A randomised controlled trial to compare a nurse practitioner to medical staff in the preparation of patients for diagnostic cardiac catheterisation: the study of nursing intervention in practice (SNIP).

BACKGROUND: A number of initiatives have employed nurses in roles traditionally associated with the medical profession but few have been evaluated in prospective randomised studies. This paper reports the results of a randomised controlled trial to assess the performance of a nurse practitioner (NP), trained to prepare patients for diagnostic cardiac catheterisation. METHODS: Eligible and consenting patients were randomised to preparation by either the NP or junior medical staff (JMS). The safety outcome measure was the rate of in-hospital major adverse clinical events including death, myocardial infarction and emergency bypass coronary surgery. Other outcome measures included rate of minor adverse events, cardiologist assessment of case preparation and presentation, patient satisfaction and duration of pre-admission clinic. RESULTS: From April 1997 to May 1998 a series of 355 patients scheduled for elective, day-case, diagnostic cardiac catheterisation were screened. Of these, 345 patients were eligible for the study. A total of 339 patients consented to participate and were randomised. Major adverse clinical events occurred in 0/175 (0%) patients in the NP group and 2/161 (1.2%) patients in the JMS group. (Risk difference = -1.2%, upper boundary of the 95% confidence interval = +2.0%) The cardiologist's evaluation that the patient's preparation was acceptable was high in both groups: NP group 98.3% vs. JMS group 98.8%: P = 1.0). Patient satisfaction, assessed by questionnaire, was greater in the NP group (P = 0.04). The median duration of the pre-admission clinic visit was lower in the NP group 165 min vs. 185 min in the JMS group, P = 0.01). CONCLUSIONS: The preparation of patients for diagnostic cardiac catheterisation can be safely performed by an appropriately trained NP. This approach may be associated with improved patient satisfaction and reduced clinic duration times.

The study of nursing intervention in practice (SNIP).

The creation of a new role for an advanced nurse practitioner in cardiovascular medicine is being evaluated in a prospective randomised controlled trial--the study of nursing intervention in practice (SNIP).

Evaluation of four Spanish word-recognition-ability lists.

Tests of word recognition ability (formerly Speech Discrimination) should be suitable for the linguistic background of the person being tested. Few efforts have been made to develop a standardized test in the Spanish language. Current literature reports on six studies that have several drawbacks. The purpose of the present study was to evaluate a commercially available Spanish language test. The material consists of four lists of 50 bisyllabic tetraphonemic Spanish words. The words were recorded at a professional laboratory (Auditec of St. Louis) by a native Spanish speaker. In the present study, the lists were evaluated in terms of interlist equivalence, word difficulty, intelligibility of the talker, and slope of the performance/intensity (PI) function. Taped lists were presented to 16 normal-hearing native Spanish speaking adults at four presentation levels. Mean intelligibility scores were poorest for list three. Statistical analysis indicated that the intelligibility of list three is significantly different than the other lists at the 0.05 level. On the average, at low presentation levels, the nine subjects of Mexican origin obtained better scores than the seven subjects of other nationalities. The slope of the PI-PB function (4.3%) was comparable to that obtained by other investigators of English lists. The words most frequently missed contain the /s/ sound and are words that retain their meaning even after deletion of the final /s/. The talker's speech intelligibility was judged to be very clear.

Auditory thresholds in children for narrow-band noise and warble tones in sound field.

Auditory thresholds for frequency-modulated (warble) tones and narrow bands of noise in a sound field were obtained for children between the ages of eight and 48 months. Differences between the two types of stimuli centered at either 500 Hz or 4,000 Hz and among three age groups were not statistically significant (P greater than 0.01). Auditory thresholds for these frequency-selective stimuli did coincide closely with the speech awareness and spondee threshold measurements obtained in the present study, and with thresholds for complex noise obtained in previous reports. Sound field warble tone thresholds differed, however, from published data in adults and unpublished data in children. Explanations for discrepancies between data in present study and previous studies are suggested, and a cautious recommendation for the use of frequency-selective stimuli in the assessment of auditory thresholds in children is emphasized.

Investigation of arterial bloodgases at altitude using constant-flow oxygen masks.

Arterial blood oxygen tensions up to 6700 m altitude (FL220) were measured polarographically while subjects breathed from various masks with constant-flow oxygen. The Sierra and Aro masks used for emergency decompression descent in commercial passenger aircraft, gave mean PaO2's of 130 +/- 7.6 and 130 +/- 12.1 torr at 6700 m (FL220) and 90 +/- 3.8 and 77 +/- 3.35 torr at 4260 m (FL140), respectively, when supplied with oxygen flows corresponding to those available in the Boeing 747. These oxygen tensions during descent are acceptable for normal physiological function in a heterogeneous population of air travellers whereas breathing ambient air during return to base at 4260 m (FL 140) (PaO2 of 48 or less) is not acceptable. The valveless Hudson 1007 and Puritan 114011 masks, used for air ambulance service, gave mean PaO2's of 110 +/- 2.7 and 98 +/- 4.5 torr at 6700 m and 80 +/- 3.0 and 77 +/- 2.5 torr at 4260 m under the same condition--significantly less than the Sierra mask.

Intelligibility of speech transduced via classroom-installed FM and conventional audio induction loop amplification systems.

This study was designed to investigate the intelligibility of speech transduced through a classroom-installed FM system and a conventional induction loop amplification (ILA) system and to examine the applicability of an FM adapter when used with commercially available hearing aids. Findings indicate that speech reproduced via the FM system is significantly better than that of the conventional audio induction loop used in this study. It seems likely that the irregular high-frequency response of the ILA system was responsible for this difference. When an FM adapter was used in conjunction with body-type hearing aids, the frequency response of the telecoil along with the positioning of the adapter determine the total performance of the aid.

Performance of hearing aids with an induction loop amplification system: laboratory versus classroom setting.

This study was designed to investigate the acoustic response of ten body-type hearing aids when used with an induction loop amplification (ILA) system in the laboratory and in the actual classroom setting. Undesirable frequency response characteristics were discovered in the classroom ILA system used in this study. These consist of a slightly poorer low-frequency response and a deep notch at about 2,500 Hz. Had the frequency response of the classroom ILA system been flat, differences between laboratory and classroom measures would have been minimized. Findings of this study support the practicality of measurement in the classroom of the operating characteristics of ILA systems.

Unreliability of half-list discrimination tests.

The present study was undertaken to investigate the reliability of the half-list forms of the CID W-22 and the NU no. 6 auditory discrimination tests with both normally hearing and sensorineurally impaired subjects. For each group of subjects, both the first half-lists and the whole-lists were scored. Analysis of the data indicated that the half-list forms of the tests were not as reliable as sometimes suggested in the literature. Further, the half-list form of the NU no. 6 was demonstrated to be not as reliable as the half-list form of the CID W-22 even before the correction coefficient was applied.