Pain following coronary artery bypass grafting: an exploration of contributing factors.

Patients suffer pain and discomfort in ICU following coronary artery bypass grafting (CABG). While the surgical procedure causes pain, it is the psychological state of the individual which influences his perception of the pain. For the patient undergoing cardiac surgery, several stressors may influence his psychological state, including coronary heart disease (CHD) itself, impending surgery and the intensive care unit (ICU) environment. The types of pain caused by the surgical procedure are discussed. Each of these aspects are brought together in an attempt to gain a better understanding of the patient's perspective of cardiac surgery, and any pain experienced as a result. Given the major influence of the patient's mind in pain perception, there is a need for nurses to consider alternative methods of pain relief in addition to drug therapy.     

Metabolic syndrome: contributing factors and treatment strategies.

Metabolic syndrome is associated with increased risk for cardiovascular and cerebrovascular disease. The World Health Organization and National Cholesterol Education Program Adult Treatment Panel III have identified physiologic abnormalities associated with metabolic syndrome, including impaired glucose metabolism, high blood pressure, elevated cholesterol levels, and abdominal obesity. It is estimated that 47 million Americans have metabolic syndrome. A variety of therapies may help reduce the incidence and risk, including diet, weight loss, physical exercise, glycemic control, and pharmacological treatments. Nursing care is focused on developing an individualized plan of care that includes family members and providing education, psychosocial support, close monitoring, and continued follow-up to ensure adherence and success in achieving patient outcomes.     

Long-term survival after out-of-hospital cardiac arrest: an 8-year follow-up.

Between 1988 and 1994, 441 patients were successfully resuscitated outside hospital in the city of Rotterdam, of whom 276 (63%) were discharged from hospital alive. Long-term survival was studied amongst those who were discharged alive. The duration of follow-up averaged 6.71 years. A survival rate of 88% after 1 year, 81% after 3 years, 77% after 5 years and 73% after 7 years was found. After multivariate analysis, age, diagnosis and gender were found to be independent and significant predictors of survival. No significant difference in survival was found in patients who had been resuscitated by emergency personnel, physicians and bystanders. Patients who were still alive were sent a EuroQol-questionnaire. No differences in outcomes between the four groups were found. Since long-term prognosis after out-of-hospital resuscitation is satisfactory, learning programmes for resuscitation should be continued.     

Pain-related factors contributing to muscle inhibition in patients with chronic low back pain: an experimental investigation based on superimposed electrical stimulation

OBJECTIVE: To evaluate muscle strength, as a component of physical deconditioning, and central activation ratio, representing the performance level during testing, in patients with chronic low back pain as compared to healthy controls, and to evaluate the contribution of cognitive-behavioral and pain-related factors to the central activation ration of patients with chronic low back pain. METHODS: Twenty-five patients with chronic low back pain and 25 age and gender-matched controls participated. Muscle strength, that is, peak torque of the quadriceps muscle, was measured on a Cybex dynamometer. During peak torque, the quadriceps muscle was percutaneously stimulated using superimposed electrical stimulation, generating an additional twitch torque in case of submaximal performance. The central activation ratio was calculated as peak torque/(peak torque + additional twitch torque). To evaluate cognitive-behavioral and pain-related factors influencing the central activation ratio, measures of fear of injury, pain catastrophizing, psychologic distress, and pain intensity were used. Differences between groups were tested using either T tests or Mann-Whitney U tests. Associations were tested by partial correlation coefficients controlling for gender. RESULTS: The male:female ratio was 15:10. Mean age and chronic low back pain duration were 42.7 (+/-9.5) and 9.9 (+/-8.3) years, respectively. Mean muscle torque (per kg lean body mass) in patients (1.95 Nm/kg +/-0.8) was less than in controls (3.16 Nm/kg +/-0.7) (P < 0.01). Median central activation ratio was lower in patients (P < 0.05). Patients experiencing increased psychologic distress and patients with a higher current pain level showed a lower central activation ratio (P < 0.05). CONCLUSIONS: When interpreting decreased muscle strength in terms of physical deconditioning in patients with chronic low back pain, submaximal performance has to be taken into account. The results suggest that patients with chronic low back pain who report increased psychologic distress and a higher level of current pain tend to show increased inhibition of muscle activity, leading to submaximal performance.     

HESI exams: an overview of reliability and validity

Schools of nursing are increasingly administering computerized exams developed by Health Education Systems, Inc (HESI) to evaluate student and program outcomes and provide evidence-based rationale for curriculum development and modification. This article describes the methods used to establish the reliability and validity of HESI specialty exams and HESI exit exams. Discussion of current reliability and validity findings and recommendations for future research to enhance the quantification of validity data for HESI exams are presented.     

HESI exams: an overview of reliability and validity

Schools of nursing are increasingly administering computerized exams developed by Health Education Systems, Inc (HESI) to evaluate student and program outcomes and provide evidence-based rationale for curriculum development and modification. This article describes the methods used to establish the reliability and validity of HESI specialty exams and HESI exit exams. Discussion of current reliability and validity findings and recommendations for future research to enhance the quantification of validity data for HESI exams are presented.     

The influence of psychological factors and an early hospital follow-up on return to work after first myocardial infarction.

The factors influencing the return to work following first myocardial infarction were studied in 112 male patients, all of whom had previously been fully employed. Delay in return to work within 4 months of discharge from hospital was seen in patients who were not given an early hospital follow-up appointment and in those who attibuted their illness to aspects of their work. Encouragement by the General Practitioner to resume employment was found to be essential if an unnecessary delay was to be avoided. Positive advice of this nature was given more frequently by General Practitioners whose patients had been seen at early hospital review. Age, a tendency to neuroticism, personal knowledge of how others had fared following a similar illness, and apparent benefit from sick payments did not appear to influence the rate of return to work.     

Heterotopic bone formation in the patient with burn injuries. A retrospective assessment of contributing factors and methods of investigation

The incidence of heterotopic bone formation in seven of 25 patients with burn injuries who required endotracheal intubation and ventilation for smoke inhalation injury was believed to be unacceptably high. Factors in the affected patients distinguishing them from those unaffected were sought. Total protein levels were found to be higher in the affected group. This may correlate with the calciuretic response to protein loading reported previously. Of the affected patients, four demonstrated extreme agitation and resisted physiotherapy. Only one of the 18 nonaffected patients was equally agitated and resistant (p less than 0.05). The additional joint trauma sustained by the affected patients may contribute to the development of heterotopic bone. In bone scans in 18 consecutive patients deemed to be at risk, all showed increased radioactivity at multiple joints. Only seven patients developed heterotopic bone. Bone scans are not sufficiently specific to be used as a diagnostic tool in detecting heterotopic bone.     

The X factor: Lack of bleeding after an acute apixaban overdose

We present an acute apixaban overdose without reported coingestants; it is the first such case report associated with multiple serum drug levels to assist in determining overdose kinetics. A 62 year old female presented to an emergency department (ED) 2 hours after ingesting sixty 5 mg tablets (5mg/kg) of her spouse's apixaban medication. She denied coingestants, and did not take her prescribed medications that day. Her vital signs were normal and she denied symptoms. Chemistry and hematology labs were unremarkable. Plasma apixaban concentrations were 2765.6 ng/ml at 14 hours post ingestion with a non-linear half life. There was no utilization of blood products or factor replacement. There was never any bleeding, and her hemoglobin did not decrease. This case demonstrates that a single ingestion of apixaban can occur without any complications occurring.     

An investigation of school playground safety practices as reported by school nurses.

The purpose of this study was to investigate school playground safety practices. The study used a purposeful sample of school nurses who attended a playground safety workshop at the 2006 National Association of School Nurses annual conference. Seventy-five questionnaires were distributed, and 64 useable questionnaires were returned. The responses indicated that little attention is being given to providing safe playground environments in schools as measured by best practices of supervision, age-appropriate design, fall surfacing, and equipment maintenance. Participants pointed to the need for better supervision and supervision training, careful selection of age-appropriate equipment, maintaining adequate fall surfaces under the equipment, and ensuring that equipment is properly maintained and repaired. The study also revealed that school nurses believe they could play a role in playground injury prevention through the collection and analysis of injury data, communication to administrators about the need for comprehensive planning of the play environment, and becoming active members of playground safety committees.     

Mobility status after inpatient stroke rehabilitation: 1-year follow-up and prognostic factors

OBJECTIVES: To evaluate the stability of mobility status achieved by stroke patients during hospital rehabilitation treatment over time and to identify reliable prognostic factors associated with mobility changes. DESIGN: Follow-up evaluation in consecutive first-ever stroke patients 1 year after hospital discharge. Multiple logistic regressions were used to analyze increases and decreases in Rivermead Mobility Index (RMI) scores (dependent variables) between discharge and follow-up. Independent variables were medical, demographic, and social factors. SETTING: Rehabilitation hospital. PATIENTS: A cohort of 155 patients with sequelae of first stroke, with a final sample of 141. MAIN OUTCOME MEASURES: Mobility status at 1-year follow-up, as measured by the RMI, and odds ratios (OR) for improvement and decline in mobility. RESULTS: Functionally, 19.9% improved the mobility levels achieved during the inpatient rehabilitation treatment; levels of 42.6% worsened. Patients with global aphasia (OR = 5.66; 95% confidence interval [CI], 1.50-21.33), unilateral neglect (OR = 3.01; 95% CI, 1.21-7.50), and age 75 years or older (OR = 5.77; 95% CI, 1.42-23.34) had a higher probability of mobility decline than the remaining patients. Postdischarge rehabilitation treatment (PDT), received by 52.5% of the final sample, was significantly and positively associated with mobility improvement (OR = 5.86; 95% CI, 2.02-17.00). Absence of PDT was associated with a decline in mobility (OR = 3.73; 95% CI, 1.73-8.04). CONCLUSIONS: In most cases, mobility status had not yet stabilized at hospital discharge. PDT was useful in preventing a deterioration in mobility improvement achieved during inpatient treatment and in helping increase the likelihood of further mobility improvement.     

Behavioral responses of an older woman receiving tocolysis after repeated failed pregnancies

The purpose of this study was to explore the behavioral responses to tocolysis of an older woman who has experienced two failed pregnancies. As a participant observer the primary researcher simultaneously provided care and recorded the woman's verbal and nonverbal behaviors. After repeated data analysis, it was found that the woman's stress mainly resulted from her un certainty about a safe passage through pregnancy and about the health of her fetus. In her effort to ensure a successful pregnancy and good fetal health, she exhibited the following behaviors: worrying about the status of her pregnancy, adopting effective strategies to ensure the success of the tocolysis, complying with medical procedures and nursing instructions, establishing the time marks of the pregnancy for the purpose of self-encouragement, and attaching importance to oral intake for the sake of good fetal health. The article concludes that medical personnel should actively identify the needs of pregnant women and provide family-centered nursing care to diminish the impact of preterm premature rupture of membrane and maximize the positive results of tocolysis.     

Diabetic retinopathy. Control of systemic factors preserves vision

Diabetic retinopathy, a retinal microangiopathy, is the leading cause of blindness for persons aged 20 to 65 years in the United States. Routine screening and early treatment are cost-effective and have been shown to help preserve sight. Primary care physicians play a key role in treatment of systemic factors that lead to poor outcomes and referral to an ophthalmologist or a retinal specialist for screening and local treatment. This article, the first of two on retinal vascular disease, provides a review of nonproliferative and proliferative diabetic retinopathy. The second article, which will appear in an upcoming issue of POSTGRADUATE MEDICINE, discusses retinal vascular disease in hypertension.     

Lack of ciprofloxacin ototoxicity after repeated ototopical application.

The possible side effects of ototopically applied ciprofloxacin on inner ear function were investigated. The hearing function of pigmented guinea pigs was evaluated by daily frequency-specific evoked response audiometry after repeated application of the drug to both ears. Ciprofloxacin appeared to have no statistically significant effect on the hearing thresholds of the experimental animals.     

Nursing faculty shortage in Canada: A scoping review of contributing factors

BackgroundStrong nursing faculty is paramount to promote disciplinary leadership and to prepare future nurses for practice. Our understanding of the factors associated with or predictive of nurse faculty retention and/or turnover is lacking.PurposeThe aim of this review is to identify and synthesize the existing literature on factors contributing to nurse faculty shortage in Canada and implications on nursing practice.MethodsA scoping review based on the Arskey and O'Malley's five stage framework for scoping reviews was undertaken. Utilizing the PRISMA protocol, a comprehensive and structured literature search was conducted in five databases of studies published in English.FindingsLimited through search inclusion and relevance of research, nine studies out of 220 papers met the criteria for this review and were thematically analyzed. Identified themes were supply versus demand; employment conditions; organizational support; and personal factors.DiscussionImpending retirement of faculty, unsupportive leadership, and stressful work environments were frequently reported as significant contributing factors to the faculty shortage.ConclusionThis scoping review provides insights into how Canada's schools of nursing could engage in grounded efforts to lessen nursing faculty shortage, both nationally and globally. We identified a gap in the literature that indicates that foundational work is needed to create context-specific solutions. The limited studies published in Canada suggest that this is a critical area for future research and funding.