The effects of a companion animal on distress in children undergoing dental procedures.

The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

The role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning in an oleic acid-injured animal model of acute respiratory failure.

The purpose of this study was to examine the role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning (ETS) in an oleic acid-injured animal model of acute respiratory failure. Previous investigations of hyperinflation as a method to prevent hypoxia-induced sequelae of ETS have demonstrated unrecognized hemodynamic consequences. In this within-subject, repeated-measures study, instrumented, oleic acid-injured dogs had continuous measurements of heart rate (HR), mean aortic blood pressure (MAP), left ventricular pressure (Plv), pulmonary artery pressure (Ppa), right ventricular afterload (Ppa(tm)), right atrial pressure (Pra), and right ventricular filling pressure (Pra(tm)) during hyperinflation and ETS when the vagi were intact and after the pulmonary branches of the vagus nerves had been severed. After severing the vagi, MAP and Plv were decreased and HR and Ppa were increased. With the vagi severed, there was less variation in MAP and Ppa but increased variation in HR. These findings suggest that vagally mediated reflexes from the lungs produce some, but not all, of the hemodynamic effects associated with hyperinflation and ETS. Continued research is necessary to discover a method of hyperoxygenation and suctioning that does not produce potentially harmful hemodynamic effects.

Using a therapy dog to alleviate the agitation and desocialization of people with Alzheimer's disease.

1. Short-term exposure to a therapy dog can reduce the number of agitation behaviors in institutionalized persons with Alzheimer's disease (AD), particularly during the period of agitation known as sundown syndrome. 2. The presence of a therapy dog can increase socialization behaviors among a group of persons with AD. 3. A therapy dog can be used as an adjunct to other calming interventions for persons with AD.

The effects of the presence of a companion animal on physiological arousal and behavioral distress in children during a physical examination.

The purpose of this study was to examine the effects of the presence of a companion animal on physiological arousal and behavioral distress exhibited by preschool children during a routine physical examination. A within-subject, time-series design was used to study 23 healthy children ages 3 years to 6 years during two physical examinations, with and without a dog. Statistically significant differences were found with greater reductions in subjects' systolic and mean arterial pressure, heart rate, and behavioral distress when the dog was present. Findings support the use of a companion animal in reducing stress experienced by children during a physical examination.

Avian companionship in alleviation of depression, loneliness, and low morale of older adults in skilled rehabilitation units.

To assess effects of a companion bird on the depression, morale, and loneliness of 40 older adults in a skilled rehabilitation unit, self-reported measures of depression, loneliness, and morale were completed on admission and 10 days later. With the presence of a companion bird the experimental group (n = 20) showed a significant decrease in depression but none in morale or loneliness from the control group (n = 20) who were without a bird. Use of a companion bird may lessen negative effects of change of residence for older adults.

Increasing patient control of family visiting in the coronary care unit.

BACKGROUND: Stress of coronary care unit admission and need for rest may contribute to a sense of helplessness, exacerbated by the unpredictability of visitor entry. Control over the environment, and particularly family visiting, could alleviate patient stress. OBJECTIVE: To determine if patient control of visit timing would minimize undesired psychophysiologic effects of coronary care unit visiting. METHODS: Data were collected at multiple points from 60 coronary care unit patients during the first 20 minutes of the evening visit and at visit end. Randomly assigned subjects used a visitor control device to communicate their wishes to potential visitors: red hallway light to restrict, and green to allow, visits. Dependent variables were heart rate and rhythm; premature ventricular contractions; systolic, diastolic, and mean arterial blood pressure; salivary cortisol; and finger temperature. Psychologic variables of visit stress versus comfort, perceived control of visits, and perceived rest between visits were measured by pre- and postvisit appraisals. RESULTS: Repeated measures analyses showed that over time, perceived control of visits and rest between visits were greater, and heart rate and diastolic blood pressure were lower for subjects with the visitor control device. Appraisal of visit stress increased slightly in this group. No statistically significant differences were found for possession of the visitor control device. Reaction to visitor entry was a short-term stress response, as indicated by increases in systolic, diastolic, and mean arterial blood pressure. CONCLUSIONS: Based on positive comments, increased perceived control over visiting, and decreased blood pressure, the visitor control device was beneficial.

The proposal-reality gap: the mechanics of implementing a funded research proposal.

In summary, planning is the key to smooth implementation of a newly funded study. Adequate planning reduces the time necessary to hire personnel, purchase equipment and supplies, acquire space, manage the budget, maintain agency contacts and provide for smooth agency orientation, and complete the pilot study. Moving smoothly into data collection ensures that the project will be on target by the end of the first year of funding and that the investigator will have an opportunity to demonstrate scholarly productivity. Pilot testing pieces of the research protocol during the period between submission of the proposal and notification of the funding decision will facilitate smooth transition either to data collection or to revision and improvement of the proposal for resubmission.

Effect of oxygen insufflation during endotracheal suctioning on arterial pressure and oxygenation in coronary artery bypass graft patients.

BACKGROUND Numerous studies have demonstrated the need for increased inspired oxygen with endotracheal suctioning to prevent hypoxemia; however, increased arterial pressure has been reported as a consequence of lung hyperinflation/inflation used to deliver hyperoxygenation. OBJECTIVES To compare insufflation during endotracheal suctioning with a standard procedure of hyperoxygenation using a ventilator on arterial pressure, pulmonary artery pressure, heart rate, arterial oxygen saturation, and blood gases in intubated, mechanically ventilated coronary artery bypass graft patients. METHODS A within-subjects, repeated-measures design was used to measure arterial pressure (systolic, diastolic, and mean), pulmonary artery pressure (systolic, diastolic, and mean), airway pressure, heart rate and rhythm, arterial oxygen tension, arterial carbon dioxide tension, pH, and arterial oxygen saturation during an oxygen insufflation protocol and a hyperoxygenation protocol via the ventilator. RESULTS Using analysis of variance for repeated measures, statistically significant time effects were found for all variables. Statistically significant differences between protocols over time were found for arterial pressure, arterial oxygen tension, and arterial oxygen saturation. CONCLUSIONS Oxygen insufflation resulted in less increase in arterial pressure than did the hyperoxygenation protocol. The hyperoxygenation protocol resulted in hyperoxia. Based on this study, oxygen insufflation is a safe alternative for providing oxygen during endotracheal suctioning.

Effects of lung hyperinflation and presence of positive end-expiratory pressure on arterial and tissue oxygenation during endotracheal suctioning.

PURPOSE: To explore the effects of endotracheal suctioning on mixed venous oxygen tension and other measures of arterial and tissue oxygenation, to determine if these would be clinically useful outcome measures of endotracheal suctioning. BACKGROUND: Measuring arterial oxygenation only as an outcome of endotracheal suctioning can be misleading in that it may appear adequate in the presence of marked decreases in mixed venous oxygen tension, a good indicator of the adequacy of tissue oxygenation. METHODS: Eighteen instrumented and oleic acid-injured animal models of acute respiratory failure undergoing closed-system endotracheal suctioning were studied according to a 2 x 2 factorial design to measure the effects of oxygen inflations at tidal volume or 135% of tidal volume either in the presence or absence of positive end-expiratory pressure. RESULTS: Using multivariate analysis of variance for repeated measures, protocol by time effects for mixed venous oxygen tension, arterial oxygen saturation, arterial oxygen tension, oxygen delivery and oxygen extraction ratio were statistically significant. Changes in mixed venous oxygen tension and arterial oxygen saturation were parallel. CONCLUSIONS: Continuous measurement of mixed venous oxygen tension allows the calculation of oxygen delivery and oxygen extraction ratio, which provide a better estimation of the effects of endotracheal suctioning on tissue oxygenation than arterial oxygen tension alone.

Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suction in patients with chronic obstructive pulmonary disease.

This within-subject study compared the effects of hyperinflations with 20% above maintenance oxygen (O2) level and 100% O2 hyperinflations before and after endotracheal suction in 11 acutely ill patients with chronic obstructive pulmonary disease. Four hyperinflations were delivered at 1.5 times the calculated tidal volume (10 ml/kg) with 100% O2 or 20% above maintenance O2 level via resuscitator bag, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. No statistically significant differences (p less than 0.05) were found between the two protocols for arterial oxygen saturation, blood pressure, or heart rate (analysis of variance for repeated measures). There was no change in heart rhythm for any of the subjects. The results of this study suggest that hyperinflation with 20% above maintenance O2 level can be used for oxygenation in patients with chronic obstructive pulmonary disease before and after endotracheal suctioning. Replication is needed before clinical implementation.

The effect of hyperinflation, inspiratory hold, and oxygenation on cardiopulmonary status during suctioning in a lung-injured model.

This study determined the effects of a 5-second inspiratory hold during ventilatory maneuvers on cardiopulmonary status before, during, and after endotracheal suctioning in an acute lung-injured model. Eight mongrel dogs were anesthetized, paralyzed, mechanically ventilated, and given intravenous oleic acid to produce pulmonary edema. Four protocols were tested in alternate order in which either tidal volume inflations or hyperinflations at an FiO2 of 0.6 were given with and without an inspiratory hold of 5 seconds before and after each of three sequential suctioning passes. In those protocols in which an inspiratory hold was used, statistically significant changes occurred in right atrial, pulmonary arterial, and aortic systolic and diastolic pressures (p less than 0.04). The use of an inspiratory hold with hyperinflation maintained PaO2 during suctioning (range of 81 to 91 mm Hg), but had the greatest decrease in PaO2 (8%) after return to the ventilator. In all protocols, with the exception of the one in which hyperinflations without an inspiratory hold were used, there was a cumulative increase in PaCO2 with tidal volume inflation protocols reaching peak PaCO2 values of 49 (+/- 7.5) mm Hg. In protocol 4 in which hyperinflation without inspiratory hold was used, PaO2 ranged from 75 (+/- 16) to 92 (+/- 34) mm Hg, and PaCO2 ranged from 37 (+/- 7) to 42 (+/- 6) mm Hg. In conclusion, the use of hyperinflation without an inspiratory hold resulted in the least undesirable changes in the variables studied. However, this protocol needs to be replicated in an acutely ill clinical population before recommended for practice.

Physiological effects of human/companion animal bonding.

Blood pressure, heart rate, and respiratory rate were recorded in 24 subjects during 3 9-minute measurement sessions in which they petted an unknown dog, petted a dog with whom a companion bond had been established, or read quietly. Based on the findings of this study, several conclusions were drawn: (1) There is a significant difference in changes over time in both systolic and diastolic blood pressure between petting a dog with whom a companion bond has been established and petting a dog with whom no bond exists; (2) the decreases in both systolic and diastolic blood pressure that occur during petting a dog with whom a companion bond has been established parallel the relaxation effect of quiet reading; and (3) there is a " greeting response" to the entry of a dog with whom a companion bond has been established, which results in significantly higher systolic and diastolic pressures than the response either to an unknown dog or to reading.