Trajectories of caregiver burden in families of adult cystic fibrosis patients.

ABSTRACTObjectives:Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden. METHODS: This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time. RESULTS: Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time. SIGNIFICANCE OF RESULTS: Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.

Dyspnea on daptomycin: eosinophilic pneumonia.

We present a case of drug-induced acute eosinophilic pneumonia with characteristic imaging and bronchioloaveolar lavage (BAL) findings. Although not a common diagnosis, it is important to consider in the right clinical scenario, including a patient with presumed pneumonia that does not respond to typical treatment. Diagnosis is confirmed by bronchoscopy with BAL. For drug-induced types, treatment includes removal of the offending agent. Corticosteroids are used if symptoms are severe and can result in rapid clinical improvement.

Enhancing the "informed" in informed consent: a pilot test of a multimedia presentation.

The use of a multimedia presentation to supplement the informed consent process for endoscopy procedures was tested at a children's hospital. Fifty consecutive children who presented for an endoscopy were randomized to one of two conditions. In group 1, informed consent for the procedure was obtained by the physician in the usual manner. In the second group, parents/guardians viewed a multimedia presentation on endoscopic procedures in addition to the typical consent process. Both groups completed measures of state anxiety, comprehension, and satisfaction. As predicted, there was a significant positive correlation between all participants' self-reported comprehension and satisfaction and a negative correlation between comprehension and anxiety. The group that viewed the multimedia presentation scored significantly higher on an objective test and was rated significantly higher in comprehension by physicians than the comparison group. There were no significant differences between the groups in self-reports of anxiety, satisfaction with medical care, and number of questions asked during consent delivery.

Nurses' perceptions of physicians' communication: the relationship among communication practices, satisfaction, and collaboration.

This study examined the relationships among nurses' perceptions of physician communication practices, nurse-physician collaboration, and nurses' job satisfaction. Two hundred five nurses employed at a pediatric hospital completed surveys on site that examined perceptions of nurse-physician and physician-patient communication, job satisfaction, and nurse-physician collaboration. Nurse reports of physicians who listened effectively and used clear, humorous, immediate, and empathic messages were strongly related to nurses' satisfaction in several contexts. Physicians' use of empathic messages emerged as a significant predictor of nurses' satisfaction with communication, relationships, and collaborative medical practices. Physician humor and clarity were significant predictors of nurses' job satisfaction. There was a significant positive correlation between nurses' perceptions of physicians' use of nurse-centered communication practices and patient-centered communication practices.