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Biomedical subjects

D K Moser

Publications and source records attributed to D K Moser.

At least 55 records · Page 3Linked to original sources
PubMed1993

Predictors of psychosocial adjustment in systemic sclerosis. The influence of formal education level, functional ability, hardiness, uncertainty, and social support.

OBJECTIVE: To determine predictors of psychosocial adjustment in patients with systemic sclerosis (SSc). METHODS: We surveyed 94 patients with SSc. Age, sex, education level, marital status, work status, income, support group attendance, length of time since diagnosis, functional status, social support, illness-related uncertainty, and hardiness were examined as potential predictors of psychosocial adjustment. The reliability and validity of the instruments used to measure these variables have been established. RESULTS: Only education level, functional ability, illness-related uncertainty, hardiness, and social support were predictive of psychosocial adjustment. Education level and functional ability explained 14% of the variance in psychosocial adjustment, while illness-related uncertainty, hardiness, and social support increased the explained variance to 38%. CONCLUSION: Although patients with relatively poorer psychosocial adjustment to illness have lower formal education levels and more functional disability, the majority of the explained variance in psychosocial adjustment is ascribable to illness-related uncertainty, low level of hardiness, and less satisfaction with social support.

Adaptation, Psychological↗
PubMed1993

Needs of recovering cardiac patients and their spouses: compared views.

Identifying the needs of patients and spouses following an acute cardiac event is an essential first step in the development of nursing interventions to facilitate couples' psychosocial adaptation. Therefore, the self-perceived needs of 49 couples were compared 5 months following the patients' hospitalization for an acute cardiac event (i.e. myocardial infarction or coronary artery revascularization). Both patients and spouses identified the need for information as being most important compared with all other needs; however, significant discrepancies were found in ratings between patients and spouses. Needs which spouses rated as having a high priority included receiving information about the patient's feelings during the recovery period, having time alone, talking with the patient about concerns, and receiving information about the expected psychological recovery. Patients did not consider these same needs as they related to their spouses particularly important. Rather, they rated the need for information about their condition, the need to have honest explanations, and the need to talk with a health professional about their problems as having the highest priority. Many of the needs that both patients and spouses ranked as being important or very important were unmet in 40-70% of the cases. In this study, both patients and spouses expressed similar needs for information, but the type of information that they wanted differed and, in the majority of cases, these needs were not met by nurses and physicians.

Adaptation, Psychological↗
PubMed1993

Pharmacologic management of heart failure: neurohormonal agents.

Intense neurohormonal activation is characteristic of heart failure and contributes to the progression of ventricular dysfunction in this syndrome. Drugs that diminish neurohormonal arousal have a beneficial effect upon morbidity and mortality in chronic heart failure. The pathophysiology of neurohormonal activation in chronic heart failure is reviewed in this article to provide a basis for understanding intervention with agents that block the actions of the renin-angiotensin and sympathetic systems. Also covered is the description of the pharmacologic actions of these two classes of drugs and patient outcomes associated with their use.

Adrenergic beta-Antagonists↗
PubMed1993

Gender differences in treatment-seeking delay in acute myocardial infarction.

Delay in seeking treatment for the symptoms of myocardial infarction can contribute to significant mortality and morbidity. Although pre-hospital delay is a serious problem in both women and men, women appear to delay substantially longer than men. Possible reasons for longer delay in women include the age at which women experience first myocardial infarction, the presence of certain chronic diseases, possible atypical presentation of cardiac symptoms in women, and physician and layperson misperception of the significance of chest pain in women. Recommendations for studying the problem of pre-hospital delay in women and for designing future interventions to reduce delay are discussed.

Age Factors↗
PubMed1992

Patterns of beat-to-beat heart rate variability in advanced heart failure.

Diminished heart rate variability is associated with high sympathetic tone and an increased mortality rate in heart failure cases. We constructed Poincaré plots of each sinus R-R interval plotted against the subsequent R-R interval from 24-hour Holter recordings of 24 healthy subjects (control group) and 24 patients with heart failure. Every subject in the control group had a comet-shaped Poincaré plot resulting from an increase in beat-to-beat dispersion as heart rate slowed. No patient with heart failure had this comet-shaped pattern. Instead, three distinctive patterns were identified: (1) a torpedo-shaped pattern resulting from low R-R interval dispersion over the entire range of heart rates, (2) a fanshaped pattern resulting from restriction of overall R-R interval ranges with enhanced dispersion, and (3) complex patterns with clusters of points characteristic of stepwise changes in R-R intervals. Poincaré pattern could not be predicted from standard deviations of R-R intervals. This first use of Poincaré plots in heart rate variability analysis reveals a complexity not readily perceived from standard deviation information. Further study is warranted to determine if this method will allow refined assessment of cardiac-autonomic integrity in heart failure, which could help identify patients at highest risk for sudden death.

Death, Sudden↗
PubMed1992

Optimal late potential criteria for reducing false positive signal-averaged electrocardiograms.

The purposes of this study were to determine for signal-averaged electrocardiograms in normal subjects: (1) the incidence of false positives for various filter frequencies and late potential criteria and (2) reproducibility over time. In 46 normal volunteers, the QRS vector magnitude was bidirectionally high-pass filtered at 25, 40, and 100 Hz. As high-pass filter frequency increased, QRS duration decreased from 98 +/- 9 to 92 +/- 9 msec (p less than 0.0001), terminal QRS root mean square voltage decreased from 60 +/- 41 to 14 +/- 9 microV (p less than 0.0001), and terminal QRS low amplitude signal duration increased from 27 +/- 7 to 41 +/- 14 msec (p less than 0.0001). For individual parameters, the incidence of false positive tests ranged from 2% to 41%, whereas there were no false positive tests for the combination of abnormal QRS duration plus either root mean square voltage or low amplitude signal duration. Measurements were repeated after 6.4 +/- 0.3 months in 26 subjects and were highly reproducible at all filter settings. The potentially high incidence of false positive tests with some criteria has important implications for the use of signal-averaged electrocardiography as a screening test in patient populations with various arrhythmia risks.

Adult↗
PubMed1991

Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function.

The effects of participation in a structured, outpatient cardiac rehabilitation program on psychosocial function after acute myocardial infarction or coronary artery bypass surgery, or both, were evaluated prospectively in 141 patients who were married or living with "a significant other" (89% men, mean [+/- standard deviation] age 63 +/- 9 years old). Forty-one patients who were participants in a 3-month cardiac rehabilitation program were compared with 100 patients who did not participate in a formal program. On average, patients in both groups were well educated, older Caucasians who had minimal cardiac dysfunction (New York Heart Association class I or II). Patients in the 2 groups were not different at baseline in sociodemographic or clinical characteristics or in any of the dependent measures of anxiety, depression, psychosocial adjustment to illness or marital adjustment. Six months after initial testing, patients who attended cardiac rehabilitation were significantly less anxious (F[1,139] = 5.09, p = 0.03), less depressed (F[1,139] = 8.39, p = 0.004), had better psychosocial adjustment (F[1,139] = 5.87, p = 0.02), and were more satisfied with their marriages (F[1,139] = 8.6, p = 0.004) than nonparticipants. The findings support the effectiveness of group cardiac rehabilitation for this subgroup of patients in facilitating their psychosocial recovery after an acute cardiac event.

Adult↗
PubMed1991

Late potentials are unaltered by ventricular filling pressure reduction in heart failure.

Exacerbation of heart failure may increase susceptibility to arrhythmias. Therefore tests to assess the risk of arrhythmia, performed after hemodynamic improvement, may be of limited value. To determine whether hemodynamic improvement alters ventricular late potentials detected by signal-averaged ECG, we studied 27 consecutive patients with dilated heart failure (left ventricular ejection fraction 0.20 +/- 0.06, 15 with coronary artery disease) before and 3 +/- 2 days after tailored vasodilator and diuretic therapy reduced ventricular filling pressures. QRS duration, terminal QRS amplitude (root mean square [RMS]), and low-amplitude (less than 40 microV) signal (LAS) duration were determined by an automated algorithm from the vector magnitude of the QRS high-pass filtered at 25 Hz and at 40 Hz. Despite marked decreases in pulmonary capillary wedge (27 +/- 7 to 16 +/- 5 mm Hg, p less than 0.001) and right atrial (13 +/- 7 to 7 +/- 4 mm Hg, p less than 0.001) pressures and a 20% increase in cardiac output, there was not a significant change in QRS duration, RMS, or LAS. Before and after therapy late potentials, defined as abnormal QRS duration RMS, or LAS, were present in 14 (52%) patients with filtering at 25 Hz and in 22 (81%) patients with filtering at 40 Hz. The signal-averaged ECG after hemodynamic improvement predicted the results during exacerbation of heart failure in all patients. Thus in patients with advanced heart failure the signal-averaged ECG obtained after hemodynamic improvement reflects the findings during exacerbation of heart failure.

Arrhythmias, Cardiac↗
PubMed1991

Treatment-seeking behavior among those with signs and symptoms of acute myocardial infarction.

Significant delays in seeking definitive treatment for the signs and symptoms of acute myocardial infarction increase morbidity and mortality. In most studies, delay times average more than 4 hours. The following variables are associated with increased delay: a medical history of angina, diabetes mellitus, or hypertension; older age; black race; seeking advice from a family member or a physician; symptom onset on a weekday; and attempts at self-treatment. Variables associated with reduced delay times are the following: pain recognized as cardiac in origin, hemodynamic instability, severe chest pain, younger age, and consultation with a coworker. Surprisingly, patients who have already experienced a myocardial infarction are just as likely to delay as patients who have not had this experience. These findings provide direction for developing and testing patient and family interventions, establishing community education programs, and reducing patient delay in response to the signs and symptoms of acute myocardial infarction.

Humans↗
PubMed1990

Comparison of frequency of late potentials in idiopathic dilated cardiomyopathy and ischemic cardiomyopathy with advanced congestive heart failure and their usefulness in predicting sudden death.

Signal-averaged electrocardiograms were obtained in 62 consecutive patients with advanced congestive heart failure (CHF) undergoing evaluation for possible heart transplantation to determine if late potentials: (1) provide unique information compared to assessment of ventricular ectopic activity on ambulatory electrocardiogram, and (2) identify a subgroup of CHF patients with higher sudden death risk. Patients with a history of cardiac arrest or sustained ventricular tachycardia were excluded. CHF was due to old myocardial infarction in 40 patients and idiopathic dilated cardiomyopathy in 22 patients. Late potentials were present in 16 of 40 (40%) patients with old infarction but in only 3 of 22 (14%) patients with nonischemic CHF (p = 0.03). Twenty-four-hour ambulatory electrocardiograms were obtained in 34 patients (55%). Total ventricular ectopic activity and repetitive forms of ectopy were similar in patients with and without late potentials. Nine patients died suddenly, 9 had nonsudden death, 15 underwent heart transplantation and 29 were alive and well after a mean follow-up of 218 +/- 154 days. At 1 year, the actuarial risk of death was 37% and of sudden death was 20%. Sudden death risk was 12% in patients with late potentials versus 21% in those without (p = 0.73). Thus, the incidence of the arrhythmia substrate producing late potentials depends on the CHF etiology. The signal-averaged electrocardiogram and ambulatory electrocardiogram provide independent information for possible risk assessment in CHF. However, late potentials are poor predictors of sudden death risk when CHF is advanced, possibly due to the heterogeneity of causes of sudden death--ventricular tachycardia being only 1 of many possible mechanisms.

Arrhythmias, Cardiac↗
PubMed1990

Cardiopulmonary resuscitation skills retention in family members of cardiac patients.

The purpose of this study was to determine if the use of a retention strategy would maintain cardiopulmonary resuscitation (CPR) skills in family members of cardiac patients. Thirty-one subjects trained in CPR received retention packets 3 and 6 months after CPR training. Sixteen subjects were tested for CPR retention at 7 months after initial training, and 15 at 12 months. Likelihood chi 2 was used to compare the 7- and 12-month groups. There were no differences between the 7- and 12-month groups, because CPR retention overall was poor. Only 19.4% of subjects reported using the retention packet; therefore, subjects were regrouped into practice and no practice groups for purposes of further statistical analysis. There were significant differences in retention in subjects who practiced compared with subjects who did not. These findings underscore the importance of promoting practice/review after initial CPR training for family members of cardiac patients.

Adult↗
PubMed1990

Is health care racist?

Many health care inequalities seem to be racially based. Racism nad racial conflict in American can be explained in the context of three historical time periods and the prevailing economic systems of those times. The problem of access to basic health care for the black underclass is enormous. Traditional solutions of health education, health promotion, and low-cost health care have done very little to change the outcomes of increased morbidity and mortality. Health care professionals need to confront the real problem of inadequate life chances and limited economic resources for the underclass through research and the restructuring of our health care delivery system.

Black or African American↗
PubMed1990

Noninvasive identification of patients at risk for ventricular tachycardia with the signal-averaged electrocardiogram.

The signal-averaged electrocardiogram (SAE) is a noninvasive means of detecting cardiac late potentials. Late potentials in patients with coronary artery disease indicate a high risk for the development of ventricular tachycardia. Although the usefulness of the SAE for directing therapy has not yet been clearly established, the test appears to be useful in the stratification of arrhythmia risk in select groups of high-risk patients. As critical care nurses frequently care for these patients, they need to be familiar with tools such as the SAE that may be used in high-risk patient assessment. This article describes the physiologic basis underlying the use of the SAE, the SAE technique, implications for nursing practice, and clinical applications of the SAE.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Psychosocial recovery from a cardiac event: the influence of perceived control.

OBJECTIVE: To determine the relationship between patients' feelings of control at baseline and psychosocial recovery 6 months after their cardiac event. PATIENTS: One hundred seventy-six patients who had had myocardial infarction, had undergone coronary artery bypass or both. DESIGN: In this longitudinal, comparative survey patients with high perceptions of control were compared with those with low perceptions of control at baseline to determine differences in psychosocial recovery 6 months later. OUTCOME MEASURES: Psychosocial recovery was operationalized as anxiety, depression, and hostility (measured by Multiple Affect Adjective Checklist) and overall psychosocial adjustment to illness (measured by Psychosocial Adjustment to Illness Scale). RESULTS: Significant differences were seen in psychosocial recovery between patients with feelings of high control versus those with feelings of low control (p = 0.006). Patients with feelings of high control at baseline were less anxious (p = 0.002), less depressed (p = 0.001), less hostile (p = 0.02), and had better psychosocial adjustment (p = 0.009) at a 6-month follow-up than those with feelings of low control. CONCLUSION: Feelings of perceived control are important for psychosocial recovery after a cardiac event.

Adaptation, Psychological↗
PubMedDate not supplied

Women's decision to seek care for symptoms of acute myocardial infarction.

OBJECTIVE: To describe the psychosocial processes by which women make the decision to seek care for the symptoms of Acute Myocardial Infarction (AMI). DESIGN: The qualitative method of grounded theory was used to study the prehospital experience of women with symptoms of AMI. PARTICIPANTS: Sixteen women between the ages of 42 and 82 years who were hospitalized in a coronary care unit after AMI. RESULTS: The women delayed a median of 5.4 hours (range 1.5 to 144 hours). The psychosocial processes by which they made the decision to seek treatment after symptom onset were dynamic and multidimensional. The fundamental structure involved two core categories: (1) maintaining control, and (2) relinquishing control. Within these two core categories there were five subcategories: symptom awareness, perceived insignificance, self-treatment, perceived threat, and lay consultation. CONCLUSION: Although these women immediately recognized their symptoms as abnormal, they did not acknowledge their seriousness until after the use of a variety of coping mechanisms and self-treatment behaviors to reduce threat and maintain control over the situation. Interventions to reduce delay should focus on the issue of perceived loss of control during symptom onset and attempt to reduce the sense of threat by describing the benefits of seeking treatment early.

Adult↗
PubMedDate not supplied

Hemodynamic adaptation to orthostatic stress after orthotopic heart transplantation.

OBJECTIVES: The purpose of this study was to compare the effects of orthostatic stress on cardiovascular stability in heart transplant recipients early and late after transplantation and in healthy controls. BACKGROUND: After transplantation, cardiac reinnervation is heterogeneous, with reports of sympathetic reinnervation after 5 months and parasympathetic reinnervation after 2 to 3 years. METHODS: Sixteen heart transplant recipients early (less than 5 months) after transplantation, 17 recipients late (1 year or more) after transplantation, and 16 matched healthy controls were subjected to 45 minutes of passive upright tilt, with the following variables measured before, during, and after the procedure: cardiac output, heart rate, stroke volume, mean arterial pressure, systemic vascular resistance, and plasma norepinephrine. RESULTS: At rest, heart rate (p < 0.0005) and mean arterial pressure (p = 0.003) were higher, and stroke volume was lower (p < 0.0005), in transplant recipients than they were in controls. With orthostasis, heart rate increased by 30% in controls and by 23% in the late posttransplantation group compared with 13% in the early posttransplantation group (p = 0.028); drop in stroke volume was three times more among controls than among those in either transplantation group (p < 0.001); late transplant recipients had higher norepinephrine increases than did the other two groups (p = 0.012). CONCLUSION: With the exception of heart rate, patterns of hemodynamic response to orthostatic stress after transplantation remain consistent over time and differ from controls. Among transplant recipients, higher mean arterial pressure mitigates the force of gravity and prevents drops in stroke volume. Clinicians may anticipate that transplant recipients will tolerate postural maneuvers well. Later after transplantation, however, orthostatic tolerance is associated with increased norepinephrine release, consistent with enhanced sympathoactivation.

Adaptation, Physiological↗