Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations.

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.

Hypoplastic left heart syndrome: a review and the report of two cases.

Caring for infants with HLHS and their parents is challenging. Social policies of the 1980s such as "Baby Doe," "Baby Fae," and diagnosis-related groups raise additional ethical and economic or financial questions. The nurse must diligently monitor tissue perfusion in the infant and the parents' coping with loss, while struggling with difficult ethical/legal issues.

Health-related quality of life in HIV disease: achieving a balance.

Using grounded theory methods, open-ended interviews were conducted with persons diagnosed with HIV disease to explore and describe how they adjust to living with their disease in relation to their health-related quality of life over the illness trajectory. A substantive theory was generated that describes the process of learning to live with the unpredictability of the disease to maintain life quality. "Archieving a Balance," the core process identified, describes the psychosocial adjustment process of persons with HIV disease from the time of diagnosis to their current circumstances. The process involves balancing the requirements of living with the progression of the disease with the desire to maintain control over one's life, to the extent possible, to maintain life quality. Achieving a Balance is described within the illness trajectory with four major stages--Disintegrating, Renormalizing, Coming to Terms, and Creating Meaning. Characteristics within these stages, which enhance or diminish life quality are described, and a definition of health-related quality, of life is proposed. Interventions are recommended for nurses who care for persons living with HIV disease.

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy.

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.

Differentiated group professional practice in nursing: a demonstration model.

This innovative professional practice model was developed to assist in the redesign of the current nursing care delivery system in hospitals. It is expected that this model will facilitate the promotion of professional practice and that the results will be positive ones for patients, nurses, and hospitals. As Barry and Gibbons wrote recently, "Changing circumstances have become so compelling that it is no longer a question of whether familiar systems need redesigning, but rather how soon and by what means a different system will take place of the existing one."

Health promoting behaviors among rural southern early adolescents.

A central element in attaining the goals and objectives of Healthy People 2010 is promoting healthy behavior lifestyles. Health promotion continues to be sanctioned as the long term most cost effective approach to a reduction in preventable health problems. Adolescents are presently an age group in jeopardy of making the transition into adulthood with healthy lifestyles. This paper describes the use of the Health Promoting Lifestyle Profile (HPLP) (Walker, Sechrist, and Pender, 1987) as a measure of health promoting behaviors in a group of rural southern early adolescents (1036 seventh and eight graders; 81% were African American). The findings suggest that rural southern adolescents perceive themselves to be enganging in health promoting lifestyle behaviors. However, some HPLP subscales seemed to be especially difficult for adolescents.

Coronary artery disease in women.

Cardiovascular disease is the number one cause of death in American women over age 40. Following menopause, the risk for coronary artery disease (CAD) in women is the same as for men. In addition, the major factors that place men at risk are the same for women. However, differences exist in the presentation of symptoms, the ease of diagnosis of CAD, and the morbidity and mortality rates following myocardial infarction (MI), coronary artery bypass surgery, and angioplasty. Because of role differences in men and women, more attention must be paid to developing successful health-promoting and life-style-change strategies in women of all ages.

Recruitment issues in research with special populations.

Special populations have been underrepresented in cardiovascular research for many reasons. However, strategies are available to obtain greater numbers of underrepresented populations in research. These strategies may be complex, time consuming, and costly, but they are necessary to ensure that eligible minorities participate in research to identify the major cardiovascular risk factors and appropriate interventions.

Health-related quality of life as an outcome in organizational research.

This article discusses the conceptual and methodological issues that continue to plague health-related quality of life (HRQOL) research. The current conceptualizations of the construct are reviewed to make explicit the issues of diversity and lack of consensus in definitions, validity of the conceptual unity of multiple domains, and lack of attention to the integration of the HRQOL construct into a theoretical meaningful model. Inadequately addressed conceptual issues have resulted in the proliferation of scales to measure HRQOL the measurement issues to a need to focus on precision and sensitivity of measures. The author offers a new conceptualization of HRQOL, which encompasses both health-care provider and patient perspectives.

Nursing research. The use of grounded theory methodology to study the process of life-style changes.

This article describes a method of evaluating research with the use of grounded theory methology, a qualitative research technique. The preceding article by Frenn and colleagues, which uses this method to study the process of life-style change, is evaluated as an example. Sample procedures, data collection and analysis, and evaluation of scientific merit are discussed.

The value of mentors and facilitators in the pursuit of excellence.

Family members, teachers, and colleagues are all influential in our socialization as professionals and nurse scientists. This article discusses lessons learned from mentors and facilitators during the various stages in my career, including clinical practice, graduate education, and academia. The value of postdoctoral experiences, whether formal or informal, in the pursuit of excellence is also discussed. Finally, the need to maintain a balanced quality of life is stressed in all phases of a career trajectory to facilitate attainment of our goals and the ability to maintain a standard of excellence.

Effects of pneumatic artificial heart driver on the rate of isovolumic pressure rise.

The aim of the research was to investigate the effects of three parameters of the artificial heart's performance on the (+) dP/dt max. Specifically, the effects of heart rate, left-sided drive pressure, and percent systole (the independent variables) on the (+) dP/dt max (the dependent variable) were examined. The study was conducted using a mock circulation which was connected to an artificial heart. Data were collected using the COMDU software developed for the computer which monitors the artificial heart. Stepwise regression analysis was used to test the three hypotheses. Hypothesis one stated the heart rate would significantly effect the (+) dP/dt max. The hypothesis was not supported. Hypothesis two stated the percent systole would significantly effect the (+) dP/dt max. Hypothesis two was also not supported. Hypothesis three stated the drive pressure would significantly effect the (+) dP/dt max. The hypothesis was supported as drive pressure accounted for 4% of the variance in (+) dP/dt max; however, the results were not clinically significant. Limitations in the study were multicollinearity among the independent variables, small sample size, and the inability of the mock circulation to represent human responses.