Validation of the questionnaire for impulsive‐compulsive disorders in Parkinson's disease

As no comprehensive assessment instrument for impulse control disorders (ICDs) in Parkinson's disease (PD) exists, the aim of this study was to design and assess the psychometric properties of a self‐administered screening questionnaire for ICDs and other compulsive behaviors in PD. The Questionnaire for Impulsive‐Compulsive Disorders in Parkinson's Disease (QUIP) has 3 sections: Section 1 assesses four ICDs (involving gambling, sexual, buying, and eating behaviors), Section 2 other compulsive behaviors (punding, hobbyism, and walkabout), and Section 3 compulsive medication use. For validation, a convenience sample of 157 PD patients at 4 movement disorders centers first completed the QUIP, and then was administered a diagnostic interview by a trained rater blinded to the QUIP results. A shortened instrument (QUIP‐S) was then explored. The discriminant validity of the QUIP was high for each disorder or behavior (receiver operating characteristic area under the curve [ROC AUC]: gambling = 0.95, sexual behavior = 0.97, buying = 0.87, eating = 0.88, punding = 0.78, hobbyism = 0.93, walkabout = 0.79). On post hoc analysis, the QUIP‐S ICD section had similar properties (ROC AUC: gambling = 0.95, sexual behavior = 0.96, buying = 0.87, eating = 0.88). When disorders/behaviors were combined, the sensitivity of the QUIP and QUIP‐S to detect an individual with any disorder was 96 and 94%, respectively. Scores on the QUIP appear to be valid as a self‐assessment screening instrument for a range of ICDs and other compulsive behaviors that occur in PD, and a shortened version may perform as well as the full version. A positive screen should be followed by a comprehensive, clinical interview to determine the range and severity of symptoms, as well as need for clinical management. © 2009 Movement Disorder Society     

Goals and potential career advancement of licensed practical nurses in Japan

Aim To investigate the effects of personal and professional variables on career advancement intentions of working Licensed Practical Nurses (LPNs). Background In Japan, two levels of professional nursing licensures, the LPN and the registered nurse (RN), are likely to be integrated in the future. Therefore, it is important to know the career advancement intentions of LPNs. Method Questionnaires were sent to a sample of 356 LPNs. Analysis of variance (anova ) and discriminative analysis were used. Results We found that those who had a positive image of LPNs along with a positive image of RNs were identified as showing interest in career advancement. The results of anova showed that age had a negative effect; however, discriminative analysis suggested that age is not as significant compared with other variables. Conclusion Our results indicate that the ‘image of RNs’, and ‘role‐acceptance factors’ have an effect on career advancement intentions of LPNs. Implications for nursing management Our results suggest that Nursing Managers should create a supportive working environment where the LPN would feel encouraged to carry out the nursing role, thereby creating a positive image of nursing in general which would lead to career motivation and pursuing RN status.     

Sleep patterns of aged persons in long-term care facilities

The nursing staff of long-term care facilities are often faced with the decision of whether or not to administer sleep medication when it is ordered 'prn'. This decision should be made on the basis of information contained in the patient's nursing sleep history as well as knowledge regarding the effects of sleep medication. This study was carried out to assess the factors involved in changes in sleep patterns of elderly patients in long-term care facilities and to evaluate the extent of use of the nursing sleep history. The sleep patterns of 102 elderly patients (mean age 78.7 years) in three long-term care facilities were assessed by means of interview questionnaire. Patients' records indicated that 71% were receiving some type of sleep medication on a regular basis. A quantitative analysis of their responses indicated that there were significant shifts in sleep patterns following admission. Only 54% of the patients in this study had a nursing sleep history and this contained only minimal information. The results indicate that the nursing sleep history is under-utilized. A better appreciation of the patient's sleep requirements could lead to a reduction in the amount of sleep medication given and an improvement in the general well-being of the long-term care elderly population.     

Binge eaters: a comparison of eating patterns of those who admit to binging and those who do not

The purpose of the study was to assess the prevalence of undiagnosed bulimic or pre-bulimic behaviours in a normal, but high risk population. A questionnaire eliciting information about eating habits and potential binge episodes, demographic background, and information about height and weight was completed by 479 college students. Subjects were designated as a non-binger, a non-labelled binger, or labelled binger according to their responses. Consistent with previous literature, findings showed a high prevalence of bulimia in the young, female, middle income population. Findings also revealed a group of students who described frequent binge episodes but did not consider themselves to have an eating disorder in that they did not label themselves as 'binge eaters' (the non-labelled binge group).     

Relationship between arterial carbon dioxide and end-tidal carbon dioxide when a nasal sampling port is used

End-tidal carbon dioxide (ETCO₂) values obtained from awake nonintubated patients may prove to be useful in estimating a patient’s ventilatory status. This study examined the relationship between arterial carbon dioxide tension (PaCO₂) and ETCO₂ during the preoperative period in 20 premedicated patients undergoing various surgical procedures. ETCO₂ was sampled from a 16-gauge intravenous catheter pierced through one of the two nasal oxygen prongs and measured at various oxygen flow rates (2, 4, and 6 L/min) by an on-line ETCO₂ monitor with analog display. Both peak and time-averaged values for ETCO₂ were recorded. The results showed that the peak ETCO₂ values (mean = 38.8 mm Hg) correlated more closely with the PaCO₂ values (mean = 38.8 mm Hg; correlation coefficient r = 0.76) than did the average ETCO₂ values irrespective of the oxygen flow rates. The time-averaged PaCO₂-ETCO₂ difference was significantly greater than the PaCO₂-peak ETCO₂ difference (P < 0.001). Values for subgroups within the patient population were also analyzed, and it was shown that patients with minute respiratory rates greater than 20 but less than 30 and patients age 65 years or older did not differ from the overall studied patient population with regard to PaCO₂-ETCO₂ difference. A small subset of patients with respiratory rates of 30/ min or greater (n = 30) did show a significant increase in the PaCO₂-ETCO₂ difference (P < 0.001). It was concluded that under the conditions of this study, peak ETCO₂ values did correlate with PaCO₂ values and were not significantly affected by oxygen flow rate. However, obtaining peak ETCO₂ values is clinically more difficult, especially when partial air-way obstruction is present.     

Significant others benefit from preoperative information

Little attention has been given to the preparation of the patient's family prior to surgery, even though nurses' clinical experience suggests that family members are often more anxious than the patient. This study explored the knowledge and anxiety of spouses and significant others of patients preparing for cardiac surgery. The subjects were selected by convenience from a preoperative class offered at the hospital where surgery was to occur. Before and after the class, the subjects completed a cardiac-surgery knowledge test and an anxiety test. The significant others were significantly more anxious than the patients prior to the class. The anxiety level of significant others was significantly reduced after the class. There were no statistically significant differences between patients and significant others on the cardiac-surgery knowledge test. These results suggest that significant others may benefit from preoperative instruction.     

Effects of chlorhexidine spray on plaque and gingival health in institutionalized persons with mental retardation

In this study, eight institutionalized males received a 0.12% chlorhexidine gluconate spray twice daily. A second group of eight males received a placebo spray in the same manner. The results indicated that pump-administered chlorhexidine spray can effectively reduce plaque and gingivitis in patients with mental retardation who are unable to brush their own teeth     

Medical tests: women's reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results

Objective To determine women's preferences for and reported experience with medical test decision‐making. Design Computer‐assisted telephone survey. Setting and participants Six hundred and fifty‐two women resident in households randomly selected from the New South Wales electronic white pages. Main outcome measures Reported and preferred test and treatment (for comparison) decision‐making, satisfaction with and anxiety about information on false results and side‐effects; and effect of anxiety on desire for such information. Results Overall most women preferred to share test (94.6%) and treatment (91.2%) decision‐making equally with their doctor, or to take a more active role, with only 5.4–8.9% reporting they wanted the doctor to make these decisions on their behalf. This pattern was consistent across all age groups. In general, women reported experiencing a decision‐making role that was consistent with their preference. Women who had a usual doctor were more likely to report experiencing an active role in decision‐making. More women reported receiving as much information as they wanted about the benefits of tests and treatment than about the side‐effects of tests and treatment. Most women wanted information about the possibility of false test results (91.5%) and test side‐effects (95.6%), but many reported the doctor never provided this information (false results = 40.0% and side‐effects = 31.3%). A substantial proportion said this information would make them anxious (false results = 56.6% and side‐effects = 43.1%), but reported they wanted the information anyway (false results = 77.6% and side‐effects = 88.1%). Conclusions Women prefer an active role in test and treatment decision‐making. Many women reported receiving inadequate information. If so, this may jeopardize informed decision‐making.     

Life after the mental hospital: the way of life of deinstitutionalized psychiatric patients

This article describes and analyses the way of life of deinstitutionalized long-term psychiatric patients in Northern Finland. The major focus of the paper is the central areas of life of the outpatients as one dimension of subjectivity. The data were collected by interviewing 25 discharged long-term psychiatric patients. The findings suggest that home was the central area of life for the outpatients but they differed in their relation to it. Some of the patients were actively building their home. For some others home was an asylum in which to hide from social life. Many patients had hobbies that only took place inside their homes. One of the problems that the outpatients had to face was lack of work. The elderly patients who generally regarded work as a virtue experienced difficulties in finding something to do in their modern suburban homes. Social participation was mostly labelled by the old and familiar hospital models. The patients had no new acquaintances. They kept contact with their former fellow patients.