The Last Word: A “Recovered Enough” Therapist

A review of the literature concerning the relationship between anorexia nervosa (AN) and religion reveals two disparate themes: religion as a cultivator of AN, and religion as a recovery benefactor. The purpose of the present study was to address this discrepancy by exploring one factor—religious coping style—suspected to influence the role religion assumes in the lives of individuals with AN. A sample of 134 women who self-identified as having received an AN diagnosis completed measures of religious coping style and anorectic symptomology. Analyses revealed that religious coping style significantly predicted severity of anorectic symptomology.     

A PROSPECTIVE STUDY OF THE SAFETY AND EFFICACY OF SUPRAPUBIC TRANSVESICAL PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

PURPOSE: We investigate the safety and efficacy of suprapubic transvesical prostatectomy, and the change in bladder wall thickness after surgery. MATERIALS AND METHODS: We conducted a prospective 1 center study of 32 consecutive patients who underwent transvesical prostatectomy from December 1996 to March 1997 for benign prostatic hyperplasia with large prostate volume, who were followed for 1 year. Pressure flow study and transrectal sonography were performed at baseline and repeated at 6 months. Bladder wall thickness was measured at baseline and regular intervals postoperatively. A morbidity questionnaire was completed during the first 6 weeks after surgery. RESULTS: An average of 63 gm. prostate adenoma were enucleated at surgery. An indwelling catheter was required for an average plus or minus standard deviation of 5.4 +/- 2.6 days after treatment. The International Prostate Symptom Score decreased from 19.9 +/- 4.4 to 1.5 +/- 2.7 and the quality of life score decreased from 4.9 +/- 1.0 to 0.2 +/- 0.4 at year 1, respectively. Maximum flow rate improved from 9.1 +/- 5.3 to 29.0 +/- 8.9 ml. per second. Residual urine decreased from 128 +/- 113 to 8 +/- 18 ml. Before surgery 30 patients had obstruction and 2 were in the equivocal zone of the International Continence Society nomogram. At 6 months after prostatectomy 30 patients did not have obstruction, and 2 who were subsequently operated on for bladder neck sclerosis were equivocal and had obstruction, respectively. No patient had significant postoperative bleeding and no heterologous blood transfusions were required. There were 4 men who had urinary tract infection and 1 who had wound infection. A slight decrease in erectile function was observed 6 weeks postoperatively, and no change in patient libido and quality of sex life was reported. The total complication rate was 31.3%. The bladder was unstable in 7 men before and 3 after surgery. A significant decrease in bladder wall thickness was observed from 5.2 +/- 0.7 at baseline to 2.9 +/- 0.9 mm. at year 1 postoperatively. CONCLUSIONS: Our study confirms the excellent clinical outcome of transvesical prostatectomy, and rapid improvement of most subjective and objective parameters during the 4 weeks after surgery. Bladder hypertrophy appears to be significantly reduced after prostate surgery. The urodynamic results in patients who underwent open surgery probably represent the maximum obtainable relief of obstruction and should be considered the reference standard to which all other treatments, including transurethral resection, should aspire.     

Low‐Risk Profile for Malignant Ventricular Arrhythmias and Sudden Cardiac Death after Surgical Ventricular Reconstruction

Background: Although it has been recently demonstrated that there was no significant difference in total survival and clinical outcomes between patients who underwent coronary artery bypass grafting (CABG) with or without surgical ventricular reconstruction (SVR), the question of whether or not SVR decreases the arrhythmic risk profile in this population has not been clarified yet. Objective: To determine the real incidence of sudden cardiac death (SCD) and sustained ventricular tachycardia/ventricular fibrillation (sustained VT/VF) in patients following CABG added to SVR and to define their clinical and echocardiographic parameters predicting in‐hospital and long‐term arrhythmic events (SCD + sustained VT/VF). Methods: Pre‐ and postoperative clinical and echocardiographic values as well as postoperative electrocardiogram Holter data of 65 patients (21 female, 63 ± 11 years) who underwent SVR + CABG were retrospectively evaluated. Results: Mean follow‐up was 1,105 ± 940 days. At 3 years, the SCD‐free rate was 98% and the rate free from arrhythmic events was 88%. Multivariate logistic analysis identified a preoperative left ventricular end‐systolic volume index (LVESVI) > 102 mL/m² (odds ratio [OR] 1.4, confidence interval [CI] 1.073–1.864, P = 0.02; sensitivity 100%, specificity 94%) and a postoperative pulmonary artery systolic pressure (PASP) > 27 mmHg (OR 2.3, CI 1.887–4.487, P = 0.01; sensitivity 100%, specificity 71%) as independent predictors of arrhythmic events. Conclusions: Our and previous studies report a low incidence of arrhythmic events in patients following SVR added to CABG, considering the high‐risk profile of the study population. A preoperative LVESVI > 102 mL/m² and a postoperative PASP > 27 mmHg had a good sensitivity and specificity in predicting arrhythmic events. (PACE 2010; 33:1054–1062)     

Down to the Wire: Tricuspid Stenosis in the Setting of Multiple Pacing Leads

Tricuspid stenosis in the setting of endocardial pacing leads is a rare entity, attributed to infection or lead malposition. We report the case of a 37‐year‐old man without these risk factors, who presented with new onset severe tricuspid stenosis in the setting of multiple chronic pacing leads. (PACE 2010; e49–e52)     

Full-time work for nurses: employers’ perspectives

Aim To examine an employer response to a government employment policy, the Nursing Graduate Guarantee (NGG), over a 2-year period (2008–2009 and 2009–2010). Background Healthcare organizations rely on a stable supply of nurses to meet their staffing needs. However, employment trends have indicated a propensity for part-time employment. The NGG was created to stimulate full-time employment of new graduate nurses in Ontario, Canada. Methods A mixed methods design was used, which included online surveys and focus groups. All healthcare providers (n = 1198) were surveyed in 2008–2009 and 2009–2010. Each year, a sample of NGG employers participated in sector-specific focus groups. Results Approximately 20% of potential healthcare employers participated in the NGG. Reasons for non-participation included lack of awareness of the initiative and lack of full-time jobs. Barriers to offering full-time employment to new graduates included lack of full-time vacancies and budget constraints. Conclusions Employers perceive flexible staffing practices as a way to contain personnel costs but often at the expense of a stable full-time nursing workforce. Implications for Nursing Management This research contributes to an understanding of employers’ perspectives on full-time hiring and participation in a government employment policy.