BACKGROUND: Cardiovascular disease is more prevalent in some ethnic groups than in others, as are risk factors stemming from cultural practices and values. Data on the health status of Asians and Pacific Islanders are scarce and sporadic, and data on the 2 groups are usually combined for analysis. OBJECTIVE: To determine ethnic and sex-related differences among white, Japanese, and Pacific Island subjects in cardiovascular risk factors and outcomes after coronary artery bypass graft surgery. METHODS: Data were collected from a random sample of 41 men and 19 women scheduled for nonemergent coronary artery bypass graft surgery: 19 white, 18 Japanese, and 23 Pacific Island/Hawaiian subjects. Subjects were interviewed about risk factors before surgery and were followed up for the first 20 hours after surgery. Problems that occurred during the remainder of the hospital stay were assessed by chart review. Instruments used included the Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II, and the Therapeutic Intervention Scoring System. RESULTS: Pacific Island and Japanese subjects differed significantly in their demographic and clinical characteristics. Pacific Islanders tended to have a more difficult postoperative course than did white subjects, whereas Japanese patients tended to have fewer problems and an easier postoperative course than other subjects. CONCLUSIONS: Further study of ethnic variations in risk factors and surgical outcomes, especially variations in comorbidities, age at the onset of signs and symptoms, and postoperative complications, is needed. Combining data obtained from Japanese and Pacific Island subjects for data analysis most likely will result in a loss of important information.
BACKGROUND: Baseline data are needed to provide a foundation for future studies investigating the effects of various nursing interventions on the oxygen requirements of critically ill patients. OBJECTIVES: To establish reference values for the oxygen requirements of adults in response to three common patient events: a nurse-administered bed bath, passive range-of-motion exercises, and turning from side to side; and to determine whether the order in which the interventions were administered had an effect on oxygen consumption. METHODS: A convenience sample of 30 healthy men and women were randomly assigned to one of three treatment groups, for which the order in which interventions were to be administered had previously been designated. Data were analyzed using analysis of variance with repeated measures. RESULTS: There was a significant difference in the mean oxygen consumption among activities, as well as between men and women, with men having a significantly higher mean oxygen consumption than that of the women. For both men and women, the mean oxygen consumption during unassisted turning and back care was significantly higher than at baseline. The oxygen consumption for men averaged 4.25 mL/kg per minute, SD = .71 at baseline, 5.08 mL/kg per minute, SD = .98 for turning, and 4.72 mL/kg per minute, SD = .90 during back care. Women averaged 3.74 mL/kg per minute, SD = .49 at baseline, 4.48 mL/kg per minute, SD = .85 for turning, and 3.89 mL/kg per minute, SD = 1.15 during back care. Changes in oxygen consumption for other interventions were nonsignificant and negligible. Oxygen consumption returned to near baseline within 15 minutes of cessation of activity. The order in which interventions were administered did not have a significant effect on oxygen consumption. CONCLUSIONS: The anterior bath and passive range of motion exercises have minimal effect on oxygen consumption. Turning and back care significantly increase oxygen consumption from the baseline value. The order in which interventions are administered does not have any appreciable effect on oxygen consumption.
BACKGROUND: Peripheral nerve stimulation is necessary to quantify the level of neuromuscular blockade and prevent prolonged paralysis related to drug accumulation. Some nurses and physicians are hesitant to administer nerve stimulation because of concerns about inflicting pain on the patient. OBJECTIVE: To describe the feeling associated with train-of-four ulnar nerve stimulation, and to quantify discomfort, monitor heart rate response, and define the amount of current necessary to stimulate thumb adduction. METHODS: Healthy, nonmedicated volunteer subjects (N = 39) were asked to describe train-of-four ulnar nerve monitoring at 3 current strengths. Heart rate was monitored throughout the testing procedure. The milliamperes delivered at each current strength and the occurrence of thumb adduction were recorded. RESULTS: Subjects described nerve stimulation generally as an unusual prickly sensation. On a discomfort scale of 1 to 10, the mean discomfort score when stimulated with the current setting at 4 (15.5-23.6 mA) was 3.63. Level 4 stimulation produced thumb adduction in 54% of subjects. No heart rate change occurred in response to nerve stimulation. CONCLUSION: Nerve stimulation by train-of-four method was moderately uncomfortable but not painful. Heart rate response could not be relied on as a measurement of discomfort. Protocols for stimulation should include testing at level 4 and increasing as necessary to cause thumb adduction.