The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

Objectives

To examine effects of sedative music on cancer pain.

Design

A randomized controlled trial.

Settings

Two large medical centers in Kaoshiung City, in southern Taiwan.

Participants

126 hospitalized persons with cancer pain.

Methods

Participants were randomly assigned to an experimental (n = 62) or a control group (n = 64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test.

Results

Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p < .001. Effect sizes were large, Cohen's d = .64, sensation, d = .70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective.

Conclusions

Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.     

Adherence to a guideline on cardiovascular prevention: a comparison between general practitioners and practice nurses

Background

Patient non-compliance with prescribed treatment is an important factor in the lack of success in cardiovascular prevention. Another important cause is non-adherence of caregivers to the guidelines. It is not known how doctors and nurses differ in the application of guidelines. Patient compliance to treatment may vary according to the type of caregiver.

Objective

To compare adherence to cardiovascular prevention delivered by practice nurses and by general practitioners.

Setting

Six primary health care centres in the Netherlands (25 general practitioners, six practice nurses).

Methods

701 high risk patients were included in a randomised trial. Half of the patients received nurse-delivered care and half received care by general practitioners. For 91% of the patients treatment concerned secondary prevention. The Dutch guideline on cardiovascular prevention was used as protocol. A structured self-administered questionnaire was sent by post to patients. Data were extracted from the practice database and the questionnaire.

Results

Intervention was received by 77% of respondents who visited the practice nurse compared to 57% from the general practitioner group (OR = 2.56, p < 0.01). More lifestyle intervention was given by the practice nurse; 46% of patients received at least one lifestyle intervention (weight, diet, exercise, and smoking) compared to 13% in general practitioner group (OR = 3.24, p < 0.001). In addition, after one year more patients from the practice nurse group used cardiovascular drugs (OR = 1.9, p = 0.03). Nurses inquired more frequently about patient compliance to medical treatment (OR = 2.1, p < 0.01). Regarding patient compliance, no statistical difference between study groups in this trial was found.

Conclusion

Practice nurses adhered better to the Dutch guideline on cardiovascular prevention than general practitioners did. Lifestyle intervention advice was more frequently given by practice nurses. Improvement of cardiovascular prevention is still necessary. Both caregivers should inquire about patient adherence on a regular basis.     

The SAFE or SORRY? programme. part II: effect on preventive care

Background

Patient care guidelines are usually implemented one at a time, yet patients are at risk for multiple, often preventable, adverse events simultaneously.

Objective

The SAFE or SORRY? programme targeted three adverse events (pressure ulcers, urinary tract infections and falls) and was successful in reducing the incidence of these events. This article explores the process of change and describes the effect on the preventive care given.

Design

Separate data on preventive care were collected along the cluster randomised trial, which was conducted between September 2006 and November 2008.

Settings

Ten hospital wards and ten nursing home wards.

Participants

We monitored nursing care given to adult patients with an expected length of stay of at least five days.

Methods

The SAFE or SORRY? programme consisted of the essential recommendations of guidelines for pressure ulcers, urinary tract infections and falls. A multifaceted implementation strategy was used to implement this multiple guidelines programme. Data on preventive care given to patients were collected in line with these guidelines and the difference between the intervention and the usual care group at follow-up was analysed.

Results

The study showed no overall difference in preventive pressure ulcer measures between the intervention and the usual care group in hospitals (estimate = 6%, CI: −7-19) and nursing homes (estimate = 4%, CI: −5-13). For urinary tract infections, even statistically significantly fewer hospital patients at risk received preventive care (estimate = 19%, CI: 17-21). For falls in hospitals and nursing homes, no more patients at risk received preventive care.

Conclusion

Though the SAFE OR SORRY? programme effectively reduced the number of adverse events, an increase in preventive care given to patients at risk was not demonstrated. These results seem to emphasise the difficulties in measuring the compliance to guidelines. More research is needed to explore the possibilities for measuring the implementation of multiple guidelines using process indicators.     

The value and limitations of a wound inspection clinic after cardiac device implantation

Background

Due to the growing number of cardiac device implantations it is important to develop methods to reduce device-implantation related complications.

Aims

To determine whether a wound inspection clinic can play a role in the detection of device-implantation related complications.

Methods

Single-center observational study evaluating patients who received a pacemaker or implantable cardioverter-defibrillator (ICD).

Results

Of 159 patients who received an appointment for the wound inspection clinic, 52 (33%) received a pacemaker and 107 (67%) received an ICD. The majority had no signs of infection. Pain (n = 13, 8%) and swelling (n = 11, 7%) were the most frequent signs observed, but they never necessitated intervention and recovered spontaneously in all patients. During follow-up (mean 20 ± 9 weeks), complications occurred in 10 patients (6%). Most complications occurred early, within 4 days after implantation. The two late complications (at 19 and 41 days) could not be recognized at the wound inspection clinic.

Conclusion

We found no useful role for a wound inspection clinic two weeks post-implant to detect device-related complications. Open rapid access to the pacemaker/ICD center for patients with signs and symptoms of (threatening) complications seems to be more appropriate to manage post-implant patients.     

Association between PON1 5′-regulatory region polymorphisms, PON1 activity and ischemic stroke

Objectives

Paraoxonase I (PON1) was known as a risk factor for cerebrovascular diseases. This study assessed the association of single nucleotide polymorphisms (SNPs) in the PON1 5′-regulatory region with ischemic stroke and serum PON1 activity.

Design and methods

Study subjects consisted of 418 healthy controls and 86 ischemic stroke patients with small vessel occlusion. SNPs were identified by DNA sequencing and a primer extension-based method.

Results

Among 10 identified SNPs, only −1434GG genotype was observed with a lower frequency in patients on borderline statistical significance (OR(95% CI), 0.297(0.083-1.060), p = 0.0615). However, haplotype analysis in a dominant model revealed that ht2 was observed with a significantly lower frequency in patients (OR(95% CI), 0.390(0.153-0.991), p = 0.0477). Both C(−1434)G mutation and ht2 distribution were associated with serum PON1 activity.

Conclusion

Our results suggest that haplotypes observed in the PON1 5′-regulatory region should be considered as risk factors for ischemic stroke.     

Ability to adjust reach extent in the hemiplegic arm

Objective

Insufficient information exists about the ability of hemiparetic patients to adjust reach extent during early recovery from stroke. Further knowledge may suggest guidance for therapy intervention. The objective of this study was to investigate the ability of hemiparetic subjects to adjust reach extent within 6 months after stroke.

Design

Repeated-measures design experiment with two factors—group and target position.

Setting

Physiotherapy department.

Participants

Nine hemiparetic and nine age- and gender-matched healthy subjects.

Methods

Participants performed 15 reaching movements in the sagittal plane, five to each target of 8, 13 and 18 cm from the starting position.

Main outcome measures

Motion analysis was used to collect information on the kinematic variables of distance moved, movement duration, peak velocity, average velocity and the timing of peak velocity. These variables were compared between the different target positions and between groups.

Results

The stroke group demonstrated a longer movement duration, lower peak and average velocity, and a later time to peak velocity compared with the healthy group. In response to the change in target position, both groups increased peak velocity for each increase in target position with no significant increase in movement duration, and showed a longer deceleration phase for the 18-cm target position. There was no significant difference between scaling of distance moved and peak velocity to target position between the groups. However, stroke subjects tended to overshoot the closer target and undershoot the more distant targets. The mean difference between groups was 12 mm [95% confidence interval (CI): −17 to 50] for the 8-cm position, 5 mm (95% CI: −34 to 23) for the 13-cm position, and 9 mm (95% CI: −39 to 22) for the 18-cm position. The difference in peak velocity between each target position was smaller in the stroke subjects compared with the healthy subjects. The mean difference between groups was 103 mm/second (95% CI: −171 to −34) for the 8-cm position, 157 mm/second (95% CI: −231 to −82) for the 13-cm position, and 171 mm/second (95% CI: −262 to −80) for the 18-cm position.

Conclusions

Some aspects of the movement organisation of stroke subjects were similar to that of healthy subjects. However, stroke subjects showed errors in adjusting reach extent and velocity appropriately for different distances.     

Bandura's exercise self-efficacy scale: Validation in an Australian cardiac rehabilitation setting

Background

Despite the established benefits of cardiac rehabilitation (CR) in improving health outcomes for people with cardiovascular disease, adherence to regular physical activity at recommended levels remains suboptimal. Self-efficacy has been shown to be an important mediator of health behaviour, including exercise.

Objectives

To assess the psychometric properties of Bandura's exercise self-efficacy (ESE) scale in an Australian CR setting.

Design

Validation study.

Setting

Cardiac rehabilitation.

Participants

One hundred and ten patients (Mean: 60.11, S.D.: 10.57 years).

Methods

Participants completed a six-minute walk test (6MWT) and Bandura's exercise self-efficacy scale at enrolment and on completion of a 6-week CR program.

Results

Bandura's ESE scale had a single factor structure with high internal consistency (0.95), and demonstrated no floor or ceiling effects. A comparison of ESE scores by distance walked on 6MWT indicated those who recorded more than 500 m at baseline had significantly higher ESE scores (Mean: 116.26, S.D.: 32.02 m) than those patients who only achieved up to 400 m on the 6MWT at baseline (Mean: 89.94, S.D.: 29.47 m) (p = 0.044). A positive and significant correlation between the change in scores on the ESE scale and the change in the 6MWT distance (r = 0.28, p = 0.035) was seen.

Conclusions

The ESE scale was a robust measure of exercise self-efficacy over the range of patients attending this outpatient cardiac rehabilitation program. Interventions to improve self-efficacy may increase CR patient's efficacy for regular physical activity.     

Measurement of soft tissue temperature and impedance following the application of transdermal direct current

Objective

To measure temperature and impedance changes at various depths in human tissue in vivo, after the application of transdermal direct current (TDC).

Design

Prospective experimental single cohort study.

Setting

Genesis Surgery Center.

Participants

Eight patients who underwent a lumbar rhizotomy for chronic low back pain consented to an additional procedure involving TDC with saline solution. Two TDC electrodes (active, 55 mm; dispersive, 62 mm) were placed 51-56 cm apart, and a current amplitude of 4.0 mA was delivered for an average of 18.4 minutes.

Main outcome measures

Temperature and impedance readings recorded by the RFG-3CF Lesion Generator probe, from depths of 5 cm to the skin surface were obtained before TDC, and just before TDC was terminated. Data were analyzed using non-parametric statistics.

Results

A statistically significant decrease in impedance (mean 48 Ω, 95% confidence interval: 26-70) was detected, but there was no interaction of impedance change with tissue depth. Overall, tissue temperature decreased by 2 °C (95% confidence interval: 1.9-2.8) from baseline to the second measurement and the change was greatest within 1 cm of the surface.

Conclusion

The data suggest that transdermal delivery of medications to deep tissues of the lumbar region may not be enhanced by use of direct current as applied clinically.     

Comparing the effectiveness of polyethylene covers (Gladwrap) with lanolin (Duratears) eye ointment to prevent corneal abrasions in critically ill patients: a randomized controlled study

Background

In unconscious ventilated patients, various eye protective measures have been used to prevent corneal abrasions. Two randomized controlled studies in Australia had compared the effectiveness of polyethylene films and eye instillations to prevent corneal abrasions but results were inconsistent. The local acceptance of polyethylene films as a standard eye protective measure is still limited.

Objectives

Our study aims to compare the effectiveness of polyethylene covers (Gladwrap™) with lanolin (Duratears^®) eye ointment in the prevention of corneal abrasions in critically ill patients.

Design

A prospective randomized controlled study was conducted between April 2004 and December 2005.

Setting and participants

One hundred and twenty ventilated patients admitted to the intensive care unit (ICU) were randomly assigned to receive either polyethylene covers or lanolin eye ointment to prevent corneal abrasions.

Methods

All participants received a standard eye care regime together with the eye protective interventions. A fluorescein stain test was performed by the eye care team daily and then weekly to detect any corneal abrasions.

Results

Four participants were not included in the data analysis as they died soon after commencement of the study. A total of 116 patients were included in the final analysis. Of the seven patients (6.0%) that had a positive fluorescein test, four (6.8%) were in the polyethylene covers group (n = 59) and three (5.3%) were in the lanolin eye ointment group (n = 57). This was not statistically significant (p = 0.519). One patient in the lanolin eye ointment group had an eye infection. Upon follow-up of those patients with positive fluorescein test results, two patients spontaneously converted to stain negative within 24 h and two patients died before the ophthalmologist's assessment. The remaining three patients were diagnosed to have epithelial cell loss without corneal abrasions.

Conclusions

With the implementation of a standardized eye care protocol, polyethylene cover is found to be equally effective in preventing corneal abrasions when compared with lanolin eye ointment. The additional benefit of polyethylene cover as a physical barrier to protect patients’ eyes needed further evaluation.     

Serum butyrylcholinesterase activity and phenotype associations with lipid profile in stroke patients

Background

Butyrylcholinesterase (BuChE) catalyzes the hydrolysis of acetylcholine and other choline esters and is also involved in lipid metabolism. The purpose of this study was to investigate any association between BuChE serum phenotype and activity and lipid profile of ischemic stroke patients.

Methods

We determined serum BuChE activities and phenotypes, and levels of total cholesterol (TC), LDL-C, HDL-C and triacylglyerol (TG) in 33 patients with acute ischemic stroke within 12 h of the onset of the attack and 29 controls.

Results

The mean (± SD) serum BuChE activity and the BuChE of U/A phenotype in the stroke individuals were significantly lower and higher than that of the control (315 (± 124) IU/L. vs. 384 (± 99) IU/L, p = 0.02, t = − 2.4 and 21.2% vs.3.4%, p = 0.026 respectively).

Conclusions

Our results showed that a negative correlation between BuChE activity with TC level, in addition the frequency of BuChE phenotypes with low activity is high in stroke patients, who have high levels of cholesterol, may have increased susceptibility to stroke.     

Changes in Passive Mechanical Properties of the Gastrocnemius Muscle at the Muscle Fascicle and Joint Levels in Stroke Survivors

Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.

Objectives

To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.

Design

To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.

Setting

Research laboratory in a rehabilitation hospital.

Participants

Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).

Interventions

Not applicable.

Main Outcome Measurements

At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.

Results

At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).

Conclusions

This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation.     

Patient perceptions of nurse-delivered cardiovascular prevention: Cross-sectional survey within a randomised trial

Background

Studies have shown that in general patients are positive about cardiovascular prevention delivered by general practitioners. Further, it has been found that care by nurses for the chronically ill leads to even greater patient satisfaction.

Objective

The aim of this survey was to answer the following questions: How do patients perceive cardiovascular prevention delivered by the practice nurse? Are patient characteristics and personal health status associated with experiences of received nurse-led care?

Design

A cross-sectional survey after completion of a randomised trial.

Setting

Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses, 30,000 patients).

Participants

Included in the randomised trial were 701 patients with at least a 10% risk of fatal cardiovascular disease within 10 years. Patients who visited a cardiovascular specialist more often than once a year and patients with diabetes were excluded from the study. In 90% of the patients it concerned secondary prevention. Half of the patients received nurse-delivered care and half received care by the general practitioner.

Method

A questionnaire was sent by post to all patients after having received one year of cardiovascular prevention. A dual moderator focus group study was held for the development of the questionnaire.

Findings

The response rate was 69%. Patients were more satisfied with nurse-delivered cardiovascular prevention compared to standard care by general practitioners. The majority of patients agreed with positive statements regarding received nurse-led care. Patient characteristics such as age, educational level and gender were significantly associated with patients experiences. Furthermore, a significant association between experiences and personal health status was found. In comparison with patients who did not smoke, smokers would recommend the practice nurse less to others (X² = 4.0, p = 0.047), felt more ‘rapped on their knuckles’ (X² = 11.5, p = 0.003), found the consultation more ‘awkward’ (X² = 8.3, p = 0.016) and thought the nurse less understanding of their personal situation (X² = 6.4, p = 0.041) and less able to explain clearly (X² = 6.5, p = 0.039).

Conclusions

The majority of patients responded positively to nurse-delivered cardiovascular prevention. Further improvement could be gained by paying more attention to motivational interviewing. Nurses should approach high risk patients more specifically according to the type of risk factor to be treated.     

Differential features of burden between spouse and adult-child caregivers of patients with Alzheimer's disease: An exploratory comparative design

Background

Research into burden among spouse and adult-child caregivers of patients with Alzheimer's disease has generated contradictory results as regards the group which suffers the greatest burden and the factors underlying any differences.

Objectives

The aim of the present study was to identify and compare the factors associated with caregiver burden among spouse and adult-child caregivers.

Design

Cross-sectional analytic study.

Settings

All clinical subjects had been referred on an out-patient basis to the Memory and Dementia Assessment Unit of the Santa Caterina Hospital in Girona (Spain).

Participants

Data were collected from 251 patients and their caregivers, 112 with spouse and 139 with adult-child caregivers.

Methods

The association between caregiver burden and the socio-demographic and clinical variables of both patients and caregivers was analysed, the results being compared for spouse vs. adult-child caregivers. Burden was analysed using a multivariate linear regression including all the variables for the two groups of caregivers.

Results

The results show greater burden among adult-child caregivers (p < .05), who experience more feelings of guilt (p < .001). In both groups the behavioural and psychological symptoms of patients were correlated with burden (p < .001). Living with the patient has a notable influence on burden among adult children (p < .001). Husbands, wives, daughters and sons, in this order, showed increasing levels of burden (p < .05) and progressively worse mental health (p < .01). However, the correlations between burden and mental health were strongest in daughters (p < .001).

Conclusion

The differences in burden between spouse and adult-child caregivers were not associated with age, physical health or clinical factors of the patients. Overall burden was greater among adult-child caregivers, especially those who lived with the patient and who had other family duties. Feelings of guilt were associated with not living with the patient, and there was a strong correlation between burden and mental health. These results support the hypothesis that spouses regard caregiving as part of their marital duties, whereas for adult children such tasks imply an important change in their lifestyle.     

The effect of a physiotherapy education compared with a non-healthcare education on the attitudes and beliefs of students towards functioning in individuals with back pain: An observational, cross-sectional study

Objectives

To investigate the difference in attitudes: (1) between first and fourth year physiotherapy students towards functioning in individuals with back pain; and (2) between physiotherapy students and non-healthcare students towards functioning in individuals with back pain.

Design

Observational, cross-sectional study.

Setting

Glasgow Caledonian University, Scotland, UK.

Participants

First year physiotherapy (n = 61) and non-healthcare students (n = 61), and fourth year physiotherapy (n = 62) and non-healthcare students (n = 62).

Main outcomes

All participants completed the Health Care Providers’ Pain and Impairment Relationship Scale (range 15 to 105). This questionnaire measures attitudes towards functioning in individuals with back pain.

Results

Fourth year physiotherapy students had more positive attitudes towards functioning in individuals with back pain than first year physiotherapy students [57.4 vs 66.6 (mean difference −9.2, 95% confidence interval −12.2 to −6.1, P < 0.01)]. Similarly, fourth year non-healthcare students had more positive attitudes towards functioning in individuals with back pain compared with first year non-healthcare students [69.2 vs 65.3 (mean difference −3.9, 95% confidence interval −7.2 to −0.5, P = 0.03)]. Physiotherapy students had more positive attitudes than non-healthcare students in the first year [66.6 vs 69.2 (mean difference −2.6, 95% confidence interval −5.5 to 0.4, P = 0.08)] and the fourth year [57.4 vs 65.3 (mean difference −7.9, 95% confidence interval −11.4 to −4.4, P < 0.01)] of study.

Conclusion

These findings suggest that physiotherapy education brings about positive student attitudes towards functioning in individuals with back pain. This may be partly attributable to receiving a university degree education, but would appear to be further enhanced by specifically receiving a physiotherapy degree. This may facilitate students to become more evidence-based practitioners following qualification.     

Frequencies of falls in Swiss hospitals: concordance between nurses' estimates and fall incident reports

Background

Patient falls are frequent incidents in hospitals, and various measurement methods are described in the literature to assess in-patient fall rates. However, the literature includes no validation of nurses’ estimates of fall frequencies, which are the preferred assessment method in multi-centre surveys.

Objectives

To explore the concordance of nurses’ estimated fall frequencies with continuously collected data.

Design

Cross-sectional, correlational secondary data analysis.

Sample/Setting

Patient fall data from 21 wards in 2 Swiss acute care hospitals participating in the RICH Nursing Study.

Methods

Registered nurses’ (N = 233) estimated fall frequencies, assessed by the International Hospital Outcome Study questionnaire in absolute number of falls over the last month, and, using a four-point Likert scale (never = 1; frequently = 4), over the last year, were compared to standardized hospital fall incident reports compiled over the same periods. Fall incident reports for the last month were assessed in absolute numbers and were calculated as fall rates per 1000 patient days, with data computed at the ward level. The concordance with nurses’ estimates was then tested using Spearman’s rho and Kendall’s tau correlations.

Results

The mean last-year fall frequencies estimated by nurses on the four-point Likert scale ranged from 1.4 to 3.1 for non-injurious falls and from 1.0 to 2.6 for injurious falls per ward. The fall rates assessed using fall incident reports over the same period ranged from 0.1 to 3.8 non-injurious falls per 1000 patient days and from 0.1 to 2.6 injurious falls per ward.Nurses’ estimates and fall incident reports correlated significantly regarding the last year, both for injurious falls (r = 0.685, p = 0.014) and non-injurious falls (r = 0.630, p = 0.028), although no statistically significant correlations were found regarding the 1 month estimates.

Conclusions

Nurses’ long-term estimates of patient incidents are concordant with continuously and systematically assessed data, and offer valid data where other measurement methods are unavailable.     

The effects of a tailored cardiac rehabilitation program on depressive symptoms in women: A randomized clinical trial

Background

Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence.

Objective

To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD.

Methods

A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over time.

Results

Baseline CES-D scores were 17.3 and 16.5 for the tailored and traditional groups, respectively. Post-intervention mean scores were 11.0 and 14.3; 6-month follow-up scores were 13.0 and 15.2, respectively. A significant group by time interaction was found for CES-D scores (F(2, 446) = 4.42, p = .013). Follow-up tests revealed that the CES-D scores for the traditional group did not differ over time (F(2, 446) = 2.00, p = .137). By contrast, the tailored group showed significantly decreased CES-D scores from baseline to post-test (F(1, 223) = 50.34, p < .001); despite the slight rise from post-test to 6-month follow-up, CES-D scores remained lower than baseline (F(1, 223) = 19.25, p < .001).

Conclusion

This study demonstrated that a modified, gender-tailored CR program reduced depressive symptoms in women when compared to a traditional program. To the extent that depression hinders CR adherence, such tailored programs have potential to improve outcomes for women by maximizing adherence. Future studies should explore the mechanism by which such programs produce benefits.     

Automated external defibrillators and in-hospital cardiac arrest: patient survival and device performance at an Australian teaching hospital

Aims

To evaluate the effect of automated external defibrillators (AEDs) on patient survival and to describe the performance of AEDs after in-hospital cardiac arrest.

Methods

Prospectively collected data were analysed for cardiac arrests in the general patient care areas of a teaching hospital during the 3 years before and the 3 years after the deployment of AEDs. The association between availability of an AED and survival to hospital discharge was assessed using multivariate logistic regression. AED performance during automated management of the initial rhythms was assessed using information captured by the AEDs.

Results

There were 84 cardiac arrests in the AED period and 82 in the pre-AED period. Patient and event characteristics were similar in each period. The initial rhythm was shockable in 16% of cases. Return of spontaneous circulation was higher in the AED period (54% vs. 35%, P = 0.02) but the proportion of hospital survivors in each period was similar (22% vs. 19%, P = 0.56). The adjusted odds ratio for hospital survival when an AED was available was 1.22 (95% CI 0.53-2.84, P = 0.64). An AED was applied in 77/84 (92%) possible cases. Median interruption to chest compressions was 12 s (inter-quartile range 12-13). An automated shock was delivered in 8/13 (62%) possible cases.

Conclusions

Availability of AEDs was not independently associated with hospital survival. Shockable presenting rhythms were not common and, in keeping with the manufacturer's specifications, the AEDs did not shock all potentially shockable rhythms. The hands-off time associated with automated rhythm management was considerable.