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PubMed1991

Strengthening nurse-family relationships in critical care.

Establishing relationships with families in critical care is an essential part of high quality care. Critical care nurse-family relationships are important to the patient and family and also benefit the nurse. Thus, nurse-family relationships should be started when families first enter the critical care environment. Cooperative and collaborative relationships require negotiation and must consider the needs of the family as well as the nurse. Barriers need to be overcome before critical care nurse-family relationships can develop. Possible barriers include limited time, perceptions that families are stressors, dysfunctional response styles, and premature judgments. Essential qualities of successful relationships include: trust, respect, empathy, warmth, sensitivity, and touching, when appropriate. Each of these qualities is dependent on the verbal and nonverbal skills of the critical care nurse. As with anything worthwhile, relationship skills take practice to develop, involving a commitment to the importance of nurse-family relationships in critical care.

Attitude of Health Personnel↗
PubMed1997

The influence of muscle group location and race on the relationship between muscle strength and power.

OBJECTIVE: This study investigated the influence of muscle group location and racial background on the relationship between measures of muscle strength and power. It was hypothesized that both African American (AA) and Caucasian American (CA) males would exhibit similar strength-power relationships, but these relationships would be dependent upon muscle group location. EXPERIMENTAL DESIGN: A cross-sectional, comparative design was used. SETTING: The Human Performance Laboratory at the U. of Oklahoma. SUBJECTS: Normal, healthy college-aged AA (n = 14) and CA (n = 15) males volunteered for this study. MEASURES: Upper and lower body strength (IRM) was assessed using a Smithpress bench press and Polaris leg press, and upper and lower body power was measured with a piezoresistive accelerometer. RESULTS: When comparing power between upper and lower body muscle groups, both AA and CA groups exhibited similar relationships (r = 0.68 and r = 0.61, respectively), however, the relationship between upper and lower body strength was relatively stronger for the AA group (r = 0.65 vs r = 0.42). When evaluating the strength-power relationship within a given muscle group, i.e., upper or lower body, there were no racial differences, but the relationship between strength and power did differ with respect to muscle group location. CONCLUSIONS: There were stronger relationships between measures of muscular strength and power for the lower limbs when compared to the upper body indicating the importance of muscle group location rather than racial ethnicity as a confounding factor that can affect neuromuscular force production. This information is important when attempting to characterize neuromuscular function relative to specific skills or motor sport performance, thus emphasizing the principle of specificity.

Acceleration↗
PubMed1998

Stability and continuity of child-caregiver and child-peer relationships.

We examined the relationship quality of 55 (27 girls) 9-year-old children with their mothers, teachers, and friends as rated by teachers and by the children themselves. The goal of this longitudinal study was to examine stability and continuity in the quality of children's relationships between infancy and 9 years of age. At age 9, children's perception of their relationships with their teachers was associated with their current teachers' ratings of their relationships with the children. Children's perceptions of their relationships with their mothers were consistent with earlier ratings of attachment security. Children's perceptions of their relationships with teachers were predicted by the quality of their attachment relationships with their first teachers. Children's perceptions of their friendship quality was predicted by preschool teacher ratings of friendship quality and the quality of their attachment relationships with their first teachers.

Child↗
PubMed1998

How the negative and positive aspects of partner relationships affect the mental health of young married people.

The relationship between marriage and positive mental health is one of the most established findings in the stress literature. Few studies, however, examine the problematic as well as the supportive impacts of marriage on mental health. This paper uses a cohort of young adults who were sampled at 18, 21, or 24 years of age and resampled seven years later when they were married at 25, 28, or 31. It examines what factors are associated with the quality of marital relationships, the relative impact of and balance between negative and positive partner relationships on mental health, and sex differences in the determinants and outcomes of marital quality. The results indicate that the structural strains of parenthood and financial need and their interaction predict problematic and supportive spousal relationships and the difference in the levels of these two relationships. Problematic relationships with spouses have considerably stronger impacts than supportive relationships on depression. However, the difference between the amounts of supportive and problematic relationships with spouses has a greater impact on mental health than levels of either considered separately. Finally, relational quality has a greater impact on the mental health of wives than husbands. These findings indicate the importance of considering how marriage affects mental health in complex, rather than in straightforward, ways.

Adolescent↗
PubMed1998

Developing, validating and consolidating the doctor-patient relationship: the patients' views of a dynamic process.

BACKGROUND: Previous research has examined the doctor-patient relationship in terms of its therapeutic effect, the need to consider the patients' models of their illness, and the patients' expectations of their doctor. However, to date, no research has examined the patients' views of the doctor-patient relationship. AIM: To examine patients' views of the process of creating a relationship with their general practitioner (GP). METHOD: A qualitative design was used involving in-depth interviews with 27 frequently attending patients from four urban general practices. They were chosen to provide a heterogeneous group in terms of age, sex, and ethnicity. RESULTS: The responders described creating the relationship in terms of three stages: development, validation, and consolidation. The development stage involved overcoming initial reservations, actively searching for a doctor that met the patient's needs, or knowing from the start that the doctor was the right one for them. The validation stage involved evaluating the nature of the relationship by searching for evidence of caring, comparing their doctor with others, storing key events for illustration of the value of the relationship, recruiting the views of others to support their own perspectives, and the willingness to make tradeoffs. The consolidation stage involved testing and setting boundaries concerned with knowledge, power, and a personal relationship. CONCLUSION: Creating a relationship with a GP is a dynamic process involving an active patient who searches out a GP who matches their own representation of the 'ideal', selects and retains information to validate their choice, and locates mutually acceptable boundaries.

Adult↗
PubMed1996

Quantitative structure-activity relationships studies with micellar electrokinetic chromatography. Influence of surfactant type and mixed micelles on estimation of hydrophobicity and bioavailability.

Applications of micellar electrokinetic chromatography (MEKC) in quantitative structure-activity relationships (QSAR) were studied. First, quantitative structure-retention relationships (QSRR), which describe the correlation between logarithm of capacity factor (log k') in MEKC and logarithm of distribution coefficient between 1-octanol and water (log P(ow)), were investigated for 60 aromatic compounds and 9 corticosteroids using three different anionic surfactants [e.g., sodium dodecyl sulfate (SDS), sodium cholate (SC), and lithium perfluorooctane sulfonate (LiPFOS)], one cationic surfactant (C14TAB), and mixed anionic micellar systems. Linear solvation energy relationships (LSER) and solvatochromic parameters were used to shed light on the different log k' vs. log P(ow) relationships of the various surfactants. It was concluded that hydrogen bonding interactions have a great influence on retention behavior in MEKC and its relationships with hydrophobicity. Interestingly, bile salt surfactants (e.g., SC) and mixed bile salt micellar systems provide better correlations for log k' vs. log P(ow) than SDS and/or SDS with buffer additives (e.g., beta-cyclodextrin, urea, and acetonitrile). Using SC micelles, only one line was adequate to describe the relationship between retention in MEKC and hydrophobicity for a group of 60 aromatic compounds. The existence of higher correlation for the SC system was attributed to a similar hydrogen bonding pattern between SC micelles and 1-octanol. In the SDS system, however, three lines were recognized for the congeneric subgroups of compounds. This is due to the hydrogen bond door (HBD) characteristic of SDS micelles that selectively differentiate between the solutes with different hydrogen bond acceptor (HBA) strength, thus demonstrating that retention is not solely based on hydrophobicity. A similar result was observed for a C14TAB-MEKC system, however, the HBA characteristic of C14TAB selectively differentiates between the solutes with different HBD strength. In addition, quantitative retention-activity relationships in MEKC were also investigated for 9 corticosteroids. Two types of biological activities [small intestinal absorption in the rat (log A/NA) and protein binding to human serum albumin (log B/F) were examined in this work. High correlations were observed between bioactivity and log k' in MEKC using bile salt surfactants and mixed bile salt systems.

Adrenal Cortex Hormones↗
PubMed1989

Protection of an unstable reaction intermediate examined with linear free energy relationships in tyrosyl-tRNA synthetase.

Linear free energy relationships (LFERs) are powerful tools in the search to understand the relationship between molecular structure and activity. They frequently link the changes in the rate constants for a reaction to changes in the equilibrium constant caused by alterations in structure. In physical-organic chemistry, these have been interpreted to give information on the structure of the transition state. Similar phenomena have been observed for reactions catalyzed by a series of engineered mutants of tyrosyl-tRNA synthetase from Bacillus stearothermophilus. LFERs are applied in this study to probe how the enzyme minimizes its side reactions. A linear free energy relationship is shown between the binding of the unstable enzyme-tyrosyl adenylate complex and its rate constant of hydrolysis. However, mutations of a key residue, His48, show significant deviation from the relationship, implying a role for the side chain in protection of the complex from hydroxide attack. A second linear free energy relationship is shown linking the rate and equilibrium constants for tyrosyl adenylate binding to the enzyme. Four distinct classes of mutation are discussed in the context of this relationship. The data from all but one of these groups of mutations conform well to a linear free energy relationship between the dissociation rate and dissociation equilibrium constants for the enzyme-tyrosyl adenylate complex with slope beta = 1.01 +/- 0.08. The specificity of binding of tyrosyl adenylate is determined solely by its dissociation rate constant of the intermediate, and the mutations have relatively little effect on the enzyme-tyrosyl adenylate association rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Monophosphate↗
PubMed2003

Does a dose-response relationship reduce sensitivity to hidden bias?

It is often said that an important consideration in judging whether an association between treatment and response is causal is the presence or absence of a dose-response relationship, that is, larger ostensible treatment effects when doses of treatment are larger. This criterion is widely discussed in textbooks and is often mentioned in empirical papers. At the same time, it is well known through both important examples and elementary theory that a treatment may cause dramatic effects with no dose-response relationship, and hidden biases may produce a dose-response relationship when the treatment is without effect. What does a dose-response relationship say about causality? It is observed here that a dose-response relationship may or may not reduce sensitivity to hidden bias, and whether it has or has not can be determined by a suitable analysis using the data at hand. Moreover, a study without a dose-response relationship may or may not be less sensitive to hidden bias than another study with such a relationship, and this, too, can be determined from the data at hand. An example concerning cytogenetic damage among professional painters is used to illustrate.

Adolescent↗
PubMed1998

Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer.

We sought to determine the strength of the evidence suggesting that estrogen and postmenopausal replacement hormones play a role in the development of breast cancer. We reviewed the existing English language literature in MEDLINE on hormones and breast cancer, including reports on cell proliferation and endogenous hormone levels, as well as epidemiologic studies of the relationship between the use of postmenopausal hormones and the risk of breast cancer in women. A factor that increases the probability that cancer will develop in an individual has been defined as a cancer cause. The Hill criteria for demonstrating a link between environmental factors and disease were used to review the evidence for a causal relationship between female hormones and breast cancer. We found evidence of a causal relationship between these hormones and breast cancer, based on the following criteria: consistency, dose-response pattern, biologic plausibility, temporality, strength of association, and coherence. The magnitude of the increase in breast cancer risk per year of hormone use is comparable to that associated with delaying menopause by a year. The positive relationship between endogenous hormone levels in postmenopausal women and risk of breast cancer supports a biologic mechanism for the relationship between use of hormones and increased risk of this disease. The finding that the increase in risk of breast cancer associated with increasing duration of hormone use does not vary substantially across studies offers further evidence for a causal relationship. We conclude that existing evidence supports a causal relationship between use of estrogens and progestins, levels of endogenous estrogens, and breast cancer incidence in postmenopausal women. Hormones may act to promote the late stages of carcinogenesis among postmenopausal women and to facilitate the proliferation of malignant cells. Strategies that do not cause breast cancer are urgently needed for the relief of menopausal symptoms and the long-term prevention of osteoporosis and heart disease.

Aged↗
PubMed1991

Dual relationships in psychotherapy.

A dual relationship in psychotherapy occurs when the therapist engages in another, significantly different relationship with the patient. The two relationships may be concurrent or sequential. For both sexual and nonsexual dual relationships, men are typically the perpetrators and women are typically the victims. This article presents examples of dual relationships, notes the attention that licensing boards and other agencies devote to this topic, reviews the meager research concerning nonsexual dual relationships, and discusses common strategies that promote both sexual and nonsexual dual relationships.

Attitude↗
PubMed1997

Nonsexual relationships between psychotherapists and their former clients: obligations of psychologists.

This article examines the issue of nonsexual relationships between psychologists and their former therapy clients. What little research is available concerning nonsexual relationships with former clients suggests that psychologists have clear reservations about some of these relationships, especially personal ones and intentional social interactions. Relationships immediately following termination are seen as particularly suspect. Drawing on the literature dealing with multiple relationships in general, and sexual relationships with former clients in particular, a number of arguments are made outlining why psychologists should avoid significant nonsexual relationships with former clients for at least some period of time following termination.

Attitude↗
PubMed1996

Pharmacokinetic-pharmacodynamic relationships for benzodiazepines.

This article reviews the literature on the plasma concentration-effect relationships for benzodiazepines, in humans and in experimental animals. Only literature that explicitly links pharmacokinetics to pharmacodynamics is included. The following questions are evaluated. Can concentration-effect relationships be demonstrated? If so, are these relations stable? Are the influences of specific factors such as age and disease on these relationships established? It is clear that, when studies are conducted and interpreted appropriately, relations can be found for a wide range of benzodiazepine effects. These include objective measures such as electroencephalography, semisubjective measures such as psychomotor performance, and subjective measures such as mood/sedation scales. A generally applicable model of the relationship which will allow prediction of effect is, however, not yet established. The relationship appears to be dependent on route and rate of administration, because of factors such as distributional delay, formation of active metabolites and, probably, acute tolerance. Furthermore, intra- and interindividual variability is considerable, probably due to varying experimental conditions and intrinsic interindividual differences. The limited data available on factors influencing the plasma concentration-effect relationships for benzodiazepines demonstrate clear changes in the pharmacodynamics after multiple doses, suggesting the development of tolerance, and a subsensitivity in patients with panic disorder. The influence of factors such as age, disease and drug interactions on the pharmacokinetic-pharmacodynamic relationship remains less clear.

Animals↗
PubMedDate not supplied

The dosage of human chorionic gonadotropins influences the relationship between progesterone and cycle outcome during in vitro fertilization-embryo transfer.

OBJECTIVE: To determine if the dose of hCG affects the initial rise in progesterone seen in patients undergoing IVF-ET and therefore affects it usefulness as a predictor of cycle outcome. DESIGN: Comparison of the rise in progesterone with cycle outcomes for IVF patients receiving 5,000 or 10,000 mIU hCG to stimulate oocyte maturation. SETTING: University-based infertility program. Patients-One hundred six patients undergoing IVF-ET on a long protocol of down-regulation with GnRH, hMG stimulation, and hCG to stimulate oocyte maturation. Stimulation protocol varied only in dose of hCG [5,000 mIU (N = 72) vs. 10,000 mIU (N = 34)]. MAIN OUTCOME MEASURE(S): Rise in progesterone from 12 hours before to 12 hours after hCG administration and its relationship with cycle outcome. RESULTS: All 106 women exhibited a rise in progesterone following the administration of hCG. As seen in earlier studies, there appeared to be a relationship between minimal progesterone increases (<3-fold) and cycle failure in patients receiving 5,000 mIU (P < .02). However, using the criteria of the previous study, there appears to be no relationship between progesterone and cycle outcome in patients receiving 10,000 mIU (P = .30). Further, the higher dose of hCG appeared to induce greater increases in progesterone over the 24-hour period examined (P < .02). After readjustment of the critical value to 3.5-fold, there was an increased tendency toward cycle failure in women exhibiting a minimal progesterone increase. Unlike the relationship associated with 5,000 mIU hCG, though, the relationship between 10,000 mIU hCG and progesterone levels was not statistically different (P = .10). CONCLUSIONS: Increasing the dose of hCG used to stimulate oocyte maturity shifts the previously described relationship between progesterone and IVF-ET-cycle outcome. However, while it remains unclear if progesterone can be used as a predictor of outcome at the higher hCG dose, it appears clear that a relationship exists between minimal progesterone response to hCG and cycle failure.

Adult↗
PubMed2002

Confidentiality and the physician-patient relationship -- ethical reflections from a surgical waiting room.

The physician-patient relationship is the primary focus of ethics in medicine. It is both a personal and a professional relationship that is founded on trust, confidence, dignity and mutual respect. Trust is the bridge to the physician-patient relationship, and the burden is on the physician not only to expect the patient's trust but also to build a solid foundation upon which the patient can place his or her trust. Great strides have been made by physicians in refining the physician-patient relationship especially in understanding and respecting the patients' right of self-determination regarding medical decision-making and protecting their rights of privacy and confidentiality. However, further refinements are needed on both sides regarding this relationship. Breaches of confidentiality are occurring in places like surgical waiting rooms and as a result, the physician-patient relationship is being damaged. This article identifies some legitimate concerns and offers some concrete solutions so that the physician-patient relationship can be further refined and the virtues and rights that support it can be reinforced.

Confidentiality↗
PubMed2005

Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.

CONTEXT: Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied. OBJECTIVE: To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder. DESIGN: Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication. SETTING: Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas. Patients Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission. MAIN OUTCOME MEASURES: Attitudes toward treatment and self-reported adherence to medication. RESULTS: The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient's admission experience (maximum likelihood chi(2)(49) = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment. CONCLUSIONS: The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.

Adolescent↗
PubMed1997

Social relationships among young adults with insulin-dependent diabetes mellitus: ten-year follow-up of an onset cohort.

Past cross-sectional studies have suggested that young adults with insulin-dependent (Type 1) diabetes mellitus (IDDM) may experience problems in their close peer relationships. For 10 years, we have followed an onset cohort of children and adolescents with IDDM (n = 57) and an age-matched group who were originally recruited after an acute illness, accident, or injury (n = 54). Now aged 19-26 years, these two groups were compared in terms of their friendship patterns, dating and love experiences, and sense of loneliness. All subjects in both groups had at least one friend. However, the IDDM group reported fewer friendships overall. The difference was accounted for by the number of less intimate friends. The two groups had similar frequencies of current romantic partners (IDDM = 63%; comparison group = 64%). While dating attitude and dating assertiveness did not differ between groups, some differences were found in terms of experiences of a primary love relationship. IDDM patients experienced less trust and sense of intimate friendship in these love relationships. No differences in loneliness were found. The preponderance of our findings indicate that the two groups had similar patterns and experiences of close peer relationships. Thus, the study does not suggest that IDDM leads to serious problems in forming social relationships for these patients during the transition to young adulthood. On the other hand, the IDDM patients' lower level of trust and intimacy within love relationships are consistent with other findings from this study suggesting specific areas of lowered self-worth that appear in social relationships.

Adolescent↗
PubMed2006

Illness uncertainty, partner caregiver burden and support, and relationship satisfaction in fibromyalgia and osteoarthritis patients.

OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by uncertainty in diagnosis, treatment, and outcome. This study assessed the role of uncertainty of illness in relationship satisfaction in patients with FMS and osteoarthritis (OA). METHODS: A total of 51 patients with FMS responded to self-report instruments assessing their uncertainty about their illness, functional ability, average pain, and relationship satisfaction. Their partners independently reported on their sense of caregiver burden and their supportiveness toward the patients. Thirty-two patients with OA and their partners served as a control group. RESULTS: Patients' functional ability and pain were related to partner caregiver burden. Partner caregiver burden was related to lower levels of partner supportiveness for the FMS dyads, but not for the OA dyads. Relationship satisfaction of patients with FMS was related to their higher levels of uncertainty of illness in interaction with their functional disability and pain and their partners' supportiveness. Under high levels of uncertainty of illness, low levels of partner supportiveness were related to lower patient relationship satisfaction, whereas low levels of uncertainty of illness were significant interacting variables in the OA sample. CONCLUSION: The results suggest that uncertainty of illness is a prominent feature affecting patients with FMS in their relationships with their partners. Suggestions for additional research to explore the role of uncertainty of illness in social relationships are presented, and the therapeutic implications for patient/partner relationships are explored.

Activities of Daily Living↗
PubMed2005

Inferring gene regulatory relationships by combining target-target pattern recognition and regulator-specific motif examination.

Although microarray data have been successfully used for gene clustering and classification, the use of time series microarray data for constructing gene regulatory networks remains a particularly difficult task. The challenge lies in reliably inferring regulatory relationships from datasets that normally possess a large number of genes and a limited number of time points. In addition to the numerical challenge, the enormous complexity and dynamic properties of gene expression regulation also impede the progress of inferring gene regulatory relationships. Based on the accepted model of the relationship between regulator and target genes, we developed a new approach for inferring gene regulatory relationships by combining target-target pattern recognition and examination of regulator-specific binding sites in the promoter regions of putative target genes. Pattern recognition was accomplished in two steps: A first algorithm was used to search for the genes that share expression profile similarities with known target genes (KTGs) of each investigated regulator. The selected genes were further filtered by examining for the presence of regulator-specific binding sites in their promoter regions. As we implemented our approach to 18 yeast regulator genes and their known target genes, we discovered 267 new regulatory relationships, among which 15% are rediscovered, experimentally validated ones. Of the discovered target genes, 36.1% have the same or similar functions to a KTG of the regulator. An even larger number of inferred genes fall in the biological context and regulatory scope of their regulators. Since the regulatory relationships are inferred from pattern recognition between target-target genes, the method we present is especially suitable for inferring gene regulatory relationships in which there is a time delay between the expression of regulating and target genes.

Algorithms↗