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PubMed1995

A problem solving intervention for caregivers of cancer patients.

Effects of a psychosocial intervention program on spouses of cancer patients, and on the cancer patients themselves, will be described. A six session intervention program, which included support, problem-solving and coping skills, was designed to help spouses to cope with the stress of caring for their partner. Forty male and forty female spouses of cancer patients of a regional oncology center were randomly assigned to intervention or usual treatment conditions. Spouses and patients were interviewed prior to intervention, and within two weeks after intervention on a battery of assessment instruments including: (1) demographic variables; (2) psychological variables; (3) health status; (4) social supports; (5) assessment of pressing problems; (6) coping skills; (7) burden levels; and (8) marital satisfaction. Participants were found to be more psychologically distressed than the general population but were not as distressed as psychiatric outpatients. Differences were also found in marital satisfaction and coping activities, when compared to the general population. No significant differences between the conditions were found on any of the measures. Caregivers' level of caregiving activities proved to be low. It is suggested that this may account for why the intervention only appeared effective for a distressed subsample of the caregivers in the study. The implications of these findings is discussed. Recommendations are also made for future research on cancer caregivers.

Adaptation, Psychological↗
PubMedDate not supplied

Clinical nursing research: you can do it!

Nurses can use clinical nursing research to strengthen the knowledge base of their practice and to develop effective nursing interventions. When planning and implementing their studies, nurses must anticipate and deal with important issues concerning the realities of clinical nursing research. These issues include developing the research question, planning for an optimal sample size, passing the Institutional Review Committee, managing conflicts between clinical and research roles, selecting instruments to measure the variables, collecting data in a clinical setting, analyzing and interpreting the data, funding the proposed study, and ensuring administrative support.

Clinical Nursing Research↗
PubMed2005

Attitudes and prescribing preferences of health care professionals in the United States regarding use of extended-cycle oral contraceptives.

OBJECTIVE: The aim of this study was to examine the attitudes and prescribing patterns of health care professionals (HCPs) in the United States regarding extended continuous oral contraceptive (OC) regimens. DESIGN: A prospective survey of HCPs prescribing contraception who attended six educational conferences from April to July 2004 was conducted. METHODS: A survey instrument that included demographic variables, attitudes and prescribing preferences regarding extended OC regimens was developed. Surveys were administered at medical meetings to a diverse array of HCPs who specifically prescribe contraception in their practice. The survey was conducted immediately prior to a presentation at the medical meetings on contraceptive update. Returned forms were scanned into Excel databases and examined with Pearson's chi(2) and multivariate logistic regression methods to assess practices and attitudes. RESULTS: There were 551 HCPs, including primary care physicians, obstetrician/gynecologists, nurse practitioners and physician assistants, prescribing contraception who were surveyed at the medical meetings. Most of the participants (87.4%) thought that extended OC regimens should be routinely offered, with 81% of the respondents reporting that they had used extended regimens in their practice. Physicians and nurse practitioners who listed their specialty as "OB/GYN" were more likely to favor the concept of routinely offering the option of extended regimens (p<.0002) and to have recommended extended regimens in their practice (OR = 2.9, 95% CI = 1.8-4.6). Only 12% of the respondents thought that withdrawal bleeding with standard 21-day/7-day OC regimens "has health benefits and is necessary." The most commonly recommended extended regimen was an 84-day active pill use period followed by a 7-day hormone-free interval. CONCLUSION: Most HCPs prescribing contraception who attended the six medical meetings favored the use of extended OC regimens and have recommended them in their practice, especially if their specialty was OB/GYN. The most commonly prescribed extended regimen was an 84-day active pill use period followed by a 7-day hormone-free interval.

Attitude of Health Personnel↗
PubMed2005

Supplemental care with medication-assisted manipulation versus spinal manipulation therapy alone for patients with chronic low back pain.

OBJECTIVES: To measure changes in pain and disability for chronic low-back pain patients receiving treatment with medication-assisted manipulation (MAM) and to compare these to changes in a group only receiving spinal manipulation. STUDY DESIGN: Prospective cohort study of 68 chronic low-back pain patients. METHODS: Outcomes were measured using the 1998 Version 2.0 American Association of Orthopaedic Surgeons/Council of Musculoskeletal Specialty Societies/Council of Spine Societies Outcomes Data Collection Instruments. The primary outcome variable was change in pain and disability. All patients received an initial 4- to 6-week trial of spinal manipulation therapy (SMT), after which 42 patients received supplemental intervention with MAM and the remaining 26 patients continued with SMT. RESULTS: Low back pain and disability measures favored the MAM group over the SMT-only group at 3 months (adjusted mean difference of 4.4 points on a 100-point scale, 95% confidence interval [CI] -2.2 to 11.0). This difference attenuated at 1 year (adjusted mean difference of 0.3 points, 95% CI -8.6 to 9.2). The relative odds of experiencing a 10-point improvement in pain and disability favored the MAM group at 3 months (odds ratio 4.1, 95% CI 1.3-13.6) and at 1 year (odds ratio 1.9, 95% CI 0.6-6.5). CONCLUSION: Medication-assisted manipulation appears to offer some patients increased improvement in low back pain and disability. Further investigation of these apparent benefits in a randomized clinical trial is warranted.

Adult↗
PubMed2005

Differential effect of sleep-wake states on lingual and dorsal neck muscle activity in rats.

Postural tone is reduced during slow-wave sleep (SWS) and absent during rapid eye movement sleep (REMS). In obstructive sleep apnea subjects, upper airway dilating muscles, including those of the tongue, show a similar pattern; this contributes to sleep-related airway obstructions. However, in healthy subjects, state-dependent changes in the activity of pharyngeal muscles are variable. In seven chronically instrumented Sprague-Dawley rats, an animal model used to study sleep and sleep-disordered breathing, we quantified lingual and postural muscle activity across the sleep-wake states by measuring the root mean square levels of the electromyograms (EMG) in successive 10s intervals collected during 2h of recording at a constant circadian time (1-3p.m.). The nuchal EMG was low and steady during SWS and further reduced with occasional twitches during REMS. In contrast, the mean lingual EMG during SWS was only 5.9+/-1.6% (S.E.) of its mean in wakefulness, and during REMS, it increased to 46+/-15% (S.E.) (p<0.03) due to the appearance of phasic bursts, the intensity of which progressively increased. The lingual and nuchal activities also had different time courses during state transitions. In obstructive sleep apnea subjects, the sleep-wake changes in the activity of pharyngeal muscles may become similar to those in postural muscles as a result of pharyngeal tone adaptations to the disorder.

Animals↗
PubMedDate not supplied

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

OBJECTIVE: To describe the dieting histories of bariatric surgery candidates. RESEARCH METHODS AND PROCEDURES: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. RESULTS: Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. DISCUSSION: Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.

Analysis of Variance↗
PubMedDate not supplied

The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study.

BACKGROUND: Today there is some evidence-based medicine support for a positive short-term treatment effect of fusion in chronic low back pain in spondylolisthesis and in nonspecific degenerative lumbar spine disorders. The long-term effect is, however, unknown. PURPOSE: To determine the long-term outcome of lumbar fusion in adult isthmic spondylolisthesis. STUDY DESIGN: Prospective, randomized controlled study comparing a 1-year exercise program with instrumented and non-instrumented posterolateral fusion with average long-term follow-up of 9 years (range, 5-13). PATIENT SAMPLE: 111 patients aged 18 to 55 years with adult lumbar isthmic spondylolisthesis at L5 or L4 level of all degrees, and at least 1-year's duration of severe lumbar pain with or without sciatica. OUTCOME MEASURES: Pain and functional disability was quantified by pain (VAS), the Disability Rating Index (DRI), the Oswestry Disability Index (ODI) work status, and global assessment of outcome by the patient into much better, better, unchanged or worse. Quality of life was assessed by the SF-36. METHODS: The patients were randomly allocated to treatment with 1) a 1-year exercise program (n=34), 2) posterolateral fusion without pedicle screw instrumentation (n=37), or 3) posterolateral fusion with pedicle screw instrumentation (n=40). Long-term follow-up was obtained in 101 (91%) patients. Nine patients in the exercise group were eventually operated on. RESULTS: Longitudinal analysis: At long-term follow-up pain and functional disability were significantly better than before treatment in both surgical groups. No significant differences were observed between instrumented and non-instrumented patients in any variable studied. In the exercise group the pain was significantly reduced but not the functional disability. Compared with the 2-year follow-up a significant increase in functional disability was observed, as measured by the DRI, but not the ODI, in the surgical group at long term. In the exercise group no significant changes were observed between the 2-year and the long-term follow-up. Cross-sectional analysis: Between the surgical and conservative group no significant differences were observed in any outcome measurement at long-term follow-up except for global assessment, which was significantly better for surgical patients. Of surgical patients 76% classified the overall outcome as much better or better compared with 50% of conservatively treated patients (p=0.015). Quality of life as estimated by the SF-36 at long term was not different between treatment groups in any of the eight domains studied but was considerably lower than for the normal population. CONCLUSIONS: Posterolateral fusion in adult lumbar isthmic spondylolisthesis results ina modestly improved long-term outcome compared with a 1-year exercise program. Although the results show that some of the previously reported short-term improvement is lost at long term, patients with fusion still classify their global outcome as clearly better than conservatively treated patients. Furthermore, because the long-term outcome of the patients conservatively treated most likely reflects the natural course, one can also conclude that no considerable spontaneous improvement should be expected over time in adult patients with symptomatic isthmic spondylolisthesis. Substantial pain, functional disability and a reduced quality of life will in most patients most likely remain unaltered over many years.

Activities of Daily Living↗
PubMedDate not supplied

Predictors of compliance with diet 6 months after heart transplantation.

OBJECTIVE: To examine and predict patient compliance with diet 6 months after heart transplantation. DESIGN: Prospective, correlational design, with nonrandom sample. SETTING: Midwestern and southern medical centers. PATIENTS: Ninety-four adult patients who had undergone heart transplantation 6 months previously (mean age 55 years; primarily married men). VARIABLES: Sixteen independent variables measured by nine instruments (with acceptable preliminary reliability and validity data) and chart review were used to predict compliance with diet 6 months after heart transplantation. STATISTICS: Descriptive statistics, correlations, and multiple regression were used to analyze the data. RESULTS: More than 85% of patients were compliant with their diet most or all of the time, and more than 70% of patients experienced little or no difficulty complying with their diet. Difficulty with dietary compliance, gastrointestinal symptoms, and health perception predicted dietary compliance (accounting for 38% of variance). CONCLUSIONS: This study will contribute to enhanced patient care and may decrease morbidity and deaths after transplantation.

Adult↗
PubMed2002

Missed opportunities to immunize: psychosocial and practice correlates.

BACKGROUND: The goal of this pilot study was to correlate missed opportunities to immunize young children with providers' psychosocial characteristics and self-reported immunization practices. METHODS: In a population of children aged 0 to 36 months, missed opportunities to immunize were established for a sample of 28 providers, who also responded to a valid and reliable instrument measuring the aforementioned variables. RESULTS: Missed opportunities were significantly lower among providers with higher vested interest (r=-0.45, p=0.02) and tended to be lower among providers with more positive attitudes toward having all children properly immunized at every healthcare visit (r=-0.33, p =0.09). Neither knowledge nor perceived barriers correlated significantly with missed opportunities. Providers missed opportunities to immunize in over half of the visits studied (mean, 0.58), yet all of them reported always immunizing at preventive and follow-up visits, almost all (96.3%) at chronic illness visits, and a majority (78.6%) at acute care visits. As a result, none of the self-reported immunization practices was significantly correlated with missed opportunities. CONCLUSIONS: Missed opportunities appear to be best predicted by motivational psychosocial factors and not by knowledge or perceived barriers. Self-reported immunization practices do not correspond to actual immunization behavior.

Child, Preschool↗
PubMed2006

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

OBJECTIVE: To describe the dieting histories of bariatric surgery candidates. RESEARCH METHODS AND PROCEDURES: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. RESULTS: Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. DISCUSSION: Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.

Adult↗
PubMed2005

Repeatability and reproducibility of thermal field-flow fractionation in molecular weight determination of processed natural rubber.

The purpose of this study is (1) to determine the repeatability and reproducibility of thermal field-flow fractionation (ThFFF) in measuring the molecular weight of compounded natural rubber, and (2) to examine the correlation between the molecular weights obtained from ThFFF and the rheological data. 8 batches of compounded natural rubber were obtained from a thermo-mechanical mastication process, and were analyzed by ThFFF in a designed testing sequence. ThFFF analysis showed the compounded natural rubbers range in weight-average molecular weight (M(w)) from 143,000 to 360,000. By taking into account both the short term variability (repeatability) as well as the long term variability (reproducibility) of the instrument, ThFFF was shown to be able to distinguish between samples differing by as little as 21,000 in M(w) and 15,600 in number-average molecular weight, M(n) (based on cis-polyisoprene calibration); and thus is a useful tool for the molecular weight analysis of natural rubber-related materials. It was also found that the rheological data (G' and tan delta) measured on both the virgin and the compounded natural rubber correlated well with the molecular weights obtained from ThFFF when normalized.

Chemical Fractionation↗
PubMed2000

[Corroboration of concurrent assessment of inappropriate hospitalization with retrospective evaluation based on patient records].

BACKGROUND AND PURPOSE: Since the availability of a German adaptation of the "appropriateness Evaluation Protocol" (AEP) for hospital utilization review, physicians and health care managers were concerned about a potential overestimation of the extent of inappropriate hospital use in a retrospective assessment. The objective was to assess the agreement of concurrent and retrospective assessment of inappropriate hospital use. METHODS: The appropriateness of 42 admissions to surgical wards in a teaching hospital was tested concurrent to the admission. In 25 hospitalized patients the appropriateness of hospital days was assessed. Results were compared with the retrospective testing of the same patients after three months. RESULTS: Agreement between concurrent and retrospective assessment within the same reviewer was 86% of admissions (95% CI = 75%-96%) and 96% of hospital days (88%-100%). Kappa showed values of 0.85 and 0.78, which can be described as excellent. A comparison of two different reviewers, one testing concurrently, the other retrospectively showed agreements of 86% and 90%. The proportion of inappropriate days was the same in both designs. CONCLUSIONS: The results refute prior concerns that a retrospective assessment of the appropriateness of hospital use is impossible because in a retrospective design important clinical information would remain unconsidered or clinical information not yet available at that time would be used for the evaluation. The possibility of an incorrect assessment due to a retrospective design is within the variability inherent to the instrument. Despite the strong agreement, the small sample of surgical patient limits the generalizability of results.

Concurrent Review↗
PubMed1984

Practicable and valid approach to evaluate the efficacy of nootropic drugs by means of rating scales.

Starting with the disputable practice of evaluating the efficacy of nootropic drugs the author has developed a strictly experimental examination approach emphasising the internal validity of experiments. The physician's assessment of the global therapeutic effect is suggested as a variable examination factor which should be treated as an independent variable and a valid instrument for judging the effect when arriving at a statistical conclusion. Differentiated rating scales and measurements are suggested as a basis for this judgment. Proven effects are described in a more differentiated manner by means of this method which helps in discussing the validity of results.

Aged↗
PubMed1995

[Clinical experiences with the hand-held keratometer].

BACKGROUND: In this investigation the clinical usefulness of an automatic handkeratometer was compared to well-known methods of corneal power measurement. Moreover, we examined the influence of the patient's position on the results. PATIENTS AND METHODS: One investigator measured 31 eyes of children in the age of 4-11 years (mean 6.3 y.) and 60 eyes of adults in the age of 22-71 years (mean: 48.3 y.) without corneal disorders consecutively by handkeratometer standing and lying, by autokeratometer and computerized videokeratography. Steepest (r1) and flattest (r2) radius, cylinder power and corresponding axis were subjected to statistical analysis. RESULTS: The mean values of the corneal radii (r1/r2) of the children were 7.63/7.82 mm for handkeratometer standing, 7.63/7.84 mm for handkeratometer lying, 7.62/7.84 mm for autokeratometer and 7.70/7.87 mm for videokeratoscope. The cylinder power was 1.11 dpt for handkeratometer standing, 1.09 dpt for handkeratometer lying, 1.23 dpt for autokeratometer and 0.95 dpt for videokeratoscope. Analysis of intraindividual variability produced by the instruments concerning astigmatism (dpt) showed in substraction for comparison of handkeratometer standing with handkeratometer lying 0.02 +/- 0.29 SD, of handkeratometer standing with autokeratometer -0.12 +/- 0.37 and of handkeratometer standing with videokeratoscope 0.16 +/- 0.35. A further comparison concerning cylinder (dpt) of handkeratometer lying with autokeratometer was -0.13 +/- 0.42 and handkeratometer lying with videokeratoscope 0.14 +/- 0.43. Difference comparison of astigmatism measurements in the 95% confidence interval (aspired difference of zero) demonstrated a high statistically significant relationship of handkeratometer standing (p < or = 0.0001) and handkeratometer lying (p < or = 0.0002) with the videokeratoscope. Mean values of the adult eyes (r1/r2) valued 7.56/7.76 mm in handkeratometer standing, 7.56/7.76 mm in handkeratometer lying, 7.57/7.78 mm in autokeratometer and 7.6/7.76 mm in videokeratoscope. The mean cylinder power with the corresponding axis was 1.15 dpt/80.5 degrees in handkeratometer standing, 1.15 dpt/77.8 degrees in handkeratometer lying, 1.15 dpt/78.3 degrees in autokeratometer and 0.95 dpt/75.2 degrees in videokeratoscope. CONCLUSIONS: The results and standard deviations of corneal power measurements of the handkeratometer were independent on patient's position and very similar to those of a common autokeratometer and videokeratoscope. Because of its quick and simple operation the handkeratometer was well accepted for corneal examination of children and can therefore be a useful alternative.

Adult↗
PubMed1998

Life satisfaction of persons with spinal cord injury compared to a population group.

Life satisfaction is thought to be the subjective part of quality of life, i.e. the feelings of the persons concerned about their functioning and circumstances. In this study, life satisfaction of spinal cord-injured persons living in the community is compared to life satisfaction of a population group. Respondents were a nationwide sample of 318 persons with spinal cord injury (response 60%) and 507 inhabitants of a large city in The Netherlands (response 42%). Life satisfaction was measured using the Life Satisfaction Questionnaire, containing one question about general life satisfaction and eight questions about domain-specific life satisfaction. Mean scores of general life satisfaction and of satisfaction with self-care ability, leisure situation, vocational situation and sexual life were lower in persons with spinal cord injury than in the population group, but satisfaction with family life was higher. However, differences in general life satisfaction, satisfaction with leisure situation and with vocational situation could be attributed to differences in the composition of both groups. Satisfaction with self-care ability was lower in persons with tetraplegia than in persons with paraplegia, but we found no differences in other questions. Several relationships between life satisfaction and age and marital status existed, but they were more pronounced in the population group than in the group of persons with spinal cord injury. Time after injury and cause of injury were not related to life satisfaction variables. Uniformity in measurement instruments would facilitate comparisons between studies.

Adolescent↗
PubMed1989

Issues in reproducibility and validity of dietary studies.

Numerous factors affect the reproducibility and validity of dietary assessment questionnaires. Although the respondents' abilities to respond accurately are most frequently discussed as the cause of apparently poor reproducibility and validity, many other factors are as important and perhaps more important. Most of these other factors are under the control of the investigator, and thus are amenable to improvement. Factors which may affect reproducibility included the degree of variability permitted by the instrument, the error-proneness of the response format, quality control of coding and keying and real dietary change in the time between the two administrations of the questionnaire. Factors affecting real or apparent validity include respondent characteristics, questionnaire design and quantification, quality control, and the adequacy of the reference data. The implications of inadequate reference data are illustrated and discussed.

Humans↗
PubMedDate not supplied

A tool to assess biomechanical gait efficiency; a preliminary clinical study.

A goal of many physiatric interventions is to improve biomechanical walking efficiency. Thus, a tool that helps assess this efficiency, independent of cardiac, pulmonary, psychologic, or other nonbiomechanical factors, would be useful. Currently used methods to measure efficiency, including comfortable walking speed, are not specific to biomechanical variables. A potential tool, the biomechanical efficiency quotient (BEQ), which uses three variables--average stride length, vertical displacement of the trunk during walking, and sacral height during standing--is proposed and preliminarily tested. This quotient is based on Saunders, Inman, and Eberhart's theories and on a prior study in able-bodied subjects. The BEQ was computed in 20 consecutive patients with neurologically based gait disability referred for gait laboratory evaluation who subjectively reported that one or two ankle-foot-orthoses (AFOs) reduced the effort necessary to walk. The quotient was calculated with and without the AFO(s) by dividing the average vertical displacement of the sacrum, which was measured with an optoelectronic system, and by a predicted displacement, which was based on the patient's sacral height and average stride length. The mean BEQ with the AFO(s) (6.3 +/- 4.4) was significantly less than the mean BEQ without the AFO(s) (9.7 +/- 7.1); P = 0.005. Furthermore, the BEQ was less with the AFO(s) compared with trials without the AFO(s) in all subjects. Percent change in BEQ with the AFO(s) (26.8 +/- 19.6) correlated with percent change in comfortable walking velocity (24.8 +/- 31.8), r = 0.73, P<0.001, across all subjects. The BEQ may be useful in specifically assessing the effect on biomechanical efficiency of physiatric interventions, despite variable nonbiomechnical factors. An instrument to measure vertical trunk displacement during walking outside of the gait laboratory would be extremely useful for further necessary longitudinal studies.

Adult↗