ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:Although some studies have examined the effects of terminal illness care models such as hospice care on survivor outcomes, no studies could be found that examined whether nursing care affected such outcomes.Objective:To determine whether specialized oncology home care services provided to terminally ill patients with lung cancer positively influenced bereavement psychological distress among survivors, compared with other models of care.Methods:A secondary analysis was performed to test the effects of home nursing care for terminally ill patients on spousal psychological distress during bereavement. Forty-six patient-spousal dyads were randomly assigned to either an oncology home care group (OHC), a standard home care group, or an office care control group. Patient-spousal dyads were entered into the study 2 months after the patient's diagnosis of lung cancer and received follow-up until the patient died. Bereaved spouses continued to receive follow-up for 25 months after the patient's death.Results:Psychological distress was significantly lower initially among spouses of patients that received the OHC intervention compared with the other two groups. Significant mean group differences were found on the subscales of depression and paranoid ideation; marginal group differences were found on the subscales of hostility and psychoticism. There were no significant differences among the groups at 25 months.Conclusions:These results suggest that the bereaved's psychological distress can be positively influenced depending on how their loved one is cared for during the terminal phase of illness.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:Although there is consensus that prevention of cardiovascular diseases is a worthwhile activity and that these efforts should begin in childhood, some controversies remain about the efficacy and timing of preventive efforts.Objective:To differentiate the cardiovascular risk factors that have a potential to respond to environmental and lifestyle modification.Methods:The sample consisted of 56 monozygotic and 29 same-sex dyzogotic twin pairs, equally distributed by gender with a mean age of 12.62 years. Systolic and diastolic blood pressure, triceps skinfold thickness, body mass, and fasting blood specimens for lipid profiles were collected during home visits. Teachers rated the subjects' Type A behaviors using the Matthews Youth Test for Health.Results:Statistically significant estimates of genetic variance were obtained for cholesterol, triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, and body mass index. Compared with the previous phase of this longitudinal study, higher estimates of genetic variance were observed for components of the lipid profile and blood pressure and lower estimates were observed for Type A behavior variables.Conclusions:Overall, the genetic influence on risk factors was moderate, leading to the conclusion that the potential to modify risk profiles during the transition from childhood to adolescence is substantial. Attitudes, behaviors, and environmental inducements that establish and maintain healthy lifestyles over long periods should be the focus of interventions and further research.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:The infusion of amphotericin-B (AmB) often produces clinically distressing rigors and chills, which promptly abate with intravenous injection of meperidine, although its mechanism of action is unknown.Objective:To examine the effects of meperidine on the transcription or secretion of Interleukin 1β (IL-1β) in human mononuclear leukocytes (MNL) exposed in vitro to the lipopolysaccharide (LPS) contained inEscherichia coliendotoxin or to AmB.Methods:Blood was drawn from eight healthy adult volunteers. The blood was centrifuged, and the layer containing MNL was separated; incubated with various combinations of medium, meperidine, and AmB; then tested for IL-1 content to determine the effect of meperidine on MNL secretion of IL-1β. To determine the effect on MNL transcription of IL-1β, the RNA was extracted from cells and the IL-1β was measured using one of two different methods.Results:Incubation of human MNL in the presence of LPS or AmB significantly increased transcription of IL-1β mRNA and secretion of IL-1β. Addition of meperidine to these cultures significantly reduced LPS-induced, but not AmB-induced, secretion of IL-1βin vitro. Meperidine did not alter IL-1β mRNA levels in MNL exposed to LPS or AmB.Conclusions:These data suggest that meperidine decreases rigors and chills in part by decreasing MNL secretion of IL-1β through a posttranscriptional mechanism.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables.Objectives:To investigate the relationships among maternal psychosocial factors(history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children.Methods:Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors.Results:Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the APPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale(17%); and childhood physical abuse was the only predictor of Role Reversal.Conclusions:Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:Despite outcomes studies measuring such variables as job satisfaction, autonomy, professionalism, turnover, leadership styles, and more recently, cost-effectiveness, no consistent relationships have been established between shared governance models and outcomes.Objectives:To define and develop an instrument to measure the governance of hospital-based nurses.Methods:The 88-item Index of Professional Nursing Governance (IPNG) was developed to measure professional nursing governance of hospital-based nurses. Psychometric properties were tested with 1,162 registered nurses from 10 hospitals.Results:Content validity after item generation was .95, using Popham's average congruency procedure. Six factors explained 42% of the variance with subscale intercorrelations between .43 and .67. All subscales had a high degree of internal consistency (alphas .87 to .91); test-retest reliability was.77. Construct validity testing showed that scores between shared governance and traditionally governed hospitals were significantly different. A correlation was found between scores on the IPNG and the Hague and Aiken Index of Centralization.Conclusions:The results of this study support the validity of the 88-item IPNG as a reliable instrument for measuring the distribution of professional nursing governance of hospitals.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background:Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently.Objective:To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes.Methods:The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed.Results:Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of decubiti, complaints, and mortality. An unexpected finding was that the relationship between RN proportion of care was curvilinear; as the RN proportion increased, rates of adverse outcomes decreased up to 87.5%. Above the level, as RN proportion increased, the adverse outcome rates also increased.Conclusions:The higher the RN skill mix, the lower the incidence of adverse occurrences on inpatient care units.

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:1998

数据来源: OVID