Psychological factors among elderly women with suicidal intentions or attempts to suicide: a controlled comparison.

The aim of this study was to measure a range of psychological factors identified as important in the literature (resilience, psychological distress, feelings of hopelessness, personal and interpersonal control) among community-dwelling elderly women (N = 31) who had suicidal intentions or attempted suicide. The target group was matched to a control group on age within 5 years. The target group reported lower resilience, personal and interpersonal control but higher psychological distress and feelings of hopelessness compared to the control group. Women who had suicidal ideation or attempts in the last 12 months reported higher personal and interpersonal control. This suggests that although suicide among older women is strongly linked to psychological factors, it warrants further investigation.

A controlled trial of Chinese herbal medicine for premenstrual syndrome.

Premenstrual syndrome (PMS) is a common disorder troubling many women during their reproductive years. The Chinese have been using herbal medicines to treat menstrual cycle related symptoms for centuries. The present study examined the effectiveness of Chinese herbal medicine for the treatment of PMS among Australian women within the theoretical framework of traditional Chinese medicine (TCM). Sixty-one women were assigned randomly into two groups within different TCM patterns. Herbal medicine and placebo were provided sequentially for a period of three months. There were significant differences (p < 0.01) in scores after three months of treatment between Chinese herbal medicine and placebo in premenstrual physical and psychological symptoms, depression, anxiety and anger favoring herbal medicine, but with no difference in perceived stress (p > 0.05). There were highly significant reductions (p < 0.001) between baseline and the end of the third herbal treatment month in all assessments in both groups except that a significant result (p < 0.05) was recorded on perceived stress only in the herbs-first group. No adverse effects were reported by any participant. The results support the hypothesis that the symptoms occurrence and severity of PMS can be effectively reduced by the use of Chinese herbal medicine.

Understanding premenstrual syndrome from a Chinese medicine perspective.

Premenstrual syndrome (PMS) is a common disorder of some women during their reproductive years, characterized by a range of cyclical physical and/or mood symptoms experienced during the last few days of each menstrual cycle. Several treatment approaches have been applied, but have shown limited success, as the exact cause and pathophysiology of PMS is still not fully identified. In this paper, the etiology and pathogenesis of PMS is compared from both a Traditional Chinese Medicine (TCM) perspective and the Western biomedicine paradigm. TCM has used herbal medicines to treat the symptoms of the premenstrual and menstrual phases for centuries. To date, very few studies on the application of TCM to PMS have applied rigorous research methods. We examine the case of PMS from each paradigm: The biomedical view and that of TCM. Similarities and differences are identified and explored, and possible treatment approaches are considered and discussed in the light of these two models.

Men's adjustment to fatherhood: implications for obstetric health care.

OBJECTIVE: To assess factors affecting first-time fathers' transition to parenthood. DESIGN: A longitudinal repeated measures study in which participants were interviewed in mid-pregnancy and completed assessments in late pregnancy, in early postpartum, and at 4 months postpartum. SELLING AND PARTICIPANTS: Two hundred twenty-five first-time fathers were recruited from a major obstetric hospital in Melbourne, Victoria, from 1995 to 1998, via their partners. MAIN OUTCOME MEASURES: Men were seen separately from their spouses, and questionnaires assessing parity history, social support, marital satisfaction, anger, anxiety, and gender role stress were completed at each time. Prenatal and postnatal distress were measured by the Edinburgh Postnatal Depression Scale. RESULTS: Men's peak period of distress was at the first assessment in pregnancy, where there was an overrepresentation of younger men, who were employed part-time and in shorter relationships. For most of the men, their anxieties decreased steadily postpartum. Lower relationship satisfaction was associated with distress, as was gender role stress, both antenatally and postpartum. Distress was also seen to affect men's attachment to their infants. CONCLUSIONS: Although most men deal effectively with the transition to fatherhood, a small group of distressed men may have continued problems in their role as a parent and partner. If more attention can be paid to their anxieties antenatally, it might benefit the men, their partners, and their infants.

Carotid artery endarterectomy: a multidisciplinary approach to improving resource utilization and quality assurance.

An estimated 780,000 people in the United States have a stroke each year. Carotid endarterectomy (CEA) is the most frequently performed surgical procedure to prevent the occurrence of stroke. Over the past several years, physicians, nurses, and allied healthcare workers have been challenged to perform this operation in a cost-effective manner without compromising clinical outcomes. At Maine Medical Center (MMC), Portland, Maine, an average of 250 CEAs are performed annually. As part of a quality-assurance initiative, MMC key stakeholders redesigned the care of patients undergoing CEA surgery. A critical pathway supported by a computerized order set was implemented; standardized discharge instructions and a patient teaching brochure were developed. A patient flow algorithm allowing select patients to bypass the intermediate care unit and transfer directly from the post-anesthesia care unit to a non-telemetry surgical bed was instituted. From January 1, 2010, to December 31, 2011, 467 chart audits were completed on 100% of CEA surgeries (cases with concomitant procedures excluded) using the Vascular Study Group of New England data collection form. Data analyzed supports the practice changes that were instituted. Allowing patients to be admitted to a non-telemetry surgical unit following CEA has resulted in significant cost savings and increased the availability of intermediate care beds to higher acuity patients without negatively affecting patient outcomes.

Health and wellbeing of older people in Anglo-Australian and Italian-Australian communities: a rural-urban comparison.

OBJECTIVE: The health and wellbeing of urban and rural Anglo- and Italian-Australian residents was compared using five domains which are deemed to influence the outcome 'ageing well'. The five domains included physical and functional status, social supports, material resources, activity and leisure, and mental efficacy. DESIGN: A cross-sectional survey carried out in a two-stage data collection process included a brief telephone interview and face-to-face interview using semistructured schedules with several psychometric measures. SETTINGS: Eastern and Western Melbourne and Mildura, Victoria, Australia. MAIN OUTCOME MEASURES: Health and wellbeing of urban and rural community-dwelling Anglo- and Italian-Australian men and women aged 50-89 years. PARTICIPANTS: Urban and rural community-dwelling Anglo- and Italian-Australian men and women aged 50-89 years. There were 364 urban Anglo-Australians, 149 rural Anglo-Australians, 190 urban Italian-Australians, and 77 rural Italian-Australians. RESULTS: Urban Anglo-Australian residents reported significantly higher general and emotional health but also reported significantly higher stress levels than their rural counterparts. The rural Italian-Australian residents reported higher resilience and personal control but poorer general and emotional health than the urban residents. CONCLUSION: If health disparities between urban and rural residents are to be successfully addressed, the link between place of residence, health status and wellbeing must be explored.

New technology applications: thrombolysis of acute deep vein thrombosis.

Treatment of deep vein thrombosis traditionally has focused on preventing the potentially life-threatening complication of pulmonary embolism rather than on removing or reducing the thrombus. Although treatment with anticoagulants may prevent thrombus propagation, the body's intrinsic thrombolytic system is left to attempt clot dissolution. Because this natural process is generally ineffective in its ability to fully recanalize a proximal vein, the risks of recurrent thrombosis as well as the disabling complication of postthrombotic syndrome increase. Moreover, the long-term consequences of postthrombotic syndrome include pain, disability, and, for many, a significant decrease in the quality of life. Recent technology using high-frequency, low-power ultrasound, or mechanical thrombectomy with catheter-directed delivery of a thrombolytic drug directly into the clot is available and showing promise. Nurses are caring for patients who receive endovascular interventions with lytic infusions. The nursing challenge is to provide safe and effective patient care.

Improving the postnatal outcomes of new mothers.

BACKGROUND: Postnatal depression persists worldwide as a troubling issue for many new mothers and their families. The practice of early discharge within 72 hours after birth from maternity hospitals in Australia requires community-based care of new mothers, typically provided by community midwives initially, and then by maternal and child health nurses (MCHN). This latter workforce encounters the onset of distress/depression in vulnerable women and is expected to manage their care, but their training does not equip sufficiently them to do this. AIMS: The aim of the study was to evaluate the effectiveness of brief training for MCHN in early detection and effective management of mildly distressed new mothers. METHODS: A controlled comparative longitudinal study was carried out with a group of first-time mothers recruited through antenatal clinics at four major hospitals in a large Australian city. Forty MCHN were allocated to the intervention group. Those in the intervention group received training in the identification and management of distressed mothers. Intervention group nurses also had access to a liaison psychiatric network for consultation and referrals. Other nurses were allocated to the control group, which provided standard management services to new mothers in their catchment areas. Mothers' outcomes in psychological and psychosocial functioning were assessed; comparing those cared for by the nurses who had received the intervention with those cared for by standard practices. Mothers' satisfaction with the maternal and child health nurse services was also assessed. RESULTS: Levels of distress peaked in early pregnancy in both groups and reduced over the study period. Rates and group levels of psychological distress and psychosocial functioning did not differ over time between mothers receiving care from the enhanced trained nurses and those receiving standard care. Differential group findings were apparent in attrition, with the more distressed mothers withdrawing from the control group and the less distressed withdrawing from the intervention group. Satisfaction with maternal and child health nurse services was high in both groups. Limitations of the study included events occurring while the study was in progress, such as staffing upheaval and unrest following the introduction of compulsory competitive tendering requirements, heavy workloads and the concurrent introduction of computerized case records that required the rapid familiarization with computer usage. CONCLUSIONS: Findings indicate that the extra training of MCHN did not substantially assist in the detection and management of postnatal distress in these new mothers. Unexpected ecological conditions of workforce disruption and extra workloads may have mitigated against the success of the programme. Limitations of the study are examined and the implications for future research are discussed.