[Psychosomatic aspects of chronic pelvic pain syndrome. Psychometric results from the pilot phase of an interdisciplinary outpatient clinic]. / Psychosomatische Aspekte des chronischen Unterbauchschmerzsyndroms. Psychometrische Ergebnisse der Pilotphase einer interdisziplinären Sprechstunde.

BACKGROUND: Chronic pelvic pain syndrome (CPPS) presents as a multicausal disorder. Complex interactions of psychological factors with somatic dysfunctions are crucial to the development and maintenance of CPPS. AIM: This study characterized the patient cohort from a psychosomatic perspective. MATERIAL AND METHODS: Subjects with CPPS were recruited from an interdisciplinary CPP outpatient clinic. Sociodemographic data, symptoms (National Institutes of Health Chronic Prostatitis Symptom Index, NIH-CPSI) and pain-related factors (Short Form of the McGill Pain Questionnaire, SF-MPQ) as well as depressive symptoms (Patient Health Questionnaire 9, PHQ-9), anxiety [Generalized Anxiety Disorder 7-item (GAD-7) Scale], the severity of somatic symptoms (PHQ-15) and quality of life (Short Form-12, SF-12) were measured. Additional socioeconomic data were obtained. RESULTS: A total of 50 men and women with a mean disease duration of 5.8 years were included in the study. The disease-related symptom severity and healthcare utilization were high. All psychometric scales showed significantly lower values compared with the general population. A high symptom burden was associated with high psychopathological findings and reduced quality of life. CONCLUSION: The psychopathological comorbidities in subjects with CPPS require specific evidence-based diagnostic and treatment methods to reduce psychopathology and improve quality of life.

Self-care research: How to grow the evidence base? (reprint).

BACKGROUND AND OBJECTIVE: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. METHOD: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. RESULTS: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. CONCLUSION: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.

Self-care research: How to grow the evidence base?

BACKGROUND AND OBJECTIVE: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. METHOD: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. RESULTS: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. CONCLUSION: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each other's work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care.

Selective microsurgical treatment of giant intracranial aneurysms.

Giant intracranial aneurysms are defined as greater than 25mm in diameter. They share the same surgical challenges and strategies as so-called complex aneurysms, sometimes smaller in size but presenting with similar complex anatomy. The surgical difficulties arise from the size of the sack, the presence of intraluminal thrombus, the thickness of the arterial wall, and the complexity of arterial branching on the neck. Preoperative imaging gathers complementary information from magnetic resonance imaging, computed tomographic angiography, and rotational catheter-based angiography with three-dimensional reconstruction including balloon-test occlusion. The therapeutic decision-making needs a multidisciplinary approach including endovascular, neurosurgical and anesthesiological expertises. The microsurgical treatment needs a step-by-step preoperative planning with anticipation of possible pitfalls and alternative strategies. Classical principles of aneurysm surgery have to be tailored to face the difficulties arising from the size of the sack and from the arterial wall calcifications.

Quality of life one year post-Shiga toxin-producing Escherichia coli O104 infection--a prospective cohort study.

BACKGROUND: In 2011, a major outbreak of hemolytic-uremic syndrome (HUS) and bloody diarrhea related to infections from Shiga toxin-producing Escherichia coli O104 (STEC) occurred in Germany. While previous research has focused on the medical components of this disease, we aimed to investigate the course of health-related quality of life (HrQoL) over 12 months including somatic and psychosocial risk factors. Furthermore, the influence of chronic fatigue (CF) on HrQoL was examined. METHODS: A prospective cohort study with n = 389 patients completing self-report scales at baseline, after 6 months (participation rate: 79%) and after 12 months (participation rate: 77%). The courses of physical and mental HrQoL over the 12 month period were calculated by employing general linear mixed models. KEY RESULTS: While the physical component score of HrQoL reached a score comparable to the general population, the mental component score remained below average 12 months after STEC infection. Female gender, prior psychiatric disorder, and prior traumatic events were risk factors for a worse HrQoL course after 12 months, while social support was identified to be protective. CF was associated with low HrQoL. In addition, the somatic symptom burden remained persistently high. CONCLUSIONS & INFERENCES: Our results show high somatic and psychosocial burden in patients 12 months after STEC infection. We recommend considering the risk factors and protective factors of poor HrQoL early in the treatment of STEC or similar diseases. Patients who are suffering from persisting somatic symptoms, CF, and impaired HrQoL may require specific aftercare.

Early onset pneumonia in neurosurgical intensive care unit patients.

To investigate early onset pneumonia in a neurosurgical intensive care unit, we studied a cohort of patients over a 13-month period and compared neurotrauma (T) with non-neurotrauma (NT) patients. Data were abstracted from the infection surveillance database. Five hundred and sixty-five adults were hospitalized in the neurosurgical intensive care unit. 57.9% had trauma and 129 patients developed 152 episodes of pneumonia. Incidence rates, restricted to the 129 first episodes of pneumonia, were 20.1 versus 15.7/1000 patient days and 34.2 versus 27.9/1000 ventilation days, in the T and NT groups respectively. In both groups, the distribution of risk stratified by hospital days was bimodal, being highest during the first three days. However, the risk was higher for T patients (at day 3, 20/1000 ventilation days versus 10.2/1000 ventilation days). The daily risk peaked again at days 5 and 6, and thereafter remained low. Pneumonia occurring within the first three days, or early onset pneumonia (EOP), was associated with trauma (P = 0.036) and, in the NT group only, with a Glasgow coma scale score lower than 9 (P = 0.062). EOP was caused by Staphylococcus aureus (33%), Haemophilus spp. (23%), other Gram-positive cocci (22%), and other Gram-negative bacilli (GNB) (19%); whereas after the third day GNB other than Haemophilus spp. accounted for 45.4% of isolates (P = 0.11). This large series confirms the high incidence of EOP in neurosurgical intensive care units, particularly among trauma patients, in relation to risk factors different from those seen in other intensive care patients. Further studies are needed to elaborate specific preventive measures during early care.

Contributors to cardiac invalidism after acute myocardial infarction.

Cardiac invalidism is a term used repeatedly in the literature during the past few decades, but little attention has been given to studying the variables contributing to this phenomenon. Data were collected from 111 patients with first acute myocardial infarction. Patients were visited at home 1 month and 4 months after hospital discharge. Social support, self-esteem, health perceptions, emotional distress, interpersonal dependency, and neuroticism were measured using standardized instruments. Illness severity was determined using the Coronary Prognostic Index, the Specific Activity Survey, and treadmill testing results. Neuroticism and social support were significant predictors of cardiac invalidism 4 months after myocardial infarction. Illness severity was not a significant predictor of cardiac invalidism or return to work. The only significant predictor of return to work was health perception. Patients receiving more support than desired experienced less cardiac invalidism after acute myocardial infarction. Physicians are encouraged not to assume that patients with large infarcts will become cardiac invalids. Psychologic recovery may require more than 4 months for many patients, but positive messages regarding patient health can influence such outcomes. Families and friends should be taught to provide appropriate types and amounts of support. The amount of support typically thought to be adequate may not be sufficient. Patients who initially receive more support than desired experience the best psychologic outcomes. High levels of support need not continue indefinitely.

Training nontraditional responders to use automated external defibrillators.

The American Heart Association is championing a national effort to make automated external defibrillators available to the public. Clinicians are beginning to grapple with the complexities involved in training laypersons to use these devices. The article reviews the experience of researchers involved in such training. Suggestions for training of nontraditional responders are derived from a review of the literature and are integrated with suggestions from active field investigators and the participants in a workshop on this topic held during the American Heart Association Public Access Defibrillation II Conference in Washington, DC (April 17-19, 1997). So far, widespread training of traditional first responders such as police and firefighters to use automated external defibrillators appears to be safe and effective. The data from studies in which nontraditional responders were trained are not as convincing. Further research is needed before we can assume that training of the public will be as easy and effective as training of traditional first responders.

Thoughts, feelings, and motivations of bystanders who attempt to resuscitate a stranger: a pilot study.

BACKGROUND: Rates of bystander cardiopulmonary resuscitation remain low nationwide. Possibly, low rates can be explained by examining the reactions of laypersons who attempt to resuscitate a stranger. OBJECTIVE: To examine the thoughts, feelings, and motivations of laypersons who have attempted to resuscitate a stranger. METHOD: Survey methods were used to do a qualitative study of 12 laypersons who had provided bystander resuscitation. A 36-item questionnaire of predominately open-ended questions was used to elicit retrospective information about the laypersons' thoughts, feelings, and motivations during several stages of the resuscitation event. Data were analyzed by using content analysis. RESULTS: Thoughts about the event included curiosity, questioning of personal capability, and recognition of differences between classroom training and real-life events. Feelings included hope, euphoria, pride, relief, satisfaction, hopelessness, doubt, agitation, anger, sadness, and fear. Primary motivations were duty and responsibility, guilt and social pressure, and altruism. All participants reported that they had excellent recall of the event. CONCLUSION: These results provide insight into a population that acts on behalf of the medical community.

Are nurses still practicing coronary precautions? A national survey of nursing care of acute myocardial infarction patients.

BACKGROUND: Coronary precautions were common when coronary care units were instituted in the 1960s. However, research has failed to provide evidence of the validity of most of these restrictions. Only the avoidance of the Valsalva maneuver is clearly indicated as a universal precaution in patients who have experienced acute myocardial infarction. OBJECTIVES: To determine if nurses continue to restrict iced and hot fluids, caffeine, rectal temperature measurement, and vigorous back rubs, and to feed and mandate bedrest for acute myocardial infarction patients. METHODS: Survey techniques were used to describe practice patterns of nurses working in hospitals across the United States. Two sampling methods were used to access a random sample. The survey was mailed to members of the American Association of Critical-Care Nurses and nonmembers working in a hospital accredited by the American Hospital Association and with an intensive care unit. RESULTS: Of the 2549 mailed surveys, 882 were returned with usable data (34.8% response rate). Iced (28.1%) and hot (8.7%) fluids continued to be restricted by nurses. Most (85.6%) restricted stimulant beverages such as coffee. Rectal temperature measurement was avoided by 55.7%, and only 73.3% taught avoidance of the Valsalva maneuver. In terms of rest, 15.6% reported avoiding vigorous back rubs, 8.4% still fed patients, and 33.8% offered bedpans to pain-free patients on the first day after admission. A complete bedbath was offered by 19.8% of nurses to stable, pain-free patients even a day after admission. CONCLUSIONS: The data supporting liberalization of coronary precautions have not been adequately disseminated.

Effects of a bedbath on mixed venous oxygen saturation and heart rate in coronary artery bypass graft patients.

OBJECTIVE: To determine the physiologic effects of a bedbath on critically ill patients. METHODS: Thirty hemodynamically stable coronary artery bypass graft patients were studied less than 24 hours after surgery in a repeated measures, quasi-experimental design. Study sites were the medical/surgical and coronary intensive care units of a large community hospital in the south-central United States. Two bedbaths consisting of bathing and turning phases were given to subjects early (mean, 3.6 hours) and late (mean, 18.5 hours) in the immediate postoperative period. Mixed venous oxygen saturation (Svo2) and heart rate were recorded at 1-minute intervals before, during, and for 5 minutes after each bedbath. RESULTS: Mean Svo2 decreased from baseline during the bathing phase of early and late bedbaths 1.6% and 1.9%, respectively, whereas mean heart rate increased from baseline 3.2% and 1%, respectively. During the turning phase, mean Svo2 decreased from baseline 9.2% and 12.1%, respectively, whereas mean heart rate increased from baseline 5.2% and 1.8%, respectively. Svo2 declined to less than 53% in 10 (33%) subjects during both early and late bedbaths. The most severe decreases in Svo2 occurred during early bedbaths and were usually associated with coughing, shivering, and/or agitation. CONCLUSIONS: Early bedbaths caused more dramatic declines in Svo2 than late bedbaths. Coughing, shivering, and agitation accentuated Svo2 declines and could be prevented by waiting to bathe coronary artery bypass graft patients until 1 day postoperatively. Routine bathing, at least in the early postoperative period, should be reconsidered.

Clinical safety and cost of heparin titration using bedside activated clotting time.

OBJECTIVE: To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time. DESIGN: Quasi-experimental study using data gathered through retrospective record review. SETTING: Coronary care, medical intensive care and telemetry units of a community hospital. SUBJECTS: Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty. INTERVENTION: Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time. RESULTS: No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time. CONCLUSION: These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.

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.

Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units.

BACKGROUND: Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels. OBJECTIVES: To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments. METHODS: In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record. RESULTS: Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05). CONCLUSIONS: Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.

Differences between men and women in anxiety early after acute myocardial infarction.

BACKGROUND: Anxiety after acute myocardial infarction influences both short- and long-term recovery. Therefore, determining specific subgroups of patients who have relatively higher anxiety levels is important. Published findings about gender differences in anxiety after acute myocardial infarction are conflicting. OBJECTIVES: To determine whether gender differences in anxiety after acute myocardial infarction exist and whether any of the sociodemographic and clinical variables that often differ between men and women with acute myocardial infarction interact with gender to influence anxiety. METHODS: A total of 424 patients with confirmed acute myocardial infarction were enrolled in this multicenter prospective study. Patients' anxiety level was measured within 72 hours of their arrival at the hospital by using the State Anxiety Inventory and the Brief Symptom Inventory. RESULTS: Women had significantly higher anxiety than did men according to both the State Anxiety Inventory (42 +/- 12.9 vs 37.7 +/- 12.5; P = .001) and the Brief Symptom Inventory (0.83 +/- 0.97 vs 0.63 +/- 0.71; P = .02). Of the sociodemographic and clinical variables examined, only marital status and income significantly interacted with gender to influence anxiety. Married women had higher anxiety than did single and widowed women, and married men had lower anxiety than did single men. Women with lower income had higher anxiety than did women with higher income; income was not related to anxiety in men. CONCLUSION: Women report significantly greater anxiety early after acute myocardial infarction than men do. Women's greater anxiety may be partially explained by marital status and lower income at the time of the infarction.

Gender differences in adjustment to acute myocardial infarction.

OBJECTIVE: To compare psychosocial adjustment, functional class, and return to work in a matched sample of women and men experiencing a first acute myocardial infarction (AMI). DESIGN: Longitudinal survey. SETTING: Subjects were identified from six hospitals in the Southern California area. Data were collected in the home setting 1 and 4 months after hospital discharge. SUBJECTS: Data on 32 women experiencing a first AMI were matched on neuroticism and cardiac dysfunction with 32 men from the same sample. MEASURES: The following instruments were administered 1 and 4 months after hospital discharge: Self-Perception Inventory (self-esteem); Profile of Mood States (emotional distress); General Health Perceptions Questionnaire (health perceptions); Interpersonal Dependency Inventory (dependency); and the UCLA Social Support Inventory (social support). The Eysenck Personality Inventory (neuroticism) was administered at 1 month. Cardiac dysfunction was measured with data available from the hospital record. Functional class was measured at 1 month with the Specific Activity Scale. Self-report of demographics and return to work were obtained 1 and 4 months, respectively. RESULTS: Women experienced improved perceptions of current health whereas their ratings of prior health decreased. Overall emotional distress, anxiety, and depression decreased significantly over time in women. Women reported wanting, receiving, and giving more support than men did at 1 month and receiving and giving more support than men did at 4 months, although stress in support relationships rose over time. In men anxiety, depression, and health concern all decreased significantly over time whereas their ratings of prior health rose. The match between social support wanted and received decreased over time in males as did their satisfaction with the support received. Men reported a higher functional class than women at 1 month, but return to work at 4 months did not differ. CONCLUSIONS: Both women and men experienced improved psychologic adjustment within 4 months after AMI, although the specific areas of improvement differed. Return to work was comparable in spite of differences in functional class. The women appeared to activate their social support system more effectively than the men after AMI. Further research is needed to determine whether differences in social support contribute to adjustment that is better than what normative data predict for women.

Predictors of self-care in persons with heart failure.

OBJECTIVE: The objective of this study was to test a model of individual patient characteristics, covering symptom severity, comorbidity, social support, education, age, socioeconomic status, and gender, derived from Connelly's Model of Self-Care in Chronic Illness as predictors of self-care in heart failure. DESIGN: This was a nonexperimental correlational study. SETTING: The study took place in 6 hospitals in southern California. PATIENTS: The study included 209 patients diagnosed with heart failure by their physicians. The typical study participant was age 73 years, Class III, married, grade-school educated, and earning an income of less than $20,000 per year. The genders were almost equally represented. OUTCOME MEASURE: Self-care was measured by the Evaluating the Change subscale of the Self-Management of Heart Failure Instrument. RESULTS: The model of 7 variables, analyzed by using multiple regression analysis, explained 10.3% of the variance in self-care. Only 2 of the variables were significant predictors of self-care: education (P =.009) and symptom severity (P =.046); 89.7% of the variance remained unexplained. CONCLUSIONS: Persons with higher education and those who are symptomatic may be more likely to engage in self-care than those who are poorly educated or asymptomatic. Further research is needed to confirm these Results and identify other predictors of self-care.

Does overprotection cause cardiac invalidism after acute myocardial infarction?

OBJECTIVE: To determine if overprotection on the part of the patient's family and friends contributes to the development of cardiac invalidism after acute myocardial infarction. DESIGN: Longitudinal survey. SETTING: Nine hospitals in the southwestern United States. SUBJECTS: One hundred eleven patients who had experienced a first acute myocardial infarction. Subjects were predominantly male, older-aged, married, caucasian, and in functional class I. Eighty-one patients characterized themselves as being overprotected (i.e., receiving more social support from family and friends than desired), and 28 reported receiving inadequate support. Only two patients reported receiving as much support as they desired. OUTCOME MEASURES: Self-esteem, emotional distress, health perceptions, interpersonal dependency, return to work. RESULTS: Overprotected patients experienced less anxiety, depression, anger, confusion, more vigor, and higher self-esteem than inadequately supported patients 1 month after myocardial infarction (p < 0.05). Inadequately supported patients were more dependent 4 months after the event. CONCLUSIONS: Overprotection on the part of family and friends may facilitate psychosocial adjustment in the early months after an acute myocardial infarction rather than lead to cardiac invalidism.