Effect of Orem's model on nurse attitudes and charting behavior.

This article describes a program evaluation that examines the effect of Orem's self-care nursing model on the attitudes of nurses and on charting behavior. Implementing Orem's model increased staff nurse satisfaction with nursing and enhanced nurses' perception of the value of patient teaching.

The sensation of pulmonary dyspnea in school-age children.

The purpose of this investigation was to describe the sensation of dyspnea in a sample of 39 school-age children with asthma and to identify strategies used to cope with the symptom. In addition, three methods to measure dyspnea intensity in children were tested and compared. Breathing on a "bad breathing day" was used as a proxy variable to represent dyspnea. The most frequent description of how breathing feels on a bad day was "it is hard to breathe." Words chosen most frequently from a checklist of sensations were "wheezy," "short of breath," "tight," and physical sensations such as "throwing up," "hurting," and "stuffiness." The children's feelings on a bad breathing day were categorized as negative moods or emotions, a wish for change, or physical symptoms. Ratings of breathing on "good", "bad," and "usual breathing" days on word descriptor, visual analogue, and color scales provided evidence of concurrent validity for the three measures of dyspnea intensity. The most frequent strategies used to cope with dyspnea were medications, change in position, decreased activity, fluids, relaxation, distraction, and social support. The findings were very similar to those previously described for an adult sample.

Correlations between dyspnea, diaphragm and sternomastoid recruitment during inspiratory resistance breathing in normal subjects.

The purpose of this study was to determine the relationship between recruitment of the DI and SM muscles measured as EMG signal amplitudes, the pattern of respiratory muscle recruitment measured with inductive plethysmography, and the intensity of the sensation of dyspnea, measured with 100 mm VAS. Eighteen normal subjects between the ages of 33 and 47 breathed under two conditions: normal controlled breathing and breathing against an inspiratory resistance at 60 percent of their maximal inspiratory pressure (MIP). The PM, RR, duty cycle (TI/TTOT, and VT were held constant. During resistance breathing, VAS dyspnea was increased when EMG-DI decreased; EMG-SM increased in association with the sensation of dyspnea. During inspiratory resistance breathing, dyspnea markedly increased and rib cage and accessory muscle recruitment was the predominant pattern of breathing. These data suggest that dyspnea may be associated with the recruitment of the accessory respiratory muscles rather than the recruitment of the diaphragm.

Effects of oral S-adenosyl-L-methionine on hepatic glutathione in patients with liver disease.

S-Adenosyl-L-methionine (SAMe) is a physiologic precursor of thiols and sulfurated compounds, which are known to be decreased in patients with liver disease. The effect of its administration on the hepatic glutathione content of liver patients was investigated. Four groups of subjects were selected: a) 9 patients with alcoholic liver disease treated with SAMe (1.2 g/day orally for 6 months); b) 7 patients with non-alcoholic liver disease treated as above; c) 8 placebo-treated patients with alcoholic liver disease; and d) 15 normal subjects as a control group. Total and oxidized glutathione were assayed by high-performance liquid chromatography of liver biopsy specimens before and after the treatment period. In all patients pre-treatment hepatic glutathione was significantly decreased as compared with controls. SAMe therapy resulted in a significant increase of hepatic glutathione levels both in patients with alcoholic and in those with non-alcoholic liver diseases as compared with placebo-treated patients. SAMe may therefore exert an important role in reversing hepatic glutathione depletion in patients with liver disease.

Dyspnea in the ventilator-assisted patient.

Our purpose in this study was to investigate the factors coincident with the occurrence of dyspnea in ventilator-assisted patients. Five alert and oriented patients with pulmonary disease that was restrictive, obstructive, or both, who were receiving mechanical ventilation, participated in this descriptive study. At 4-hour intervals and at complaint of dyspnea, patients quantified the severity of their dyspnea using the visual analogue and modified Borg scales. At each measurement of dyspnea, nurses observed concomitant physiologic and environmental variables. A moderate correlation (r = 0.51, p less than 0.001) was found between the number of events and activities occurring in the intensive care unit environment and the occurrence and severity of dyspnea. The visual analogue scale and modified Borg scale measures of dyspnea were highly correlated (r = 0.92, p less than 0.001) and may be useful tools for assessing dyspnea in patients undergoing mechanical ventilation.

Predictors of dyspnea intensity in asthma.

Predictors of dyspnea were studied during induced airflow obstruction or cough in an attempt to increase understanding of factors related to observed variability in the descriptions of the experience of dyspnea. Thirty-one adult subjects with asthma participated in a 2-day protocol using a laboratory analog of asthma. Air flow obstruction and dyspnea were induced on Day 1 with inhalations of methacholine in doubling concentrations from 0.063 to 2.0 mg/ml. Cough was induced on Day 2 with inhalations of 3% sodium gluconate solution. Dyspnea was assessed on both days by a visual analog technique. The magnitude of dyspnea was not related to airway caliber. There was a significant negative relationship between age and magnitude of dyspnea and between cigarette pack years and dyspnea intensity. Dyspnea at baseline was positively related to dyspnea intensity during induced bronchoconstriction. Dyspnea during cough was not related to airway caliber, but there was a significant difference between males and females in the intensity of dyspnea at cough threshold. These findings may explain some of the variability observed in the experience of dyspnea in asthma.

Emotionally triggered asthma as a predictor of airway response to suggestion.

Twenty-nine male and female adults with asthma were tested to determine the relationship between perceived response to emotional triggers of asthma and bronchoconstrictive suggestion. Subjects were told that they were inhaling a bronchoconstricting agent in four increasingly potent concentrations, when in fact the solution the subjects inhaled was nebulized isotonic saline. Ten subjects responded to suggestion with a greater than 20% increase in specific airway resistance, but this response could not be predicted by the report of perceived emotional triggers of asthma. The finding that perception of asthmatic response to emotional arousal does not predict airway response to bronchoconstrictive suggestion may mean that suggestion is an invalid proxy variable for studying the role of psychological factors in provocation of asthma.

The sensations of pulmonary dyspnea.

This study compared recalled physical and emotional sensations during episodes of acute dyspnea across pulmonary disease groups. The convenience sample consisted of 68 subjects with emphysema-bronchitis, asthma, vascular, and restrictive disease. Temporal patterns of physical and emotional sensations before and during episodes of dyspnea were identified. The frequency of sensations was remarkably similar across disease categories with few significant differences identified. Rather than the disease category, the frequency, intensity, and periodicity of the symptom of dyspnea had the greatest effect on the quality and frequency of sensations reported. The intensity of usual dyspnea reported on a visual analog scale varied significantly among groups, p = .026, with asthmatics having the lowest mean score and vascular subjects the highest. Females reported significantly greater usual dyspnea than males, p = .005. The variables of pulmonary disease group, gender, fatigue, and total network of social support were significantly related to usual dyspnea, and pulmonary group, gender, and attendance at Better Breathers classes were significantly related to worst dyspnea.

[Effects of isometheptene on gallbladder contraction]. / Effetti dell' isometeptene sulla contrazione della colecisti.

In order to verify the influence of the adrenergic system on the gallbladder contraction the Authors studied the effect of isometeptene, a sympathomimetic drug active on beta receptors, on gallbladder emptying. The gallbladder was studied on 6 subjects using a real-time (linear array) equipment with a 3,5 MHz transducer. In fasting subjects the gallbladder emptying was obtained by a fatty meal. In the next day the fatty meal stimulation was associated with the administration of isometeptene. The mean values +/- S.D. of the follow parameters were evaluated: -gallbladder basal volume -gallbladder residual volume both after fatty meal and after the association with isometeptene -gallbladder maximum emptying percentage in two experiences. The results show that the isometeptene doesn't inhibit significantly the gallbladder emptying induced by a fatty meal.

Further development of the Norbeck Social Support Questionnaire: normative data and validity testing.

This article describes the second phase of testing the Norbeck Social Support Questionnaire (NSSQ), an instrument designed to measure multiple dimensions of social support. Three studies were conducted to provide a normative data base and to further test validity. In the first study, data from 136 employed adults were obtained. The amount and type of support available for a functioning group of male and female respondents and sources of support for this sample are described. In the second and third studies, the instrument was found to be very stable over a seven-month interval and sensitive to changes within the social support networks of a group of graduate students during their first year of study. Construct validity of the instrument was established by comparing convergent and discriminant constructs to the NSSQ. Concurrent validity with another social support questionnaire was demonstrated. Predictive validity was tested in a sample of 53 graduate students through assessing the buffering effect of social support on measures of negative mood following life stress. Two NSSQ subscales, aid and duration of relationships, had significant interaction effects with life stress on the outcome of negative mood. Duration of relationships also had a significant main effect. After subtracting the main effect for life stress from the overall R2 in the multiple regression analysis, the NSSQ functional support subscales and their interactions with life stress accounted for 19 percent of the variance on negative mood, and the NSSQ network property subscales and their interactions accounted for 20 percent of the variance.