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Articles 1 - 30 of 30
Full-Text Articles in Medicine and Health Sciences
Women With Knee Osteoarthritis Have More Pain And Poorer Function Than Men, But Similar Physical Activity Prior To Total Knee Replacement, S. M. Tonelli, Barbara A. Rakel, N. A. Cooper, W. L. Angstom, K. A. Sluka
Women With Knee Osteoarthritis Have More Pain And Poorer Function Than Men, But Similar Physical Activity Prior To Total Knee Replacement, S. M. Tonelli, Barbara A. Rakel, N. A. Cooper, W. L. Angstom, K. A. Sluka
Barbara A. Rakel
ABSTRACT: BACKGROUND: Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown. METHODS: This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity …
Prolonged Ulcerative Laryngitis, Barbara Rakel, J. Spiegel, R. Sataloff
Prolonged Ulcerative Laryngitis, Barbara Rakel, J. Spiegel, R. Sataloff
Barbara A. Rakel
No abstract provided.
Effectiveness Of Transcutaneous Electrical Nerve Stimulation On Postoperative Pain With Movement, Barbara Rakel, Rita Frantz
Effectiveness Of Transcutaneous Electrical Nerve Stimulation On Postoperative Pain With Movement, Barbara Rakel, Rita Frantz
Barbara A. Rakel
This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in …
The Relationship Between Pain And Physical Function In Older Adults With Knee Osteoarthritis, N. Blodgett, Barbara Rakel, C. Vance, A. Amendola, D. Walsh, K. Sluka
The Relationship Between Pain And Physical Function In Older Adults With Knee Osteoarthritis, N. Blodgett, Barbara Rakel, C. Vance, A. Amendola, D. Walsh, K. Sluka
Barbara A. Rakel
No abstract provided.
Hypoalgesia In Response To Transcutaneous Electrical Nerve Stimulation (Tens) Depends On Stimulation Intensity, F. Moran, T. Leonard, S. Hawthorne, C. Hughes, E. Mccrum-Gardner, M. Johnson, Barbara Rakel, K. Sluka, D. Walsh
Hypoalgesia In Response To Transcutaneous Electrical Nerve Stimulation (Tens) Depends On Stimulation Intensity, F. Moran, T. Leonard, S. Hawthorne, C. Hughes, E. Mccrum-Gardner, M. Johnson, Barbara Rakel, K. Sluka, D. Walsh
Barbara A. Rakel
Transcutaneous Electrical Nerve Stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naive healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset …
Committee Meetings: An Electronic Alternative, Barbara Rakel
Committee Meetings: An Electronic Alternative, Barbara Rakel
Barbara A. Rakel
All too often, meetings are called without much thought as to whether or not they are necessary, wasting the staff's time and the organization's money. Sharing information and gathering input through electronic mail eliminates unproductive meetings and increases member productivity.
Redesigning The Rn And Na Roles, R. Gould, R. Thompson, Barbara Rakel, J. Jensen, E. Hasselman, L. Young
Redesigning The Rn And Na Roles, R. Gould, R. Thompson, Barbara Rakel, J. Jensen, E. Hasselman, L. Young
Barbara A. Rakel
No abstract provided.
An Investigation Of The Development Of Analgesic Tolerance To Tens In Humans, R. Liebano, B. Rakel, C. Vance, D. Walsh, K. Sluka
An Investigation Of The Development Of Analgesic Tolerance To Tens In Humans, R. Liebano, B. Rakel, C. Vance, D. Walsh, K. Sluka
Barbara A. Rakel
Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality used to control pain. Animal models show that repeated TENS application produces analgesic tolerance and cross-tolerance at spinal opioid receptors. The aim of the present investigation was to examine whether repeated application of TENS produces analgesic tolerance in humans. One hundred healthy subjects were randomly assigned to 1 of 4 groups: control, placebo, low-frequency (4Hz) or high-frequency (100Hz) TENS. TENS was applied daily for 5days to the nondominant upper limb; pressure-pain threshold (PPT) measurements were recorded before and after TENS. Temporal summation to mechanical stimulation was recorded on days 1 and …
Nonpharmacologic Treatment Of Pain, M. Titler, B. Rakel
Nonpharmacologic Treatment Of Pain, M. Titler, B. Rakel
Barbara A. Rakel
Nonpharmacologic interventions for pain treatment are important complementary therapies but are not substitutes for pharmacologic management of pain. Use of nonpharmacologic pain treatments in critical care settings is helpful to decrease pain, but the challenge remains for nurses to have the knowledge, time, and skill to use these interventions in a busy daily practice with severely ill patients. Although numerous studies testing the effectiveness of nonpharmacologic interventions for pain management are available, the varying methods and interventions used in these studies make it difficult to draw conclusions. Further research on the use of these interventions for pain reduction is necessary …
A New Transient Sham Tens Device Allows For Investigator Blinding While Delivering A True Placebo Treatment, Barbara Rakel, N. Cooper, H. Adams, B. Messer, L. Frey Law, D. Dannen, C. Miller, A. Polehna, R. Ruggle, C. Vance, D. Walsh, K. Sluka
A New Transient Sham Tens Device Allows For Investigator Blinding While Delivering A True Placebo Treatment, Barbara Rakel, N. Cooper, H. Adams, B. Messer, L. Frey Law, D. Dannen, C. Miller, A. Polehna, R. Ruggle, C. Vance, D. Walsh, K. Sluka
Barbara A. Rakel
This study compared a new transient sham transcutaneous electrical nerve stimulation (TENS) that delivers current for 45 seconds to an inactive sham and active TENS to determine the degree of blinding and influence on pain reduction. Pressure-pain thresholds (PPT), heat-pain thresholds (HPT), and pain intensities to tonic heat and pressure were measured in 69 healthy adults before and after randomization. Allocation investigators and subjects were asked to identify the treatment administered. The transient sham blinded investigators 100% of the time and 40% of subjects compared to the inactive sham that blinded investigators 0% of the time and 21% of subjects. …
Interventions Related To Patient Teaching, Barbara Rakel
Interventions Related To Patient Teaching, Barbara Rakel
Barbara A. Rakel
This study validated 13 nursing interventions related to patient teaching. Four of the labels address the process of patient teaching, whereas the other nine concern content specific to teaching efforts. With the help of 46 master's-prepared nurses from across the country, critical (major) and supporting (minor) activities for each label were identified. This study is one of many steps toward the construction of a taxonomy of nursing interventions focused on direct care treatments that nurses perform on behalf of patients. The ultimate goal is to provide nurses with a standardized language that can be used to document their unique role …
Effects Of Transcutaneous Electrical Nerve Stimulation On Pain, Pain Sensitivity, And Function In Patients With Knee Osteoarthritis: A Randomized Controlled Trial, C. Vance, Barbara Rakel, N. Blodgett, J. De Santana, A. Amendola, M. Zimmerman, D. Walsh, K. Sluka
Effects Of Transcutaneous Electrical Nerve Stimulation On Pain, Pain Sensitivity, And Function In Patients With Knee Osteoarthritis: A Randomized Controlled Trial, C. Vance, Barbara Rakel, N. Blodgett, J. De Santana, A. Amendola, M. Zimmerman, D. Walsh, K. Sluka
Barbara A. Rakel
Background and Objective:Transcutaneous Electrical Nerve Stimulation (TENS) is commonly used for treatment of pain; however the effects on a variety of pain and function measures is unclear. The purpose of the current study was to determine the effect of high (HF) and low (LF) frequency TENS, on a variety of outcome measures: resting pain, movement-evoked pain, and pain sensitivity in subjects with osteoarthritis of the knee. SUBJECTS:75 subjects with knee osteoarthritis (31-94 years, M=29, F=46) were assessed. METHODS:Subjects were randomly assigned to receive HF-TENS (100 Hz) (n=25), LF-TENS (4 Hz) (n=25) or Placebo (P) TENS (n=25) [pulse duration=100msec; intensity=10% below …
Hyperalgesia Increases In Older Adults After Total Knee Replacement Surgery (Abstract), Barbara Rakel, T. Brennan, K. Herer, L. Fink, A. Riesselman
Hyperalgesia Increases In Older Adults After Total Knee Replacement Surgery (Abstract), Barbara Rakel, T. Brennan, K. Herer, L. Fink, A. Riesselman
Barbara A. Rakel
No abstract provided.
From Book To Bedside: Putting Evidence To Use In The Care Of The Elderly, M. Titler, J. Mentes, Barbara Rakel, L. Abbott, S. Baumler
From Book To Bedside: Putting Evidence To Use In The Care Of The Elderly, M. Titler, J. Mentes, Barbara Rakel, L. Abbott, S. Baumler
Barbara A. Rakel
BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, …
Managing Constipation Using A Research-Based Protocol., G. Hall, M. Karstens, Barbara Rakel, E. Swanson, A. Davidson
Managing Constipation Using A Research-Based Protocol., G. Hall, M. Karstens, Barbara Rakel, E. Swanson, A. Davidson
Barbara A. Rakel
No abstract provided.
Clinical Outcome Of Emergency Repeat Coronary Artery Bypass Surgery, J. Lemmer, D. Ferguson, Barbara Rakel, N. Rossi
Clinical Outcome Of Emergency Repeat Coronary Artery Bypass Surgery, J. Lemmer, D. Ferguson, Barbara Rakel, N. Rossi
Barbara A. Rakel
To determine the clinical outcome of patients requiring emergency repeat coronary artery bypass graft (CABG) procedures, we reviewed 23 such procedures performed for ongoing myocardial ischemia refractory to medical management. The operative mortality was 17%. On follow-up, an average of 24.9 months after emergency reoperation, 14 of the 19 survivors (74%) had recurrent angina. As compared to a randomly selected group of 25 patients who underwent elective repeat CABG procedures during the same time period, the incidence of late cardiac events was significantly higher (79% in the emergency group, 30% in the elective surgery group) and fewer patients had received …
Physical Modalities In Chronic Pain Management, Barbara Rakel, J. Barr
Physical Modalities In Chronic Pain Management, Barbara Rakel, J. Barr
Barbara A. Rakel
The following conclusions can be made based on review of the evidence: There is limited but positive evidence that select physical modalities are effective in managing chronic pain associated with specific conditions experienced by adults and older individuals. Overall, studies have provided the most support for the modality of therapeutic exercise. Different physical modalities have similar magnitudes of effects on chronic pain. Therefore, selection of the most appropriate physical modality may depend on the desired functional outcome for the patient, the underlying impairment, and the patient's preference or prior experience with the modality. Certain patient characteristics may decrease the effectiveness …
Split-Thickness Skin Graft Donor Site Care: A Quantitative Synthesis Of The Research, Barbara Rakel, M. Bermel, L. Abbott, S. Baumler, M. Burger, C. Dawson, J. Heinle, I. Ocheltree
Split-Thickness Skin Graft Donor Site Care: A Quantitative Synthesis Of The Research, Barbara Rakel, M. Bermel, L. Abbott, S. Baumler, M. Burger, C. Dawson, J. Heinle, I. Ocheltree
Barbara A. Rakel
Split-thickness skin grafting (STSG) is a frequently used reconstructive technique but is associated with a large variation in practice. The purposes of this article are to integrate and synthesize the available empirical evidence regarding STSG donor site dressings, identify which dressings are associated with the best outcomes, and provide practice recommendations. This review of 33 studies found transparent film to be the best dressing for the care of STSG donor site wounds. Transparent film was associated with one of the fastest healing rates (9.47 days), a smooth epithelialized surface, a low infection rate (10 out of 394 patients or 3%), …
Development Of Alterations In Learning: Situational Learning Disabilities, Barbara Rakel, G. Bulechek
Development Of Alterations In Learning: Situational Learning Disabilities, Barbara Rakel, G. Bulechek
Barbara A. Rakel
Until now the nursing diagnosis knowledge deficit has served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept, situational learning disability (SLD), a component of Alterations in Learning, which has been identified as an area to be developed in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27-bed telemetry step-down unit is provided. The data support the development of two nursing diagnoses: (1) situational learning …
Women With Knee Osteoarthritis Have More Pain And Poorer Function Than Men, But Similar Physical Activity Prior To Total Knee Replacement, S. M. Tonelli, Barbara A. Rakel, N. A. Cooper, W. L. Angstom, K. A. Sluka
Women With Knee Osteoarthritis Have More Pain And Poorer Function Than Men, But Similar Physical Activity Prior To Total Knee Replacement, S. M. Tonelli, Barbara A. Rakel, N. A. Cooper, W. L. Angstom, K. A. Sluka
Barbara A. Rakel
ABSTRACT: BACKGROUND: Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown. METHODS: This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity …
Adjusting Pulse Amplitude During Transcutaneous Electrical Nerve Stimulation (Tens) Application Produces Greater Hypoalgesia, M. Pantaleao, M. Laurino, N. Gallego, C. Cabral, Barbara Rakel, C. Vance, K. Sluka, D. Walsh, R. Liebano
Adjusting Pulse Amplitude During Transcutaneous Electrical Nerve Stimulation (Tens) Application Produces Greater Hypoalgesia, M. Pantaleao, M. Laurino, N. Gallego, C. Cabral, Barbara Rakel, C. Vance, K. Sluka, D. Walsh, R. Liebano
Barbara A. Rakel
Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique used for pain modulation. During application of TENS there is a fading of current sensation. Textbooks of electrophysical agents recommend that pulse amplitude should be constantly adjusted. This seems to be accepted clinically despite the fact that there is no direct experimental evidence. The aim of the current study was to investigate the hypoalgesic effect of adjusting TENS pulse amplitude on pressure pain thresholds (PPTs) in healthy humans. Fifty-six healthy TENS naive participants were recruited and randomly assigned to 1 of 4 groups (n = 14 per group): control, placebo TENS, …
Implementation Of The Agency For Health Care Policy And Research Pain Guidelines, K. Schmidt, M. Alpen, Barbara Rakel
Implementation Of The Agency For Health Care Policy And Research Pain Guidelines, K. Schmidt, M. Alpen, Barbara Rakel
Barbara A. Rakel
Implementation of clinical practice guidelines in a large setting is a complex process. This article describes the many issues encountered in trying to implement Agency for Health Care Policy and Research acute pain and cancer pain guidelines in an academic medical center. Issues addressed include the membership of the task forces involved, incorporation of the guidelines into the institution-specific standards of care, selection and implementation of self-reporting tools for assessment of pain throughout the institution, issues involved in standardizing documentation of pain throughout the institution, measurement of the current status of pain control and integration into the existing quality assessment …
Effectiveness Of Transcutaneous Electrical Nerve Stimulation For Treatment Of Hyperalgesia And Pain, J. Desantana, D. Walsh, C. Vance, Barbara Rakel, K. Sluka
Effectiveness Of Transcutaneous Electrical Nerve Stimulation For Treatment Of Hyperalgesia And Pain, J. Desantana, D. Walsh, C. Vance, Barbara Rakel, K. Sluka
Barbara A. Rakel
Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005-2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials …
Nasogastric And Nasointestinal Feeding Tube Placement: An Integrative Review Of Research, Barbara Rakel, M. Titler, C. Goode, J. Barry-Walker, G. Budreau, Kathleen Buckwalter
Nasogastric And Nasointestinal Feeding Tube Placement: An Integrative Review Of Research, Barbara Rakel, M. Titler, C. Goode, J. Barry-Walker, G. Budreau, Kathleen Buckwalter
Barbara A. Rakel
The authors present a review of the research on various methods for determining placement of nasogastric and nasointestinal feeding tubes. They also discuss research on associated risk factors, complications specific to critical care patient populations, and techniques for postpyloric placement. They present research consensus, recommendations for practice, and implementation strategies.
Infusing Research Into Practice To Promote Quality Care, M. G. Titler, Charmaine Kleiber, Victoria Steelman, C. Goode, Barbara Rakel, J. Barry-Walker, S. Small, Kathleen Buckwalter
Infusing Research Into Practice To Promote Quality Care, M. G. Titler, Charmaine Kleiber, Victoria Steelman, C. Goode, Barbara Rakel, J. Barry-Walker, S. Small, Kathleen Buckwalter
Barbara A. Rakel
This article describes the Iowa Model of Research in Practice, a heuristic model used at the University of Iowa Hospitals and Clinics for infusing research into practice to improve the quality of care. The components of the model are presented with examples. The impact of the model on patient, staff, and fiscal outcomes is delineated.
Assessment And Treatment Of Postoperative Pain In Older Adults, Barbara Rakel, Keela Herr
Assessment And Treatment Of Postoperative Pain In Older Adults, Barbara Rakel, Keela Herr
Barbara A. Rakel
No abstract provided.
Determining Cost Of Nursing Interventions: A Beginning, J. Dochterman, G. Bulechek, B. Head, D. Ahrens, I. Androwich, M. Clarke, P. Cullen, R. Friedrich, L. Gerand, O. Glick, S. Haas, Keela Herr, M. Johnson, Meridean Maas, K. Megivern, J. Mentes, Sue Moorhead, K. Morex, B. Nagles, L. Nosek, M. J. Oakland, S. Pehler, K. Podgorney, Barbara Rakel, C. Rapp, P. Sisul, Victoria Steelman, M. Titler, F. Vlasses
Determining Cost Of Nursing Interventions: A Beginning, J. Dochterman, G. Bulechek, B. Head, D. Ahrens, I. Androwich, M. Clarke, P. Cullen, R. Friedrich, L. Gerand, O. Glick, S. Haas, Keela Herr, M. Johnson, Meridean Maas, K. Megivern, J. Mentes, Sue Moorhead, K. Morex, B. Nagles, L. Nosek, M. J. Oakland, S. Pehler, K. Podgorney, Barbara Rakel, C. Rapp, P. Sisul, Victoria Steelman, M. Titler, F. Vlasses
Barbara A. Rakel
Creating more sophisticated models that describe and value nursing care will enable more sophisticated management of nursing resources. The authors used the Nursing Interventions Classification (NIC) as the basis for describing actions performed by nurses. Nursing experts evaluated each intervention in order to assign the time required for each task and the minimum level of education required to perform each task. Fifty-four percent of the interventions were determined to require fewer than 30 minutes. Over 70% of the interventions in the NIC were deemed to require basic RN education to per-form them safely and appropriately. With the time and skill …
A Meta-Analysis Of Effects Of Heparin Flush And Saline Flush: Quality And Cost Implications, C. Goode, M. Titler, Barbara Rakel, D. Ones, Charmaine Kleiber, S. Small, P. Triolo
A Meta-Analysis Of Effects Of Heparin Flush And Saline Flush: Quality And Cost Implications, C. Goode, M. Titler, Barbara Rakel, D. Ones, Charmaine Kleiber, S. Small, P. Triolo
Barbara A. Rakel
The purpose of this meta-analysis was to estimate the effects of heparin flush and saline flush solutions on maintaining patency, preventing phlebitis, and increasing duration in peripheral heparin locks. The average effect size (d value) across 15 studies with a total sample size of 3,490 was .0573 for patency (clotting). The 95% credibility interval ranged from -.2267 to .3413. The average effect size across 13 studies with a total sample size of 2,356 was -.0757 for phlebitis. The 95% credibility interval ranged from -.2497 to .0983. The average effect size for duration across six samples with a total sample size …
University Of Iowa Hospital And Clinics: Outcomes Management, Mary Berg, M. Dreher, K. Davenport, J. Greiner, R. Howell, A. Mutnick, G. Jensen, Barbara Rakel, F. Johlin, V. Kraus, R. Reiter, K. Leo, J. Ryan, J. Mccloskey
University Of Iowa Hospital And Clinics: Outcomes Management, Mary Berg, M. Dreher, K. Davenport, J. Greiner, R. Howell, A. Mutnick, G. Jensen, Barbara Rakel, F. Johlin, V. Kraus, R. Reiter, K. Leo, J. Ryan, J. Mccloskey
Barbara A. Rakel
Delivery of quality patient care and management of patient outcomes is critical to the success of academic medical centers in the ever-changing health care market. The University of Iowa Hospitals and Clinics (UIHC) promotes quality care through the provision of organizational structures and processes that are described in this article. In addition, quality of care and outcomes management are described by members in various roles within the UIHC health care system. It is the authors' belief that understanding quality from these various perspectives helps UIHC work across departments to achieve excellence in patient care.
Improving Practice Through Research: The Case Of Heparin Vs. Saline For Peripheral Intermittent Infusion Devices, C. Goode, Charmaine Kleiber, M. Titler, S. Small, Barbara Rakel, Victoria Steelman, J. Walker, Kathleen Buckwalter
Improving Practice Through Research: The Case Of Heparin Vs. Saline For Peripheral Intermittent Infusion Devices, C. Goode, Charmaine Kleiber, M. Titler, S. Small, Barbara Rakel, Victoria Steelman, J. Walker, Kathleen Buckwalter
Barbara A. Rakel
Peripheral intermittent infusion devices are commonly used to administer periodic doses of medications to adults and children. Research findings provide a strong base for changing practice to using saline instead of heparin to flush these devices in children over 28 days old and in adults. This research-based change in practice will enhance the quality of care that patients receive and decrease the costs of their care.