Scientific advances in the genetic understanding and diagnosis of malignant hyperthermia.

Malignant hyperthermia (MH), a potentially fatal disorder triggered by certain types of general anesthesia, has received much attention in the scientific literature. From the first case report in 1960 until the present, hundreds of studies have been conducted. The diagnosis of MH has evolved from subjective assumptions by family history and clinical diagnosis to more sophisticated laboratory testing. A genetic basis for MH was recognized in the early 1990s and, since then, complex genetic pathways have been demonstrated. The purpose of this paper is to summarize the research literature on what is known scientifically about the diagnosis and genetic basis of MH.

A concept analysis of control in the perianesthesia period.

Control is a word used frequently with many connotations and nuances. It has emerged as thematic in recent qualitative studies of patients' experiences of the perianesthesia period. The purpose of this paper was to conduct a concept analysis of control in the perianesthesia period, using Walker and Avant's eight-step method. The literature was reviewed, which identified the defining attributes. Model, borderline, contrary, and illegitimate cases are presented, and antecedents and consequences are identified. Control in the perianesthesia period is defined as the perception of the power of choice. Sometimes that choice is to relinquish control to others. The purpose of this concept analysis of control was to clarify the concept and to provide insight into the patients' perspective, enabling nurses to assess and approach patients from a different viewpoint--one that seeks to help the perianesthesia experience become a less threatening, frightening one and instead a partnership that enhances the well-being of the individual.

The relationship of continuity and discontinuity, functional ability, depression, and quality of life over time in stroke survivors.

The purpose of this study was to examine the concepts of continuity and discontinuity over time and to explore their relationships with depression, functional ability, and global quality of life (QOL). In a repeated-measures design, 51 participants in an inpatient rehabilitation hospital were entered within 1 month of stroke and followed at 3 and 6 months; 33 completed the study. Depression, functional ability, and QOL all changed significantly between time 1 and time 2 and remained so through time 3 (6 months after stroke). There were no changes in continuity or discontinuity over time. Continuity/self, continuity/other, and discontinuity correlated moderately with depression and QOL at time 1; discontinuity and functional ability at time 1 correlated moderately with QOL at time 3. Functional ability related to discontinuity at time 3 and with QOL, otherwise, functional ability did not relate to the other variables, such as depression, in any time period. Although other variables changed over time, the sense of continuity/discontinuity did not. One of nursing's contributions to stroke survivors' rehabilitation may be in helping patients feel more continuous and less discontinuous with their prestroke sense of self.

A comparison of preoperative airway assessment techniques: the modified Mallampati and the upper lip bite test.

The purpose of this study was to compare the preoperative anesthetic airway evaluation methods of the modified Mallamapti test (MMT) and upper lip bite test (ULBT) with the direct laryngoscopic views obtained during tracheal intubation. Positive relationships were predicted for the MMT and ULBT with direct laryngoscopic view and between the MMT and ULBT. We assessed 50 patients' airways preoperatively by MMT and ULBT. Intraoperatively, laryngoscopic views were graded on the Cormack and Lehane scale. Descriptive statistics and correlations were computed. There was no relationship between the MMT and the ULBT and the Cormack and Lehane scale. There was a significant relationship between the ULBT and the Cormack and Lehane scale (r = 0.512; P <.001 ). The ULBT was superior to the MMT in every measure in this study: sensitivity (55% vs 11%), specificity (97% vs 75%), positive predictive value (83% vs 9%), and accuracy (90% vs 64%). The findings of this study support those of a previous study of the ULBT. Because of the ease of the ULBT and the promising results of this small study, we recommend further research with a larger, more diverse sample.

Physical assessment skills: a descriptive study of what is taught and what is practiced.

The purpose of this study was to investigate physical assessment skills taught in undergraduate baccalaureate nursing programs and the physical assessment skills used by practicing nurses. Twelve educators teaching physical assessment and 51 practicing nurses were surveyed on 120 physical assessment skills listed in standard nursing textbooks. Median scores were computed on all the skills. The educators taught all of the skills, 92.5% of the skills were taught and practiced in class and 7.5% were taught but not practiced. For the practicing nurses, 37% of the skill were never used, 29% were used on a daily/weekly basis, with 34% used on a monthly/occasional basis. Based on these findings, we recommend that the content of physical assessment courses be reevaluated, with courses focusing on what nurses need to know to practice nursing.

"I was actually a nurse": the meaning of professionalism for baccalaureate nursing students.

An important process in any profession is the development of professional identity. Understanding how students experience professionalism is important to provide appropriate educational experiences to foster this aspect of professional socialization. Therefore, this study investigated baccalaureate student nurses' perspectives of what it means to be professional. This qualitative study was based on Pollio, Henley, and Thompson's interpretive framework, an existential-phenomenological approach. The purpose of the interpretation was to recognize patterns or themes in an experience. Figural experiences in one's life emerge against a backdrop, or ground. Sixty-nine baccalaureate nursing students at different educational levels participated. They described specific experiences in which they felt professional. The student experience of being professional was one grounded in a world of self and others. Three interrelated themes emerged from this ground-belonging, knowing, and affirmation. The ground of self and others provides the backdrop of the experience. It is through self and others that the figural themes are experienced. The themes are inherently inter-related. For example, the experiences of belonging and knowing were affirming to students, and affirmation enhanced their sense of knowing and belonging. Implications of the findings are explored.

A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement.

Cuffed endotracheal tubes are one aspect of airway management designed to ensure safety, yet patients can be at risk for injury from underinflated and overinflated endotracheal cuffs. Tracheal pressures exceeding approximately 48 cm H2O impede capillary blood flow, potentially causing tracheal damage, and pressures below approximately 18 mm Hg may increase the risk of aspiration. There is no standard identified in the literature describing the method of cuff inflation, and nurse anesthetists use various cuff inflation techniques. The purpose of this study was to compare endotracheal cuff pressures obtained by estimation techniques with direct endotracheal cuff pressure measurements. A convenience sample of 40 anesthesia providers (nurse anesthesia students, Certified Registered Nurse Anesthetists, and anesthesiologists) inflated the endotracheal tube cuff using their usual inflation technique. The endotracheal tube cuff pressure was measured with a noninvasive manometer connected to the pilot balloon. Pressures obtained by estimation techniques ranged from 6 to 60 cm H2O (mean = 44.5; SD = 13.07). Analysis revealed that fewer than one third of the anesthesia providers inflated the cuff within an ideal range. No differences were found between level of anesthesia provider and cuff inflation pressures. We conclude that estimation techniques for cuff inflation are inadequate and suggest that direct measurements be used.