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Biomedical subjects

S B Dunbar

Publications and source records attributed to S B Dunbar.

At least 19 recordsLinked to original sources
PubMed2001

Psychological reactions among family members of patients with implantable defibrillators.

OBJECTIVE: To describe psychological reactions among family members of patients receiving an implantable cardioverter/defibrillator (ICD) during the first 9 months after implantation. METHODS: Eighty-two family members (age 56+/-12 years, 74 percent female, 79 percent married, 88 percent Caucasian) of ICD patients completed questionnaires regarding their mood (Profile of Mood State), cognitive illness appraisals (Meaning of Illness Questionnaire) and coping strategies (Jalowiec Coping Scale) prior to ICD implantation, and as well as 1 and 9 months postoperatively. RESULTS: Total mood disturbance score (TMD), threat appraisal, and emotion- and problem-focused coping were highest prior to ICD implantation, and decreased during the first postoperative month showing stable values thereafter. There was no change in challenge appraisal. Multiple regression analysis found that the use of psychotropic drugs (anxiolytics, sedatives; Beta = .25), emotion-focused coping (Beta = .37), and challenge appraisal (Beta =-.21) at 1 month accounted for 26 percent of variance in TMD at 9 mon ths. CONCLUSION: A spouse's ICD implantation is a major stressful event for family members leading to a diminished mood state prior ICD implantation. Reduction in emotion-focused coping and the use of challenge appraisal may improve mood state in family members of ICD patients during early follow-up.

Adaptation, Psychological↗
PubMed2000

The perceptions of menopause of African-American and white women and affect on willingness to participate in a HRT clinical trial.

Menopause is a normal developmental process for women; however, few studies of healthy menopausal women and African-American women have been reported. While hormone replacement therapy (HRT) has been touted as a treatment for menopausal women, clinical trials of HRT still need to be conducted to determine its potential positive and negative effects. This is a focus group study of 21 women of menopausal age (11 African-Americans and 10 White women) to determine their experiences with menopause and their willingness to participate in a HRT clinical trial. Results indicated generally positive attitudes toward menopause and a variety of symptoms of varying degrees of severity in African-American and White women. Limited knowledge about menopause and HRT were apparent; however, White women were more likely to be receiving HRT and were more informed about HRT than African-American women. White women also were more positive about participating in a HRT clinical trial than African-American women who feared cancer as a potential side effect.

Black or African American↗
PubMed1999

Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation.

BACKGROUND: Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device. OBJECTIVES: The purpose of this study was to examine the association of emotional status after internal cardioverter defibrillator (ICD) implantation and subsequent arrhythmia events. METHODS: An analysis of data obtained in a prospective longitudinal study of responses to the ICD measured mood disturbance (Profile of Mood States; POMS) before implant and at 1, 3, 6, and 9 months postoperatively. Subjects included 144 men and 32 women with a mean age of 60 +/- 13 years and a mean left ventricular ejection fraction (LVEF) of 33 +/- 12%. Arrhythmia events were measured by self-report of shocks and by ICD device interrogation to obtain the number and type (defibrillation, cardioversion, and antitachycardia pacing) of therapies delivered by the ICD. For each time point, POMS scores of subjects who had arrhythmia events were compared with those who did not. For subjects who had ICD shocks, pre-event and post-event POMS scores were also compared. Multiple logistic regression was used at each time point to determine if clinical, demographic and psychological data could predict arrhythmia events. RESULTS: Patients with arrhythmia events had higher POMS scores throughout the 9 months of follow-up. Higher level of mood disturbance (specifically anxiety, fatigue, and confusion) at 1 and 3 months were independent predictors of subsequent arrhythmia events at 3 and 6 months after controlling for LVEF, the presence of coronary artery disease, pre-implant arrhythmia history, and the use of amiodarone and beta-blocking agents. There were no differences in POMS scores before and after ICD shocks, reinforcing the notion that negative emotions were a cause, rather than a consequence, of arrhythmia events. CONCLUSIONS: Mood disturbances, such as anxiety, may increase the risk for arrhythmia events after ICD insertion.

Adult↗
PubMed1998

Discoverer, teacher, friend: a tribute to Marguerite Kinney.

This tribute to Dr Marguerite Kinney, a transformational leader in cardiovascular nursing, highlights her influence on the lives and careers of previous students and those she has mentored. Examples of Dr Kinney's excellence in teaching, leadership, scholarship and research, and creative thinking within the discipline of nursing are provided.

Cardiovascular Diseases↗
PubMed1998

Heart failure: strategies to enhance patient self-management.

Successful management of heart failure requires an active partnership between the patient and health care providers. This can be facilitated through a focused patient education plan that begins in acute care and has continuity into the community. Elements of the education plan involve both teaching content areas and self-management behaviors. Clinical pathways for heart failure incorporate teaching and educational strategies to guide the work of the multidisciplinary team, and the advanced practice nurse has tremendous potential in facilitating improved patient outcomes.

Activities of Daily Living↗
PubMed1997

Cognitive therapy for ventricular dysrhythmia patients.

Living with a serious ventricular dysrhythmia and its treatment poses certain psychological stressors including anxiety, depression, fear, and a sense of loss of control. Additional stressors related to side effects and technology issues may be present depending on whether the patient is treated with antidysrhythmic medications, an internal cardioverter defibrillator, or both. Cognitive therapy has been used with some success to reduce patient fear and improve psychological outcomes in some patient populations with illnesses characterized by loss of control including cancer and epilepsy. This article outlines a cognitive therapy approach for use with patients who have a serious ventricular dysrhythmia.

Adaptation, Psychological↗
PubMed1996

Agency for health care policy and research: Clinical practice guidelines for heart failure.

The Agency for Health Care Policy and Research (AHCPR) and Rand Corporation convened a panel of experts to review published studies on care of the patient with heart failure. The outcome was the Clinical Practice Guideline for the evaluation and care of patients with left ventricular systolic dysfunction, published in June 1994. This article reviews key points in the clinical practice guideline and summarizes important areas for future research to improve patient outcomes.

Health Planning Organizations↗
PubMed1995

Drug profiles: maximizing therapeutic effectiveness.

Major cardiac events are inevitably followed with a pharmacologic plan of therapy for cardiac patients. Careful assessment of the patient's drug regimen is an important aspect of cardiovascular nursing practice. Such assessment will reveal implications for education, compliance counseling, and side effect evaluation. A thorough drug history should include information about both prescription and nonprescription drug use. Assessment for adherence is improved by using supportive, open-ended questions. Assessment for side effects that affect quality of life is important, particularly in the area of sexual dysfunction. Sexual function should be assessed before beginning cardiovascular drug therapy and monitored for changes during treatment. Using principles of chronopharmacology, or therapy based on the time-dependent effects of drugs, nurses can schedule cardiovascular medications and evaluate patient responses in relation to circadian variability in vulnerability and symptoms. Assessment for ease of self-management of the drug regimen should be a particular focus with non-English-speaking patients and those with complex or costly drug regimens.

Cardiovascular Agents↗
PubMed1994

Management of heart failure. II. Counseling, education, and lifestyle modifications.

OBJECTIVE: This article reviews the role of counseling, education, dietary modifications, and exercise for patients with heart failure due to left ventricular systolic dysfunction. DATA SOURCE: We reviewed studies published in English between 1966 and 1993 and referenced in MEDLINE or EMBASE. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with terms for the specific areas of interest. Where data were lacking, we relied on opinions of panel members and peer reviewers. STUDY SELECTION AND DATA SYNTHESIS: Studies were reviewed to determine whether patients had heart failure due to systolic dysfunction (left ventricular ejection fraction, < 0.35 to 0.40) and whether clinical outcomes were reported. Studies that reported only intermediate outcomes (eg, hemodynamics) were not reviewed. CONCLUSION: Counseling and education can improve patient outcomes and decrease unnecessary hospitalizations. Patients with mild to moderate heart failure should be restricted to 3 g/d of sodium initially. Those who are unresponsive to this dosage or who have more severe disease should be advised to consume 2 g/d or less. Patients should be strongly advised to drink no more than 30 mL/d of alcohol or, preferably, to abstain completely. Exercise training is safe and can improve exercise duration and symptoms. Adherence to the treatment plan should be stressed and monitored at each visit. Clinicians should inform patients of the seriousness of their disease and their prognosis, but they should emphasize that patients can continue to remain active and enjoy a reasonable quality of life.

Counseling↗
PubMed1994

Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease.

A prospective, randomized, controlled clinical trial in patients with coronary artery disease (CAD) and a concurrent physical disability evaluated the effects of a home exercise training program on cardiovascular function and blood lipids. Eighty-eight men between the ages of 42 and 72 years (mean 62) with documented CAD and a physical disability with functional use of > or = 2 extremities including 1 arm were randomized to either a 6-month home exercise training program using wheelchair ergometry or to a control group that received usual and customary care. Both groups received dietary instructions and were requested to follow a fat-controlled diet. Exercise test variables with echocardiography and blood lipids were measured at baseline and at 6 months. The home exercise training group significantly improved both peak exercise left ventricular ejection fraction (p = 0.007) and fractional shortening (p = 0.01) between baseline to 6 months, whereas the control group showed no significant changes. Exercise training effects of decreased resting heart rate (p = 0.03) and decreased peak rate pressure product (p = 0.03) were also found in the treatment group. No exercise-related cardiac complications occurred. Both groups significantly (p < or = 0.01) increased high-density lipoprotein cholesterol levels. These results indicate that physically disabled men with CAD can safely participate in a home exercise training program which may result in intrinsic cardiac benefits. The metabolic cost of activities of daily living imposed on this disabled population may also have a positive effect on high-density lipoprotein cholesterol levels.

Adult↗
PubMed1993

Circadian rhythms: implications for cardiovascular nursing and drug therapy.

A greater understanding of the role of biologic rhythms in cardiovascular functioning has recently been established. Circadian variations in ischemic events such as acute myocardial infarction, sudden cardiac death, and cerebrovascular emboli have been well documented. New approaches to therapy based on circadian fluctuations in physiology and pathology have led to better timing of drug administration and treatments to optimize desired outcomes and minimize untoward effects. This article discusses these emerging trends and gives examples related to beta-adrenergic blockade, nitrate and steroid therapy, and anticoagulation. Directions for future nursing research are suggested.

Adrenergic beta-Antagonists↗
PubMed1992

Neurogenic electrocardiographic abnormalities in subarachnoid hemorrhage.

ECG abnormalities are a frequent, potentially life-threatening complication of subarachnoid hemorrhage. Yet, the mechanism behind these ECG abnormalities is poorly understood. Nursing literature has given this phenomenon little attention. However, neurogenic ECG abnormalities have implications for critical care nursing practice and research. In this article the most frequently documented neurogenic ECG abnormalities occurring in patients with subarachnoid hemorrhage have been discussed. The proposed pathophysiologic mechanisms and nursing implications were also discussed. Patients with neurogenic ECG abnormalities require complex, multifaceted nursing assessment and intervention. Only with a better understanding of the phenomenon will the critical care nurse be able to meet the needs of these patients.

Arrhythmias, Cardiac↗
PubMed1991

The transition from nonoral to oral feeding in children.

In this single-subject study, an evaluation was completed to determine the effect of occupational therapy intervention on the oral intake of 3 children who had their nutritional needs met by nonoral methods prior to the administration of an oral feeding program. Treatment consisted of a gradual increase of food presentation with the application of behavioral management methods and the presentation of developmentally appropriate play activities. Oral intake was measured during baseline and intervention phases to establish the effect of intervention. An analysis indicated an increase in oral intake in the intervention phase in 2 of the 3 children. The results, that occupational therapy intervention can increase the oral intake of children in transition from nonoral to oral feeding, might be strengthened through the replication of this study on larger populations.

Behavior Therapy↗