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PubMed2002

Impact and prevention of voice problems in the teaching profession: embracing the consumers' view.

Teachers are vulnerable to developing voice problems due to their specific occupational demands during teaching. Information on how the teaching profession is impacted by voice problems and what the profession perceives to be useful information for preventing voice problems is important for health care service providers. A total of 122 subjects from the teaching profession (55 practicing teachers and 67 prospective teachers) were therefore surveyed to ascertain their perception of their voice condition and the impact of voice problems on their communication, social life, personal emotions, and occupation. The results showed that the practicing teachers perceived their voice to be significantly worse than the prospective teachers. In addition, the teachers also faced significantly more difficulties in their daily communication than the prospective teachers. These two groups of subjects believed that information on breathing exercises and specific vocal hygiene strategies would help them prevent voice problems.

Adult↗

PubMed2003

[Psychological intervention for coping with painful medical procedures in pediatric oncology].

BACKGROUND: Psychological treatments for procedural distress have shown good results in pediatric oncology and several institutions recommend their implementation to reduce the procedural distress, anxiety and pain associated with painful medical procedures. OBJECTIVES: To assess the results of a psychological intervention in the first child participating in the study "Prospective Analysis of a Psychological Program for Coping with Medical Procedures in Pediatric Oncology". METHODS: We performed a single-case study, using pain and anxiety self-reports by the child and an observational scale in a psychological intervention with the following components: Breathing exercises, imagery, reinforcement, and behavioral rehearsal. RESULTS: The psychological intervention decreased procedural distress, anticipatory anxiety and pain. The 3-year-old child was able to give pain and anxiety self-reports using appropiate tools. CONCLUSIONS: The potential benefits of this kind of intervention are discussed, and some recommendations for future research are proposed.

Adaptation, Psychological↗

PubMed1990

Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education.

The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women. Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task. Half of the Ss in each group received a hypnotic induction at the beginning of each session; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education. Both hypnotic Ss and highly susceptible Ss reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control Ss' births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other 3 groups. We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study.

Adolescent↗

PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗

PubMed2003

Is very early extubation after lung transplantation feasible?

OBJECTIVE: To evaluate donor graft function, intraoperative blood consumption, and oxygenation and hemodynamic stability in patients undergoing lung transplantation. DESIGN: Prospective pilot study. SETTING: University hospital. PARTICIPANTS: Forty-three patients undergoing lung transplantation from January 1999 to June 2001. INTERVENTIONS: Hemodynamic monitoring, early extubation, and noninvasive ventilation criteria. MEASUREMENTS AND MAIN RESULTS: The 31 nonearly extubated patients showed a lower PaO(2)/fraction of inspired oxygen (F(I)O(2)), a higher mean pulmonary arterial pressure, extravascular lung-water index (EVLWI) and vasoactive drug support (norepinephrine), and more blood products consumption than 12 early extubated patients at the end of surgery. Seven of 12 early extubated patients did not show any signs of respiratory failure after tracheal extubation; they were alert and able to perform deep breathing exercise and coughing. In the other 5 patients, hypoxemia, hypercapnia, and an increase of respiratory rate >30 breaths/min were observed. The intermittent application of noninvasive pressure ventilation by face mask avoided endotracheal intubation. CONCLUSION: The use of a short-acting anesthetic drug, appropriate intraoperative extubation criteria, epidural analgesia, and postoperative noninvasive ventilation make early extubation of lung-transplanted patients possible and effective.

Adult↗

PubMed2003

Inspiratory muscle fatigue in swimmers after a single 200 m swim.

Inspiratory muscle fatigue may occur in as little as 6 min during high-intensity spontaneously breathing exercise. The aims of this study were to determine whether inspiratory muscle fatigue occurs during swimming exercise and whether inspiratory muscle strength differs between the supine and standing body positions. Seven competitive swimmers were recruited to perform a single 200 m front-crawl swim, corresponding to 90-95% of race pace. Inspiratory muscle strength was measured at residual volume using a hand-held mouth pressure meter that measured maximal inspiratory pressure in the upright and supine positions. At baseline, maximal inspiratory pressure in the supine position was significantly lower than maximal inspiratory pressure in the upright position (112 +/- 20.4 and 133 +/- 16.7 cmH2O, respectively; P < or = 0.01). Post-exercise maximal inspiratory pressure in the supine position (80 +/- 15.7 cmH2O) was significantly lower than baseline maximal inspiratory pressure in the supine position (P < or = 0.01). The results indicate that a single 200 m front-crawl swim corresponding to 90-95% of race pace was sufficient to induce inspiratory muscle fatigue in less than 2.7 min. Furthermore, although diaphragm muscle length is optimized when supine, our results indicate that the force output of the diaphragm and inspiratory accessory muscles is greater when upright than when supine.

Adult↗

PubMed2003

Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries.

PRIMARY OBJECTIVE: To examine the potential efficacy of a mindfulness-based stress reduction approach to improve quality of life in individuals who have suffered traumatic brain injuries. RESEARCH DESIGN: Pre-post design with drop-outs as controls. METHODS AND PROCEDURES: We recruited individuals with mild to moderate brain injuries, at least 1 year post-injury. We measured their quality of life, psychological status, and function. Results of 10 participants who completed the programme were compared to three drop-outs with complete data. EXPERIMENTAL INTERVENTION: The intervention was delivered in 12-weekly group sessions. The intervention relied on insight meditation, breathing exercises, guided visualization, and group discussion. We aimed to encourage a new way of thinking about disability and life to bring a sense of acceptance, allowing participants to move beyond limiting beliefs. MAIN OUTCOMES AND RESULTS: The treatment group mean quality of life (SF-36) improved by 15.40 (SD = 9.08) compared to - 1.67 (SD = 16.65; p = 0.036) for controls. Improvements on the cognitive-affective domain of the Beck Depression Inventory II (BDI-II) were reported (p = 0.029), while changes in the overall BDI-II (p = 0.059) and the Positive Symptom Distress Inventory of the SCL-90R (p = 0.054) approached statistical significance. CONCLUSIONS: The intervention was simple, and improved quality of life after other treatment avenues for these participants were exhausted.

Adaptation, Psychological↗

PubMed2000

Capability of respirator wearers to detect aerosolized qualitative fit test agents (sweetener and Bitrex) with known fixed leaks.

This study was designed to evaluate and compare the ability of respirator wearers to detect qualitative respirator fit test agents (saccharin and Bitrex) when the respirators were modified to include fixed size leaks. In recent years the number of persons who require fit testing has increased, partly in response to the needs of health care workers with potential exposure to infectious bio-aerosols. Many health care providers have chosen qualitative respirator fit testing using saccharin and/or Bitrex for a variety of reasons, including (but not limited to) low initial equipment cost. Respirators were modified to include a mid-line sampling probe between the nose and mouth for quantitative fit testing with a TSI PortaCount. A second modification included the introduction of a shortened 14-gauge intravenous catheter at the bridge of the nose. The fixed leak was designed to produce fit factors < 100 when unplugged, with an average fit factor of 67 among 26 respirator wearers. A complete fit test was not performed, because one purpose of this study was to determine the ability of respirator wearers to detect a known fixed leak during a single normal breathing exercise, without introducing unknown and potentially variable size leaks. Sensitivity threshold screening included a placebo and requirement to correctly characterize the taste of the agent used. Quantitative fit factors without leaks ranged from 96 to > 20,000 and 22 to 160 with the leak present. Twenty four of 26 subjects had fit factors < 100 (92%) when fixed leaks were induced. All subjects correctly detected Bitrex with fixed leaks (sensitivity = 100%). Nine of 26 subjects (35%) were unable to detect saccharin in the presence of a known fixed leak even though the average fit factor for these subjects was 77. When the two subjects with fit factors > 100 were excluded, only 16 of 24 respirator wearers were able to detect saccharin with fixed leaks (sensitivity = 67%). There were several important aspects of our study design worth noting, including the introduction of a placebo during sensitivity threshold testing, limiting the subject response time to a single maneuver, using a higher concentration of Bitrex than commercially available, and requiring the subjects to correctly characterize the taste of the qualitative test agent. In conclusion, leak detection was correctly identified with Bitrex, but not saccharin.

Adolescent↗

PubMed2004

Complementary and alternative medicines (CAM) in the management of asthma: an examination of the evidence.

Although individuals are using Complementary and Alternative Medical (CAM) therapies to help manage their asthma, there is no clear direction in the current guidelines for the use of CAM in asthma. This literature review undertakes to determine the current science regarding the use of CAM in asthma management. Electronic literature searched all EBM Reviews, Medline, OVID full text, and PubMed and National Complementary and Alternative Medication databases for Randomised Controlled Trials (RCT) published in English between 1997 and 2002 with keywords "asthma" and "complementary medicine" or "complementary therapy" or "alternative medicine" or "alternative therapy." Abstracts (N=197) were reviewed for inclusion in the review and duplicates discarded (N=65). Abstracts of non-RCT studies, review articles, and surveys were also discarded (N=66). Abstracts discussing environmental control measures and pharmaceutical alternatives to steroid therapy were discarded (N=9). The 15 final studies were grouped within three categories: mind-body and relaxation, manual therapies, and diet and reviewed for statistical and clinical significance, suggesting some CAM therapies have shown minimally significant improvements in asthma quality of life (breathing exercises) or pulmonary function (relaxation) and immune function (relaxation and acupuncture) in select asthma populations. Although CAM therapy is being used in the management of asthma, these 15 studies show a tendency to little or no significant difference between placebo or sham therapy. This may be due, in part, to the enhanced placebo effect of sham therapies used as control and the small size of most studies. Although the changes in the immune function seen in two studies are provocative, these changes did not translate to changes in lung function. More research is needed to assist in determining the efficacy of CAM therapies in asthma management.

Acupuncture Therapy↗

PubMed2005

A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus.

OBJECTIVES: The objective of the study was to study the short-term impact of a brief lifestyle intervention based on yoga on some of the biochemical indicators of risk for cardiovascular disease and diabetes mellitus. DESIGN: The variables of interest were measured at the beginning (day 1) and end (day 10) of the intervention using a pre-post design. SETTING: The study is the result of operational research carried out in our Integral Health Clinic (IHC). The IHC is an outpatient facility which conducts 8-day lifestyle modification programs based on yoga for prevention and management of chronic disease. A new course begins every alternate week of the year. SUBJECTS: The study is based on data collected on 98 subjects (67 male, 31 female), ages 20-74 years, who attended one of our programs. The subjects were a heterogeneous group of patients with hypertension, coronary artery disease, diabetes mellitus, and a variety of other illnesses. INTERVENTION: The intervention consisted of asanas (postures), pranayama (breathing exercises), relaxation techniques, group support, individualized advice, lectures and films on the philosophy of yoga and the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. OUTCOME MEASURES: The outcome measures were fasting plasma glucose and serum lipoprotein profile. These variables were determined in fasting blood samples, taken on the first and last day of the course. RESULTS: Fasting plasma glucose, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, very- LDL cholesterol, the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol, and total triglycerides were significantly lower, and HDL cholesterol significantly higher, on the last day of the course compared to the first day of the course. The changes were more marked in subjects with hyperglycemia or hypercholesterolemia. CONCLUSIONS: The observations suggest that a short lifestyle modification and stress management education program leads to favorable metabolic effects within a period of 9 days.

Adult↗

PubMed2005

Particle deposition in children's lungs: theory and experiment.

A mathematical model of inhaled aerosol particle deposition for children is presented and validated with data from two published experimental studies. The model accurately predicts deposition fraction (DF) in children as a function of particle size for particles in the size range 1-3 microns for both sedentary and exercise breathing conditions. When the experimental data are grouped according to age, the model is able to predict age-dependent trends in DF at the studied particle sizes under sedentary breathing conditions. The model predicts that when ventilatory conditions are held constant, age-dependent changes in morphology result in decreasing DF with age; however, under realistic conditions these changes may be masked by age-dependent changes in ventilation. Despite the fact that mean DF differs significantly from adult values only in children younger than 9, the model predicted that dose-per-surface area may still be greater in children due to smaller lung sizes.

Adolescent↗

PubMed1999

Empirically supported treatments in pediatric psychology: procedure-related pain.

OBJECTIVE: To use the Chambless criteria for empirically supported treatments and determine if any interventions for procedure-related pain in children and adolescents can be designated as "well established," "probably efficacious," or "promising." METHODS: The Chambless criteria were applied to 13 treatment outcome studies identified by a comprehensive literature review. RESULTS: A detailed summary is provided for each study, including the following information: citation, subjects, diagnostic criteria, baseline, experimental design, assessment measures, treatment protocol, outcome, and follow-up. CONCLUSIONS: Cognitive behavioral therapy is a "well-established treatment" for procedure-related pain in children and adolescents. Treatment includes breathing exercises and other forms of relaxation and distraction, imagery and other forms of cognitive coping skills, filmed modeling, reinforcement/incentive, behavioral rehearsal, and active coaching by a psychologist, parent, and/or medical staff member. I discuss future challenges for biobehavioral research and practice in the area of procedure-related pain.

Adolescent↗

PubMed1997

The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether the addition of incentive spirometry (IS) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting (CABG). Patients were given the spirometer and instructed in its use, as often occurs in clinical settings. SUBJECTS: Patients with chronic airflow limitation following CABG (N = 185) participated. METHODS: Subjects were randomly assigned to receive either postoperative pulmonary physical therapy (breathing exercises, secretion removal, mobility) or physical therapy combined with IS. RESULTS: No difference was found between the two groups in atelectasis, spirometry, oxygen saturation, pulmonary infection, or hospital stay. CONCLUSION AND DISCUSSION: Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population. Use of the spirometer, however, was not monitored, and although the study mimicked practice as it often occurs, the effectiveness of the spirometer cannot be fully evaluated.

Adult↗

PubMed1989

Zenker's diverticulum: a cause for complete esophageal obstruction and its management.

Besides the gastroenterologists, we as gastroenterology nurses and associates are probably the first line of help for patients with this disorder. By having a sound background knowledge of the mechanisms by which Zenker's diverticulum can occur and the possible complications that can arise, we can coordinate a task force of appropriate paramedical personnel: the nutritionist who can instruct the patient on good healthy dietetics, the social worker who may be able to arrange "meals on wheels," the physical therapist who can teach the patient to re-think the way he or she swallows and good deep breathing exercises. We can give our patients a sound understanding of their problem by educating them in language that they understand. By so doing we will be encouraging them in their own preventative measures to promote wellness, which is one of endoscopy's major aims in health care.

Aged↗

PubMedDate not supplied

Symptom monitoring and dependent care during cancer treatment in children: pilot study.

Symptom monitoring by parents/caregivers of children with cancer and what the caregiver and child did to help alleviate symptoms during chemotherapy were studied. The Therapy-Related Symptom Checklist (TRSC) child version was administered to parents/caregivers of 11 children and adolescents (mean age, 10.4 years; SD, 6.1 years; range, 2-18 years; 45% were boys). The Karnofsky scale was completed by clinicians to rate the child's functional status. The TRSC child version and functional status scores were inversely related. All children experienced nausea; the most frequent symptoms reported were in TRSC subscales: fatigue, nausea, eating, fever, oropharynx, pain, and hair loss. Care strategies that helped were distraction, massage, mouth rinses, and vitamins; some reported that their child received medications for pain, nausea, and vomiting. Using complementary medicine categories, the care strategies were diet/nutrition/lifestyle change (eg, more high-fat, high-calorie foods; new foods; any food the child likes; and much sleep and rest); mind/body control (eg, play, video games, television, reading, activity puzzle, breathing exercises, relaxation methods, and prayer); manual healing method (massage and skin-to-skin contact); and biologic treatments (vitamins). The first 2 categories were the most used. Systematic assessment with a self-report checklist enables the provider to identify and prioritize (according to reported severity) those symptoms needing intervention.

Adolescent↗

PubMed1989

The integrated approach of yoga: a therapeutic tool for mentally retarded children: a one-year controlled study.

Ninety children with mental retardation of mild, moderate and severe degree were selected from four special schools in Bangalore, India. Forty-five children underwent yogic training for one academic year (5 h in every week) with an integrated set of yogic practices, including breathing exercises and pranayama, sithilikarana vyayama (loosening exercises), suryanamaskar, yogasanas and meditation. They were compared before and after yogic training with a control group of 45 mentally retarded children matched for chronological age, sex, IQ, socio-economic status and socio environmental background who were not exposed to yoga training but continued their usual school routine during that period. There was highly significant improvement in the IQ and social adaptation parameters in the yoga group as compared to the control group. This study shows the efficacy of yoga as an effective therapeutic tool in the management of mentally retarded children.

Adolescent↗

PubMedDate not supplied

Realistic expectations of the labor coach.

This descriptive, retrospective survey (part of a larger study) employed a questionnaire to determine the behaviors of 40 expectant fathers to the stress generated by their spouses' labors and deliveries. Results indicated that the experience was stressful for all the expectant fathers, and expectant fathers only coached their spouses with their breathing exercises at labor's peak. Fathers spent more time trying to hide their feelings and worrying about their usefulness. These findings have significance for the prenatal education of couples, the education of health professionals, and the practice of labor and delivery nursing.

Fathers↗

PubMed1983

Specialist approach to childhood asthma: does it exist?

Twenty six paediatricians and 21 consultant physicians concerned in the care of children with asthma answered a postal questionnaire on various aspects of the management of asthma, attitudes to referral, and the nature of advice given to parents and children. The 47 specialists had considerable differences in opinion for more than half the questions, including the role of allergen skin tests and the use of "breathing exercises." In addition, the paediatricians disagreed with the responses of the non-paediatricians on common issues such as whether to use aminophylline suppositories and whether swimming helps children grow out of asthma. These results have disturbing implications for the advice that specialists give to general practitioners, children, and parents.

Asthma↗