A day at a time: Predicting smoking lapse from daily urge.

Smokers who recently quit (N?=?214) monitored smoking urges for up to 26 days after quitting. Computers administered 4–5 assessments daily at random times; participants rated urges on waking and when they experienced temptation episodes. Urge intensity after cessation did not generally exceed urges reported during baseline ad lib smoking. Urge intensity and temptation frequency consistently declined over the quit period. Controlling for urge intensity at baseline, all daily urge intensity measures predicted lapse the following day in proportional hazards survival analyses. Average duration of temptation episodes also predicted lapses; frequency of temptation did not. To isolate the effect of day-to-day variations in urges, participants' nicotine dependence and urge intensity on quit day were controlled for. Only urge intensity at waking still predicted lapse risk; this was not because of this measure being closer in time to the day's lapses. Among lapsers, urge intensity at waking and in temptations rose preceding a lapse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empathy and the collective good: Caring for one of the others in a social dilemma.

We predicted that feeling empathy for another member of the collective in a social dilemma would create an altruistic desire to allocate resources to that person as an individual, reducing collective good. To test this prediction, 2 studies were run. In each, participants faced a dilemma in which they could choose to benefit themselves, the group, or other group members as individuals. In Study 1, empathy for another group member was manipulated; in Study 2, naturally occurring empathic response was determined by self-report. In both studies, participants who experienced high empathy allocated more resources to the target of empathy, reducing the overall collective good. These results suggest the importance of considering self-interest, collective interest, and other-interest (altruism) as three distinct motives, each of which may operate in social dilemmas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing time for greater effectiveness: designing doctor''s ideal day

We cannot rely on geriatricians, internists, and family practitioners alone in the medical community to provide all of the geriatric care. Even though there are alternatives to the use of specialists, we cannot afford to ignore the largest group of current physician trainees who will provide a great deal of geriatric medical care in the future. We need to help make the basic principles of geriatric care part of every training program for every resident, whether in general or specialty programs.     

Educating the elderly diabetic at a day hospital

Elderly people who develop diabetes should have an individual programme of education, tailor-made after assessing their physical and social needs. Avoid bombarding them with too much information, much of which may be inappropriate and even frightening. The Day Hospital, with its multidisciplinary team of nurse, doctor, social worker, physiotherapist and occupational therapist, is an ideal setting for educating and supervising the elderly diabetic. Ongoing assessment is provided through regular monitoring, education through games and group discussions, and home visits where necessary     

Caring for AIDS patients at home--requirements for development of the concept

Exercise tolerance in chronic obstructive pulmonary disease (COPD) patients treated with oral aminophylline may be different from those treated with high-dose inhaled ipratropium bromide. The purpose of this study was to compare the effects of therapeutic doses of oral aminophylline with high-dose ipratropium bromide on spirometry and exercise tolerance. The study was conducted on three consecutive days in a double-blind, randomized, crossover fashion. Baseline studies obtained on each study day included vital signs, simple spirometry and a symptom-limited maximal cardiopulmonary stress test, after which patients received one of the following treatments on each day: Treatment 1, inhaled ipratropium (total dose of 144 micrograms) with placebo tablets; Treatment 2, inhaled placebo with oral aminophylline (400 mg); Treatment 3, inhaled placebo and placebo tablets. Simple spirometry was repeated at 60 and 120 min after baseline. Vital signs and cardiopulmonary stress testing was repeated at 120 min. Eighteen patients were enrolled in the study, and 17 of these completed the study. There was a significant (P < 0.05) increase in both forced expiratory volume in 1 s (FEV1), from 0.75 (0.21) to 0.92 (0.3), and forced vital capacity (FVC), from 1.8 (0.79) to 2.11 (0.84), with high-dose ipratropium despite prior beta-agonist therapy. Lack of improvement in exercise capacity was noted with ipratropium despite improvement in spirometry. These results suggest that elderly patients with severe COPD may have exercise limitation that is not directly dependent on severity of airflow obstruction. Ipratropium bromide and aminophylline demonstrated no acute effects on exercise capacity.     

The influence of hypnosis on memory after one day and one week.

High- and low-hypnotizable subjects were given repeated tests in either hypnotic or wake conditions to recall pictures they had seen either one day or one week earlier. Hypnotic procedures were associated with increased memory performance by subjects; specifically, hypnotic subjects reported more correct material. Also, hypnotic procedures were associated with increased confidence in memory reports; in particular, high-hypnotizable subjects tested in the hypnotic condition displayed the most confident errors. The pattern of findings for subjects tested after one day differed from that of subjects tested after one week, and this difference was related to the subjects' hypnotizability. Findings are discussed in terms of memory performance and the confidence associated with that performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caring for caregivers

In home health nursing, the whole family is the client. In a recent issue of Home Care Provider, Knox and Thobaben discussed the need to identify the significant family members who influence health care resources and decisions. Whatever their relationship to the patient, these individuals frequently provide his or her primary care.     

Designing and developing a new high dependency unit. Here's one I prepared earlier...

A new high dependency unit is established for postoperative cardiac patients, from design to implementation Facilities were incorporated within financial, time and space constraints. Layout and use of space was determined for optimal working conditions and care of the patient. The choice of equipment was a vital part of the high dependency unit. The crucial role of nurses in this project is emphasised.     

Caring for a family member with a traumatic brain injury

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.     

Improving everyday error detection, one picture at a time: A performance-based study of everyday task training.

Objective: Research suggests that dementia patients detect fewer action errors than age-matched controls; however, little is known about the derivation of their error-monitoring difficulties. The aims of the study are to evaluate a novel, task-training action intervention (TT-NAT) designed to increase error monitoring in dementia patients and to pinpoint the relation between error monitoring and neuropsychological processes. Method: Participants (n = 45) with dementia were administered the Standard NAT, a performance-based test requiring completion of three everyday tasks. A second group (n = 42) was administered the TT-NAT, which includes a brief training session prior to the commencement of each task. All participants were compared on the following variables: total errors, proportion of errors detected, and proportion of errors corrected. Correlations between error-monitoring variables and neuropsychological tests of executive functioning and language were performed. Results: TT-NAT participants produced fewer total errors and detected significantly more errors than Standard NAT participants (z = 3.0; t = 3.36; p     

Caring for the caregivers

The relationship between disabled elderly veteran care receivers' functional status and their in-home family caregivers' strain was examined in this study. The convenience sample was composed of 93 dyads. Data were obtained from care receivers' health care records and included the Folstein Mini-Mental State Examination (MMS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (ADL), and Robinson's Caregiver Strain Index (CSI). Major findings were: 52% of caregivers experienced significant strain; 59% of care receivers were cognitively impaired to some extent and were severely impaired in IADL and ADL; and the relationships between care receivers' functional status (cognitive, ADL and IADL) and caregiver strain were statistically significant.     

Caring for the hypochondriac

The patient's manner and the content of his complaints offer early diagnostic leads. The hypochondriac clings to his symptoms. Rather than relief, his goal is forming a relationship with the doctor that provides care and understanding. The physician's goal must be the provision of this care in such manner as to reassure, treat sparingly and convert this potentially fatal illness to a chronic disorder with which the patient can function to the limits of his capabilities.     

Scientific opportunities ... ''taken at the flood''

Rodent trapping and drag sampling in Van Cortlandt Park, New York City, yielded all stages of Ixodes scapularis, the deer tick vector of Lyme disease and human granulocytic ehrlichiosis (HGE). Polymerase chain reaction analyses of the ticks showed Borrelia burgdorferi and the Ehrlichia sp. that causes HGE.