Adaptive functioning in children in the first six months after surgery for brain tumours

Purpose.?To examine the adaptive functioning of children who underwent surgery for brain tumours with a view to analyse the related acute impairments and to describe their short-term outcome.

Method.?We investigated adaptive functioning in 25 children (ranging from 2 to 18 years of age) for 40 days and again 3 and 6 months after they underwent surgery for various brain tumours. The Vineland Adaptive Behaviour Scales (VABS) were used to assess their adaptive functioning, considering the four main domains and all the subdomains.

Results.?The results remained stable over the follow-up period considered. The domain in which the scores were most severely affected was Daily Living, followed by the Socialisation and Communication domains. Within the Communication domain, the abilities investigated in the Receptive subdomain revealed the worst impairments. Within the Daily Living domain, impairments were most evident in the children's capacity to take care of themselves and handle domestic activities. In the Socialisation domain, Play and Leisure Time, and Interpersonal Relationships were the subdomains most severely impaired.

Conclusions.?These findings are relevant because identifying children's adaptive functioning difficulties sooner could help their rehabilitation to be tailored and thus have a positive fallout on their long-term outcome.     

Stroke caregivers' strain: prevalence and determinants in the first six months after stroke

Purpose. Many disabled stroke survivors live at home supported by informal caregivers. Research has revealed that these caregivers are experiencing strain. This study aims to examine the prevalence and differences over time of caregivers' strain in the first 6 months post-stroke and to predict caregiver strain based on patients' and caregivers' characteristics and service input.

Method. Ninety consecutive patients and their caregivers were assessed at 2, 4 and 6 months post-stroke. The Caregiver Strain Index was used to evaluate strain. Patients' motor function, functional ability, health status, emotion and participation and caregivers' gender and relation to the patient and service input after discharge were measured to determine the predictive factors.

Results. Nearly one out of three caregivers experienced strain. No differences were seen between 2, 4 and 6 months post-stroke. Correlation and multiple regression analyses revealed that in predicting strain, the patients' functional and activity level plays an important role in the sub-acute phase while the participation level gets more important over time.

Conclusions. These findings emphasize the importance of maximal physical recovery and optimal reintegration in the community. This is not only essential for the patients themselves but also a pre-requisite to reduce the strain of their caregivers.     

Stroke caregivers' strain: prevalence and determinants in the first six months after stroke

Purpose. Many disabled stroke survivors live at home supported by informal caregivers. Research has revealed that these caregivers are experiencing strain. This study aims to examine the prevalence and differences over time of caregivers' strain in the first 6 months post-stroke and to predict caregiver strain based on patients' and caregivers' characteristics and service input.

Method. Ninety consecutive patients and their caregivers were assessed at 2, 4 and 6 months post-stroke. The Caregiver Strain Index was used to evaluate strain. Patients' motor function, functional ability, health status, emotion and participation and caregivers' gender and relation to the patient and service input after discharge were measured to determine the predictive factors.

Results. Nearly one out of three caregivers experienced strain. No differences were seen between 2, 4 and 6 months post-stroke. Correlation and multiple regression analyses revealed that in predicting strain, the patients' functional and activity level plays an important role in the sub-acute phase while the participation level gets more important over time.

Conclusions. These findings emphasize the importance of maximal physical recovery and optimal reintegration in the community. This is not only essential for the patients themselves but also a pre-requisite to reduce the strain of their caregivers.     

Validation of the brief pain inventory in patients six months after cardiac surgery

The Brief Pain Inventory (BPI) is a questionnaire developed to assess the severity of pain and the impact of pain on daily function. The purpose of the current study was to evaluate the psychometric properties of the BPI for use in patients undergoing cardiac surgery. Between September 2004 and September 2005, 534 patients completed the BPI before surgery and 462 responded six months after surgery. The BPI was validated with respect to construct validity, internal consistency, criterion validity, and responsiveness. To evaluate the criterion validity, the BPI was validated against the bodily pain (BP) scale of the Medical Outcomes Study Short-Form Health Survey (SF-36). The factor analysis resulted in two distinct factors, supporting the validity of the two-factor structure of the original BPI, with high loadings on pain severity and pain interference. Results indicated acceptable internal consistency, with Cronbach's alpha coefficients between 0.84 and 0.94. The association between the BPI and the SF-36 BP dimension supported the criterion validity, with correlation coefficients between 0.47 and 0.65. The pain severity scale and the pain interference scale declined from baseline to follow-up. These results supported the responsiveness of the BPI. The study confirmed that the BPI shows good psychometric properties of reliability, validity, and responsiveness, enabling it to be used to measure pain in patients after cardiac surgery. Validating pain measures for use in this population is an important part of establishing a foundation for future studies on chronic pain after cardiac surgery.     

Infection in renal transplantation. The first six months

Infection continues to be the number one cause of morbidity in terms of complications for the renal transplant patient. Overwhelming infection may lead to hypoxemia, sepsis, and cardiovascular instability, which necessitate intensive care nursing for the patient. Although the care may be similar to that of other patients with these pathophysiologic processes, the transplant patient has the added complication of iatrogenic immunosuppression. On the other hand, immunosuppressive therapy may be discontinued, if necessary, in order to save the patient's life. Therefore, if the renal transplant patient needs to be treated in the intensive care unit, it is primarily important for the nurse to monitor for signs and symptoms of the infections.     

Goal achievement in the six months after inpatient rehabilitation for stroke

Purpose. The purpose of the project was to identify characteristics associated with successful re-integration into the community post-inpatient rehabilitation after stroke. A key issue was determining re-integration from the person's perspective, taking into account the person's preferred lifestyle choices.

Method. Research design: A prospective exploratory follow up study. Participants: A consecutive sample of 45 participants discharged from IP rehabilitation following stroke and 23 carers associated with the participants. Measures: Goal attainment scaling was utilised to determine successful community integration. Factors that may have contributed to goal achievement were measured prior to discharge and at 6 months post-discharge. Scales used include the Functional Independence Measure, Mini Mental test, the CES-D depression scale and a self-efficacy scale, Strategies Used by People to Promote Health. London Handicap Scale scores and Carer Strain Index were collected at 6 months.

Results. Twenty percent of participants achieved all their goals. Significant correlations were observed between goal achievement score and concurrent measures of physical function, depression and self efficacy at 6 months post-discharge.

Conclusions. Stroke survivors who achieved their goals were less likely to be depressed, showed stronger self efficacy beliefs and more positive perceptions of their participation in everyday and community life.     

Knee muscle isometric strength,voluntary activation and antagonist co-contraction in the first six months after stroke

Purpose: Muscle weakness may contribute to functional problems after stroke, but is rarely addressed during rehabilitation. Functional problems are commonly thought to be caused by abnormal movement patterns or possibly disuse atrophy. We investigated voluntary isometric strength, activation and the extent of co-contraction in the knee muscles during the first six months during stroke. Methods: Twelve stroke patients (58 3 years, mean SEM, 7 female) were studied bilaterally on admission for rehabilitation (21 1 days after stroke) and then at 1, 2, 3, and 6 months. Twenty healthy controls (61 5 years, 17 female) were tested once on their preferred leg. Subjects performed maximal voluntary contractions of the quadriceps and hamstring muscles. Simultaneous measurements were made of agonist force and surface EMG from agonist and antagonist muscles. Voluntary activation was estimated using the twitch superimposition technique. Results: Both paretic muscles showed lower (p 0.01-0.0005) voluntary strength than both non-paretic and control muscles until three months after stroke. Co-contraction of antagonists was similar in all groups and greater during knee extension than flexion. Stroke patients showed considerable bilateral voluntary activation failure (25-40%, p 0.01-0.001) throughout the study while most control subjects did not (group mean 7%). Conclusions: The muscle weakness and bilateral activation failure in the stroke patients was not explained by either excessive antagonist activity or disuse atrophy. They had potential for increased voluntary strength and if this were addressed during rehabilitation, then the rate and extent of functional recovery might be enhanced.     

Psychosocial outcome six months after heart transplant surgery: a preliminary report.

With improvement in survival of patients treated with heart transplant, evaluation of recovery with respect to psychosocial function has become an important issue. In this study, psychosocial functioning of 44 heart transplant recipients pretransplant was compared to their functioning 6 months posttransplant. Before transplantation, patients experienced considerable psychosocial distress attributable to illness. At 6 months after transplantation, the majority of patients showed significant improvement in emotional, domestic, sexual, social, and vocational functioning. However, 25% of patients showed deterioration in psychosocial adjustment and 11% showed an increase in mood disturbance. Further effort is indicated to improve psychosocial outcome of heart transplantation.     

Knee muscle isometric strength, voluntary activation and antagonist co-contraction in the first six months after stroke

Purpose: Muscle weakness may contribute to functional problems after stroke, but is rarely addressed during rehabilitation. Functional problems are commonly thought to be caused by abnormal movement patterns or possibly disuse atrophy. We investigated voluntary isometric strength, activation and the extent of co-contraction in the knee muscles during the first six months during stroke. Methods: Twelve stroke patients (58 3 years, mean SEM, 7 female) were studied bilaterally on admission for rehabilitation (21 1 days after stroke) and then at 1, 2, 3, and 6 months. Twenty healthy controls (61 5 years, 17 female) were tested once on their preferred leg. Subjects performed maximal voluntary contractions of the quadriceps and hamstring muscles. Simultaneous measurements were made of agonist force and surface EMG from agonist and antagonist muscles. Voluntary activation was estimated using the twitch superimposition technique. Results: Both paretic muscles showed lower (p 0.01-0.0005) voluntary strength than both non-paretic and control muscles until three months after stroke. Co-contraction of antagonists was similar in all groups and greater during knee extension than flexion. Stroke patients showed considerable bilateral voluntary activation failure (25-40%, p 0.01-0.001) throughout the study while most control subjects did not (group mean 7%). Conclusions: The muscle weakness and bilateral activation failure in the stroke patients was not explained by either excessive antagonist activity or disuse atrophy. They had potential for increased voluntary strength and if this were addressed during rehabilitation, then the rate and extent of functional recovery might be enhanced.     

Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment

Aim of the study

To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH).

Method

During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA.

Result

There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most common complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −0.44 to −0.71, p ≤ 0.001).

Conclusion

HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.     

Starting out. The first six months posthospital for spinal cord-injured veterans

Thirty-one former patients were contacted 6 mo after their completion of a spinal cord injury rehabilitation program: 14, paraplegics; 8, complete quadriplegics; 9, incomplete quadriplegics. Mean age was 38.5 yr. Most respondents were living in a family setting. Income ranged from substantial to barely adequate. Half of the respondents needed no assistance with activities of daily living; for the others, family members were the primary helpers. Almost all described their social contacts as sufficient for their needs. Half had not needed to use community resources for the disabled; the others had used a range of resources. Two respondents were employed, four were in school, six others had plans for eventual employment. Neither extent of disability nor income seemed related to likelihood of entering the workforce. Most respondents reported frequent local travel; some had traveled extensively. The large majority engaged in one or more hobbies and/or physical activities. Just over half of the respondents had had no sexual activity after discharge. Of the sexually active, half had found the experience frustrating. Except for the 30- to 39-yr-old respondents, the majority expressed satisfaction with most aspects of their lives.     

A biliary endoprosthesis functioning after six years

The functional lifetime for biliary endoprostheses has typically been 7 months. When combined with sphincterotomy for common bile duct stones, it affords an alternative to surgery in high risk patients. Biliary endoprostheses often require replacement in these patients, though recent reports suggest they are functioning longer. We present an 85-year-old asymptomatic woman with a 6-year-old biliary endoprosthesis, believed to be the longest functioning stent reported in the literature.     

Quality of life six months after coronary artery bypass surgery: a preliminary report

Ninety-six patients who had coronary artery bypass grafting showed improvement on the Psychosocial Adjustment to Illness Scale at six months postoperatively. Findings of improved sexual function and vocational status were unexpected in light of previous studies. Older patients showed less psychologic distress than younger ones after coronary artery bypass surgery.     

Adaptive functioning and depressive symptoms in school-aged children

AIM: This paper is a report of a secondary data analysis to the hypothesis that a child's resourcefulness moderates the relationships between the primary female caregiver's variables (depressive symptoms and learned resourcefulness) and the child's outcomes (depressive symptoms and adaptive functioning). BACKGROUND: School-aged children between 10 and 12 years of age are at an important stage of development characterized by dramatic biological and psychosocial challenges. Maladaptive functioning and depressive symptoms increase markedly in this stage. To prevent long-term effects of depressive symptoms and impaired adaptive functioning, identifying moderators of the relationship between stress and these mental health indicators is critical. METHODS: A secondary analysis was conducted in 2004 using the data obtained in 2000 from a community-based sample of 122 school students aged 10-12 years and their primary female caregivers in four suburban public schools in Northeastern Ohio. Instruments included the Self-Control Schedule, Beck Depression Inventory, the Children's version of the Self-Control Schedule, the Children's Community Living Skills Scale, and the Children's Depression Inventory. FINDINGS: Children's resourcefulness significantly moderated the relationship between their female caregiver's depressive symptoms and their own adaptive functioning (P<0.01). Children's resourcefulness had a statistically significant impact on depressive symptoms and adaptive functioning (P<0.001). CONCLUSION: The key to reducing depressive symptoms and enhancing adaptive functioning among middle school children is to build their resourcefulness skills, especially in children whose female caregivers are depressed. This is an important role for school nurses.     

Physical activity six months after a myocardial infarction

In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged ≤ 65 years. The self-report question showed that < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.     

Performance expectations of the associate degree nurse graduate within the first six months

The Oklahoma Associate Degree Nursing Directors Council was determined to be proactive in defining the role of the associate degree registered nurse (ADN) within the evolving health care delivery system. A task force was formed by the Council to design and implement strategies for defining the emerging roles. Strategies included surveying health care employers on the performance expectations of the ADN graduates within the first six months of employment. The employers were asked to determine the importance of various functions and abilities that the ADN graduates may or may not possess. Surveys returned were representative of a variety of rural and urban agencies throughout the state and bordering areas. Responses were grouped into 21 categories. Ranked highest was the ability to demonstrate verbal and written communication effectively with accountability to the employer and personal attributes such as open-mindedness, flexibility, and receptiveness to criticism ranked second and third. The lowest rankings received were for competency with fiscal management. The results of the survey highlight the continued need to stress strong communication skills, as well as professional accountability throughout the educational process.