ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Although psychosocial therapy has been shown to reduce mortality after myocardial infarction, it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest, a main cause of cardiovascular mortality.Objective:Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors.Method:Survivors of out-of-hospital ventricular fibrillation or asystole (N= 129), documented by electrocardiograms from registries of a citywide Medic One unit and two county-wide emergency units, were randomized into a two group, experimental, longitudinal design. The intervention consisted of 11 individual sessions, implementing three components: physiologic relaxation with biofeedback training focused on altering autonomic tone; cognitive behavioral therapy aimed at self-management and coping strategies for depression, anxiety, and anger; and cardiovascular health education. The primary outcome measure was cardiovascular mortality.Results:Risk of cardiovascular death was significantly reduced 86% by psychosocial therapy,p= .03. Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias. The cardiovascular death in the therapy group was due to stroke. Controlling for depression, previous myocardial infarction, low ejection fraction, decreased heart rate variability, and ventricular ectopic beats had little impact on estimated treatment effect. The risk of all-cause mortality was reduced by 62% in the therapy group,p= .13. There were a total of three deaths in the therapy group and eight deaths in the control group.Conclusions:Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:The entorhinal cortex provides sensory information to the hippocampus for memory and learning. Damage to the entorhinal cortex is common in patients who experience traumatic brain injury, stroke, and Alzheimer's disease. Entorhinal damage is assumed to interfere with sensory integration; however, substantive knowledge of behavioral patterns is lacking.Objectives:To describe specific behavioral deficits associated with entorhinal cortex injury related to special senses identification, sensory integration, and spatial learning.Method:Adult male rats received bilateral entorhinal cortex damage (n= 19) or sham surgery (n= 11) with a subset randomized to participate in special senses identification, exploration, and sensory integration testing. Spatial learning was examined using a water maze.Results:Lesion and control animals were similar in special senses identification testing. Sensory integration was markedly impaired in lesion animals over 3 days for all integration tasks; however, travel deficit persisted for 4 days. By day 5 sensory integration ability was equal. Lesion animals were significantly impaired across all days of spatial learning for swim time (p= .0001) and directional heading error (p= .03). Control animals exposed to sensory testing demonstrated significantly more efficient learning (p= .005) on swim days 2 and 3 versus control animals not exposed to sensory testing.Conclusions:Early and prolonged behavioral changes are evident following entorhinal cortex damage including sensory integration deficits and persistent spatial learning impairment.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:The cognitive capacity to direct attention (CDA) is essential for self-care and independent functioning. Older women may be more vulnerable to fatigue-related losses in CDA following surgery for breast cancer. Normal functional variations in CDA associated with aging might affect attentional responses in older women newly diagnosed with breast cancer, and factors such as extent of surgery or symptom distress might influence CDA over time.Objectives:To examine (a) differences in CDA and symptom distress in older women newly diagnosed with breast cancer as compared to a control group of older women without breast cancer; (b) the pattern of change in CDA and symptom distress from the pretreatment period to 3 months after surgery; and (c) to examine the relationship of CDA with symptom distress and extent of surgery over time.Methods:Women, 55 to 79 years of age, newly diagnosed with breast cancer (N= 47), were assessed with measures of CDA and symptom distress: (a) before surgery, (b) at 2 weeks postsurgery, and (c) 3 months postsurgery. To account for normal variations associated with aging, 48 women of similar age without breast cancer were assessed following a routine screening mammogram and 3 months later.Results:Before treatment, the breast cancer group scored significantly lower than the control group (p< .05) on measures of CDA and higher on symptom distress. Repeated measures ANOVA showed significant main effects of group, but not time, for the measures of CDA and symptom distress with the breast cancer group having worse status than the control group. For CDA only, there was a significant group by time interaction effect (p= .005) so that the breast cancer group showed a gradual gain in CDA over time.Conclusions:Reduced performance in a cognitive function was observed before treatment and found to persist over an extended interval in older women newly diagnosed with breast cancer.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Limited data are available regarding the onset or trajectory of cardiovascular autonomic deterioration in persons with type 1 diabetes.Objective:To describe differences in heart rate variability among adolescents with type 1 diabetes, adults with type 1 diabetes who have coexisting renal failure, and adolescent and adult controls.Research Design and Methods:A correlational design was used to compare the status of heart rate variability in adults with type 1 diabetes and renal failure (n= 62); healthy adult controls (n= 67); adolescents with type 1 diabetes (n= 55); and healthy adolescent controls (n= 28). Convenience samples of adult patients with diabetes awaiting kidney or pancreas and kidney transplantation, and adolescents with diabetes were recruited from local university-based clinics. Volunteers served as healthy controls. The short-term R-R variability measures included in this study were changes in heart rate with deep breathing and with the Valsalva maneuver. Twenty-four hour ambulatory heart rate monitoring with power spectral analysis was also obtained to assess long-term R-R variability.Results:Adult patients with type 1 diabetes awaiting transplantation had significantly poorer heart rate variability measures than any of the other three populations studied (p< .0001). Adult control values also were significantly lower than either teenage controls or youths with diabetes (p< .05). Although most long-term R-R variability measures were lower in adolescents with diabetes versus controls, only one measure of parasympathetic modulation (i.e., pNN50) was significantly lower (p= .042). There were significant negative associations between HbA1cand sympathetic modulation (i.e., low hertz) in both the adult group (r= − .406,p= .029) and the adolescent group (r= −.324,p= .025) with diabetes.Conclusions:Type 1 diabetes is associated with decreased heart rate variability, with the extent of the decrease related to the age of the individual and the severity of the disease.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:With a national trend toward less aggressive treatment of hospitalized terminally ill patients, families increasingly participate in decisions to withdraw life-sustaining treatment. Although prior research indicates decision making is stressful for families, there have been no psychometric reports of actual stress levels and few discussions of the reasoning used by families compared to clinicians in reaching the decision.Objectives:The purpose of this study was to assess levels of family stress associated with decisions to withdraw life-sustaining treatments, to assess factors that affected stress, and to compare families and clinicians on their reasoning about the decision.Methods:Data were collected from hospital decedent charts, family members of decedents, and clinicians who cared for decedents. Data from families were collected in individual interviews, shortly after decedent death and 6 months later, using psychometric measures and semi-structured interview questions. Clinicians were interviewed once shortly following patient death.Results:Family stress associated with the withdraw decision was high immediately following the death of the decedent and, while it decreased over time, remained high a half a year later. Several factors affected stress; most notably, stress was highest in the absence of patient advance directives. In reaching the decision, both families and clinicians prioritized what the patient would want, although families, more strongly than clinicians, endorsed doing everything medically possible to prolong the patient's life.Conclusions:Findings add compelling evidence for the power of advance directives, whether written or verbal, to reduce the stress associated with family decision-making.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:While the historical interview has been shown to diagnose stress urinary incontinence (UI) with reasonable accuracy, it is less accurate in the diagnosis of urge or mixed UI.Objectives:To construct an optimal model for the diagnosis of motor urge UI, and to refine this model into a simplified instrument that can be used to diagnose motor urge UI during a routine incontinence evaluation.Methods:A model was constructed to allow a more accurate diagnosis of motor urge UI using historical data. Initially, an optimal model was developed that used three key symptoms, age, gender, a history of neurologic disorder, obstruction diagnosed via voiding pressure study, and the urethral resistance algorithm to diagnose motor urge UI. A simplified model was then constructed using factors such as symptoms of motor urge UI, age, and gender that were readily accessible to the nurse when completing a routine UI evaluation. This simplified model was used to develop an instrument for the clinical diagnosis of motor urge UI.Results:While the agreement between clinical and urodynamic diagnosis was relatively high among patients with genuine stress UI (93% accuracy rate), it was considerably less among patients with urge and mixed UI, yielding accuracy rates of 63% and 35%, respectively. An optimal model for diagnosing motor urge UI was constructed and provided an overall accuracy rate of 91%. A simplified model was then constructed and evaluated for performance by least squares fit test. It revealed an R2of 0.85 and an adjusted R2of 0.84.Conclusions:A combination of age, gender, and three key symptoms (diurnal frequency, nocturia, and symptom of urge incontinence) provide an accurate and clinically useful model for the diagnosis of motor urge UI. Additional research is recommended to test the validity and reliability of the instrument derived from this model.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior.Objectives:The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures.Method:The Jefferson Scale of Attitudes Toward Physician-Nurse Collaborationwas administered to 639 physicians and nurses in the United States (n= 267) and Mexico (n= 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design.Results:Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed.Conclusions:Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background:Vignettes are used by nurse researchers use to determine how clinical judgments about patient care situations are made. However, when vignettes are designed there is often a restriction on the number of characteristics studied, which oversimplifies the richness and complexity of real world healthcare situations.Objectives:The purpose of this article is to describe a factorial survey. Its multilevel design of independent variables allows for real world complexity in a way not tested by a sample set of four to six identical vignettes. Nurses' judgments about patients' confusion and the application of restraints are used to illustrate the method.Method:The factorial survey is an experimental design that can be developed in three steps: (a) identifying and using the variables, (b) writing a coherent vignette, and (c) randomly generating the vignettes.Results:The unit of analysis is the vignette and Ordinary Least Squares (OLS) regression is used for analyses. In the example provided on confusion recognition and restraint use, patient characteristics accounted for the majority of explained variance in confusion recognition of (40%, R2= 0.40) and restraint intervention for (43%, R2= 0.43). The results for both models were strikingly similar as the same patient characteristics all were significant predictors for confusion recognition and restraint use.Conclusions:The versatility of the factorial survey lies in the researcher's ability to use it to test judgments in a variety of complex clinical simulations, to aid in concept development, and to identify consensus and disagreement among nurses. The multilevel design of the independent variables allows for real world complexity in a way not tested by a sample set of four to six identical vignettes.

ISSN:0029-6562    

出版商:OVID    

年代:2001

数据来源: OVID