Feasibility and effectiveness of school-based relaxation in lowering blood pressure.

Progressive muscle relaxation (PMR) is a broadly useful anxiety reduction technique that has been found to lower blood pressure (BP) in essential hypertension. The present investigation is the first to evaluate the feasibility and efficacy of wide-scale PMR instruction as a public health promotion strategy aimed at adolescents. Students (N = 1,400) in Grades 9 and 10 at two large Baltimore City public high schools underwent BP screening; those with BP persistently above the 85th percentile were randomly assigned to (a) 12 weeks daily PMR instruction provided in class for academic credit or (b) a control condition. The latter students had their BP measured at the same frequency as the PMR students and completed the PMR course during the following year. Approximately two thirds of eligible students entered and completed the study. Results demonstrated that treatment students (n = 51) enjoyed daily PMR, mastered the technique, and achieved reduced systolic BP at posttest relative to the untrained controls (n = 59). At follow-up 4 months later, group BP differences were not significant. Implications for use of PMR to promote cardiovascular health are discussed.

The differentiation hypothesis: distinguishing between perceiving and memorizing.

The differentiation hypothesis states that perceiving and memorizing are functionally undifferentiated for young children (preschoolers). With age, additional strategies are implemented under intentional recall conditions, thus providing greater recall than under incidental conditions. Appel and colleagues presented initial evidence in 1972 that appeared to support the predicted Age X Recall Instruction (incidental, intentional) interaction of the differentiation hypothesis. Subsequent research in children's memory, however, has failed to replicate the critical features of the Appel et al. data. A closer look at Appel et al.'s procedures revealed a methodological flaw present in both their Experiments 1 and 2--the variable of instructional condition was manipulated within subjects. In addition, an inspection of their reported Age X Instruction interaction revealed a larger quadratic than linear component. The difference between incidental and intentional recall first increased and then decreased with age. Correcting for these errors of method and analysis, the present experiment found no support for the differentiation hypothesis. Recall did increase with age, but the increase was not differential with respect to incidental or intentional recall instructions.

Microcomputer applications for home health-care services.

Principles in selecting a microcomputer system for use in a home health-care (HHC) service and potential applications for an HHC microcomputer system are described. To ensure that the quality of care provided to patients at home is comparable with that provided to inpatients, HHC services must be well organized, provide adequate channels of communication among staff members, and maintain complete and accurate records of the selection, training, therapy, evaluation, and follow-up of all home-therapy patients. A well-designed microcomputer system can increase the efficiency and accuracy with which those goals are met. Selection of a system should be based on the needs of a particular HHC service; factors that should be considered include whether the system will be compatible with other hospital computer systems and whether the majority of users will be able to operate the program easily. Potential applications for an HHC microcomputer system include printing labels for home-therapy products, calculating prices and providing billing data, maintaining prescription files, generating reports for drug-use review, and monitoring inventory levels. By employing an organized approach to the selection and implementation of a microcomputer system for a home health-care service, hospital pharmacists can make an important contribution to improving HHC service operations.

Home health-care bibliography.

A home health-care bibliography is presented. The bibliography includes a selection of references to descriptive reports, research papers, editorials, letters, and commentaries on home health-care (HHC) services. This bibliography represents important literature from the past 12 years on program planning, marketing, trends, and reimbursement for HHC services as well as specific types of home therapy. The bibliography can be helpful to pharmacy administrators and clinicians who are interested in designing HHC programs or becoming involved in the provision of home therapy.

Minimizing the risk of brain herniation during treatment of diabetic ketoacidemia: a retrospective and prospective study.

We studied retrospectively, 219 episodes of diabetic ketoacidemia in 119 patients aged 13 months to 30 years, to determine the trend of the concentration of sodium in serum as glucose declined during treatment of uncomplicated episodes and of episodes with complications attributable to brain swelling. Of 20 complication, 13 were minor (headache only) and 7 major (death or near death). The concentration of sodium in serum failed to rise as that of glucose declined in 82 (54%) of 164 uncomplicated episodes and in 18 (95%) of 20 complicated episodes (p less than 0.01). Hence complications were more likely to occur among patients with a failure of the concentration of sodium to rise as glucose declined. Fifty-eight episodes of diabetic ketoacidemia in 40 patients aged 1 1/2 to 20 years were then studied prospectively on a 48-hour treatment plan to provide the volume of deficit evenly, with half the deficit of sodium in the first 42 hours. Sodium concentration in serum rose in 55 (95%) of 58 episodes as that of glucose declined. No patient had a major complication. We conclude that failure of the sodium concentration measured in serum to rise as glucose concentration declines is a marker for excessive administration of free water. An expanded repair period, with repair fluid containing an average of 125 mmol/L Na+ early in therapy, will usually protect against a downward trend in the concentration of sodium in serum and therefore against a rapid decline in effective serum osmolality. This regimen may be protective against near-death episodes and brain herniation during treatment.

Use of an outpatient medical record audit to achieve educational objectives: changes in residents' performances over six years.

OBJECTIVE: To evaluate the effectiveness of a process whereby a faculty-resident committee annually audits outpatient record keeping and preventive care practices and provides feedback to resident physicians. DESIGN: Pre- and postfeedback audits with interventions and observations repeated over six consecutive academic years. SETTING: The adult primary care practice of housestaff in a university-affiliated hospital. SUBJECTS: All 139 physicians in an internal medicine residency program from 1981-82 through 1986-87, of whom 37 were present for three consecutive years. INTERVENTION: Each year, residents were given individualized, detailed, typewritten feedback based on audits of their outpatient records. MEASUREMENTS AND MAIN RESULTS: Each resident physician had a minimum of four (mean 5.2) outpatient records per year audited against standards for record-keeping practices and the provision of preventive care. Overall performance scores for each resident audit improved from a mean of 39.7 +/- 12.3 (SD) in 1981-82 to a mean of 58.5 +/- 14.1 (SD) in 1986-87 (possible range 0 to 100, observed range 9.4 to 86.6). The overall performance scores of individual residents, who received two cycles of feedback, improved an average of 11.5 (95% confidence limits 7.6, 15.3), from a mean of 48.4 +/- 11.4 (SD) during their first year of residency to 59.8 +/- 13.9 (SD) during their third year. General (primary care) and traditional-track residents improved at similar rates, although mean performance scores were consistently higher for general than for traditional-track residents. Analysis of variance revealed that all changes and differences were statistically significant. CONCLUSIONS: An ongoing chart audit and feedback system can be associated with improvements both in the performance of individual residents and in the long-term performance of a residency program.

Diminished pulse pressure under mental stress characterizes normotensive adolescents with parental high blood pressure.

An exaggerated blood pressure response to mental stress is believed to characterize young adults with genetic risk of essential hypertension, suggesting that stress-induced changes might provide a useful index of pathogenetic processes. We explored this by studying pressor responsivity to competitive tasks in adolescents drawn from a large urban population. Individuals with systolic or diastolic pressures persistently between the 85th and 95th percentiles were evaluated on basal blood pressure, parental history of hypertension, and pressor and heart rate response to a challenging video game. Basal pressure was measured again at 6, 10, and 14 months. A persistently diminished pulse pressure was the cardiovascular characteristic that most reliably typified normotensive subjects with familial hypertension. Response to the video game was the best indicator of risk status. Contrary to expectations derived from research with convenience samples, epidemiologic investigation points to an increased peripheral resistance and lower cardiac output as the cardiovascular pattern more prominently associated with genetic risk in the normotensive adolescent.