Prospective postmarket device studies versus returned product analysis as a predictor of system survival.

Monitoring and reporting mechanisms are vital tools for clinicians to assess ICD system performance over time for optimal patient care. This article explores the various reporting mechanisms available to the clinician, both historical and current, and compares and contrasts two such methods. The lead survival rates obtained by return product analysis (RPA) are compared with those from an ongoing prospective chronic study that actively follows patients for clinical ICD system failures (Tachyarrhythmia Chronic Systems Study [TCSS]). Examination of available data shows that a prospective study such as the TCSS is capable of detecting clinically significant adverse events in 2.2% of the 3,958 leads followed. By comparison, RPA-based monitoring of the same leads detects "out of specification" events in 0.5% of the 78,571 leads followed. Statistical analyses of two separate families of leads (RV leads and SQ Patch leads) show that survival rates obtained by the two methods begin to differ at approximately 2 years of implant experience, with 95% confidence intervals no longer overlapping at 3 years. The authors conclude that prospective chronic device studies are a superior tool for the ongoing monitoring of implanted device performance compared to RPA-based reports.

A randomized trial of daily and thrice-weekly trimethoprim-sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia in human immunodeficiency virus-infected persons. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)

We enrolled 2,625 human immunodeficiency virus-infected patients into a randomized trial to assess the efficacy and tolerability of daily vs. thrice-weekly trimethoprim-sulfamethoxazole (160 mg/800 mg) for prophylaxis of Pneumocystis carinii pneumonia (PCP). The rate of PCP was 3.5 and 4.1 per 100 person-years in the daily and thrice-weekly groups, respectively, with a relative risk (RR) of 0.82 (95% confidence interval [CI], 0.61-1.09; P = .16) (RR of <1.0 favors daily trimethoprim-sulfamethoxazole). The RR for PCP determined by on-treatment analysis was 0.59 (P = .03). The RR for death was 0.91 (P = .12); for bacterial pneumonia, 0.82 (P = .06); and for combined PCP and bacterial pneumonia, 0.84 (P = .04). Discontinuation due to adverse events occurred more commonly in the daily trimethoprim-sulfamethoxazole group (RR, 2.14; 95% CI, 1.73-2.66; P < .001). Overall estimates for efficacy end points favored daily trimethoprim-sulfamethoxazole, although rates of intolerance were higher among patients receiving that dose. Daily trimethoprim-sulfamethoxazole may offer advantages as a first choice for PCP prophylaxis; thrice-weekly dosing is an appropriate option for patients intolerant of the daily dose.

Obstructive sleep apnea.

Humans spend one-third of their lives sleeping, yet the role of this phase of the circadian rhythm is not clear. Theories postulating the purpose of sleep include the restorative theory and the humeral theory. Both theories have identified weaknesses. What is known is that chronic disruption of sleep and/or sleep deprivation causes significant physiological and psychological symptoms. These include fatigue, lethargy and daytime somnolence accompanied by irritability, memory loss, decrease in judgment and paranoia. Obstructive sleep apnea (OSA) imposes another, more life-threatening dimension for the client.

Sleep: a reality or dream for the hospitalized adult?

Nursing research literature is examined to determine the extent of sleep loss for the hospitalized adult. Research from the patient's perspective, nurses' assessment of patient's sleep and somnographic studies are considered. Although these three methods are inconsistent in the exact extent of sleep loss, all suggest that hospitalized patients experience less sleep than their normal pattern. Reasons for patients losing sleep are explored. Environmental factors in critical care areas are the most cited reason for loss of sleep yet other reasons are suggested. Consequences of sleep loss are explored. Some nursing interventions offered in the existing literature are examined for their feasibility. Finally, directions for future research are offered from this review of the literature.

The relationship between critical care nurses' knowledge about sleep, and the initiation of sleep promoting nursing interventions.

This descriptive correlation study examined the relationship between critical care nurses' sleep-promoting nursing interventions and their knowledge about sleep; the priority they gave to sleep; their perceptions about the ICU environment; the quantity and quality of sleep they perceived the patients to have obtained; and their sleep promoting nursing interventions. The data were described and then analysed using multiple regression/correlational analysis. Critical care nurses were not very knowledgeable about sleep. They perceived the ICU environment to be moderately conducive to sleep and perceived that they had only some ability to change the ICU environment in order to promote sleep. There was no statistically significant relationship between critical care nurses', sleep promoting nursing interventions and their knowledge about sleep. Several explanations for this are given. There was a statistically significant relationship between sleep promoting nursing interventions and the priority critical care nurses gave to sleep. Several implications for nursing research were drawn from the data and presented.