RESUMEN
Intergenerational value transmission affects parent-child relationships and necessitates constant negotiation in families. Families with adolescents from rapidly changing societies face unique challenges in balancing the traditional collectivistic family values that promote harmony with emerging values that promote autonomy. Using modern Turkey as an example of such a culture, the authors examine the transmission process in families that hold more traditional and collectivistic values than their adolescent children. Special consideration is given to generational and cultural differences in the autonomy and relatedness dimensions.
Asunto(s)
Cultura , Terapia Familiar/métodos , Relaciones Intergeneracionales/etnología , Relaciones Padres-Hijo/etnología , Valores Sociales/etnología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Autonomía Personal , TurquíaAsunto(s)
Albuterol/análogos & derivados , Androstadienos/administración & dosificación , Broncodilatadores/administración & dosificación , Administración por Inhalación , Anciano , Albuterol/administración & dosificación , Índice de Masa Corporal , Progresión de la Enfermedad , Método Doble Ciego , Quimioterapia Combinada , Femenino , Fluticasona , Estudios de Seguimiento , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Factores de Riesgo , Xinafoato de Salmeterol , Fumar/efectos adversos , Espirometría , Análisis de SupervivenciaRESUMEN
This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) > or = 10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS < or = 10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.
Asunto(s)
Negro o Afroamericano/etnología , Terapia Cognitivo-Conductual/organización & administración , Depresión/prevención & control , Complicaciones del Embarazo/prevención & control , Atención Prenatal/organización & administración , Población Blanca/etnología , Adulto , Negro o Afroamericano/educación , Negro o Afroamericano/estadística & datos numéricos , Actitud Frente a la Salud/etnología , Competencia Cultural , Depresión/diagnóstico , Depresión/etnología , Estudios de Factibilidad , Femenino , Humanos , North Carolina , Investigación Metodológica en Enfermería , Proyectos Piloto , Pobreza/psicología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/etnología , Atención Prenatal/psicología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Escalas de Valoración Psiquiátrica , Práctica de Salud Pública , Conducta de Reducción del Riesgo , Servicios de Salud Rural/organización & administración , Población Blanca/educación , Población Blanca/estadística & datos numéricosRESUMEN
This qualitative study explored the experiences of seven couples where the female partner experienced depressive symptoms during pregnancy. Female and male partners were interviewed together and data was collected and analyzed according to Colaizzi's ( 1978 ) phenomenological research design. The interviews yielded the following themes: (a) Challenges and stressors associated with depressive symptoms during pregnancy, (b) Pregnancy's effect on mood states, (c) Relationship dynamics that influence moods, (d) Pregnancy and the influence of mood on relationship dynamics, and (e) Reliance on external sources of support. The findings extend current research and provide insight into possibilities of how to enhance assessment and intervention for women who are depressed during pregnancy by including a relational component. Findings, clinical implications, and future research are discussed.
Asunto(s)
Trastorno Depresivo/enfermería , Trastorno Depresivo/psicología , Conflicto Familiar/psicología , Relaciones Enfermero-Paciente , Complicaciones del Embarazo/enfermería , Complicaciones del Embarazo/psicología , Apoyo Social , Adolescente , Adulto , Afecto , Imagen Corporal , Investigación en Enfermería Clínica , Femenino , Humanos , Entrevista Psicológica , Estilo de Vida , Evaluación en Enfermería , Embarazo , Espiritualidad , Adulto JovenRESUMEN
Interviews were conducted with 21 pregnant or recently pregnant African American and Caucasian low-income women living in a rural southeastern community to elicit perceived barriers to seeking help for depressive symptoms in pregnancy and ways to overcome these barriers, as well as intervention suggestions. Participants identified themes regarding barriers to seeking help. These were: (1) lack of trust, (2) judgment/stigma, (3) dissatisfaction with the health care system, and (4) not wanting help. Themes identified regarding overcoming barriers were: (1) facilitating trust and (2) offering support and help. These and other findings point to the importance of integrating women's ideas into culturally sensitive interventions for women with depressive symptoms or depression in pregnancy that can be provided by a psychiatric nurse-practitioner or other mental health provider.
Asunto(s)
Depresión/psicología , Accesibilidad a los Servicios de Salud/organización & administración , Aceptación de la Atención de Salud/psicología , Complicaciones del Embarazo/psicología , Atención Prenatal/organización & administración , Servicios de Salud Rural/organización & administración , Negro o Afroamericano/psicología , Actitud del Personal de Salud , Depresión/prevención & control , Femenino , Grupos Focales , Conducta de Ayuda , Humanos , Evaluación de Necesidades , Investigación Metodológica en Enfermería , Pobreza/psicología , Embarazo , Complicaciones del Embarazo/prevención & control , Mujeres Embarazadas/psicología , Investigación Cualitativa , Grupos de Autoayuda , Apoyo Social , Sudeste de Estados Unidos , Estereotipo , Encuestas y Cuestionarios , Confianza , Población Blanca/psicologíaRESUMEN
This study used a qualitative descriptive research design to discover the relevance and meaning of spirituality in the lives of 130 urban low-income pregnant women by asking the open-ended question, "How does your faith or spirituality affect your pregnancy if at all?" Forty-seven percent of the women in this study described how spirituality affected their pregnancy positively, 45% described that spirituality did not affect them, and 5.4% were unsure. A content analysis of those who answered positively revealed six themes from the data describing the meaning of faith or spirituality in pregnancy: (a) guidance and support; (b) protection, blessing, or reward; (c) communication with God; (d) strength and confidence; (e) help with difficult moral choices; and (f) a generalized positive effect. These findings point to the importance of attending to spirituality as a resource in pregnancy for those who value it and further exploring the meaning of spirituality in pregnancy.
Asunto(s)
Negro o Afroamericano/psicología , Salud Holística , Mujeres Embarazadas/psicología , Calidad de Vida , Espiritualidad , Población Blanca/psicología , Adulto , Femenino , Humanos , Narración , Embarazo , Atención Prenatal/métodos , Encuestas y Cuestionarios , Población Urbana , Salud de la MujerRESUMEN
OBJECTIVES: We previously introduced the concept of the collaborative percutaneous tracheostomy (PercTrach) performed in conjunction with pulmonary medicine/critical care (PCC), and now present a robust experience that validates our original concept of exploiting subspecialty expertise. METHODS: One hundred consecutive PercTrachs were performed. The PCC team performed bronchoscopic guidance, while the otolaryngology team performed the PercTrach using the Blue Rhino introducer set. Demographic data were gathered. RESULTS: One hundred PercTrachs were performed between May 2003 and December 2005. The mean +/- SD patient age was 54.3 +/- 15.9 years. Procedural times ranged from 5 to 37 minutes, with a mean of 12.9 +/- 5.7 minutes. Surgical complications included one patient with bleeding who required surgical intervention. CONCLUSIONS AND SIGNIFICANCE: There are numerous benefits to capitalizing on the respective expertise represented by otolaryngology and PCC including conservation of operating room time, rapid and safe establishment of the tracheostomy, and educational benefits for both programs.
Asunto(s)
Traqueostomía/instrumentación , Adulto , Anciano , Conducta Cooperativa , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Derivación y Consulta , EspecializaciónRESUMEN
Obstructive sleep apnea syndrome is caused by upper airway collapse during inspiration, causing intermittent hypoxemia, hypercapnia, acidosis, sympathetic nervous system activation, and arousal from sleep. Nighttime blood pressure is higher, but unexpectedly, daytime hypertension occurs. The prevalence of hypertension is very high and the incidence of hypertension increases as the number of apneic and hypopneic events per hour rises. Obesity is a major predisposing factor for the development of obstructive sleep apnea. Daytime sleepiness, snoring, and breathing pauses are important symptoms to elicit from the patient or sleep partner. Resistant hypertension is an important clue. Overnight polysomnography is required for diagnosis. Weight loss, avoidance of nocturnal sedatives, cessation of evening alcohol ingestion, and avoidance of the supine position during sleep are initial therapeutic actions in mild obstructive sleep apnea syndrome. Continuous positive airway pressure is the treatment of choice for patients unable to find relief from lifestyle changes. Blood pressure modestly improves with treatment.
Asunto(s)
Apnea Obstructiva del Sueño , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea , Ritmo Circadiano , Presión de las Vías Aéreas Positiva Contínua , Humanos , Hipertensión/etiología , Hipertensión/fisiopatología , Hipertensión/prevención & control , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/fisiopatología , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/epidemiología , Apnea Obstructiva del Sueño/fisiopatología , Apnea Obstructiva del Sueño/terapia , Pérdida de PesoRESUMEN
OBJECTIVE: To investigate the role of a portable screening device (SleepStrip) in the diagnosis of obstructive sleep apnea (OSA). METHODS AND MATERIALS: Prospective, nonrandomized double-blinded single cohort study at an academic health center. Patients with suspected OSA scheduled for an attended overnight Level I polysomnogram (PSG) and who consented to participate in the study wore the SleepStrip device at home the night after the PSG. The apnea-hypopnea index (AHI) determined by PSG was compared with the results of the SleepStrip recording. RESULTS: Thirty-seven patients with a mean age of 52.1 +/- 12.2 years and mean body mass index of 35.7 +/- 5.2 participated in the study. The overall agreement between the AHI and the SleepStrip results using Cohen's Kappa value was 0.139 (P = 0.19). The sensitivity and specificity of the SleepStrip for diagnosing severe OSA when the AHI was >40 were 33.3% and 95% (P = 0.05). When the AHI was >25, the SleepStrip sensitivity and specificity were 43.8% and 81.3% (P = 0.26). The sensitivity and specificity of the SleepStrip for diagnosing OSA in patients with an AHI >15 were 54.6% and 70%, respectively (P = 0.26). CONCLUSION: The SleepStrip has a low correlation with the AHI as measured by PSG. Further studies are needed before this device can be recommended as a screening tool for the diagnosis of OSA. EBM RATING: B-2b.
Asunto(s)
Monitoreo Ambulatorio/instrumentación , Polisomnografía , Apnea Obstructiva del Sueño/diagnóstico , Adolescente , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Tamizaje Masivo/instrumentación , Persona de Mediana Edad , Monitoreo Ambulatorio/métodos , Estudios ProspectivosRESUMEN
OBJECTIVES: Modifications of the percutaneous tracheostomy (PercTrach) technique have made this a straightforward and safe procedure in appropriately selected patients. We sought to determine its value in high-risk patients. STUDY DESIGN/METHODS: A retrospective study of high-risk and low-risk patients on whom bedside PercTrach was performed between May 2003 and October 2004 at the Medical College of Georgia. The patients were prospectively stratified into groups based on their comorbidities (morbid obesity or coagulopathy). The Ciaglia Blue Rhino introducer set was used in all cases. RESULTS: Fifty-four consecutive patients were included in the study; the high-risk patients (n = 16) were younger than the low-risk (n = 38) patients (48.2 vs. 53.6 years, respectively), but had significantly higher Acute Physiology and Chronic Health Evaluation II scores (10.1 vs. 5.4, P = .0001). There were seven morbidly obese patients with a mean body mass index of 64.4 and a mean weight of 184.9 kg. There were 9 patients with a total of 10 coagulopathic conditions (7 = International Normalized Ratio [INR] of >1.5, 2 = heparin drip, 1 = platelet count < 20,000). One patient included in the study met requirements for two categories with a platelet count of 17,000 and an INR of 1.7. The procedural times ranged from 5 to 30 minutes. The high-risk PercTrachs took 14.4 +/- 5.0 minutes on average, compared with 12.2 +/- 4.8 minutes in the low-risk group (P = .115). One patient in the low-risk group bled from an anterior jugular communicating vein injury, requiring wound exploration and vein ligation. There were no other significant complications. CONCLUSIONS: There were no statistically significant differences in intraoperative or perioperative outcomes between the PercTrachs performed in high-risk versus low-risk patients. PercTrachs may be performed safely even in high-risk patients such as those with morbid obesity and coagulopathy.
Asunto(s)
Traqueostomía/métodos , Adulto , Factores de Edad , Anciano , Trastornos de la Coagulación Sanguínea , Comorbilidad , Humanos , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias , Estudios Prospectivos , Factores de Riesgo , Traqueostomía/instrumentación , Resultado del TratamientoRESUMEN
OBJECTIVES: The introduction of percutaneous tracheostomy (PercTrach) has resulted in tension over the scope of practice between otolaryngologists and pulmonary/critical care (PCC) specialists. We sought to determine the value of a collaborative approach to the performance of PercTrach at the bedside in the intensive care unit setting. STUDY DESIGN AND METHODS: A retrospective study of consecutive patients who underwent bedside PercTrach at the Medical College of Georgia between May of 2003 and November of 2003. All cases were performed in conjunction with the PCC team, which typically provided bronchoscopic guidance during the performance of the procedure, whereas the PercTrach was performed by the otolaryngology team, although these roles were occasionally reversed. In all cases, the PercTrach was performed using the Ciaglia Blue Rhino introducer set. RESULTS: Twenty-three patients (12 males, 11 females) with a mean age of 47.6 +/- 14.3 (range 23-65) years underwent PercTrach. The procedural times ranged from 7 to 21 minutes, with a mean of 13.9 +/- 4.4 minutes; this represented 9.6 minutes on average to insert the tracheostomy tube and an additional 4.3 minutes to completely secure the tracheostomy tube. The time interval from consultation to PercTrach was less than 24 hours in 16 of 23 cases (overall mean time to PercTrach = 41.7 +/- 37.1 hours), with delays beyond 24 hours related in most instances to patient stability. CONCLUSION: A multidisciplinary approach to PercTrach results in a number of clinical and educational benefits. Chief among these benefits is a rapid, cost-effective response to requests for elective tracheostomy. Practicing otolaryngologists with a prior bias against this approach (as we had) should reconsider adopting this revised procedure.
Asunto(s)
Broncoscopía/métodos , Conducta Cooperativa , Unidades de Cuidados Intensivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Grupo de Atención al Paciente , Traqueostomía/métodos , Adulto , Anciano , Eficiencia , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Sistemas de Atención de Punto , Estudios Retrospectivos , EspecializaciónRESUMEN
Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States, is increasing worldwide and is projected to be the third leading cause of death in the United States by the year 2020 (1). It affects nearly 16 million Americans, and more than $18 billion is spent annually on medications, physician visits, and hospitalizations. COPD is characterized by chronic airflow obstruction with episodic acute exacerbations, which result in increased morbidity and mortality. Patients hospitalized with exacerbations have an overall mortality rate of 3% to 4%, and up to 24% of patients requiring care in the intensive care unit die (2). Since forced expiratory volume in 1 second correlates closely with life expectancy and exacerbation rate, early diagnosis (through spirometric testing) and prevention may reduce acute exacerbations and health care costs.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Insuficiencia Respiratoria/prevención & control , Enfermedad Aguda , Antibacterianos/uso terapéutico , Broncodilatadores/uso terapéutico , Ensayos Clínicos como Asunto , Expectorantes/uso terapéutico , Glucocorticoides/uso terapéutico , HumanosRESUMEN
Exacerbations of COPD are a major source of morbidity and mortality, resulting in tremendous increases in healthcare costs. Spirometric testing of at-risk persons can help identify patients early in the disease course who may benefit from early intervention to slow the disease process. Avoidance of irritants, smoking cessation, and use of pharmacologic agents aimed at decreasing airflow obstruction are strategies for reducing the frequency and severity of exacerbations. Patients should be educated about modifiable risk factors, such as cigarette smoking, environmental exposures, improper inhaler technique, influenza and pneumonia vaccination, pulmonary rehabilitation, and use of supplemental oxygen. Early, aggressive interventions are necessary to improve quality of life, decrease hospital admissions, improve morbidity and mortality, and reduce overall healthcare costs.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Aguda , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Broncodilatadores/uso terapéutico , Progresión de la Enfermedad , Humanos , Terapia por Inhalación de Oxígeno , Educación del Paciente como Asunto , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Factores de Riesgo , Cese del Hábito de Fumar , EspirometríaRESUMEN
The stress response to critical illness can have many deleterious effects. Appropriate use of sedation and analgesia can attenuate the stress response, alleviate pain and anxiety, and improve compliance with care. Agitation responds best to anxiolytic drugs; pain is best relieved by analgesics. A combination of these drugs can act synergistically, because most analgesics provide some degree of sedation. In select cases, neuromuscular blocking agents are required, but they should not be used without concomitant sedation and analgesia. Use of agents needs to be tailored to the needs of individual patients; indications, anticipated length of need, and underlying organ system derangements are important considerations.
Asunto(s)
Analgésicos/uso terapéutico , Ansiedad/tratamiento farmacológico , Cuidados Críticos , Enfermedad Crítica , Hipnóticos y Sedantes/uso terapéutico , Bloqueantes Neuromusculares/uso terapéutico , Dolor/tratamiento farmacológico , Estrés Fisiológico/tratamiento farmacológico , Analgésicos/efectos adversos , Ansiedad/fisiopatología , Humanos , Hipnóticos y Sedantes/efectos adversos , Monitoreo Fisiológico , Bloqueantes Neuromusculares/efectos adversos , Dolor/fisiopatología , Estrés Fisiológico/fisiopatologíaRESUMEN
OBJECTIVES: To determine if the mean sleep latency (mSL) and the presence of significant sleep onset rapid eye movement periods (SOREMPs) can be predicted from the results of the first three naps in selected patients undergoing multiple sleep latency test (MSLT). METHODS: Retrospective analysis of a number of MSLTs to identify the tests in which the mSL category and the presence of > or =2 naps with SOREMPS can be accurately predicted from the sleep latencies (SLs) of and SOREMPs in the first three naps. RESULTS: The study included 588 consecutive MSLTs performed on 552 patients during a 3-year period. (1) The mSL was normal (> or =10 min) for all MSLTs (n=90, 15%) if either (a) the SL was normal in each of the first three naps, or (b) SL was 20 min for any two of the first three naps. (2) The mSL was low (<5 min) or borderline (> or =5 and <10 min) for 99% MSLTs with SL in the low or borderline categories, respectively. (3) The accuracy of predicting > or =2 naps with SOREMPs was 100% (normal SL), 96% (borderline SL), and 89% (low SL). (4) The mSL category (normal or low) and the presence of > or =2 naps with SOREMPs were predicted with 100% accuracy in 23% of all MSLTs. CONCLUSIONS: The category of mSL can be predicted with >99% accuracy, if SL is normal, borderline, or low in each of the first three naps, or if the patient does not sleep in any two of the first three naps. MSLT can probably be shortened to three naps in up to 23% to reduce time, labor, discomfort, and cost of the test.