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.     

The influence of ethnicity on Gleason score

BackgroundTo determine if Gleason score exhibits any significant variation between African-Americans and Caucasian men with prostate cancer.MethodsWe conducted a retrospective cohort study. Inclusion required diagnosis of prostate cancer and reporting it to the TriHealth tumor registry from 1995–2005. We excluded individuals of any other ethnicity than the two of interest (N = 15) and individuals without a reported Gleason score (N = 82). For each patient we collected data on ethnicity, Gleason score, age, American Joint Committee on Cancer (AJCC) stage, insurance status, and surgery. Gleason score was divided into low-grade (1–6) and high-grade disease (7–10). Institutional Review Board approval was obtained prior to data collection.ResultsA total of 1916 patients, (1476 Caucasians, 440 African-Americans) were eligible for inclusion in the study. There was no significance difference between either ethnicity for age, insurance status, and the percentage of men needing a transurethral resection of the prostate (TURP). There was no difference between either ethnicity for stages 0, 1, and 4. African-Americans were more likely to have stage 2 disease, while Caucasian men possessed more stage 3 disease (p<0.05). African-Americans were significantly more likely to not have any prostate surgery (p<0.05). Caucasian men were more likely to have a prostatectomy. African-American men with prostate cancer were significantly more likely to have a high-grade Gleason score compared to Caucasian men (OR = 1.22, 95% CI = 1.11–1.35).ConclusionAfrican-American race is a predictor of more advanced Gleason score at the time diagnosis of prostate cancer.     

Executive function of children with extremely low birthweight: a case control study

This study examines the executive function (EF) skills of extremely-low-birthweight (ELBW) children at school compared with their peers. Thirty children with ELBW and 50 control children (both with a mean age of 62+/-4 months) were administered tests of EF including the Tower of Hanoi task, Finger Sequencing task, and Tapping Test. Children with ELBW, including those who scored more than 1 SD below the mean on the Peabody Picture Vocabulary Test-Revised, scored significantly lower than their peers on all executive tasks. There was limited correlation between EF and previous general quotient index scores obtained at routine assessment using the McCarthy Scales of General Ability at 4 years of age for the children with ELBW. Results suggest that children with ELBW are at risk for deficits in 'executive' behaviours including planning, sequencing, and inhibition which may have implications for later learning.     

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.