A pilot study of immune and mood outcomes of a community-based intervention for dementia caregivers: the PLST intervention.

Providing care to a family member with dementia is conceptualized as a chronic stressor with adverse psychological and physical effects. The purpose of this pilot study was to evaluate mood and immune outcomes of caregivers exposed to a community-based psychoeducational nursing intervention based on the progressively lowered stress threshold (PLST) model. The PLST intervention is designed to strengthen the psychological resources of dementia caregivers by teaching methods of preventing and/or managing behavioral problems exhibited by the person with dementia.

A nursing application of telecommunications. Measurement of satisfaction for patients and providers.

Consumer and provider satisfaction is key to the continued use and expansion of telehealth technology. This pilot study compared satisfaction of providers and patients with wound consultations done in person with those done via real-time interactive video technology. Eleven telehealth consultations with a nurse expert were immediately followed by an in-person consultation with a second nurse expert.

How accurate are chronic wound assessments using interactive video technology?

This project examined the accuracy of chronic wound assessments made using an interactive, video telecommunications system (Teledoc 5000, NEC America, Inc., Irving, TX) by comparing a nurse expert's in-person wound assessments with wound assessments made from taped Teledoc sessions. Wound assessments determined the absence or presence of nine wound characteristics instrumental in guiding treatment (e.

Translating pressure ulcer guidelines into practice: it's harder than it sounds.

Objective: To determine the cost-effectiveness of a guideline-based pressure ulcer prevention protocol over time.

Design: Retrospective and prospective quasi-experimental longitudinal design. Costs are presented from the long-term-care facility perspective.

Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes.

The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol.

A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability.

This paper reports on the development and testing of a tool designed to assess chronic wounds for the clinical signs and symptoms of localized infection. Thirty-one wounds were assessed by two independent nurse observers for the signs and symptoms of infection using the Clinical Signs and Symptoms Checklist. The Clinical Signs and Symptoms Checklist delineates 12 signs and symptoms of infection (i.

An instrument to measure healing in pressure ulcers: development and validation of the pressure ulcer scale for healing (PUSH).

Background: Currently, there is no instrument that provides an accurate and simple method of monitoring pressure ulcer healing in clinical practice. This article reports the two studies that were conducted to assess the validity of the Pressure Ulcer Scale for Healing (PUSH) as a tool to monitor healing of stage II-IV pressure ulcers.

Methods: Subjects in both studies (N = 103 and N = 269) were elderly (mean Study 1, 75 years, mean Study 2, 80 years), and the majority were women (Study 1, 51%, Study 2, 70%).

The validity of the clinical signs and symptoms used to identify localized chronic wound infection.

It is uncertain how accurately classic signs of acute infection identify infection in chronic wounds, or if the signs of infection specific to secondary wounds are better indicators of infection in these wounds. The purpose of this study was to examine the validity of the "classic" signs (i.e.

Braden scale: validity in community-based older adults receiving home health care.

The purpose of this study was to examine the validity of the Braden Scale and optimal frequency of risk reassessment in older adults receiving home health care. Data were collected from the records of 1,711 nonhospice patients aged 60 years or older who did not have pressure ulcers at the beginning of home health care. Patient records were followed forward chronologically to one of two outcomes: pressure ulcer development or pressure ulcer absence (pressure ulcer free when home health services were no longer required, institutionalization, death, or end of study period).

Beta blockade in patients with congestive heart failure. Why, who, and how.

In patients with CHF, physicians should aim to treat the LV dysfunction, not just the CHF symptoms. LV dysfunction is a chronic disease that is usually progressive, even when it seem compensated. The risk of sudden death or progressive CHF is very real.

Accuracy of Doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates.

Pulmonary hypertension has been associated with poor outcome after liver transplantation. We assessed the diagnostic accuracy of Doppler echocardiography in detecting significant pulmonary hypertension. Seventy-four potential liver transplant candidates underwent Doppler echocardiography in which the systolic right ventricular pressure (RVsys) was used to estimate the systolic pulmonary artery pressure (PAsys).

Do oxygen-enriched atmospheres exist beneath surgical drapes and contribute to fire hazard potential in the operating room?

The purposes of this study were to (1) describe the microenvironment in terms of oxygen concentration beneath the drapes of healthy subjects who were simulating patients undergoing minor surgical procedures with supplemental oxygen and to (2) evaluate the efficacy of using a scavenger system beneath the drapes. A convenience sample of 12 healthy volunteer subjects was studied in an ambulatory surgery center operating room, which was ventilated with 25 air exchanges per hour. The study was carried out in 2 parts.

Heart transplantation for radiation-associated end-stage heart failure.

Radiation-induced heart disease is an increasingly recognized late sequela of mediastinal radiation therapy for malignant neoplasms. We report four cases of heart transplantation for end-stage heart failure induced by mediastinal radiation therapy. Short-term and intermediate-term results are excellent with all four patients currently surviving a mean of 48 months after transplantation.

Pressure ulcers in community-based older adults receiving home health care. Prevalence, incidence, and associated risk factors.

Objectives: To determine the prevalence and incidence of pressure ulcers in community-based adults receiving home health care and to identify risk factors for incident Stage II to IV pressure ulcers.

Design: Retrospective cohort study.

Setting: A large midwestern urban home health care agency.

Effect of electrical stimulation on chronic wound healing: a meta-analysis.

The purpose of this meta-analysis was to quantify the effect of electrical stimulation on chronic wound healing. Fifteen studies, which included 24 electrical stimulation samples and 15 control samples, were analyzed. The average rate of healing per week was calculated for the electrical stimulation and control samples.

Improvement in pulmonary hemodynamics during intravenous epoprostenol (prostacyclin): A study of 15 patients with moderate to severe portopulmonary hypertension.

Pulmonary hypertension associated with increased pulmonary vascular resistance (PVR) and occurring in the setting of portal hypertension is referred to as "portopulmonary hypertension." Intravenous epoprostenol (prostacyclin) is a potent pulmonary and systemic vasodilator with antithrombotic properties. It can decrease PVR and pulmonary artery pressure in patients with primary (idiopathic) pulmonary hypertension.

Pressure ulcer research: pressure ulcer treatment. A monograph from the National Pressure Ulcer Advisory Panel.

The AHCPR guideline on Treatment of Pressure Ulcers was released in December 1994. This guideline was based on the best available scientific evidence published between 1966 and May 1, 1993. Over 45,000 abstracts were reviewed in the literature analysis.

Nursing assessment: impact on type and cost of interventions to prevent pressure ulcers.

Objective: To describe pressure ulcer preventive interventions and their cost, and to compare the preventive intervention use and cost with level of risk.

Design: Comparative, descriptive design.

Setting And Subjects: A large midwestern Veteran's Affairs Medical Center with 260 long-term care beds.

Cost-effectiveness of an intensive pressure ulcer prevention protocol in long-term care.

Conducted in a 77-bed long-term-care facility, this study compared the costs of implementing an intensive pressure ulcer prevention protocol plus the calculated costs of treatment before and after implementing the protocol. A total of 69 patients comprised the preprotocol sample; 16 of them developed 26 ulcers. The postprotocol sample consisted of 63 patient, 3 of whom developed 5 ulcers.

Pressure ulcer healing: what is it? What influences it? How is it measured?

Defining healing requires a set of measurements that quantify the physical factors that change during healing. Such a list of measures gives a de facto definition of what constitutes pressure ulcer healing and what influences it. This paper attempts to answer a more specific question: Which measurements are strong candidates for inclusion in a tool for monitoring pressure ulcer healing? Three sets of clinical measurements are analyzed--the assessment proposed by the Agency for Health Care Policy and Research Guideline Development Panel for the Treatment of Pressure Ulcers; the recommendations of the Wound Healing Society; and the Pressure Sore Status Tool.

Recipient selection and management before cardiac transplantation.

Cardiac transplantation is a proven, effective therapy for selected patients with end-stage congestive heart failure. Recipient selection is performed by a multidisciplinary team consisting of transplant physicians and surgeons. Clinicians responsible for patient assessment must establish the severity of cardiac dysfunction, formulate a prognosis, and stratify patients according to risk for mortality.

Adjuvant therapy for ulcer care.

Adjuvant therapies, specifically electrotherapy, hyperbaric oxygen, ultrasound, and hydrotherapy, are considered increasingly for use with conventional local wound care to support healing of pressure ulcers. This article describes the characteristics of these modalities, their physiologic effects on the healing process, and the research to evaluate their efficacy.