Survivorship of the St Georg Sled medial unicompartmental knee replacement beyond ten years.

There have been several reports of good survivorship and excellent function at ten years with fixed-bearing unicompartmental knee replacement. However, little is known about survival beyond ten years. From the Bristol database of over 4000 knee replacements, we identified 203 St Georg Sled unicompartmental knee replacements (174 patients) which had already survived ten years. The mean age of the patients at surgery was 67.1 years (35.7 to 85) with 67 (38.5%) being under 65 years at the time of surgery. They were reviewed at a mean of 14.8 years (10 to 29.4) from surgery to determine survivorship and function. There were 99 knees followed up for 15 years, 21 for 20 years and four for 25 years. The remainder failed, were withdrawn, or the patient had died. In 58 patients (69 knees) the implant was in situ at the time of death. Revision was undertaken in 16 knees (7.9%) at a mean of 13 years (10.2 to 21.6) after operation. In seven knees (3.4%) this was for progression of arthritis, in three (1.5%) for wear of polyethylene, in four (2%) for tibial loosening, in two (1%) for fracture of the femoral component and in two (1%) for infection. Two knees (1%) were revised for more than one reason. The mean Bristol knee score of the surviving knees fell from 86 (34 to 100) to 79 (42 to 100) during the second decade. Survivorship to 20 years was 85.9% (95% CI 82.9% to 88.9%) and at 25 years was 80% (95% CI 70.2% to 89.8%). Satisfactory survival of a fixed-bearing unicompartmental knee replacement can be achieved into the second decade and beyond.

The pregnant trauma patient.

Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. Primary goals are aggressive resuscitation of the mother and maintenance of uteroplacental perfusion and fetal oxygenation by the avoidance of hypoxia, hypotension, hypocapnia, acidosis and hypothermia. Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.

Repressive adaptation in children with cancer: a replication and extension.

Prior research has shown a higher incidence of a repressive adaptive style in children with cancer. To explore whether repressive adaptation in this population is premorbid or reactive, adaptive style was assessed longitudinally in children with cancer at the time of diagnosis and at 6 months and 1 year after diagnosis. Comparison groups included healthy children and children with other serious but nonmalignant chronic illnesses. At diagnosis, children with cancer showed a higher incidence of a repressive adaptive style than healthy children, and the incidence of repressive adaptation remained stable over time. Children with other chronic illnesses also showed levels of repressive adaptive style comparable to the cancer group. These findings suggest a shift toward repressiveness in response to the diagnosis of cancer that is then maintained over time and necessitate further examination of the health consequences of adaptive style in this population.

Adherence to antiretroviral therapy among HIV-positive children: examination of the role of caregiver health beliefs.

This study examined the association between two components of the Health Belief Model (perceived vulnerability and barriers) and adherence to antiretroviral therapy (ART) among children who are HIV-infected. The parents/caregivers of 30 children (mean age = 5.21, SD = 3.18) who were HIV-infected and who were on active ART were surveyed to assess current methods of adherence assessment and educational efforts within the institution. All participants (except one) were African American and reported low monthly family incomes (M = $869.45, SD = $832.63). Assessment instruments included measures of perceived vulnerability, caregiver-reported adherence and perceived barriers, and objective measures of adherence (clinical pill count; electronic measurement). The results failed to demonstrate a significant relationship between parental perceived vulnerability, perceived barriers and adherence to antiretroviral medications. Methods of assessing adherence provided significantly discrepant estimates of adherence. Results are discussed in terms of implications for patient care and for future research in this area. The addition of behavioural and motivational components to traditional educational approaches may positively impact treatment results.

The effect of microwave heating on the acidity of 0.9% saline in 1 litre and 100 mL polyvinyl chloride packaging.

OBJECTIVE: Microwave warming of intravenous crystalloid solutions is an accepted practice in operating suites and emergency departments. These intravenous solutions are stored in polyvinyl chloride (PVC) and are known to be acidic. Some of this acidity may be from PVC packaging. We asked if microwave heating affected the acidity of 0.9% saline solution in 1 litre and 100 mL PVC bags. METHODS: Seven 1 litre bags were heated in an 800 Watt microwave for 2 minutes each and seven 100 mL bags were heated for 30 seconds each. After overnight cooling to room temperature, pH and temperature were measured and compared with two control groups of 7 unheated bags. RESULTS: There was no significant difference between the pH of heated and unheated solutions of saline. The median pH of the 1 litre bags were 5.01 (control) and 5.02 (heated). The median pH of the 100 mL bags were 4.58 (control) and 4.59 (heated). Post hoc, we found the 100 mL bags were more acidic than the 1 litre bags by a median difference of 0.43 pH units (P = 0.002). CONCLUSIONS: Microwave heating does not change the acidity of 0.9% saline in 1 litre or 100 mL PVC packaging.

Trajectory of certain death at an unknown time: children with neurodegenerative life-threatening illnesses.

Childred with neurodegenerative life-threatening illnesses (NLTIs) account for a significant proportion of children requiring palliative care. Most of their care is provided at home by their families over many years, yet there is a paucity of research examining families' experiences with a child with an NLTI is dying at home. In this grounded theory study, data were collected from 8 families through observations and audiotaped interviews. Families moved through a process of navigating uncharted territory as they lived with their dying child. The illness trajectory of cetain death at an unknown time was not a steady decline. Instead, families lived much of their lives on plateaus of relative stability where they often felt alone and isolated from health-care professionals. Inevitable, periods of instability originated in subsequent precipitating events in the process that led to families dropping off the plateau on the way to the child's inevitable death. Implications for research and practice are discussed.

Coping strategies and behavior problems of urban African-American children: concurrent and longitudinal relationships.

The development and correlates of 82 inner-city African-American children's coping strategies were examined across three years. Results indicated no change in the mean frequency of self-reported coping strategies over the three years, and a significant correlation of emotion-focused strategies with increased self- and mother-reported behavior problems. Child-reported externalizing problems (and, to a lesser degree, internalizing problems) predicted changes in coping strategies across assessments.

Low-end specificity of childhood measures of emotional distress: consistent effects for anxiety and depressive symptoms in a nonclinical population.

Previous research regarding the low-end specificity of self-report measures of affective distress in children suggests that defensiveness acts differentially to lower scores on self-report measures of depressive symptoms, but not on self-report measures of anxiety. This investigation examined this issue in a nonclinical sample of 442 children, ages 7 to 16. Participants completed measures of depressive symptoms (Children's Depression Inventory), anxiety symptoms (State-Trait Anxiety Inventory for Children) and defensiveness (Children's Social Desirability Scale). In contrast to previous research, the results in this study indicated similar effects of defensiveness on measures of depressive symptoms and anxiety. Low-end depression participants obtained significantly higher defensiveness scores, as did low-end anxious participants. In an attempt to circumvent the effects of defensiveness, we measured anhedonia (Pleasure Scale for Children, or PSC) as a proxy of depressive symptoms. We also found the PSC to be subject to the effects of defensiveness at approximately the same magnitude as the measures of anxiety and depressive symptoms.

The role of parental and extrafamilial social support in the psychosocial adjustment of children with a chronically ill father.

The relationships among illness stress, perceived support, and child psychosocial adjustment were examined for children living with a chronically ill father. Participants included fathers, mothers, and one child from 53 families in which the father had hemophilia and, in some cases, was HIV seropositive. Objective indicators of severity of illness and subjective measures of the physical and psychological impact of illness were used as sources of children's stress. Results indicated that the impact of illness, but not the severity of illness itself, related to child psychosocial adjustment. Main effects were observed for parental support on child- and parent-reported internalizing problems and stress-buffering effects were obtained for parental support and extrafamilial support on parent-reported internalizing problems. Parental support also demonstrated a stress-buffering effect for child-reported depression. Assessment and intervention implications for behavioral clinicians and researchers are discussed.

Family members' uncertainty about parental chronic illness: the relationship of hemophilia and HIV infection to child functioning.

Examined the relationships among parental and child uncertainty about fathers' illnesses and child internalizing problems. Participants included 65 families in which the father had hemophilia, approximately one half of the fathers also were HIV infected. Within each family, respondents included the father, the mother and one child. Outcome variables included both self- and parent-reported child internalizing behaviors. Results indicated that family members' illness uncertainty was intercorrelated, that child uncertainty about the father's illness predicted both anxiety and depressive symptoms in the child, and that mother's uncertainty predicted child-reported anxiety beyond the child's uncertainty.

The role of family processes and coping strategies in the relationship between parental chronic illness and childhood internalizing problems.

Sixty-nine families (father, mother, and one child) in which the father had hemophilia, approximately half of whom were HIV positive, were assessed in an examination of the relationship between parental chronic illness, family functioning, child coping strategies, and child adjustment. Latent variable path analyses with partial least-squares estimation procedures (PLS) were used to test a model of the relationship between parental chronic illness, family process variables, child coping strategies, and child internalizing behavior problems. The severity of the father's illness predicted family process variables, which predicted the coping style of the child. The use of more avoidant coping strategies was associated with more internalizing problems.

Coping strategies of family caregivers of home hospice patients with cancer.

PURPOSE/OBJECTIVE: To identify the use and effectiveness of coping strategies identified by family caregivers of patients with terminal cancer. DESIGN: Exploratory, descriptive. SETTING: Six nonprofit home hospices in Canada. SAMPLE: Twenty Caucasian family caregivers of 20 patients with terminal cancer who were enrolled in home hospice. METHODS: Subjects were recruited on admission to hospice and completed the revised Jalowiec Coping Scale. MAIN RESEARCH VARIABLES: Family caregivers' assessment of their use of 60 possible coping strategies and the extent to which those strategies were effective. FINDINGS: In this study, the problem was defined as caring for the patient in the two weeks prior to the interview. Family caregivers of patients with cancer receiving home hospice care found that keeping busy, thinking positively, and learning more about the problem were effective coping strategies. Talking the problem over with family and friends also was found to be an effective strategy. CONCLUSIONS: Family caregivers need encouragement to maintain hope and a positive attitude so that they can continue caregiving. Social, volunteer, and professional support are important for caregivers. IMPLICATIONS FOR NURSING PRACTICE: To provide guidance and support to family caregivers, nurses need to explore the meanings that caregivers attach to the caregiving experience and assist caregivers in reframing these meanings in a positive light.

Needs of family caregivers of patients receiving home hospice care for cancer.

PURPOSE/OBJECTIVES: To identify needs of family caregivers of home hospice patients with cancer. DESIGN: Exploratory, descriptive. SETTING: Six nonprofit homecare hospices in Canada. SAMPLE: Twenty Caucasian family caregivers of 20 patients with cancer enrolled in home hospice. METHODS: Subjects were recruited on admission to hospice and completed the Home Caregiver Need Survey in the home. MAIN RESEARCH VARIABLES: Family caregivers' assessment of their poorly satisfied informational, household, patient care, personal, spiritual, and psychological needs. FINDINGS: Family caregivers needed time for themselves away from the house and for their personal needs. They also lacked sufficient time to rest and did not experience adequate sleep. Caregivers needed to learn ways to help patients maintain some independence. A 24-hour hotline can be an important resource for caregivers. CONCLUSIONS: Family caregivers need social, volunteer, and professional support while caring for a family member at home so that their own physical and emotional health does not suffer. IMPLICATIONS FOR NURSING PRACTICE: To provide guidance and support to family caregivers, nurses should assess the needs of caregivers and tailor interventions to meet those needs. Nurses also should facilitate the development of a social, volunteer, and professional support network.

Predicting alcohol and drug use in early adulthood: the role of internalizing and externalizing behavior problems in early adolescence.

Unique and interactive internalizing and externalizing behavior problems in adolescence were examined in relationship to drug and alcohol use in young adulthood. Results indicated that higher externalizing scores in adolescence predicted more alcohol use in young adulthood for both males and females and also predicted more marijuana and hard drug use for males. Lower internalizing scores were found to predict more marijuana and hard drug use in young adulthood for boys, but not for girls.