The Effects of Nursing Back Rub on Pain and Wound Cytokines and The Relationship Between Pre-CABG Mood and Post-CABG Wound Cytokines

This study, guided by psychoneuroimmunology theory, examined the effects of a 10-minute nursing back rub in 20 coronary artery bypass graft (CABG) patients on pain and four proinflammatory wound cytokines (IL-1β, IL-6, IL-8, and TNF-α). It also examined the relationships between the Profile of Mood States (POMS) and the proinflammatory cytokines. A control group (n = 8) received time with the researcher, and an experimental group (n = 12) received a slow stroke effleurage back rub. All participants initially completed the POMS and after surgery, wound fluid was collected from the mediastinal chest tube before and after the intervention. Analysis showed the experimental group had a significant decrease in pain (df 11, p=0.001). Pretest mean levels of cytokines one hour before the back rub were: IL-1β, 15.1 pg/ml; IL-6, 104,680pg/ml; IL-8, 6,953 pg/m, and TNF-α, 3.5 pg/ml. Posttest cytokine mean levels were: IL-1β, 13.71 pg/ml; IL-6, 94,658.5 pg/ml; IL-8, 22,431 pg/ml; and TNF-α, 3.6 pg/ml. There were no significant changes in any cytokine levels in either group from pretest to posttest. Great variability in cytokine concentrations was noted in both the experimental and the control group. No significant relationships were found between the POMS Total Mood Disturbance Score (TMDS) and cytokine levels. There was a significant inverse relationship (r = -.560, p=.016) between the POMS score of tension-anxiety and IL-6. There was a significant positive correlation (r = .475, p=.034) between IL1-β and weight. This study has contributed support to a nursing intervention that appears to reduce pain perception, to the understanding of wound cytokine levels in CABG patients, and to psychoneuroimmunology research in that wound fluid IL-6 levels in were lower in patients who were tense/anxious before surgery. Further research needs to be done on wound healing and stress reducing interventions

Telenursing Intervention Increases Psychiatric Medication Adherence in Schizophrenia Outpatients

BACKGROUND: Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors. OBJECTIVES: This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems. STUDY DESIGN : The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months. STUDY RESULTS : Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298. CONCLUSIONS: Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk

Governed by the rules? The female voice in parliamentary debates

[Summary of the book containing this chapter:] Speaking Out is the first wideranging collection to focus on the female voice in public contexts. Despite an ever-growing role in public life, many women even in the Western developed world still struggle to gain access to the public arena, and once there, to gain recognition and respect for their effectiveness as speakers. The contributors to this volume show how female speech is often received and evaluated quite differently from the speech of men, whether within government and politics, law, the church, education, the business world, or the media. The book is written with passion by a stellar group of scholars in language and gender from around the English-speaking world, offering students a broad theoretical and contextual canvas. They consider both the barriers and the opportunities encountered by women seeking to gain recognition in the public sphere on the basis of 'the way they speak'