Purpose in life and depressive symptoms in persons living with HIV disease.

PURPOSE: To examine relationships among purpose in life, HIV disease severity, demographic variables, and depressive symptoms in people living with HIV disease (PLWHIV). The hypothesis tested was that purpose in life is a stronger predictor of depressive symptoms than is HIV disease severity. DESIGN: Descriptive, correlational study using a convenience sample of 123 PLWHIV recruited from an urban infectious disease clinic in a university teaching hospital in the Southeast United States. METHODS: A self-administered questionnaire, including a sociodemographic tool, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Purpose in Life Scale (PIL), was used to collect data. Concurrent severity of HIV disease measures included HIV RNA viral load, CD4+ T-lymphocyte count, and the Revised HIV Medical Symptom Scale. Analytical methods included descriptive and inferential statistics and hierarchical regression analysis. FINDINGS: Depressive symptoms were greater and purpose in life was lower than in normative samples. Purpose in life was a stronger predictor of depressive symptoms than was HIV disease severity. CONCLUSIONS: Purpose in life was more important than were laboratory markers of disease progression for predicting depressive co-morbidity. Results from this study indicate the need for routine assessment of depressive symptoms in PLWHIV. Purpose in life should be explored as a potential buffer for depressive symptoms.

A model for initial care of the infertile couple.

Infertility affects an estimated 6.1 million women in the United States. Although more than 1.2 million women seek medical care for infertility each year, the majority drop out of the treatment process before achieving a successful pregnancy. An expert panel of five reproductive endocrinologists developed the Individualized Infertility Care Plan model to aid obstetrician-gynecologists and primary care physicians in streamlining the critical period encompassing diagnosis and initial treatment of the patient with uncomplicated infertility. The model emphasizes the importance of the physician's establishing a strong, lasting relationship with the infertile patient.

Mastery of stress in mothers of preterm infants.

PURPOSE: To explore the relationships among stress, social support, mastery, and depression. DESIGN: Descriptive correlational study. SETTING: 60-bed, Level 3 NICU in an urban medical center in a Mid-Atlantic state. PARTICIPANTS: 31 mothers who delivered infants born between 26 and 36 weeks gestation. Inclusion criteria included no maternal illness or complications requiring hospitalization beyond four days, and no report of a recent major stressful life event other than the birth of the child. MAJOR OUTCOME MEASURES: The Mastery of Stress Instrument, the Account of Social Resources Inventory, and the Center for Epidemiologic Studies-Depression Scale. RESULTS: Social support was positively related to mastery and inversely related to depression. CONCLUSIONS: Mothers of preterm infants experienced significant levels of stress and depression in the early postpartum period.

Ideal residency curriculum in reproductive endocrinology and infertility.

OBJECTIVE: Knowledge in reproductive endocrinology and infertility is fundamental to the delivery of quality women's health care. In 1991, the American Fertility Society formed a resident education committee to gather data on the current status of reproductive endocrinology and infertility training and develop an ideal curriculum. METHODS: Program directors and reproductive endocrinology and infertility faculty from 288 residencies in obstetrics and gynecology were surveyed about training in reproductive endocrinology and infertility; 257 (89%) of the program directors (survey I) and 203 (82%) of the reproductive endocrinology and infertility faculty (survey II) responded. An ideal curriculum has been developed from consensus discussions, review of survey data, and polling of experienced educators. The curriculum was reviewed and approved by the board of directors of both the Society for Reproductive Endocrinologists and the American Fertility Society. RESULTS: The curriculum is divided into subject matter and therapeutics, which are prioritized into three levels of knowledge: critical core curriculum, less critical material, and material with which residents should have familiarity and general knowledge. In addition, other recommendations and suggestions are made regarding the number of rotations, duration of rotations, and teaching methods. CONCLUSION: The ideal curriculum may serve as a guide to assist program directors in the formulation of the most effective residency training in reproductive endocrinology and infertility. The curriculum can help prioritize what should be taught and where an emphasis can be placed. There is not enough time or resources to teach residents all aspects of reproductive endocrinology and infertility.

The alienation of the sufferer.

Suffering is a particularly human experience that often brings with it loneliness or alienation from others. The theory described in this article explains the mechanisms through which suffering affects an individual's sense of community and connectedness with others. The intricate patterns are explained to provide a basis for prescriptive nursing to prevent or reverse this loss of connectedness. First, the article develops the concept of suffering and its influences on relationship with the self and with others and the relationship of others with the sufferer. Then, the concept of alienation is developed in this context, its philosophical roots explored, and a continuum described that encompasses alienation through connectedness. Related concepts of separation, shame, and stigma are briefly described as partial cases of alienation of the sufferer that also show the pervasiveness of the phenomenon. Next, the personal characteristics of an individual who might help are developed through the concept of wisdom. Last, an explanation is given as to why care is the contextual framework through which alienation is reversed and connectedness achieved. Although suffering, alienation, and care have gone by many names, the essences of these phenomena have been recurrent theme in descriptions of human response.

Endometriosis.

The surgical approach to treatment of endometriosis is shifting away from laparotomy toward endoscopy as technology and experience improve. All patients with minimal or mild disease and a significant portion of those with advanced disease can be treated endoscopically with little difference in clinical outcome but a significant difference in cost. The various lasers as well as sharp dissection and bipolar cautery are adequate tools for this approach. With complete surgical destruction, medical suppressive therapy adds little therapeutic benefit. There is little evidence to suggest that laparoscopic presacral neurectomy or uterine nerve ablation should be routinely added. Long-term recurrence of disease is probably less than 25%. It is likely that the American Fertility Society classification will be revised to adapt to our changing knowledge and treatment strategy.

Development and testing of the Mastery of Stress Instrument.

The purpose of this research was to develop and test an instrument to measure mastery of stress. Mastery is defined as a human response to difficult or stressful circumstances in which a person gains competence, control, and dominion over the experience of stress. The instrument consists of four 15-item scales: Certainty, Change, Acceptance, and Growth.

An epidemiologic study of NCLEX.

This study of NCLEX performance was designed to identify the best risk indices for students who do not pass the test, to pinpoint the earliest time in their academic careers that their risk can substantially be known, and to estimate the effectiveness of a formal review course. Results show that 62% of the variance in NCLEX scores can be predicted with a combination of variables that includes four nursing school course grades, the test scores of the Scholastic Aptitude Test, and National League for Nursing test scores. Whether a student took an NCLEX review course was not a significant predictor of performance. A method of deriving risk estimate from these values is also shown.

Visualization of free peritoneal fluid with transvaginal sonography. A preliminary study.

Visualization of free peritoneal fluid during sonographic examination is often of considerable clinical importance. To determine the sensitivity of transvaginal sonography in the detection of this finding, measured amounts of isotonic saline were instilled into the abdominal cavities of 15 women undergoing diagnostic laparoscopy while a 5-MHz transvaginal probe was employed to view the pelvic contents. Small amounts of free fluid could be visualized easily in all the patients (mean +/- SD, 25.8 +/- 6.4 mL). Fluid was first seen in the cul-de-sac in 10 patients and in the adnexal region in 5. When fluid instillation was continued to a total volume of 200 mL, the pelvic viscera were distinctly outlined in all the patients, markedly enhancing visualization of the uterus, tubes and ovaries. Transvaginal sonography seems to be a sensitive and reliable method of detecting free peritoneal fluid. Instillation of fluid into the peritoneal cavity may be a clinically useful technique for enhancing the sonographic visualization of pelvic structures.

A theory of mastery.

Mastery is a human response to difficult or stressful circumstances in which competency, control, and dominion have been gained over the experience of stress. The goal of the theory of mastery is to explain how individuals who experience illness or other stressful health conditions may emerge, not demoralized and vulnerable, but healthy and possibly stronger. The human response to stress is fundamentally an existential problem. As such, the theory of mastery has philosophic as well as conceptual roots.

A model of parenting stress.

A preliminary theoretical model of parenting stress was tested. The additive effects of a series of stresses, namely, stressful pregnancy, stress of labor and delivery, and the stress of parenting were examined in a causal model of parenting stress. Factors theoretically expected to be protective in stressful circumstances, like, personality strength, prior experience, age, education, and social support, were predicted to be negatively related to stress. Data from 101 mothers whose infants were 6 weeks old were analyzed using path analysis. The data fit the model and explained 41% of the variance in parenting stress. The empirical model showed significant paths from prior experience and social support to the stress of pregnancy. The mother's education was the only significant variable in the pathway to labor and delivery stress and it was positively related to stress. Paths to parenting stress existed from personality and from pregnancy stress, but not from labor and delivery stress or any of the other variables.

Use of a single random serum progesterone value as a diagnostic aid for ectopic pregnancy.

We evaluated the usefulness of serum progesterone (P) determinations in differentiating between ectopic pregnancy (EP), normal intrauterine pregnancy (IUP), and abnormal IUP. Values were obtained from 233 samples from 54 patients with IUP, 100 samples from 26 patients with abnormal IUP, and 125 samples from 46 patients with EP. Although mean values from all three groups were significantly different, we could not detect a single value that readily predicted both the presence and absence of EP. Only 2% of patients with EP (excluding those having undergone ovulation induction) had a P greater than 20 ng/mL and only 2% of patients with IUP had a value less than 10 ng/mL. Thirty-one percent of IUP, 23% of abnormal IUP, and 52% of EP had values that fell between 10 and 20 ng/mL, which limits the clinical usefulness of this test.

A primary care focus on pediatric cardiology.

Primary care pediatric cardiology is principally concerned with prevention of heart disease and early detection of existing disease. One of the clinician's major resources for practice is tables of normal values. These include tables for height, weight, heart rate, respiratory rate, BP, and cholesterol. A second resource is the recommendations for preventive treatment of RF and infective endocarditis. The clinician also must have a preventive attitude toward practice and be able to maintain vigilance of "well" children for years in order to help prevent illnesses that constitute the nation's most prevalent threat of mortality.

Scheduling by computer.

Often our work requires us to schedule something rather complicated. Computers offer a solution to what may be very routine, repetitious, and time-consuming work. The purpose of this article is to describe a user skill for adapting a spreadsheet program to do scheduling.

Literary works as a mode of knowing.

The phenomena of nursing are deeply rooted in the human condition. Knowledge of human responses is developed in the arts as well as the sciences. Literary works often reveal much about human responses that are a foundation for providing compassionate care for patients.

Comparison between 1-hour and 24-hour follow-up radiographs in hysterosalpingography using oil based contrast media.

A comparison was made between oil-contrast hysterosalpingogram (HSG) with 1-hour follow-up radiograph and the traditional 24-hour follow-up radiograph with respect to detection of tubal patency and pelvic adhesive disease. The results on either modality were assessed by subsequent laparoscopy. The 1-hour HSG was comparable to the 24-hour HSG in defining tubal patency. Even though it was inferior to the 24-hour HSG with respect to identifying pelvic adhesions, it may serve as an adequate substitute to the above since the sensitivity of the HSG in identifying adhesions is low and has little influence on the clinical decision process in the evaluation of infertility.

The effects of topical lidocaine on infant response to circumcision.

The effects of a topical anesthetic used prior to newborn circumcision on the parameters of heart rate, respiratory rate, oxygen saturation levels, seconds of crying time, and overt generalized reaction to the procedure were investigated. In the double-blind design, an experimental group (n = 20) received 4% lidocaine cream mixed with 500 mg acid mantle cream two hours before circumcision, and a control group (n = 24) received 500 mg acid mantle cream two hours before circumcision. The circumcision was divided into five events with parameters recorded 30 seconds into each event. The results showed a significant difference in the heart rate between the treated and untreated group, but the respiratory rate and oxygen saturation levels did not differ significantly. Seconds of crying time also differed significantly between groups, as did overt generalized response. There were no untoward reactions. Results showed that topical lidocaine, simple and safe to use, reduced parameters associated with pain and stress.

Endometrial biopsy in the cycle of conception: histologic and lectin histochemical evaluation.

The histologic features and lectin binding patterns of endometrial tissue obtained in 16 cases of inadvertent biopsy during the cycle of conception were studied. Six biotinylated lectins that bind to specific glycoconjugates of secretory or gestational endometrium in paraffin-embedded tissue were used. These lectins were wheat germ agglutinin (WGA), Ricinus communis agglutinin-I (RCA-I), Concanavalin A agglutinin (Con-A), peanut agglutinin (PNA), Dolichos biflorus agglutinin (DBA), and soybean agglutinin (SBA). On review, the histologic sections showed day 20 to 26 patterns. In retrospective analysis, 15 of the 16 cases had increased stromal edema and vascular congestion compared with endometria of equivalent postovulatory dates not associated with conception. In 2 cases, spiral arterioles showed increased thickness. There was no evidence of renewal or prominence of glandular secretions. Most lectin binding was similar to that of the secretory phase of the menstrual cycle (WGA, RCA-I, gland lumenal secretions and stromal granulocytes; Con-A, gland cell cytoplasm and predecidua). There was focal, irregular staining of gland secretions with PNA, DBA, and SBA, lectins that generally react only with gland secretions in later gestation. These results indicate that vascular changes including edema and congestion appear to be the earliest persistent morphologic manifestations of the pregnant endometrium. Secretory gland changes, however, are subtle and are not identifiable by routine histology.