1/4. Storytelling and the interpretation of meaning in qualitative research.AIM: This paper reviews literature on narrative analysis and illustrates the meaning-making function of stories of chronic illness through analysis and discussion of two case studies from a study of acute episodes of chronic obstructive pulmonary disease (COPD). BACKGROUND: Individuals living with COPD experience acute exacerbations characterized by extreme dyspnea, but there has been little research to provide understanding of these events from the perspectives of individuals with COPD, family caregivers, and nurses. Narrative analysis -- considered in the context of the aims of qualitative research -- illuminates how these people make sense of acute exacerbation events by telling stories. DESIGN AND methods: In an ethnographic study, 10 patient-family nurse units in two Canadian general hospitals participated in interviews concerning acute episodes of COPD. Narrative analysis enabled identification of several story forms and their functions. RESULTS: Examples were found of a story told twice with different meanings, and of a patient's 'death story' used to communicate distrust of the nurse's ability to recognize the seriousness of distress and implications for its potential course. These examples are presented, and interpreted with respect to issues of meaning. CONCLUSIONS: The analysis indicates that stories told by patients in the context of nurse-client interactions inform understanding of the individual's acute exacerbation events beyond the biophysical.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Improving dyspnea management in three adults with chronic obstructive pulmonary disease.This case report describes occupational therapy intervention for three adult outpatients with chronic obstructive pulmonary disease (COPD) at one large urban hospital. The occupational therapy intervention was based on the Management of dyspnea Guidelines for Practice (Migliore, in press). The learning and practice of controlled breathing were promoted in the context of physical activity exertion in a domiciliary environment. In addition to promoting dyspnea management, the controlled-breathing strategies aimed to facilitate energy conservation and to increase perceived breathing control. Although no causality can be determined in a case study design, the patients' dyspnea with activity exertion decreased and their functional status and quality of life increased following goal-directed, individualized occupational therapy intervention combined with exercise training.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Genetic and biophysical basis for bupivacaine-induced ST segment elevation and VT/VF. anesthesia unmasked brugada syndrome.BACKGROUND: brugada syndrome is an inherited disease associated with sudden cardiac death. The electrocardiographic pattern associated with brugada syndrome has been linked to the use of sodium channel blockers, including antiarrhythmics, trycyclics and anesthetics. OBJECTIVE: We report a case of bupivacaine-induced brugada syndrome, in which we investigated the genetic, biophysical and path physiological mechanism involved. methods AND RESULTS: The patient developed a Brugada-like electrocardiographic pattern twice under the influence of bupivacaine. The first occurrence was accompanied by ventricular tachycardia (VT) which subsided after withdrawal of the anesthetic. The VT was also observed during co-administration of diltiazem and isosorbide-5-mononitrate, agents thought to facilitate ST segment elevation in the brugada syndrome. Genetic analysis revealed a missense mutation in the alpha subunit of the cardiac sodium channel, SCN5A. Biophysical analysis by whole-cell patch-clamping revealed a reduction in sodium current as a result of the mutation. The study of bupivacaine in the wedge model revealed use-dependent changes in conduction, heterogeneous loss of the action potential dome in RV epicardium and phase 2 re-entry when the preparations were pretreated with low concentrations of the calcium channel blocker verapamil. CONCLUSION: Our findings indicate that bupivacaine may induce the electrocardiographic and arrhythmic manifestations of the brugada syndrome in silent carriers of SCN5A mutations. The data have important implications in the management of patients who develop ST segment elevation when under the influence of anesthetics such as bupivacaine.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |
4/4. Functional status and quality of life in chronic obstructive pulmonary disease.Exertional dyspnea often causes patients with chronic obstructive pulmonary disease (COPD) to unconsciously reduce their activities of daily living (ADLs) to reduce the intensity of their distress. The reduction in ADLs leads to deconditioning which, in turn, further increases dyspnea. Both dyspnea and fatigue are important factors affecting health-related quality of life (HRQOL). The functional status of patients relates to how well they perform ADLs. Activities, however, may not be severely limited until the disease becomes advanced. The elimination of an ADL depends on the necessity or desirability of that activity and the intensity of the associated symptoms. HRQOL is measured using symptoms, functional status, and a rating of their impact on the individual. The Pulmonary Functional Status Scale (PFSS) and the Pulmonary Functional Status and dyspnea Questionnaire (PFSDQ) are 2 COPD-specific functional status questionnaires. Pedometers or accelerometers can quantify the levels of activity of patients with COPD. HRQOL is measured with validated multidimensional questionnaires that cover symptoms, physical, psychological, and social domains. Ideally, these instruments are discriminative (i.e., separate degrees of impairment) and evaluative (i.e., detect small changes after therapy). HRQOL questionnaires may be generic (e.g., Medical Outcomes Study Short Form-36 [SF-36]) and can measure favorable changes after intervention, such as pulmonary rehabilitation, or they can be disease specific with disease-related domains, e.g., Chronic Respiratory disease Questionnaire (CRQ) with domains of dyspnea, fatigue, emotion, and mastery; and St. George's Respiratory Questionnaire (SGRQ) with domains of symptoms, activity, and psychosocial impact. A case is presented that depicts how these tools may be used to evaluate improvement with intervention in a patient with COPD.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |