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BACKGROUND: Studies suggest that moderate drinking may benefit cognition and the effect may favor women. This study investigated effects of moderate drinking on visuospatial functioning in postmenopausal women. Visuospatial processes are sensitive to alcohol abuse and are thought to be sensitive to hormonal fluctuations. Three questions were posed in order to: explore visuospatial processes in moderate-drinking and abstaining postmenopausal women, assess visuospatial differences in women using no estrogen replacement therapy (No-ERT), ERT alone (ERT-only), and ERT with progestin (ERT+Pro), and identify alcohol/ERT interactions associated with visuospatial performance. METHODS: Two hundred fourteen postmenopausal women participated (75 No-ERT; 63 ERT-only; 76 ERT+Pro. All were moderate drinkers or teetotalers and all received the Block Design test from the Wechsler Adult Intelligence Scale-Revised. A raw score was calculated and progress at 30-sec intervals was assessed. RESULTS: ANOVA revealed an alcohol main effect [F(3,202) = 4.74; p < 0.004] on 60- to 120-sec change scores. Teetotalers had significantly smaller change scores (less improvement) compared with all levels of drinkers. ANOVA on design 9 (the most difficult trial) revealed an ERT main effect [F(3,202) = 4.37; p < 0.02]. ERT nonusers scored significantly lower than ERT-only and ERT+Pro groups. A design 9 trend toward an alcohol x ERT interaction was noted [F(6,202) = 1.93; p < 0.08], and a design 9 time x alcohol interaction was revealed [F(6,404) = 2.65; p < 0.02]. CONCLUSIONS: These data suggest that moderate drinking may be positively associated with visuospatial processes in postmenopausal women. They also suggest that ERT, alone and with progestin, is positively associated with visuospatial processes, but only when the task is difficult. These findings support Kaplan's assertion that subtle performance deficits may not be detectible with traditional endpoint measures. A provocative alcohol x ERT trend suggests that alcohol consumption should be considered in studies of ERT effects on cognitive ability. [ABSTRACT FROM AUTHOR]

More than one-half of alcoholics may exhibit deficits in the processing of visual-spatial information, learning and memory, problem-solving and abstracting capabilities, and the regulation of goal-directed behavior. Research using nonalcoholic subjects suggests that some of these deficits may be familial and may predate the development of alcoholism. Results using alcoholic subjects are inconclusive, however, perhaps reflecting the effects of long-term alcohol consumption on cognitive performance. Factors that may influence the interpretation of results include psychiatric disorders, emotional instability, and type of alcoholism. Studies are needed to determine whether children from alcoholic families who become alcoholic themselves prove to be those who were previously most deficient in cognitive abilities. [ABSTRACT FROM AUTHOR]

Purpose: To identify patient characteristics and perioperative factors associated with non-home patient discharges and the impact of current delirium nursing interventions on discharge disposition, especially non-home dispositions., Methods: A retrospective pilot chart review was conducted using electronic health records from five networked hospitals in the Mountain West region of the US. The sample comprised 75 randomly selected patients aged 65 or older who screened positive for delirium during hospitalization. Relationships between patient characteristics, nursing interventions, and discharge dispositions were analyzed using chi-square tests and logistic regression., Results: Most participants (69.3%) were discharged to non-home facilities. Delayed urinary catheter removal was a significant nursing intervention factor. Patients with delayed urinary catheter removal were at increased risk of being discharged to a non-home setting compared with those with early urinary catheter removal (aOR: 14.11, P = .010). Preoperative hypoalbuminemia and surgery durations exceeding 60 minutes were associated with non-home dispositions., Conclusion: Delayed urinary catheter removal, surgery duration greater than 1 hour, and preoperative hypoalbuminemia increased the likelihood of non-home discharge placement for older adults who experience postoperative delirium., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The objectives of the current process improvement project were to improve access to health care and enhance care for older adults living in rural areas and to decrease morbidity and mortality. This project implemented an evidence-based screening tool, the Rapid Geriatric Assessment (RGA), as a routine screening in a patient-centered medical home for older adults in rural areas. Z-testing was used to measure the change, defined as scoring positive for at least one of four geriatric syndromes, as a result of using the RGA tool. Approximately one third had at least one such change following implementation of the RGA. In addition to the change in geriatric conditions, a significant change (48%) was noted in the number of patients who implemented an advance directive. We recommend the RGA be integrated in routine screening as it can help providers establish a targeted treatment plan for older adults who may be at increased risk for burden of disease. [ Journal of Gerontological Nursing, 48 (9), 47-51.].

Purpose/aims: The purpose of this study was to determine whether resiliency activities, compiled into a practice playbook designed for implementation by nurse leaders and self-initiation by clinical nurses, improves resilience in both the nurse leaders and direct care nurses who implement them., Background: Evidence indicates strengthening nurse resilience increases well-being, protects against burnout, improves retention and increases patient safety., Methods: A resilience playbook was assembled to include stress-reduction activities. Resilience was measured at baseline and after two phases during which participants engaged in leader-led and self-initiated activities. The Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience., Results: A total of 118 nurses completed both phases; 17 leaders and 101 clinical nurses. A significant increase in mean CD-RISC scores was detected among those who participated in self-initiated activities (p = 0.01). Initiating or participating in leader-led activities did not positively impact resilience scores. Further, clinical nurses who participated in leader-led activities were not more likely to participate in self-initiated activities., Conclusions: This study supports self-initiated resilience-strengthening activities as beneficial to nurses, but not leader-led initiatives. These results are especially important for nursing leaders as they strive to reduce burnout, improve nurse retention and achieve exceptional practice quality., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care., Method: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery., Results: The number of years' experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk's ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk's ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication., Discussion: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge.

Objective: The aim of this study was to increase understanding of patient perceptions of nursing professional image, appearance, and identification to inform implementation of professional clinical attire., Background: There is growing evidence of patient preference for and organizational implementation of professional clinical attire., Methods: A total of 350 randomly selected inpatients were surveyed using the professional image and patient preferences survey prior to a revision of the dress code for nursing., Results: Patients gave high scores for nursing image, appearance, and identification, with no support for color-coded uniforms., Conclusions: Organizations should assess patient perceptions before implementation of a dress code for nursing.

This study describes a sample of Latino/as in substance abuse treatment. We were interested in substance use patterns, gender differences, family history of addiction, and depression. Questionnaires completed by Latino/as (N = 209) were identified from 12,000 sets completed by participants in treatment from 1993-2003. Significant gender differences emerged, with Latinas reporting higher rates of stimulant abuse and depression. A family history of substance use disorders in primary or secondary family members was reported by 91% of participants. These data suggest that understanding gender differences related to substance use and depression among Latino/as in treatment warrants attention.

Background: While some reported benefits of moderate drinking are thought to be the direct results of physiological mechanisms associated with consumption, other effects may be attributable to mediating factors. Both explanations suggest that moderate drinkers may be healthier than nondrinking and heavier-drinking peers. The purpose of this study was to determine whether moderate-drinking postmenopausal women report healthier dietary and exercise patterns, and whether they demonstrate better physiological functioning compared with peers. This study also aimed to describe patterns of relationships between alcohol and measures of general health functioning in postmenopausal women., Methods: One-hundred and fifteen women aged 50 to 65 participated. Participants completed alcohol interviews, diet and exercise questionnaires, and bone density examination. Blood pressure, height, and weight were assessed, and blood was collected to conduct basic chemistry and complete blood count tests., Results: Postmenopausal moderate drinkers failed to demonstrate healthier dietary or exercise habits, and did not exhibit significantly better health-functioning compared with peers. They did evidence positive associations between drinking and healthy behavior, and between drinking and cardiovascular health. Relationships between alcohol and blood analytes differed between drinking groups, some of which suggested possible negative health consequences for higher-end drinkers in both drinking groups., Conclusions: These data suggested that moderate-drinking postmenopausal women are not significantly healthier than their non- or heavier-drinking peers, but may drink as part of a larger effort to take care of their health. Despite this, even 1-drink-per-drinking-day moderate drinkers may have tendencies toward unhealthy conditions. Limitations include small sample size, inability to assess specific cardiac risk and socioeconomic status, small number of correlations, and clinical relevance of analyte values.

The literature remains contentious regarding the separate and combined effects of moderate drinking and estrogen replacement therapy (ERT) on cognition. In the current study, the authors sought to disentangle the predictive utility of alcohol use, ERT and their interaction on the episodic and semantic memory stores of postmenopausal women. It was predicted that relationships between moderate drinking, ERT and cognition would be attenuated by demographic and health-related factors. Postmenopausal women (n = 298) completed a battery of cognitive tests designed to assess speed and accuracy of episodic and knowledge-based cognitive processing. Potentially confounding variables were categorized and tested as mediators in hierarchical regression analyses. Moderate drinking was a weak predictor of episodic availability prior to removal of potential mediators. ERT use was a significant predictor of episodic and knowledge-based availability; no mediators were identified. Alcohol moderated ERT, as a combined alcohol/ERT variable was shown to be related to cognition. Neither moderate drinking nor ERT use was associated with cognitive speed. These findings suggest that positive relationships between alcohol and cognition are likely mediated by other variables, and should not be regarded as a benefit of drinking. Further, results support ERT as a predictor of knowledge-based and episodic availability, independent of mood stabilization or socioeconomic influences. Finally, alcohol and ERT appear to interact to impact both episodic and knowledge-based performance., (Copyright 2008 S. Karger AG, Basel.)

Purpose: The overarching purpose of this work was to generate a framework on which to build a traumatic brain injury (TBI) system-support action plan for individuals with a TBI living in a rural state., Methods: Four research questions were posed aimed at describing rural service/support needs and service satisfaction among persons with a TBI, as well as rural service/support availability as defined by providers. One hundred and ninety-four providers/agencies and 250 individuals/family members completed one of two versions (provider/agency, individual/family member) of a Needs and Resources Assessment., Results: Data analyses indicated that the majority of individual respondents lived at an impoverished income level and lived with a TBI for approximately 12 years. Quality of life was perceived as significantly lower after the TBI than before. Employment decreased significantly following a TBI. Reasons for unemployment included a perceived inability to work, problems regarding proper accommodation and/or perceptions regarding being chosen as suitable job candidates., Conclusions: Provider data confirmed that many important services are rarely available or specific to TBIs. Basic assistance with employment, cognitive training and occupational therapy were among those most needed. Paradoxically, a high proportion of individuals reported feeling satisfied with most services. Applications of these data along with recommendations for other rural states are described.

Objective: The authors investigated saliva as a potentially reliable medium for estradiol (E2) measurements in postmenopausal women. The goal of this study was to determine whether or not saliva could be used in studies of postmenopausal women in place of serum samples. Specifically, the authors wondered whether or not saliva and serum E2, obtained simultaneously from samples collected from postmenopausal women, would correlate., Design: Samples of saliva and serum were collected simultaneously from 43 postmenopausal women. 31 were regular users of estrogen therapy (ET), 12 used no ET. Pearson's correlation coefficients were conducted to determine the degree of relationship between saliva and serum samples among ET users and non-users., Results: Among ET users saliva and serum E2 levels were significantly and positively correlated (r = 0.81, p < 0.0001). The two E2 values were not significantly correlated among ET non-users (r = 0.32, p < 0.31)., Conclusions: These data suggest that saliva E2 may be a fairly robust predictor of serum E2, but only among postmenopausal women who use ET.

Studies suggest that use of estrogen replacement therapy (ERT) after menopause may be beneficial toward preservation of cognitive functioning. However, potentially confounding variables such as alcohol consumption are typically not systematically considered. The purpose of this study was to determine whether ERT users and nonusers differ with regard to memory and concentration ability when potential confounds are eliminated. Alcohol consumption was included as an independent variable so that ERT by alcohol interactions could be examined. One-hundred-sixty-two postmenopausal women participated in the study and were classified as moderate drinkers or teetotalers. Logical Memory (Wechsler Memory Scale-Revised), Digit Span (Wechsler Adult Intelligence Scale-Revised) and the Cognitive Symptom Checklist-Memory subscale were administered. No main effects of ERT were found. However, ERT by alcohol interactions among some Digit Span Forward variables were observed. We conclude that confounding variables such as alcohol consumption, may be at least partly responsible for observed differences in cognition commonly attributed to ERT.

Do old people drink? Community surveys suggest that alcohol consumption is lowest among elders compared to any other age group, and that patterns of drinking are relatively stable across mid-to-late life. But is this an accurate portrayal of those individuals seeking medical guidance? In other words, what is the likelihood of alcohol abuse or misuse among the typical hospital, outpatient clinic, or emergency room patient? How difficult is it to spot potential alcohol misuse among the elderly? The purpose of this paper is to address these questions and to assist physicians of the medical community in the important function of early detection and prevention of alcohol abuse/misuse in patient populations.

Four measures of anger were investigated in sober male and female alcoholics and nonalcoholic peers. The relationships among anger variables, past drinking behavior, and substance abuse consequences in alcoholics were explored. Additionally, the interrelationships among anger, depression, and anxiety in the groups were examined, and the relationships between an overall dysphoria index and drinking behavior and substance abuse consequences were determined. 104 alcoholics (sober 21 to 45 days) and 70 community controls, aged 21 to 56, were given the Spielberger Anger Expression Inventory, the Beck Depression Inventory, and the Spielberger State Anxiety Inventory. Alcoholics scored higher than controls on Trait Anger, Anger-In, and Anger-Out, but not on State Anger. There were no main effects of sex. Anger-In was significantly negatively correlated with the Quantity-Frequency Index in alcoholic males. Anger-In was significantly positively correlated with depression in male and female alcoholics and with substance abuse consequences in the latter group. The depression measure was significantly correlated with consequences in female, but not in male alcoholics. These data have treatment implications, especially for female alcoholics.

Evidence for impaired psychological functions mediated by the left hemisphere in sober alcoholics is inconsistent. We predicted that sober alcoholics have deficits in immediate and delayed memory similar to deficits found in left hemisphere damaged patients. Four prose stories were administered to 24 alcoholics and 24 nonalcoholic peers and were scored according to Webster et al's criteria for essential and detail propositions. These investigators found that right hemisphere stroke patients performed significantly worse than controls on recall of detail propositions, but left hemisphere damaged stroke patients performed worse on recall of both detail and essential propositions. Similar to their left hemisphere group, our alcoholics were impaired on both proposition types supporting the hypothesis of a residual mild generalized brain dysfunction state in sober alcoholics.

Objective: To analyze visuospatial cognition in recently detoxified alcoholics from the perspectives of three ways of conceptualizing spatial information processing: egocentric versus allocentric orientation, featural versus configural analysis, and categorical versus coordinate spatial judgements., Method: Twenty-eight chronic alcoholics (19 men, 9 women) were compared to 20 (10 men, 10 women) controls of comparable age and education on a battery of tests of visuospatial scanning, construction, mental imagery, and anterograde and remote spatial memory. Tests were administered 21-40 days after alcoholics entered treatment., Results: Alcoholics displayed impairment in visuospatial scanning, construction, utilizing and manipulating information from visual images and on three tests of anterograde spatial memory, but remote spatial memory was not significantly affected. Their deficits were evident on some measures of allocentric orientation, featural and configural analysis, but consistent deficits on egocentric orientation or categorical or coordinate spatial judgments were not seen., Conclusions: Deficits in spatial cognition exhibited by alcoholics do not seem to arise from dysfunction in any localized brain region. Small but potentially important impairments in fundamental aspects of spatial information processing such as scanning and use of visual imagery were found. The empirical basis and clinical significance of these deficits requires further study.

Menopause is associated with increased risk for certain diseases. By affecting hormone levels, alcohol consumption might influence the occurrence or progress of these diseases.