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Biomedical subjects

D K Moser

Publications and source records attributed to D K Moser.

At least 19 recordsLinked to original sources
PubMed2006

The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms.

The time that elapses from the onset of symptoms of acute myocardial infarction (AMI) to treatment has a significant effect on mortality and morbidity. This study reports the effectiveness of an education and counselling intervention on knowledge, attitudes and beliefs about AMI symptoms and the appropriate response to symptoms. The intervention was tested in a randomised controlled trial of 200 people with a history of coronary heart disease (CHD). The groups were equivalent at baseline on study outcomes, clinical history and sociodemographic characteristics with the exception of more women in the intervention group (38% vs. 24%). The results of repeated measures ANOVA showed that the intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms that was sustained to 12 months (p=0.02). There were no differences between groups' attitudes and beliefs over time. It is concluded that a short individual teaching and counselling intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms in people at risk of AMI sustained to 12 months.

Adaptation, Psychological↗
PubMed2001

Biobehavioral characteristics of infants with failure to thrive.

Failure to thrive (FTT) is a syndrome of growth failure that results in an infant who is behaviorally difficult. The current thinking is that FTT results from a problematic infant-mother interaction, with the infant making a significant contribution to the interactional process. It is possible that the behavioral characteristics of the infant with FTT may be related to underlying physiologic response patterns, specifically, activity of the autonomic nervous system. The purpose of this study is to examine the relationships among behavioral responsiveness, heart rate variability as a marker of autonomic nervous system activity, and nutritional status in infants with FTT. Infants with FTT were matched with healthy growing infants (n = 14 pairs). Results from the study indicated that infants with FTT exhibited considerably more negative behaviors and exhibited low heart rate variability. It appears that there may be a physiologic basis to the behaviors that are exhibited by infants with FTT. Prospective research is needed to further clarify this relationship.

Adult↗
PubMed2001

Cardiac power output during transition from mechanical to spontaneous ventilation in canines.

Hemodynamic instability during weaning from mechanical ventilation is one proposed cause of weaning failure. This study evaluated cardiac power output (CPO) as an indicator of significant hemodynamic alteration and cardiac reserve during the transition from controlled mechanical ventilation to spontaneous ventilation using three clinical weaning modes. It also compared CPO with commonly used indicators of hemodynamic instability during weaning. The data suggest that CPO is a sensitive indicator of significant hemodynamic alteration and could be used to optimize cardiovascular function during weaning from mechanical ventilation to increase the likelihood of weaning success. Key words: cardiac output, cardiac power output, hemodynamic monitoring, mechanical ventilation

Animals↗
PubMed2001

Heart rate variability and hemodynamic alterations in canines with normal cardiac function during exposure to pressure support, continuous positive airway pressure, and a combination of pressure support and continuous positive airway pressure.

Variations in intrathoracic pressure generated by different ventilator weaning modes may significantly affect intrathoracic hemodynamics and cardiovascular stability. Although several investigators have attributed cardiovascular alterations during ventilator weaning to augmented sympathetic tone, there is limited investigation of changes in autonomic tone during ventilator weaning. Heart rate variability (HRV), the analysis of beat-to-beat changes in heart rate, is a noninvasive indicator of autonomic tone that might be useful in the identification of patients who are at risk for weaning difficulty due to underlying cardiac dysfunction. The authors describe HRV and hemodynamics in response to 3 ventilatory conditions: pressure support (PS) 10 cmH2O, continuous positive airway pressure (CPAP) 10 cmH2O, and a combination of PS 10 cmH2O and CPAP 10 cmH2O (PS + CPAP) in a group of canines with normal ventricular function. Six canines were studied in the laboratory. Continuous 3-lead electrocardiographic data were collected during baseline (controlled mechanical ventilation) and following transition to each of the ventilatory conditions (PS, CPAP, PS + CPAP) for analysis of HRV. HRV was evaluated using power spectral analysis to define the power under the curve in a very low frequency range (0.0033 to < 0.04 Hz, sympathetic tone), a low frequency range (0.04 to < 0.15 Hz, primarily sympathetic tone), and a high frequency range (0.15 to < 0.40 Hz, parasympathetic tone). A thermodilution pulmonary artery catheter measured cardiac output and right ventricular end-diastolic volume to describe global hemodynamics. There were significant increases in very low frequency power (sympathetic tone) with a concomitant significant reduction in high-frequency power (parasympathetic tone) with exposure to PS + CPAP. These alterations in HRV were associated with significantly increased heart rate and reduced right ventricular end-diastolic volume. Although there was a small but significant increase in cardiac output with exposure to PS, HRV was unchanged. These data indicate that there was a relative shift in autonomic balance to increased sympathetic and decreased parasympathetic tone with exposure to PS + CPAP. The increase in intrathoracic pressure reduced right ventricular end-diastolic volume (preload). This hemodynamic alteration generated a change in autonomic tone, so that cardiac output could be maintained. Individuals with autonomic and/or cardiovascular dysfunction may not be capable of this type of response and may fail to successfully wean from mechanical ventilation.

Analysis of Variance↗
PubMed2001

Comparison of anxiety assessments between clinicians and patients with acute myocardial infarction in cardiac critical care units.

BACKGROUND: Although anxiety is common after acute myocardial infarction and can adversely affect physical recovery, it is not part of the routine clinical assessment of patients with myocardial infarction. Furthermore, evidence suggests that patients and clinicians differ significantly in their assessments of patients' anxiety levels. OBJECTIVES: To determine the extent to which clinicians assess anxiety in patients with acute myocardial infarction and to compare patients' self-ratings with their clinicians' assessments. METHODS: In a prospective, descriptive study, 101 patients used the Spielberger State Anxiety Index to assess their anxiety during the first 48 hours after admission for acute myocardial infarction. Patients' scores were compared with nurses' and physicians' assessments of the patients' anxiety as reported in the medical record. RESULTS: Only 45 patients (45%) had anxiety assessments noted in the record. Of those 45, 26 patients (58%) were described simply as anxious without any further description of the level of anxiety. Eleven (24%) of those 45 patients had behaviors of anxiety recorded, again without any indication of the level of anxiety. No association between patients' self-assessments and their clinicians' assessments was apparent (lambda = .03; P > .05). CONCLUSIONS: Anxiety was not routinely assessed, despite nearly half the patients reporting moderate to extreme anxiety when asked. When clinicians assessed anxiety, their assessments did not match patients' self-ratings of anxiety. A simple, easy-to-use instrument for discriminating levels of anxiety is needed.

Aged↗
PubMed2000

Impact of cardiopulmonary resuscitation training on perceived control in spouses of recovering cardiac patients.

The objectives of this study were to determine whether there are differences in emotional distress among spouses of recovering cardiac patients based on level of perceived control, and to determine whether perceived control can be enhanced by cardiopulmonary resuscitation (CPR) training. A total of 219 spouses of cardiac patients recovering from an acute cardiac event were enrolled and 196 completed the study. Spouses were assigned to either a no-treatment control group or one of two CPR training groups. Perceived control and emotional adjustment were measured at baseline and again 1 month after subjects received CPR training. Spouses with high perceived control were less anxious, less depressed, and less hostile at baseline. Perceived control increased significantly in spouses after both CPR training groups, but was unchanged in the control group. After a partner's cardiac event, perceived control is important for psychological recovery in spouses and can be increased by CPR training.

Adaptation, Psychological↗
PubMed2000

A controlled trial of cardiopulmonary resuscitation training for ethnically diverse parents of infants at high risk for cardiopulmonary arrest.

OBJECTIVE: Parents of infants hospitalized in the neonatal intensive care unit are routinely taught cardiopulmonary resuscitation (CPR) as part of the preparation for transition to home. A variety of methods are used to teach CPR knowledge and skills. The purpose of this study was to compare the psychosocial consequences of three different methods of CPR training for parents of infants at high risk for cardiopulmonary arrest. DESIGN, SETTING, AND SUBJECTS: In this prospective, multisite clinical trial, 335 parents and other caretakers of infants hospitalized in the neonatal intensive care unit were followed for 1 yr. Participants were 69% female, 49% Latino/Latina, with a mean age of 30 +/- 8 yrs. INTERVENTION: Subjects initially were randomized to one of four CPR training protocols: a video-only class, an instructor-taught class, an instructor-taught class combined with a social support intervention, and a control group. The social support intervention involved a group discussion after CPR training with regular telephone follow-up over the next 6 months by a nurse. MEASUREMENTS AND MAIN RESULTS: Data on psychosocial adjustment to illness, anxiety, and depression were collected at baseline, 2 wks, and 3 and 6 months. There were significant differences among the groups over time in anxiety (p = .007) and psychosocial adjustment to illness (p = .001). Parents in the CPR-video protocol had significantly less early anxiety and better postdischarge psychosocial adjustment compared with parents in the social support intervention at 2 wks after hospital discharge. Patterns of change over time, however, supported the efficacy of the CPR-social support intervention or the CPR-instructor protocols when compared with the CPR-video protocol. CONCLUSION: The results confirm that parents have difficulty adjusting after an infant's discharge from the neonatal intensive care unit and support the positive psychosocial effects of helping parents prepare for a home emergency by teaching CPR. The additional staff resources required to provide parents with social support along with CPR training are not justified based on the findings of the current study.

Adult↗
PubMed2000

Effect of psychosocial factors on physiologic outcomes in patients with heart failure.

Despite advances in its treatment, the epidemic of heart failure continues unabated in the United States and is escalating worldwide. The extremely high morbidity and mortality seen with heart failure demand creative approaches to this problem. Attention to nontraditional risk factors for rehospitalization and mortality, in addition to traditional medical risk factors, may yield improved outcomes. Psychosocial factors, particularly lack of social support and depression, are associated with poorer outcomes in cardiac patients. However, few studies have been conducted among patients with heart failure. In this article, the evidence relating poor quality of life, social isolation and lack of emotional support, anxiety and depression, and morbidity and mortality in patients with heart failure is discussed. Also explored are possible mechanisms for the association between psychosocial variables and physical outcomes and related clinical and research implications.

Anxiety↗
PubMed2000

A comparison of hemodynamic changes during the transition from mechanical ventilation to T-piece, pressure support, and continuous positive airway pressure in canines.

The immediate transition from positive pressure mechanical ventilation to spontaneous ventilation may generate significant cardiopulmonary hemodynamic alterations based on the mode of weaning selected, particularly in individuals with preexisting cardiac dysfunction. The purpose of this study was to compare hemodynamic responses associated with the initial transition to 3 modes of ventilator weaning (spontaneous ventilation/T-piece, pressure support [PS], and continuous positive airway pressure [CPAP]). Right ventricular hemodynamic responses were evaluated with a thermodilution pulmonary artery catheter; while left ventricular hemodynamic responses were measured by a transducer-tipped Millar catheter and conductance catheter. Two groups of canines were studied. Group 1: normal biventricular function (n = 10) and group 2: propranolol-induced biventricular failure (n = 10). Dependent variables were measured at baseline on controlled mechanical ventilation (MV) and following the initial transition to each of 3 randomized spontaneous ventilatory conditions: T-piece, PS 5 cmH2O, and CPAP 5 cmH2O. Both groups significantly increased cardiac output in response to T-piece. Right ventricular stroke work was also significantly increased with T-piece and CPAP in both groups of subjects. Left ventricular response depended on baseline ventricular function. Baseline ventricular function influenced hemodynamic response to the immediate transition from mechanical to spontaneous ventilation. There were also differential hemodynamic responses based on the ventilatory mode. Consideration of baseline cardiac function may be an important factor in the selection of an appropriate mode of spontaneous ventilation following controlled MV.

Animals↗
PubMed2000

Correlates of anxiety, hostility, depression, and psychosocial adjustment in parents of NICU infants.

PURPOSE: The birth of a premature or critically ill infant can result in debilitating parental responses. This study identifies correlates of parental anxiety, hostility, depression, and psychosocial adjustment so that nurses can identify parents likely to need special attention or intervention. DESIGN: An explanatory, correlational design was used. SAMPLE: The study involved 469 parents (mothers = 299, 65 percent; mean age 29.1 +/- 6.8 years) of infants hospitalized in five Level III NICUs. MAIN OUTCOME VARIABLE: The main outcomes were those variables which correlated with the independent variables and included: parent status (mother or father), ethnicity, employment status, and education. RESULTS: Parents experienced high levels of anxiety, hostility, and depression. Poorer family functioning, lower levels of social support, and lower perceived control were associated with higher levels of anxiety, hostility, and depression and with poorer adjustment. Parental status (mother or father), ethnicity, employment status, and education were significantly related to parental responses.

Adaptation, Psychological↗
PubMed2000

Differences between men and women in anxiety early after acute myocardial infarction.

BACKGROUND: Anxiety after acute myocardial infarction influences both short- and long-term recovery. Therefore, determining specific subgroups of patients who have relatively higher anxiety levels is important. Published findings about gender differences in anxiety after acute myocardial infarction are conflicting. OBJECTIVES: To determine whether gender differences in anxiety after acute myocardial infarction exist and whether any of the sociodemographic and clinical variables that often differ between men and women with acute myocardial infarction interact with gender to influence anxiety. METHODS: A total of 424 patients with confirmed acute myocardial infarction were enrolled in this multicenter prospective study. Patients' anxiety level was measured within 72 hours of their arrival at the hospital by using the State Anxiety Inventory and the Brief Symptom Inventory. RESULTS: Women had significantly higher anxiety than did men according to both the State Anxiety Inventory (42 +/- 12.9 vs 37.7 +/- 12.5; P = .001) and the Brief Symptom Inventory (0.83 +/- 0.97 vs 0.63 +/- 0.71; P = .02). Of the sociodemographic and clinical variables examined, only marital status and income significantly interacted with gender to influence anxiety. Married women had higher anxiety than did single and widowed women, and married men had lower anxiety than did single men. Women with lower income had higher anxiety than did women with higher income; income was not related to anxiety in men. CONCLUSION: Women report significantly greater anxiety early after acute myocardial infarction than men do. Women's greater anxiety may be partially explained by marital status and lower income at the time of the infarction.

Aged↗
PubMed2000

Heart failure management: optimal health care delivery programs.

Heart failure is the single most costly health care expenditure in the United States. The major proportion of these costs is attributable to rehospitalizations, and by many estimates the majority of rehospitalizations might be preventable with better health care delivery. The past 5 years have seen an explosion in the number of heart failure disease management programs put in place across the country to try to decrease the economic burden of heart failure and improve patient outcomes. Yet few of these are based on programs tested by researchers, let alone tested in randomized, controlled trials. This chapter summarizes findings from studies of heart failure disease management programs from 1980 to the present, critiques those studies, and offers suggestions for future research in this area.

Delivery of Health Care↗
PubMed1999

Stress during mechanical ventilation: benefit of having concrete objective information before cardiac surgery.

BACKGROUND: Negative emotional reactions and difficulty in communicating are common in patients receiving mechanical ventilation and may adversely affect recovery from cardiac surgery. OBJECTIVE: To determine the effect of providing concrete objective information about emotional stress and difficulty in communicating related to mechanical ventilation to Korean cardiac surgery patients. METHODS: A quasi-experimental 2-group design was used. The 22 subjects in the control group received the usual information; the 21 in the experimental group received concrete objective information in addition to the usual information. State anxiety, negative affect, use of sedative and analgesic medications, and difficulty communicating were compared between the 2 groups after surgery. RESULTS: Patients who received concrete objective information experienced less anxiety and negative mood during mechanical ventilation, less difficulty in communicating, and a shorter intubation time than did patients in the control group. The 2 groups did not differ in the amount of sedative or analgesic medication used per hour during mechanical ventilation. CONCLUSIONS: Nursing interventions that include concrete objective information help cardiac patients cope with the stresses associated with surgery and mechanical ventilation.

Adult↗
PubMed1998

Comparison of cardiopulmonary resuscitation training methods for parents of infants at high risk for cardiopulmonary arrest.

STUDY OBJECTIVES: To compare three different methods of teaching CPR to parents of infants at high risk for sudden cardiopulmonary arrest and to identify characteristics that predict difficulty in learning CPR. METHODS: We conducted a prospective, multicenter clinical trial of 480 parents and other infant caretakers. Subjects were randomly assigned to 1 of 3 CPR training protocols: an instructor-taught CPR class, an instructor-taught CPR class followed by a social support intervention, or a self-training video module. CPR proficiency was evaluated with the use of a CPR skills checklist. RESULTS: Of 480 subjects, 301 (63%) were able to demonstrate successful CPR after training. Univariate analysis revealed that unsuccessful learners were likely to be less educated, to have lower incomes, to never have attended a previous CPR class, and to have better psychosocial adjustment to their infant's illness, compared with successful learners. The proportion of successful learners was significantly higher in the 2 instructor-taught classes than in the self-training video class. Multiple logistic regression analysis was used to develop a predictive profile to describe unsuccessful learners. The following characteristics independently predicted unsuccessful learners: CPR learned in the self-training video group, fewer years of education, and better psychosocial adjustment. CONCLUSION: Most parents of infants at high risk for sudden death can demonstrate successful CPR skills at the completion of 1 class. However, a significant minority will require extra attention to be successful. Self-training video instruction may not be an adequate substitute for instructor-taught CPR.

Adult↗
PubMed1998

Kathleen Dracup, mentor extraordinaire.

This article describes events that illustrate why Dr Kathleen Dracup is an extraordinary mentor to students and colleagues. Her commitment to the advancement of her students and colleagues, her gentle but persistent encouragement to grow, and her generosity in providing pivotal opportunities are highlighted. Examples of her important contributions with students to cardiovascular research and successes enjoyed by students as a result of their relationships with Dr Dracup are presented.

Education, Nursing↗