Physiological improvement with moderate exercise in type II diabetic neuropathy.

OBJECTIVE: The objective of this study was to demonstrate improvement in nerve function with moderate exercise in patients with type II diabetic neuropathies. RESEARCH DESIGN AND METHODS: Fives subjects with type II diabetes mellitus and distal, predominantly sensory polyneuropathies were studied. The subjects completed an 8-week program of a supervised moderate exercise program (40-75% of maximal 02 uptake reserve) with a subsequent 16-week program of monitored similar exercise. The same experienced electrophysiologist performed the electrodiagnostic studies both before and after the 24-week exercise period. These studies monitored physiological changes (conduction velocities, response amplitudes) in motor and sensory fibers as well as F-wave latencies. RESULTS: The exercise program produced a documented increase in aerobic exercise capacity. Despite the small number of subjects studied and the relatively short exercise period, there was a statistically significant improvement in nearly all electrophysiological parameters evaluated post exercise including motor conduction velocities and amplitudes, sensory conduction velocities, and F-wave latencies. This improvement included a statistically significant improvement in absolute median motor evoked response amplitudes as well as the recording of sensory nerve action potentials not present prior to exercise. There were no adverse effects from the exercise. CONCLUSIONS: This study supports the hypothesis that exercise can be performed safely in patients with type II diabetic neuropathies and can produce improvement in their nerve function. This study also supports the hypothesis that ischemia may have a meaningful role in the pathogenesis of neuropathies in patients with type II diabetes mellitus.

Patients' perspective on the comprehensive preventive health evaluation in veterans with spinal cord injury.

STUDY DESIGN: Survey research methods. OBJECTIVES: To assess patient satisfaction with the annual comprehensive preventative health evaluation (CPHE) and to determine if the patient's needs were being met. SETTING: Department of Veterans Affairs National Survey, United States. METHODS: A total of 853 subjects with spinal cord injuries participated in a mailed survey regarding the annual CPHE. Subjects were asked about satisfaction with the examination, preferences on how the examination is conducted and whether their needs were being met with the examination. RESULTS: In all, 76% of the subjects that responded to the survey had completed a CPHE within the previous year. Subjects cited getting their medication and supplies refilled and talking to the doctor as the top two reasons for completing the evaluation. Subjects indicated that they would most like to discuss their muscle strength and weakness, bladder care, chronic pain, digestion and bowel care issues, and equipment problems during their evaluation. The majority of subjects (81%) indicated that they were satisfied with the CPHE. Subjects that were satisfied with the CPHE were also more satisfied with other aspects of care as well. CONCLUSION: The majority of respondents had completed a CPHE within the previous year. Most respondents cite health issues related to the spinal cord injury as areas they would most like to discuss during the evaluation. The majority of subjects were satisfied with the conduct of the CPHE.

Breathing pattern retraining and exercise in persons with chronic obstructive pulmonary disease.

Breathing pattern retaining, in the form of pursed-lip breathing, has been used as one method in pulmonary rehabilitation to help alleviate the symptoms of dyspnea endured by people who suffer from airflow obstruction secondary to chronic obstructive pulmonary disease (COPD). Other techniques such as biofeedback also have been successfully used. This article describes the altered breathing patterns used by patients with COPD at rest and during physical activity. The literature is reviewed regarding techniques of breathing pattern retraining that have been developed to improve the capacity of persons with COPD to perform activities of daily living, a primarily rehabilitative outcome.

Spouse quality of life before and 1 year after heart transplantation.

These results indicate that overall perceived quality of life in spouses of heart transplant patients did not change significantly from the pretransplant period to 1 year posttransplantation. Conversely, specific factors influencing quality of life such as health, socioeconomic satisfaction, family satisfaction, coping styles, and the impact of the transplant experience on the spouses' life did change after transplantation. One year after heart transplantation, spouses reported less satisfaction with their health and socioeconomic status but more satisfaction with their family than they experienced before the transplant. In addition, spouses used less fatalistic, emotive, optimistic, and self-reliant coping styles after transplant than before. Lastly, spouses perceived the transplant experience more positively after the transplant than they did before the transplant. An ideal analysis would encompass data collected at more frequent periods pretransplantation and posttransplantation. The significant negative change found in the spouses' perceived health 1 year after transplant when compared with the spouses' perceived health before the transplant was based on a single-item question. A more comprehensive measure is needed to assess the health changes in the spouse that take place over time. This investigation highlights the importance of studying the impact that a catastrophic illness has on family members and the patient. As health care systems cut costs and streamline production, the needs of spouses and family members are more likely to be ignored. As a result, at some point in the future they could enter the health care arena as patients themselves. Early interventions are thus necessary to support family members of patients during the illness and throughout the recovery trajectory.

Impact of the heart transplant waiting process on spouses.

BACKGROUND: Practitioners working with candidates for heart transplants and their families know that the heart transplant waiting process is psychologically stressful and demanding. Spouses of heart transplant candidates struggle with multiple demands. Although many have studied the impact of heart transplantation on patients, only a few investigators have studied the impact of the heart transplant waiting period on spouses. METHODS: Using survey research methods, we studied the impact of the heart transplant wait on the lives of 85 spouses of heart transplant candidates from three sites using the following: Spouse Transplant Stressor Scale, Jalowiec Coping Scale, Family Inventory of Resources for Management, Quality of Life Index, a six-item rating scale, and a demographic form. RESULTS: One-third of the sample (30.6%) believed that the heart transplant waiting experience had a negative impact on their life, two-thirds (65.9%) believed it had a positive impact, and 3.5% believed that the heart transplant experience had no impact on their life. The longer the patient partner waited for a heart transplant, the more negative the impact was on the spouse's life (r = -0.23, p = 0.04). Spouses experiencing a negative impact from the heart transplant experience reported higher stressor scores (F = 3.74, p = 0.03), used more negative coping strategies (F = 3.69, p = 0.03), and had a lower quality of life (F = 3.28, p = 0.04). CONCLUSIONS: Spouses who reported a more negative impact from the heart transplant waiting experience were under more stress, used negative coping strategies, reported a lower quality of life, and had patient partners who waited longer for a heart.

Spouse stressors while awaiting heart transplantation.

OBJECTIVES: The objectives of this study were to identify common stressors experienced by spouses of heart transplantation (HT) candidates; to identify differences in stressors among spouses of HT candidates based on selected demographic variables; and to report preliminary psychometric data on the newly developed Spouse Transplant Stressor Scale. DESIGN: Comparative, cross-sectional survey. SAMPLE: Spouses of 85 HT candidates awaiting HT at midwestern and southeastern medical centers and a midwestern Department of Veterans Affairs hospital. MEASURES: Spouse Transplant Stressor Scale (Collins), an investigator-developed rating form and demographic data sheet. RESULTS: Spouses of HT candidates reported high levels of stress during the wait for a donor heart. Factors related directly to the transplantation experience were rated as the most stressful. Fear that the patient (partner) would die before a heart became available was the worst stressor for the spouses. Working spouses perceived more stressors related to responsibility, socioeconomics, and self. Stressors associated with the transplantation process itself were equally stressful for spouses who work and spouses who do not work.

Decisions not to transplant: futility or rationing.

Since the 1980s, heart transplantation has become an acceptable treatment therapy for patients with end-stage congestive heart failure. In recent years, the demand for heart transplantation has exceeded the supply of available organs. Potential transplant candidates undergo rigorous screening to determine which patients will be offered transplantation as a treatment option. Heart transplant recipients are selected based on a determination of which patients will experience an improvement in symptomatology, functional class ability, and life expectancy after transplantation. Refusal of transplantation for an individual patient is usually framed in a futility argument: Either transplantation will not benefit the patient or the risks involved in undergoing the transplant are considered to outweigh the benefits. However, futility is an elusive and ambiguous concept. Furthermore, although authors, clinicians, and ethicists argue for the separation of futility and rationing issues, clearly it is not always possible to do so. The purpose of this article is to argue that many decisions to refuse heart transplantation are actually based on the rationing of organs and not on futility.

Cardiac allograft vasculopathy.

As the survival rates for cardiac transplant patients improve, the long-term complications of the procedure are becoming apparent. One such complication is a rapidly progressing form of coronary artery disease known as cardiac allograft vasculopathy (CAV). CAV is a major limiting factor in long-term graft survival. It is thought to develop immediately after transplantation, although initially it may be unrecognized because of a lack of sensitive screening techniques. It is estimated that 12% of cardiac transplant recipients will develop CAV each year after transplantation. Most researchers agree that CAV is primarily an immune-related response to transplantation. However, other factors such as hyperlipidemia and obesity have also been implicated as predictors of CAV. This article explores the pathophysiology, risk factors, detection, and treatment of CAV in the cardiac transplant population.

Cardiac retransplantation: determining limits.

OBJECTIVE: Cardiac transplantation has become an acceptable treatment option for end-stage congestive heart failure. Because of the increasing demand, there are not enough hearts to supply all patients in need of cardiac transplantation. This significant supply and demand imbalance necessitates that rationing decisions be made. This article will explore decisions made surrounding cardiac retransplantation. CONCLUSIONS: Early statistics suggest that survival for patients undergoing retransplantation is lower than first-time transplant recipients. In addition, the question of justice or fairness arises. Patients who are offered second and third heart transplants may deprive a significant number of patients who have not had their first chance at transplantation. The authors propose, based on medical suitability, respect for autonomy, and the principle of justice, that cardiac transplantation be a one-time treatment option. Retransplantation should not be allowed.

Increasing practice-based research: doctorally prepared clinical nurse specialists may be the answer.

The CNS role is proposed as an expert practitioner, educator, consultant, and research within a specialty area. The role, as originally envisioned, was to bridge the gap between practice and research. The research component of the role is frequently given the least emphasis in actual practice. This is problematic for a practice discipline building its scientific base. Many have proposed collaborative practice models to remedy this situation. This paper proposes that a CNS, prepared at the doctoral level, may be the more appropriate solution. Because CNSs maintain a strong practice base, they directly observe problems in the practice setting. With the appropriate research preparation, doctorally prepared CNSs can be in a position to solve clinical problems and advance the science of nursing.

Sexual harassment . . . some see it . . . some won't.

Is sexual harassment a serious issue for managers, and does it occur as much in business as the popular press would have us believe? How difficult will it be to implement the newly issued EEOC guidelines? Out of a joint survey with Redbook magazine, HBR takes a look at these and other questions. Eliza Collins and Timothy Blodgett explore definitions of harassment, analyze respondents' replies, and suggest ways to counter the problem.