PubMed Health⌕ Search

Biomedical subjects

Cynthia Arslanian-Engoren

Publications and source records attributed to Cynthia Arslanian-Engoren.

13 recordsLinked to original sources
PubMed2006

Symptoms of men and women presenting with acute coronary syndromes.

This study evaluated symptom similarities and differences between men and women presenting with acute coronary syndromes (ACSs) and determined whether differences in presentation are intrinsic to patient gender or to other factors. This study was a subgroup analysis of patients from an ACS registry. We compared differences in symptom presentation between men and women and analyzed them using binary logistic regression with all variables and 2 x 2 interactions. Patient gender was forced to remain in the models. Women comprised 35% of the 1,941 patients admitted with confirmed ACS. Men were more likely to present with chest pain, left arm pain, or diaphoresis. Nausea was more common in women. Dyspnea did not differ between groups. After binary logistic regression, gender remained a statistically significant predictor of diaphoresis and nausea, but not of chest or left arm pain. We found that differences in occurrence of chest pain and left arm pain between men and women are explainable by differences in co-morbidities and history; the higher occurrence of diaphoresis in men and of nausea in women is partly related to maleness or femaleness. In conclusion, gender should be considered when evaluating patients with symptoms of ACS.

Acute Disease↗
PubMed2005

Patient cues that predict nurses' triage decisions for acute coronary syndromes.

The purpose of this study was to determine the patient cues that emergency department (ED) nurses use to triage male and female patients with complaints suggestive of acute coronary syndromes (ACSs) and to determine if cues used by ED nurses to make clinical inferences varied by patient sex or nurses' demographic characteristics. Using clinical vignette questionnaires with different patient characteristics, ED nurses' triage decisions were evaluated to determine the patient cues used to predict ACS. Men and women were equally likely to be given an ACS triage decision and this was not affected by nurses' demographic characteristics. However, nurses used different cues to triage men and women with complaints suggestive of ACS, although by receiver operating characteristic curves, the differences between sexes were small. In addition, female vignette patients were more likely than male vignette patients to be assigned a suspected cause of cholecystitis for their presentation in a small subset of 13 (11:2; odds ratio, 1.653; 95% confidence interval, 1.115-24.47; p=.036). This study provides insight into the complex phenomenon of triage decision making and warrants further exploration.

Acute Disease↗
PubMed2005

Treatment-seeking decisions of women with acute myocardial infarction.

Women who experience symptoms of an acute myocardial infarction (MI) are less likely than men to seek medical attention after the onset of initial symptoms. The purpose of this study was to facilitate a better understanding of the treatment-seeking decisions of women who seek emergency evaluation for symptoms suggestive of MI. A qualitative, semi-structured, feminist, post structuralist interview approach was used to explore the treatment-seeking decisions of ten women hospitalized for a MI. The oral descriptions were tape-recorded, transcribed verbatim, and analyzed using the Morse and Field method. Content analysis revealed ten important issues that influenced women's treatment-seeking decisions: associating symptoms with non-cardiac causes, minimizing symptoms, experiencing non-classic symptoms, mass media portrayal, male family member experience, knowledge deficit, family insistence, experiencing increased pain, experiencing difficulty breathing, and having expectations different from realities. Based on their language and subjectivity, participants revealed the power of the meaning of heart disease on treatment-seeking decisions.

Aged↗
PubMed2005

An ontological view of advanced practice nursing.

Identifying, developing, and incorporating nursing's unique ontological and epistemological perspective into advanced practice nursing practice places priority on delivering care based on research-derived knowledge. Without a clear distinction of our metatheoretical space, we risk blindly adopting the practice values of other disciplines, which may not necessarily reflect those of nursing. A lack of focus may lead current advanced practice nursing curricula and emerging doctorate of nursing practice programs to mirror the logical positivist paradigm and perspective of medicine. This article presents an ontological perspective for advanced practice nursing education, practice, and research.

Education, Nursing, Graduate↗
PubMed2005

Hospital and long-term outcome of trauma patients with tracheostomy for respiratory failure.

Studies of tracheostomy for respiratory failure have suggested a poor prognosis, however, trauma patients may have a better outcome. Data from 113 trauma patients were retrospectively analyzed for comorbidities, laboratory values, and hospital course. Long-term survival was determined from the Social Security Death Index. Trauma patients were young, overwhelmingly male, relatively healthy, and frequently uninsured. Seventy-five per cent of trauma patients were liberated from mechanical ventilation by hospital discharge. Timing of tracheostomy had no effect on days of mechanical ventilation or hospital length of stay. Hospital survival was 98 per cent, and 3-year Kaplan-Meier survival was 80 per cent. Older age and higher admission creatinine levels were predictive of late death. Trauma patients who undergo tracheostomy are likely to survive and be liberated from mechanical ventilation.

Adult↗
PubMed2004

Hospital and long-term outcome after tracheostomy for respiratory failure.

OBJECTIVE: To determine the patient characteristics, hospital course, hospital cost, posthospital survival, and functional outcome in a group of patients with tracheostomy for respiratory failure. DESIGN: Retrospective chart review combined with prospective evaluation of functional status. SETTING: An urban, tertiary-care medical center. PATIENTS: Adult patients with tracheostomy for respiratory failure between January 1, 1998, and December 31, 2000. METHODS: Retrospective chart review and prospective administration of the Short Form-36 (SF-36) for health status outcome. RESULTS: Four hundred twenty-nine patients were studied. Hospital mortality was 19%. Only 57% of survivors were liberated from mechanical ventilation. At 100 days, 6 months, 1 year, and 2 years after discharge, 24%, 30%, 36%, and 42% of hospital survivors had died, respectively. Patients liberated from mechanical ventilation and having their tracheostomy tubes decannulated had the lowest mortality (8% at 1 year); the mortality of ventilator-dependent patients was highest (57%). Sixty-six patients completed the SF-36 for functional status. While emotional health was generally good, physical function was quite limited. Median hospital direct variable cost was $29,340. CONCLUSION: Overall survival and functional status are poor in patients with tracheostomy for respiratory failure. Patients who are liberated from mechanical ventilation and have their tracheostomy tubes removed have the best survival; however, it comes at a higher hospital cost and longer length of stay.

Adult↗
PubMed2002

Feminist poststructuralism: a methodological paradigm for examining clinical decision-making.

AIM: To present the philosophical framework of feminist poststructuralism, discuss its use as an innovative research approach and its implications for nursing knowledge development and practice. BACKGROUND: This perspective examines the construction of meaning, power relationships, and the importance of language as it affects contemporary healthcare decisions. It seeks to identify and expose biases that marginalize the healthcare needs of women and contribute to healthcare disparities for this population. Additionally, a feminist poststructuralist perspective seeks to develop new knowledge for understanding gender differences. NURSING APPLICATION: A feminist poststructuralist perspective represents an alternative paradigm for studying the phenomenon of clinical decision-making. An empirical application example of a feminist poststructuralist perspective is provided. This exemplar investigated emergency department registered nurses' triage decisions for men and women with symptoms suggestive of coronary heart disease.

Attitude of Health Personnel↗
PubMed2002

Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery.

STUDY OBJECTIVES: To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery. DESIGN: Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years. PATIENTS: One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery. SETTING: A university-affiliated tertiary care center. MEASUREMENTS AND RESULTS: Compared to septuagenarians, octogenarians were more likely to be widowed (p < or = 0.001) and to have had preoperative strokes (p < or = 0.05) but were less likely to have diabetes mellitus (p < or = 0.001). They were less likely to have undergone mitral valve surgery (p < or = 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p < or = 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians. CONCLUSION: Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.

Age Factors↗
PubMedDate not supplied

The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study.

BACKGROUND: Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. OBJECTIVES: This article serves to describe the experience of patients who survived PMV and to identify salient factors that contributed to successful liberation. METHODS: A phenomenological approach was used to explore the lived experience of seven PMV survivors. RESULTS: Six mutually exclusive themes emerged from the participants' descriptions to create a structural description of the lived experience. CONCLUSIONS: Survivors credited their own self-determination and the expertise and care of health care professionals with their ability to be successfully liberated from prolonged mechanical ventilation. Although surviving PMV was described as frightening and traumatic, comfort and resolve were derived from family members, religion, prayer, and angelic encounters. These findings are useful in providing direction for critical care clinical practice and future research.

Adult↗
PubMedDate not supplied

Do emergency nurses' triage decisions predict differences in admission or discharge diagnoses for acute coronary syndromes?

Coronary heart disease is the number 1 killer of adults in the United States, affecting 1 in 5 men and women. However, women are more likely than men to die after an acute coronary event and are less likely to receive prompt or aggressive treatment. Few studies have examined the role of emergency nurses' triage decisions in these disparities, even though nurses often determine initial patient priority and urgency status for emergency cardiac evaluation and treatment. The purpose of this prospective study was to examine if nurses' initial triage decisions could predict admission or discharge diagnoses for acute coronary syndromes (ACS). A total of 108 nurses' triage decisions made by 13 nurses were examined. There were no differences in nurses' triage decisions based on patient gender, race, or age. By multivariate analysis, chest pain, history of coronary heart disease, history of myocardial infarction, and smoking were predictive of an ACS decision. Overall, accuracy for predicting admission diagnosis was poor. Sensitivity and specificity were 57% and 59%, respectively, with a positive predictive value of 68% and a negative predictive value of 56%. It was similarly poor for predicting discharge diagnosis. Sensitivity and specificity for discharge diagnosis were 55% and 69%, respectively, with a positive predictive value of 17% and a negative predictive value of 93%. Findings indicate limitations in the ability of nurses' triage decisions to predict admission and discharge diagnoses for ACS.

Adult↗
PubMedDate not supplied

Black, Hispanic, and White women's knowledge of the symptoms of acute myocardial infarction.

OBJECTIVE: To examine Black, Hispanic, and White women's knowledge of the symptoms of acute myocardial infarction. DESIGN: Descriptive, nonexperimental design. SETTING: Detroit, Michigan, and San Antonio, Texas, metropolitan areas. PARTICIPANTS: A convenience sample of 78 ethnically diverse women. Hispanics (n = 26) were recruited from San Antonio, Texas; Blacks (n = 26) were recruited from Detroit, Michigan; and Whites were recruited from San Antonio, Texas (n = 13), and Detroit, Michigan (n = 13). MAIN OUTCOME MEASURES: Participants ranked 10 acute symptoms they believed represented a myocardial infarction: anxiety, arms ache, change in thinking, chest pain, cough, fatigue, decreased appetite, headache, indigestion, and shortness of breath. Next, participants assigned a likelihood score for each acute symptom as representing a myocardial infarction. RESULTS: Hispanic women were more likely than Black women to perceive the symptom of headache as indicative of a myocardial infarction. Women older than age 45 were more likely to assign a higher likelihood score to the symptom of shortness of breath than were women age 45 or younger. CONCLUSIONS: Age and ethnic differences were noted in women's perception of the signs and symptoms indicative of a myocardial infarction.

Adolescent↗