Changes in adolescents' conflict responses associated with consecutive presentation of hypothetical conflict situations

The advantages of using hypothetical situations are one reason they have been widely used to examine adolescents' responses to conflict situations. One frequently used research protocol involves presenting several conflict scenarios to participants during a single session. However, in real-life situations multiple conflicts rarely occur within short periods of time, and the nature of this presentation may be associated with changes in adolescents' reports of conflict behaviors. Trend analyses of emotional, conflict goal, and conflict tactic responses from grade 8, 10, 12, and college students to consecutively presented conflict situations showed that responses were associated with presentation of the hypothetical situations. Findings revealed an increase in reports of assertive conflict behaviors and a decrease in reports of constructive conflict behaviors with successive situation presentation. Results from the current study suggest that researchers must consider trends in responses when examining findings from successive situation presentation methodologies because adolescent reports of conflict behavior may change as situation presentation proceeds.

Factors related to providers' decisions for and against withholding or withdrawing nutrition and/or hydration in adult patient care

Decisions that are made near the end of life include consideration of withholding or withdrawing nutrition and/or hydration. These decisions present ethical challenges to health care providers who are caring for terminally ill patients. Clinical studies published during the last twenty years provide empirical data about the many factors that influence these decisions. The purpose of this systematic literature review is to synthesize the research findings related to provider decisions about withholding or withdrawing nutrition and/or hydration in adult patient care. The clinical, educational, and ethical implications of these decisions are proposed.

Factors related to adult patient decision making about withholding or withdrawing nutrition and/or hydration

End-of-life decisions that focus on withholding or withdrawing nutrition and/or hydration present difficult choices at particularly vulnerable times for patients and families. Clinical ethics studies published in the last twenty years provide insight about the decision making process that can be useful to all parties involved. The purpose of the systematic research review is to synthesize empirical data about patient/surrogate decision making related to withholding or withdrawing nutritional sustenance toward the end of life, and contextual factors that influence their decision making. Future topics for clinical ethics research and clinical practice implications are posed.

Palliative fever management in Alzheimer patients. quality plus fiscal responsibility

Aggressive medical treatment of infections does not affect the progressive course of dementia of the Alzheimer type (DAT) and has limited effect on the mortality rate. Utilization of health care resources and discomfort during a fever episode were compared in three differing treatment conditions: in 18 patients in a dementia special care unit (DSCU) who received palliative management, 26 patients in a DSCU who were treated aggressively, and 17 DAT patients in traditional long-term care units who were treated aggressively. Both groups of patients in the DSCU had lower discomfort scores, lower utilization of high-cost health care resources, and higher utilization of analgesics and narcotics. A nursing model of care incorporating hospice concepts into the DSCU is suggested.

Survival analysis of hemophilia-associated AIDS cases in the US

Using national hemophilia-associated AIDS (acquired immunodeficiency syndrome) surveillance data and the life table method of survival analysis, the median length of survival of hemophilic patients in the United States after the diagnosis of AIDS was 11.7 months; the cumulative probability of survival at one year was 49.2 +/- 2.0 percent; at two years, 28.9 +/- 2.3 percent. Patients 13-29 years of age at the time of diagnosis had the longest survival and those 60 years and older had the shortest. Patients diagnosed since 1986 survived longer than those diagnosed before 1986. Length of survival did not differ significantly by race, coagulation disorder, AIDS manifestation at the time of diagnosis, or region of residence. Seven patients survived more than 36 months after AIDS was diagnosed. These patients were similar to those surviving for a shorter duration except that they were more likely to have met only the 1987 revision of the Centers for Disease Control AIDS surveillance case definition (as opposed to the 1985 case definition). Results of this study suggest that survival among hemophilic patients after the diagnosis of AIDS is similar to that reported by other investigators for other AIDS risk groups, excluding patients with Kaposi's sarcoma.