The efficacy of therapeutic touch for improving functional ability in elders with degenerative arthritis.

The purpose of this Rogerian study was to determine whether therapeutic touch improved functional ability in elders with arthritis as compared to routine treatment and progressive muscle relaxation. Eighty-two non-institutionalized elders were randomly assigned to therapeutic touch or progressive muscle relaxation treatments. Subjects served as their own control for 4 weeks, then received six treatments at 1-week intervals. Pain, tension, mood, and satisfaction improved after therapeutic touch and progressive muscle relaxation. Hand function improved after therapeutic touch; walking and bending improved after progressive muscle relaxation. Functional ability was significantly different between the two groups for mobility and hand function. Lower scores (indicating better function) were attained by the therapeutic touch group.

The effectiveness of therapeutic touch for decreasing pain in elders with degenerative arthritis.

The purpose of this study was to determine if Therapeutic Touch (TT) decreased pain in elders with degenerative arthritis, compared with routine treatment and progressive muscle relaxation (PMR). Eighty-two noninstitutionalized subjects, age 55 or older, were randomly assigned to TT or PMR treatments. Subjects served as their own controls for 4 weeks and then received six treatments at 1-week intervals. Visual analogue scales (VAS) for pain intensity and distress were used. Significant differences from baseline to postsixth treatment were found within groups. TT decreased pain (t(46) = 7.60, p = < .001) and distress (t(44) = 7.08, p = < .001). PMR decreased pain (t(36) = 6.58, p = .005) and distress (t(36) = 6.90, p = < .001). Differences in effectiveness existed between the TT and PMR groups; the pain and distress scores were lower in the PMR group. The differences approached significance for pain, F(2, 76) = 2.8, p = .06, and were significant for distress, F(2, 75) = 5.6, p = .005.

An analysis of the impact of participation in an international study program on the cognitive development of senior baccalaureate nursing students.

As we move into a global society, increasing attention is being given to international and transcultural learning in higher education. The purpose of the study was to analyze the impact of participation in a 3-month international study program on the cognitive development of senior baccalaureate nursing students. Using Perry's theory of adult cognitive development as a conceptual basis and a quasi-experimental cohort design, data were collected from eight students participating in a semester abroad program in England and 20 randomly selected students not participating in the program, using the Measurement of Epistemological Reflection. The students participating in the program demonstrated significantly more cognitive growth (p = .044) and were 3.125 times as likely to advance in the Perry positions. Within a shrinking educational economy, these findings provide support for the establishment or revision of international study.

Fixed mini-dose warfarin for prophylaxis of thromboembolic disease in pregnancy: a safe alternative for the fetus?

BACKGROUND: Fixed mini-dose warfarin has been used for thromboprophylaxis in high-risk nonpregnant patients with encouraging results. The usefulness of this strategy in pregnant women requires documentation of fetal safety. CASE: A woman with antithrombin III deficiency suffered a venous thrombosis during early pregnancy and could not be successfully managed long term with heparin. One milligram of warfarin daily was used for prophylaxis, and serial fetal blood samples were used to monitor the fetal coagulation status. No apparent coagulation abnormalities were demonstrated in the fetus at 33, 36, and 38 weeks' gestation. The woman suffered no further thromboses throughout the remainder of her pregnancy and puerperium. CONCLUSIONS: The efficacy of fixed mini-dose warfarin for prophylaxis in pregnancies at risk for thromboembolic disease will require further investigation. This fetus did not appear vulnerable to coagulation abnormalities as a consequence of the warfarin regimen.

Studies on sound and carious enamel with the quantitative acoustic microscope.

The scanning acoustic microscope gives strong contrast from small caries lesions in sections of human enamel. The uniqueness of the acoustic microscope lies in its ability to image elastic properties. In addition to revealing the extent and the shape of lesions, the microscope may also be used to measure the elastic properties point by point across an area of interest. Since enamel is anisotropic, measurements of the Rayleigh velocity and attenuation were made as a function of direction on a section of sound enamel. The velocity was greatest parallel to the prism axis, and the attenuation was least in this direction. Measurements of V(z) across a section through a lesion are presented. The variation of attenuation can be interpreted in terms of the development of demineralization, initially along prism boundaries and then along cross-striations. The variation of velocity indicates a substantial reduction of elastic stiffness in the lesion.

The use of red cell distribution width in the detection of iron deficiency in chronic hemodialysis patients.

Forty patients on maintenance hemodialysis were studied to determine the usefulness of the red blood cell distribution width (RDW) in screening these patients for iron deficiency. Serum ferritin was used as the indicator of body iron stores. The sensitivity of RDW elevation in determining the likelihood of iron store depletion was 89%; and the negative predictive value of a normal RDW was 93%. The specificity of RDW elevation for iron deficiency was only 45%, and the positive predictive value was 32%. This study has confirmed the usefulness of the RDW as a screening test for iron deficiency in chronic hemodialysis patients. However, the low specificity and positive predictive value of the test also suggests the need for further studies when there is an unexplained elevation of the RDW.

Evaluation of the in vitro detection of the hypercoagulable state using the thrombin generation test and plasma clot impedance test.

This study reports the correlation of the thrombin generation test and the plasma clot impedance test with clinical evidence of hypercoagulability. Thrombin generation is increased and the rate of change of plasma from a liquid to a gel (clot impedance) is increased in situations where the risk of thrombosis is increased. These situations include increasing clinical signs and/or symptoms of thromboembolism, positive lung scans, postoperative total hip replacement, patients over 40 years old, low serum antithrombin III, thrombocytosis, transient cerebral ischemia, and positive isotope venogram for thrombosis. The two tests failed to indicate a significant effect of antiplatelet drugs on the hypercoagulable state. This study shows that the thrombin generation and plasma clot impedance tests are practical, rapid and useful tests for the detection and monitoring of the hypercoagulable state.