Comparison of 2 methods of managing gastric residual volumes from feeding tubes.

BACKGROUND: Research-based standards do not exist for the management of gastric residual volumes from feeding tubes. Withdrawing and returning residual volumes can lead to clogged tubes and exposes patients to possible contamination of the feeding system. However, discarding residual volumes may place patients at risk for electrolyte imbalance and may alter fluid or nutritional balance. OBJECTIVES: To investigate the effects of discarding versus returning gastric residual volumes on body weight, serum electrolyte levels, and the rate of complications associated with tube feeding. METHODS: Thirty-five subjects receiving enteral feedings were recruited from intensive care units at 3 Midwest hospitals and randomized to a discard group or a return group. Eighteen sets of usable data were obtained. RESULTS: Repeated-measures analysis of variance indicated no significant differences between the 2 groups for any of the variables. Complications related to enteral feedings were more common in the return group (n = 8), which had 2 episodes of tube clogging and 1 episode of diarrhea and nausea. None of these complications were experienced by patients in the discard group (n = 10). CONCLUSIONS: Both groups had significant numbers of complications, including a total of 15 episodes, 7 in the discard group and 8 in the return group, of feeding delays due to high gastric residual volumes. Although serum electrolyte levels did not differ significantly between the 2 groups, potassium levels tended to be lower in the discard group. Considerations for the care of critically ill patients with feeding tubes are discussed in light of these findings.

The dilemma of factitious demographic distinctions in psychological research.

Terms such as race, sex and age are assumed to reflect biological characteristics and distinctions. In psychological research, these terms are often treated as if they were a reflection of a meaningful set of psychological constructs. A review of articles in 3 prominent journals over a 30-year period reveals that these supposed biological identifiers are not used consistently and lack empirical and conceptual validity. An analysis of those articles shows that, over time, the term race has given way to the use of the more general and psychologically relevant term ethnicity, sex and gender have been used interchangeably, and the psychological constructs underlying or supposedly reflected in age are seldom discussed. It is proposed that psychosocial researchers and editors adopt a consistent definition of these terms and that research include an effort to identify the underlying concepts that the investigators assume to be reflected in these distinctions whenever these labels are used to report research findings.

Blastomycosis-induced respiratory failure: the successful application of continuous positive airway pressure.

A patient diagnosed with pulmonary blastomycosis was seen initially by her primary care physician for severe pain in her right elbow and was treated with steroid therapy and analgesics. She also had been treated for chronic cough and congestion for approximately 2 months before admission. She showed no improvement at home. She was hospitalized for right epicondylitis, and progressively worsening restrictive pulmonary symptoms developed, including hypoxemia and dyspnea. She was transferred to the intensive care unit and treated with mask continuous positive airway pressure (CPAP) and intravenous amphotericin B. Despite worsening hypoxemia, successful management of oxygenation was achieved with CPAP, averting the need for intubation and mechanical ventilation. This case demonstrates the usefulness of CPAP in infectious disorders that create restrictive lung impairment.

Single photon emission computed tomography in long-term survivors of adult brain tumours.

Sixteen patients with primary brain tumours were examined on average eight years after treatment with surgery or whole brain irradiation using standard clinical assessment, CT, a neuropsychological test battery, and single photon emission CT (SPECT) with 99mTc-exametazime. Seventeen lesions were discovered on inspection of SPECT images, 11 with x-ray CT. Quantitative assessment of tracer uptake compared with 16 matched healthy volunteers was consistent with the presence of lesions. Measurement of uptake in brain regions of the hemisphere not containing the primary tumour still showed significant reductions in patients. This may be due to remote direct effects of the tumour or, more likely, to the whole brain irradiation received. Psychometric performance on most tests was significantly impaired in the patient group and was correlated with abnormalities of tracer uptake to relevant brain regions.

Documenting the primary nursing summary note: a leap toward professionalism.

A newly developed documentation tool greatly enhances professional nursing practice, empowerment, and interdisciplinary collaboration. The Primary Nursing Summary Note captures the essence of the nursing process, records and validates it in the interdisciplinary patient progress notes, and facilitates the provision of high quality, cost-effective health care.