Phosphatidylcholine coated chest drains: are they better than conventional drains after open heart surgery?

INTRODUCTION

Inadequate thoracic drainage after open heart surgery has serious deleterious consequences. Thrombus formation within the chest drains is primarily responsible for the occlusion of chest drains. Chest drains coated with derivatives of phosphatidylcholine (PC), commonest phospholipid on cell membranes, potentially have a less thrombogenic surface.

MATERIALS AND METHODS

In a prospective randomised double blind study, we compared PC-coated drains (Group I, n = 25) with non coated drains (Group II, n = 26) after open heart surgery. Drain performance, post-operative complications and clinical course were compared.

RESULTS

PC-coated drains had a significantly shorter period of drainage, 20.4 +/- 1.0 versus 28.9 +/- 3.7 h (P < 0.05). Otherwise, mean volume drained, number clots removed from drain and the ease of drainage of the two types of drains were similar. There were no significant differences in the incidence of post-operative pericardial effusions, dysrhythmias, ambulation time and hospital stay.

CONCLUSIONS

We conclude that the PC coated drains may be of importance in cases where prolonged drainage is anticipated otherwise they have no significant advantage.

Quality of life and the cancer experience: the state-of-the-knowledge

PURPOSE/OBJECTIVES

To address the state-of-the-knowledge concerning quality of life (QOL) issues and the cancer experience from theoretical, research, clinical, and educational perspectives.

DATA SOURCES

Published books and articles and a panel of experienced QOL experts who convened at the Oncology Nursing Society's State-of-the-knowledge Conference on Quality of Life in February 1995.

DATA SYNTHESIS

Despite the evolution and support of QOL in oncology nursing practice, education, and research, there remains gaps in theory, research, and practice related to QOL. This article explores these gaps in knowledge and recommends future directions for QOL theory, research, education, and practice.

CONCLUSIONS

Further conceptual work and resolution of QOL methodologic issues to guide clinical practice and education are warranted. The impact of cultural variables and precancer life experiences on patients' perceptions of QOL also must be addressed.

NURSING IMPLICATIONS

Oncology nurse clinicians, educators, and researchers must continue to work collaboratively to enhance the knowledge base regarding QOL and to improve the nursing care provided to individuals with cancer.

Quality of life in breast cancer

PURPOSE

Currently, 1,721,700 women are living with breast cancer in the United States. As the number of survivors of breast cancer continues to rise, so must our knowledge about unique quality-of-life concerns. This article reports the results of a study on quality of life in women with breast cancer and validates the model of quality of life in this population.

DESCRIPTION OF STUDY

To explore these concerns and to validate a breast cancer quality-of-life model, 21 survivors of breast cancer, across three age strata (younger than 40 years, 40 to 60 years, and older than 60 years), were interviewed and asked to complete quantitative surveys on pain and quality of life.

RESULTS

Across all age groups, unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being. In the domain of physical well-being, the areas of worst outcome were in menstrual changes and fertility, fatigue, and pain. In the domain of psychological well-being, predominant needs were in the areas of fear of the spread of cancer, distress from surgery, recurrence, fear of second cancer, impact on self-concept, and fear of future tests. The social well-being subscale identified the greatest disruption in the area of family distress. The spiritual well-being subscale showed greatest disruption in the area of uncertainty, although other aspects of this domain were usually rated in a positive direction (e.g., importance of religious activities).

CLINICAL IMPLICATIONS

The data demonstrated the need for further research, assessment, and intervention across each of the quality-of-life domains. There is a significant need to address physical problems; however, the psychological domain demonstrated the greatest area of distress. The multidimensional needs of breast cancer survivors emphasize the need for multidisciplinary collaboration.

Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease

The present study examined whether training in cognitive coping skills would enhance pain coping strategies and alter pain perception in adults with sickle cell disease (SCD). Sixty-four African Americans with SCD were randomly assigned to either a cognitive coping skills condition (three 45-min sessions in which patients were trained to use 6 cognitive coping strategies) or a disease-education control condition (three 45-min didactic-discussion sessions about SCD). Pain sensitivity to calibrated noxious stimulation was measured at pre- and posttesting, as were cognitive coping strategies, clinical pain, and health behaviors. Results indicated that, compared with the randomly assigned control condition, brief training in cognitive coping skills resulted in increased coping attempts, decreased negative thinking, and lower tendency to report pain during laboratory-induced noxious stimulation.

Behavioral descriptors that differentiate between seizure and nonseizure events in a pediatric population

The diagnosis and treatment of epilepsy relies heavily on descriptions of behavioral changes noted during seizure episodes. A pilot study was completed to determine the frequency of occurrence of behaviors commonly associated with seizures in a pediatric population (n = 153). Caretakers of the children (ages = 4 months to 19 years) were asked to respond to a checklist containing 40 behavioral descriptors. Thirteen descriptors were found to differentiate between seizure and nonseizure events. Twelve of these behaviors were endorsed significantly more frequently by caretakers of children with seizures including the following: does not remember what happened, moves mouth funny, drools, jerking/twitching, becomes stiff, changes in breathing, stares off, bites or chews tongue, eyes look glassy, will not respond, mumbles or slurs words, and eyes or head turn to one side. One behavior, fidgets in seat, was significantly more associated with nonseizure episodes. The behavioral descriptors may be presented in a checklist format or incorporated within a clinical interview in primary care settings for initial screening of children with possible seizure disorders.

Young black males and trauma: predisposing factors to presentation in an urban trauma unit

Young black males are disproportionately represented as patients in trauma units. Unemployment, low educational level, and family composition may predispose young black males to trauma unit admission. To test this hypothesis, 300 males between the ages of 18 and 40 admitted to the Cook County Hospital Trauma Unit were surveyed with respect to demographic data, family composition, educational level, and employment background. The majority of patients were black (87%) and unemployed (68%). The most common diagnoses were penetrating trauma (53.2%) and assault (33.5%). Highest unemployment and lowest educational levels were found among patients who were victims of penetrating trauma or assault. Sixty-six percent reported the presence of an adult male in the household while growing up, and 93% reported the consistent presence of their biological mother. There was a significant correlation between race, trauma mechanism, unemployment, low educational level, and family composition. Recognition and amelioration of the economic and educational inequities that may exist in this population might reduce the incidence of trauma significantly.

Knowledge and beliefs about hypertension among Jamaican female clients

Hypertension is a major health problem in the Caribbean Region. If health promotion programs are to be appropriate and effective, the clients' knowledge and beliefs regarding this chronic health problem need to be identified. The purpose of this study was to determine the knowledge level and beliefs about hypertension among female clients attending primary health care clinics in Jamaica, West Indies. Data were collected from 240 female clients with the use of a pretested interview schedule. Findings indicated that the respondents were of low socio-economic status, lacked knowledge regarding the predisposing factors and characteristics of the disease and had a number of misconceptions surrounding the illness. Implications for nurses and health care providers are discussed with suggestions for future research.

Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease

The present study examined whether training in cognitive coping skills would enhance pain coping strategies and alter pain perception in adults with sickle cell disease (SCD). Sixty-four African Americans with SCD were randomly assigned to either a cognitive coping skills condition (three 45-min sessions in which patients were trained to use 6 cognitive coping strategies) or a disease-education control condition (three 45-min didactic-discussion sessions about SCD). Pain sensitivity to calibrated noxious stimulation was measured at pre- and posttesting, as were cognitive coping strategies, clinical pain, and health behaviors. Results indicated that, compared with the randomly assigned control condition, brief training in cognitive coping skills resulted in increased coping attempts, decreased negative thinking, and lower tendency to report pain during laboratory-induced noxious stimulation.

Unscheduled readmissions for uncontrolled symptoms. A health care challenge for nurses

The purpose of this study was to measure the impact of nursing strategies to improve cancer pain management on hospital readmission for uncontrolled pain. Strategies include implementing a pain resource nurse program (PRN), making pain management a focus in the continuous quality improvement process of the institution and creating a supportive care service. Admissions were compared before and after implementation of the strategies. Results for 1989 to 1990 revealed 5772 total admission with 4.4% (255) admissions for uncontrolled pain; results for 1992 to 1993 revealed 4066 total admissions with 3.0% (121) admissions for uncontrolled pain. Findings indicate that strategies were effective in reducing the number of readmissions for uncontrolled pain.

Measurement of the quality of life in cancer survivors

A QOL instrument was developed to measure the specific concerns of long term cancer survivors. The QOL-CS is based on previous versions of the QOL instrument developed by researchers at the City of Hope National Medical Centre (Grant, Padilla, and Ferrell). This instrument was revised over a one year pilot by Hassey-Dow and Ferrell. The revised instrument included 41 items representing the four domains of quality of life incorporating physical, psychological, social, and spiritual well being. The present study was conducted as a mail survey to the membership (n = 1,200) of the National Coalition for Cancer Survivorship with 686 subjects responding to the survey. This survey included a Demographic tool, QOL-CS and the FACT-G tool developed by Cella. Psychometric analysis, performed on 686 respondents, included measures of reliability and validity. Two measures of reliability included test-retest and internal consistency. The overall QOL-CS tool test-retest reliability was 0.89 with subscales of Physical r = 0.88, Psychological r = 0.88, Social r = 0.81, and Spiritual, r = 0.90. The second measure of reliability was computation of internal consistency using Cronbach's alpha coefficient as a measure of agreement between items and subscales. Analysis revealed an overall r = 0.93. Subscale alphas average ranged from r = 0.71 for spiritual well being, r = 0.77 for physical, r = 0.81 for social, and r = 0.89 for psychological. Several measures of validity were used to determine the extent to which the instrument measured the concept of QOL in cancer survivors. The first method of content validity was based on a panel of QOL researchers and nurses with expertise in oncology. The second measure used stepwise multiple regression to determine factors most predictive of overall QOL in cancer survivors. Seventeen variables were found to be statistically significant accounting for 91% of the variance in overall QOL. The fourth measure of validity used Pearson's correlations to estimate the relationships between the subscales of QOL-CS and the subscales of the established FACT-G tool. There was moderate to strong correlation between associated subscales including QOL-CS physical to FACT physical (r = 0.74), QOL-CS Psych to FACT Emotional (r = 0.65), QOL Social to FACT Social (r = 0.44). The overall QOL-CS correlation with the FACT-G was 0.78. Additional measures of validity included correlations of individual items of the QOL-CS tool, factor analysis, and construct validity discriminating known groups of cancer survivors. Findings demonstrated that the QOL-CS and its subscales adequately measured QOL in this growing population of cancer survivors.

Not a business matter

Some Canadians believe that turning Canada's public health care system into a privately based operation is the panacea for the health care debt. The Alberta government is at the forefront of this movement toward a privately managed, business-oriented health system.

An institutional commitment to pain management

PURPOSE

To share the development, implementation, and evaluation of a program called "An Institutional Commitment to Pain Management," which is based on the philosophy of organizational influence on pain management.

METHODS

A tested pain education model was disseminated to 32 physician/nurse teams in settings throughout California, after which the 64 professionals returned to their institutions to serve as role models and catalysts to change the practice of pain management. Each team member completed a 39-item survey about knowledge and attitudes related to pain, which was developed by B.R.F. and colleagues, and also identified three goals for the implementation of course information. Precourse data also included administration of the knowledge and attitudes survey to participating physicians' and nurses' colleagues (10 physicians and 20 nurses per institution). Each team completed five chart audits using the pain audit tool (PAT), which was developed by B.R.F. and colleagues at the City of Hope National Medical Center. The PAT identifies how pain is managed currently at the institutional level. Final course evaluation 8 months after course completion included a summary of activities implemented by the teams as well as the factors that served as barriers and benefits to improve the quality of pain management.

RESULTS

Two hundred seventy-two physicians and 629 nurses completed the survey about knowledge and attitudes related to pain, and 154 PATs were submitted. These results, as well as evaluation at the completion of the course, are discussed.

CONCLUSION

The Institutional Commitment to Pain Management program is an evolving model that was developed to overcome barriers to pain relief by obtaining the commitment from institutions to improve the management of pain for their patients.

The impact of cancer pain education on family caregivers of elderly patients

PURPOSE/OBJECTIVES

To examine the impact of pain education on family members providing home care to elderly patients with cancer.

DESIGN

Quasiexperimental.

SETTING

Homes of selected patients from two California medical centers.

SAMPLE

Fifty family caregivers of patients experiencing cancer-related pain.

METHODS

The pain education program included three components: pain assessment, pharmacologic interventions, and nonpharmacologic interventions. Patients and their family caregivers were evaluated prior to initiation of the program and at one and three weeks following the interventions.

MAIN RESEARCH VARIABLES

Quality of life (QOL); knowledge and attitudes about pain; and caregiver burden.

FINDINGS

Findings based on measures of QOL and caregiver burden demonstrated the physical and psychological impact of family caregiving and pain management. Comparison between elderly patients with cancer and family caregivers revealed the pain experience's significant impact on family members caring for a loved one in pain.

CONCLUSIONS

The pain education program was effective in improving knowledge and attitudes regarding pain management.

IMPLICATIONS FOR NURSING PRACTICE

Pain management is a priority for nurses, and use of interventions such as structured pain education improves QOL outcomes for elderly patients and their family caregivers.

Nurses' perceptions of the meaning of quality of life for bone marrow transplant survivors

Nurses play an integral role in the care of bone marrow transplant (BMT) patients from pre-transplant to posttransplant. The purpose of this study was to explore the nurses' perceptions of the impact of transplant on the quality of life (QOL) of survivors. The conceptual framework for the study was the model of QOL developed by Ferrell, Grant, Schmidt, Rhiner, Whitehead, and Forman (1992). It depicts the QOL domains of physical well-being, psychological well-being, social concerns, and spiritual well-being. One hundred fifty nurses responded to a mailed survey. The items were based on the Quality of Life-BMT Survey used previously with patients. Nurses' and patients' responses to the same item were compared. Results reflect that transplant nurses generally perceived patients as having a poorer QOL than they actually reported. Nurses described transplant as having both positive and negative consequences. Transplant was seen as providing patients with a second chance at life and an opportunity to increase their QOL. Nurses described negative consequences as resulting from physical losses, psychological distress, financial distress, and loss of relationships. The findings of the study have implications for training future transplant nurses and for improving nursing care for transplant patients.

Survey of the provision of supportive care services at National Cancer Institute-designated cancer centers

PURPOSE

The purpose of this survey was to determine the scope of supportive care services (SCS) designed to promote quality of life during cancer therapies at National Cancer Institute (NCI)-designated cancer centers.

METHODS

A survey was mailed to the medical directors and nursing directors of 52 NCI-designated comprehensive (n = 26), clinical (n = 11), and planning cancer centers (n = 15) in the United States. Only one survey was completed from each institution. Survey questions identified services provided such as pain management, terminal care, psychosocial programs, and spiritual care.

RESULTS

Thirty-nine questionnaires were received for a total response rate of 75%. Of the respondents, 45% were comprehensive cancer centers, 24% clinical cancer centers, and 29% planning centers. One center did not identify their NCI designation. Sixty-one percent of the centers reported research programs in supportive care. Outside funding was reported in 51% of the respondents, with 39% having American Cancer Society (ACS) or National Institutes of Health (NIH) funding and 28% having private industry funding. Overall SCS self-ratings improved from a 21% rating of excellent to very good 5 years ago to the current 54% rating.

CONCLUSION

Survey results provide data on SCS across a representative sample of NCI cancer centers and can be used to develop standards for future cancer control programs.