Differences in blood pressure: does the length of time between measurements have an effect?

Taking blood pressure measurements correctly is essential in order to successfully evaluate a patient's blood pressure from the initial measurement and subsequent measurements over time. With the purpose to determine if the time between blood pressure measurements in an office or clinic bears an influence on any variation in measurement, a study was carried out under which two blood pressure measurements five minutes apart were taken using an automatic instrument in order to evaluate the existence of any differences as well as to identify which arm should be the control arm and to evaluate the absolute measurements between both arms. During this study, the authors observed a decrease in the mean for the repeated blood pressure measurement of 7.7 mmHg (IC 95%: 4.7-10.7 mmHg, p < 0.0001) for the systolic measurement and of 2.9 mmHg (IC 95%: 1.6-4.2 mmHg) for the diastolic measurement. 78% of the patients in this study registered a difference between the two measurements, either systolic or diastolic > or = 5 mmHg. It was not possible to establish a significant relationship between the decrease in these blood pressure measurements and factors such as age, sex, cardiac frequency or hypertension. The control arm was the right arm in 59.3% of the patients. The absolute mean of the differences between both arms was 8.4 mmHg (IC 95%: 6.8-10 mmHg) for the systolic measurements and 5 mmHg (IC 95%: 3.9-6.1 mmHg) for the diastolic measurements. 26 patients, 44.1%, registered a difference in pressure between their arms > or = 10 mmHg.     

氯氮平对血糖的影响及护理对策

目的探讨氯氮平对血糖的影响,报告其护理对策与健康教育体会.方法比较314例精神分裂症病人服用氯氮平前后血糖的变化及分析糖尿病发生与性别、体重的关系.结果服药前后血糖经统计学分析,差异有显著性(P＜0.01).糖尿病发生与体重改变相关,而与性别无明显相关性.结论氯氮平可诱发糖尿病,有必要采取护理干预.     

Collagen powder: hydrocolloidal dressings. Their effectiveness in radiodermatitis

The authors analyze the effectiveness of a collagen cicatrizant powder for use in treating radiodermatitis compared with extra fine hydrocolloidal dressings by evaluating skin lesions according to the Radiation Therapy Oncology Group (RTOG) intensity scale. As the same time, the authors evaluate the patient's opinion regarding the treatment he/she receives. This study was carried out in the Valladolid University Clinical Hospital's Department of Radiotherapy. This study showed that the Catrix brand dressing is more effective than hydrocolloidal dressings as a treatment of lesions caused by radiodermatitis. Both the nursing personnel and patients involved in this study rated this Catrix product higher than those hydrocolloidal dressings products tested.     

Three dimensional gait analysis and controlling spastic foot on stroke patients]

INTRODUCTION: The purpose of this work is to assess the interest of three dimensional gait analysis in measuring the effect of orthesis and of selective tibial neurotomy without visual analysis. METHOD: After clinical examination, gait in the two groups was recorded by a three dimensional motion system (Vicon-Oxford Metrics) with free velocity. The gait of ten stroke patients was compared bare-foot and with ankle-foot orthesis. The gait of nine stroke patients was compared bare-foot before and six month after selective tibial neurotomy. Kinematics data were studied in the sagittal plane, and muscular electrical activity was detected on the affected side by a ten-channel telemetry system using surface electrodes. An analogic visual scale ( EVA) was used by the patient, to assess discomfort during walking. RESULTS: In the "orthesis" group, calf spasticity was 2.5 on the Ashworth scale. With ankle-foot orthesis, the walking discomfort on EVA was significantly reduced from 4.25 to 1.16. Gait speed increased significativelly at 0.42 m s(-1) to 0.59 m s(-1). In swing phase, equinus disappeared. In stance phase equinus and recurvatum were controlled, anterior pelvic tilt decreased and hip extension increased. In the "neurotomy" group, 6 months after the tibial neurotomy, calf spasticity decreased from 3.4 to 0. The walking discomfort on EVA, was significantly reduced from 5.97 to 3.6. Gait speed increased from 0.51 m s(-1) to 0.54 m s(-1). Ankle dorsiflexion on the affected side, was possible during stance for five patients and residual motricity was released during swing phase for two patients. Stance knee recurvatum was corrected in five patients. CONCLUSION: Three dimensional analysis specifies the functional gait disability in stroke patients. It specifies the degree of correction provided by orthesis or tibial neurotomy in the various gait cycle phases and the impact on the superior joints.     

Mehrdimensionale Erfassung der Schmerzwahrnehmung und ihre Bedeutung für das Verhalten chronischer Rückenschmerzpatienten

A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.     

Development of a diabetes diet-related quality-of-life scale

OBJECTIVE: The purpose of this study was to assess the reliability and validity of the Diabetes Diet-Related Quality-of-Life (DDRQOL) scale, which is a measure of the influence of diet therapy on patients' quality of life (QOL). RESEARCH DESIGN AND METHODS: Patients with type 2 diabetes (n = 236) who were being treated on an outpatient basis were asked to complete the self-administered DDRQOL instrument. The factor validity, convergent and discriminant validity, internal consistency, and reproducibility of the DDRQOL scale were then assessed. Spearman's rank correlation coefficients among the DDRQOL scale and each of the SF-36 subscale scores were calculated to evaluate its convergent and discriminant validity. RESULTS: Based on the results of the factor analysis, the following seven subscales were adopted for the DDRQOL: "satisfaction with diet," "burden of diet therapy," "perceived merits of diet therapy," "general perception of diet," "restriction of social functions," "vitality," and "mental health." As hypothesized, the DDRQOL scale was associated with each of the SF-36 subscales, with convergent and discriminant validity being generally exhibited. Cronbach's alpha-coefficient was between 0.71 and 0.84, suggesting strong internal consistency. The intraclass correlation coefficient of the subscales, with the results of a test-retest conducted 2 weeks later, was between 0.46 and 0.75, suggesting some degree of reproducibility. CONCLUSIONS: These findings indicate that the DDRQOL scale has a reasonable degree of reliability and validity, and its application for the assessment of the needs of a patient's diet and the evaluation of diet education with regard to QOL is awaited.     

Are Emergency Department Patients Thinking about Advance Directives?

Objectives : To assess the percentage of adult patients presenting to an urban ED who have a written advance directive (AD) and to determine whether age, sex, a patient's perception of his or her health status, and having a regular physician are associated with the patient's having an AD.
Methods : This was a cross-sectional patient survey performed at a community teaching hospital ED. Surveys were completed by 511 adult ED patients during representative shifts over a 3-month period. The questions included age, sex, "self-reported" health status, whether the patient had a "regular" physician, a patient-generated list of medical problems, and whether the patient had a written AD. For this study, ADs included health care proxies, living wills, and do-not-attempt-resuscitation (DNAR) orders.
Results : Of the patients surveyed, 27% reported having an AD. Males and females were equally likely to have an AD. Factors associated with an increased likelihood of having an AD were older age, having a "regular" physician, and the patient's perception of his or her health status as ill. Most patients who had an AD (82%) discussed it with their families, but only 48% discussed it with their physicians.
Conclusion : Only 27% of the adult patients presenting to the ED had an AD. Older age, the patient's perception of his or her health status as ill, and having a "regular" physician increased the likelihood of having an AD.     

The Lawton instrumental activities of daily living scale

By detecting early functional decline, the scale can help nurses with discharge planning. OVERVIEW: Acute illness or a worsening chronic condition can hasten functional decline in older adults. During hospitalization, reduced mobility and other factors may rapidly decrease an older patient's ability to perform activities crucial for independent living, and the effects might be permanent. The Lawton Instrumental Activities of Daily Living (IADL) Scale assesses a person's ability to perform tasks such as using a telephone, doing laundry, and handling finances. Measuring eight domains, it can be administered in 10 to 15 minutes. The scale may provide an early warning of functional decline or signal the need for further assessment. For a free online video demonstrating use of this assessment, go to http://links.lww.com/A246.     

Including a measure of health status in Medicare's health maintenance organization capitation formula: reliability issues

Medicare's formula for determining capitation levels for risk-based HMOs, the Adjusted Average Per Capita Cost (AAPCC), has been criticized as a poor basis for establishing payments. Among new adjusting factors suggested for the formula is a measure of beneficiaries' functional health status. The ability of such a measure to improve predictions of Medicare costs has been demonstrated in several studies. In addition to possessing predictive validity, a measure considered for inclusion in the AAPCC must also be reliable. In this paper, the authors examine a measure of functional health status for intrarater reliability or, equivalently, stability over time. A sample of 1,616 Medicare beneficiaries was surveyed twice--in late 1982 and in January 1984. Using a five-point scale, functional health status scores were calculated for each of the beneficiaries at two points in time. For 68.4% of the sample, functional health scores were unchanged over the year, and second-year scores were within one point of first-year scores for 94.3% of the sample. Based on the intraclass correlation coefficient, the scores on this functional health scale demonstrated substantial to "almost perfect" agreement over the 1-year period.     

Always, never, or sometimes: examining variation in condom-use decision making among Black adolescent mothers

Our purpose in this study was to describe Black adolescent mothers' decisions regarding condom use and non-use with their male sex partners, including their children's fathers. Research on partner type and condom use has been insufficiently focused on understanding the specific influence that the biological father of the baby has on condom use among adolescent mothers. We conducted five focus groups and three interviews with 31 predominantly African-American mothers. We found that their decisions to use condoms always, never, or sometimes were based on partner type and on emotional and relationship factors. The "baby daddy" was the only partner with whom they never used condoms. HIV/STI prevention interventions for adolescent mothers must address risk taking with their children's biological fathers.     

Erfahrungen mit der Anwendung von Schmerztagebüchern in der ambulanten Versorgung von Patienten mit chronischen Schmerzen

For the present investigation 31 out-patients suffering from chronic pain received a pain diary, that is a booklet in which they recorded their pain level on visual analogue scales and daily activities several times during a day. We used weekly interviews and the patient's records in the diary to evaluate the patient's compliance and the influence of a pain diary on the pain perception and on the physician-patient-interaction. We found that most of the patients were willing and able to use the pain diary. 30 out of 31 patients kept the diary voluntarily for an average period of 4 weeks. 70% of the patients regarded the pain diary as helpful irrespective of whether or not they considered it at the same time as burden. Only 10% reported difficulties in using the pain diary. The majority of patients (70%) noticed no change by the use of the diary in their general pain perception, about 17% reported to feel an increasing fixation on their pain, while 13% felt more distance from their pain by using a pain diary. The use of a pain diary produces a survey over the pain for a longer period than a usual consultation could present. In particular the relationship between the pain level and other recorded events and activities becomes visible. The apin data become especially clear when displayed graphically in a "pain curve". In this way therapeutic interventions can be checked whether or not they are efficient. Each patient was asked at every meeting to indicate on a separate visual analogue scale the pain level he would consider bearable. This mark was accepted by all patients as their aim for the therapy, a more realistic aim than the expectation of a complete freedom from pain. When observed over a period of at least two weeks we found this mark staying constant with half of the patients. In 23.8% the patients decreased this subjectively bearable pain level more than 1 cm, in 14.3% the level was increased. In 9.5% it varied without any clear tendency. For many patients the pain diary was an impulse for an argument with their pain and life situation. Patients from this study reported a better control over their pain and improved conciousness of their own body. As the patient plays an active part the pain diary promotes an equal cooperation between physician and patient. The new information derived from a pain diary enables both patient and physician to alter their point of view.     

Failure to embrace the barrier/condom use message.

The objective of this study was to examine the consistency of barrier/condom use among men who have sex with men in the Kansas City metropolitan area. The authors sought to determine if barrier/condom usage patterns were associated with the type of sex act and whether it was insertive or receptive, HIV testing frequency, and number of sexual partners. Data were extracted from a 2003 community health assessment of the gay, lesbian, bisexual, and transgendered community in the metropolitan area. The health assessment instrument was anonymous, self-administered, and distributed at events in that community. Responses from 623 men indicated that consistent use of a barrier/condom was low regardless of the sex act. There was no relationship between barrier/condom usage patterns and HIV testing frequency for any sex act or the number of sex partners, with the exception of anal intercourse. The authors concluded that a different approach is needed to translate the barrier/condom use message into a behavioral response.     

Racial Differences in Receiving Morphine among Prehospital Patients with Blunt Trauma

Background

Pain management is an important part of prehospital care, yet few studies have addressed the effects of age, sex, race, or pain severity on prehospital pain management.

Objectives

To examine the association of sex, age, race, and pain severity with analgesia administration for blunt trauma in the prehospital setting.

Methods

In this retrospective cohort study, we used the automated registry of a large urban Emergency Medical Services agency to identify records of all patients transported for blunt trauma injuries between February 1 and November 1, 2009. We used bivariable and multivariable analyses with logistic regression models to determine the relationship between analgesia administration and patient sex, race, age, pain score on a pain scale, and time under prehospital care.

Results

We identified 6398 blunt trauma cases. There were 516 patients (8%) who received analgesia overall; among patients for whom a pain scale was recorded, 25% received analgesia. By multivariable analysis, adjusting for race, sex, age, time with patient, and pain score, African-American and Hispanic patients were less likely than Caucasian patients to receive analgesia. Pain score and prehospital time were both significant predictors of analgesia administration, with higher pain score and longer prehospital time associated with increased administration of pain medication. Neither sex nor age was a significant predictor of analgesia administration in the regression analysis.

Conclusion

This study suggests that Caucasians are more likely than African-Americans or Hispanics to receive prehospital analgesia for blunt trauma injuries. In addition, patients with whom paramedics spend more time and for whom a pain score is recorded are more likely to receive analgesia.     

Normative study and reliability of French version of the dizziness handicap inventory]

GOAL: To determine the normality per age group of the "Echelle du Handicap lié aux Troubles de l'Equilibre et aux Vertiges" (EHTEV) French version of the "Dizziness Handicap Inventory" (DHI) and to assess the effect of sex on the scores and the reproductibility. SUBJECTS AND METHODS: The normative scores and the effect of the sex were determined in a group of 120 subjects without any instability disorder. Sixty-three women and 57 men, aged 20-79 years were graded by age section of 10 years. After 8-10 weeks the same questionnaire was submitted again to 47 individuals of this same group to assess the reproductibility. RESULTS: The scores of the instability showed that handicap increased with the age. The mean score for the 50-79 year-old group is almost four times greater that of the 20-49 years old. Correlation between scores and age is 0.70 for physical handicap, 0.76 for emotional handicap, 0.69 functional handicap and 0.83 for global score. There is no significant influence of sex. The reproductibility coefficient is 0.98. CONCLUSION: The scores of the EHTEV increase with age. There is no significant influence of sex on scores and the coefficient of the reproductibility is good. But the translation of this handicap scale, need a study of validity and reliability.     

A Comparison of Quality-of-Life in Patients with Dual Chamber Pacemakers and Individually Programmed Atrioventricular Delays

Dual chamber pacemakers are increasingly implanted to achieve optimal hemodynamics by AV synchrony, but the effect of AV delay programming on the patient's quality-of-life has been less well studied. The influence of an individually programmed AV delay between 100 and 250 ms on quality-of-life was investigated in a randomized, double-blind crossover study of 13 patients (69 ± 10 years of age) with dual chamber pacemakers implanted because of high degree AV block. During radionuclide ventriculography at rest, the "optimal AV delay" with the maximal left ventricular ejection fraction and the "most unfavorable AV delay" with the least ejection fraction were determined. The ejection fraction at rest with the "optimal AV delay" was 51%± 10%, and with the "most unfavorable AV delay," 44%± 11% (P < 0.0001). The optimal AV delay determined by radionuclide ventriculography correlated well with the optimal AV delay determined by Doppler echocardiography using flow velocity integrals (r = 0.78, P < 0.0016). Each patient was assigned in random order to either AV delay during a 2-week period and then the pacing mode was switched for another 2-week period. At the end of each period, patients were assessed by a functional status questionnaire to assess physical capability and two further questionnaires to quantify cardiovascular symptoms or self-perceived health. There were no differences in the two AV delays regarding the patient's perceived physical capability and specific symptoms. The patient's total judgment was identical to the optimal AV delay (score 36%± 19%) and the most unfavorable AV delay (33%± 21%). Thus, in patients with a dual chamber pacemaker, an individually programmed AV delay affects left ventricular function at rest, but has no influence on quality-of-life. The determination of the flow velocity integral by Doppler echocardiography is a simple and reliable method to optimize the AV delay if necessary.     

Patient satisfaction with primary medical care. Evaluation of sociodemographic and predispositional factors

As patient satisfaction has been demonstrated to influence certain health-related behaviors (e.g., compliance with medical regimens and use of medical services), research has attempted to identify its key determinants. Although the influence of patient characteristics often has been studied, attention has been focused on sociodemographic characteristics (e.g., age and sex) rather than attitudinal or situational factors (e.g., confidence in the medical care system and feelings of internal control) that may predispose one toward satisfaction with care received. Data to test the relative importance of these types of determinants were collected in a general household survey of 400 persons. The patient satisfaction scale developed and tested by Roghmann and his colleagues using nonmetric multidimensional scaling was used. Multiple regression analysis was performed on the data. Results show that certain predispositional factors (confidence in the community's medical care system, having a regular source of care, and being satisfied with life in general) are more important predictors of patient satisfaction than patient's age, sex, race, educational attainment, or income.     

Empowerment and job satisfaction in associate degree nurse educators

The purpose of this study was to examine empowerment, job satisfaction levels, and relationships among 139 associate degree nursing educators.The Conditions of Work Effectiveness II, Psychological Empowerment Scale, and Job Diagnostic Survey were used. Findings indicated that the majority of educators were satisfied with their jobs as nursing faculty and felt empowered in their workplaces. Psychological empowerment demonstrated the strongest positive correlation with job satisfaction. There were no significant differences in empowerment or job satisfaction based on educators' tenure status, educational level, evidence of scholarship, or academic rank. Based on the findings of this study, the authors recommend that deans use resources to provide faculty opportunities to expand their departmental influence and spend more time with students, as well as place faculty in positions that highlight their relevance to the college and nursing program.