasing pain from PODs 1 to 3 (p < 0.05). Pain on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.42, p < 0.05), and distress on POD 5 was positively correlated with an unfavorable cosmetic result (r = 0.44, p < 0.05). The results of this study are encouraging and support the continued testing of dressings to minimize pain and distress, as well as enhancing cosmetic result.

Caring for vascular leg ulcers: essential knowledge for the home health nurse

Vascular leg ulcers are a significant clinical problem. Home health nurses play a critical role in caring for clients with vascular leg ulcers and require an understanding of the pathogenesis and treatment of these ulcers. This article differentiates the pathogenesis of venous and arterial ulcers and describes the critical aspects of their treatment. Interventions include modifying activity, promoting blood flow, applying compression therapy, providing local wound and skin care, improving nutrition, and treating infection.

Vascular infections: medical and surgical therapies

Vascular infections are a serious problem, often associated with high morbidity and mortality. This article reviews the etiology, pathophysiology, risk factors, and treatment of surgical wound infections, prosthetic graft infections, aortoenteric fistulas (AEFs), and infected vascular ulcers. The primary cause of surgical wound infections is contamination by skin organisms during surgery. Prosthetic graft infections typically result from a progressive wound infection. Comorbid conditions are also related to vascular infections. Nurses should identify vascular patients at increased risk for infection, monitor them closely, and intervene to optimize the healing environment.

Nutrition, tissue oxygenation, and healing of venous leg ulcers

The purpose of the prospective study described in this article was to explore nutrition, tissue oxygenation, and healing in venous ulcer patients. Nutritional risk, anthropometric measures, biochemical indices, two 3-day dietary records, and transcutaneous tissue oxygen levels were obtained. Wound surface area was evaluated 2 times, 4 weeks apart. A convenience sample of 25 English-speaking persons with 1 or more venous ulcers participated (mean age 59.8 years, 60% men, 48% white). Moderate or high nutritional risk existed in 84% of the persons in the sample. Based on body mass index, more than 50% of the persons in the sample were obese. Nonetheless, 17 of 25 persons in the sample had 1 or more abnormal biochemical nutritional indices. In addition, caloric intake (17 of 20), protein intake (15 of 20), and zinc intake (17 of 20) were inadequate to meet the needs for healing. No statistically significant relationships were found between biochemical nutritional indices, tissue oxygenation, and healing. The women in the sample were more likely to heal than were the men (P < 0.05). This study begins to document the problems of overnutrition and undernutrition in the venous ulcer population. Future studies need to explore the effects of obesity and inadequate intake on the healing of venous ulcers. Additional examination of the differences between men and women also is warranted to identify predictors of venous ulcer healing.

Nutritional risk, status, and intake of individuals with venous ulcers: a pilot study

Chronic leg ulcers occur in at least 1% of the adult population. The healing of these ulcers remains a clinical challenge. The purpose of this pilot study was to explore the nutritional risk, status, and intake of seven patients with venous ulcers. The Public Awareness Checklist categorized two subjects as being at low risk, two as moderate risk, and three subjects as high nutritional risk. Biochemical indicators of nutritional status identified abnormalities in hemoglobin and/or hematocrit, albumin, transferrin, zinc, and total lymphocyte count. Mean daily intake was inadequate to meet caloric needs in five of six subjects. By conservative estimates (RDA), two subjects had an inadequate protein intake. Data suggest that at least some individuals with venous ulcers are at nutritional risk, have abnormalities in their nutritional status, and/or have an inadequate intake to support healing. Future research is needed to explore the relationship between nutrition and rate of healing in individuals with venous ulcers.

Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions

OBJECTIVE

To describe the frequency, manifestations, and correlates of impaired healing of saphenous vein (SV) harvest incisions in hospitalized patients who had undergone coronary artery bypass grafting (CABG).

DESIGN

Prospective, descriptive, correlational.

SETTING

West Coast university-affiliated medical center.

PATIENTS

Thirty-two English-speaking adults who had undergone CABG.

OUTCOME MEASURES

Impaired wound healing of SV-harvest incisions.

RESULTS

The overall incidence of impaired healing was 43.8%. The most frequent manifestations of impaired wound healing at discharge were prolonged erythema (8/32), prolonged drainage (8/32), and both prolonged erythema and drainage (2/32). Correlates of impaired healing of SV-harvest incisions were body mass index (product-moment correlation = 0.39, p = 0.026) and preoperative use of diuretics (point biserial correlation = 0.42, p = 0.016).

CONCLUSIONS

Impaired healing of SV-harvest incisions in this sample occurred more frequently than previously indicated in the literature. Although severe wound infections were infrequent, a high degree of impaired healing occurred (43.8% of patients who had undergone CABG). Future studies need to explore the long-term effects of impaired healing and test interventions to mitigate impaired healing in this population.

Subcutaneous tissue oximetry: implications for wound healing and monitoring critically ill patients

Availability of oxygen and adequate blood flow to wounded tissues are important factors for the prevention of impaired wound healing. Oxygen is essential for the growth of new blood vessels, formation of collagen, and the prevention of infection. Subcutaneous tissue oximetry, an experimental technology for evaluating tissue oxygen and perfusion, is being researched for use in the evaluation of hypovolemia, hemorrhagic shock, sepsis, and would healing. This technology eventually may assist in the management of critically ill patients by promptly alerting physicians to decreased oxygen delivery and allowing for more timely intervention.

Vascular nursing research review: 1980--1990

The specialty of vascular nursing has developed and flourished over the last decade. Recently, the vascular nursing literature has grown tremendously. Nurse researchers have begun to explore the unique needs of individuals with vascular disease. Areas currently under investigation include individual and family adaptation to vascular disease and clinical therapeutics for individuals with vascular disease. The research literature from 1980 to 1990 is examined to determine the amount and major themes of vascular nursing research. Unexplored areas of vascular nursing are identified, and recommendations for future research proposed.