PubMed Health⌕ Search

Biomedical subjects

C M Ruland

Publications and source records attributed to C M Ruland.

At least 19 recordsLinked to original sources
PubMed2005

The mediating role of appraisal and coping in the relationship between optimism-pessimism and quality of life.

Longitudinal data from 165 women diagnosed and treated for breast cancer were used to investigate if the relationship between optimism-pessimism and quality of life (QOL) is attributed to the appraisal and coping strategies. The women completed the Life Orientation Test-Revised (LOT-R), as a measurement of optimism-pessimism, the Mental Adjustment to Cancer (MAC) Scale, as a measure for coping, a VAS for appraisal and the EORTC QLQ-C30, as a measure for QOL at two time points: at diagnosis and 12-months after breast cancer surgery. Optimism-pessimism had both a direct and indirect influence on QOL. Two coping strategies were particularly strong mediators for the indirect influence: fighting spirit and hopeless/helpless. Optimists responded with fighting spirit, which had a positive effect on their QOL. On the other hand, pessimists responded with hopeless/helplessness, which had a negative effect on their QOL. The relationship between pessimism and QOL at time of diagnosis was also mediated by appraisal, such as threat. The two coping strategies remained fairly stable over the 12 months within the optimists and pessimists.The results suggest that the influence of optimism and pessimism on QOL appears to be mediated by coping both before and after treatment for breast cancer. Fighting spirit and hopeless/helplessness appear to reflect the characteristic coping strategies for optimists and pessimists.

Adaptation, Psychological↗
PubMed2004

Pessimism as a predictor of emotional morbidity one year following breast cancer surgery.

The prevalence of and predictive factors for emotional morbidity (measured by the Hospital Anxiety and Depression Scale (HAD)) one year following surgery, with special focus on dispositional optimism/pessimism (measured by the Life Orientation Test (LOT-R), was examined in 165 women, newly diagnosed with breast cancer. Patients characteristics, appraisal of cancer diagnosis, beliefs about treatment efficacy, treatment decision-making participation, coping and emotional morbidity was assessed by self-rating questionnaires. Prevalence of anxiety and depression cases at time of diagnosis was 34 and 12%, respectively, and 26 and 9% after one year. Prevalence of emotional morbidity was significantly enlarged among pessimists at all assessments. Pessimism was the strongest predictor for anxiety (OR: 0.86 C.I. 95% 0.77 - 0.95) and depression (OR: 0.83, C.I. 95% 0.73 - 0.95) one year following breast cancer surgery. Optimists and pessimists differed not only in regard to coping styles, but also in regards to predictors of emotional morbidity. Optimists experiencing anxiety at time of breast cancer diagnosis had about six times higher risk of experiencing anxiety after one year, compared to optimists without preoperative anxiety. For pessimists, the more pessimistic one was about one's overall future the higher risk for developing anxiety following one year of breast cancer surgery. Pessimists, who endorse helpless/hopeless coping style when receiving a diagnosis of breast cancer, had three times greater risk for experiencing depression one year after breast cancer surgery, than pessimists who did not. Health care professionals should therefore provide intervention for pessimists, as well as for patients with high anxiety scores at time of diagnosis.

Adaptation, Psychological↗
PubMed2002

Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally?

This study assesses the perception of the decision-making process of 25 surgeons and 194 patients (aged 21-81 years) who had newly diagnosed breast cancer and had to undergo mastectomy or breast-conserving surgery (BCS). The majority of women wanted to participate in decision-making. When it was medically possible to give a choice between BCS and mastectomy, only 59% of women received a choice. The main reason that 11% of the women went against surgeon's recommendations was fear of cancer recurrence. The most influential factors for women were the surgeon's recommendation, and fear of cancer recurrence. Medical assessment and the cosmetic result were the most influential factors for the surgeons. Female surgeons were more influenced by their assessment of the women's need for security, than male. In conclusion, not all women who are eligible for BCS receive an option. Women and surgeons emphasize influencing factors differently. The surgeon's gender was found to influence recommendation given.

Journal Article↗
PubMed2001

Representing patient preference-related concepts for inclusion in electronic health records.

In recent years shared decision making between patients and their health care providers and the inclusion of patient preferences in patient care have been, in theory, embraced as models for good clinical practice. Patients' experiences, values, and preferences are increasingly acknowledged as important pieces of evidence for appropriate health care decision making. To effectively use information about patient preferences in patient care, this information, which is gathered through a process of preference elicitation, needs to be integrated with other types of information, e.g., diagnoses, treatments, and patient status indicators within the context of a longitudinal electronic health record. This integration requires that patient preference-related concepts be represented nonambiguously and in a manner that renders them suitable for computer rather than human processing. In this article, the authors describe important patient preference-related concepts and illustrate the use of the LOINC semantic structure as a terminology model to create fully specified names for a sample of 15 preference elicitations from 8 published research articles.

Decision Making↗
PubMed2001

Eliciting exercise preferences in cardiac rehabilitation: initial evaluation of a new strategy.

Cardiac rehabilitation (CR) programs may be more effective in promoting long-term exercise if participants are helped to devise exercise programs that are individually tailored to their exercise preferences. This paper describes an initial evaluation of 'CHOICE' (Creating better Health Orientation by Improving Communication about Exercise experiences), an instrument designed to elicit cardiac patients' exercise preferences. In individual interviews with 16 women, CHOICE was used to help participants select exercise features that were important to them for maintaining long-term exercise. Exercise preferences were then summarized on individual preference forms. Study participants in this pilot study had no problems in selecting exercise features contributing to exercise maintenance and could easily discriminate between their relative importance. Further, there were large variations in the importance participants placed on different exercise features. This suggests the need for eliciting patients' exercise preferences so exercise programs can be individually designed. In conclusion, CHOICE is an applicable instrument for eliciting exercise preferences.

Aged↗
PubMed2001

Developing a module for nursing documentation integrated in the electronic patient record.

Norway's regional teaching hospitals are working together on a project to develop an interdisciplinary electronic patient record (EPR). This paper presents the results of a project to develop nursing documentation as part of an integrated EPR to improve the quality and continuity of patient care. The project used a consensus process as a working norm. The most important result is that the five hospitals have agreed on a framework for nursing documentation, and on the main components that need to be implemented in the electronic patient record.

Computer User Training↗
PubMed2001

Evaluating the Beta version of the International Classification for Nursing Practice for domain completeness, applicability of its axial structure and utility in clinical practice: a Norwegian project.

The purpose of this Norwegian project was to evaluate the International Classification for Nursing Practice (ICNP) Beta version for domain completeness, applicability of its axial structure and utility in clinical practice. A subset of terms addressing the areas of circulation and elimination were abstracted from the nursing records of a cardiac intensive care unit and a nursing home. Abstracted terms were mapped to terms in the ICNP. In the ICNP, the same or similar terms were found for 47% of the documented circulation terms and 69% of the documented elimination terms that addressed nursing phenomena. For nursing interventions, 27% of the documented circulation terms and 35% of the documented elimination terms mapped to the ICNP. The research team encountered difficulty in coding terms with the ICNP that expressed patients' perspectives, preferences, behaviours and experiences, and terms that represented signs-and-symptoms. Recommendations for further development of the ICNP include improvement in granularity, precision and conceptual definitions of terms; inclusion of time-related terms for representing nursing phenomena; and an easier method for navigating around the ICNP.

Abstracting and Indexing↗
PubMed2001

An information system to improve financial management, resource allocation and activity planning: evaluation results.

UNLABELLED: An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. PURPOSE: To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. METHODS: Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. RESULTS: Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

Attitude to Computers↗
PubMed2000

Clinicians' use of a palm-top based system to elicit patient preferences at the bedside: a feasible technique to improve patient outcomes.

While there is an increased emphasis on shared decision making between patients and clinicians, there has been little research on decision support systems (DSSs) to assist clinicians in eliciting and integrating patient preferences in clinical care and evaluating their effect on patient outcomes. This paper presents the results of nurses' use of CHOICE, a palm-top based DSS for preference-based care planning that assists nurses in eliciting patient preferences for functional performance at the bedside and to select care priorities consistent with patient preferences. Nurses' use of CHOICE changed nursing care to be more consistent with patient preferences and improved patients' preference achievement. The study demonstrated that the use of computer-based decision support for preference-based care planning can improve patient-centered care and patient outcomes.

Aged↗
PubMed1998

Improving patient outcomes by including patient preferences in nursing care.

While preference elicitation techniques have been effective in supporting patients in their abilities to make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. This paper presents a study that tested the effect of eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice on nurses' care priorities and patient outcomes. The study showed that information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patient outcomes of preference achievement and physical functioning. These results emphasize the importance of continuing to refine strategies for eliciting and integrating patient preferences into patient care as a means to improve patient outcomes.

Aged↗
PubMed1997

Decision support for assessing patient preferences for geriatric care.

This paper describes a pilot study that tested the strategy and feasibility of a decision support system (DSS) that assists nurses in integrating patients' preferences for self-care functions in the assessment of elderly patients. 12 elderly clients and a clinical nurse specialist (CNS) participated in this study. The CNS reported the assessment strategy to be very helpful to learn about patients' strengths and weaknesses in self-care functioning. Clients reported that being asked about their preferences helped them clarify their goals, and created a shared understanding between nurse and patient. This pilot study also suggests that patients have a clear understanding of their predominant problems and can discriminate between their preferences. It further supports previous literature that there is a substantial difference in values patients place on clinical outcomes. This highlights the importance of an individual approach to patient care and the usefulness of DSS to assist nurses in eliciting patient preferences.

Aged↗
PubMed1997

Including patient preferences in nurses' assessment of older patients.

The refinement of a patient assessment tool for older patients, Lorensen's Self-Care Capability Scale, is described where a systematic elicitation of patient preferences is included in the assessment. This study tests a decision analytic approach as a strategy for formalizing subjective judgement, which makes it possible to include patients' own values and preferences in planning patient care. Applying this technique to patient assessment contributes to explicitly tailoring nursing care decisions to desired outcomes as preferred by individual patients. A shared approach to decision making between nurse and patient ensures a mutual understanding about goals, priorities and patient values through discussion and negotiation. This pilot study supported the merit of including patient preferences systematically in the assessment of older patients. The method provides an important decision aid for nurses in planning nursing care in accordance with patients' own values and preferences for care.

Activities of Daily Living↗
PubMed1995

Scapulothoracic anatomy for the arthroscopist.

Because endoscopic management has recently been introduced as treatment for painful subscapular snapping, we designed a cadaveric study to identify the boundaries of the scapulothoracic spaces and the relationship of important neurovascular structures to safe portal sites for arthroscopic surgery. We studied eight fresh, unembalmed cadaveric shoulders by anatomic dissection alone and eight fresh, unembalmed cadaveric shoulders by dissection after arthroscopy. We noted the following findings: (1) the scapulothoracic articulation has two triangular spaces, the serratus anterior space and the subscapularis space, that are divided obliquely by the serratus anterior muscle; (2) the boundaries of the larger serratus anterior space include the chest wall anteriorly, the serratus anterior muscle posteriorly, and the rhomboids medially; (3) the boundaries of the subscapularis space are the serratus anterior muscle anteriorly, the subscapularis muscle posteriorly, and the axilla laterally; and (4) a well-defined bursa occupies the serratus anterior space. Based on these findings, we recommend that portals for arthroscopic surgery should be inferior to the spine of the scapula and three to four finger-breadths from the vertebral border of the scapula (1) to avoid the neurovascular structures at the superomedial angle of the scapula, (2) to avoid the dorsosacpular nerve and artery, and (3) to prevent perpendicular orientation of the arthroscope to the lateral chest wall.

Arthroscopy↗
PubMed1992

Regional anesthesia for foot and ankle surgery.

We present our experience with the use of regional anesthesia in 1295 of 1862 (69.5%) surgical procedures of the foot and ankle between 1986 and 1989. Regional anesthesia was used for surgical procedures of the forefoot, midfoot, hindfoot, and ankle in the setting of elective surgery and trauma. From the viewpoint of the surgeon, regional anesthesia was completely successful in 95% of the procedures performed. Sample patient surveys confirmed that 87% of patients were satisfied with the use of regional anesthesia for their operative procedure. There were four (0.3%) minor complications, one being lidocaine toxicity. With increasing experience, the expanded indications and uses of regional anesthesia for foot and ankle surgery are proving to be simple, safe, reliable, and well tolerated by the patient.

Adolescent↗
PubMed1991

Triangulation of pedicular instrumentation. A biomechanical analysis.

Tensile load-to-failure pullout tests were performed on 54 cadaveric spinal segments. The vertebrae were grouped by adjacent levels and matched for bone mineral density (g/cm2), which was measured by dual-photon absorptiometry. Triangulation of Steffee screws and CD pedicle screws was accomplished by transverse plates specifically designed to increase fixation within the same vertebra before the longitudinal Steffee plate or CD rod was applied. A transverse plate with adjustable length was also tested to accommodate variable interpedicular distances. Comparative pullout load-to-failures were as follows: laminar hook, 809 SE 99.4 N; single CD pedicular screws, 863 SE 108 N; single Steffee pedicular screw, 1245 SE 75.3 N; adjustable transverse plate, 1341 SE 114; triangulated Steffee pedicle screws with a transverse plate, 1701 SE 151 N; and triangulated CD pedicle screws with a transverse plate, 2096 SE 115 N. Three triangulated constructs with pedicle screws and a transverse plate (CD, Steffee, and Kirschner) provided significantly greater fixation than conventional pedicular or laminar hook based instrumentation systems (P less than 0.05). Improved treatment of spinal deformities in the elderly and osteoporotic population is dependent on improving the fixation at the metal-bone interface of spinal implants Particularly in osteoporotic vertebrae, the strength of fixation of two triangulated pedicle screws is better than either laminar hooks or single pedicle screws. The strength of fixation of triangulated pedicle screws connected by a transverse plate is superior to a single pedicle screw because it is dependent on the mass of bone between the screws rather than simply the amount of bone within the screw thread.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1978

Hypergastrinemia of antral origin in duodenal ulcer.

A case of recurrent duodenal ulcer, basal gastric hypersection, and hypergastrinemia of antral origin is presented. The diagnosis was suggested preoperatively by stimulation tests with secretin and food. Billroth II antrectomy led to normalization of serum gastrin within half an hour. The gastrin content of the antral mucosa was not increased, neither was antral G-cell hyperplasia demonstrable. Postoperatively the basal gastric acid output and fasting serum gastrin levels were normal, without a postprandial increase in serum gastrin concentrations. The case does not support the existence of a specific disease called antral G-cell hyperplasia.

Adult↗