Ventricular Pacing Thresholds Following High-Energy Implantable Cardioverter Defibrillator Shocks in Integrated Bipolar Defibrillation Systems

By: Yoshio Yamanouchi, MD, Kei Miyoshi, MD, Sunao Kodama, MD, Yuhei Shiga, MD, Shunichiro Sumi, MD, Hideya Niimura, MD, Hideaki Toujou, MD, and Hidenori Urata, MD

BACKGROUND:

Increased ventricular pacing thresholds have been observed following monophasic implantable cardioverter defibrillator (ICD) shocks.

AIM:

To examine changes following high-energy biphasic shocks delivered by integrated bipolar ICD systems.

METHOD:

Ten episodes of ventricular fibrillation (VF) were induced at 10 min intervals in nine pigs with integrated ICD systems. After 10 s of each episode of VF, a 40 J biphasic shock was delivered, which successfully terminated VF (a total of 10 shocks). The bipolar pacing threshold at the right ventricular apex was measured before each shock and at 1 min intervals after each shock.

RESULTS:

The mean pacing threshold was 0.029±0.059 μJ before the first shock and gradually increased to 0.14±0.10 μJ after the 10th shock.

CONCLUSION:

It may be necessary to pace at a high-voltage output following biphasic shocks delivered by integrated bipolar ICD systems.

Keywords: High-energy ICD shock, Pacing threshold

Sumber: Exp Clin Cardiol. 2009, 14 (1): 3-5

Hospital-Based Emergency Nursing in Rural Settings

By: Jennifer F. Brown

ABSTRACT

In 2006, the Institute of Medicine (IOM) released a series of reports that highlighted the urgent need for improvements in the nation’s emergency health services. This news has provided new energy to a growing body of research about the development and imple­mentation of best practices in emergency care. Despite evidence of geographical dis­parities in health services, relatively little attention has been focused on rural emergency services to identify environmental differences. The purpose of this chapter is to sum­marize the contributions of nursing research to the rural emergency services literature. The research resembles a so-called shotgun effect as the exploratory and interventional studies cover a wide range of topics without consistency or justification. Emergency nursing research has been conducted primarily in urban settings, with small samples and insufficient methodological rigor. This chapter will discuss the limitations of the research and set forth an agenda of critical topics that need to be explored related to emergency nursing in rural settings.

Keywords: rural emergency nursing; disaster nursing; nursing research

Sumber: Annual Review of Nursing Research, Volume, 2008

Alcohol, burn injury, and the intestine

By: Mashkoor A Choudhry & Irshad H Chaudry

Abstract

A significant number of burn and other traumatic injuries are reported to occur under the influence of alcohol (EtOH) intoxication. Despite this overwhelming association between EtOH intoxication and injury, relatively little attention has been paid to determining the role of EtOH in post-injury pathogenesis. This article reviews studies which have evaluated the impact of EtOH on post-burn intestinal immunity and barrier functions. The findings from these studies suggest that while a smaller burn injury by itself may not have an adverse effect on host defense, when combined with prior EtOH intoxication it may become detrimental. Experimental data from our laboratory further supports the notion that EtOH intoxication before burn injury suppresses intestinal immune defense, impairs gut barrier functions, and increases bacterial growth. This results in increased bacterial translocation which may contribute to post injury pathogenesis. Altogether, the studies reviewed in this article suggest that EtOH intoxication at the time of injury is a risk factor, and therefore blood EtOH should be checked in burn/trauma patients at the time of hospital admission.

Keywords: Inflammation, tissue damage, trauma

Selengkapnya dapat dibaca pada [Sumber]: Journal Emerging Trauma Shock. 2008 Jul–Dec; 1(2): 81–87.

Perawatan Diabetes di Pedesaan Amerika

Diabetes Care Among Rural Americans

By: Sharon Williams Utz

ABSTRACT

The prevalence of diabetes in the United States is higher among those living in rural/ nonmetropolitan statistical areas than in urban centers. Managing this complex chronic illness is complicated by factors such as limited access to care, low socioeconomic status, aging, and membership in a racial or ethnic minority group. A review of the literature was conducted focusing on research about rural Americans with diabetes by searching databases of CINAHL, PubMed, and MEDLINE, and selecting articles in English that were published between 2000 and 2007. Search terms included: nursing, research, rural, rural nursing, rural health services/programs, and diabetes care. Additional search strategies included journal hand searching and networking. Twenty-six research reports were found and included qualitative and quantitative methods and program evaluations. All regions of the United States were represented except the Northwest. The vast ma­jority of research reports were of descriptive studies (n = 16), with program evaluation reports (n = 7) and studies testing an intervention (n = 3) also represented. The quality of each study is examined and summarized.

Keywords: diabetes care; rural; nursing; research

Sumber: Annual Riview of Nursing Research, Volume 26, 2008