Continuous quality improvement to an electroconvulsive therapy delivery system

1. ECT is known to be highly effective in relieving severe depression; however, there are few published articles focusing on nursing care of patients receiving ECT. 2. Education is an important component of nursing care. Lack of information about ECT can cause a high level of anxiety and reluctance to consent to ECT. 3. Using the Continuous Quality Improvement Model, nurses can improve the quality of a whole system of care delivery.     

Effect of frequent WBC treatments on the back pain therapy in elderly men

Abstract

Cryotherapy is the application of a stimulus of a cryotherapeutic temperature below ?100?°C in a period of 1–3?min in order to stimulate and use physiological reactions of human body to cold. It can be applied to specific body parts or to a whole body. Whole-body cryotherapy is a treatment method applied in treatment of motor organ issues, nervous system diseases, psychiatry, dermatology and laryngology. The research group consisted of 80 male in the age range of 65–77 suffering from chronic, lasting more than 3 months, lower back pain. The subjects qualified to the research were divided into two groups. Group A consisted of 40 patients who participated in whole-body cryotherapy (WBC) twice a week. Group B also contained 40 patients who participated in WBC whole week. Examinations were conducted twice. The first one was conducted before the commencement of the treatment while the second one after the therapy was over. The results of the research did not show any statistically significant improvement in patients from Group A. However, the results obtained by Group B have proven significant condition improvement and enable the researchers to conclude that WBC is effective in treating patients with lower back pain.     

Outcome of an interdisciplinary pain management program in a rehabilitation clinic

The Chronic Pain Section at Reykjalundur has 33 beds for patients with various chronic pain problems. About 200 patients are treated annually. For 3 years, 158 patients were enrolled in a random study focusing on increasing the patients' functioning and eliminating analgesic drugs through an interdisciplinary rehabilitation program. Patients answered a questionnaire at admission, before discharge from the clinic and about one year after discharge. The follow-up was done with a mailed questionnaire. The focus was on the patients' functioning rather than absence of pain. The program's duration was 7 weeks. The first 2 weeks were utilized for evaluation, information and education (pain school). Pain relieving drugs were gradually withdrawn but anti-inflammatory drugs were used when indicated. Cognitive behavioral therapy was applied in an increasing number of cases over the 3 year period by specially trained nurses and a psychiatrist. Pain, anxiety and depression were self-evaluated on a numeric rating scale (NRS). About 50% of the patients had a history of pain for more than 5 years. Low back pain was the most common diagnosis (48.1%) and 28.5% had post-traumatic pain. A significant reduction in pain, anxiety and depression was found both at discharge (p < 0.0001) and at follow-up (p < 0.001). Before entering the program, only 18.4% of the patients were able to work whereas 48.1% returned to work after discharge and 59.2% were working at follow-up.     

An analysis of VDT monitor placement and daily hours of use for female bifocal users

A population of 72 bifocal wearers was studied to determine the relationship between VDT (video display terminal) placement for those who reported musculoskeletal pain and those who did not. The mean hours worked was 50.4 minutes (p=0.003) greater for those who reported head/neck pain versus those who did not and 48.6 minutes (p=0.004) greater for those who reported shoulder/arm pain that those who did not. There was no statistically significant difference between the means of monitor height, distance, or angle for those who reported pain symptoms versus those who did not. This study indicates that, self reported pain symptoms are correlated with hours of VDT work and that there appears to be a threshold at approximately five hours for pain symptoms among bifocal wearers. No such correlation can be made for monitor placement     

Yoga for stress reduction and injury prevention at work

At work employees face numerous psychological stressors that can undermine their work performance. These stressors, stemming from a variety of possible causes, have enormous health and financial impacts on employees as well as employers. Stress has been shown to be one of the factors leading to musculo-skeletal disorders (MSDs) such as: include back pain, carpal tunnel syndrome, shoulder or neck tension, eye strain, or headaches. Yoga is an ancient form of exercise that can reduce stress and relieve muscular tension or pain. Practicing yoga at the workplace teaches employees to use relaxation techniques to reduce stress and risks of injury on the job. Yoga at the workplace is a convenient and practical outlet that improves work performance by relieving tension and job stress.     

Functional disability among chronic pain patients receiving long-term opioid treatment

This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer were more likely to have worse disability on all 3 measures (average pain interference score >5, OR = 5.36, p < .0001; activity limitation days ≥ 30, OR = 4.05, p < .0001; unemployed due to health reasons, OR = 4.06, p < .0001). Depression might play a crucial role in the lives of these patients; identifying and treating depression symptoms in chronic pain patients should be a priority.     

Field study of age-differentiated strain for assembly line workers in the automotive industry

A field study in an automotive supply industry company was conducted to explore age-differentiated strain of assembly line workers. Subjective and objective data from 23 female workers aged between 27 and 57 years were collected at the workplace belt buckle assembly during morning shifts. Subjects with medication or chronic diseases affecting heart rate and breath rate were excluded. For subjective data generation different questionnaires were used. Before the Work Ability Index and the Munich Chronotype Questionnaire were completed by the subjects. Short questionnaires (strain-ratings, NASA-TLX) directly at begin and end of the work were used for obtaining shift-related data. During the whole shift (6 a.m. - 2.45 p.m.) bodily functions were logged with a wireless chest strap. In addition, the motion of the hand-arm-system was recorded for 30 times, 3 minutes each after a fixed time-schedule. First results show that younger subjects need significant less time for assembly (mean = 14.940 s) compared to older subjects (mean = 17.040 s; t(472.026) = -9.278 , p < 0.01).     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

Campus walkability, pedometer-determined steps, and moderate-to-vigorous physical activity: a comparison of 2 university campuses

OBJECTIVE AND PARTICIPANTS: At 2 Arizona State University (ASU) campuses, the authors measured student activity and distance walked on campus, as well as student-reported walkability around the student union. METHODS: Students from ASU-Polytechnic (n = 20, 33% male) and ASU-Tempe (n = 20, 60% male) recorded distance walked on campus and wore physical activity monitors for 5 days. RESULTS: Polytechnic students spent an average of 36.9 minutes in moderate-to-vigorous physical activity each week; Tempe students spent 69.5 minutes (p < .001). At Polytechnic, students walked an average of 7,674 steps per weekday; at Tempe, 11,294 steps (p = .003). Female students at Polytechnic walked an average of 1.3 km/d; at Tempe, 4.3 km/d (p < .001). At Polytechnic, men walked an average of 1.4 km/d; at Tempe, 3.1 km/d (p = .03). Tempe students rated campus walk-ability as very good, whereas Polytechnic students rated it fair (p < .001). CONCLUSIONS: Students at both campuses met activity recommendations; noted differences may be attributed to the built environment's contribution to walkability.     

The antidepressant nefazodone. A review of its pharmacology, clinical efficacy, adverse effects, dosage, and administration

Nefazodone is an antidepressant medication which received approval from the Food and Drug Administration for treatment of major depressive disorder in 1994. This article summarizes the pharmacodynamics, pharmacokinetics, adverse effects, and drug interactions of nefazodone as well as its administration and dosing schedule. The potential efficacy of nefazodone in treating anxiety, premenstrual syndrome, chronic pain conditions, and sleep disturbances also is summarized. Nefazodone has a favorable side effects profile which makes it an attractive alternative option for patients who withdraw from treatment when they develop adverse effects to other available antidepressants.     

Is Pain a Significant Factor in Elder Self-Neglect?

ABSTRACT

Purpose. Pain is a worldwide health concern leading to cognitive impairments, depression, and decline in activities of daily living when poorly controlled. Self-neglect is also a serious public health issue being the most common allegation reported to Adult Protective Services (APS). The purpose of this analysis is to determine whether self-reported pain is associated with validated cases of self-neglect compared with matched controls.

Methods. This is a cross-sectional study of 80 (APS) validated cases of self-neglect aged 65 years and older and 80 control participants recruited from a geriatric clinic at Harris County Hospital District. Control participants were matched for age, race, gender, and zip code. Both groups were administered the Wong-Baker FACES rating scale and the Mini-Mental State Examination in their homes by a geriatric nurse practitioner and a research assistant.

Summary of Results. Self-reported pain was noted in 43% of the self-neglect group compared with only 28% in the control group (χ² = 3.85, df = 1, p = .05). This difference became non-significant after stratifying for MMSE scores of 19 or greater (χ² = 3.38, df = 1, p = .066). The self-neglecting elderly also reported significantly higher levels of pain compared with the matched controls (t = 2.5, df = 143, p = .014). This mean difference remained significant after stratifying by MMSE scores of 19 or greater (t = 2.6, df = 124, p = .009).

Conclusion. The data provide preliminary support for the relationship between self-reported pain and elder self-neglect. Research is needed to determine whether pain is a causal or associated factor in self-neglect and whether therapeutic intervention can improve the syndrome of self-neglect.     

Dying patients' thoughts of ending their lives: a pilot study of rural New Mexico

Forty-nine hospice patients in rural New Mexico were directly interviewed concerning their thoughts about ending their lives. Thirty-one patients (63%) did not have thoughts of ending their lives, whereas 18 patients (37%) reported having suicidal thoughts. There were no differences between patients with and without thoughts of suicide related to gender; ethnicity; age; education; disease; religion; importance of religion; location of hospice agency; remaining financial, family, or spiritual issues; satisfaction with hospice care; sum of hospice personnel seen; or sum of medical equipment used. There were significant differences between patients with and without thoughts of suicide related to the number of household members (p = .02); the symptoms of trouble sleeping (p = .04) and nervousness (p =.03); and Medicare insurance coverage for hospice care (p =.01). No other symptom, including pain and hopelessness, was significant. Seven (39%) of the 18 patients who thought of ending their lives told someone about these thoughts. There were no variable differences between patients who did and did not tell someone about these thoughts.     

Recurrent pain in college students.

The authors investigated the prevalence of recurrent pain in a college student sample. Of the 1,564 students surveyed, 467 (29%) indicated that they had experienced recurrent pain at an intensity that was mostly in the mild-to-moderate range. Students who reported having recurrent pain were significantly older and more depressed than students who did not indicate they suffered from recurrent pain. Pain intensity was positively correlated (r = .14) with depression among the students who reported having recurrent pain. Implications of the findings for future research, treatment, and health promotion efforts are discussed.     

Decentering constructs predict experience and tolerance of pain: evidence from a cold pressor study / Constructos relacionados con el descentramiento predicen la experiencia y la tolerancia al dolor: evidencia obtenida mediante la prueba del frío

Abstract

Decentering is a detached, observer perspective on one’s current mental contents. Recent work has identified two potential aspects of decentering, Observer Perspective (OP) and Reduced Struggle (RS), that independently predict the effects of decentering. Specifically, both OP and RS predict reduced psychological distress in response to negative affect, with some variability in predictive utility across outcomes. In this study, we sought to extend previous work by examining OP and RS as predictors of responses to an external source of distress, a painful stimulus. Participants completed measures of decentering, followed by a cold pressor task for up to four minutes. We recorded time that participants were able to withstand the cold-water bath and the intensity of the pain experienced. We found that both OP and RS predicted partiacipants’ pain tolerance and pain intensity, but that only RS did so uniquely. Results are discussed with respect to theory on decentering.     

Factors associated with exercise participation in adults with arthritis

Most people with arthritis are not regularly active. Understanding what factors influence exercise is essential for designing programs to increase participation. The objective of this study was to examine the correlates of exercise in people with arthritis. Using a cross-sectional design, sociodemographic, health-related, and psychosocial variables were collected from community-dwelling individuals with arthritis (N = 141). Associations with exercise level were examined with bivariate statistics (ANOVAs, chi-squares) and logistic-regression analyses. Exercisers were less likely than nonexercisers and insufficiently active people to report that arthritis negatively affected their physical and social functioning, and they reported more positive affect and greater self-efficacy (p < .05). Exercisers also reported less pain than nonexercisers (p < .05). In multiple logistic-regression analyses, self-efficacy and physical limitations remained independent predictors of exercise. The results suggest the need to target exercise self-efficacy when designing exercise interventions. Results also suggest the need to tailor exercise programs to individuals' physical limitations.     

Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Effect of ergonomic and workstyle risk factors on work related musculoskeletal disorders among IT professionals in India

'Workstyle' can be described as a mechanism by which ergonomic and psychosocial risk factors interact to affect the development, exacerbation and/or maintenance of upper limb pain and functional limitations. Workstyle is associated with the increase in the work demand. In today's life use of computer in the workplace is very common and it causes to increase the work demand among the workers who are working with computer. As work demand increase, according to the characteristic of workstyle, risk of the development of musculoskeletal disorders also increased. This study aimed at to findout the association between ergonomics risk factors, workstyle and WRMSD. Two hundred IT professionals participated in this study. Result revealed that most prevalenet body regions were lower back (20%), Upper back (16%) and shoulder (14%). Study result says that there is a positive association between workstyle score with musculoskeletal pain (r=0.85). Also it revealed that posture and regional pain is associated (r=0.62), per day use of computer and musculoskeletal pain (r=0.46), micro breaks and pain (r=0.87) and productivity and the pain (r=0.95). This study further validates these observations and extends support for the assessment of working postures and workstyle behaviors during the design of WMSD treatment.     

Female sexual pain disorders and cognitive behavioral therapy

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.