Biomedical subjects
J Smith
Publications and source records attributed to J Smith.
Improving pain management in an acute care setting. The Crawford Long Hospital of Emory University experience.
PURPOSE: To identify which of three pain intensity measurement scales is most appropriate for use with patients admitted to the inpatient units of the study hospital. The following questions were addressed: Is one of the scales easier for most patients? Is the choice of scales influenced by nursing unit, age, education, race, SES, diagnosis, or type of pain experienced? Do patients perceive that a rating scale helps them describe their pain more effectively? SAMPLE: 267 patients admitted over a 3-week period completed a four-page questionnaire and demographic form distributed on admission. The primary admitting diagnosis for 39.5% of the sample reflected acute pain, 40.3% chronic pain, and 20.2 no pain. METHODS: Three pain rating scales were presented: two visual analogues (one contained a 100 mm line; the other contained six faces depicting graduated levels of distress); and a cognitive number rating scale. Each scale used a 0 (no pain) to 10 (worst pain possible) rating format. Patients completed the questionnaire by rating the intensity of pain experienced using each of the three scales once over the next 24 hours. The last page contained questions related to which of the scales was easiest to use, whether the scale was helpful or needed further explanation, and work and education information. The demographic form was completed from information contained in the patient record. FINDINGS: The scale selected most frequently was the visual analogue containing faces (48.6%), followed by the number (35.3%) and line scales (16.1%). None of the demographic information was found to significantly influence choice of preferred scale. A majority (85.8%) indicated a rating scale as helpful; only 13.6% indicated a need for further explanation. The means for pain intensity ranged from 5.09 to 5.75. The interval between pain ratings for the majority (> 71%) was less than 2 hours. Patients tended to tell the nurse about their pain when the intensity exceeded the midpoint on the scales. A reliability coefficient for the three scales was computed at alpha = 0.88. CONCLUSION: The use of rating scales for pain assessment in adult inpatient units was viewed positively by patients. Recommendations for incorporating self-ratings of pain intensity are set forth. Involving both patients and providers in the process is essential to improving both our processes and the outcomes achieved.
Female genital mutilation. Female circumcision. Who is at risk in the U.S.?
Female genital mutilation/female circumcision (FGM/FC) refers to a group of traditional practices that involve partial or total removal of the external female genitalia or other injury to the female genital organs for cultural, religious, or other non-therapeutic reasons. These practices are usually performed by a nonmedical practitioner in the home or other nonclinical setting. Complications occurring immediately after the practice as well as those encountered months and years afterward can result in disability or premature death. In 1996 Congress directed the Department of Health and Human Services to develop estimates of the prevalence of women and girls with or at risk for FGM/FC in the United States. This paper reports those estimates, as derived by the Centers for Disease Control and Prevention, which showed that in 1990 there were an estimated 168,000 girls and women living in the United States with or at risk for FGM/FC.
Alternation in mitral valve and septal movements in a patient with pulsus alternans.
In a patient with recent aortic valve replacement, echocardiography, phonocardiography, and external pulse recordings were employed to evaluate a prolonged period of pulsus alternans. Alternation in left ventricular end-diastolic and end-systolic diameters, systolic diameter shortening, diastolic ventricular filling, systolic ejection time and diastolic period (A2Q) were seen. In addition, two features were noted which have not been previously reported: (1) Alternation in the timing of mitral valve motion, such that prior to the weak beats, closure of the mitral valve did not occur until 40-70 msec. after the onset of the Q-wave on the ECG. Before the strong beats, however, mitral closure coincided approximately with the Q-wave. (2) Alternation of the movement of the interventricular septum with abnormal or paradoxical movement during weak beats and normal movement during the strong beats. The first observation lends credence to the theory that stretch-tension relationships are important in the maintenance of pulsus alternans in some patients. The paradoxical septal motion during the weak beats may be due either to a discordant right and left ventricular alternans or alternate contractile defection of the septum.