Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD.

BACKGROUND: Rates of mortality and readmission are high in patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In this population, the prognostic value of the Medical Research Council Dyspnoea Scale (MRCD) is uncertain, and an extended MRCD (eMRCD) scale has been proposed to improve its utility. Coexistent pneumonia is common and, although the CURB-65 prediction tool is used, its discriminatory value has not been reported. METHODS: Clinical and demographic data were collected on consecutive patients hospitalised with AECOPD. The relationship of stable-state dyspnoea severity to in-hospital mortality and 28-day readmission was assessed. The discriminatory value of CURB-65, MRCD and eMRCD, in the prediction of in-hospital mortality, was assessed and compared. RESULTS: 920 patients were recruited. 10.4% died in-hospital and 19.1% of the 824 survivors were readmitted within 28 days of discharge. During their stable state prior to admission, 34.2% of patients were too breathless to leave the house. Mortality was significantly higher in pneumonic than in non-pneumonic exacerbations (20.1% vs 5.8%, p<0.001). eMRCD was a significantly better discriminator than either CURB-65 or the traditional MRCD scale for predicting in-hospital mortality, and was a stronger prognostic tool than CURB-65 in the subgroup of patients with pneumonic AECOPD. CONCLUSIONS: The severity of dyspnoea in the stable state predicts important clinical outcomes in patients hospitalised with AECOPD. The eMRCD scale identifies a subgroup of patients at a particularly high risk of in-hospital mortality and is a better predictor of mortality risk than CURB-65 in exacerbations complicated by pneumonia.

Boosting your career with a mentor.

Mentoring is the last topic in a series of six articles designed to help orthopaedic nurses adjust career goals and strengthen their professional and personal achievements. Becoming a protege to an experienced and successful person can be the linchpin that helps bring together the other elements-resume writing, job interviews, critical thinking, networking, and going back to school-you need to achieve your full potential. This article describes what to look for and expect from a mentor, how-to be a good protege, and the mentor-protege relationship. The author uses her personal experience as a mentor and protege to describe the risks and rewards of this influential relationship.

Analysis of motor vehicle crash data in an urban trauma center: implications for nursing practice and research.

OBJECTIVE: To examine the incidence of risk behaviors (safety restraint use and alcohol use) and demographic characteristics of motor vehicle crash victims. DESIGN: Retrospective, descriptive, correlational. SETTING: One major, urban, Level 1 trauma center. SUBJECTS: The medical records of 864 motor vehicle crash victims (drivers, passengers, pedestrians, bicycle riders, and motorcycle riders) admitted to the trauma center between July 1, 1989, and June 30, 1990, were reviewed. RESULTS: Eighty-two percent of motor vehicle occupants (403 drivers and passengers) were not wearing safety restraints at the time of the crash. Thirty-six percent of drivers (92) and 42% (47) of pedestrians were intoxicated on admission to the trauma center. Failure to use safety restraints was associated with alcohol use in this population. Subjects who engaged in risk behaviors were predominantly adolescent and young adult males. CONCLUSIONS: These data suggest the need for further research into correlates of risk behaviors and interventions to prevent future injury related to these behaviors.

After the casualties: Vietnam nurses' identities and career decisions.

This qualitative study explores the effect of the Vietnam War on 50 military nurses' careers. Results indicate that the nurses' responsibilities in stateside hospitals often seemed diminished and patient needs distinct from those of battle casualties. Findings confirm that the nurses' postwar reactions were similar to those of nurse veterans of other wars, and that the year-long exposure to young wounded men in Vietnam directly altered the career choices of 44 nurses.

Post-traumatic stress disorder in an urban trauma population.

This descriptive study examined the incidence of post-traumatic stress disorder (PTSD) in individuals who experienced physical traumas within the past 6 months and the relationship between severity of physical injury and PTSD. The sample consisted of 92 subjects who were treated at a Level 1 trauma center in an urban hospital. Scores on the Impact of Event Scale indicated that over half of the sample had medium or high levels of PTSD. However, the severity of physical injury from trauma was not related to PTSD development.

How to use word processing software to conduct content analysis.

Nurses' interest and involvement in qualitative research methods has increased in recent years. Researchers who use these methods often find data analysis time-consuming and tedious. Word processing software available for personal computers can provide an efficient and organized way to accomplish qualitative data analysis used in grounded theory, ethnographic, phenomenologic, and historic research. This article describes how to transcribe interviews and create files for analysis with WordStar software.