Perceived learning needs of patients with heart failure.

OBJECTIVE: To determine the perceived learning needs of patients with heart failure (HF) compared with identified needs by registered nurses (RNs). DESIGN: Descriptive, comparative. SETTING: Two midwestern hospitals: 1 community hospital and 1 that is part of a large, university-affiliated, integrated health care system. SAMPLE: A convenience sample of 84 adult patients with HF from left ventricular systolic dysfunction and 84 registered nurses. OUTCOME MEASURE: The Heart Failure Learning Needs Inventory, developed for this study, was used to rate 98 individual items divided into 8 subscales suggested in the Agency for Health Care Policy and Research (AHCPR) practice guidelines. The subscales include general HF information, psychologic adaptation to illness, risk factors, medications, diet, activity, prognosis, and signs and symptoms. RESULTS: Multivariate analysis of variance was completed. The patients perceived the subscales of general HF information, risk factors, medications, prognosis, and signs and symptoms as more important to learn than the RNs did (P <.05). Patients perceived diet information as less important to learn than the RNs did (P <. 05). There were no differences in the patients' and nurses' perceptions in the activity and psychologic subscales. The patients perceived all 8 subscales as more realistic to learn than the RNs did (P <.05). Although not in identical order, both groups ranked education related to medication and signs and symptoms as the 2 priority areas. Diet information was ranked eighth by the patients and third by the RNs. CONCLUSION: The findings are consistent with previous research supporting the overall trend that patients with HF perceived patient education to be more important and realistic to learn during hospitalization than the nurses did. Patients and nurses identified education related to signs and symptoms and medication as the 2 most important content areas. In comparison with the AHCPR clinical practice guidelines, the group of RNs studied would ascribe the additional category of signs and symptoms as essential content to be taught during hospitalization.

[Pseudo-obstruction of the colon]. / Die Pseudoobstruktion des Kolons.

Pseudoobstruction of the colon is characterized by clinical and radiological findings suggesting a mechanical obstruction of the large intestine without any organic cause. 11 of our patients and 344 cases reported in the literature have been reviewed. 90% of the patients have an associated major system disorder, most of them (40%) are localized in the pelvis. An imbalance in sympathetic-parasympathetic innervation as an aetiological factor is discussed. Diagnosis is generally made on the basis of the plain roentgenogram of the abdomen and a barium enema of the colon. Surgical decompression is indicated when no improvement can be achieved by conservative treatment within 72 hours. Immediate surgical intervention becomes mandatory in case of the cecal diameter being greater than 12 cm or an evident perforation. Cecostomy is of crucial benefit. Extensive necrosis requires a colonic resection.