Bone density, health beliefs, and osteoporosis preventing behaviors in men.

PURPOSE: To examine the effect of bone mineral density (BMD) screening via dual-energy x-ray absorptiometry (DXA) results on osteoporosis preventing behaviors (OPB), knowledge of osteoporosis, and health beliefs of men aged 50 years or older (N = 196) was evaluated. DESIGN: An experimental, 2-group longitudinal design was used. The independent variable was DXA, dependent variables were osteoporosis preventing behaviors, and mediating variables were general knowledge of osteoporosis and Health Belief variables. Half of the men had low bone density. Men diagnosed to be osteoporotic increased their calcium intake. FINDINGS: Health belief variables predicted calcium intake and/or exercise. In addition, 9 men in the experimental group were taking medications to prevent/restore bone loss at Time 3. Healthcare providers play a significant role in assessing bone loss and preventing and treating osteoporosis in men. IMPLICATIONS: The cost of a DXA screen is far less than financial and social costs due to osteoporotic fractures.

Indicators of acute deterioration in adult patients nursed in acute wards: a factorial survey.

OBJECTIVES: The primary objective of the study was to determine which professional, situational and patient characteristics predict nurses' judgements of patient acuity and likelihood of referral for further review. A secondary aim was to test the feasibility of the factorial survey method in an acute area. BACKGROUND: There is increasing recognition that indicators of deterioration in acutely unwell adults are being missed and referrals delayed. The reasons for this are unclear and require exploration. Assessing nurses' clinical decision-making or judgements in a 'real-world' situation is problematic. DESIGN: The study used a factorial survey design where participants completed randomly generated paper-based vignettes on one occasion. METHODS: The dependent variables were assessment of patient acuity and likelihood of referral. Independent variables consisted of a number of patient characteristics, i.e. heart rate, blood pressure, nurse characteristics, i.e. clinical experience, and situational characteristics i.e. staffing. SETTING AND PARTICIPANTS: Participants were registered nurses working in acute areas excluding intensive care and theatre. Ninety-nine participants responded resulting in 1940 completed vignettes. RESULTS: An early warning score was the single most significant predictor of referral behaviour accounting for 9.6% of the variance. When this was not included in the vignette, nurses used physiological characteristics e.g. respiratory rate, urine output, neurological status. These explained 12% of the variance in the model predicting assessment of patient acuity and 9.4% or the variance predicting likelihood of referral. CONCLUSIONS: When given a series of vignettes, nurses appear to use appropriate physiological parameters to make decisions about patient acuity and need for referral. Our results support the use of early warning scoring systems. Education and professional development should focus more on developing and maximising clinical experience and expertise rather than knowledge acquisition alone. A factorial survey method is feasible to explore decision-making in this area. RELEVANCE TO PRACTICE: This study has several implications for practice. The emergence of an early warning scoring system as a significant individual predictor supports the use of such systems. However, the small amount of explained variance suggests that there are other influences on nurses' assessment of patient acuity and referral decisions that were not measured by the factorial survey approach. Educational provision might focus not just on knowledge acquisition but include educational delivery methods that incorporate or mimic real-ward settings.

Biological mechanisms related to the effectiveness of guided imagery for chronic pain.

Specific aims of this pilot study were to (a) determine the effect of a guided imagery (GI) intervention over an 8-week period on pain and pain disability in a sample of persons with chronic noncancer pain (CNCP) and (b) analyze the mediating effects of neuroendocrine and neuroimmune functioning on the effectiveness of GI on outcome variables. A simple interrupted time-series design (12-week period) was used. GI was introduced at Week 4 and used daily by 25 participants for the remaining 8 weeks. Measures of pain and pain disability were obtained at the beginning of the study period and at six repeated 2-week intervals. Measures of hypothalamic-pituitary-adrenal (HPA) axis activation (plasma cortisol), immune-mediated analgesia (lymphocyte subset counts and proliferation), and immune-mediated hyperalgesia (interleukin-1ß) were obtained at the beginning of the study and at Week 11. Usual pain levels were lower after the introduction of GI at Week 4 (Wilks' λ = 52.31; df = 2, 22; p = .000). Pain disability levels were lower after the introduction of GI at Week 4 (Wilks' λ = 5.98; df = 6, 18; p = .001). Correlation coefficients between change scores of dependent variables and mediating variables were not significant. GI was effective in reducing pain intensity and pain disability over an 8-week period; however, the results did not support the expected effects of decreased HPA axis activation, improved immune-mediated analgesia, and reduced immune-mediated hyperalgesia in mediating these outcomes. These findings may be related to procedural and theoretical issues and limitations related to the study design.

Validation of the World Health Organization Quality of Life HIV instrument in a Zambian sample.

Given the longevity achievable with the current treatment for people living with HIV, quality of life (QOL) has emerged as a significant health outcome measure. The purpose of this study was to test the QOL factor structure in a Zambian sample using the World Health Organization Quality of Life-HIV (WHOQOL-HIV) instrument. A cross-sectional 2 × 2 factorial design was conducted with 160 people living with HIV. Factor analysis yielded 3 new scales: Zambian WHOQOL-HIV, Zambian WHOHIV Medication Dependence, and Zambian WHOHIV spirituality religion personal beliefs (SRPB), and validated the Overall Quality of Life and General Health Perceptions Scale. The study tested the WHOQOL-HIV instrument, validated a scale that can be used for regular assessment, and yielded three comprehensive QOL assessment scales to monitor disease progression and response to care. The assessments will lead to the development of holistic nursing interventions based on perception of QOL.

Validation of the Osteoporosis Smoking Health Belief instrument.

Smoking has a deleterious effect on bone mineral density. Psychometric properties were conducted for 3 smoking cessation subscales of the Osteoporosis Smoking Health Belief (OSHB) instrument: barriers, benefits, and self-efficacy. The instrument was evaluated by 6 nurse researchers, administered to a pilot sample of 23 adult smokers aged 19-39, and to a convenience sample of 59 adult smokers aged 19-84 years attending bingo at churches and community centers. Principal components factor analyses were conducted on the 18 items at both time points and accounted for 65.05% of the variances in the matrix at Time 1 and 71.19% at Time 2. The 3 statistical factors corresponded to the theoretically derived concepts. Cronbach's alphas for benefits of not smoking were .86 at Time 1 and .88 at Time 2; for barriers, .78 at Time 1 and .89 at Time 2; and for self-efficacy, .94 at Time 1 and .96 at Time 2. The test-retest correlations were .68 for benefits, .74 for barriers, and .79 for self-efficacy. Paired t tests showed no significant change over time. The OSHB meets relevant measurement criteria.

Depressive symptoms among HIV-positive pregnant women in Thailand.

PURPOSE: To examine predictors of depressive symptoms among human immunodeficiency virus (HIV)-positive, pregnant women in Thailand. DESIGN: Correlational, cross-sectional study. METHODS: Data were collected at prenatal clinics in five hospitals in Thailand from January 2004 to January 2006. One hundred twenty-seven HIV-positive pregnant women completed questionnaires in Thai on depressive symptoms, self-esteem, emotional support, physical symptoms, and demographics. Simultaneous multiple regression was used to analyze predictors of depressive symptoms. FINDINGS: Seventy-eight percent of the 127 participants reported depressive symptoms to some degree. Physical symptoms (beta= .192, p<.05) were positively associated with depressive symptoms, but self-esteem (beta=-.442, p<.001), emotional support (beta=-.193, p<.01), and financial status (beta=-.209, p<.01) were negatively correlated with depressive symptoms. CONCLUSIONS: The study results have added new knowledge about depressive symptoms and their predictors in HIV-positive pregnant women in Thailand. CLINICAL RELEVANCE: Depressive symptoms have been associated with faster progression to acquired immunodeficiency syndrome among HIV-positive individuals. The high rate of depression in our study suggests that HIV-positive pregnant women in Thailand should all be screened for depressive symptoms. Causes of physical symptoms should be identified and treated. Emotional support and self-esteem should be strengthened for HIV-positive pregnant Thai women.

Depressed patients understand heart failure prognosis but not how to control it.

BACKGROUND: Depression prevalence in patients with heart failure (HF) is 21% to 42%. Conceptual illness beliefs that patients have about HF may be associated with depression. METHODS: We examined whether accuracy of illness beliefs was associated with depression. Illness belief scores were compared with depression severity, and multivariable analyses were performed to determine factors that were independently associated with depression. RESULTS: In 219 elderly patients with HF, depression prevalence was 47%. Accuracy of illness beliefs was associated with depression (r = .224; P = .049), due solely to accuracy of beliefs about consequences of HF (P = .005). Beliefs about how to control HF remained stable as depression severity increased. After controlling for significant univariable factors, mean illness belief and consequence scores remained associated with depression. CONCLUSION: In this sample, accuracy of beliefs about HF consequences increased but beliefs about how to control HF remained unchanged as depression severity worsened. This combination of HF beliefs may influence coping through self-care behaviors.

The Humpty Dumpty Falls Scale: a case-control study.

PURPOSE: The purpose of this descriptive study was to assess whether the Humpty Dumpty Falls Scale (HDFS) identifies hospitalized pediatric patients at high risk for falls. DESIGN AND METHODS: The study was a matched case-control design. A chart review of 153 pediatric cases who fell and 153 controls who did not fall were pair-matched by age, gender, and diagnosis. RESULTS: High-risk patients fell almost twice as often as low-risk patients (odds ratio 1.87, confidence interval = 1.01, 3.53, p = .03). PRACTICE IMPLICATIONS: A Falls Prevention Pediatric Program with the HDFS tool addresses the Joint Commission Patient Safety Goals, but further research is needed to examine HDFS sensitivity-specificity.

Oncology nurses' responses to patient-initiated humor.

The purpose of this study was to investigate potential predictors (patient variables) that would result in oncology nurses' recognition of and response to patient-initiated humor (PIH). Participants included 47 nurses of an 80-member Oncology Nursing Society chapter (57% response rate), which yielded 232 usable vignettes. Previously collected qualitative data of patient-nurse conversations were used to construct simulated vignettes using a factorial survey design. Five randomly generated vignettes containing 14 independent patient variables with different levels were used to examine nurses' identification of PIH. The unit of analysis in factorial survey is the vignette. Multiple regression and analysis of variance were used to analyze variables in each vignette. Two of 14 variables were significant: "verbal" (actual words the patient spoke) and "intonation" (inflection, pitch, or manner of speech). A 2x2 factorial analysis of variance using verbal and intonation variables revealed that oncology nurses' recognition of and response to PIH were primarily predicted by patients' verbal words. This study distinguishes PIH as a patient-initiated behavior rather than nurse-driven interventions and is a new venue for research in patient-nurse interactions. Results demonstrate the central role of patient-centered communication to inform clinical practice about patient preferences, individualized integration/participation in their care, and a knowledge base of patient-centered behaviors for outcomes of personal importance.

Safety work: initiating, maintaining, and terminating restraints.

PURPOSE: This study examines the variations and complexities in nurses' decision making about the initiation, maintenance, and termination of physical restraints. METHODS: This qualitative research used a semistructured interview of registered nurses on medical-surgical units at a midsized hospital in the Midwest. RESULTS: All the nurse respondents easily recalled caring for a patient in restraints and detailed in their accounts a complex trajectory of care that centered on safety. However, most nurses reported that the trajectory of restraint use was started by other departments, shifts, or nurses. The findings revealed a forceful interplay of patient, nurse, family, healthcare worker, and organizational factors that influence nurses' decision making about restraint use. CONCLUSIONS: This article discusses how a deeper understanding of the intricacies of the decision-making processes related to restraints can help clinical nurse specialists tailor education, impact policy, and serve as role models to reduce the use of restraints in hospitals.

Preferences for Care Near the End of Life: instrument validation for clinical practice.

This article presents descriptive data and a psychometric evaluation of the Preferences for Care Near the End of Life (PCEOL) tool developed by Gauthier and Froman. The PCEOL tool identifies dimensions related to care near end of life and asks respondents to consider personal preferences in the context of their values. Analyses were conducted on data from a convenience sample of 68 adults recruited at a workshop series on anticipatory guidance for end-of-life care. Participants included nurses, nursing students, nursing assistants, social workers, and older adults. Findings supporting a 3-factor structure (personal autonomy, healthcare provider input, and spirituality and family) are interpreted and discussed. Implications are given for using the PCEOL tool in nursing care situations.

Factor analysis of the Appraisal of Self-care Agency Scale in American adults with diabetes mellitus.

PURPOSE: The purpose of this methodological secondary data analysis study is to examine the reliability, construct validity, and dimensionality of the Appraisal of Self-care Agency Scale (ASAS) in an American sample of adults with diabetes mellitus. METHODS: The sample consisted of 141 insulin-requiring adults with diabetes mellitus recruited from a Diabetes Care Center in the southern United States. The ASAS, along with Hurley's Insulin Management Diabetes Self-efficacy and Insulin Management Diabetes Self-care Scales, was used in the study to determine convergent validity, thus contributing to the construct validity of the ASAS. Other data analysis consisted of internal consistency estimates of reliability, Pearson correlations, and factor analysis. RESULTS: The findings suggest that the ASAS consists of a single substantive dimension and has adequate construct validity and reliability. CONCLUSION: Revision of certain items and conducting further analysis of the scale, prior to its adoption in clinical practice, should be considered.

Osteoporosis knowledge, health beliefs, and DXA T-scores in men and women 50 years of age and older.

PURPOSE: To compare the knowledge of osteoporosis, revised health belief model variables (RHBM), and DXA (dual energy x-ray absorptiometry) T-scores among men and women 50 years of age and older. DESIGN: This was a secondary analysis that used 218 healthy community-based women 50 to 65 years of age and 226 healthy community-based men >or=50 years of age. Data for women were collected for 18 months during 2001-2003, and data for men were collected for 18 months during 2004-2006. The variables were knowledge of osteoporosis, RHBM variables (susceptibility, seriousness, benefits and barriers of calcium intake and of exercise, health motivation, self-efficacy of calcium intake and exercise), and DXA T-scores. METHOD: The women and men completed an osteoporosis questionnaire prior to having a DXA screening test. A total of 190 women and 187 men had DXA scans. FINDINGS: More than half of the sample had abnormal bone density scans. Knowledge of osteoporosis was low for women and even lower for men. Seven of the nine health belief variables were associated with gender. Women perceived osteoporosis to be serious and that they were susceptible. Men did not perceive osteoporosis to be serious or that they were susceptible. Men were more health motivated and more confident of their ability to engage in exercise.

DXA, health beliefs, and osteoporosis prevention behaviors.

OBJECTIVE: This experimental longitudinal study was designed to examine the relationship between having a bone density through dual energy X ray absorptiometry (DXA) and osteoporosis preventing behaviors (OPB) among healthy postmenopausal women. METHODS: Subjects were 203 healthy community-based women 50-65 years of age. Mediating variables were general knowledge of osteoporosis and revised health belief model variables. Treatment group women (n = 101) had a DXA screen and control group women (n = 102) did not. Study questionnaires were completed at three time points; initially and at 6 months and 12 months. RESULTS: Repeated measures ANOVA revealed treatment group women scored significantly higher on perceived susceptibility and calcium intake. Wilks's Lambda F revealed a significant difference in use of osteoporosis preventing medications. DISCUSSION: Personal knowledge gained from DXAs increased perceived susceptibility to osteoporosis, calcium intake, and use of osteoporosis preventing medications and appears to be an effective intervention in promoting OPB in younger postmenopausal women.

Predictors of cardiac rehabilitation initiation.

This study determines the effects of 15 potential predictors on cardiac rehabilitation (CR) initiation: demographic information, measures of perceived severity, perceived susceptibility, perceived cardiac threat, social support, depression, comorbid conditions, left ventricular ejection fraction, strength of physician recommendation, and benefits and barriers. Results showed that greater strength of physician recommendation and less disease severity were significant predictors of higher levels of CR initiation; female gender was a marginally significant predictor of less CR initiation. The strength of the associations for these predictors varied. Strength of physician recommendation was the strongest predictor. This information can be used to increase the number of patients starting CR through programs designed to increase physician awareness of the importance of their recommendation, the continuing need to refer women to CR, and the need to design programs that meet women's needs.

The relationship of continuity and discontinuity, functional ability, depression, and quality of life over time in stroke survivors.

The purpose of this study was to examine the concepts of continuity and discontinuity over time and to explore their relationships with depression, functional ability, and global quality of life (QOL). In a repeated-measures design, 51 participants in an inpatient rehabilitation hospital were entered within 1 month of stroke and followed at 3 and 6 months; 33 completed the study. Depression, functional ability, and QOL all changed significantly between time 1 and time 2 and remained so through time 3 (6 months after stroke). There were no changes in continuity or discontinuity over time. Continuity/self, continuity/other, and discontinuity correlated moderately with depression and QOL at time 1; discontinuity and functional ability at time 1 correlated moderately with QOL at time 3. Functional ability related to discontinuity at time 3 and with QOL, otherwise, functional ability did not relate to the other variables, such as depression, in any time period. Although other variables changed over time, the sense of continuity/discontinuity did not. One of nursing's contributions to stroke survivors' rehabilitation may be in helping patients feel more continuous and less discontinuous with their prestroke sense of self.

Patch test reactivity to a cobalt-chromium-molybdenum alloy and stainless steel in metal-allergic patients in correlation to the metal ion release.

Nickel, chromium, and cobalt released from stainless steel and CoCrMo alloys have been postulated to trigger hypersensitivity reactions. The objective of this study was to assess the ion release from a CoCrMo alloy and stainless steel in vitro and the cutaneous reactivity to it by patch test. 52 metal-allergic patients and 48 non-allergic controls were patch tested to stainless steel and CoCrMo discs. In addition, using atomic absorption spectrometry, the release of nickel, cobalt, and chromium from both materials was assessed upon 2-day exposure to distilled water, artificial sweat (AS), and cell culture medium. There was low nickel ion release from stainless steel (0.3-0.46 microg/cm(2)/2 days) and CoCrMo discs (up to 0.33 microg/cm(2)/2 days) into the different elution media. Chromium release from the 2 materials was also very low (0.06-0.38 microg/cm(2)/2 days from stainless steel and 0.52-1.36 microg/cm(2)/2 days from CoCrMo alloy). In contrast, AS led to abundant cobalt release (maximally 18.94 microg/cm(2)/2 days) from the CoCrMo discs, with concomitant eczematous reaction upon patch testing: 0 of the 52 metal-allergic patients reacted to stainless steel discs and 5 of the 52 patients to CoCrMo discs (all 5 patients were cobalt allergic and 3 also nickel and chromium allergic). None of the controls reacted to the discs. Apart from nickel being a focus of allergological research, our results point to the possibly underestimated association of cobalt release and potential hyperreactivity to CoCrMo alloy.

Development and testing of the Survey of Illness Beliefs in Heart Failure tool.

This study establishes reliability and construct validity of the Survey of Illness Beliefs in Heart Failure (HF) tool, which measures the accuracy and certainty of illness beliefs people have about HF. Factor analysis produced a 2-component structure of 14 items that revealed accurate and inaccurate illness beliefs (alpha=0.87 and 0.71, respectively). Construct validity was supported with significantly greater accuracy in illness belief scores in patients evaluated or listed for heart transplantation or enrolled in an HF research study (P=.008 and .02, respectively). The reliability and validity of the tool is sufficient to support its use in clinical research.

Comparing teaching practices about humor among nursing faculty: an international collaborative study.

Humor has been recognized by nurse researchers as a therapeutic intervention known to have positive psychological and physiological outcomes for patients. There is, however, no research that examines how nurses learn about humor. The purpose of this preliminary study was to examine nursing faculty members' teaching practices about humor education in the classroom and in clinical settings. Nursing faculty members from four nursing programs, two in the United States, one in Northern Ireland, and one in Taiwan, were surveyed about the inclusion of humor in the nursing curriculum. Findings revealed that substantially more humor education was included in clinical settings in the USA and Northern Ireland than in the classroom. In Taiwan, however, humor education was included more in the classroom than in clinical settings. Older and more experienced nurses with higher levels of education reported using less humor in teaching practices.

In vitro pyrogen test--A new test method for solid medical devices.

Medical devices manufactured for implantation into humans must be free of any contamination with viable bacteria. However, remnants of dead bacteria and bacterial components alone may induce an inflammatory immune response. Pyrogen tests for such inflammatory contaminations are generally performed either by determining the content of lipopolysaccharide in rinsing solutions of batch samples by limulus amoebocyte lysate assay, by injecting the rinsing solutions into rabbits or by implanting batch samples into rabbits and measuring change of body temperature. In this study, we show that the in vitro pyrogen test (IPT), which measures the release of the inflammatory cytokine IL-1beta in fresh or cryopreserved human whole blood, can be used to assess the pyrogenic contamination of implantable medical devices. This test was used to check neurosurgical implants, namely aneurysm clips, as a proof of principle. Owing to the direct contact of the test material with the blood cells, this test does not require rinsing procedures, which have variable efficacy. The use of human blood ensures the detection of all substances that are pyrogenic for humans and reflects their relative potency. The safety of the products as delivered could be confirmed. The effects of sterilization and depyrogenization procedures on intentional pyrogenic contaminations of samples could be followed. This new application of the already internationally validated method promises to replace further rabbit pyrogen tests. It generates extremely sensitive results with an extended range of detectable pyrogenic contaminants.