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PubMed1997

Transesophageal echocardiography in rats using an intravascular ultrasound catheter.

In vivo assessment of cardiac structure and function in small animals is an important experimental goal, but currently available techniques have significant limitations. A commercially available intravascular ultrasound (IVUS) system was adapted to perform transesophageal echocardiography (TEE) in rats. Twelve Sprague-Dawley rats (270-370 g) were anesthetized with intraperitoneal pentobarbital sodium. A 4.3-Fr, 30-MHz or an 8-Fr, 20-MHz IVUS catheter was inserted into the esophagus to obtain long-axis views of the aortic arch, short-axis views of the ascending aorta, and long-axis views of the pulmonary artery. A preshaped, 8-Fr, 20-MHz catheter was used to obtain short-axis images of the left ventricle (LV) at the midpapillary muscle level, which were used to measure LV diastolic and systolic dimensions (diameters) and to calculate LV mass and fractional shortening. Measurements by TEE were compared with those obtained by transthoracic echocardiography in 6 of 12 rats. Postmortem, the LV was weighed to determine actual LV mass. The correlation coefficients between TEE- and transthoracic echocardiography-calculated LV mass and actual LV mass were 0.94 and 0.88, respectively, and had a good agreement with actual LV mass. Inter- and intraobserver variability of TEE measurements was <10%. IVUS instrumentation may offer an alternative technique for the accurate, serial assessment of LV dimensions, mass, and systolic function and a means of imaging the great vessels in small laboratory animals.

Animals↗
PubMed1999

Relationship between baroreceptor reflex function and end-organ damage in spontaneously hypertensive rats.

The purpose of this study was to further illustrate the relationship between baroreceptor reflex sensitivity (BRS) and hypertensive end-organ damage (EOD) and to test the hypothesis that impairment of BRS aggravates EOD in hypertension. We studied baroreflex-mediated changes in heart rate [expressed as baroreceptor sensitivity to heart rate control (BRS(HR))] and blood pressure [expressed as baroreceptor sensitivity to blood pressure control (BRS(BP))] in spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) that were used as controls, both at the age of 50-52 wk. Rats were also instrumented to record BP, HR, and BP variability (BPV) in the conscious, unrestrained state. In SHR compared with WKY, BP and BPV were significantly increased, whereas BRS(HR) and BRS(BP) were significantly decreased. SHR had remarkable EOD when compared with WKY (EOD score: 6.3 +/- 2.5 vs. 2.9 +/- 0.8, P < 0.01). Univariate regressive analysis demonstrated that EOD score was increased with BP and BPV and decreased with BRS. In multivariate analysis, EOD score was predicted by greater systolic BP and lower BRS and HR variability. These results indicate that BRS is negatively related to BPV and EOD score, and impaired BRS might be one of the major causes for hypertensive EOD.

Animals↗
PubMed1996

Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder.

OBJECTIVE: Despite the increasing awareness of attention deficit hyperactivity disorder (ADHD) in adults, there are a limited number of controlled pharmacologic studies of this disorder; most of the trials have focused on the psychostimulants. Because the tricyclic anti-depressant desipramine has been found to be effective in treating ADHD in pediatric groups, the authors tested its efficacy in adults with ADHD. METHOD: The authors conducted a randomized, 6-week, placebo-controlled, parallel-design study of desipramine at a target daily dose of 200 mg in 41 adult patients with DSM-III-R ADHD. They used standardized structured psychiatric instruments for diagnosis and, as the dependent variables (outcome), used separate assessments of ADHD, depressive, and anxiety symptoms at baseline and at each biweekly visit. RESULTS: There were highly significant differences in the reduction of ADHD symptoms between adults receiving desipramine and placebo. Within the desipramine-treated group, there were clinically and statistically significant differences between baseline and the week 6 end point for 1) reduction of 12 of 14 symptoms of ADHD and 2) decreases in the broad categories of hyperactivity, impulsivity, and inattentiveness. In contrast, placebo-treated patients showed no differences between baseline and end point for any of the ADHD symptoms assessed. According to strict, predefined criteria for response, 68% of desipramine-treated subjects and no subjects in the placebo group were considered positive responders. Response to desipramine was independent of dose, level of impairment, gender, or lifetime psychiatric comorbidity with anxiety or depressive disorders. CONCLUSIONS: These results, similar to findings in children and adolescents with ADHD, indicate that desipramine is effective in the treatment of ADHD in adults.

Adolescent↗
PubMed2002

Caregivers' descriptions of sleep changes and depressive symptoms.

PURPOSE/OBJECTIVES: To describe caregiver sleep and depression using caregiver narratives. To compare qualitative descriptions with quantitative scores. DESIGN: Descriptive, one-time, open-ended interview followed by structured sleep and depression questions. SETTING: Interview conducted in person or via telephone at caregiver's preference. SAMPLE: 47 caregivers of patients with advanced stage cancer. Caregivers had a mean age of 54 years, and most were female (81%), Caucasian (82%), and spouses (61%). They provided care for a mean of 24 months. Patients' diagnoses were lung cancer (36%), colorectal cancer (13%), or recurrences (51%). METHODS: Two cancer care sites in southern California provided participants. After consent, the researcher conducted interviews. The Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiological Studies-Depression (CES-D) instruments were administered following interviews. MAIN RESEARCH VARIABLES: Sleep pattern changes and depression levels over time as defined by caregivers. FINDINGS: Caregivers described severe fluctuations in sleep patterns over time and how these changes affected caregiver depressive symptoms. PSQI and CES-D scores matched narrative comments. CONCLUSIONS: Caregivers' narratives suggest they suffer progressive sleep deprivation that affects their emotions and ability to continue as caregivers. IMPLICATIONS FOR NURSING: Nurses must recognize the severe sleep problems experienced by caregivers and respond with interventions to increase sleep quality and decrease depression.

Anecdotes as Topic↗
PubMed2002

Early detection of breast cancer by self-examination: the influence of perceived barriers and health conception.

PURPOSE/OBJECTIVES: To discover the factors that influence the decision to perform breast self-examination (BSE). DESIGN: Quantitative, correlational. SETTING: Institutional; urban and suburban. SAMPLE: A nonrandomized convenience sample of 93 women. METHODS: Willing participants were asked to complete by mail a short demographic form, the Reduced Laffrey's Health Conception Scale, Champion's Health Belief Instrument, and a BSE questionnaire. MAIN RESEARCH VARIABLES: Health conception, barriers to BSE, frequency and thoroughness of BSE practice. FINDINGS: A wellness conception of health and frequency were not significantly related, nor did a significant relationship exist between a wellness conception of health and thoroughness of BSE. A negative relationship between barriers and thoroughness was highly significant. A statistically significant relationship did not exist between barriers and frequency of BSE. CONCLUSIONS: Those with a clinical conception of health practiced BSE less frequently. If health is viewed as the absence of disease, BSE may be perceived as looking for trouble. Subjects with greater barriers were less thorough when they practiced BSE. The specific barriers tested in this study (i.e., feelings about practicing BSE, worry about breast cancer, embarrassment, time, unpleasantness of procedure, lack of privacy) interfered more with the thoroughness of the behavior than with the frequency of the behavior. The most reported barrier was worry about breast cancer. The data suggest that worry may interfere with performing BSE thoroughly. IMPLICATIONS FOR NURSING: This work offers insight into the thoughts and behavior of women to promote a behavior that could save their lives. Potential implications for nursing practice could include issues related to better education and assessment of barriers to practicing BSE in women.

Adult↗
PubMed2004

Computerized symptom and quality-of-life assessment for patients with cancer part I: development and pilot testing.

PURPOSE/OBJECTIVES: To develop and test an innovative computerized symptom and quality-of-life (QOL) assessment for patients with cancer who are evaluated for and treated with radiation therapy. DESIGN: Descriptive, longitudinal prototype development and cross-sectional clinical data. SETTING: Department of radiation oncology in an urban, academic medical center. SAMPLE: 101 outpatients who were evaluated for radiation therapy, able to communicate in English (or through one of many interpreters available at the University of Washington), and competent to understand the study information and give informed consent. Six clinicians caring for the patients in the sample were enrolled. METHODS: Iterative prototype development was conducted using a standing focus group of clinicians. The software was developed based on survey markup language and implemented in a wireless, Web-based format. Patient participants completed the computerized assessment prior to consultation with the radiation physician. Graphical output pages with flagged areas of symptom distress or troublesome QOL issues were made available to consulting physicians and nurses. MAIN RESEARCH VARIABLES: Pain intensity, symptoms, QOL, and demographics. INSTRUMENTS: Computerized versions of a 0 to 10 Pain Intensity Numerical Scale (PINS), Symptom Distress Scale, and Short Form-8. FINDINGS: Focus group recommendations included clinician priorities of brevity, flexibility, and simplicity for both input interface and output and that the assessment output contain color graphic display. Patient participants included 45 women and 56 men with a mean age of 52.7 years (SD = 13.8). Fewer than half of the participants (40%) reported using a computer on a regular basis (weekly or daily). Completion time averaged 7.8 minutes (SD = 3.7). Moderate to high levels of distress were reported more often for fatigue, pain, and emotional issues than for other symptoms or concerns. CONCLUSIONS: Computerized assessment of cancer symptoms and QOL is technically possible and feasible in an ambulatory cancer clinic. A wireless, Web-based system facilitates access to results and data entry and retrieval. The symptom and QOL profiles of these patients new to radiation therapy were comparable to other samples of outpatients with cancer. IMPLICATIONS FOR NURSING: The ability to capture an easily interpreted illustration of a patients symptom and QOL experience in less than 10 minutes is a potentially useful adjunct to traditional face-to-face interviewing. Ultimately, electronic patient-generated data could produce automated red flags directed to the most appropriate clinicians (e.g., nurse, pain specialist, social worker, nutritionist) for further evaluation. Such system enhancement could greatly facilitate oncology nurses coordination role in caring for complex patients with cancer.

Academic Medical Centers↗
PubMed1992

The relationship of instrumentality and expressivity to sexual orientation in women.

The study reported here investigated the relationship between Instrumentality (I) and Expressivity (E) (two personality variables related to sex roles), sexual orientation, occupational level and marital status. The hypothesis was that women high in I and low in E may find traditional heterosexual relationships to be in conflict with their personality traits, and that a lesbian choice may offer a way of life more in keeping with such traits. The study used a sample of 159 women, and found that neither I nor E alone, nor I x E, could predict sexual orientation. A weak relationship was found between I and housewifery, such that women who were married with children and did not have a job outside the home tend to score lower on I. Expressivity bore no relationship to any of the variables. Women who were high on I and low on E were not more likely to be lesbian. The study concludes that there is no relationship between I, E, and sexual orientation; also that it is inappropriate to use housewives as a heterosexual comparison group for lesbian women.

Adult↗
PubMed2006

Are systemic emboli reduced in computer-assisted knee surgery?: A prospective, randomised, clinical trial.

We undertook a prospective, randomised study using a non-invasive transcranial Doppler device to evaluate cranial embolisation in computer-assisted navigated total knee arthroplasty (n = 14) and compared this with a standard conventional surgical technique using intramedullary alignment guides (n = 10). All patients were selected randomly without the knowledge of the patient, anaesthetists (before the onset of the procedure) and ward staff. The operations were performed by a single surgeon at one hospital using a uniform surgical approach, instrumentation, technique and release sequence. The only variable in the two groups of patients was the use of single tracker pins of the imageless navigation system in the tibia and femur of the navigated group and intramedullary femoral and tibial alignment jigs in the non-navigated group. Acetabular Doppler signals were obtained in 14 patients in the computer-assisted group and nine (90%) in the conventional group, in whom high-intensity signals were detected in seven computer-assisted patients (50%) and in all of the non-navigated patients. In the computer-assisted group no patient had more than two detectable emboli, with a mean of 0.64 (SD 0.74). In the non-navigated group the number of emboli ranged from one to 43 and six patients had more than two detectable emboli, with a mean of 10.7 (sd 13.5). The difference between the two groups was highly significant using the Wilcoxon non-parametric test (p = 0.0003).Our findings show that computer-assisted total knee arthroplasty, when compared with conventional jig-based surgery, significantly reduces systemic emboli as detected by transcranial Doppler ultrasonography.

Acetabulum↗
PubMed1992

Application of ultrasound for feeding and finishing animals: a review.

The ability to evaluate carcass traits in live animals is of value to research, educational, and industry personnel. Ultrasonic technology has been tested since the early 1950s and continues to be under investigation as a means of accomplishing this task. The accuracy of ultrasound in predicting carcass traits is variable and is dependent on species, ultrasonic instrumentation, and(or) the skill of the technician. Based on this review, the ranges of correlation coefficients (r) for carcass traits as predicted by ultrasound to the respective carcass measurement are as follows: swine (fat .20 to .94; longissimus muscle .27 to .93), sheep (fat .42 to .95; longissimus muscle .36 to .79) and beef (fat .45 to .96; longissimus muscle .20 to .94; marbling .20 to .91). Although these correlation coefficients give an indication of the accuracy of ultrasound, it should be noted that these statistics do not reflect population variation or bias. Applications of ultrasound in swine finishing programs include the successful prediction of market weight carcass characteristics and the prediction of percentage of lean cuts before slaughter. In contrast, the application of ultrasound in lamb finishing programs has met with limited success. Most data indicate that weight and(or) visual estimations of fat are at least as accurate as ultrasound predictions of carcass composition. In beef finishing programs, ultrasound has, at times, been used successfully to predict fat and muscle traits before slaughter and beef carcass chemical composition. The ability to predict marbling, however, remains unclear and requires further investigation. Ultrasound has also been used in beef finishing programs to predict days on feed to a constant body compositional end point. When summarized, these data indicate that a single ultrasonic measurement of fat can be helpful in predicting days on feed in yearling cattle. When used alone, however, a single backfat measurement does not provide adequate accuracy. Therefore, factors such as age, sex, breed type, weight, and hip height are needed to help predict days on feed more accurately.

Agriculture↗
PubMed2005

Five-year changes in middle ear function for older adults.

Longitudinal changes in tympanometric measures of middle ear function over five years were reported for a large population of older adults. Findings were similar for men and women, for right and left ears, and across age groups from 48 to 92 years. Although some of the mean changes reached statistical significance, the vast majority of observed changes were small in magnitude relative to the observed variability and the tolerances of the measuring instrument. Observed mean changes in Peak Ytm for older adults were quite small and were in the positive direction. This is counter to changes that would be predicted on the basis of increases in the stiffness of the middle ear transmission system with advancing age suggested in earlier reports. Overall, the findings suggest little in the way of functional change in middle ear mechanics over a span of five years in older adults.

Acoustic Impedance Tests↗
PubMed1984

A review of therapeutic intervention research on gross and fine motor progress in young children with cerebral palsy.

Recently, perhaps due to increased societal demands for accountability, early intervention programming for handicapped infants and young children has been questioned. Therapeutic intervention provided through occupational and/or physical therapy has been increasingly implemented in habilitation settings for children diagnosed as having cerebral palsy, although research justifying this increase is inconclusive. This review presents a comprehensive evaluation of 18 studies that evaluated early occupational and/or physical therapy intervention for children with cerebral palsy. An analysis of these studies revealed that as research paradigms become more rigorous, support for therapeutic intervention effectiveness decreases. This finding was explained in light of the currently inadequate levels of technology relating to instrumentation and the manipulation of the many variables that have been suggested to affect therapeutic intervention effectiveness.

Age Factors↗
PubMed1998

Validation of pulse dynamic blood pressure measurement by auscultation.

BACKGROUND: The accurate measurement of arterial blood pressure is essential for the diagnosis and treatment of hypertension. The development of new automated methods of measurement that provide reliable determinations of blood pressure should be valuable in the assessment of hypertension not only in the clinic or hospital but also, in the home for self-monitoring. DESIGN: We evaluated a noninvasive method for the measurement of systolic and diastolic blood pressures in 132 subjects. METHODS: Measurements obtained using the pulse dynamic method of blood pressure determination were validated with simultaneous manual measurements. Two qualified nurses used Korotkoff sounds to determine systolic (phase I) and diastolic (phase IV) blood pressures according to the Association for the Advancement of Medical Instrumentation 1987 guidelines. RESULTS: Inter-nurse variability was 2.7 +/- 4.1 mmHg (mean +/- SD) for systolic blood pressure and 4.0 +/- 3.7 mmHg for diastolic blood pressure and correlations were r = 0.98 and 0.94, respectively. We observed excellent agreement between auscultatory and pulse dynamic methods for systolic (127 +/- 21 versus 132 +/- 20 mmHg; r = 0.97) and diastolic (72 +/- 10 versus 71 +/- 10 mmHg; r = 0.89) blood pressures. Bland-Altman analysis demonstrated that there was a mean difference (reference-device) between the two methods of - mmHg (pulse dynamic value higher) and SD of 5 mmHg for systolic blood pressure and a mean difference of 1 mmHg (pulse dynamic value lower) and SD of 5 mmHg for diastolic blood pressure. CONCLUSION: The results of this study demonstrate that this noninvasive method of measurement of blood pressure is accurate and reliable and should therefore be appropriate for the evaluation of hypertension both in the home and in clinical settings.

Journal Article↗
PubMed2001

[Biliary complications during videolaparoscopic cholecystectomy. Remarks on methodology and indications in the training period].

In our study we have considered the activity of a surgeon working in our Surgery Department during his laparoscopic training period. We focus our attention on a date related to the same complications checked in 27 cases of cholelithiasis operated by the same surgeon. We have observed three cases of biliary cholelithiasis fistulas, all of them during the three last operations. The examination of the above mentioned cases considers the clinical post-surgery situation and the therapeutic standards we adopted to work out the complications. Now we can precisely state, according to our experience, the particular directions for the videolaparoscopic training period. In addition we can propose one simple mathematical formula to value the IRL (Laparoscopic Risk Index) concerning three variables: the experience of the surgeon; the instruments condition; the clinical situation of the patient. The relation of these three factors turned in numbers suggests the chance of success of a videolaparoscopic operation. We conclude our study mentioning the gasless videolaparoscopic technique that seems to have a large indication, according to the same Surgery School. This technique is particulary indicated on those classes of patients in which the CO2 insufflation into abdominal cavity and the increase of endocavity pressure can represent a contraindication to the videolaparoscopic approach: in this case the surgeon will follow the surgical indication to solve the clinical situation, as happens in war surgery.

Adult↗
PubMed2001

Energy for living with cancer: preliminary findings of a cancer rehabilitation group intervention study.

PURPOSE/OBJECTIVES: To evaluate the acceptability and efficacy of a rehabilitation group intervention for people with cancer experiencing cancer-related fatigue (CRF) and examine the effects of the program on CRF distress. quality of life (QOL), and depression. DESIGN: Prospective, pre-/post-test intervention. SETTING: An outpatient area of a 551 -bed tertiary-care community hospital in the southeastern United States. SAMPLE: 20 participants have completed the program in four different groups. The preliminary mean age was 63.6 (range = 38-86). These participants had six different types of cancers, and 15 patients were receiving some form of cancer therapy during their participation in the program. METHODS: After providing informed consent participants completed the Cancer-Related Fatigue Distress Scale, the Center for Epidemiological Studies-Depression, the Functional Living Index-Cancer, and a demographic Information form. The intervention consists of eight weekly, 90-minute sessions with educational and sharing components. At the eighth session, participants were asked to complete the three instruments plus a program evaluation. MAIN RESEARCH VARIABLES: CRF distress, depression, QOL. FINDINGS: Preliminary results indicate that the program provided information, support, and management strategies for CRF. The mean for the program evaluations overall was 9.8 (0-10 scale, range = 9-10). Statistically significant differences were found for pre- and post-test fatigue distress and QOL scores. CONCLUSIONS: Preliminary findings indicate that this intervention is appropriate and beneficial for patients with cancer experiencing fatigue, even for those patients who are very debilitated. IMPLICATIONS FOR NURSING PRACTICE: The program can be used as a rehabilitation program to help people with cancer to manage the sequelae of their illness and treatments.

Adaptation, Psychological↗
PubMed2001

Anxiety, stress and coping strategies among University of South Pacific students.

This study set out to examine the relationship between stressors and coping strategies utilized by students, as well the prevalence of depression, anxiety and social dysfunction amongst this group within the cross-cultural framework of the University of the South Pacific (USP). Respondents included students from 10 countries served the University of the South Pacific. The research instrument constituted a questionnaire based on demographic variables plus three scales to elicit responses pertaining to stressors, depression and coping strategies. The findings highlight a number of variables that should be of at least some concern to the University with respect to the aforesaid areas mentioned. Regarding demographics, the data reveal a close parity between gender proportions, a relatively young student population and most of them transiting between the first and third years of studies. In terms of stress and depression, a minority of respondents reported stress-related problems and furthermore, small numbers made use of mental and counseling services provided by the University and other parties concerned. In terms of coping, quite a large number of coping variables were utilized by respondents in coming to terms with problems. The study concludes with implications regarding the role of USP in the light of stress and depression-related concerns revealed in the findings.

Adaptation, Psychological↗
PubMed2000

A criterion-referenced multidimensional job-related model prediction capability to perform occupations among persons with chronic pain.

OBJECTIVE: The purpose of this prospective study was an exploration of the construct of the criterion-referenced multidimensional job-related model (CMVA) aimed for predicting patients' with chronic pain capability to perform occupations. METHODS: The study samples were 1) participants (n=84) who at present were not performing employed work (median sick-listing period 12 months) because of chronic pain and 2) participants (n = 104) who at present were performing employed work at least 20 hours of a workweek. The participants had experiences of 40 different occupations classified into five of the occupational categories of Jist's Enhanced Dictionary of Occupational Titles. Data were collected through ten assessment instruments and a structured interview, comprising 54 variables and 465 items. Data were analyzed using multiple regression with forward entering of variables. RESULTS: The CMVA model (Adjusted R^2 0.777, F (4, 183) = 164.067; p<0.001) was able to explain 78% of the variance. CMVA contained the aspects; "the work demands-variable, the person-variable of work life values, the environment-variable of social support and the two occupational performances-variables; self-perceived capability to perform work tasks/the simulated work tasks". CONCLUSIONS: The construct of CMVA was robust suggesting that among persons with chronic pain, the predictors focusing on their capability to perform occupations are of great importance.

Journal Article↗
PubMed1992

The relationship between social support and maternal behaviors and attitudes: a meta-analytic review.

Used meta-analysis to analyze 66 studies that evaluated the relationship between social support available to the mother and maternal behaviors and attitudes. Investigators sampled relatively homogeneous populations of white, middle-class, married mothers of young children without physical or mental disabilities. A variety of instruments were used to assess key study variables. Significant correlations existed between both emotional and material support and maternal behaviors. Implications of these findings for funding of family support programs and for professionals working with mothers are discussed.

Attitude↗
PubMed2004

A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticular hyaluronan in osteoarthritis of the knee.

OBJECTIVE: To investigate the efficacy and tolerability of a course of 5 injections of hyaluronan (HA) given at intervals of one week in patients with symptomatic, mild to moderate osteoarthritis (OA) of the knee. METHODS: A double blind, randomized, parallel group, multicenter (17 centers), saline vehicle-controlled study was conducted over 18 weeks. Patients received either 25 mg (2.5 ml) HA in a phosphate buffered solution or 2.5 ml vehicle containing only the buffer by intraarticular injection. Five injections were given at one week intervals and the patients were followed for a further 13 weeks. The Western Ontario McMaster (WOMAC) OA instrument was used as the primary efficacy variable and repeated measures analysis of covariance was used to compare the 2 treatments over Weeks 6, 10, 14, and 18. RESULTS: Of 240 patients randomized for inclusion in the study, 223 were evaluable for the modified intention to treat analysis. The active treatment and control groups were comparable for demographic details, OA history, and previous treatments. Scores for the pain and stiffness subscales of the WOMAC were modestly but significantly lower in the HA-treated group overall (Weeks 6 to 18; p < 0.05) and the statistically significant difference from the control was not apparent until after the series of injections was complete. The physical function subscale did not reach statistical significance (p = 0.064). Tolerability of the procedure was good and there were no serious adverse events that were considered to have a possible causal relationship with the study treatment. CONCLUSION: Intraarticular HA treatment was significantly more effective than saline vehicle in mild to moderate OA of the knee for the 13 week postinjection period of the study.

Adjuvants, Immunologic↗