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Biomedical subjects

S C Smeltzer

Publications and source records attributed to S C Smeltzer.

11 recordsLinked to original sources
PubMed1992

Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function.

PURPOSE: The aim of this study was to assess the utility of clinical assessment of respiratory muscle weakness in MS. PATIENTS AND METHODS: We studied 40 MS patients who performed pulmonary function tests using standard procedures and measures of respiratory muscle strength. Descriptive clinical indices included a history of detailed neurologic findings, including upper and lower extremity weakness, cerebellar signs, and evidence of cerebral lesions and other clinical signs including dependence in activities of daily living, shortness of breath, weak voice, dysarthria and dysphagia. We devised an index comprised of four clinical signs: the patient's report of difficulty in clearing pulmonary secretions and his report of a weakened cough, the examiner's observation of the patient's cough, and ability to count on a single exhalation. RESULTS: Mean values of TLC (95 percent +/- 14) VC (91 percent +/- 19), and RV (106 percent +/- 34) were normal. By contrast, MVV (68 percent +/- 20), PImax (74 percent +/- 27) and PEmax (51 percent +/- 22) were decreased. Stepwise multiple regression indicated that the best single predictor of expiratory muscle weakness was the index score; the combination of index score, upper extremity weakness, and maximal voluntary ventilation accounted for 60 percent of the variance in PEmax. CONCLUSION: We conclude that clinical assessment is a better predictor of respiratory muscle weakness than spirometry and that a systematic clinical assessment supplemented by respiratory muscle assessment and MVV can uncover subtle respiratory muscle weakness in patients with MS.

Adult↗
PubMed1991

Use of the Trajectory Model of nursing in multiple sclerosis.

Multiple sclerosis (MS) is a chronic, demyelinating disorder that is unpredictable in its overall course, in the type of symptoms that will predominate, and in its eventual outcome. It has been used as a model in research, education, and practice to examine the course of chronic illness, patient and family responses, coping and adjustment to chronic illness, and specific concepts and variables of interest to researchers. MS is used in this paper to evaluate for nursing practice the utility of the Corbin and Strauss trajectory model of nursing. The assumptions and major concepts of the trajectory framework are discussed, use of the model in multiple sclerosis is demonstrated, and the strengths and limitations of the framework as a nursing model are identified.

Chronic Disease↗
PubMed1988

Pulmonary function and dysfunction in multiple sclerosis.

Pulmonary function was studied in 25 patients with clinically definite multiple sclerosis with a range of motor impairment. Forced vital capacity (FVC), maximal voluntary ventilation (MVV), and maximal expiratory pressure (MEP) were normal in the ambulatory patients (mean greater than or equal to 80% predicted) but reduced in bedridden patients (mean, 38.5%, 31.6%, and 36.3% predicted; FCV, MVV, and MEP, respectively) and wheelchair-bound patients with upper extremity involvement (mean, 69.4%, 50.4%, and 62.6% predicted; FVC, MVV, and MEP, respectively). Forced vital capacity, MVV, and MEP correlated with Kurtzke Expanded Disability Status scores (tau = -0.72, -0.70, and -0.65) and expiratory muscle weakness occurred most frequently. These findings demonstrate that marked expiratory weakness develops in severely paraparetic patients with multiple sclerosis and the weakness increases as the upper extremities become increasingly involved.

Adult↗
PubMed1988

Pregnancy and multiple sclerosis.

MS is an unpredictable, potentially disabling condition that occurs most commonly in women of reproductive age. The decision to have a baby after this diagnosis is a difficult and very personal one. Each couple considering a family deserves preconception counseling with accurate information and support to facilitate an informed decision. Consistently, studies have found that pregnancy is a period of safety from worsening of MS but that exacerbation occurs at two to three times the expected rate after delivery. Gestational history does not seem to affect the ultimate prognosis of the disease. The decision to bear children then seems to depend first on the desire of the woman to have a family. Additional issues to consider for a woman with MS considering pregnancy are current physical impairment and support available from father, family, and friends. There is considerable evidence that some protective factor exists during pregnancy to cause the disease to be less active. Presumably, this is a soluble factor or factors that suppress the cellular immune system. This is of great potential scientific interest, since it may contribute to our understanding of MS and potentially lead to newer avenues of research and treatment.

Adult↗
PubMedDate not supplied

Women and AIDS: sociopolitical issues.

HIV infection and AIDS in women will continue without adequate diagnosis and treatment as long as women are not treated as full partners in society. Until issues related to women and their place in society are considered within the sociopolitical context, women who are at risk for HIV infection, those infected with the HIV virus, and those with AIDS will continue to receive inadequate attention. The National Center for Nursing's National Action Agenda, Nursing and the HIV Epidemic, provides some direction for addressing these issues and those that relate to practice, education, research, and health policy. It is incumbent on nurse researchers to conduct research related to the critical issues associated with HIV infection and AIDS in women, disseminate the findings of that research, and use those findings to inform and move health policy in this area forward. It is equally important to understand the issues that affect women--ethnic considerations, sexual practices, IV drug use--within the context or present political climate of our society. That climate allowed an NIH study that could identify risky sexual behaviors of adolescent and adult subjects who consent to participate in such a study to be called to a halt--not because of concerns about the study design or the scientific rigor of the study, but because of an elected official's fear that asking such questions will encourage these behaviors and his personal belief that such issues should not be discussed in polite society. These issues must be brought forward, acknowledged, and discussed if they are to be dealt with effectively. Otherwise, the relentless course of AIDS will continue.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Attitudes of nurses toward computerization: a replication.

To assess the attitudes of nurses toward computerization, Stronge and Brodt's questionnaire, Assessment of Nurses' Attitudes Toward Computerization was used to survey head nurses, staff registered nurses, and licensed practical nurses in a 500-bed hospital. Nurses' attitudes were generally favorable toward computers and there were no significant differences in attitudes by nurses' job title, level of education, age, or years of nursing experience. Previous experience with computers was the only variable significantly related to total mean score with those nurses who had previously used computers having significantly (p less than 0.001) more favorable attitudes toward computers than those who reported no previous computer use. A factor analysis was obtained; five factors emerged. Although the factors are similar to the categories identified by Stronge and Brodt, results of the factor analysis suggest response bias.

Adult↗
PubMedDate not supplied

Testing of an Index of Pulmonary Dysfunction in Multiple Sclerosis.

The reliability and validity of an Index of Pulmonary Dysfunction in Multiple Sclerosis (Index) comprised of four readily assessed clinical signs was studied. Forty patients with MS performed pulmonary function testing and underwent clinical evaluation to determine whether or not the Index correctly identified those patients with pulmonary dysfunction. The Index correctly predicted the presence or absence of significant respiratory muscle weakness (defined as Pemax less than 50% of predicted) in 32 (80%) of the subjects. All subjects who had normal expiratory muscle strength (Pemax greater than or equal to 80% of predicted) were correctly classified by the Index; however, not all patients with isolated expiratory muscle weakness were correctly identified. Test-retest reliability, interrater reliability (Spearman rho coefficients of 0.87 and 0.94, respectively), and internal consistency (alpha = .83) of the Index were acceptable. Index scores were not associated with changes in any other PFT results except residual volume, which increased with the severity of respiratory muscle weakness. The Index has acceptable validity and reliability for use in clinical practice to identify those neurological patients with expiratory muscle weakness.

Adult↗