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Biomedical subjects

K C Richards

Publications and source records attributed to K C Richards.

16 recordsLinked to original sources
PubMed2004

Predictors of circadian sleep-wake rhythm maintenance in elders with dementia.

Minimal data exists to predict which elders with dementia in nursing homes will maintain circadian sleep-wake rhythms during senescence and which elders with dementia in nursing homes will experience sleep-wake rhythm deterioration. This circadian deterioration is one of the background factors identified in the Needs-driven Dementia-compromised Behavior Model. The objective of this study was to determine predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes. This secondary analysis identifies predictors of maintaining circadian sleep-wake rhythm in a convenience sample of 171 elders with dementia residing in seven nursing homes in the Southern United States. An autocorrelogram of the circadian sleep-wake rhythm for each participant determined whether or not the rhythm had deteriorated. Using measures of depression, cognitive function, physical and psychosocial activity, medications, and sleep apnea, as well as demographic characteristics of the sample, logistic regression determined the best predictors of rhythm maintenance. The best predictors of circadian sleep-wake rhythm maintenance in elders with dementia residing in nursing homes were physical activity (p = 0.00) and psychosocial activity (p = 0.00). The interaction term between these variables was not significant (p = 0.24). These findings suggest that providing meaningful daytime physical and psychosocial activity may assist in maintaining circadian sleep-wake rhythmicity. Additional research is needed to determine if these interventions would improve circadian sleep-wake rhythm in elders with dementia residing in nursing homes.

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PubMed2001

Visitation in critical care: processes and outcomes of a performance improvement initiative.

When family members became dissatisfied with a restrictive visiting policy in a combined coronary and medical intensive care unit, this situation was seen as an opportunity to better meet patient and family needs. A review of the literature indicated that open visitation policies enhance patient and family satisfaction, while a survey of patients, families, and health care team members revealed a desire for a more open visitation policy. Nursing staff, with input from other disciplines, developed and implemented a less restrictive visitation policy. Post-intervention surveys revealed higher patient and family satisfaction and a marked decrease in formal complaints.

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PubMed2001

The effect of individualized activities on the sleep of nursing home residents who are cognitively impaired: a pilot study.

This pilot study investigated a program of individualized activities designed to enhance nocturnal sleep in five cognitively impaired veterans residing in a dementia care unit. Actigraphy documented 24-hour sleep-wake patterns of the residents for 3 days. Those meeting the criteria for inclusion then participated in an Individualized Activity Intervention timed to occur during peak napping times for 14 days. During the 10th, 12th, and 14th days of intervention, actigraphy provided a repeat measure of sleep-wake patterns. The results indicated an increase in nocturnal sleep with increased efficiency, as well as a decrease in daytime napping. This pilot study encourages further investigation of this potential method for enhancing nocturnal sleep in cognitively impaired elderly adults.

Activity Cycles↗
PubMed2000

Effects of massage in acute and critical care.

This is a discussion of the results of a systematic review of 22 articles examining the effect of massage on relaxation, comfort, and sleep. The most consistent effect of massage was reduction in anxiety. Eight of 10 original research studies reported that massage significantly decreased anxiety or perception of tension. Seven of 10 studies found that massage produced physiologic relaxation, as indicated by significant changes in the expected direction in one or more physiologic indicators. In the three studies in which the effect of massage on discomfort was investigated, it was found to be effective in reducing pain. In only three studies was the effect of massage on sleep examined. The methods for measuring sleep were unclear in two of the studies, and results were inconclusive in the other. Further research is needed to investigate the effect of massage on discomfort and promoting sleep.

Acute Disease↗
PubMed1998

Migratory leptomeningeal inflammation with relapsing polychondritis.

We report a case of relapsing polychondritis with focal sensorimotor seizures, aseptic meningitis, and migratory leptomeningeal enhancement on contrast MRI. These abnormalities on imaging studies correlated accurately with laterality of the patient's seizures, facilitating early aggressive management of his neurologic symptoms.

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PubMed1998

Effect of a back massage and relaxation intervention on sleep in critically ill patients.

BACKGROUND: Critically ill patients are deprived of sleep and its potential healing qualities, although many receive medications to promote sleep. No one has adequately evaluated holistic nonpharmacological techniques designed to promote sleep in critical care practice. OBJECTIVES: To determine the effects of (1) a back massage and (2) combined muscle relaxation, mental imagery, and a music audiotape on the sleep of older men with a cardiovascular illness who were hospitalized in a critical care unit. METHODS: Sixty-nine subjects were randomly assigned to a 6-minute back massage (n=24); a teaching session on relaxation and a 7.5-minute audiotape at bedtime consisting of muscle relaxation, mental imagery, and relaxing background music (n=28); or the usual nursing care (controls, n=17). Polysomnography was used to measure 1 night of sleep for each patients. Sleep efficiency index was the primary variable of interest. One-way analysis of variance was used to test for difference in the index among the 3 groups. RESULTS: Descriptive statistics showed improved quality of sleep among the back-massage group. Initial analysis showed a significant difference among the 3 groups in sleep efficiency index. Post hoc testing with the Duncan procedure indicated a significant difference between the back-massage group and the control group; patients in the back-massage group slept more than 1 hour long than patients in the control group. However, the variance was significantly different among the 3 groups, and reanalysis of data with only 17 subjects in each group revealed no difference among groups (P=.06). CONCLUSIONS: Back massage is useful for promoting sleep in critically ill older men.

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PubMed1996

Cardiac dysrhythmia during sleep in the critically ill: a pilot study.

BACKGROUND: Few investigators have examined the hemodynamic status related to circadian and sleep-related cardiovascular events in critically ill patients. OBJECTIVE: To describe the relationships among nocturnal angina, myocardial infarction, and sleep, and to describe the cardiac rhythm, heart rate, and frequency of premature supraventricular and ventricular contractions during the sleep of critical care patients with cardiovascular disease. METHODS: A descriptive survey was done on nine patients in the medical intensive care unit of a large medical center. All subjects had cardiovascular disease and were studied during one night of sleep. RESULTS: There were no incidences of chest pain during the study and no changes in baseline cardiac rhythm associated with sleep staging. There was a significant statistical difference in mean heart rate among waking, stage 1 nonrapid-eye-movement sleep, and stage 2 nonrapid-eye-movement sleep; a lower heart rate was observed in stage 2 nonrapid-eye-movement sleep. The mean heart rate decreased by 3% to 4% from the waking state to sleep. No clinical or statistically significant differences in the frequency of premature supraventricular and ventricular contractions between sleep stages or sleeping and waking were found. CONCLUSIONS: The results of this pilot investigation do not suggest that dysrhythmia occurs more frequently during certain sleep stages or during the sleep state in critical care unit patients with cardiovascular disease. The mean heart rate slowed by 3% to 4% during rapid-eye-movement and nonrapid-eye-movement sleep, but decreases in heart rate were not as great as those noted in normal, healthy subjects.

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PubMed1996

Sleep promotion.

The aging process introduces many changes that affect the whole person, including sleep. Age-related changes in the nervous system, acute and chronic illnesses, medications, primary sleep disorders, and factors associated with hospitalization in the critical care unit are elements identified with sleep disturbance in the elderly patient hospitalized in the critical care unit. One of the most important challenges for critical care nurses is to promote a healing environment for elderly patients where they can obtain the sleep necessary for recovery. Potentially effective nursing interventions for sleep promotion are those caring interventions that focus on the body-mind connection, such as back massage, relaxing music, imagery, and muscle relaxation. Investigations of the effectiveness of nursing interventions for sleep promotion are needed.

Age Factors↗
PubMed1994

Sleep promotion in the critical care unit.

Promoting the quiet and relaxation necessary for sleep in a busy, noisy critical care environment is a problem critical care nurses face daily. Descriptive studies have defined and increased understanding of this problem, but few interventional studies have been accomplished. Interventions that have demonstrated significant improvements in sleep quality in the critical care environment are an audiotape of the sounds of the ocean or rain, a masking signal, and a back massage.

Critical Care↗
PubMed1968

Regulation of production and release of lipoprotein by the perfused rat liver.

The relationship between protein and triglyceride release into d < 1.007 lipoprotein was studied in the isolated perfused rat liver. Livers were perfused with a medium either high or low in linoleate content. Perfusion with the linoleate-rich medium resulted in a marked increase in the net release of both d < 1.007 lipoprotein triglyceride and lipoprotein protein, and caused a significant increase in amino acid incorporation into the protein moiety. Amino acid incorporation into d 1.008-1.21 protein was not affected by fatty acid concentration, while incorporation into whole perfusate and tissue proteins was depressed by a perfusate high in fatty acid content. Electron microscopic studies demonstrated that the livers with the higher rate of triglyceride release also produced a greater number of lipoprotein particles. The particles they released were also somewhat larger. These studies suggest that the intracellular concentration of newly esterified triglyceride and (or) some other lipid metabolite can specifically influence the release and perhaps the synthesis of d < 1.007 lipoprotein protein. They also suggest that the liver increases its rate of triglyceride release primarily by producing more lipoprotein particles.

Amino Acids↗
PubMedDate not supplied

Implementing a councilor model: process and outcomes.

The councilor model of shared governance was implemented at the Central Arkansas Veterans Healthcare System in January 1995. The goal was to reduce, eliminate, and consolidate nursing committees, enhance communication, and increase the decision-making abilities and opportunities of staff members. A study was conducted to determine the perceptions of the nursing staff relative to the culture of the organization after implementation of the model. The authors describe the process and outcomes of the resulting performance improvement processes, organizational redesign, and outcomes of this initiative.

Arkansas↗
PubMedDate not supplied

Measurement of sleep in critically ill patients.

Research to evaluate interventions to promote sleep in critically ill patients has been restricted by the lack of brief, inexpensive outcome measures. This article describes the development and testing of an instrument to measure sleep in critically ill patients. A convenience sample of 70 alert, oriented, critically ill males was studied using polysomnography (PSG), the gold standard for sleep measurement, for one night. In the morning the patients completed the Richards-Campbell Sleep Questionnaire (RCSQ), a five-item visual analog scale. Internal consistency reliability of the RCSQ was .90 and principal components factor analysis revealed a single factor (Eigenvalue = 3.61, percent variance = 72.2). The RCSQ total score accounted for approximately 33% of the variance in the PSG indicator sleep efficiency index (p < .001). The data provide support for the reliability and validity of the RCSQ.

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