Using the transtheoretical model to facilitate behavior change in patients with chronic illness.

Nurse practitioners spend a considerable amount of time encouraging patients with chronic illness to acquire positive behaviors such as exercising and self-monitoring, and to stop negative behaviors like smoking and intake of foods high in fat. These lifestyle changes can be facilitated through use of the transtheoretical model of stages and processes of behavior change. The significance is that it assists health care providers in developing interventions that are specifically focused for the patient depending on stage of readiness to change. The application of the model in the practice setting is discussed, and a specific example of activities developed for use in patients with asthma is given. The protocols can be adapted for any patient who needs to make lifestyle behavior changes.

Panning for gold: sifting through chart audit data for patient outcomes.

Randomly observing patients after a 6-month period of clinic visits that included time for an educational component revealed that although patients were making positive changes to improve their health, an identifiable pattern of improvement in health status was not apparent. A chart audit was performed to gather demographic and outcome data in a more systematic manner. This article describes the process for completing the chart audit and analyzing the data. The potential for chart audits to raise research questions for subsequent development of outcomes evaluation studies is discussed. The author presents a model for a health care outcome research study that can be applied to improve effectiveness of care.

The unique management of refractory advanced systolic heart failure.

Advanced systolic heart failure refractory to ambulatory pharmacotherapy continues to be a clinical dilemma with increasing incidence and prevalence. By establishing the presence of signs and symptoms, clinicians could better evaluate hemodynamic perturbations, therefore targeting them through the use of intravenous diuretics, intravenous vasodilators, and intravenous inotropic therapy. This review focuses on the unique features that characterize advanced heart failure, and discusses the special clinical considerations in managing this morbid entity.

Facilitating behavior change. Use of the transtheoretical model in the occupational health setting.

1. Researchers have identified five stages of change and the 10 experiential and behavioral processes most effective in helping people move from one stage to the next. This model is referred to as "transtheoretical" because it encompasses many theories of behavior change. 2. Each stage of change tends to be characterized by the use of specific processes. Experiential strategies are used most frequently by individuals in the contemplation and preparation stages of change. Behavioral processes are used most frequently by individuals in the action and maintenance stages. 3. The transtheoretical model assists providers in developing interventions targeted not only for employees who are prepared to take action, but also for the majority of the population who are not yet intending to change their behavior, or for those who are only considering a lifestyle change. 4. Using this information, the occupational health nurse can design specific interventions targeted to an individual's current stage of change, with the potential to accelerate the employee's progress toward increasing the adoption and maintenance of the desired behavior.

Influence of donor and recipient gender on cardiac allograft vasculopathy. An intravascular ultrasound study.

BACKGROUND: Cardiac allograft vasculopathy remains the leading limitation to long-term survival after cardiac transplantation. While the influence of donor and recipient gender in the pathogenesis of cardiac vasculopathy is still poorly understood, studies have indicated that female allografts may be at higher risk for the development of cardiac allograft vasculopathy. The purpose of this study was to characterize the influence of donor and recipient gender on the early genesis of cardiac allograft vasculopathy by using intravascular ultrasound. METHODS AND RESULTS: Thirty-six consecutive cardiac transplant recipients were divided into three groups on the basis of donor and recipient gender as follows: group 1, female donor and male recipient (n = 8); group 2, male donor and female recipient (n = 7); and group 3, male donor and male recipient (n = 21). The three groups were similar with regard to donor and recipient age, weight, body surface area, serum lipids, left ventricular function, histocompatibility, cellular and vascular rejection, and cytomegalovirus infection. To precisely quantitate the extent of cardiac allograft vasculopathy, intravascular ultrasound was performed in all patients at the time of first annual angiography. Intimal thickening and intimal index were accurately quantitated by intravascular ultrasound. Intimal thickening was significantly greater in group 1 (0.55 +/- 0.15 mm) than in group 2 (0.18 +/- 0.04 mm) or group 3 (0.29 +/- 0.05 mm) (P < .05). In addition, the intimal index was greater in group 1 (0.20 +/- 0.04) than in group 2 (0.07 +/- 0.02) or group 3 (0.15 +/- 0.02) (P < .01, group 1 versus group 2). CONCLUSIONS: Male recipients of female allografts have a higher degree of vascular intimal hyperplasia detected by intravascular ultrasound at 1 year after heart transplantation. These findings indicate that donor and recipient gender influences the early genesis of cardiac allograft vasculopathy.

Efficacy and tolerability of enalapril and sustained-release verapamil in older patients with mild to moderate essential hypertension.

The study involved 113 patients over age 50 years with mild to moderate essential hypertension, randomly assigned to treatment with enalapril (n = 54) or sustained-release verapamil (n = 59). During an eight-week titration period, doses were adjusted to achieve supine diastolic blood pressures (DBP) below 90 mmHg; patients were then given maintenance doses for eight weeks. Mean blood pressures were reduced significantly from 147.7/93.9 mmHg at baseline to 137.7/84.5 mmHg at the end of the maintenance period in the enalapril group and from 155.1/95.1 to 142.4/86.2 mmHg in the verapamil group. In the patients who completed treatment, the mean daily doses required to maintain DBP below 90 mmHg were 9.6 mg of enalapril and 244.9 mg of verapamil. There were 11 treatment failures in the enalapril group and 22 in the verapamil group: eight of the enalapril and 17 of the verapamil patients did not attain goal blood pressures and three and five were withdrawn because of side effects. It is concluded that both enalapril and sustained-release verapamil were generally effective and well tolerated in the treatment of mild to moderate hypertension in the middle-aged and older patients.