Stephanie J. Richardson

Prevalence of sleep disturbance and its relationship to pain in adults with chronic pain

The study examined the prevalence and relationship between sleep disturbance and chronic pain. Research questions were: (1) What is the prevalence of sleep disturbance in adults with chronic pain, and how does this prevalence compare with healthy and insomniac adults? (2) What is the relationship between sleep disturbance and chronic pain? (3) What is the relationship of patient characteristics to sleep? This descriptive, correlational field study was done at an interdisciplinary pain clinic, sampling 99 adults, and using an 11-point pain scale and a visual analog sleep scale. For every disturbance item, more than 47% of subjects reported a score of 50 or higher, twice as high as those for healthy adults, indicating disrupted sleep. For every effectiveness item, more than 54% of subjects reported a score of 50 or less, significantly lower than for healthy adults, indicating poor sleep quality. For every supplementation item, more than 60% reported mean scores of 10 or less, indicating minimal napping, yet scores were higher than for healthy adults. For all three scales, scores were similar to the mean scores for insomniacs. Soundness of sleep showed a small but significant positive (r <.30) correlation with years of pain. Supplementation scale items were not correlated with either years of pain or pain intensity. Fragmentation was significant on the basis of gender, with men having higher scores than women. Age was a negative predictor of sleep latency. Education and age were negative predictors of the quality of sleep.

Effects of relaxation and imagery on the sleep of critically ill adults.

The purpose of this study was to determine the effects of relaxation and imagery on the sleep of critically ill adults. The study was an experimental clinical trial with random assignment to two groups. Analysis used repeated measures ANOVA. Thirty-six adults (17 males and 19 females) with a variety of physical diagnoses in three critical-care units in two large metropolitan hospitals were studied. Outcome measures were scores on a visual analog sleep scale, measured on three mornings. The intervention was a combination of relaxation and imagery, delivered on two evenings. All subjects’ sleep improved over time. There were significant interaction effects between the intervention, gender, and time, with males’ scores improving rapidly, and females’ scores first dropping, then improving rapidly. A combination of relaxation and imagery is effective in improving the sleep of the critically ill adult, with men responding immediately to relaxation and imagery with improved sleep, and women taking more time to respond to the intervention.

A collaborative preceptor model for clinical teaching of beginning nursing students.

With decreased clinical and faculty resources, monitoring students in the clinical area for safety and progress can be difficult. The authors discuss a project that used preceptors for selected beginning students to address issues related to high student-to-faculty ratios, individualized teaching, role modeling, and increased faculty time for scholarship. Based on student evaluation of the pilot project, the authors recommend using nurse preceptors for teaching beginning nursing students.

The formation of the oceanic temperate forests of New Zealand

ABSTRACT The pre-clearance New Zealand lowlands were largely in complex, liana-rich, multi-layered conifer–angiosperm forest. Here it is designated oceanic temperate forest (OTF), its climatic envelope is defined, global distribution is assessed and origin is reviewed. Often described as Gondwanan or relic, tree genera characteristic of the OTF are more likely to be shared with tropical regions to the north than with temperate fragments of Gondwana (southern Australia, southern South America). The OTF arose out of the warm temperate to subtropical forests of Zealandia that formed during the Palaeogene. Warm, fire-prone environments in the middle Miocene permitted an influx of Australian taxa. During the Pliocene/Pleistocene increasingly cool climates, less fire and loss of old, leached soils, reduced floristic diversity. Many low-nutrient specialists and arid-adapted Australian-origin taxa were lost, along with many now exclusively tropical genera. Reduction in ectomycorrhizal tall tree genera left only Nothofagaceae and myrtaceous Kunzea and thus OTF formations are largely arbuscular mycorrhizal. Lack of fast-growing, ectomycorrhizal cold-tolerant trees is a key reason for the marked physiognomic differences between northern temperate broadleaved forests and those of the New Zealand OTF. The pronounced oscillations in extent of dry, cool habitats and warm, moist habitats in this isolated archipelago during the Pleistocene had a profound effect on the composition and distribution of the OTF. We suggest two drivers have strongly modified both geographic and trait distribution in the flora. First, ‘glacial–interglacial asymmetry’—trees adapted to harsh glacial climates have more difficulty persisting in the face of strong biotic competition in warm, wet interglacial landscapes than trees adapted to interglacials do in persisting in climatically protected sites in cold, dry glacial landscapes. And second, the ‘Pleistocene ratchet’—the propensity of many forest species that lose range during a glacial (or interglacial) to fail to recover it entirely during the subsequent interglacial (glacial).

A comparison of tools for the assessment of sleep pattern disturbance in critically ill adults.

Sleep pattern disturbance is a common nursing diagnosis among critically ill adults. Using nursing judgement in selecting the sleep assessment tool to be used in a critical care unit is a complex process that can help identify the insomnia more precisely and can lead to nursing interventions tailored to the individual patients needs and situation.

Sleep Patterns in Older Bereaved Spouses

The study examined the prevalence and pattern of reports of sleep disturbance over two years in a group of 296 adults aged 50 years and over, and assessed the relationship between patterns of sleep disturbance and bereavement adjustment over time. A sample of 192 widows and widowers were compared to a matched sample of 104 non-bereaved persons. About half of the bereaved respondents experienced sleep disruption in the first month following their loss. Regardless of bereavement status, one-third of the sample experienced ongoing sleep disruption, and 10% consulted a physician for difficulty sleeping. Persons with a pattern of consistent sleep disturbance showed statistically significant differences in grief outcomes that persisted over time and tended to be female, older, with poor health, and taking more medications.

Relationships, gene flow and species boundaries among New Zealand Fuscospora (Nothofagaceae: southern beech)

We analysed DNA profiles at eight simple sequence repeat (SSR) loci for 449 individuals of Fuscospora species from New Zealand. The two species with serrated leaves (F. fusca and F. truncata) are clearly distinct genetically despite the occurrence of wild hybrids. Further, from our results, we infer that they are no more closely related to each other than they are to either of the entire-leaved species (F. cliffortioides and F. solandri). Although genetic groups corresponding with F. cliffortioides and F. solandri can be distinguished, our data suggest that considerable admixture may occur between them in some areas. Nonetheless, the broadly sympatric distribution of these two genetic groups, and their consistency with morphological and ecological groups, support their recognition at species rank rather than their treatment as varieties of one variable species.

Redundancy in a computer-generated order list: meeting the needs of nurses at various levels of practice expertise.

Paper-based clinical practice standards usually pertain to a single diagnosis or clinical condition. When a computerized provider order entry system applies multiple paper-based practice standards to one patient, it generates an order list containing redundant orders. Nurses respond to redundant orders on the basis of their level of nursing expertise with clinical care, computers, and practice standard domains. In this project, orders from three practice standards were manually combined to create a single order list, resulting in 15 duplicate and overlapping orders. A relational database was developed to test the automated removal of redundant orders. As expected, the automatically evaluated order list contained only one of each duplicate order and only the parent of each overlapping order group. Orders were then grouped by related system or function for readability. It is possible to automate the removal of duplicate and overlapping orders from an order list before display to the nurse.

Medical students' perspectives on biomedical informatics learning objectives

Objectives: To explore medical student perspectives regarding the importance of biomedical informatics learning objectives to career development, and the amount of emphasis that should be placed on content associated with these objectives in the curriculum. Methods A Web-based survey was e-mailed to 405 students enrolled at the University of Utah, School of Medicine in spring 2008. Respondents rated the importance of biomedical informatics learning objectives using a five-point Likert-type scale, and indicated whether this content should be given a minimal, moderate or large amount of emphasis. ANOVA and the Kruskal-Wallis test were conducted to determine differences in perceived importance and desired emphasis by academic year. Results A total of 259 medical students submitted a survey for an overall response rate of 63.9%. Learning objectives associated with the physician role of Clinician received the highest overall rating (mean = 3.29 ± 0.47). Objectives for the physician roles of Clinician, Life-long Learner and Manager received higher ratings than the Educator/Communicator and Researcher roles in terms of both perceived importance and amount of emphasis. Student ratings of importance varied significantly by academic year, with third-year students consistently assigning lower ratings to learning objectives for the Educator/Communicator, Researcher and Manager roles compared to students in some other years. Conclusions Study results suggest that biomedical informatics content is desired by medical students at the University of Utah. Study findings are being used to inform efforts to integrate biomedical informatics content into the curriculum and may assist other medical schools seeking to incorporate similar content.