The effect of psychosocial nursing intervention on the mood state of patients with implantable cardioverter defibrillators and their caregivers

This study sought to determine whether mood state and psychosocial adjustment four months after implantable cardioverter defibrillator (ICD) placement were better for patients and caregivers who received a program of psychosocial interventions than for those who received usual postoperative care and follow-up. Thirty-four adult ICD recipients (17 experimental and 17 control) and their significant other (SO) caregivers were randomly assigned to an experimental or control group. The intervention consisted of weekly, postoperative telephone follow-up, evaluation and counseling by a psychiatric liaison nurse, and participation in an ICD support group. There were no significant differences between treatment and control groups on the outcome measures of adjustment (Profile of Mood States, Psychosocial Adjustment to Illness Scale). Outcomes were not associated with age, ejection fraction, length of hospital stay or family income, and there were no differences in outcomes based on gender, employment status, thoracotomy versus non-thoracotomy procedure, or shocked versus unshocked status. The results do not indicate that the extra time spent to provide individualized attention to these ICD recipients and their SOs was advantageous for the outcomes measured. Adaptation to the device may occur over time regardless of intervention.

Stress-induced immunosuppression and therapeutic touch

OBJECTIVE

The specific aim of this study was to evaluate the effectiveness of therapeutic touch in reducing the adverse immunological effects of stress in a sample of highly stressed students. Long-term goals are to develop methods by which a variety of stress-reduction techniques can be tested for efficacy.

DESIGN

Experimental.

SETTING

A large urban medical university in a southern coastal city.

SUBJECTS

Healthy medical and nursing students who are taking professional board examinations.

INTERVENTION

Therapeutic touch.

MAIN OUTCOME MEASURES

T-lymphocyte function (CD25) and immunoglobulin levels.

RESULTS

Subjects who received therapeutic touch and subjects who did not had significantly different levels of IgA and IgM; CD25 (mitogen-stimulated T-lymphocyte function) and IgG levels differed in the expected direction between the two groups, but the differences were not statistically significant. Apoptosis (programmed cell death) was significantly different between the two groups.

CONCLUSIONS

The small sample size requires cautious interpretation of the results. This is a pilot study designed to provide evidence to show that further study of therapeutic touch as an intervention that may be useful in reducing the adverse immunologic consequences of anxiety related to stress in otherwise healthy students is warranted. Change in immune function related to anxiety and the relief of anxiety can be measured. Subsequent power analysis suggests sample sizes of 90 subjects per group are required to confirm the conclusions.

Long-term exercise patterns and immune function in healthy older women. A report of preliminary findings

The purpose of this study was to examine the relationship between active versus inactive lifestyle and immunocompetence in older women. A sample of 46 independently dwelling, ambulatory and mentally alert women 60-98 years was examined, 25 who rated themselves as 'active' and 21 who rated themselves as 'inactive'. Lymphocyte subpopulations were analyzed by flow cytometry using selected monoclonal antibodies. The self-reported active subjects (also validated by their current unsolicited participation in a formal exercise class) demonstrated significantly higher percent change in CD25 mitogen stimulated lymphocytes (P = 0.0335) than those who reported themselves to be sedentary.

Quality and cost outcomes of transitional care

Longitudinal analysis of the outcomes of a transitional care program documented success in discharging patients home with remarkable compliance to discharge plans and sustained improvement in mental status and functional independence. Inpatient costs were significantly reduced.

The influence of stress intrusion on immunodepression in generalized anxiety disorder patients and controls

Previous work from our group has examined the relationship between stress and immunodepression in medical students taking National Boards, Part I, and has described a relationship between stress intrusion scores (SIS) and immunodepression. We have also shown that a high proportion of individuals with generalized anxiety disorders (GAD) and panic disorders (PD) exhibit enhanced stress intrusion (SI) and are more prone to upper respiratory infections (URI). In the present preliminary study, we sought to establish a model to evaluate further the role of SI level on the extent of immunodepression. This would serve to assess in further studies the mechanism(s) of stress-induced immunodepression, its relationship to morbidity, and the role of therapeutic interventions. In 14 GAD patients and 14 controls, we correlated the expression of interleukin-2 receptors (CD25) on T lymphocytes stimulated with anti-CD3 in short term cultures and the frequency of URI and the SIS to assess the relationships among these parameters. A decreased expression of CD25 correlates linearly with increasing SIS and with a higher number of sick days with URI. These results support our previous observations that GAD patients are more susceptible to URI. Moreover, they suggest that there may be a direct relationship between immunodepression and morbidity and between SIS and immunodepression.

Studying multidimensional constructs through cluster analysis

The analysis of multidimensional constructs presents a challenge. The challenge is to combine the information from the dimensions relating to the construct in a meaningful way. This article examines a complex construct known as the nursing practice environment and describes the use of cluster analysis to combine information from three dimensional measurements to operationalize the construct.

Coordination as a critical element of managed care

Although the concept of coordination is not new to nursing, little is known about how it contributes to cost-effective patient care outcomes. The authors examined the mechanisms used by staff nurses to coordinate patient care services in practice environments characterized by low, moderate, and high levels of uncertainty. Regardless of practice environment conditions, nurses used the same mechanisms to coordinate patient care. These findings suggest a potential for inadequate communication among providers, poor coordination of services, and lost efficiency. Strategies to improve coordination of patient care services are discussed.

During HIV infection, CD4+ CD38+ T-cells are the predominant circulating CD4+ subset whose HLA-DR positivity increases with disease progression and whose V beta repertoire is similar to that of CD4+ CD38- T-cells

Three-color automated flow cytometry was carried out on peripheral blood CD4+ and CD8+ T-lymphocytes of 42 HIV-positive patients using tri-color anti-CD4 or anti-CD8, phycoerythrin-anti-CD38, and fluorescein-anti-HLA-DR, mAbs to elucidate further the T-cell activation hypothesis recently proposed to explain CD4+ T-cell abnormalities observed during HIV infection. CD4+ CD38+ T-cells constituted the major part of circulating CD4+ T-cells in HIV-infected patients and their HLA-DR molecule positivity increased as their disease progressed. The level of CD38 and HLA-DR expression on CD4+ T-cells was positively correlated to that of CD8+ T-cells and to the level of beta 2-microglobulin. Next, to determine whether CD38 expression was associated with a selective expansion or deletion of V beta gene-defined subsets, we compared the V beta gene frequencies between CD38+ and CD38- T-cells from HIV-infected CDC stage II patients using 13 mAbs specific to V beta families. While selective expansion of certain V beta families was observed in CD4+ and CD8+ T-cells the T-cell receptor V beta subset distribution was similar among CD38+ and CD38-, CD4+ and CD8+ T-cells, suggesting that CD38+ expression was either independent of an HIV-encoded antigen-driven process or rather indicative of T-cell immaturity. It is proposed that the phenotype of circulating CD4+ and CD8+ T-cells of HIV-infected patients is a feature of two different mechanisms: (i) an in vitro activation state responsible for increased DR expression and selective expansion of V beta gene-defined subsets, and (ii) T-cell immaturity due to an increased turnover of these cells and accounting for increased CD38 expression.

Dissemination and use of research findings in nursing practice

This study built on two previous studies (Brett, 1987; Coyle & Sokop, 1990) that found no significant relationships between use of nursing research and nursing education level. These two studies had fewer than 5 per cent of their subjects with master's degrees in nursing. The new population studied had 49 per cent master's prepared nurses, which provided the necessary foundation to expand the examination of the relationship of higher education and use of research findings among nurses. Whereas the overall extent of dissemination and use of research findings among nurses in the sample was similar to that of the two previous studies, it was found that nurses with a master's degree reported higher utilization than those with a bachelor's degree. This finding suggests a unique and critical role for the master's-prepared nurse in the dissemination and use of research findings in the practice setting.

Immunomodulatory effects of alpha interferon and thymostimulin in patients with neoplasias

In this report, we have evaluated the immunological effects following administration of alpha interferon (IFN-alpha) in combination with thymostimulin (TP-1), as well as of IFN-alpha and TP-1 alone in patients with neoplasias who underwent surgery and were subsequently treated with conventional chemotherapy. Data suggest that the combination of IFN-alpha and TP-1 is the most effective in the up-regulation of some immune parameters such as the CD4(+)-CD8+ cell-dependent antibacterial activity. Since this immune function plays an important role in the host protection against different targets such as invading microorganisms and/or neoplastic cells, the administration of TP-1-IFN-alpha is advisable for patients with neoplasias under chemotherapy.

A cost-effectiveness analysis of acute care case management outcomes

Case management was more cost effective in a moderately uncertain practice environment than in either a low or a high uncertainty environment. The environmental state, case manager role differentiation, and information coordination contributed most strongly to these outcomes.

Control of Listeria monocytogenes in the delicatessen industries: the lessons of a listeriosis outbreak in France

During a recent outbreak of foodborne listeriosis which occurred in France in 1992, investigations were carried out in order to identify the plants associated with the production of contaminated products. These investigations were made in six 'suspect' delicatessen plants following the first epidemiological investigations, and in one 'control plant'. The first visits were made during working operations. Two hundred and seventy samples were taken ('environmental' swabs, air samples, products), with 68% of the swabs being positive for Listeria monocytogenes in raw product areas, and 33% positives in the finished product area. The epidemic phagovar was identified in a single plant preparing pork tongues in aspic. The major causes of contamination identified were contact of cooked products with soiled surfaces, cross-contamination between 'raw' and 'cooked' channels and the inadequacy of cleaning and disinfection procedures. A second visit was also made to five plants to provide validation of their cleaning and disinfection procedures. Among 112 swabs collected, 17% of the samples from raw product surfaces and 7% from finished product surfaces were found to be positive. These results suggest that cleaning and disinfection procedures were unable to eliminate sources of L. monocytogenes when not correctly applied.

Beliefs and perceptions about children in pain: a survey

This survey examined beliefs about pain in children and perceptions of the adequacy of pain management among 228 nursing personnel in a pediatric setting in the Southeast. Nursing education correlated positively with both beliefs and perceptions of current practice. Years of nursing experience, number of years of pediatric nursing experience, and age were not significantly correlated with either factor. Respondents perceived the need for (a) educating physicians about effective pain management, (b) more information about pain management in the neonatal/infant population, (c) more collaboration between nurses and physicians when managing pain in children, and (d) more support for nurses to influence pain management. The overwhelming majority (> 95%) of respondents expressed interest in learning more about assessment and management of pain in children.

Case management: the relationship between structure & environment

In response to increasingly uncertain practice environments, case management structural dimensions of role differentiation, task coordination, and decentralization remained constant, while nurse participation in decision making increased significantly.

Environmental uncertainty: implications for practice model redesign

Analysis of one academic medical center revealed three distinct nursing practice environments distinguished by increasing levels of complexity, change, unpredictability, and uncertainty. Designing practice models to accommodate these conditions will facilitate more efficient and effective patient outcomes.

Case management and preventive services among infants from low-income families

To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequivalent control group with covariate measures design was employed in a sample of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) provided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child health care was characterized by fragmentation of services. Case management was segregated from preventive services, and multiple PHNs delivered care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiveness (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate immunization was 8% less in continuous care ($359) than in the fragmented approach ($386), although the difference in rates of adequate immunization was nonsignificant (experimental group, 64%; control group, 60%). These findings suggest that continuous PHN care with integrated case management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-management approach.

A measure of perceived environmental uncertainty in hospitals

The purpose of this study is to evaluate the preliminary psychometric properties of the Perceived Environmental Uncertainty Questionnaire (PEUQ). Environmental uncertainty (EU) refers to times when within the organization unanticipated events and problems occur with frequency and cannot be predicted by members of the organization due to a lack of critical information. The PEUQ was designed as a measure of EU and was tested with 375 patient-care and nonpatient-care hospital employees. Internal consistency as measured by Cronbach's alpha was .81. Confirmatory factor analysis supported two of the PEUQ's hypothesized three factors: state and effect EU. These two factors accounted for 61.1% of the variance in subjects' level of uncertainty. Factor analysis failed to confirm response uncertainty as a subconstruct of EU. Contrasted group analysis found expected differences in the level of perceived EU between workers on different hospital units (t = -5.02, p < .001). This study provides evidence of the PEUQ's beginning reliability and validity as a measure of EU. Failure to identify response uncertainty as a salient subconstruct of EU warrants further exploration. The design of nursing care delivery structures (NCDS) to minimize EU first requires a means to measure hospital units' EU. The establishment of the PEUQ's psychometric soundness is antecedent to measuring EU and improving the efficacy of our NCDS.

Body size values of white and black women

The purpose of this naturalistic study was to compare values held by 36 white and 31 black women related to body size, and to identify factors that influence these values and linkages between body size values and weight management activities. Black women of lower SES were significantly different from black women of higher SES and white women, regardless of SES, in that they were heavier, viewed themselves as heavier, and perceived attractive body size as heavier. Black lower status women had to become a great deal heavier than the other groups before they defined themselves as overweight. We suggest that black lower social status women have a wider range of "normal" and attractive body size and that this wider range is developed from comparisons of other women in their social milieu and influences the initiation of weight loss activities.

Maternal risk factors in infants with very low birth weight

To determine whether maternal risk factors associated with the delivery of very low birth weight infants under 1501 g are different from those associated with low birth weight infants of 1501 to 2500 g, prenatal data on 12,247 deliveries were evaluated. The sample contained 302 very low birth weight infants. Maternal race, age, height, weight, gravidity, parity, past pregnancy performance, and pregnancy complications were analyzed. Factors related to very low birth weight but not to low birth weight infants were previous abortions, previous fetal deaths, and hypertensive vascular disease. Race, maternal height, and prepregnancy weight were not related to very low birth weight but were associated with an increase in low birth weight. There was no significant difference in the rate of very low birth weight or low birth weight by maternal age from 14 to 40 years. These results contradict the concept of a uniform set of predisposing factors for birth of all infants weighing 2500 g or less.

[Plasmodium falciparum and drepanocytic gene in Popular Republic of Congo. I. Prevalence of malaria and drepanocytic trait among school children in Brazzaville area (author's transl)]

From 1978 to 1979, 5 surveys, among schoolchildren, were carried out during the rainy season in the neighbourhood of Brazzaville (R.P. Congo): 3 in PK 45 village (northern part of the capital), 2 in Djoumouna village (southern part), and 1 in "Talangai" (a suburb of the capital). 868 exams (plasmodic and splenic index fitted with hemoglobin composition [Hb AA or Hb AS]) were done. It appeared that 19,6% of schoolchildren examined were heterozygous sicklers (AS). This percentage confirmed the previous results from other authors in different countries of Central Africa. On the other hand, in spite of an intense transmission, both plasmodic and splenic index were, on the average, relatively low (24,5 and 24,8% respectively). Plasmodium falciparum was largely predominant (95,3% of infections) but P. ovale and P. malariae were also found (1,9% for each species). From our study no obvious "protecting effect" can be attributed to sickle cell trait because plasmodic index of children AA and AS were similar (23,8 and 27,6% respectively). A slight decrease of splenic index was noticed in AS in regard to AA (19,4 and 26.1% respectively). It is difficult to consider this no significative regression as a definitive proof of a premunition stronger in AS than in AA. Effectively some splenic infarctus are well known to be a regular physiopathological process occurring in homozygous SS but often in heterozygous AS too. In such highly endemic and stable malaria area the problem of a suitable antimalaria strategy remains to be solved.