Biomedical subjects

L V Doering

Publications and source records attributed to L V Doering.

23 records · Page 2Linked to original sources

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

Determinants of intensive care unit length of stay after coronary artery bypass graft surgery.

OBJECTIVE: The purpose of this study is to identify independent preoperative, intraoperative, and postoperative determinants of intensive care unit (ICU) length of stay in patients undergoing coronary artery bypass graft (CABG) surgery and to evaluate the usefulness of a mortality risk scoring system, the Parsonnet score, as a prognostic indicator of ICU length of stay after CABG. METHODS: A prospective nonrandomized sample of 109 consecutive patients was enrolled before CABG and followed prospectively until ICU discharge. Multivariate linear regression was used to identify factors independently associated with ICU length of stay. RESULTS: One preoperative variable (Parsonnet score) and 4 postoperative variables (length of intubation, presence of arrhythmias, early hemodynamic instability, and 12-hour fluid balance) explained 45.6% of the variance in ICU length of stay. Intraoperative variables were not independent correlates of ICU length of stay. Classification as "extremely high" risk by Parsonnet scoring (score 20) yielded a positive predictive value of 84% for ICU stay >1 day. Negative predictive value was 42.8%. CONCLUSIONS: Preoperative and postoperative variables explained a large portion of the variance in ICU stay after CABG. Although the Parsonnet score was not helpful in identifying patients who require only a short ICU stay, it may help clinicians screen for patients likely to require stays >1 day and plan appropriate use of resources in the ICU.

Adult↗

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

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↗