Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest-posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P< or =0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001-0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001-0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.

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The purpose of our pilot study was to evaluate the effects of a companion animal (dog) on physiologic arousal and behavioral distress among children undergoing a dental procedure. A repeated measures experimental design was used to study 40 children between the ages of 7 and 11 years who were undergoing procedures in a pediatric dental clinic. Half the children had the dog present during the procedure and half did not. Data were obtained before, during, and after the procedure. Behavioral distress was measured using the Observational Scale of Behavioral Distress; procedures were videotaped. Physiologic arousal was measured using a YSI telethermometer taped to the child's index finger. Student's t-test and repeated measures analysis of variance were used to answer the research question. No significant differences in behavioral distress or physiologic arousal were found between experimental and control groups. Further analysis revealed that for children who initially verbalized distress on arrival at the clinic, the presence of the dog decreased physiologic arousal during the time the child was on the dental table waiting for the dentist to arrive. Further research should be conducted to verify the effect of a companion animal on initial stress experienced by children for whom the visit to the dentist is most stressful.

Behavioral disturbances are a commonfeature of Alzheimer's disease (AD). Prior studies have demonstrated a significant reduction in agitation behaviors during short-term exposure to a dog on an Alzheimer's special care unit (SCU)for persons with AD. The purpose of this study was to determine the effect over time of a resident dog on problem behaviors of persons with AD in an SCU. A within-participants repeated-measures design was used for this study. The Nursing Home Behavior Problem Scale was used to document behaviors (on days and evenings) I week before and 4 weeks after placement of the dog. Participants on the day shift exhibited significantly fewer problem behaviors across the 4 weeks of the study (F[1, 80] = 7.69, p < .05). No significant change in behaviors occurred on the evening shift. Thefindings support the long-term therapeutic effects of dogs for persons residing in Alheimer's SCUs.

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The purpose of this systematic review of the literature was to determine the association of sepsis with mortality in the severely injured adult patient by means of a comparative analysis of sepsis in burn and trauma injury with other critically ill populations. The MEDLINE (PubMed), Cochrane Library, and ProQuest databases were searched. The following keywords and MeSH headings were used: "sepsis," septicemia," "septic shock," "epidemiology," "burns," "thermal injury," "trauma," "wounds and injuries," "critical care," "intensive care," "outcomes," and "mortality." Included studies were clinical studies of adult burn, trauma, and critically ill patients that reported survival data for sepsis. Thirty-eight articles were reviewed (9 burn, 11 trauma, 18 general critical care). The age of burn (<45 years) and trauma (34-49 years) groups was lower than the general critical care (57-64 years) population. Sepsis prevalence varied with trauma-injured patients experiencing fewer episodes (2.4%-16.9%) contrasted with burn patients (8%-42.5%) and critical care patients (19%-38%). Survival differed with trauma patients experiencing a lower rate of mortality associated with sepsis (7%-36.9%) compared with the burn (28%-65%) and critical care (21%-53%) groups. This study is the first to compare sepsis outcomes in three distinct patient populations: burn, trauma, and general critical care. Trauma patients tend to have relatively low sepsis-associated mortality; burn patients and the older critical care population have higher prevalence of sepsis with worse outcomes. Great variability of criteria to identify septic patients among studies compromises population comparisons.