A scientific approach to nursing practice.
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Biomedical subjects
Publications and source records attributed to R Crow.
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The influence of a 6-week intervention on factors thought to be related to ectopic cardiac rhythms was tested in normal men with frequent ventricular premature contractions (VPCs), using a randomized, controlled and partial crossover design. The VPC intervention trial experimental regimen included total abstinence from caffeine and smoking, reduction of alcohol intake, and a physical conditioning program. Effects were studied in detail among 81 healthy men with persistent VPCs. VPCs were measured during standard states of rest, dynamic and isometric exercise and other stresses, and 24-hour ambulatory monitoring. Adherence to the treatment was excellent. The experimental group achieved more than 80% of activities asked of them, and little "contamination" occurred in the control group. VPCs were analyzed according to VPC/min, VPC/man and VPC/total number of heart beats. Moderate changes in VPC rates occurred in both experimental and control groups but no significant group differences were found at rest or during any induction test. This 6-week, multiple-factor "hygienic" intervention program had no significant influence on the frequency or occurrence of VPCs in apparently normal men with persistent and frequent VPCs. Because the mechanisms and the significance of VPCs are different in patients with ischemic heart disease, our approach and methods may be useful for similar trials among cardiac patients of adjunct or non-drug therapy for ectopic rhythms.
An analytical study was performed to estimate the magnitude of the visual Q wave duration bias produced by pressurized ink round stylus electrocardiographic (ECG) recorders. With a paper speed of 25 mm/sec and the ECG tracing width of 0.25 mm, the visually measured Q waves are on the average 8 msec too short. The corresponding error with the older type flat stylus recorder is less than 2 msec. Considerable differences can thus be anticipated in the frequency of observed ECG abnormalities in studies which use different types of electrocardiographs. The effect of the visual Q wave duration measurement bias on the diagnostic ECG classification was investigated in a group of 237 patients with old myocardial infarction and 299 subjects with no clinical evidence of infarction. An 8 msec measurement bias toward too short Q wave duration was observed to result in a potential loss of diagnostic accuracy of about 25% in some ECG coding categories. As a corrective procedure, it is recommended that the baseline width produced by a round recording stylus of uniform thickness irrespective of the vertical deflection velocity should be less.
The yield and reproducibility of various methods of ventricular premature beat (VPB) detection are examined in otherwise healthy middle-aged men first found to have VPB in a 2-min lead I ECG rhythm strip. With a combination of an isometric and treadmill exercise test, VPB were repeatedly detected in 83%. Test-retest reliability in classifying the subjects by frequency of VPB was 67%. The reliability of detecting complex VPB was 47% for multiform VPB, 35% for pairs of VPB, 17% for runs and 36% for VPB showing the R-on-T phenomenon. These data suggest that simple and complex VPB detected by the described methods among normal men are poorly reproducible in the individual. Taking the VPB reproducibility for the group as a whole, the proportion of subjects having different frequency or kinds of ectopic beats is reasonably stable for the different test occasions.
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Current work of the Laboratory of Physiological Hygiene is reviewed on the epidemiology and prevention of ectopic ventricular rhythms (VPB). The evidence suggests that uniform simple VPB at rest, or exercise-induced, are prognostically important only in those having clinically manifest coronary disease. A simple rhythm strip is an effective first screen method for detecting individuals having rather frequent VPB, and frequency of VPB is correlated with complex ectopic rhythms. A multifaceted stress induction test induces VPB and does it consistently. Hygienic intervention, in which cardiac stimulants are removed and conditioning exercises given, is being tested as VPB suppressive therapy.
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The Hypertension Detection and Follow-up Program (HDFP) findings demonstrate the predictive value of baseline systolic blood pressure (SBP) and of pulse pressure (PB) in five-year mortality from all causes. Grouping participants into four SBP strata revealed an approximately two-fold increase in age-adjusted mortality rate from SBP stratum I to SBP stratum IV. This effect remained after the contributions of other risk factors were controlled by multivariate analysis. In contrast, baseline diastolic blood pressure (DBP) had little demonstrable effect on mortality in this particular population. The predictive power of pulse pressure was similar to that of SBP. The group mean SBP of every stratum fell progressively during the trial, the change being of greater magnitude in the stepped care (SC) group than in the referred care (RC) group. Also, the reduction in all-cause mortality associated with SC treatment was observed at all levels of baseline SBP. An analysis using life table regression with SBP as a time-dependent variable showed that the postrandomization reduction in SBP was a significant factor in reducing mortality. Similarly, reduced DBP was also contributory. Prospective studies are required to answer definitively the question of the efficacy of treatment of systolic hypertension. Nevertheless, the present analysis of the HDFP data, despite design limitations, supports the advisability of reducing elevated systolic blood pressure.
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