Will outpatients complete living wills? A comparison of two interventions

OBJECTIVE

To test the efficacy of two intervention methods that aimed to increase the percentage of adult clinic patients who completed living wills and placed them on file with their physicians within a four-month period.

DESIGN

There were one control and two intervention groups. Surveys were separated by age and gender categories and randomly selected for the final sample.

SETTING

The internal medicine outpatient clinic of a large tertiary hospital.

PARTICIPANTS

All patients who visited the clinic were asked whether they would be willing to fill out a survey. The final sample included 167 adult patients who comprised three study groups.

INTERVENTIONS

The first intervention relied solely on a booklet that described the Minnesota Living Will Act, general information concerning advance directives, and medical interventions that could be considered extraordinary if used for a patient in a terminal condition. The second intervention relied on both the booklet and repeated physician-initiated discussions with the patient about the probable value of a living will.

MAIN RESULTS

The booklet/physician intervention was found to be significantly more effective than either the booklet-only intervention or no intervention (p less than 0.05 and 0.01, respectively).

CONCLUSIONS

The physician intervention used in this population could be undertaken in any primary care clinic. Time spent in discussion before a crisis may be significantly shorter and qualitatively better than time spent in discussion with families who must make decisions during a crisis.

Nurses' fear of death and comfort level with dying patients

This study examined differences in nurses' fear of death and level of comfort with patients having a poor prognosis for survival, as a function of the nurses' occupational level, work setting, and level of exposure to such patients. In addition, the relationship among the multidimensional aspects of fear of death and level of comfort with patients' poor prognosis was assessed. The sample included 312 professional and paraprofessional nurses who worked in hospitals and nursing homes. Level of comfort with working with dying patients was found to differ significantly by exposure to such patients and by occupational role. Fear of death for significant others was found to differ significantly by work setting. Finally, a significant inverse relationship was found between comfort working with dying patients and overall fear of death. Suggestions for future research are presented.

Characterization of a new subfamily of class I genes in the H-2 complex of the mouse

A previously undescribed subfamily of mouse class I MHC genes, consisting of two to three members, has been identified. The structure and organization of one of these, Mb1, has been determined. Mb1 consists of five exons with open reading frames and potentially encodes a class I-like transmembrane protein. In the genome, Mb1 is linked to the H-2 complex, mapping telomeric to Qa. However, this gene has low (ca. 60%) nucleotide identity with other class I sequences and is no more related to mouse class I genes than to class I genes from other species. Mb1 transcripts have not been found in a variety of adult tissues or cell lines, suggesting that, if Mb1 is expressed, its expression is highly regulated. From DNA sequence identity and intron-exon organization, Mb1 appears to be a primordial gene which antedates mouse speciation and which has evolved independently of the rest of the class I gene family. Examination of various species of wild mice demonstrates the presence of a discrete Mb1 subfamily over long evolutionary periods of time.

Predictors of burnout in professional and paraprofessional nurses working in hospitals and nursing homes

Burnout is a phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, forcing them to psychologically withdraw. To understand the experience of professional and paraprofessional nurses suffering from burnout requires a close examination of the environments in which they function. This study examined interpersonal, intrapersonal and situational factors expected to contribute to the six dimensions of burnout among nursing staff who worked in acute care and long-term care health facilities. The sample included 312 professional and paraprofessional nurses. The following research question was explored using a series of stepwise multiple regression analyses: of the following variables interpersonal (professional exposure to patients with poor prognosis for survival, work relationships, informal support), intrapersonal (coping strategies, fear of death, comfort working with patients with poor prognosis for survival) and situational (personal and work demographics), which are the significant predictors of the six dimensions of burnout in professional and paraprofessional nurses? Findings revealed that work relationships and tension-releasing and instrumental problem-focused coping were the most powerful predictors of burnout. Based upon this, it was concluded that nursing burnout is both an organizational and a personal problem. Recommendations for practice are presented.

Functional translation of exercise responses from graded exercise testing to exercise training

This study attempts to develop a quantitative approach to the prescription of absolute exercise intensity during level ground ambulation (min/mile) or cycle ergometry (kpm) from responses observed during GXT. A total of 345 subjects performed GXT and exercise training sessions with either the Bruce treadmill protocol and level ground ambulation (N = 154) or cycle ergometry (N = 191). Responses from 90% of each group were used to generate equations for predicting training pace (or power output) from the time (or power output) during the GXT when target HR was achieved. FAI was also included in the prediction of training pace (or power output). The remaining 10% of subjects in each group were used to cross-validate the prediction equations. The correlation between the time (or power output) during GXT when the training HR was observed and the pace of ambulation (or power output) was 0.70 for treadmill walking and 0.88 for cycle-cycle. Correlations were increased by the addition of FAI to the prediction equation. The results of this investigation suggest that the absolute intensity of exercise for training can be predicted accurately from GXT results.

Comparative Training Responses to Rope Skipping and Jogging

In brief: It has been suggested that ten minutes of rope skipping is equal to 30 minutes of jogging for improved cardiovascular efficiency. This study compared physiological adaptations to six-week programs of jogging and rope skipping. Twenty-six sedentary volunteers (17 women and nine men) aged 18 to 35 years were assigned to a jogging, rope-skipping, or control group. Training frequency was five times per week; each session was 30 minutes for the jogging group and ten minutes for the rope-skipping groups. Significant differences (p <.05) in o2 max were observed in each group. o2 max increased 5.1 ml· kg(-1)· min(-1) for the jogging group (13%) and 2.8 ml· kg(-1)· min(-1) for the rope-skipping group (7%). The rope-skipping group had higher injury and drop-out rates. It was concluded that ten minutes of rope skipping does not elicit a training response comparable to 30 minutes of jogging.

Comparison of MHC genes among distantly related members of the genus Mus

The genomic content of class I and class II MHC DNA sequences in a variety of wild mice has been analyzed. The panel of mice includes members of three subgenera of the genus Mus. By genomic hybridization with the use of a variety of DNA probes, both class I and class II DNA sequences appear to be conserved in all of the species examined. However, the number of class I DNA sequences differs among the species. Furthermore, this variation appears to result from differential increases within subsets of class I genes. These data suggest that the class I multigene family is dynamic and changing over short periods of evolutionary time. In contrast, none of the class II genes appears to vary in copy number. More extensive polymorphism was noted amongst the class II beta genes than the alpha genes. Interestingly, the genomic sequence corresponding to E beta 2 is highly conserved, leading to the prediction that it is a genetically functional sequence.

Comparison of MHC genes among distantly related members of the genus Mus

The genomic content of class I and class II MHC DNA sequences in a variety of wild mice has been analyzed. The panel of mice includes members of three subgenera of the genus Mus. By genomic hybridization with the use of a variety of DNA probes, both class I and class II DNA sequences appear to be conserved in all of the species examined. However, the number of class I DNA sequences differs among the species. Furthermore, this variation appears to result from differential increases within subsets of class I genes. These data suggest that the class I multigene family is dynamic and changing over short periods of evolutionary time. In contrast, none of the class II genes appears to vary in copy number. More extensive polymorphism was noted amongst the class II beta genes than the alpha genes. Interestingly, the genomic sequence corresponding to E beta 2 is highly conserved, leading to the prediction that it is a genetically functional sequence.

An analysis of the mechanism of 5-hydroxytryptamine-induced vasopressor responses in ganglion-blocked anaesthetized dogs

5-Hydroxytryptamine (5-HT) administered intravenously (i.v., 1--30 micrograms kg-1) to ganglion-blocked anaesthetized dogs produced dose-related increases in diastolic blood pressure and we have analysed the mechanism involved. Cyproheptadine and methysergide (10--100 micrograms kg-1 i.v.) were potent and specific antagonists of the 5-HT induced rise in blood pressure, while the alpha-adrenoceptor blocking agent phentolamine (0.3--3 mg kg-1 i.v.) also caused dose-related inhibition. Syrosingopine pretreatment converted the vasopressor action of 5-HT to a vasodepressor action and acute bilateral adrenalectomy caused a marked reduction in the 5-HT-induced rise in blood pressure. In two dogs, 5-HT (30 micrograms kg-1 i.v.) markedly increased the venous plasma concentrations of noradrenaline and adrenaline. We concluded that the 5-HT-induced rise in diastolic pressure in the ganglion blocked anaesthetized dog is due largely to the release of catecholamines of which a substantial component is from the adrenal gland. The rise in diastolic blood pressure is specifically blocked by low doses of cyproheptadine and methysergide suggesting that the release of catecholamines is mediated by specific 5-HT receptors located mainly within the adrenal medulla.

Adenocarcinoma of the colon presenting as anaemia

All patients with adenocarcinoma of the colon treated surgically at the Austin Hospital over a five-year period were reviewed to determine the relevance of anaemia in diagnosis. It was found that one-fifth of the patients presented with symptoms of anaemia to the doctor of first contact, and of these, one-third had an unwarranted delay in diagnosis (mean delay 13 months).