Kenneth C. Pike

Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival.

BACKGROUND Although psychosocial therapy has been shown to reduce mortality after myocardial infarction, it is unknown whether the benefits of psychosocial therapy on mortality reduction extend to out-of-hospital sudden cardiac arrest, a main cause of cardiovascular mortality. OBJECTIVE Describe efficacy of psychosocial therapy on two-year cardiovascular mortality in sudden cardiac arrest survivors. METHOD Survivors of out-of-hospital ventricular fibrillation or asystole (N = 129), documented by electrocardiograms from registries of a citywide Medic One unit and two countywide emergency units, were randomized into a two group, experimental, longitudinal design. The intervention consisted of 11 individual sessions, implementing three components: physiologic relaxation with biofeedback training focused on altering autonomic tone; cognitive behavioral therapy aimed at self-management and coping strategies for depression, anxiety, and anger; and cardiovascular health education. The primary outcome measure was cardiovascular mortality. RESULTS Risk of cardiovascular death was significantly reduced 86% by psychosocial therapy, p = .03. Six of the seven cardiovascular deaths in the control group were caused by ventricular arrhythmias. The cardiovascular death in the therapy group was due to stroke. Controlling for depression, previous myocardial infarction, low ejection fraction, decreased heart rate variability, and ventricular ectopic beats had little impact on estimated treatment effect. The risk of all-cause mortality was reduced by 62% in the therapy group, p = .13. There were a total of three deaths in the therapy group and eight deaths in the control group. CONCLUSIONS Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.

Increasing Walking and Bright Light Exposure to Improve Sleep in Community‐Dwelling Persons with Alzheimer's Disease: Results of a Randomized, Controlled Trial

OBJECTIVES: To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimers disease (AD).

Early-Stage Memory Loss Support Groups: Outcomes from a Randomized Controlled Clinical Trial

OBJECTIVES This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimers Association chapter to a wait-list (WL) control condition. METHODS One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participants quality of life; secondary outcomes included mood, family communication, and perceived stress. RESULTS On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role-emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers. DISCUSSION These results support the efficacy of ESML support groups for individuals with dementia.

Effects of gender and age on heart rate variability in healthy individuals and in persons after sudden cardiac arrest.

The purpose of this study was to describe the effects of gender and age on heart rate variability (HRV) in healthy volunteers (n = 111; 40 men and 71 women) and in persons after sudden cardiac arrest (SCA) (n = 95; 79 men and 16 women). Frequency-domain measurements and six time-domain measurements of HRV (SDANN, 24-hour SD, SD, RMSSD, RR50, and %RR50) were taken. Two-factor analysis of variance was performed. In general, HRV was significantly lower in healthy women compared with healthy men in all the time-domain and frequency-domain variables except for the high-frequency components, RMSSD, RR50, and %RR50. There were no significant gender differences in the SCA sample. All the time-domain and frequency-domain measurements decreased with age in the healthy sample, but only the frequency-domain measurements decreased with age in the SCA sample.

Occupational Stressors, Stress Responses, and Alcohol Consumption Among Professional Firefighters: A Prospective, Longitudinal Analysis

This dual-site longitudinal prospective study monitored and measured change in self-reported occupational stressors, emotional trauma, symptoms of stress, and alcohol consumption in urban firefighters. Study participants were 188 firefighters employed by two urban fire departments. The results showed that of 19 occupational stressors examined, only 5 (26%) changed significantly over time, and of those 5, only two—job skill concerns and concerns regarding reduction in force and benefits—decreased, reflecting less bothersome subjective ratings. Of the 12 measures of posttraumatic and other symptoms of stress, 9 (75%) increased significantly over time and none decreased significantly, whereas alcohol consumption was stable over time. Job stressors, trauma caseness, and stress response symptoms at baseline were strongly and significantly associated with the same measures at the two-year follow-up. The implications of the findings for prevention and remediation of stress disorders in fire service personnel are considered. It can be concluded that the stressful nature of urban firefighting is significantly associated with negative health outcomes, including the potential overreliance on alcohol use.

Improving Dementia Care in Assisted Living Residences: Addressing Staff Reactions to Training

More than 1 million older adults, many with significant cognitive impairment, receive care in assisted living residences (ALRs), and their numbers are increasing. Despite this, ALR staff are often inadequately trained to manage the complex emotional, behavioral, and functional impairments characteristic of these residents. Nurses are in a unique position to improve this situation by training and supervising ALR staff. To facilitate such training, an understanding of staff reactions to receiving training as well as a systematic yet flexible method for training is needed. This article provides information on one such program (STAR-Staff Training in Assisted-living Residences), discusses challenges that arose when offering this program across 3 states in 6 diverse ALRs (rural, urban, for-profit, and not-for-profit sites), and describes how these challenges were addressed. We illustrate how nurses can successfully train ALR staff to improve resident and staff outcomes and offer guidance for those interested in providing such training.

Dimensions of physical frailty and cognitive function in older adults with amnestic mild cognitive impairment.

OBJECTIVE The objective of this study was to examine relationships between dimensions of physical frailty and severity of cognitive impairment in older adults with amnestic mild cognitive impairment (aMCI). PATIENTS AND METHODS The prevalence of physical frailty dimensions including slow gait speed, low physical activity, and low grip strength was examined among 201 sedentary older adults with aMCI. Associations between dimensions of physical frailty and severity of cognitive impairment, as measured with the Alzheimers Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) and individual dimensions of cognitive function were examined using multiple linear regression models. RESULTS Greater than 50% of participants met physical frailty criteria on dimensions of slow gait speed, low physical activity and low grip strength. Slower gait speed was associated with elevated severity of cognitive impairment. Both gait speed and physical activity were associated with individual dimensions cognitive function. CONCLUSIONS Dimensions of physical frailty, particularly gait speed, were associated with severity of cognitive impairment, after adjusting for age, sex and age-related factors. Further studies are needed to investigate mechanisms and early intervention strategies that assist older adults with aMCI to maintain function and independence.

Sampling Bias and Other Methodological Threats to the Validity of Health Survey Research

Data from a longitudinal occupational health survey of professional fire fighters were used to explore the potential impact of two types of methodological bias: sample selection and reactivity. No significant differences on demographic variables were observed between the group who first responded after a within-study change in survey administration format (Delayed) and respondents who had completed surveys since the studys inception (Initial). However, statistically significant differences in the studys 26 outcome measures provided some evidence that between-group differences did exist and that an “administration format” type of response bias was also potentially present. The effect sizes associated with the 37 observed significant differences ranged from small to medium. These results provide a context for a reexamination of standard techniques for the identification and interpretation of survey research biases. Methods are suggested to strengthen tests for selection bias and to minimize the impact of response biases.

Work and nonwork stressors, negative affective states, and pain complaints among firefighters and paramedics

Prior research has suggested that occupational stressors may contribute to the etiology, progression, and chronicity of pain problems in workers. This study used anonymous survey methods to assess the prevalence and frequency of self-reported pain symptoms and their relationships to demographic variables, sources of occupational stressors, nonwork stressors and affective distress in a large sample (N≈2000) of employed career public sector firefighters and paramedics. The findings were consistent with those of previous studies of high strain workers. More than 95% of the firefighter/paramedic sample reported at least one pain complaint (using a 1 week assessment time frame). A hierarchical multiple regression analysis entering demographic, occupational, and nonwork stressors, as well as measures of negative affective states targeting total pain scores, yielded significant relationships. Five occupational stressors were associated with respondent pain complaints. The results also suggest that negative affective states mediated the relationships between work and nonwork variables, and pain complaint outcomes. The implications of these findings for the development of preventive interventions for firefighters and paramedics as well as other emergency service workers are considered.

Promoting CARE: including parents in youth suicide prevention.

This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an “intervention as usual” (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.