The exercise intensity-music-tempo preference relationship: A decennial revisit.

Tempo is a key determinant of the motivational effects of music during exercise and has been the focus of numerous empirical studies (e.g., Karageorghis & Jones, 2014). The present study sought to address the limitations of previous related work and revisit the relationship between exercise intensity and music-tempo preference using unfamiliar, non-lyrical music (to isolate the tempo manipulation). A within-within experimental design was employed to test hypotheses pertaining to the non-linear relationship and associated psychological outcomes (e.g., core affect and state attention). Twenty-four participants (Mage = 20.6 years, SD = 0.92 years) exercised at five intensities (10% of peak V̇O2 below ventilatory threshold [VT]; 5% of peak V̇O2 below VT, at VT, midway between VT and the respiratory compensation point [RCP], and at RCP) during which they were administered music tracks at four tempi (90 bpm, 110 bpm, 130 bpm and 150 bpm) and a no-music control. A music liking item, measures of core affect (valence and arousal), attentional focus and perceived exertion were recorded during the exercise bouts. Results indicated that unlike previous findings with familiar, lyrical music, there was no discernible relationship between exercise intensity and preference for music tempo. The most positive psychological outcomes were associated with fast-tempo music. In accord with previous findings, slow-tempo music attracted low liking scores and the least desirable psychological outcomes at every exercise intensity. The present findings have implications for the use of unfamiliar, non-lyrical music during exercise. Specifically, that such music should be ∼10 bpm faster than familiar, lyrical music.

Non-cardiovascular comorbidity, severity and prognosis in non-selected heart failure populations: A systematic review and meta-analysis.

BACKGROUND: Non-cardiovascular comorbidities are recognised as independent prognostic factors in selected heart failure (HF) populations, but the evidence on non-selected HF and how comorbid disease severity and change impacts on outcomes has not been synthesised. We identified primary HF comorbidity follow-up studies to compare the impact of non-cardiovascular comorbidity, severity and change on the outcomes of quality of life, all-cause hospital admissions and all-cause mortality. METHODS: Literature databases (Jan 1990-May 2013) were screened using validated strategies and quality appraisal (QUIPS tool). Adjusted hazard ratios for the main HF outcomes were combined using random effects meta-analysis and inclusion of comorbidity in prognostic models was described. RESULTS: There were 68 primary HF studies covering nine non-cardiovascular comorbidities. Most were on diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD) and renal dysfunction (RD) for the outcome of mortality (93%) and hospital admissions (16%), median follow-up of 4 years. The adjusted associations between HF comorbidity and mortality were DM (HR 1.34; 95% CI 1.2, 1.5), COPD (1.39; 1.2, 1.6) and RD (1.52; 1.3, 1.7). Comorbidity severity increased mortality from moderate to severe disease by an estimated 78%, 42% and 80% respectively. The risk of hospital admissions increased up to 50% for each disease. Few studies or prognostic models included comorbidity change. CONCLUSIONS: Non-cardiovascular comorbidity and severity significantly increases the prognostic risk of poor outcomes in non-selected HF populations but there is a major gap in investigating change in comorbid status over time. The evidence supports a step-change for the inclusion of comorbidity severity in new HF interventions to improve prognostic outcomes.

Impact of non-cardiovascular disease comorbidity on cardiovascular disease symptom severity: a population-based study.

OBJECTIVES: Non-cardiovascular comorbidity is common in cardiovascular disease (CVD) populations but its influence on chest pain (CP) and shortness of breath (SOB) symptom-specific physical limitations is unknown. We wanted to test the a priori hypothesis that an unrelated comorbidity would influence symptom-specific physical limitations and to investigate this impact in different severities of CVD. METHOD AND RESULTS: The study was based on 5426 patients from ten family practices, organised into eight a priori exclusive severity groups: (i) no CVD or osteoarthritis (OA) (reference), (ii) index hypertension, ischaemic heart disease (IHD) and heart failure (HF) without OA, (iii) index OA without CVD and (iv) same CVD groups with comorbid OA. The measure of CP physical limitations was Seattle Angina Questionnaire and for SOB physical limitations was the Kansas City Cardiomyopathy Questionnaire. Adjusted baseline associations between the cohorts and symptom-specific physical limitations were assessed using linear regression methods. In the study population, 1443 (27%) reported CP and 2097 (39%) SOB. CP and SOB physical limitations increased with CVD severity in the index and comorbid groups. Compared with the respective index CVD group, the CP physical limitation scores for comorbid CVD groups with OA were lower by: -14.7 (95% CI -21.5, 7.8) for hypertension, -5.5 (-10.4, -0.7) for IHD and -22.1 (-31.0, -6.7) for HF. For SOB physical limitations, comorbid scores were lower by: -9.2 (-13.8, -4.6) for hypertension, -6.4 (-11.1, -1.8) for IHD and -8.8 (-19.3, 1.65) for HF. CONCLUSIONS: CP and SOB are common symptoms, and OA increases the CVD symptom-specific physical limitations additively. Comorbidity interventions need to be developed for CVD specific health outcomes.

Genetics professionals' experiences with grief and loss: implications for support and training.

This study was designed to determine the degree to which clinical genetics professionals are comfortable with grief and loss, whether discomfort with grief and loss is associated with clinician distress, and what factors predict comfort with grief and loss for the purpose of developing recommendations for support and training. We surveyed 300 clinical geneticists (MDs), genetic counselors (GCs) and genetic nurses randomly selected from their professional associations. Out of 225 eligible clinicians, 172 completed surveys (76% response rate). The vast majority of respondents have clinical interactions with patients and families who are experiencing grief, loss and/or death. However, nearly 20% of respondents reported that they did not feel 'comfortable in the presence of grief and loss'. Twenty-nine percent of respondents disagree or strongly disagree that they 'have been adequately trained to address issues of death, dying, grief/bereavement, and end of life care'. Reported discomfort with grief and loss was strongly correlated with clinician distress. Predictors of comfort with grief and loss included perceived adequacy of training, tolerance for uncertainty, significant personal experiences of loss and deriving meaning from patient care. In conclusion, as follows. A significant minority of clinical genetics professionals experience discomfort in the presence of grief and loss, and feel inadequately prepared for such experiences. Greater attention should be paid to training clinicians in how to deal with grief and loss, and supporting them through such difficult experiences in an effort to reduce their distress.

End-of-life issues in intensive care units: a national random survey of nurses' knowledge and beliefs.

OBJECTIVE: To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units. METHODS: A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia. RESULTS: Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent. CONCLUSIONS: Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.

A road map for navigating end-of-life care.

As nurses begin to develop the sensitivities and skills necessary to preserve the integrity of clinical care and professional life, they must recognize the legitimacy of their perspectives and the value and consequences they have for the well-being of patient and family care. Nurses have much to contribute to the development of ethical practice environments for patients, families, multidisciplinary team members, and themselves. The frenzied, and at times anesthetized, culture of clinical settings can mitigate against the kind of deliberate reflection that is necessary if nurses are to act with ethical integrity. Knowing the rules of the road for end-of-life care and being attentive to common warning signs and addressing them proactively, enables nurses to provide patients and families with the highest quality care at the end of life.

Environments that support ethical practice.

Our healthcare system is fundamentally flawed in the ability to provide quality end-of-life care. The provision of quality end-of-life care involves a complex interaction of personal, professional, and societal values and practices. Attention to each dimension of end-of-life care is essential to improve the care of the dying patient and his/her family. Given the complexity of this problem, this article focuses on the critical care environment and the aspect of organizational culture and specific strategies for improvement. Several inter-related components of an environment which may foster ethical thinking, decision-making, and behaviors are discussed including organizational culture, individual agency, collaboration, and educational resources. Every member of the healthcare team has the responsibility to be a catalyst for creating a critical care environment where ethical practice is expected and rewarded rather than punished and suppressed. As a healthcare team, our ultimate goal is to provide healing and humane end-of-life care for all patients and families.

Assisted suicide: clinical realities and ethical challenges.

The increasing attention to assisted suicide, as evidenced by recent legislation, initiatives, court decisions, and research, propels the issue to a new level of importance and urgency within society and the health professions. Nurses cannot help but be confronted by and struggle with the complex moral and professional quandaries related to assisted suicide. Critical care nurses must continue to evaluate the implications of the possible legalization of assisted suicide and to define the boundaries of morally acceptable professional practice. The challenges to the roles and responsibilities of critical care nurses that might occur if assisted suicide were legalized must be thoughtfully and responsibly explored.

Establishing therapeutic boundaries as patient advocates.

Pediatric nurses often struggle to define their advocacy role with patients and their families. Nursing is based on the therapeutic use of self and caring. An unclear therapeutic relationship can undermine nurses' advocacy efforts. Nurses are encouraged but often not guided about staying within the parameters that define a professional and therapeutic relationship between the nurses and the patient/family. Examining the impact of unclear boundaries on the patient/family relationship and the nurse's ability to serve as an advocate provides the basis for suggested constructive strategies for addressing the related issues.

The language of miracles: ethical challenges.

In the context of health care decision making, the language of miracles is expressed by both parents and professionals. Without mutual understanding of the meaning of miracles, parents and professionals may experience conflict about treatment goals. Understanding the dynamics of appeals to miracles, examining caregiver responses, and employing strategies to assess parental knowledge, understanding the meaning of miracles and faith, and allowing for hope are essential for respectful and mutual accommodation.

Keeping secrets: the ethical and legal challenges.

Blatant examples of breeches of confidentiality are less common in comparison to the daily indiscretions that occur by members of the health care team or support staff. Yet such breeches of confidentiality are rarely identified as ethical or legal problems and therefore remain unaddressed. To uphold their moral and legal obligation to protect private information, nurses must examine the nature of their obligations and devise strategies to create and maintain a culture that holds health care professionals accountable for their actions.

The baby K case: ethical challenges of preserving professional integrity.

Caring for Baby K, an infant born with anencephaly, created moral distress and violated the integrity of some nurses. This article explores the nature of professional nurses' claims of violations of their integrity, argues for a broader moral framework for examining such dilemmas, and suggests strategies for addressing these issues in the clinical setting.

Creating an ethical practice environment: a focus on advocacy.

In order for nurses to be effective advocates, they must practice in an environment that fosters competency, collaboration, communication, and ethical values. This article addresses the meaning of advocacy, explores whether nurses can be effective advocates in complex practice environments, identifies barriers to advocacy, and suggests individual and systems approaches to support advocacy in critical care.

When values conflict with obligations: safeguards for nurses.

Increasingly, nurses are being confronted with clinical situations that challenge their personal and professional integrity. For integrity to be preserved, safeguards must be developed and an environment that supports ethical practice fostered. Standards such as those promulgated by the JCAHO provide an important opportunity for nurses to create mechanisms to assure that diverse religious, cultural, and ethical beliefs of nurses are respected and upheld.