Improving pain management by nurses: A pilot peer intervention program

Significant pain continues to be reported by many hospitalized patients despite the numerous and varied educational programs developed and implemented to improve pain management. A theoretically based Peer Intervention Program was designed from a predictive model to address nurses' beliefs, attitudes, subjective norms, self-efficacy, perceived control and intentions in the management of pain with p.r.n. (as required) narcotic analgesia. The pilot study of this program utilized a quasi-experimental pre-post test design with a patient intervention, nurse and patient intervention and control conditions consisting of 24, 18 and 19 nurses, respectively. One week after the intervention, significant differences were found between the nurse and patient condition and the two other conditions in beliefs, self-efficacy, perceived control, positive trend in attitudes, subjective norms and intentions. The most positive aspects of the program were supportive interactive discussions with peers and an awareness and understanding of beliefs and attitudes and their roles in behavior.

The importance of the relevance of the issue to the group in voting intentions: The case of the Australian republic referendum

A questionnaire was distributed on the Australian republic issue to examine the interplay between norms and relevance of the issue to the group on voting intentions. Supporters of an Australian republic (N = 188) indicated the level of support for a republic within their peer Group, the relevance of the republic issue to the group, and measures designed to assess voting intentions and other attitude outcomes. Analysis revealed an interaction between normative support and relevance of the issue to the group. On the measure of intention, increasing normative support was associated with increased intention to vote in an attitude-consistent way at both relevance levels, but the effect was heightened when the issue was highly relevant to the group. On the outcomes of willingness to express opinion and perceived personal importance of the republic issue, normative support had a positive effect only when the issue was highly relevant to the group. Mediation analyses revealed that the impact of normative support and group relevance on intention were mediated through perceived personal importance of the republic issue.

A review of peer support in the context of cancer

Peer support interventions for people with cancer, their families, and friends have been widely used throughout the world. The present study reviewed the research literature on psychosocial oncology over the past decade to assess the prevalence and contribution of articles on peer support. Using CD-Rom databases, 25 articles were retrieved for review. In each article, patients or their family members were the target group for supportive interventions, which were primarily for the delivery of peer support and included either a qualitative or quantitative evaluation of the program. A definitional taxonomy for peer support interventions, which identified eight discrete settings, was derived from three key dimensions: style of supervision, interpersonal context, and mode of delivery. The studies suggested that peer support programs help by providing emotional and informational support from the perspective of shared personal experience. However, a paucity of research-particularly randomized controlled trials-was noted. The reasons may include inherent difficulties in isolating for study what is essentially a naturalistically occurring interpersonal dynamic from the complex social and community contexts from which it emanates. The authors discuss the gap between practice and theory in this area and recommend a broader and more inclusive view of supportive care for people with cancer. (C) 2003 by The Haworth Press, Inc. All rights reserved.

Thinking collaboratively about the peer-review process for journal- article publication

In this conversation, Kevin K. Kumashiro shares his reflections on challenges to publishing anti-oppressive research in educational journals. He then invites eight current and former editors of leading educational research journals - William F. Pinar, Elizabeth Graue, Carl A. Grant, Maenette K. P. Benham, Ronald H. Heck, James Joseph Scheurich, Allan Luke, and Carmen Luke - to critique and expand on his analysis. Kumashiro begins the conversation by describing his own experiences submitting manuscripts to educational research journals and receiving comments by anonymous reviewers and journal editors. He suggests three ways to rethink the collaborative potential of the peer-review process: as constructive, as multilensed, and as situated. The eight current and former editors of leading educational research journals then critique and expand Kumashiro's analysis. Kumashiro concludes the conversation with additional reflections on barriers and contradictions involved in advancing anti-oppressive educational research in educational journals. Copyright © by the President and Fellows of Harvard College.

A review of plasma endothelin-1 levels in CABG patient group

Introduction: Endothelin-1 is a potent vasoconstricting growth peptide. In physiologic conditions basal levels maintain vascular homeostasis, conversely in pathological situations it may be expressed in response to chronic and acute vascular injury. Elevated levels of plasma ET-1 have been identified in sub-populations at risk of ischaemic heart disease (IHD) including smokers, diabetics and hyerlipidaemic subjects and in patients with atherosclerotic disease. This peptide may be chronically expressed, such as in congestive heart failure where it has been used as a prognostic marker of disease severity and also acutely, after cardiac revascularisation surgery, possibly as a result of endothelial injury and ischaemia. Aims: The objectives of this study were to (1) identify basal endothelin-1 concentrations in a young healthy control group with no risk factors for IHD (control group 1); (2) to compare; (1) venous plasma ET-1 levels preoperatively and post-operatively in patients undergoing CABG surgery, (3) to compare pre-operative plasma ET-1 levels from the CABG group with an age and gender matched control group (control group 2) and (4) combine all three groups to assess correlations between plasma ET-1 and the various risk factors for IHD, including smoking, hypertension, hyperlipidemia, diabetes and family history. Methods: Venous specimens were collected in chilled EDTA tubes and samples measured using an ELISA assay (Biomedica), following the standard protocol for human EDTA plasma. Results: Forty CABG patients (5F, 35M, mean age 66 yrs), 15 control group 1 subjects (8F, 7M, mean age 29 yrs) and 30 control group 2 subjects (5F, 25M, mean age 61 yrs) participated in the study. No significant difference was detected in plasma ET-1 levels between the controls (1) and (2), and the CABG group, where plasma ET-1 levels were 3.37+/ 5.19 pmol/L, 1.99+/3.74 pmol/L and 1.28+/1.27 pmol/L, respectively. There was a non-significant elevation in post-op ET-1 plasma in comparison with the pre-op levels (2.50+/0.51 Vs 1.45+/6.44). There were also no statistical correlation between risk factors for IHD including smoking, hypertension, NIDDM, hyperlipidemia or family history when data from both patient and controls groups was merged. Conclusion: Contrary to other findings, plasma ET-1 does not appear to a valid marker for IHD or factors which are strongly associated with the pathogenesis of this disease.

Recreational fishing and fishing policies in the Netherlands and Australia: A comparative review

This article compares fisheries management, environmental problems and policies of the Netherlands and Australia. From this comparison lessons can be learned for countries that experience economic growth and on increase of leisure activity. In both countries, conflicts between the user groups, e.g. commercial and recreational fishers, are identified and the ways in which policymakers deal with these problems are outlined. Often suggested tools to address these problems are decision-making procedures based on a holistic framework in which economic, sociocultural, political/institutional, ecological aspects are included in the decision framework. Recreational fishing is today often the dominant factor in the resolution of these matters because of the relative economic, social and political power of recreational fishers as a group.

Reaching those most in need: a review of diabetes self-management interventions in disadvantaged populations

There has been increased recognition of the importance of developing diabetes self-management education (DSME) interventions that are effective with under-served and minority populations. Despite several recent studies in this area, there is to our knowledge no systematic review or synthesis of what has been learned from this research. An electronic literature search identified five formative evaluations and ten controlled DSME intervention trials focused on under-served (low-income, minority or aged) populations. The RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) evaluation framework was used to evaluate the controlled studies on the dimensions of reach, efficacy, adoption, implementation, and maintenance. Fifty percent of the studies identified reported on the percentage of patients who participated, and the percentages were highly variable. The methodological quality of the articles was generally good and the short-term results were encouraging, especially on behavioral outcomes. Data on adoption (representativeness of settings and clinicians who participate) and implementation were almost never reported. Studies of modalities in addition to group meetings are needed to increase the reach of DSME with under-served populations. The promising formative evaluation work that has been conducted needs to be extended for more systematic study of the process of intervention implementation and adaptation with special populations. Studies that explicitly address the community context and that address multiple issues related to public health impact of DSME interventions are recommended to enhance long-term results. Copyright (C) 2002 John Wiley Sons, Ltd.

How to do safe sternal reentry and the risk factors of redo cardiac surgery: A 21-year review with zero major cardiac injury

Objectives: Resternotomy is a common part of cardiac surgical practice. Associated with resternotomy are the risks of cardiac injury and catastrophic hemorrhage and the subsequent elevated morbidity and mortality in the operating room or during the postoperative period. The technique of direct vision resternotomy is safe and has fewer, if any, serious cardiac injuries. The technique, the reduced need for groin cannulation and the overall low operative mortality and morbidity are the focus of this restrospective analysis. Methods: The records of 495 patients undergoing 546 resternotomies over a 21-year period to January 2000 were reviewed. All consecutive reoperations by the one surgeon comprised patients over the age of 20 at first resternotomy: M:F 343:203, mean age 57 years (range 20 to 85, median age 60). The mean NYHA grade was 2.3 [with 67 patients (1), 273 (11),159 (111), 43 (IV), and 4 (V classification)] with elective reoperation in 94.6%. Cardiac injury was graded into five groups and the incidence and reasons for groin cannulation estimated. The morbidity and mortality as a result of the reoperation and resternotomy were assessed. Results: The hospital/30 day mortality was 2.9% (95% Cl: 1.6%-4.4%) (16 deaths) over the 21 years. First (481), second (53), and third (12) resternotomies produced 307 uncomplicated technical reopenings, 203 slower but uncomplicated procedures, 9 minor superficial cardiac lacerations, and no moderate or severe cardiac injuries. Direct vision resternotomy is crystalized into the principle that only adhesions that are visualized from below are divided and only sternal bone that is freed of adhesions is sewn. Groin exposure was never performed prophylactically for resternotomy. Fourteen patients (2.6%) had such cannulation for aortic dissection/aneurysm (9 patients), excessive sternal adherence of cardiac structures (3 patients), presurgery cardiac arrest (1 patient), and high aortic cannulation desired and not possible (1 patient). The average postop blood loss was 594 mL (95% CI:558-631) in the first 12 hours. The need to return to the operating room for control of excessive bleeding was 2% (11 patients). Blood transfusion was given in 65% of the resternotomy procedures over the 21 years (mean 854 mL 95% Cl 765-945 mL) and 41% over the last 5 years. Conclusions: The technique of direct vision resternotomy has been associated with zero moderate or major cardiac injury/catastrophic hemorrhage at reoperation. Few patients have required groin cannulation. In the postoperative period, there was acceptable blood loss, transfusion rates, reduced morbidity, and moderate low mortality for this potentially high risk group.

Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women

We aimed to determine the effectiveness of the vaginally administered spermicide nonoxynol-9 (N-9) among women for the prevention of HIV and other sexually transmitted infections (STIs), We did a systematic review of randomised controlled trials, Nine such trials including 5096 women, predominantly sex workers, comparing N-9 with placebo or no treatment, were included. Primary outcomes were new HIV infection, new episodes of various STIs, and genital lesions. Five trials included HIV and nine included STI outcomes, and all but one (2% of the data) contributed to the meta-analysis. Overall, relative risks of HIV infection (1.12, 95% confidence interval 0.88-1.42), gonorrhoea (0.91, 0.67-1.24), chlamyclia (0.88, 0.77-1.01), cervical infection (1.01, 0.84-1-22), trichomoniasis (0.84, 0.69-1.02), bacterial vaginosis (0.88, 0.74-1.04) and candidiasis (0.97, 0.84-1.12) were not significantly different in the N-9 and placebo or no treatment groups. Genital lesions were more common in the N-9 group (1.18, 1.02-1.36). Our review has found no statistically significant reduction in risk of HIV and STIs, and the confidence intervals indicate that any protection that may exist is likely to be very small. There is some evidence of harm through genital lesions. N-9 cannot be recommended for HIV and STI prevention.

How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review

Objective To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. Design Systematic review of studies assessing BNP for prognosis m patients with heart failure or asymptomatic patients. Data sources Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. Study selection and data extraction We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data. Data synthesis 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance-that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk. Conclusion Although systematic reviews of prognostic studies have inherent difficulties, including die possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients mid for patients with heart failure at all stages of disease.