Determinants of sexual dysfunction and interventions for patients with obstructive sleep apnoea: a systematic review.

AIMS: Obstructive sleep apnoea (OSA) may negatively affect a couple's sexual relationship. This systematic review evaluated what characteristics are determinants of sexual function and dysfunction in women and men with OSA, and what interventions are shown to be effective. METHODS: A systematic literature review was conducted using PubMed, CINAHL, Cochrane and TRIP, and articles published between January 2004 and December 2014 in English; original research; adults ≥ 18 years; and both experimental and non-experimental designs. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. Of 21 studies, six studies (no randomised control trials, RCTs) included women and 15 (with six RCTs) studies included men. Extracted data were scrutinised and adjusted until consensus was reached; suitable quantitative data were pooled in statistical meta-analysis. RESULTS: Sexual function was affected similarly in both genders, but effective interventions were reported only for men. In some studies, OSA severity and medications contributed to greater sexual dysfunction. In women, menopausal status, hormone levels and SaO2 < 90% were determinants of sexual dysfunction, while for men factors included BMI, hormonal status and inflammatory markers. Continuous positive airway pressure (CPAP) not only improved clinical measures such as excessive daytime sleepiness but also the erectile and orgasmic function. Nevertheless, sildenafil was superior CPAP with regard to erectile dysfunction. CONCLUSIONS: The findings illustrate important contributors to sexual dysfunction; however, firm generalisations cannot be made. There were limited RCTs and none for women, indicating further RCTs are needed to determine how OSA affects sexual function.

Sexual counselling of cardiac patients: nurses' perception of practice, responsibility and confidence.

BACKGROUND: Cardiac patients may experience problems with sexual activity as a result of their disease, medications or anxiety and nurses play an important role in sexual counselling. We studied the practice, responsibility and confidence of cardiac nurses in the sexual counselling of these patients. METHOD: An adapted version of the nurses' survey of sexual counselling of MI patients was administered during a scientific meeting of the Council on Cardiovascular Nursing and Allied Professionals within the European Society of Cardiology. RESULTS: Most of the 157 cardiovascular nurses (87%) who completed the survey felt responsible to discuss sexual concerns with their clients, especially when patients initiated a discussion. However in practice, most respondents rarely addressed sexual issues. The items that nurses reported to counsel patients were closely related to the cardiac disease, symptoms and medications and seldom more sensitive subjects (e.g. foreplay, positions). Nurses estimated that their patients could be upset (67%), embarrassed (72%) or anxious (68%) if they were asked about sexual concerns. One-fifth of the nurses felt they had insufficient knowledge and 40% sometimes hesitated to discuss sexual concerns with clients because they might not know how to answer questions. Additional education on sexuality was significantly related to being more comfortable and active in sexual counselling. CONCLUSION: Although cardiac nurses feel responsible and not anxious discussing patients' sexual concerns, these issues are not often discussed in daily practice. Nurses might need more knowledge and specific practical training in providing information on sexual concerns and sexual counselling to cardiac patients.

[Customary use of compression stockings for prevention of thrombosis in medical intensive care units in Germany]. / Praxis medizinischer Thromboseprophylaxestrümpfe auf konservativen Intensivstationen in Deutschland.

BACKGROUND: Stockings for thrombosis prophylaxis (MTS) are generally advised for all immobilized patients by the German Societies of Surgery, Orthopedics, and Phlebology. In critical care patients, the indication is unclear and many questions are left unanswered, especially if combined with heparins for prophylaxis of thromboembolism. We evaluated the customary use of MTS in critical care patients. METHODS: A multiple choice questionnaire was sent to the nursing staff of 324 randomly selected German non-surgical ICUs. The answers of 144 units (44.4%) could be evaluated, 15 of which were special neurology, 88 special internal medicine, 41 mixed. RESULTS: Each 8th ICU principally avoids MTS, each 19th ICU principally provides all patients with MTS. Of those who use special indications, the degree of immobilisation plays an indecisive role with 50% for and 50% against MTS. In particular, coma serves as a contraindication. Effective anticoagulation excludes the need for MTS in half of the ICUs. Polyneuropathies and dysesthesias are the far most noticed arguments against MTS. CONCLUSIONS: There seems to be an uncertainty about the indication of MTS for non-surgical critical ill patients. With respect to available guidelines, a decision in principle for MTS should be made. However, in the individual patient with relative contraindications and progressively effective anticoagulation, MTS may be dispended relatively liberally.

Use of videotaped interventions in research.

Evaluating conceptual and methodological issues are important considerations when developing a videotape for research intervention. The process of developing a videotape for research involves several critical steps to maintain scientific rigor during the project. Establishing content validity of the videotape script and maintaining scientific integrity while producing the videotape are key components. Issues such as copyright and intellectual property are important considerations. The use of videotape provides a consistent method of providing information to research subjects. Careful attention to the research process during each phase of development of the videotape will enhance the success of the project.

Importance and timing of sexual counseling after myocardial infarction.

BACKGROUND: This study examined differences in the perceptions of the importance and timing of sexual counseling in patients with myocardial infarction (MI). METHODS: Using a longitudinal descriptive prospective design, subjects were identified from the discharge records of three health-care agencies after having experienced an acute MI in the last 4 to 8 weeks. The Sexual Counseling Needs of MI Patients Survey and a consent form were mailed to patients at 2, 4, and 6 months after MI. Patients (N = 91) rated the importance and timing of 14 sexual counseling items using a Likert scale (1 to 5), and reported the preferred method of education. The possible range for the importance score was 14 to 70. RESULTS: Mean importance ratings for each of the 14 items at each of the data collection periods ranged from 3.28 to 4.59. The mean overall importance score at 2 months (56.96), 4 months (56.52), and 6 months (55.19) reflected the importance of these items for teaching. There was no significant difference between importance scores at each of these time periods. Subjects were divided as to when sexual counseling should occur, in hospital or after discharge, for items related to specific sexual counseling. The most preferred educational method at 2, 4, and 6 months after MI were written materials, followed by individual discussion, and a videotape to watch at home. CONCLUSIONS: Patients validated the importance of each of the specific areas for sexual counseling after MI. The timing and educational methods for sexual counseling must be further addressed in future research. Sexual counseling initiated in the acute-care setting and continued throughout the recovery period can impact the quality of life of patients with MI and their partners.

Perspectives of nurses and patients on the need for sexual counseling of MI patients.

The concept of sexual integrity was used to analyze nurses' and patients' perceptions of the need to provide sexual counseling for patients in the acute care setting who have had a myocardial infarction. A qualitative approach with content analysis was used. Data were categorized using the determinants of sexual integrity: self-identity, communication, and environment. For patients, self-identity and communication were the predominant themes that emerged from the data. A lack of information related to issues of sexual functioning was the most prominent subcategory. The nurses' responses contained all three determinants of sexual integrity; roles, lack of information, use of verbal and nonverbal communication, and lack of time were the most prominent subcategories emerging from the data. The findings indicate a need to provide information to patients and nurses on sexual counseling.

Sexuality in aging: implications for nursing facility staff.

Sexuality is an area that is frequently overlooked by staff who work with the elderly in nursing facilities. The nursing literature supports a need for education of nursing facility staff about sexual issues and concerns of facility residents. This article describes the effect of an educational intervention on one sample of facility staff and recommends strategies for the education and practice of staff members employed in nursing facilities.

Sexual counseling following acute myocardial infarction.

Sexual counseling needs of myocardial infarction (MI) patients are frequently overlooked by nurses. This study sought to determine to what extent sexual counseling of MI patients was addressed in the acute care setting. The survey of 96 patients showed that sexual counseling was largely not addressed for this group of patients and that specific information on resuming sexual activity was not provided for most patients. Seventy-one percent of patients believed that staff should address sexuality in the hospital setting. It was found that receipt of sexual counseling significantly differed by marital status of the patient. Nurses need to take a more active role in sexual assessment and education in order to improve the quality of life of patients post-MI.

Sexual counseling of MI patients: nurses' comfort, responsibility, and practice.

Myocardial infarction patients often have unanswered questions about resuming sexual activity after this life-threatening event. Critical care nurses can play a pivotal role in educating patients in this sensitive area. However, sexual counseling is an area of nursing that is frequently neglected. The authors assessed comfort and responsibility levels and their relationship to the practice of sexual counseling by critical care nurses.

Sexual counseling of MI patients by cardiac nurses.

This study examined the assessment of sexual concerns and the practice of sexual counseling with myocardial infarction patients in a convenience sample of 171 cardiac nurses from three hospitals in the Midwest. Seventy-five percent of nurses (n = 129) had offered to discuss sexual concerns with less than 2% of their clients in the preceding year, and 71% of nurses (n = 122) had never referred clients for sexual counseling to another professional. Analysis of 17 items on the practice index indicated that nurses are not assessing sexual concerns, and specific information relevant to myocardial infarction patients largely is not being taught.

Knowledge and attitudes of older adults about sexuality in ageing: a comparison of two studies.

Two studies using separate samples sought to explore differences among male and female elders on their knowledge, attitudes, and sexual behaviour using a nonexperimental approach. Two different samples from separate health and wellness groups were surveyed using the Aging Sexual Knowledge and Attitude Scale (White 1982). Additional data were collected on sexual satisfaction, sexual activity, and demographic variables. In the first study, questionnaires were mailed to the homes of 759 members of the wellness group. The second study was conducted in a similar manner, but with random selection of 400 males and 400 females. Both groups showed a moderate amount of knowledge and permissive attitudes with no significant differences observed between males and females. Reported sexual satisfaction was variable. Subjects were sexually active with activity varying from 0 to 30 times per month, with a mean of 4 times per month. Findings suggest that males and females are comparable on their knowledge and attitudes about sexuality in ageing and most are sexually active. Many are seeking further information on the impact of chronic illness and medications on sexuality.

On the range of alpha-adrenergic regulation of coronary vascular resistance.

In order to obtain an estimate of the range of alpha-adrenergic resistance regulation in the coronary vascular system, the following studies were performed: in 15 anesthetized dogs the circumflex coronary artery was cannulated and perfused with above-normal constant pressure to that coronary venous oxygen tension never fell below 40 mmHg. Thus, it was possible to eliminate the influence of the metabolic factor regulating coronary resistance. Furthermore, 15 isolated isovolumetrically working guinea-pig hearts were perfused according to the Langendorff method. Stimulation, resp. blockade, of alpha-receptors was achieved by administering xylometazoline, resp. phentolamine. Xylometazoline increased coronary resistance in both the isolated and the in-situ heart. Administering maximum doses to the anesthetized dog led to an increase in resistance to about 200%. This is equivalent to a reduction of conductance to about 50%. Phentolamine produced no significant effects in the isolated heart. Maximum dosage administered to the heart in situ led to a resistance decrease to about 60%, equivalent to an elevation of conductance to about 170%. If we let control values of coronary resistance and conductance be equal to 100%, our experiments showed alpha-adrenergic regulation of coronary resistance to range from about 60% to 200% and conductance to range from about 50% to 170%.

Curent periodical shelving: a special design.

A modification of standard library shelving is described for the display of current unbound journals. Plexiglass book supports are used to hold the issues in an upright position.