Developing interactive continuing education on the Web.

BACKGROUND: To meet the continuing education needs of advanced practice nurses, on-line continuing education modules were designed as part of a grant-funded nurse practitioner learning project. METHOD: Three modules were planned from the results of a nurse practitioner (n=187) survey of computer availability and skills, topic preference, and their potential for taking on-line continuing education. RESULTS: The development and implementation of two of the three modules demonstrates the interactive framework, extensive use of links, pre- and posttesting, and on-line registration. The two modules were designed to be interactive, realistic self-studies that closely resemble clinical practice. CONCLUSIONS: Outcome data are currently being collected on-line and will be analyzed for efficacy of this delivery system for continuing education.

Evaluating on-line continuing education for nurses.

The rapid increase in web sites for nursing continuing education demands critical appraisal by the user. The level of anonymity of the web site authors and sponsors may lead to a laxity of accountability found in no other media. This article discusses criteria for web site evaluation and provides a rating instrument to assist learners in determining the quality and usability of an on-line nursing continuing education offering. Using the rating instrument, two web sites are reviewed. A list of selected nursing continuing education web sites is included.

Locus of control among alcoholics, recovering alcoholics, and non-alcoholics.

An alcoholic's relapse to drinking is thought to be related to various interpersonal and intrapersonal factors. Drinking-Related Locus of Control (DRIE) scores among alcoholics, recovering alcoholics, and non-alcoholics were compared in this investigation. Each group consisted of 22 males similar in age and other socioeconomic factors. Results indicated significant differences among the three groups. The non-alcoholic group scored more internally than the alcoholic or recovering alcoholic groups; the recovering alcoholic group scored more internally than the alcoholic group. The findings suggest that assessment of the alcoholic's DRIE scores may be useful in planning and monitoring the treatment of this disease.

[Economic considerations in critically ill intensive care patients]. / Okonomische Erwägungen beim kritisch-kranken Intensivpatienten.

Since 1992 the data for all patients referred to our ICU have been entered on computer and analyzed for parameters relevant to therapeutic effectiveness on the one hand and cost-containment on the other. The analysis of data for 5424 patients concerning APACHE II-score, age, number of ICU days, time of mechanical ventilation and/or hemodialysis, cardio-respiratory complications and insufficiency, ICU discharge date and hospital discharge date demonstrates a profile or our intensive care services using all resources efficiently. The data revealed no ethically acceptable parameter or necessity to include economic considerations in medical decisions which had to be taken for individual patients and situations.

[Diagnosis and therapy of tracheal rupture after blunt thoracic trauma]. / Diagnostik und Therapie der Trachealruptur nach stumpfem Thoraxtrauma.

Tracheobronchial ruptures are rare but potentially lifethreatening events. We report on the case of a 34-year-old suicidal unrestrained car driver, who developed subcutaneous and mediastinal emphysema and right-sided haematothorax following blunt thoracic trauma. Fibreoptical inspection of the tracheobronchial system revealed a rupture (approximately 2 cm in length) of the pars membranacea of the trachea ending shortly above the carina. CT-scan confirmed the diagnosis of mediastinal emphysema, tracheal rupture and, in addition, left-sided pulmonary contusion. A repair of the tracheal tear was performed by right-sided thoracotomy using a double-lumen tube. The left-sided double-lumen tube was used postoperatively to achieve respirator ventilation with low pressure on the tracheal lumen and on the suture of the tracheal tear. On the other hand, sufficient airway pressure with PEEP for the left lung showing contusion could be provided, using the endobronchial tube. The postperative course was without complications. The patient was on respiratory support for three days due to his-pulmonary contusion. Following final endoscopic control of the trachea he was discharged from the ICU one week after the trauma. The clinical and radiological signs of tracheobronchial ruptures are discussed (respiratory distress, haemoptysis, cyanosis, localised pain, hoarseness, coughing, dysphagia, stridor, subcutaneous emphysema and pneumothorax, tension pneumothorax, mediastinal emphysema). Fibreoptic bronchoscopy is the present gold standard for confirming the diagnosis. The surgical and anaesthesiological approach to the management of tracheobronchial ruptures is described reviewing the current literature.

Determination of serum concentrations of type III procollagen peptide in mechanically ventilated patients. Pronounced augmented concentrations in the adult respiratory distress syndrome.

Type III procollagen peptide (PCP) is a byproduct of type III collagen synthesis and a potential marker of collagen secretion. In chronic diffuse interstitial lung diseases, elevated PCP concentrations have been found in serum as well as in bronchoalveolar lavage fluid. It has been proposed that PCP is a marker of early, active stages of fibrosis. As severe fibrosis is a frequent complication in adult respiratory distress syndrome (ARDS), we investigated PCP in patients with ARDS and compared the results with those from patients requiring mechanical ventilation because of heart failure and after neurosurgical and surgical interventions, and those from spontaneously breathing patients, including healthy volunteers and patients with pneumonia, liver cirrhosis, and renal failure. PCP concentrations in patients with ARDS were extremely elevated compared with those in control subjects (p less than 0.001) and correlated positively with FiO2 (r = 0.71, p less than 0.01). These results support the pathophysiologic concept of early fibrogenesis in ARDS. As preventing pulmonary fibrosis in ARDS is essential in improving survival rate, we believe PCP can be a valuable diagnostic tool in ARDS.