Consistent application of gate control theory in the screening and selection of patients for implantable therapy

The purpose of this article is to provide pragmatic instruction in the identification of favorable candidates for implantable devices. Protocol for psychological assessment and decisionmaking is submitted with particular attention to the consistent application of gate control theory. Strategies are discussed with reference to the influence of culture in the decision-making process,multidisciplinary assessment and treatment, pain management rather than cure, dynamic rather than one-time decisions, and psychological selection criteria.The holistic paradigm is highlighted as an explanatory model from which procedures can evolve. A template is submitted in the structuring of recommendations.     

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.     

A review of the health promotion and health beliefs of traditional and Project 2000 student nurses

In this study it was proposed that a more rigorous theoretical component in nursing education courses would produce a nurse who was a proficient health educator and promotor of health A sound knowledge base will enable the student to develop positive attitudes and beliefs towards promoting health and providing health education as a part of nursing practice To test this hypothesis, two groups of students were asked to complete a questionnaire and the answers subsequently compared The results and data analysis supported the hypothesis only in a limited way and a further study on a larger group of students would provide greater insight into the question     

Predictive Validity of the Global Assessment Form Used in a Final-year Undergraduate Rotation in Emergency Medicine

OBJECTIVES: To determine whether the predictive validity of Global Assessment Form (GAF) knowledge subdomain marks exceeds that of the overall GAF marks with respect to written examination marks for an undergraduate rotation in emergency medicine, and to determine the interdependence between subdomain marks on the GAF. METHODS: Final-year clinical clerks completing a four-week rotation through the emergency departments of a university teaching center were evaluated using both a ten-subdomain GAF for clinical performance and an independent written examination. The GAF and examination marks were prospectively obtained for clinical clerks over a two-year period. Pearson correlations were calculated between examination marks and both the GAF knowledge subdomain and the GAF overall mark. Olkin's Z score was calculated to determine the significance of the difference between correlations. Interdependencies between subdomains of the GAF were calculated using an alpha coefficient and inter-item correlations. RESULTS: Data sets were reviewed for 347 clinical clerks. Nine sets of data were excluded (incomplete evaluations); 338 sets were analyzed. Means for overall clinical mark and examination mark were 80.11% (SD = 4.375) and 81 (SD = 7.66). Among subdomains, knowledge had the highest correlation with the examination mark (0.19). Overall clinical marks had lower correlation with the examination marks (0.169); the difference was not significant (Olkin's Z = 0.40). The correlation of the examination marks with the average marks of all subdomains excluding knowledge was even lower (0.12). The tenitem alpha for the GAF was 0.92. CONCLUSIONS: Clinical GAF assessments of knowledge, as measured by written examination, do not appear to be any more predictive than overall clinical impression. There is substantial consistency between subdomain scores, suggesting that assessors are not effectively discriminating between them when assigning marks.