Sleep disturbance and disease activity in adult patients with inflammatory bowel diseases.

The aim of the study was to identify whether poor quality of sleep is connected to inflammatory bowel disease (IBD) and if so, whether sleep disturbances are related to disease activity. Prospective, observational cohort study was performed. In all enrolled adult patients, the disease activity was assessed by using Crohn's Disease Activity Index (CDAI) for Crohn's disease (CD) and Partial Mayo Score for ulcerative colitis (UC), respectively. All patients were also asked to respond to a questionnaire to define Pittsburgh Quality Sleep Index (PSQI). Sixty-five patients were enrolled in our study: n = 30 with CD and n = 35 with UC. The poor sleep was noted in 78% (40/51) patients with clinically exacerbation and in 35% (5/14) patients in remission (P = 0.002; OR 6.5, 95% confidence interval, 1.8 - 23.6). A global PSQI score of 5 points yielded a sensitivity of 84%, a specificity of 39%, and a positive predictive value of 89% for discriminating participants with exacerbation of IBD from those in clinical remission; PSQI higher than 6 indicates the exacerbation of IBD with 77% sensitivity and 62% specificity. The poorest sleep quality was reported in IBD patients with severe exacerbations (9.1 ± 2.9). Sleep disturbance was confirmed in adult IBD patients, both in CD and UC. Confirmation of the relationship between sleep abnormalities and IBD may show the new pathway in pathophysiology, course and treatment of IBD.

Effect of lateral position on arterial and venous blood gases in postoperative cardiac surgery patients.

BACKGROUND: Investigators have suggested that lateral position may have clinically significant effects on oxygenation in cardiac surgery patients. Presence of lung disease and type of cardiac surgery may be important considerations. OBJECTIVES: To determine the effect of position (left, right, supine) on blood gases in patients who have had coronary artery bypass or cardiac valvular surgery and to compare the effect of position on blood gases in cardiac surgery patients having preoperatively diagnosed lung disease with those having no lung disease. METHODS: A repeated measures design was used to study 120 mechanically ventilated, postoperative cardiac surgery patients. Subjects were randomly assigned a sequence of three positions (supine, and 45; right and left lateral) after cardiac surgery. Heart rate, respiratory rate, and arterial blood gas values were collected in each position. Venous blood gas values were collected from a subset of 40 subjects. RESULTS: A statistically significant effect of position on PaO2 was found in the group as a whole. The mean PaO2 in the left lateral position was lower than the value in the right or supine positions. No significant effects for position and pH, PaCO2, or bicarbonate were detected. No significant effects were found for type of surgery or the presence of absence of preoperative lung disease. A significant effect of position on venous pH was detected. No significant position effects were found for PvO2, PvCO2, bicarbonate, or venous saturation. No significant position effects were found for the calculated arterial-venous oxygen difference. CONCLUSIONS: The results of this study support those of previous research, which reported lower PaO2 in postoperative coronary artery bypass graft patients in the left lateral position. Mean differences in PaO2 were small, suggesting that the known benefits of lateral positioning in the early postoperative period outweigh the potential risks.

Effect of position on selected hemodynamic parameters in postoperative cardiac surgery patients.

BACKGROUND: Indirect/noninvasive blood pressure, heart rate and central venous pressure are frequently monitored hemodynamic parameters in postoperative cardiac surgery patients. No previous studies have explored the effect of lateral position on these variables in this population. OBJECTIVES: To determine differences in (1) blood pressure, central venous pressure, or heart rate measurements among postoperative cardiac surgery patients due to position (supine, 45 degrees right lateral, and 45 degrees left lateral), (2) responses to position between patients having cardiac surgery in which the myocardium was opened (valvular replacement) and those in which it was not (coronary artery bypass graft), and (3) responses to position between cardiac surgery patients having preoperatively diagnosed lung disease and those without lung disease. METHODS: Phlebostatic axis in lateral positions was determined by echocardiography and geometric diagrams prior to the initiation of data collection. Postoperative cardiac surgery patients (N = 120) were studied in the three positions in random sequences. In each position, simultaneous blood pressure measurements were obtained from each arm, and central venous pressure and heart rate were recorded. RESULTS: Statistically significant differences were found in response to position in systolic and diastolic blood pressure, central venous pressure, and heart rate. Certain positions produced greater changes in selected variables, both in the total group and within specific subgroups. No differences were found between coronary artery bypass graft and valve (closed or opened myocardium) subgroups or between subgroups with and without lung disease. CONCLUSIONS: Lateral positioning of postoperative cardiac surgery patients appears to cause no detrimental effects on indirect/noninvasive blood pressure or heart rate measurements. However, significant differences in central venous pressure may occur and supine positioning for determination of central venous pressure is recommended.

Reviews and summaries of research related to AACN 1980 research priorities: clinical topics.

This article reviews and summarizes the research conducted following publication of the 1980s American Association of Critical-Care Nurses' clinical research priorities. Original research conducted on the clinical priority topics between 1981 and 1991 was included. Review articles, doctoral dissertations, theses and abstracts were excluded unless judged to provide important information on the topic. Following the statement of each priority, progress in the area is summarized. Limitations and measurement issues are discussed as appropriate. Recommendations for future research are provided, and progress in the area is summarized.

Determining AACN's research priorities for the 90s.

The American Association of Critical-Care Nurses completed a three-phased process of priority identification for critical care nursing research. In phase 1, a 78-item survey was generated following a comprehensive review of potential research topics. In phase 2, approximately 1000 critical care nurses rated each item on the survey for importance to critical care nursing. Based on these results, the AACN Research Committee formulated a clinical and a nonclinical (contextual) list of research topics. Each list contained 25 topics. In phase 3, topics were given final rankings at a 1-day Consensus Conference on Research Priorities. Both Likert-type and magnitude estimation scaling were used to determine priority ranking of items on each list. As a result, both clinical and contextual research priorities were established for AACN.

Reviews and summaries of research related to AACN 1980 research priorities: contextual topics.

This article reviews and summarizes the research conducted following publication of the 1980s American Association of Critical-Care Nurses' contextual research priorities. Reports of original research conducted on the contextual priority topics between 1981 and 1991 were included. Review articles, doctoral dissertations, theses, and abstracts were excluded unless judged to provide important information on the topic. Following the statement of each priority, progress in the area is summarized. Limitations and measurement issues are discussed as appropriate. Recommendations for future research are provided, and progress in the area is summarized.

Effect of lateral positions on tissue oxygenation in the critically ill.

OBJECTIVE: The purpose of this study was to assess the effect of lateral positions on tissue oxygenation in critically ill patients. DESIGN: The study design was prospective and quasi-experimental, and we used a convenience sample with random assignment. SETTING: The study took place in the intensive care unit and the cardiac intensive care unit of a 450-bed medical center in the northwestern United States. PATIENTS: The sample included 12 adult patients with indwelling pulmonary artery and radial arterial catheters who were receiving mechanical ventilation and who met the criteria of "critical illness" by having impaired arterial oxygenation (PaO2 < or = 70 mm Hg) and/or cardiac index < or = 2.0 L/min/m2. OUTCOME MEASURES: The outcome measures were dependent variables reflecting oxygen delivery including heart rate, cardiac output, arterial oxygen content (CaO2) and oxygen consumption, and the adequacy of tissue oxygenation (serum lactate). INTERVENTION: Each patient was passively turned to each of the three positions (right and left 45 degrees lateral and supine) according to a computer-generated, randomized positioning sequence. Dependent variables were measured 15 minutes after each position change. No changes in ventilator settings or vasoactive drugs occurred during data collection. RESULTS: Analysis of variance for repeated measures was used in the data analysis. Post hoc analysis determined an effect size of 0.558 and power of 0.80 at an alpha level of.05. No statistically significant differences caused by position were found in mean CaO2, cardiac output, heart rate, respiratory rate, PaO2, SaO2, or lactate level. Pearson correlation analysis found no significant relationships between the primary variables reflecting oxygen delivery (cardiac output and CaO2) and serum lactate levels. CONCLUSIONS: These findings suggest that lateral positioning of critically ill patients who are hypoxemic or have low cardiac output does not further endanger tissue oxygenation. Evaluation of individual patient responses to position changes in the clinical setting is encouraged until further studies using more heterogenous populations can provide more definitive guidance.

Diagnosing alpha 1-antitrypsin deficiency.

Alpha 1-antitrypsin deficiency is a genetically transmitted disorder associated with an increased risk of emphysema and liver disease. The highest incidence occurs in whites of Northern European descent; the disorder affects between 70,000 and 100,000 individuals in the United States. Most persons with alpha 1-antitrypsin deficiency are misdiagnosed or undiagnosed. The laboratory tests used to screen for and diagnose the disorder are simple, inexpensive, and provide an opportunity to prevent the development of clinical disease through education about cofactor avoidance. This article provides a review of the epidemiology, genetics, and clinical presentation of this disorder.

Endothelins: new players in cardiovascular physiology and disease.

Intercellular signaling is an important factor in cardiovascular regulation and the development of disease. The endothelins (ETs) are a recently described family of signaling peptides that appear to be important in cardiovascular regulation. Initial studies showed ET to be a potent vasoconstrictor of vascular smooth muscle. Subsequently, ET binding and activity have been demonstrated in a wide variety of tissues, including cardiac, venular, adrenal, and neural. Numerous studies have implicated the ETs in cardiovascular diseases such as hypertension, heart failure, and atherosclerosis. This article briefly reviews ET signaling pathways and the roles ET may play in cardiovascular regulation and disease.

Exercise self-efficacy.

Practitioners have the opportunity to enhance the health of their patients by improving exercise adherence through appropriate exercise prescription and monitoring. Regular physical exercise can prevent or improve many of the chronic health conditions commonly observed in clinical practice. Unfortunately, efforts to help patients adopt an exercise program are often unsuccessful. Researchers have shown that exercise self-efficacy is an important predictor of the adoption and maintenance of exercise behaviors. Self-efficacy is the belief and conviction that one can successfully perform a given activity. Patient compliance with exercise prescriptions is more likely to be successful if exercise self-efficacy is assessed and enhanced. Several questions arise for practitioners who are encouraging their patients to exercise: What are the determinants of exercise self-efficacy? How can exercise self-efficacy be assessed in the clinical setting? What can be done to enhance exercise self-efficacy? This article reviews the research literature addressing these questions and presents tools for assessing self-efficacy and prescribing appropriate exercise in the low-active adult population.

Endothelin binding in brain of normotensive and spontaneously hypertensive rats.

The endothelins (ETs) are a recently discovered family of peptides which appear to be involved in hemodynamic regulation; they have potent vasoconstrictor properties and dose-related effects on blood pressure when administered peripherally. Little is known about the role of ET in the brain. The purpose of this study was to characterize the binding properties of various ETs in the brain of normotensive (Wistar-Kyoto) and hypertensive (spontaneously hypertensive) rats. [125I]ET 1 was prepared using the enzymobead lactoperoxidase method and purified by high-pressure liquid chromatography. Membrane fractions were prepared from homogenates of various brain regions. A differential distribution of ET binding was found among the 14 brain regions studied. The cerebellum, brainstem and area postrema/nucleus tractus solitarius had the highest binding, whereas the cortex, pituitary and septum had the least binding. Competition experiments performed with hypothalamus, brainstem and cerebellum demonstrated different Ki values for the ET studied. ET 2 had the highest affinity with a Ki of 4 x 10(-1) M, whereas the ET analog, Ala3,11-ET 1, had the lowest affinity with a Ki of 3 x 10(-10) M. Saturation experiments indicated a single class of high-affinity receptors in cerebellar (Kd = 2.5 x 10(-11) M, maximal binding Bmax = 1.25 x 10(-12) mol/mg) and hypothalamic membranes (Kd = 1.9 x 10(-11) M, Bmax = 0.93 x 10(-12) mol/mg). No differences in Kd or Bmax were detected between Wistar-Kyoto and spontaneously hypertensive rats hypothalamic and cerebellar tissues. The results of this study suggest a role for ET in the brain, but revealed no differences between normotensive and hypertensive strains.