108 results on '"Zullo TG"'
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2. Effects of a closed tracheal suction system on ventilatory and cardiovascular parameters
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Harshbarger, SA, primary, Hoffman, LA, additional, Zullo, TG, additional, and Pinsky, MR, additional
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- 1992
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3. Critical thinking ability of new graduate and experienced nurses.
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Fero LJ, Witsberger CM, Wesmiller SW, Zullo TG, and Hoffman LA
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CRITICAL thinking ,PERFORMANCE ,NURSES ,NURSING ,NURSE-patient relationships - Abstract
Aim. This paper is a report of a study to identify critical thinking learning needs of new and experienced nurses. Background. Concern for patient safety has grown worldwide as high rates of error and injury continue to be reported. In order to improve patient safety, nurses must be able to recognize changes in patient condition, perform independent nursing interventions, anticipate orders and prioritize. Methods. In 2004-2006, a consecutive sample of 2144 newly hired nurses in a university-affiliated healthcare system completed the Performance Based Development System Assessment consisting of 10 videotaped vignettes depicting change in patient status. Results were reported as meeting or not meeting expectations. For nurses not meeting expectations, learning needs were identified in one of six subcategories. Results. Overall, 74·9% met assessment expectations. Learning needs identified for nurses not meeting expectations included initiating independent nursing interventions (97·2%), differentiation of urgency (67%), reporting essential clinical data (65·4%), anticipating relevant medical orders (62·8%), providing relevant rationale to support decisions (62·6%) and problem recognition (57·1%). Controlling for level of preparation, associate ( P = 0·007) and baccalaureate ( P < 0·0001) nurses were more likely to meet expectations as years of experience increased; a similar trend was not seen for diploma nurses ( P = 0·10). Controlling for years of experience, new graduates were less likely to meet expectations compared with nurses with >=10 years experience ( P = 0·046). Conclusion. Patient safety may be compromised if a nurse cannot provide clinically competent care. Assessments such as the Performance Based Development System can provide information about learning needs and facilitate individualized orientation targeted to increase performance level. [ABSTRACT FROM AUTHOR]
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- 2009
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4. Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.
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Hoffman LA, Tasota FJ, Scharfenberg C, Zullo TG, and Donahoe MP
- Abstract
BACKGROUND: Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes. OBJECTIVE: To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients' care in a step-down medical intensive care unit. METHODS: Work sampling techniques were used to collect data when the nurse practitioner had 6 months' or less experience in the role (T1), after the nurse practitioner had 12 months' experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities. RESULTS: Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001). CONCLUSION: The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients' families and collaborating with health team members. [ABSTRACT FROM AUTHOR]
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- 2003
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5. Exercise maintenance following pulmonary rehabilitation: effect of distractive stimuli.
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Bauldoff GS, Hoffman LA, Zullo TG, Sciurba FC, Bauldoff, Gerene S, Hoffman, Leslie A, Zullo, Thomas G, and Sciurba, Frank C
- Abstract
Study Objective: To determine if distractive auditory stimuli (DAS) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program (PRP) and, thereby, maintenance of gains achieved during the program.Design: Experimental, randomized, two-group design with testing at baseline, 4 weeks, and 8 weeks.Setting: Outpatient.Patients: Twenty-four patients (4 men and 20 women) with moderate-to-severe COPD (FEV(1) 41.3 +/- 13% predicted [mean +/- SD]).Intervention: Experimental group subjects (n = 12) were instructed to walk at their own pace for 20 to 45 min, two to five times a week, using DAS with a portable audiocassette player. The control group (n = 12) received the same instructions, but no DAS.Measurements and Results: Primary outcome measures were perceived dyspnea during activities of daily living (ADL) and 6-min walk (6MW) distance. Secondary outcome measures were anxiety, depressive symptoms, health-related quality of life (QoL), global QoL, and breathlessness and fatigue at completion of the 6MW. In addition, all subjects recorded the distance and time walked using self-report (pedometers and daily logs). There was a significant decrease in perceived dyspnea during ADL (p = 0.0004) and a significant increase in 6MW distance (p = 0.0004) over time in the DAS group compared to the control group. DAS subjects increased 6MW distance 445 +/- 264 feet (mean +/- SD) from baseline to 8 weeks, whereas control subjects decreased 6MW distance to 169 +/- 154 feet. No significant differences were noted for the remaining variables. The cumulative distance walked by the DAS group was 19.1 +/- 16.7 miles compared to 15.4 +/- 8.0 miles for the control group, a 24% difference (p = 0.49). Despite this difference, self-report exercise log data were similar for the two groups.Conclusion: Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea, whereas control subjects could not maintain post-PRP gains. DAS is a simple, cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training. [ABSTRACT FROM AUTHOR]- Published
- 2002
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6. Predictors and impact of atrial fibrillation after isolated coronary artery bypass grafting.
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Hravnak M, Hoffman LA, Saul MI, Zullo TG, Whitman GR, Griffith BP, Hravnak, Marilyn, Hoffman, Leslie A, Saul, Melissa I, Zullo, Thomas G, Whitman, Gayle R, and Griffith, Bartley P
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- 2002
7. Auto-positive end-expiratory pressure during tracheal gas insufflation: testing a hypothetical model.
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Miro AM, Hoffman LA, Tasota FJ, Delgado E, Lutz J, Zullo TG, Pinsky MR, Miro, A M, Hoffman, L A, Tasota, F J, Delgado, E, Lutz, J, Zullo, T G, and Pinsky, M R
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- 2000
8. Fatigue in women with myocardial infarction.
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Varvaro FF, Sereika SM, Zullo TG, and Robertson RJ
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This study measured fatigue in women 6 weeks after myocardial infarction. Fatigue was experienced by the women as chronic, generalized, intermittent, and longstanding. More than one third of the women attributed their fatigue directly to the heart attack or hospitalization. Significant relations were found between fatigue and the physiological dimension of the Sickness Impact Sale (SIP), the Perceived Health Assessment and Risk Protection Survey (PHARPS), and the site of infarction, as well as with the psychological dimension of the SIP. There was an inverse significant relation between fatigue scores and the Psychological General Well-Being (PGWB) Index. Although not reaching statistical significance, fatigue scores for women 65 and older were higher than for younger women. [ABSTRACT FROM AUTHOR]
- Published
- 1996
9. An adaptive faculty development program for improving teaching skills
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Claus, JM and Zullo, TG
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- 1987
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10. Desired competencies and employment prospects for educational research personnel in schools of dental medicine
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Jacobs, SS and Zullo, TG
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- 1975
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11. Concerns of entering dental students
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Sachs, RH, Zullo, TG, and Close, JM
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First‐year students from three dental schools were surveyed during their first week of classes to assess their areas of concern. Factor analysis of the data revealed five independent areas of concern–psychosocial, academic, time, isolation, and money. A high degree of similarity was found in the order in which students ranked their concerns. Significant differences in the intensity of concern were found for academics and time. The implications of this study for future research on stress and coping behavior are discussed.
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- 1981
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12. Goals, objectives, and outcomes: case study of a program assessment
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Wintner, AJ, Hamilton, P, Zullo, TG, and Cose, JM
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This manuscript assesses the outcome of a dental educational program in relation to institutional goals and program objectives. The study, covering the total population of 841 graduates of a dental school from 1972 through 1978, focused on the first classes to complete a significantly revised curriculum. The data identified specific characteristics such as (1) the distribution of dental practices, (2) general practices versus specialization, (3) solo vis‐s‐vis multiple or group practices, (4) residency training and advanced education, (5) faculty positions, (6) publications and research, (7) hospital affiliations, and (8) community activities. A pattern of responses developed that appears to indicate that those outcomes noted above, when combined with end‐of‐course and licensure examinations, supports an assumption of achievement of program objectives and institutional goals.
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- 1980
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13. Factor analysis of comprehensive examinations
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Zullo, TG and Penkrot, R
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In working toward new, integrated curricula, dental schools have often failed to concurrently revise their evaluative techniques to be more compatible with the objectives of the curriculum. One question of major importance is whether the schools are totally aware of their students' capabilities or are graduating students proficient in some fields while lacking in others. Is the student's overall or total score satisfactory even though deficiencies may exist in certain areas? This latter situation is a real possibility when the simple sum of subtest scores is used as the primary means in assessing students. Using factor analysis, the scores on the subtests of eight dental school comprehensive examinations (total of 1,023 subjects, on first‐, second‐, and third‐year examinations given between December 1970 and May 1972) at the University of Pittsburgh School of Dental Medicine were examined. The results, culled from the correlation matrices, Chi‐square analysis, and factor matrices, indicated that the subtests did not form a homogenous unit (one, general factor), and hence that use of the total score is questionable.
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- 1975
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14. A factor analysis of perceptual and motor abilities of dental students
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Zullo, TG
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- 1971
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15. Principal components analysis of the dental aptitude test battery
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Zullo, TG
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- 1971
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16. Evaluation of curricular innovations
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Zullo, TG
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- 1968
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17. To the editors.
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Rosborough D, Hravnak M, Hoffman LA, Saul MI, Zullo TG, and Whitman GR
- Published
- 2002
18. Enhancing Nurses' Pain Assessment to Improve Patient Satisfaction.
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Schroeder DL, Hoffman LA, Fioravanti M, Medley DP, Zullo TG, and Tuite PK
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- Adult, Aged, Arthroplasty, Replacement nursing, Clinical Competence, Female, Focus Groups, Humans, Male, Middle Aged, Nurse-Patient Relations, Nursing Evaluation Research, Nursing Staff, Hospital psychology, Surveys and Questionnaires, Young Adult, Nursing Staff, Hospital education, Pain Management nursing, Pain Measurement nursing, Patient Satisfaction statistics & numerical data
- Abstract
Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement. This was a single-group pre-/posttest design. Nurse (knowledge assessment) and patient (American Pain Society Patient Outcomes Questionnaire Revised [APS-POQ-R], HCAHPS) responses evaluated pre- and postimplementation of the online educational program. Nurse focus group followed intervention. Nurses' knowledge improved significantly (p < .006) postintervention. HCAHPS scores (3-month average) for items reflecting patient satisfaction improved from 70.2 ± 9.5 to 73.9 ± 6.0. APS-POQ-R scores did not change. Focus group comments indicated need for education regarding linkages between pain management and patient satisfaction. Education on linkages between patient satisfaction and pain management can improve outcomes; education on strategies to further improve practice may enhance ability to achieve benchmarks.
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- 2016
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19. Perception of facial attractiveness following modification of the nose and teeth.
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Bui KK, Rinchuse DJ, Zullo TG, and Cozzani M
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- Adolescent, Adult, Attitude to Health, Female, Humans, Male, Malocclusion psychology, Nose Diseases psychology, Photography, Sex Factors, Visual Analog Scale, Young Adult, Beauty, Dentition, Face anatomy & histology, Nose anatomy & histology
- Abstract
Objective: We investigated how laypeople perceive persons with straight teeth and nose, mild to moderate modification of the nose, and mild to moderate modification of the teeth. The objectives were to determine: (1) how modification of the nose or teeth affects others' perceptions of target persons' facial attractiveness, (2) whether these evaluations are affected by the target persons' or raters' gender, (3) whether the frontal view or three-quarter view has any effect on the ratings., Materials and Methods: Survey data were collected from 226 college students at Seton Hill University (49% male, 51% female; age range, 18-25 years) who rated, on a 100mm VAS, photos of subjects with straight teeth and nose (control), mild to moderate modification of the nose, and mild to moderate modification of the teeth from the frontal and three-quarter views., Results: Male and female target photos with teeth modification were considered the least attractive. Both male and female target photos showed that female raters evaluated both control and nose modification conditions more positively than did male raters. For male and female target photos, the frontal view was less esthetically pleasing under teeth modification., Conclusions: Both male and female evaluators judged teeth modification as the least attractive compared to nose modification. It is recommended for rhinoplasty patients with malaligned teeth that it may be beneficial for cosmetic surgeons to establish an interdisciplinary approach working with orthodontists., (Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.)
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- 2015
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20. Postthoracotomy Pain Syndrome Following Surgery for Lung Cancer: Symptoms and Impact on Quality of Life.
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Hopkins KG, Hoffman LA, Dabbs Ade V, Ferson PF, King L, Dudjak LA, Zullo TG, and Rosenzweig MQ
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Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy-Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.
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- 2015
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21. Effects of a video guided T'ai Chi group intervention on center of balance and falls efficacy: a pilot study.
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Katrancha ED, Hoffman LA, Zullo TG, Tuite PK, and Garand L
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- Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Independent Living, Male, Multivariate Analysis, Patient Compliance statistics & numerical data, Pilot Projects, Program Evaluation, Accidental Falls prevention & control, Geriatric Assessment methods, Postural Balance physiology, Tai Ji organization & administration, Video Recording
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This pilot study evaluated effects of a video-guided T'ai Chi group intervention on center of balance (COB) and falls efficacy, using a one arm, pre/post design. Thirty-two participants began the study, 17 completed pre- and post-testing and 15 were lost to follow-up. Outcomes were compared for the 17 participants who completed pre- and post-testing and subgroups based on session attendance. Irrespective of session attendance, participant COB scores improved. There was a significant negative correlation between number of sessions attended and pre and post scores on the fall efficacy (fear of falling) measure, indicating those with higher fear of falling were less likely to complete the study. Older participants were also less likely to continue participation. Findings indicate potential benefits of T'ai Chi in improving COB (a fall risk factor) among community-dwelling older adults. However, those with greater potential benefit (higher fear scores, older participants) were less likely to continue participation., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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22. Development and validation of the Dyspnea Index (DI): a severity index for upper airway-related dyspnea.
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Gartner-Schmidt JL, Shembel AC, Zullo TG, and Rosen CA
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- Adolescent, Adult, Aged, Aged, 80 and over, Cognition, Dyspnea physiopathology, Dyspnea psychology, Dyspnea therapy, Factor Analysis, Statistical, Female, Humans, Interviews as Topic, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Principal Component Analysis, Prognosis, Reproducibility of Results, Severity of Illness Index, Young Adult, Dyspnea diagnosis, Respiration, Respiratory System physiopathology, Surveys and Questionnaires
- Abstract
Objectives: To (1) develop and validate the Dyspnea Index (DI); (2) quantify severity of symptoms in upper airway dyspnea; and (3) validate the DI as an outcome measure., Study Design: Survey development and validation., Methods: Three hundred sixty-nine participants were recruited for different phases of the study. Two hundred participants with chief complaints of dyspnea were given a 41-item questionnaire addressing common symptoms of dyspnea related to the upper airway. The questions were then reduced based on principal component analysis (PCA) and internal consistency resulting in a 10-item questionnaire. Cognitive interviews were conducted with 15 participants. Test-retest reliability and discriminant validity were measured from 51 participants. The DI was further validated by administering the index to 57 healthy controls (HC). Validation of the DI as a treatment outcome tool occurred with 46 participants' pre- and post-treatment scores., Results: PCA revealed that only a single factor was being measured in both the original 41- and 10-item questionnaires. Additional cognitive interviewing suggested that no modification was needed to the DI. Test-retest reliability was r = 0.83. Discriminant validity was r = 0.62. The Mann-Whitney test demonstrated significant differences between healthy/symptomatic participants. Scores from the HC cohort resulted in a mean of 3.12 (SEM = 0.484; SD = 3.65) for the normative values., Conclusions: The DI is an effective and efficient instrument to quantify patients' symptoms of upper airway dyspnea. It is a statistically robust index, with significant reliability and validity, and can be dependably used as a treatment outcome measure., (Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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23. Perceptions of midline deviations among different facial types.
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Williams RP, Rinchuse DJ, and Zullo TG
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- Adolescent, Adult, Attitude, Beauty, Differential Threshold physiology, Female, Humans, Male, Malocclusion pathology, Malocclusion psychology, Sensory Thresholds physiology, Sex Factors, Smiling, Young Adult, Dental Arch anatomy & histology, Face anatomy & histology, Incisor anatomy & histology, Visual Perception physiology
- Abstract
Introduction: The correction of a deviated midline can involve complicated mechanics and a protracted treatment. The threshold below which midline deviations are considered acceptable might depend on multiple factors. The objective of this study was to evaluate the effect of facial type on laypersons' perceptions of various degrees of midline deviation., Methods: Smiling photographs of male and female subjects were altered to create 3 facial type variations (euryprosopic, mesoprosopic, and leptoprosopic) and deviations in the midline ranging from 0.0 to 4.0 mm. Evaluators rated the overall attractiveness and acceptability of each photograph., Results: Data were collected from 160 raters. The overall threshold for the acceptability of a midline deviation was 2.92 ± 1.10 mm, with the threshold for the male subject significantly lower than that for the female subject. The euryprosopic facial type showed no decrease in mean attractiveness until the deviations were 2 mm or more. All other facial types were rated as decreasingly attractive from 1 mm onward. Among all facial types, the attractiveness of the male subject was only affected at deviations of 2 mm or greater; for the female subject, the attractiveness scores were significantly decreased at 1 mm. The mesoprosopic facial type was most attractive for the male subject but was the least attractive for the female subject., Conclusions: Facial type and sex may affect the thresholds at which a midline deviation is detected and above which a midline deviation is considered unacceptable. Both the euryprosopic facial type and male sex were associated with higher levels of attractiveness at relatively small levels of deviations., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)
- Published
- 2014
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24. Development and validation of the cough severity index: a severity index for chronic cough related to the upper airway.
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Shembel AC, Rosen CA, Zullo TG, and Gartner-Schmidt JL
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- Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Female, Humans, Male, Middle Aged, Quality of Life, Reproducibility of Results, Surveys and Questionnaires, Treatment Outcome, Young Adult, Cough diagnosis, Outcome Assessment, Health Care methods, Severity of Illness Index
- Abstract
Objectives/hypothesis: To develop and validate a cough severity index (CSI) which quantifies patients' symptoms associated with upper airway chronic cough and to provide a tool for treatment outcome measures., Methods: Two hundred patients who had a complaint of chronic cough and/or dyspnea were given a 49- item questionnaire developed through a clinical consensus of the most common symptoms of chronic cough of upper airway origin. The instrument was reduced to 10 questions using statistical methodology. Fifty subsequent patients were given the CSI to measure test-retest reliability at two different moments in time. Twenty healthy controls (HC) were given the instrument to obtain validity. An additional 95 participants provided pre- and posttreatment outcomes using the CSI., Results: Principle Component Analysis (PCA) revealed a single factor with the original 49 questions. A combination of PCA, rank-ordering item-total correlation and communality, as well as clinical consensus further reduced the questionnaire to 10 items. Internal consistency of the CSI was 0.97. Test-retest reliability was r = 0.83. An r = 0.60 for divergent validity between the CSI and the Cough-Specific Quality-of-Life Questionnaire (CQLQ) demonstrated two fairly separate instruments, although both measured cough. Mann-Whitney test was significant between symptomatic patients and healthy controls (P < 0.0004). The results of 20 HC showed a mean of 0.45 (standard deviation = 1.39). Results for treatment outcomes revealed significance with the Wilcoxon test (P < 0.0001) and paired samples t test showed significantly different correlations between pre- and postmeasures., Conclusion: The CSI is a short, simple instrument that can be used in the clinical setting to quantify a patient's symptoms of chronic cough of upper airway origin. It represents a statistically reliable, valid, and clinically relevant instrument that can be used to measure treatment outcomes for chronic cough., (© 2012 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2013
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25. Quantifying component parts of indirect and direct voice therapy related to different voice disorders.
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Gartner-Schmidt JL, Roth DF, Zullo TG, and Rosen CA
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- Adult, Aged, Counseling, Diet adverse effects, Dysphonia diagnosis, Dysphonia physiopathology, Dysphonia psychology, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Motivation, Patient Education as Topic, Prospective Studies, Self Care, Time Factors, Dysphonia therapy, Phonation, Speech Acoustics, Speech-Language Pathology methods, Voice Quality, Voice Training
- Abstract
Voice therapy changes how people use and care for their voices. Speech-language pathologists (SLPs) have a multitude of choices from which to modify patient's vocal behaviors. Six SLPs performed 1461 voice therapy sessions and quantified the percentage of time spent in eight component parts of indirect and four component parts of direct voice therapy across five common voice disorders. Voice therapy data collection forms were prospectively completed immediately following each therapy visit. The SLPs were free to choose the component parts of voice therapy best suited for their respective patients. Results showed that direct voice therapy represented more than 75% of the treatment time across all voice therapy sessions. In the components of direct voice therapy, there was no statistical difference between percentages of time spent in resonant voice and flow phonation across all voice disorders. However, a significant difference was found for the time spent addressing transfer to conversational speech for muscle tension dysphonia, lesions, and scar than for vocal immobility and atrophy. Interestingly, while SLPs used a more common approach to direct voice therapy across voice disorders, they tended to vary the use of indirect components of therapy across voice disorders with certain components being addressed in greater length for specific voice disorders. Collectively, these results indicate that although SLPs may individualize their approach to indirect voice therapy, when it comes to direct voice therapy, SLPs have a common approach to voice therapy regardless of voice disorder., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
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26. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience.
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Choi J, Donahoe MP, Zullo TG, and Hoffman LA
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- Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Education, Medical, Continuing, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Stress, Psychological, Surveys and Questionnaires, Young Adult, Caregivers psychology, Critical Illness nursing, Intensive Care Units, Patient Discharge
- Abstract
Background: Chronically critically ill patients typically undergo an extended recovery after discharge from the intensive care unit, making involvement of family caregivers essential. Prior studies provide limited detail about specific ways this experience affects caregivers., Objectives: To (1) describe lifestyle restrictions and distress among caregivers of chronically critically ill patients 1 and 6 months after discharge and (2) explore how caregivers' lifestyle restrictions and distress differ according to patients' and caregivers' characteristics., Methods: Sixty-nine chronically critically ill patients and their family caregivers completed follow-up at 1 and 6 months after discharge from the intensive care unit. Data were collected from medical records and survey via telephone or mail., Results: Caregivers' perceived lifestyle restrictions (Changes in Role Function) decreased from 1 month (mean [SD], 23.0 [8.3]) to 6 months (19.4 [8.6]) after discharge (P = .003), although patients' problem behaviors and caregivers' distress (8.9 [9.3] vs 7.9 [9.6], respectively; P = .32) did not change. Change in caregivers' lifestyle restrictions differed by patients' disposition (P = .02) and functional status (Health Assessment Questionnaire; P = .007). Caregiver's lifestyle restrictions remained high when patients never returned home or never recovered their preadmission functional status. Caregivers reported the most restrictions in social life and personal recreation. Patients' negative emotions and pain caused the most caregiver distress., Conclusions: Caregivers of chronically critically ill patients perceived fewer lifestyle restrictions over time but reported no change in patients' problem behaviors or distress. Lifestyle restrictions and distress remained high when patients never returned home or regained their preadmission functional status.
- Published
- 2011
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27. Critical thinking skills in nursing students: comparison of simulation-based performance with metrics.
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Fero LJ, O'Donnell JM, Zullo TG, Dabbs AD, Kitutu J, Samosky JT, and Hoffman LA
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- Adult, Cross-Over Studies, Female, Humans, Male, Middle Aged, Nursing Education Research, Patient Simulation, Problem Solving, Psychometrics, Videotape Recording, Young Adult, Clinical Competence, Education, Nursing, Educational Measurement methods, Students, Nursing psychology, Thinking
- Abstract
Aim: This paper is a report of an examination of the relationship between metrics of critical thinking skills and performance in simulated clinical scenarios., Background: Paper and pencil assessments are commonly used to assess critical thinking but may not reflect simulated performance., Methods: In 2007, a convenience sample of 36 nursing students participated in measurement of critical thinking skills and simulation-based performance using videotaped vignettes, high-fidelity human simulation, the California Critical Thinking Disposition Inventory and California Critical Thinking Skills Test. Simulation-based performance was rated as 'meeting' or 'not meeting' overall expectations. Test scores were categorized as strong, average, or weak., Results: Most (75.0%) students did not meet overall performance expectations using videotaped vignettes or high-fidelity human simulation; most difficulty related to problem recognition and reporting findings to the physician. There was no difference between overall performance based on method of assessment (P = 0.277). More students met subcategory expectations for initiating nursing interventions (P ≤ 0.001) using high-fidelity human simulation. The relationship between videotaped vignette performance and critical thinking disposition or skills scores was not statistically significant, except for problem recognition and overall critical thinking skills scores (Cramer's V = 0.444, P = 0.029). There was a statistically significant relationship between overall high-fidelity human simulation performance and overall critical thinking disposition scores (Cramer's V = 0.413, P = 0.047)., Conclusion: Students' performance reflected difficulty meeting expectations in simulated clinical scenarios. High-fidelity human simulation performance appeared to approximate scores on metrics of critical thinking best. Further research is needed to determine if simulation-based performance correlates with critical thinking skills in the clinical setting., (© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.)
- Published
- 2010
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28. Analysis of laryngeal framework surgery: 10-year follow-up to a national survey.
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Young VN, Zullo TG, and Rosen CA
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- Follow-Up Studies, Health Care Surveys, Humans, Otorhinolaryngologic Surgical Procedures adverse effects, Prosthesis Implantation adverse effects, Glottis surgery, Larynx surgery, Otorhinolaryngologic Surgical Procedures statistics & numerical data, Prosthesis Implantation statistics & numerical data, Vocal Cord Paralysis surgery
- Abstract
Objectives: Laryngeal framework surgery, including medialization laryngoplasty (ML) and arytenoid adduction (AA), are common treatments for vocal fold paralysis and glottal incompetence. Little information is known about the incidence of ML/AA surgery nationwide, in particular the success and complication rates., Methods: A 25-item questionnaire was mailed to 6,644 Board-certified otolaryngologists., Results: The response rate was 25.7% (n = 1,707). Sixty-three percent perform ML and/or AA, representing 29,748 procedures. Experience with Silastic medialization implants has decreased over time, while utilization of other materials has increased. The overall complication rate was 15%, including 0.8% implant extrusion and 6% revision rates. The most common revision was placement of a larger implant (37% of all revisions). Airway compromise requiring intervention was observed in 2.2%, and suboptimal voice outcome in 4%. Although not statistically significant, a trend was observed of decreasing complication rate with increasing experience., Conclusions: Laryngeal framework surgeries are being performed with increasing frequency in the United States. The overall complication rate is slightly increased in the present study, but airway compromise and poor vocal outcome are decreased, and the need for revision surgery is unchanged. These findings suggest a continued high level of efficacy of these procedures.
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- 2010
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29. Impact of a disease-management program on symptom burden and health-related quality of life in patients with idiopathic pulmonary fibrosis and their care partners.
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Lindell KO, Olshansky E, Song MK, Zullo TG, Gibson KF, Kaminski N, and Hoffman LA
- Subjects
- Adaptation, Psychological, Aged, Analysis of Variance, Anxiety diagnosis, Anxiety psychology, Depression diagnosis, Depression psychology, Disease Progression, Female, Health Status Indicators, Humans, Idiopathic Pulmonary Fibrosis mortality, Idiopathic Pulmonary Fibrosis nursing, Male, Pilot Projects, Psychometrics, Respiratory Function Tests, Stress, Psychological, Surveys and Questionnaires, United States, Caregivers psychology, Disease Management, Idiopathic Pulmonary Fibrosis drug therapy, Quality of Life
- Abstract
Background: Patients were recruited from the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, located within the University of Pittsburgh Medical Center. Idiopathic pulmonary fibrosis results in scarring of the lung and respiratory failure, and has a median survival of 3 to 5 years from the time of diagnosis. The purpose of this study was to determine whether patients with idiopathic pulmonary fibrosis and their care partners could be more optimally managed by a disease-management intervention entitled "Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management," which nurses delivered using the format of a support group. We hypothesized that participation would improve perceptions of health-related quality of life (HRQoL) and decrease symptom burden., Methods: Subjects were 42 participants randomized to an experimental (10 patient/care partner dyads) or control (11 patient/care partner dyads) group. Experimental group participants attended the 6-week program, and controls received usual care. Before and after the program, all participants completed questionnaires designed to assess symptom burden and HRQoL. Patients and care partners in the intervention group were also interviewed in their home to elicit information on their experience after participating in the Program to Reduce Idiopathic Pulmonary Fibrosis Symptoms and Improve Management., Results: After the intervention, experimental group patients rated their HRQoL less positively (P = .038) and tended to report more anxiety (P = .077) compared with controls. Care partners rated their stress at a lower level (P = .018) compared with controls. Course evaluations were uniformly positive. Post-study qualitative interviews with experimental group participants suggested benefits not exemplified by these scores. Patient participants felt less isolated, were able to put their disease into perspective, and valued participating in research and helping others., Conclusion: Further exploration of the impact of disease-management interventions in patients with advanced lung disease and their care partners is needed using both qualitative and quantitative methodology. Disease-management interventions have the potential to positively affect patients with advanced lung disease and their care partners.
- Published
- 2010
- Full Text
- View/download PDF
30. Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury.
- Author
-
Puccio AM, Hoffman LA, Bayir H, Zullo TG, Fischer M, Darby J, Alexander S, Dixon CE, Okonkwo DO, and Kochanek PM
- Subjects
- Adolescent, Adult, Analysis of Variance, Antioxidants metabolism, Brain Injuries metabolism, Enzyme-Linked Immunosorbent Assay, Female, Glasgow Coma Scale, Humans, Lipid Peroxidation, Male, Middle Aged, Biomarkers metabolism, Brain metabolism, Brain Injuries therapy, Hyperbaric Oxygenation methods, Hyperoxia metabolism, Oxidative Stress
- Abstract
Preliminary evidence suggests local brain tissue oxygenation (PbtO(2)) values of
or=20 mm Hg to avoid hypoxia. This study tested the impact of a short (2 h) trial of normobaric hyperoxia on measures of oxidative stress. We hypothesized this treatment would positively affect cerebral oxygenation but negatively affect the cellular environment via oxidative stress mechanisms. Cerebrospinal fluid (CSF) was serially assessed in 11 adults (9 male, 2 female), aged 26 +/- 1.8 years with severe TBI (Glasgow Coma Scale score, 6 +/- 1.4) before, during, and after a FiO(2) = 1.0 challenge for markers of oxidative stress, including lipid peroxidation (F(2)-isoprostane [ELISA]), protein oxidation (protein sulfhydryl [fluorescence]), and antioxidant defenses (total antioxidant reserve (AOR) [chemiluminescence] and glutathione [fluorescence]). Physiological parameters [PbtO(2), arterial oxygen content (PaO(2)), intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP)] were assessed at the same time points. Mean (+/-SD) PbtO(2) and PaO(2) levels significantly changed for each time point. Oxidative stress markers, antioxidant reserve defenses, and ICP, MAP, and CPP did not significantly change for any time period. These preliminary findings suggest that brief periods of normobaric hyperoxia do not produce oxidative stress and/or change antioxidant reserves in CSF. Additional studies are required to examine extended periods of normobaric hyperoxia in a larger sample. - Published
- 2009
- Full Text
- View/download PDF
31. Multiple flow rates measurement of exhaled nitric oxide in patients with sarcoidosis: a pilot feasibility study.
- Author
-
Choi J, Hoffman LA, Sethi JM, Zullo TG, and Gibson KF
- Subjects
- Cystic Fibrosis metabolism, Feasibility Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Pilot Projects, Respiratory Function Tests, Sarcoidosis, Pulmonary diagnosis, Sarcoidosis, Pulmonary physiopathology, Severity of Illness Index, Breath Tests methods, Exhalation, Nitric Oxide analysis, Pulmonary Alveoli metabolism, Sarcoidosis, Pulmonary metabolism
- Abstract
Fraction of end tidal exhaled nitric oxide (FeNO) has been introduced as a non-invasive marker of airway inflammation in patients with asthma and may have value in monitoring disease activity in patients with sarcoidosis. This pilot study explored: 1) feasibility of the multiple flow rates maneuver to estimate alveolar (C(AlV)NO) and airway wall (J(AW)NO) NO in patients with sarcoidosis; and 2) utility of exhaled NO (FeNO, C(Alv)NO and J(AW)NO) measurements to detect and monitor treatment response in patients with active pulmonary sarcoidosis. Patients with sarcoidosis (n = 42) and healthy non-smokers (n = 20) underwent FeNO measurement at 7 flow-rates (50 to 400 ml/s). Using the Tsoukias and George (1998) model, C(Alv)NO and J(AW)NO were estimated. Both patients and healthy non-smokers were able to perform the multiple flow rates maneuver without discomfort, with first measurement success rate of 57% and 65%, respectively. No significant difference was found between patients with sarcoidosis and healthy non-smokers in exhaled NO. None were correlated with pulmonary function tests, except a significant negative correlation between C(Alv)NO and FVC% (p = 0.001) and DLCO% (p = 0.012). In 8 patients with active sarcoidosis, FeNO, C(Alv)NO or J(AW)NO were not different from those of patients with inactive sarcoidosis. Treatment of active sarcoidosis using oral prednisone and methotrexate did not show any consistent pattern of changes in C(Alv)NO or J(AW)NO. Due to a large inter-subject variability and difficulty controlling use of the inhaled corticosteroids, exhaled NO measurement did not appear to be a clinically useful method of monitoring disease progression in sarcoidosis.
- Published
- 2009
32. Hemodynamic and molecular response to intermittent hypoxia (IH) versus continuous hypoxia (CH) in normal humans.
- Author
-
Rodway GW, Sethi JM, Hoffman LA, Conley YP, Choi AM, Sereika SM, Zullo TG, Ryter SW, and Sanders MH
- Subjects
- Adult, Gene Expression Regulation, Enzymologic physiology, Humans, Lymphocytes enzymology, Male, Oxygen administration & dosage, RNA, Messenger metabolism, Adaptation, Physiological physiology, Blood Pressure physiology, Heart Rate physiology, Hypoxia physiopathology, Nitric Oxide Synthase Type II genetics
- Abstract
The hemodynamic response to hypoxia may be influenced by exposure pattern and inducible biological signals, such as nitric oxide synthase (iNOS) expression. The systemic blood pressure (BP) and heart rate (HR) response to intermittent and continuous hypoxia (IH and CH) were examined as was the relationship between these responses and iNOS expression in 10 normal subjects. BP and HR were recorded during exposure to IH or CH (total hypoxic time=60 min/dayx3 days for each exposure profile), whereas arterial oxygen saturation (SpO2) was maintained at 80-90%. Total RNA was isolated from peripheral blood lymphocytes before exposure on Day 1 and 2 hours after the last exposure on Day 3, and it was assayed for iNOS messenger RNA (mRNA) expression using quantitative polymerase chain reaction (PCR). HR, systolic BP (SBP), and diastolic BP (DBP) increased during both experimental conditions (P<0.05), with no difference by exposure pattern or evidence of facilitation over 3 days. No significant change occurred in iNOS mRNA during IH or CH when pre- and post-exposure values were compared. However, iNOS expression at the end of Day 3 was negatively correlated with the average end-exposure DBP (r=-0.79) and mean BP (MBP; r=-0.76) on Days 1-3 of the IH (P<0.05), but not CH exposure. It is concluded that both IH and CH are associated with significant but comparable hemodynamic changes. The negative correlation between BP and iNOS mRNA with IH, but not CH, may suggest differential modulation of the hemodynamic response to the 2 exposure patterns.
- Published
- 2007
- Full Text
- View/download PDF
33. Comparison of 2 models for managing tracheotomized patients in a subacute medical intensive care unit.
- Author
-
Hoffman LA, Miller TH, Zullo TG, and Donahoe MP
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pennsylvania, Respiration, Artificial, United States, Intensive Care Units, Models, Nursing, Subacute Care, Tracheotomy
- Abstract
Objective: To compare 2 models for managing patients admitted to a subacute medical intensive care unit (MICU) who required prolonged mechanical ventilation (> or = 7 d)., Methods: The subjects were 192 consecutive patients (mean +/- SD age 61.5 +/- 16.1 y, 52% male, 86% white) managed during alternating 7-month blocks of time by an attending physician in collaboration with an acute care nurse practitioner (ACNP) (n = 98 patients) or by an attending physician in collaboration with critical care/pulmonary fellows (n = 94 patients). The total observation time was 28 months (14 mo per team)., Results: At unit entry, there were no significant differences in age, sex, race, comorbidity, Acute Physiology and Chronic Health Evaluation III score, or time of tracheostomy between the patients managed by the 2 teams. Patients managed by the ACNP team were more likely to have required mechanical ventilation due to an acute pulmonary problem (p = 0.005). At subacute MICU discharge, the groups were not significantly different in regard to subacute MICU length of stay, days on mechanical ventilation, or discharge weaning status (p > 0.05). The number of readmissions to the MICU was similar for the ACNP team (n = 7) and fellows team (n = 8), as were readmissions to the subacute MICU < or = 72 h after discharge (ACNP = 2, fellows = 1). Each team had 2 deaths without treatment limitation., Conclusion: As hypothesized, management of patients who required prolonged mechanical ventilation with tracheostomy had equivalent outcomes with the ACNP team or the fellows team.
- Published
- 2006
34. Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit.
- Author
-
Hoffman LA, Tasota FJ, Zullo TG, Scharfenberg C, and Donahoe MP
- Subjects
- Aged, Education, Continuing, Female, Humans, Length of Stay, Male, Middle Aged, Respiration, Artificial, United States, Intensive Care Units organization & administration, Medical Staff, Hospital, Nurse Practitioners, Outcome Assessment, Health Care, Patient Care Team, Physicians
- Abstract
Background: Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff., Objective: To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows., Methods: During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes., Results: Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02)., Conclusions: In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.
- Published
- 2005
35. Short-term complications and resource utilization in matched subjects after on-pump or off-pump primary isolated coronary artery bypass.
- Author
-
Hravnak M, Hoffman LA, Saul MI, Zullo TG, Cuneo JF, and Pellegrini RV
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Aged, Atrial Fibrillation epidemiology, Atrial Fibrillation etiology, Blood Transfusion statistics & numerical data, Cardiopulmonary Bypass economics, Cardiopulmonary Bypass mortality, Cohort Studies, Coronary Artery Bypass economics, Coronary Artery Bypass mortality, Databases as Topic, Female, Humans, Male, Matched-Pair Analysis, Patient Readmission statistics & numerical data, Reoperation statistics & numerical data, Retrospective Studies, Stroke epidemiology, Stroke etiology, Stroke Volume physiology, Cardiopulmonary Bypass adverse effects, Coronary Artery Bypass adverse effects, Coronary Artery Bypass methods
- Abstract
Background: Studies suggest that patients who undergo off-pump coronary artery bypass grafting (OPCABG) have fewer short-term complications and use fewer inpatient resources than do patients who undergo standard coronary artery bypass grafting (CABG) with extracorporeal circulation. However, dissimilarity between groups in risk factors for complications has hindered interpretation of results., Objectives: To compare the prevalence of selected complications (atrial fibrillation, stroke, reoperation, and bleeding) and inpatient resource utilization (length of stay, discharge disposition, total charges) between subjects undergoing primary isolated CABG or OPCABG who were matched with respect to key risk factors., Methods: Retrospective, causal-comparative survey conducted in 1 center for 18 months. Patients who underwent primary isolated CABG or OPCABG were matched for sex, age (within 2 years), left ventricular ejection fraction (within 0.05), and graft-patient ratio (exact match) and compared for prevalence of new-onset atrial fibrillation, stroke, reoperation within 24 hours, and bleeding. Statistical analysis included Wilcoxon and t tests for paired comparisons., Results: The sample (107 matched pairs) was 63% male, with a mean age of 66 (SD 9.5) years, a mean left ventricular ejection fraction of 0.51 (SD 0.13), and a mean graft-patient ratio of 3.41 (SD 0.74). The 2 groups did not differ significantly in New York Heart Association class (P = .43), Acute Physiology and Chronic Health Evaluation III score (P = .22), postoperative beta-blocker use (P = .73), or comorbid conditions. None of the complications examined differed significantly between pairs., Conclusion: Patients with comparable risk profiles have similar prevalences of selected complications after CABG and OPCABG.
- Published
- 2004
36. Are symptom reports useful for differentiating between acute rejection and pulmonary infection after lung transplantation?
- Author
-
De Vito Dabbs A, Hoffman LA, Iacono AT, Zullo TG, McCurry KR, and Dauber JH
- Subjects
- Activities of Daily Living, Acute Disease, Adult, Aged, Cough etiology, Diagnosis, Differential, Dyspnea etiology, Female, Follow-Up Studies, Graft Rejection complications, Humans, Male, Middle Aged, Respiratory Tract Infections complications, Respiratory Tract Infections etiology, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Treatment Outcome, Graft Rejection diagnosis, Lung Transplantation adverse effects, Respiratory Tract Infections diagnosis
- Abstract
Background: Prompt treatment of acute rejection and pulmonary infection reduces morbidity and mortality in lung transplant recipients. Symptoms, spirometry, and bronchoscopy are used to detect these complications. Of these, symptom reporting is the least invasive, yet has received little critical examination., Objective: To examine the potential for using reports of symptoms, such as cough and shortness of breath, to recognize clinically significant acute rejection and pulmonary infection after lung transplantation., Methods: Symptoms reported during routine follow-up visits were compared between lung transplant recipients (LTR) with clinically significant acute rejection (grade >or= A2) and those without (grade A0 or A1) and between LTR with rejection (grade >or= A2) and those with pulmonary infection., Results: LTR with rejection (grade >or= A2) reported more symptoms (P < .01) than did those without (grade A0, A1); however, the magnitude of difference was minimal. LTR with clinically significant acute rejection (grade >or= A2) reported symptoms at a rate comparable with those having pulmonary infection., Conclusions: Although symptoms may alert LTR to changes in their condition, no symptoms (respiratory, general, or activities of daily living [ADL]) differentiate between grades of rejection or pulmonary infection.
- Published
- 2004
- Full Text
- View/download PDF
37. Pattern and predictors of early rejection after lung transplantation.
- Author
-
DeVito Dabbs A, Hoffman LA, Iacono AT, Wells CL, Grgurich W, Zullo TG, McCurry KR, and Dauber JH
- Subjects
- Chi-Square Distribution, Cohort Studies, Female, Graft Rejection classification, Graft Rejection drug therapy, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Pennsylvania epidemiology, Predictive Value of Tests, Prevalence, Regression Analysis, Retrospective Studies, Risk Factors, Severity of Illness Index, Statistics, Nonparametric, Time Factors, Graft Rejection epidemiology, Lung Transplantation adverse effects
- Abstract
Background: Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation., Objectives: To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection., Methods: Data for donor, recipient, and posttransplant variables were retrieved retrospectively for 250 recipients of single or double lung transplants., Results: Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002)., Conclusions: Recipients who experienced higher grades for their first episode of acute rejection (P = .03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.
- Published
- 2003
38. Effect of tracheal gas insufflation during weaning from prolonged mechanical ventilation: a preliminary study.
- Author
-
Hoffman LA, Tasota FJ, Delgado E, Zullo TG, and Pinsky MR
- Subjects
- Adult, Aged, Blood Pressure physiology, Female, Heart Rate physiology, Humans, Male, Middle Aged, Oximetry, Statistics, Nonparametric, Tidal Volume physiology, Tracheostomy, Insufflation methods, Oxygen Inhalation Therapy methods, Respiration, Artificial, Ventilator Weaning
- Abstract
Background: Tracheal gas insufflation reduces inspired tidal volume and minute ventilation in spontaneously breathing patients and may facilitate weaning from mechanical ventilation., Objective: To determine if tracheal gas insufflation can reduce ventilatory demand during weaning trials in patients who require prolonged mechanical ventilation., Methods: A reduction in ventilatory demand was defined as a relative decrease in tidal volume, minute ventilation, and mean inspiratory flow during trials with tracheal gas insufflation compared with the values during trials without this therapy. A total of 14 subjects underwent T-piece trials with and without insufflation (flow rate 6 L/min) on 2 consecutive days; the order of insufflation was randomized. Tidal volume, minute ventilation, and mean inspiratory flow were measured at baseline (without insufflation) and 2 hours later., Results: Differences in ventilatory demand were not significant when comparisons were made for condition (tracheal gas insufflation vs no flow) or time (baseline vs 2 hours) for the total group (P = .48). Subjects were classified post hoc as responders (n = 9) or nonresponders (n = 5). Comparisons between responders and nonresponders indicated a significant (P = .02) 3-way multivariate interaction for group (responder vs nonresponder), condition (tracheal gas insufflation vs no flow), and time (baseline vs 2 hours) for ventilatory demand variables., Conclusion: Tracheal gas insufflation can reduce ventilatory demand during weaning trials in some patients who require mechanical ventilation.
- Published
- 2003
39. Early discharge following abdominal aortic aneurysm repair: Impact on patients and caregivers.
- Author
-
Jones MA, Hoffman LA, Makaroun MS, Zullo TG, and Chelluri L
- Subjects
- Aged, Blood Vessel Prosthesis Implantation, Caregivers, Female, Health Services statistics & numerical data, Humans, Length of Stay, Male, Minimally Invasive Surgical Procedures, Multivariate Analysis, Prospective Studies, Quality of Life, Treatment Outcome, Aortic Aneurysm, Abdominal rehabilitation, Aortic Aneurysm, Abdominal surgery, Patient Discharge
- Abstract
Although early discharge is common place, little is known about its impact after abdominal aortic aneurysm (AAA) surgery. We sought to prospectively describe patient outcomes and caregiving experience after early discharge following elective AAA repair using a standard or endovascular grafting system (EGS) procedure. Fifty-one patients (Standard, n=25; EGS, n=26) completed questionnaires on symptoms and health-related quality of life (HRQoL) while hospitalized and 1, 4, and 8 weeks after discharge. Data were also obtained from caregivers. HRQoL decreased at Week 1 in both groups but returned to near baseline by Week 8. Standard AAA patients experienced more symptoms and activity limitations, but these were concentrated in Week 1. Most caregivers were positive about caregiving and required no additional resources. Findings suggest that most patients who undergo early discharge following elective AAA surgery experience few problems. Those problems that occur concentrate in the week following discharge, suggesting the need for closer monitoring at this time., (Copyright 2002 Wiley Periodicals, Inc.)
- Published
- 2002
- Full Text
- View/download PDF
40. Resource utilization related to atrial fibrillation after coronary artery bypass grafting.
- Author
-
Hravnak M, Hoffman LA, Saul MI, Zullo TG, and Whitman GR
- Subjects
- Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, Atrial Fibrillation economics, Atrial Fibrillation therapy, Coronary Artery Bypass economics, Health Resources
- Abstract
Background: Studies of resource utilization by patients with new-onset atrialfibrillation after coronary artery bypass grafting have addressed only length of stay and bed charges., Objective: To compare resource utilization between patients with new-onset atrial fibrillation and patients without atrialfibrillation after isolated coronary artery bypass grafting., Methods: Retrospective review of clinical and administrative electronic databases for 720 subjects who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass in 25 months at one medical center The prevalence of atrial fibrillation was determined, and resource utilization in various hospital cost centers was compared between subjects with and without atrialfibrillation., Results: The prevalence of new-onset atrial fibrillation was 33.1%. Compared with subjects without atrialfibrillation, subjects with atrialfibrillation had a longer stay (5.8 +/- 2.4 vs. 4.4+/-1.2 days, P<.001), more days receiving mechanical ventilation (P =.002) and oxygen therapy (P<.001), and higher rates of readmission to the intensive care unit (4.6% vs. 0.2%, P<.001). Subjects with atrial fibrillation also had more laboratory tests (P<.001) and more days receiving cardiac drugs, heparin, diuretics, and electrolytes. Subjects with atrialfibrillation had higher total postoperative charges ($57261 +/- $17101 vs. $50905 +/- $10062, P = .001), a mean difference of $6356. The mean differences were greatest for bed charges ($1642), laboratory charges ($1215), pharmacy ($989), and respiratory care ($582)., Conclusion: The economic impact of atrialfibrillation after coronary artery bypass grafting has been underestimated.
- Published
- 2002
41. Effect of positioning on oxygenation in single-lung transplant recipients.
- Author
-
George EL, Hoffman LA, Boujoukos A, and Zullo TG
- Subjects
- Analysis of Variance, Blood Pressure physiology, Female, Heart Rate physiology, Humans, Male, Middle Aged, Lung Transplantation, Oxygen metabolism, Posture physiology
- Abstract
Background: Many benefits and adverse effects of positioning are related to changes in ventilation and perfusion. A number of unique factors related to the allograft make the effects of positioning difficult to determine in single-lung transplant recipients., Objectives: To determine the effect of 3 body positions (supine, lateral with allograft lung down, and lateral with native lung down) on oxygenation and blood flow in single-lung transplant recipients in the 24 hours immediately after surgery., Methods: A quasi-experimental repeated-measures design with stratified assignment to 1 of 3 different sequencing patterns for turning group was used to study 15 transplant recipients, 9 with emphysema and 6 with fibrosis. Oxygenation, ventilation, and blood flow measures (heart rate, blood pressure) were assessed after each turn. The effect of ischemic reperfusion injury was also explored., Results: The oxygenation, ventilation, and bloodflow variables did not differ significantly across group, diagnosis, or time. Oxygenation variables measured when the allograft lung was dependent did not differ significantly from such measurements obtained when the native lung was dependent., Conclusions: No single position maximizes oxygenation in the immediate postoperative period in single-lung transplant recipients. Although a single standard protocol for positioning cannot be supported, the study does support the idea that transplant recipients can be safely turned in the immediate postoperative period without compromising oxygenation or hemodynamic status.
- Published
- 2002
42. Quality of life assessment in patients undergoing endovascular or conventional AAA repair.
- Author
-
Aquino RV, Jones MA, Zullo TG, Missig-Carroll N, and Makaroun MS
- Subjects
- Aged, Cohort Studies, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Prospective Studies, Stents, Time Factors, Angioplasty, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation, Quality of Life
- Abstract
Purpose: To compare health-related quality of life outcomes in a cohort of abdominal aortic aneurysm (AAA) patients treated concurrently with either a conventional or endoluminal intervention., Methods: Between December 1997 and April 1999, 51 AAA patients treated by either open or endovascular techniques were enrolled in this prospective study. Conventional therapy was performed in 26 patients (19 men; mean age 70.4 +/- 6.0 years) with anatomical features unsuitable for the endovascular approach. Twenty-five patients (23 men; mean age 70.7 +/- 7.2 years) underwent endoluminal AAA exclusion using either the Ancure or bifurcated Enduring stent-grafts. The Medical Outcomes Study Short-Form 36-item health survey was administered preoperatively and at 1, 4, 8, and > or = 52 weeks after discharge., Results: At 1 week, both groups showed significant reductions (p < 0.001) in mean scores compared to baseline in 4 dimensions (physical function, social function, role-physical, and vitality), but the decline was more pronounced in patients having open repair. Endoluminal patients returned to their baseline scores by the 4th postoperative week, whereas complete recovery to baseline in the conventional patients was delayed to the 8th week., Conclusions: Patients treated endoluminally exhibit better physical and functional scores as early as 1 week after discharge; they also return to baseline status significantly earlier than the conventional group. These findings document the perceived advantage of endovascular therapy over conventional AAA treatment.
- Published
- 2001
- Full Text
- View/download PDF
43. Atrial fibrillation: prevalence after minimally invasive direct and standard coronary artery bypass.
- Author
-
Hravnak M, Hoffman LA, Saul MI, Zullo TG, Cuneo JF, Whitman GR, Clochesy JM, and Griffith BP
- Subjects
- Aged, Atrial Fibrillation etiology, Cross-Sectional Studies, Female, Humans, Incidence, Male, Middle Aged, Pennsylvania, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Atrial Fibrillation epidemiology, Coronary Artery Bypass, Minimally Invasive Surgical Procedures, Postoperative Complications epidemiology
- Abstract
Background: This study identified and compared the prevalence of new-onset atrial fibrillation (AFIB) following standard coronary artery bypass grafting (SCABG) with cardiopulmonary bypass (CPB) and minimally invasive direct vision coronary artery bypass grafting (MIDCAB) without CPB. A further comparison was made between AFIB prevalence in SCABG and MIDCAB subjects with two or fewer bypasses., Methods: This is a retrospective, comparative survey. Patients with new-onset AFIB who underwent SCABG or MIDCAB alone were identified electronically using a triangulated method (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9 CM] code; clinical database word search; and pharmacy database drug search)., Results: The total sample (n = 814; 94 MIDCAB, 720 SCABG) exhibited a trend toward lower AFIB prevalence in MIDCAB (23.4%) versus SCABG (33.1%) subjects (p = 0.059). AFIB prevalence in the SCABG subset with two or less vessel bypasses (n = 98; n = 18 single vessel, n = 80 double vessels) and MIDCAB subjects (n = 94; n = 90 single vessels, n = 4 double vessels) was almost identical (SCABG subset 24.5% versus MIDCAB 23.4%, p = 0.860). Slightly more than half (56.9%) of new-onset AFIB subjects were identified by ICD-9 CM codes, with the remainder by word search (37.7%) or procainamide query (5.4%)., Conclusions: In this sample, the number of vessels bypassed seemed to have a greater influence on AFIB prevalence than the application of CPB or the surgical approach. Retrospective identification of AFIB cases by ICD-9 CM code grossly underestimated AFIB prevalence.
- Published
- 2001
- Full Text
- View/download PDF
44. Tracheal gas insufflation. Limits of efficacy in adults with acute respiratory distress syndrome.
- Author
-
Hoffman LA, Miro AM, Tasota FJ, Delgado E, Zullo TG, Lutz J, and Pinsky MR
- Subjects
- Acute Disease, Adult, Aged, Aged, 80 and over, Carbon Dioxide blood, Evaluation Studies as Topic, Female, Hemodynamics physiology, Humans, Intubation, Intratracheal, Male, Middle Aged, Oxygen blood, Partial Pressure, Plethysmography, Positive-Pressure Respiration, Prospective Studies, Respiratory Dead Space physiology, Respiratory Distress Syndrome physiopathology, Insufflation methods, Respiratory Distress Syndrome therapy
- Abstract
In mechanically ventilated adults with acute respiratory distress syndrome (ARDS), peak airway pressures (Paw(peak)) above 35 cm H(2)O may increase the risk of barotrauma or volutrauma. Tracheal gas insufflation (TGI), an adjunctive ventilatory technique, may facilitate a reduction in set inspiratory pressure in these patients, and thereby in the tidal volume (VT) and Paw(peak) used in their ventilation, without a consequent increase in arterial carbon dioxide tension (PaCO(2)). The purpose of this study was to: (1) assess the limits of efficacy of continuous TGI at two levels of decreased mechanical ventilatory support; and (2) determine an appropriate time interval after initiation of TGI at which to evaluate response. We prospectively studied eight adults with ARDS and increased airway pressures (40.2 +/- 2.7 cm H(2)O) who were managed with pressure-control ventilation (PCV). After obtaining baseline ventilatory and hemodynamic measures, we initiated TGI at 10 L/min, adjusting ventilator positive-end expiratory pressure (PEEP) to maintain baseline VT, and decreased the set inspiratory pressure by 5 cm H(2)O. Data were obtained after 30 and 60 min. Set inspiratory pressure was then decreased by an additional 5 cm H(2)O (total: 10 cm H(2)O), and data were again obtained after 30 min. Baseline (zero TGI) measures were then again recorded. Thirty minutes after decreasing the set inspiratory pressure by 5 cm H(2)O with TGI at 10 L/min, there was a 15% decrease in Paw(peak) and a 16% decrease in VT as compared with their baseline values. However, Pa(CO(2)) remained constant (59 +/- 10 mm Hg versus 57 +/- 6 mm Hg) (p = NS). There was no change in Pa(O(2)) or in hemodynamic variables, and no differences between variables, at 30 min versus 60 min in seven subjects. The remaining subject did not tolerate the reduction in set inspiratory pressure for 60 min. Thirty minutes after the set inspiratory pressure was decreased by 10 cm H(2)O with TGI at 10 L/min, there was a 26% decrease in Paw(peak) and a 26% decrease in VT. However, Pa(CO(2)) increased by 19% and Pa(O(2)) decreased by 13%. Six subjects completed this phase of the protocol for 30 min, and one subject completed it for 60 min. TGI can be used to rapidly facilitate a 5 cm H(2)O reduction in set inspiratory pressure without an increase in Pa(CO(2)). The ability to achieve a 5 cm H(2)O reduction in set inspiratory pressure without adverse physiologic effects was evident within 30 min. Attempts to further reduce set inspiratory pressure were not successful.
- Published
- 2000
- Full Text
- View/download PDF
45. Long-term survival estimates of cast gold inlays and onlays with their analysis of failures.
- Author
-
Studer SP, Wettstein F, Lehner C, Zullo TG, and Schärer P
- Subjects
- Confidence Intervals, Dental Casting Technique, Follow-Up Studies, Humans, Proportional Hazards Models, Survival Analysis, Time Factors, Treatment Outcome, Dental Restoration Failure, Gold Alloys therapeutic use, Inlays statistics & numerical data
- Abstract
The aim of the present study was to assess the clinical behaviour of cast gold restorations with respect to define a gold control against current and future ceramic and composite restorations. The study sample included 50 patients with 303 cast gold restorations. All restorations were cemented with a non-adhesive technique. A total of 303 restorations were evaluated clinically and radiographically using modified United States Public Health Service criteria. Restorations recorded as having an A- or a B-rating were defined as successful. Of the 303 restorations, 42 were judged as failures, which resulted in a failure rate of 13.8% for a mean observation time (+/- s.d.) of 18.7 ( +/- 9.5) years. The estimated Kaplan-Meier survival rates (s.e.) were 96.1% (+/- 1.1%) at 10 years, 87.0% (+/- 2.2%) at 20 years and 73.5% (+/- 5.4%) at 30 years. In total, biological reasons were counted 25 times in comparison to 17 technical reasons for those 42 failed cast gold restorations, with 17 secondary caries (40%) as the most common biological reason and with 13 retention losses (31%) as the most common technical reason. The endodontically treated tooth was exclusively identified as a risk factor. The restoration type (inlay versus onlay) did not influence the survival rate.
- Published
- 2000
- Full Text
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46. Determining Quality of Life in Older and Younger Women With Congestive Heart Failure and Myocardial Infarction.
- Author
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Varvaro FF, Olds NB, Zullo TG, and Murali S
- Abstract
The purpose of this study was to compare quality of life (QOL) between older and younger women diagnosed with congestive heart failure (CHF) or myocardial infarction (MI) and to ascertain if QOL varied with age. Using the Medical Outcomes Survey (MOS-SF-36) we examined 131 women: 69 diagnosed with CHF and 62 with MI. Older women (age equals 65 years) with CHF had a higher mean for general health, whereas younger women (age equals 64 years) had higher mean scores for role physical, vitality, role emotion, and social functioning. Older women with MI had higher mean scores on role emotion, mental health, and social functioning. The younger MI women had higher mean scores on physical functioning, and role physical. Aspects of QOL may vary in subsets of women depending on age and cardiac diagnosis. This suggests the need for age appropriate intervention in women with MI and CHF.
- Published
- 1999
47. Reliability of three methods of occlusion classification.
- Author
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Du SQ, Rinchuse DJ, Zullo TG, and Rinchuse DJ
- Subjects
- Humans, Models, Dental, Observer Variation, Reproducibility of Results, Malocclusion classification
- Abstract
Four orthodontic faculty at one dental school classified 25 dental casts according to the classification systems of Angle, Katz, and the British Incisor Classification. The dental casts were selected from a pool of 350 pretreatment graduate orthodontic cases and were those deemed the most atypical. The results demonstrated that Katz's classification was more reliable than both Angle and the British. Angle's classification was the least reliable of the three methods.
- Published
- 1998
- Full Text
- View/download PDF
48. Hypoalgesic effect of caffeine in experimental ischemic muscle contraction pain.
- Author
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Myers DE, Shaikh Z, and Zullo TG
- Subjects
- Adult, Analgesics, Non-Narcotic therapeutic use, Caffeine therapeutic use, Female, Humans, Ischemia, Middle Aged, Muscle Contraction, Muscles blood supply, Pain classification, Pain drug therapy, Pain metabolism, Pain Measurement, Purinergic P1 Receptor Antagonists, Receptors, Purinergic P1 drug effects, Tension-Type Headache drug therapy, Analgesics, Non-Narcotic pharmacology, Caffeine pharmacology, Pain physiopathology
- Abstract
It has been theorized that adenosine is a leading candidate for the metabolite responsible for ischemic muscle pain. The purpose of this study was to determine the effect of the non-selective adenosine receptor antagonist, caffeine, on ischemic skeletal muscle contraction pain. Seven healthy adult volunteers with no history of pain disorders, systemic disease, or habitual caffeine use, were chosen for the two-session, cross-over, double-blind study. Every subject received either 200 mg of caffeine (NoDoz, Bristol-Myers) or identical placebo 1 hour before each of the two trials. Ischemia of the forearm was achieved by inflation of a blood pressure cuff to 250 mm Hg. Forearm muscle activity was generated by performance of wrist curis using a 5-gram bar at a rate of 40 cycles per minute. Pain was rated at 15-second intervals for 1 minute using a visual analog scale (0 to 10) with verbal descriptors. Significance was determined by univariate and multivariate analyses of variance and covariance including repeated measures. Pain ratings at 15 seconds in the caffeine trial were significantly lower (P < 0.02) than those in the placebo trial. This effect continued at 30 seconds (P < 0.05). However, by 45 seconds, pain in the caffeine trial was not significantly lower (P = 0.4) than that in the placebo trial. These results show that high-dose caffeine exhibits considerable analgesic efficacy in experimental muscle pain, adding support for a role of adenosine in producing ischemic muscle contraction pain.
- Published
- 1997
- Full Text
- View/download PDF
49. A comparison of two teaching simulations in preclinical operative dentistry.
- Author
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Long NK, Zullo TG, and Hinkelman KW
- Subjects
- Analysis of Variance, Ceramics, Evaluation Studies as Topic, Humans, Inlays, Multivariate Analysis, Students, Dental, Dentistry, Operative education, Education, Dental methods, Models, Dental, Tooth, Artificial
- Abstract
The purpose of this study was to determine whether a ceramic tooth would be as effective as a natural tooth in teaching preclinical operative skills. Subjects consisted of all second-year students enrolled in a preclinical inlay course. Students were classified into high- and low-dexterity groups, randomly assigned to one of the tooth simulators, taught the same four procedures, and asked to keep a log of the amount of time spent on each. All students participated in a practical examination that consisted of preparing a cavity for a gold casting using a resin tooth. There were no statistically significant differences between students who prepared natural teeth and those who prepared ceramic teeth for either the qualitative practical examination score or the amount of preparation time required. High-dexterity students achieved significantly higher scores on the practical than did low-dexterity students, whether practicing on natural or ceramic teeth. The MOD onlay required significantly more time to complete than did any of the other preparations on both natural and ceramic tooth simulators. Written evaluations of the ceramic simulators revealed that students perceived ceramic teeth to be as good or better than natural teeth because of their anatomic uniformity.
- Published
- 1997
50. Home-based, upper-arm exercise training for patients with chronic obstructive pulmonary disease.
- Author
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Bauldoff GS, Hoffman LA, Sciurba F, and Zullo TG
- Subjects
- Fatigue, Female, Humans, Male, Middle Aged, Outcome Assessment, Health Care, Pilot Projects, Arm, Exercise Therapy, Lung Diseases, Obstructive rehabilitation
- Abstract
Prior studies demonstrate the ability of upper extremity training to increase arm strength and endurance when incorporated into a pulmonary rehabilitation program. However, patients with severe chronic obstructive pulmonary disease (COPD) may have transportation or mobility problems that make it difficult to travel to a rehabilitation site to obtain this training. This pilot study was designed to determine whether a home-based, upper-arm exercise program could increase arm strength and endurance, and decrease perceptions of breathlessness and fatigue during five activities of daily living. Twenty patients with severe COPD (FEV1 0.80 +/- 0.42) were randomized to an experimental (n = 10) or control group (n = 10). The experimental-group training included three upper arm exercises five times a week for 8 weeks, with training level incremented during weekly home visits. Control-group subjects were contacted weekly to equalize attention from health care providers. During the upper-extremity endurance test for number of rings moved, no significant differences between groups were seen for interaction or treatment. However, there was a significant interaction between treatment and time for perceived fatigue (p = 0.0012), with the experimental group perceiving less fatigue during upper arm work than did the control group. No change was seen in perceived breathlessness. Findings of this study suggest that a home-based, upper-arm exercise program can reduce perceptions of fatigue for patients with severe COPD during activities involving upper arm work. Testing in a larger sample is indicated to determine whether this training can also improve ability to perform unsupported arm work.
- Published
- 1996
- Full Text
- View/download PDF
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