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Biomedical subjects

S M Sereika

Publications and source records attributed to S M Sereika.

At least 19 recordsLinked to original sources
PubMed2001

Cognitive function and reproductive hormones in adjuvant therapy for breast cancer: a critical review.

Deterioration in cognitive function-particularly learning, memory, and attention-has been reported by women with breast cancer who receive adjuvant chemotherapy. Deficits in cognitive function reported by women with breast cancer are similar to those experienced by women as a consequence of natural or surgical menopause. The basis of these deteriorations may include reductions in reproductive hormone levels, particularly estrogens and progesterones, that occur as a result of adjuvant chemotherapy. This paper critically examines the literature related to the impact of adjuvant chemotherapy and reproductive hormone changes on cognitive function in women with breast cancer and suggests direction for future research in this area. The paper proposes a framework for investigation of the problem and discusses the challenges associated with the conduct of this research.

Antineoplastic Agents↗
PubMed2001

The use of life review to enhance quality of life of people living with AIDS: a feasibility study.

People living with AIDS (PLWA) are confronted with uncertainty and their own mortality at an earlier than expected age. Life review, an intervention that has the potential to increase life satisfaction in the elderly experiencing transition points in their lives, may have a similar effect when used with PLWA. Therefore, the purpose of this feasibility study was to explore the use of life review in a sample of 20 PLWA through a randomized controlled trial of its effectiveness in decreasing depressive symptoms and in increasing self esteem, quality of life, and purpose in life. Compared to the control group, the treatment group had an improved overall quality of life and self-esteem over 12 months, less depressive symptoms over 12 months, and a greater purpose in life at 3 months. The effects that were seen were mainly small to medium effects. The findings from this feasibility study suggest the potential value of life review to enhance quality of life, purpose in life, and self-esteem, and to decrease depressive symptoms in PLWA. Further research is needed with a larger sample and with other groups such as PLWA experiencing virologic failure.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Problem drinking and medication adherence among persons with HIV infection.

OBJECTIVE: To examine the relation between problem drinking and medication adherence among persons with HIV infection. DESIGN: Cross-sectional survey. SETTING/PARTICIPANTS: Two hundred twelve persons with HIV infection who visited 2 outpatient clinics between December 1997 and February 1998. MEASUREMENTS AND MAIN RESULTS: Nineteen percent of subjects reported problem drinking during the previous month, 14% missed at least 1 dose of medication within the previous 24 hours, and 30% did not take their medications as scheduled during the previous week. Problem drinkers were slightly more likely to report a missed dose (17% vs 12 %, P =.38) and significantly more likely to report taking medicines off schedule (45% vs 26%, P =.02). Among drinking subtypes, taking medications off schedule was significantly associated with both heavy drinking (high quantity/frequency) (adjusted odds ratio [OR], 4.70; 95% confidence interval [95% CI], 1.49 to 14.84; P <.05) and hazardous drinking (adjusted OR, 2.64; 95% CI, 1.07 to 6.53; P <.05). Problem drinkers were more likely to report missing medications because of forgetting (48% vs 35%, P =.10), running out of medications (15% vs 8%, P =.16), and consuming alcohol or drugs (26 % vs 3 %, P <.001). CONCLUSION: Problem drinking is associated with decreased medication adherence, particularly with taking medications off schedule during the previous week. Clinicians should assess for alcohol problems, link alcohol use severity to potential adherence problems, and monitor outcomes in both alcohol consumption and medication adherence.

Adult↗
PubMed2000

Adherence in chronic disease.

Nonadherence to treatment regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Adolescent↗
PubMed1999

Screening and predicting adolescent depressive symptoms in rural settings.

Adolescent depression with related suicidal behavior is a serious health problem. This article describes depressive symptoms, reported life events, and demographic risk factors in 846 rural adolescents. The results indicate that self-reported depressive symptoms in rural adolescents is significantly (p < .05) related to gender, death in the family, and the perceived positive and negative impact of life events, as well as the specific events of losing a close friend, an increase in number of arguments with parents, trouble with classmates, and trouble with police. The type of school program and trouble with siblings was marginally significant (p < .10). These demographic factors and life events may assist health-care professionals in identifying adolescents at risk for depressive symptoms.

Adolescent↗
PubMed1999

Effect of endotracheal suctioning on cerebral oxygenation in traumatic brain-injured patients.

OBJECTIVE: In patients with severe head injuries, brain damage occurs not only from the primary trauma but also secondarily from a reduction in cerebral oxygenation as a result of brain swelling, ischemia, and elevated intracranial pressure (ICP). However, routine interventions designed to maintain oxygenation, such as endotracheal suctioning (ETS), also may negatively affect the cerebrovascular status by increasing the ICP. The purpose of this study was to determine whether ETS influences cerebral oxygenation in patients with traumatic brain injury. DESIGN: Descriptive, prospective, with repeated assessments within each patient. SETTING: Ten-bed trauma intensive care unit in a university Level I trauma center. SUBJECTS: Nineteen patients who were 16 yrs or older, had acute head injury, a Glasgow Coma Scale score < or =8; external ventricular drain and arterial pressure devices in place, and were intubated and mechanically ventilated. INTERVENTIONS: ETS protocol consisting of administration of four ventilator-delivered breaths at 135% of the patients' actual tidal volume, 100% F(IO)2, before and after suctioning with a standardized catheter at a 16-L flow rate. MEASUREMENTS AND MAIN RESULTS: This study examined cerebrovascular responses as measured by the traditional measures of ICP and cerebral perfusion pressure, as well as middle cerebral artery velocity and jugular venous oxygen tension that occurred during ETS in head-injured adults. The results of this study show that both ICP and cerebral perfusion pressure are increased during ETS. In the majority of patients (84%), the ICP returned to baseline values within 2 mins. CONCLUSIONS: The increase in jugular venous oxygen tension associated with increases in middle cerebral artery velocity and mean arterial pressure suggests that cerebral oxygen delivery was maintained during ETS. Cerebral changes associated with ETS using the described protocol are consistent with the preservation of cerebral oxygenation.

Adolescent↗
PubMed1999

Psychometric properties of the Index of Homophobia Scale in registered nurses.

The psychometric properties of the Index of Homophobia Scale (IHS; Bouton et al., 1987) were examined in a sample of registered nurses (n = 95). Scores on the IHS may range from 0 (no homophobia) to 28 (highly homophobic). This sample had relatively low total scores on the IHS (M = 7.99, SD = 5.41), indicating that subjects were predominantly not homophobic. Internal consistency as estimated by Cronbach's alpha was .88. The average item mean was 1.14 (SD = 0.29) ranging from .77 to 1.48. Corrected item-to-total scale correlations were satisfactory, ranging from .58 to .75. Inter-item correlations ranged from .35 to .67 indicating some redundancy in content sampling. The 7-item IHS indicates promise for future use with registered nurses, and perhaps also with other health care professionals in adequately and accurately measuring homophobia.

Adult↗
PubMed1998

Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome.

STUDY OBJECTIVES: To determine the incidence of, outcome of, and risk factors for anesthesia-related pulmonary aspiration in the predominantly pediatric population receiving anesthesia care. DESIGN: Using a clinical concurrent quality assessment system we developed, we used data stored in a custom-designed computerized database to initiate a retrospective review. Statistical relationships were analyzed by Fisher's exact test and binary logistic regression with commercially available software. SETTING: University-affiliated pediatric hospital. PATIENTS: All patients receiving anesthesia (n = 50,880) between April 1, 1988, and March 31, 1993. MEASUREMENTS AND MAIN RESULTS: Aspiration occurred in 52 (0.10% or 10.2 per 10,000) of the 50,880 general anesthesia cases. Aspirate was food or gastric contents in 25 cases (0.049% or 4.9 per 10,000), blood in 13 (0.026% or 2.6 per 10,000), and unknown material in 14 (0.0275% or 2.76 per 10,000). There were no deaths attributable to aspiration. Morbidity was confined to unanticipated hospital admission (n = 12), cancellation of the surgical procedure (n = 4), and intubation, with or without ventilation (n = 15). Aspiration occurred significantly more often in patients with greater severity of underlying illness (ASA physical status III or IV) (p = 0.0015), intravenous induction (p = 0.0054), and age equal to or greater than 6.0 years and less than 11.0 years (p = 0.0029). Emergency procedures had a marginally significant increased aspiration risk (p = 0.0527). CONCLUSIONS: The overall incidence of anesthesia-related aspiration in our series (0.10%) was twice that reported in studies of adults, and four times (0.25%) higher for those at highest risk (ASA physical status III or IV vs. physical status I or II). Anesthesia-related pulmonary aspiration was proven to be a rare event in this tertiary pediatric center and its consequences relatively mild. Because of the very low frequency and the lack of serious outcome after aspiration in ASA physical status I and II pediatric patients, it appears that routine prophylactic administration of histamine blockers or propulsive drugs in healthy pediatric patients is unwarranted.

Adolescent↗
PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Aged↗
PubMed1998

Effect of neuromuscular blockers and opiates on the cerebrovascular response to endotracheal suctioning in adults with severe head injuries.

BACKGROUND: Intracranial hypertension occurs in response to routine procedures such as endotracheal suctioning in patients with severe head injuries. In some patients, the intracranial pressure does not immediately return to baseline levels. OBJECTIVES: To examine the effect of drug administration on cerebrovascular response to endotracheal suctioning in adults with severe head injuries. METHODS: Seventy-one subjects were divided into 3 groups: those who received no drugs, those treated with opiates only (morphine sulfate and fentanyl citrate), and those treated with a neuromuscular blocking agent (vecuronium bromide) plus opiates. A controlled protocol involving 2 sequences of endotracheal suctioning that included hyperoxygenation, hyperinflation, and suctioning was used for all subjects. Two-way repeated-measures analyses of variance were done with type of drug as the between-subject factor and phase of suctioning as the within-subject factor. Survival analysis was used to compare the return of intracranial pressure to baseline levels among the 3 groups. RESULTS: Changes in intracranial pressure were significantly smaller in subjects who received a neuromuscular blocking agent plus opiates than in subjects who did not receive any drugs or received opiates only. The greatest increase in intracranial pressure from baseline was in the first and second phases of suctioning. The 3 groups showed no significant difference in the return of intracranial pressure to baseline level. CONCLUSIONS: Neuromuscular blockers attenuate the increases in intracranial pressure that occur with endotracheal suctioning. It is not known whether control of procedurally induced elevations in intracranial pressure affects long-term outcomes in adults with severe head injuries.

APACHE↗
PubMed1997

Critical care nurses, ethical decision-making and stress.

Considerable attention has focused on describing ethical issues that critical care nurses face in their practice: however, less attention has been directed at describing the process of ethical decision-making. Systematic research linking aspects of ethical-decision making and stress is lacking. This cross-sectional study examines the relationship between selected aspects of ethical decision-making, stress and selected nurse characteristics. Sixty-one critical care nurses completed the Nurse's Ethical Decision Making--ICU Questionnaire and the Health Professions Stress Inventory. Findings revealed that nurses who selected the patient advocacy model had significantly higher nurse autonomy scores, that perceived anxiety had a negative association with nurse autonomy, and that workplace restrictions and stress were related.

Adult↗
PubMed1997

An evaluation of a self-management program for adults with asthma.

The purpose of this study was to evaluate the impact of a self-management program for adults with moderate to severe asthma on compliance with inhaled, prescribed, nonemergency medications; asthma symptoms; and airway obstruction. In this controlled experimental study, 55 subjects from a rural community were randomized to one of two groups. Self-efficacy theory served as the framework for this study. Primary measures included the Metered Dose Inhaler (MDI) Chronolog, a journal of daily asthma concerns, and a peak-flow meter to appraise airway obstruction. Secondary measures included the Asthma Self-Management Assessment Tool (ASMAT) and the Self-Efficacy for Asthma Management Scale (SEAMS). These measures were completed pre- and post-intervention. Data analysis using descriptive and inferential statistics revealed that subjects receiving the self-management program increased compliance with inhaled medications (U = 271, p = .043).

Adolescent↗
PubMed1996

Sensitivity and specificity of plasma and urine complement split products as indicators of lupus disease activity.

OBJECTIVE: To determine if measurement of serum complement split products (C4d, Bb, C5b-9) is better than conventional C3 and C4 measurements in distinguishing patients with varying degrees of lupus disease activity, and to determine if the presence of C3d in urine is helpful in distinguishing lupus patients with from those without early lupus nephritis. METHODS: Lupus disease activity was prospectively determined at 3 consecutive visits an average of 4 months apart, using the Systemic Lupus Activity Measure (SLAM), the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and physician global assessment (PGA). Blood samples were evaluated for the presence of C4d, Bb, and C5b-9 by quantitative microassay plate enzyme immunoassay at each patient visit. We characterized urinary excretion of C3 fragments (with attention to C3d) by sodium dodecyl sulfate-polyacrylamide gel electrophoresis with Western blotting. RESULTS: Thirty-one SLE patients were enrolled in the study. The mean SLAM score and the mean SLEDAI score each correlated well with the PGA at all 3 visits. A SLAM score of 6 and a SLEDAI score of 4 had the best overall sensitivity and specificity for predicting moderate-to-severe disease activity by PGA (100% and 73%, respectively, for the SLAM and 86% and 94%, respectively, for the SLEDAI). Serum C4d and Bb were more sensitive indicators of current moderate-to-severe lupus disease activity at all 3 visits than were serum C5b-9, C3, and C4. C3 and C4 were more specific indicators of moderate-to-severe disease activity. Serum C4d and Bb were more sensitive at predicting moderate-to-severe disease activity at subsequent visits than were C5b-9, C3, and C4. Urine C3d was better than C3, plasma C4d, Bb, C5b-9 and anti-double-stranded DNA antibody in distinguishing patients with from those without acute lupus nephritis (P = 0.02). CONCLUSION: C4d and Bb are sensitive indicators of moderate-to-severe lupus disease activity and may be most helpful in situations where conventional measurements are not, such as in lupus patients whose C3 and C4 levels remain normal despite evidence of clinical disease activity. It appears from this study that detection of urine C3d may be a simple way of measuring complement activation in the setting of lupus renal disease. The availability of instruments for clinical disease activity measurement such as the SLAM and the SLEDAI may enable more consistent definition of lupus disease activity and may thus provide a means for better examining the role of complement activation products in predicting lupus disease activity in larger patient populations.

Adult↗
PubMed1992

Factors associated with long-term depressive symptoms of sexual assault victims.

Of 63 sexual assault victims who were a mean 7.9 years postevent, almost two thirds (60%, n = 38) demonstrated some degree of depression. Over half (56%, n = 35) the sample also reported a history of childhood sexual abuse. Three factors had a significant positive association with higher levels of depression: nondisclosure of the assault to significant others due to concerns about stigma; the presence of children living with the victim; and a civil lawsuit pending. One factor, currently being sexually active, had a significant negative association with depression. Results are discussed from the perspective of depression, a common pathway by which unresolved sexual trauma is expressed.

Adaptation, Psychological↗
PubMed1987

The hemodynamic effects of ventricular pacing with and without atrioventricular synchrony in patients with normal and diminished left ventricular function.

The relative hemodynamic effects of heart rate, inotropic state, and atrioventricular (AV) synchrony during ventricular pacing were evaluated in 10 patients with normal left ventricular ejection fraction (LVEF) (0.66 +/- 0.07, mean S.D.) and in eight patients with a diminished LVEF (0.34 +/- 0.18). Hemodynamics were measured at AV intervals of 130, 0, and -130 msec during ventricular pacing at a baseline rate that was 10 pulses/min greater than the resting heart rate, at 130 pulses/min alone, and at 130 pulses/min during continuous intravenous infusion of dobutamine. During baseline ventricular pacing and during ventricular pacing at 130 pulses/min with and without dobutamine, both groups of patients had a significant decrease in cardiac index, stroke volume index, and stroke work index when the AV pacing interval was decreased from 130 to 0 msec. The observed decrease in these three hemodynamic variables was similar when patients with diminished LVEF were compared to patients with normal LVEF. No further significant decrease in cardiac index, stroke volume index, and stroke work index occurred in either group when the AV interval was changed from 0 to -130 msec during baseline ventricular pacing or during ventricular pacing at 130 with and without dobutamine. Beneficial hemodynamic effects occur during ventricular pacing when AV synchrony is maintained at resting heart rates and during increases in heart rate and inotropic state in patients with normal and diminished LVEF.

Adult↗
PubMedDate not supplied

Left ventricular dysfunction and duration of mechanical ventilatory support in the chronically critically ill: a survival analysis.

OBJECTIVE: The purpose of this study was to determine whether there was a greater risk for prolonged duration of mechanical ventilatory support (MVS) for those who demonstrated left ventricular dysfunction (LVD) compared to those without evidence of LVD when controlling for nutritional and general health status and spontaneous breathing pattern. DESIGN: A secondary analysis was used on data obtained in a retrospective survey of patient records. SETTING: Five adult critical care units at an academic medical center in the Midwest. SUBJECTS: Twenty-seven chronically critically ill adults requiring MVS who later successfully weaned from MVS. OUTCOME MEASURE: Duration of MVS. INSTRUMENTATION: LVD was determined with use of a criterion-based checklist. Serum albumin level as determined by the hospital's clinical laboratory served as the indicator of nutritional and general health status. The rapid shallow breathing index was used to describe the spontaneous breathing pattern. RESULTS: Adjusted survival function estimates were obtained on fitting a Cox proportional hazards model. When adjusting for the known covariates, serum albumin level and rapid shallow breathing index, the duration of MVS was significantly longer for those who demonstrated LVD when compared to those without evidence of LVD [X2Wald(1) = 4.72, p < 0.05]. CONCLUSIONS: The findings of this secondary analysis lend support to the fact that when controlling for serum albumin level and rapid shallow breathing index, LVD is related to the duration of MVS in patients who successfully wean.

Aged↗
PubMedDate not supplied

Multiple authorship: issues and recommendations.

The increase in multidisciplinary research has led to a subsequent expansion of multiple authored articles in nursing as well as other disciplines. Although there are benefits to multiple authorship, there also are areas of possible conflict. The lack of adequate guidelines to address issues that may arise from multiple authorship heightens the possibility of disputes. Developing a blueprint for the preparation and presentation of papers emanating from a research team's work early in the project can avoid conflicts and ensure that the efforts of the appropriate individuals are reflected in the publications. This article discusses several issues related to authorship, including the assignment of authorship credit, the increased pressures to publish, and the complexity of authorship issues associated with multisite studies. The authors offer recommendations to reduce problems that may arise among members of a research team because of authorship issues. In addition, they include the guidelines that their multidisciplinary research team developed early in their project.

Authorship↗