Biomedical subjects

D K Moser

Publications and source records attributed to D K Moser.

68 records · Page 4Linked to original sources

PubMedDate not supplied

Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction.

OBJECTIVE: To determine the impact of sociodemographic, clinical, cognitive, emotional, and social factors on patient delay in seeking treatment for symptoms of acute myocardial infarction. DESIGN: Multicenter descriptive survey. SETTING: Forty-three hospitals in North America. SUBJECTS: Two hundred and seventy-seven patients with confirmed acute myocardial infarction enrolled in a thrombolytic clinical trial. OUTCOME MEASURES: Time from symptom onset to arrival at the hospital for treatment. RESULTS: Patients with longer delays were older, had lower incomes, had diabetes, experienced their symptoms at home, did not appraise their symptoms as serious or originating from the heart, had symptoms that were intermittent in nature, waited to see whether symptoms disappeared, worried about troubling others, feared what might happen if they sought treatment, and did not realize the importance of symptoms. CONCLUSION: Patient appraisal of seriousness of symptoms is related to delay, whereas severity, nature, and knowledge of symptoms are not related. Cognitive and emotional responses affect patients' decisions to seek treatment.

Adult↗

PubMedDate not supplied

Do apnea monitors decrease emotional distress in parents of infants at high risk for cardiopulmonary arrest?

INTRODUCTION: The immediate post-partum period is stressful for most parents. The need to use a home apnea monitor may tax parental coping skills even further. Therefore, we conducted a study to assess the psychosocial consequences of apnea monitoring on parental emotional distress and family functioning. METHOD: We studied 104 parents of infants at high risk for cardiopulmonary arrest. Fifty-two parents had infants who used home apnea monitors, and 52 parents were age-matched and gender-matched control subjects. Data were collected during the infant's hospitalization, and then at 2 weeks, 3 months, and 6 months after discharge. At 1 year, parents were interviewed about their attitudes toward using the apnea monitor. RESULTS: Both groups experienced elevated levels of emotional distress, but the group with infants who used the monitors had significant increases in depression and hostility immediately following discharge from the hospital compared with baseline, whereas the non-monitored group had a significant increase in hostility at 6 months. At 1-year follow-up, the majority of the parents reported that they used the monitor every night, felt more secure in using it, and judged it helpful. DISCUSSION: The immediate period following hospital discharge of infants who need to use a home apnea monitor is characterized by significant emotional distress for the parents, which resolves over time. Anticipatory education and counseling of parents is recommended.

Adaptation, Psychological↗

PubMedDate not supplied

Effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden.

OBJECTIVES STUDY OBJECTIVES: (1) To compare the effects of 3 methods of cardiopulmonary resuscitation (CPR) training for parents of infants at risk for cardiac or respiratory arrest on anxiety, perception of control, and sense of burden; and (2) to identify parents' attitudes about CPR training and willingness to perform CPR if needed. METHODS: A longitudinal, controlled trial was conducted with parents and other caretakers of high-risk infants. Subjects were recruited from 5 level III neonatal intensive care units. We enrolled each of 578 subjects in 1 of 4 groups: (1) CPR-Video; (2) CPR-Didactic; (3) CPR-Social Support; or (4) control (no CPR training). Of these, 335 completed the entire study. Data were collected at baseline, and 2 weeks and 6 months after CPR training. The main outcomes measured were perceived anxiety, control, and burden related to caring for a high-risk infant and attitudes about responding to an emergency. RESULTS: Subjects reported moderately high anxiety, sense of burden, and feelings of loss of control before CPR training. Within groups, subjects in all 3 treatment groups reported improvement in perceptions of anxiety, control, and burden 2 weeks after CPR training, with continued improvement evident 6 months after CPR training (P =.001). In contrast, perceptions were unchanged in the control group. Among groups, at 2 weeks there were significant differences in means between control and CPR-Didactic groups (P =.01), and at 6 months there were significant differences in means between control and CPR-Didactic groups (P =.01) and between control and CPR-Social Support groups (P =.01). CONCLUSION: CPR training is an important intervention for promoting a sense of control and reducing the anxiety and sense of burden experienced by parents of neonates at risk for cardiopulmonary arrest.

Adult↗

PubMedDate not supplied

Treatment-seeking behavior for acute myocardial infarction symptoms in North America and Australia.

OBJECTIVE: The goal of this study was to compare North American and Australian patients' sociodemographic, clinical, cognitive, emotional, and social factors associated with behavior in seeking treatment for symptoms of acute myocardial infarction. PATIENTS: Subjects included 277 North Americans (mean age, 58 +/- 12 years; 72% men) and 147 Australians (mean age, 62 +/- 13 years; 66% men) with acute myocardial infarction. METHODS: Data were obtained with the Response to Symptoms Questionnaire and from the patients' hospital records. RESULTS: In both groups, patients who delayed longer (P </=.05) had lower incomes, known diabetes mellitus, and symptom onset while at home; in addition, they appraised their symptoms as not serious, waited for symptoms to go away, and worried about troubling others. Additional factors associated with longer delay in North Americans (P </=.05) were older age, intermittent symptoms, and attribution of symptoms to a noncardiac cause; other contributing factors include not recognizing the symptoms as cardiac and fearing the consequences of seeking help. In Australians (P </=. 05), contributing factors were fewer years of education, a history of hypertension, and embarrassment about seeking help. CONCLUSION: Programs to reduce delay in response to acute myocardial infarction symptoms must take account of cognitive and emotional processes and differences in response in the particular cultures of patients.

Adult↗

PubMedDate not supplied

Self-care abilities of patients with heart failure.

BACKGROUND: Self-care is difficult for patients with heart failure (HF) because early symptoms are subtle and the treatment regimen is complex. The primary purpose of this study was to describe HF self-care abilities and the difficulties that patients have in achieving success in self-care. A secondary purpose was to compare self-care abilities in patients experienced with HF with those patients who are newly diagnosed. METHODS: Descriptive, cross-sectional, comparative surveys were conducted to assess demographic and clinical factors that may interfere with self-care and lifestyle changes made to accommodate the diagnosis of HF. Symptoms the patients had and self-care responses to those symptoms were assessed by using the Self-Management of Heart Failure questionnaire. RESULTS: The 139 patients were primarily elderly, male, retired, unmarried, and earning less than $20,000 annually. Hearing and eyesight were impaired and most patients were functionally compromised. Most of the group had multiple HF symptoms during the past year, yet their knowledge of the importance of signs and symptoms was poor and many misperceptions were evident. Recognition of changes in signs and symptoms was difficult for most patients, but easier for those more experienced with HF. Experienced patients were more likely to use appropriate self-care remedies than newly diagnosed patients. Few patients were comfortable evaluating the effectiveness of their self-care actions and most had low self-confidence in their ability to perform self-care. CONCLUSIONS: With the low level of self-care ability and the number of difficulties these patients face, it is not surprising that rehospitalization rates remain high. Specific recommendations for the teaching and delivery of care are provided.

Age Distribution↗

PubMedDate not supplied

Evidence of time-dependent autonomic reinnervation after heart transplantation.

BACKGROUND: Confirming the clinical significance of reinnervation is important in understanding and anticipating how heart rate (HR) responses of transplant recipients to physiologic stress differs early and late after transplant from that of normal individuals. OBJECTIVES: To evaluate the functional significance of cardiac reinnervation early and late after heart transplantation. METHODS: Handgrip and deep breathing tests, passive 80 degrees head-up tilt, and heart rate (HR) responsiveness of 33 transplant recipients (n = 16 at < 5 months and n = 17 at > 1 year after transplant) were compared with those of 16 age- and sex-matched control participants. RESULTS: HR responses to handgrip and passive tilt were absent early after transplant. HR acceleration normalized but was blunted late after transplant. These findings are consistent with late (>1 year) sympathetic reinnervation in transplant recipients. CONCLUSIONS: When caring for transplant recipients, nurses should consider the time elapsed since transplant in evaluating HR responsiveness to common procedures and interventions.

Analysis of Variance↗

PubMedDate not supplied

Factors differentiating dropouts from completers in a longitudinal, multicenter clinical trial.

BACKGROUND: Subject dropout from a prospective, longitudinal trial can produce biases in the remaining sample that affect study findings and their interpretation, yet little is known about factors contributing to dropout. OBJECTIVE: To determine characteristics differentiating those who complete from those who drop out of a longitudinal multicenter clinical trial. METHODS: In this study, 578 parents and other caretakers of infants at risk for cardiopulmonary arrest enrolled in a longitudinal trial investigating the psychosocial impact of cardiopulmonary resuscitation training. In this secondary analysis, the baseline sociodemographic, emotional, psychosocial, and infant characteristics of those who dropped from the trial were compared with those who completed the study. RESULTS: The study was completed by 60% (n = 347) of the participants. Those most likely to drop out were fathers or other caretakers (vs. mothers) employed outside the home who spoke English (vs. Spanish); were assigned to an experimental group (vs. a control group); had higher levels of depression, hostility, and overall psychosocial distress; and held negative views about health care. CONCLUSION: Although a few sociodemographic characteristics differentiated dropouts from completers, personal, emotional and psychosocial factors were the predominant predictors of dropouts. Other reputed sources of retention difficulties (e.g., income, education, minority status, lack of social support, or problems with family functioning) did not predict dropout.

Adult↗

PubMedDate not supplied

Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events?

OBJECTIVE: Acute myocardial infarction is often accompanied by anxiety, but the effect of this emotion on recovery is unclear. The purpose of this study was to determine the association between patient anxiety early after acute myocardial infarction and the incidence of subsequent in-hospital complications. METHODS: We assessed anxiety level within 48 hours of patient arrival at the hospital in 86 confirmed myocardial infarction patients. Anxiety was measured using the Brief Symptom Inventory. Myocardial infarction complications were defined as reinfarction, new onset ischemia, ventricular fibrillation, sustained ventricular tachycardia, or in-hospital death. RESULTS: More complications were seen in patients with higher versus lower levels of anxiety (19.6% vs 6%; p = .001). Multiple logistic regression was used to control for those clinical and sociodemographic factors that can influence the incidence of complications and demonstrated that higher anxiety level was independently predictive of complications. Patients with higher anxiety levels were 4.9 times (p = .001) more likely to have subsequent complications. CONCLUSIONS: Anxiety early after myocardial infarction onset is associated with increased risk of ischemic and arrhythmic complications. This finding suggests that anxiety should be considered among the conventional risk factors for in-hospital acute myocardial infarction complications.

Anxiety↗

PubMedDate not supplied

Natural killer cell anergy to cytokine stimulants in a subgroup of patients with heart failure: relationship to norepinephrine.

Heart failure is a disease characterized by chronically high levels of plasma norepinephrine and anergy in the cytotoxicity of circulating natural killer (NK) lymphocytes. This study shows that NK anergy extends to a significantly reduced cytotoxicity in response to the powerful NK stimulants, interleukin (IL)-2 and interferon (IFN)-alpha. Fifteen patients with heart failure, New York Heart Association stage III or IV, were studied for NK-cell-mediated cytotoxicity. The patients were divided into two groups based upon their NK cytotoxicity function: (1) those who had minimal baseline cytotoxicity and failed to respond following stimulation by IL-2 and IFN-alpha (n = 6), and (2) those who were about at the level of normal controls, and were responsive to IL-2 and IFN-alpha (n = 9). There was no relationship between the anergy and the etiology of the heart failure, laboratory indicators of heart failure, serum albumin or sodium, state anxiety, age or sex of the subjects. There was a statistically significant negative correlation between the response of NK cells to the stimulators IL-2 and IFN-alpha and the level of plasma norepinephrine in the heart failure patients. This was corroborated by in vitro testing of direct effects of norepinephrine on normal NK cells, which indicated that baseline cytotoxicity and the ability of these cells to respond to IL-2 were inhibited in a dose-dependent manner. The findings indicate that the NK cell anergy seen in heart failure patients extends to the response to the stimulators IL-2 and IFN-alpha in a subgroup of patients.

Adult↗

PubMedDate not supplied

Effects of ventricular ectopy on sinus R-R intervals in patients with advanced heart failure.

OBJECTIVE: To determine the effect of ventricular ectopy on subsequent sinus R-R intervals. DESIGN: Comparative, repeated-measures design. SETTING: University medical center. SUBJECTS: Ten consecutive sinus R-R intervals and their standard deviations before and after ventricular ectopy from 24-hour ambulatory electrocardiogram recordings were obtained from 25 patients with heart failure (left ventricular ejection fraction 0.18 +/- 0.08; New York Heart Association Functional Class III-IV) and three healthy subjects. RESULTS: The effects of 7564 single ventricular ectopic beats, 272 ventricular couplets, and 49 episodes of ventricular tachycardia in the patients with heart failure and 1369 single ventricular ectopic beats in the three healthy subjects were evaluated. Repeated-measures ANOVA indicated no significant differences in sinus R-R intervals immediately before or after ventricular ectopy. Standard deviation of sinus R-R intervals before and after ventricular ectopy did not differ significantly. CONCLUSIONS: Ventricular ectopy does not significantly alter subsequent sinus R-R intervals and is unlikely to affect measurement of heart rate variability, particularly by techniques that use standard deviation methods.

Adult↗

PubMedDate not supplied

Recommendations for improving cardiopulmonary resuscitation skills retention.

Massive community efforts are devoted to delivering cardiopulmonary resuscitation (CPR) training to health professionals and lay people. However, although most people can successfully learn to perform CPR, skills retention is universally poor. Beginning as early as 2 weeks after initial training, CPR skills begin to deteriorate in a wide variety of subjects including nurses, physicians, emergency medical technicians, family members of patients with cardiac disease, and other lay people. Methods tested to improve retention are reviewed, and the role of practice and review is examined. The failure of many factors to improve retention of CPR skills is discussed. Finally, suggestions for improvement in retention of CPR skills based on a review of the literature and pertinent theory are offered.

Cardiopulmonary Resuscitation↗

PubMedDate not supplied

Comparing methods of cardiopulmonary resuscitation instruction on learning and retention.

This article describes a study of two methods of teaching CPR where immediate and long-term retention of CPR skills and knowledge were compared. Forty-nine subjects were randomly assigned to either a control group (didactic instruction) or an experimental group (modular instruction). Knowledge retention was evaluated by means of a written examination. Skills retention was evaluated by the Mandel observation instrument. The knowledge and skills performance of both groups, immediately following the class and at 3 months follow up, were not significantly different. Based on these results, modular instruction appears to be an effective alternative to the conventional time-consuming and expensive method commonly used for CPR instruction.

Adult↗

PubMedDate not supplied

Extended comparison of quality of life between stable heart failure patients and heart transplant recipients.

Heart failure has been associated with poor quality of life, which can improve after heart transplantation. Long-term quality-of-life comparisons between patients with heart failure stabilized with medical therapy and heart transplant recipients have not been performed. We assessed quality of life at the time of heart transplantation evaluation and again after 41 months in 12 patients with advanced heart failure stabilized with medical therapy and in 19 patients who had gone on to undergo heart transplantation. Quality of life was measured by three questionnaires. Both groups had similar quality-of-life and clinical features during the transplantation evaluation. Over time, feelings of anxiety and depression, psychologic adaptation, and perceived functional capability improved in the transplant recipients. However, transplant recipients reported more weakness after surgery; this was the major symptom that limited activities. At follow-up 41 months later, we found no significant differences in quality-of-life changes over time between patients stabilized with medical therapy and heart transplant recipients. Overall quality of life for patients who remain stable while receiving medical therapy may not be significantly different from patients who have undergone transplantation.

Aged↗

PubMedDate not supplied

Retention and use of cardiopulmonary resuscitation skills in parents of infants at risk for cardiopulmonary arrest.

Policies of most neonatal intensive care units include teaching cardiopulmonary resuscitation (CPR) to parents or other caretakers prior to infant hospital discharge. However, little is known about CPR skills retention in this population or the outcome of parents' use of CPR. This is a study to measure CPR skills 6 months following CPR training to identify characteristics predicting successful performance and to determine if parents used CPR. A sample of 100 parents or related caretakers of infants at risk for an out-of-hospital respiratory or cardiac arrest 6 months following CPR training were asked to demonstrate CPR on an infant mannequin and 94 agreed to participate. Although they were excluded from the study if they had a CPR course within the past 2 years, 37% had taken CPR sometime in the past. Only one third of participants (n = 31, 33%) were able to perform satisfactory CPR. Those who demonstrated satisfactory CPR skills were more likely to have had previous CPR training and to have experienced higher levels of social support at the time of training than those who achieved unsatisfactory CPR performance ratings (p < .05). A logistic regression analysis revealed previous CPR training, social support, and level of anxiety at time of CPR training to be the most important predictors of CPR skills retention. Seven parents reported using CPR to resuscitate their infant who had suffered a respiratory arrest. All seven were successful. CPR skills decay is significant for caregivers of infants at high risk for cardiopulmonary arrest. Parents should be encouraged to review the steps of CPR frequently and to attend refresher classes. A significant proportion of parents of infants hospitalized in the neonatal intensive care unit are called upon to use CPR and are able to use it appropriately.

Adult↗