Georgia L. Narsavage

An explanatory model of functional status in chronic obstructive pulmonary disease

The purpose of this study was to test an explanatory model of variables influencing functional status in chronic obstructive pulmonary disease (COPD). The sample consisted of 104 patients with COPD (85 males, 19 females, mean age = 65.5, SD = 7.7). The variables in the initial model were age, length of illness, pulmonary function, oxygen desaturation during exercise, dyspnea, depressed mood, anxiety, self-esteem, exercise capacity, and functional status. Path analysis revealed that exercise capacity (beta = .337, p = .0007), dyspnea (beta = .324, p = .0009), and depressed mood (beta = -.204, p = .011) directly influenced functional status Dyspnea (beta = .488, p < .0001), depression (beta = -.217, p = .003), and pulmonary function (beta = .421, p < .0001) indirectly influenced functional status through exercise capacity. Self-esteem (beta = -.492, p = .004) and anxiety (beta = .696, p < .0001) indirectly influenced functional status through depressed mood. The findings of this study suggest that efforts to improve functional status of individuals with COPD should focus on interventions that influence exercise capacity, dyspnea, anxiety, and depressed mood.

The development and psychometric evaluation of the Pulmonary Functional Status Scale: an instrument to assess functional status in pulmonary disease.

BACKGROUND This article describes the development and psychometric evaluation of the Pulmonary Functional Status Scale (PFSS). The PFSS was developed to address the need for a self-administered, disease-specific, functional status outcome measure that was conceptually based, relatively short, and comprehensively assessed the psychosocial domains affected by chronic pulmonary disease. METHODS Content validity of the PFSS was established by a panel of experts. Construct validity was determined by principal components factor analysis using data from 365 subjects derived from several studies that used the PFSS. The sample was predominantly white (80%), married (36%), and male (56%) with a mean age of 68.1 years, mean forced expiratory volume in one second of 1.18 L and mean forced vital capacity of 2.31 L. Test-retest reliability was evaluated in 17 outpatients with chronic obstructive pulmonary disease. Concurrent validity was assessed by correlating responses on the total PFSS with the Sickness Impact Profile (SIP) score (n = 39), and the 12-minute walk test (n = 104). RESULTS The factor structure solution used 35 of the 50 submitted items, explained 48.7% of the variance, and yielded three factors: Daily Activities/Social Functioning, Psychological Functioning, and Sexual Functioning. Cronbachs alpha coefficients for the total PFSS was 0.93 and the test-retest correlation coefficient was rho = 0.75 (P = 0.001). The correlation between the total PFSS score and the SIP and 12-minute walk test were r = -0.54 (P < 0.001) and r = 0.62 (P < 0.001), respectively. CONCLUSION The PFSS has solid psychometric properties that make it acceptable for use in clinical practice as well as research.

Physiologic status, coping, and hardiness as predictors of outcomes in chronic obstructive pulmonary disease

The purpose of this study was to examine the relationship of physiologic status, coping, and hardiness to exercise ability and functional status in 96 adult patients with chronic obstructive pulmonary disease (COPD). Exercise ability was measured by the distance walked in 12 minutes (12MD) and functional status by the Pulmonary Functional Status Scale (PFSS). The mean FEV1 and FVC were 1.61 ± .81 and 3.08 ± .95 L, respectively. The commitment (r =-.18) and challenge (r = -.21) components of hardiness were significantly correlated with the 12MD. The commitment component of hardiness was significantly correlated with functional status (r =-.17). Control was not a significant variable. Physiological status, problem-solving coping, and challenge were the best predictors of exercise ability (R2 =.26). Physiological status and commitment were the best predictors of functional status (R2 =.149).

Factors related to chronic obstructive pulmonary disease readmission in Taiwan.

This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.

Predictors of Survival in Patients With Non-Small Cell Lung Cancer

PURPOSE/OBJECTIVES To examine how routine laboratory biomarkers and clinical parameters available within medical records related to overall survival in patients with non-small cell lung cancer (NSCLC). DESIGN Retrospective chart review. SETTING University-based cancer center in rural West Virginia. SAMPLE 110 patients from the U.S. Appalachian region with a primary diagnosis of NSCLC at initial hospitalization. METHODS Electronic medical records were reviewed for one year after discharge or until death. The Kaplan-Meier method was used to compare survival curves for each prognostic factor. Cox proportional hazards model was used for multivariate analyses. MAIN RESEARCH VARIABLES Total white blood cell, neutrophil, lymphocyte, and platelet counts; hemoglobin level; body mass index (BMI); performance status; and cancer stage. FINDINGS Low BMI (lower than 18.5 lb/in2), advanced cancer stage (IIIB or IV), and elevated neutrophil (higher than 8 x 103/mcl) and platelet (300-826 x 1012/L) counts were significant, independent prognostic factors for shorter survival time in NSCLC. BMI (hazard ratio [HR] = 2.15, 95% confidence interval [CI] [0.94, 4.9]) and neutrophil (HR = 2.93, 95% CI [1.53, 5.59]) and platelet (HR = 2.65, 95% CI [1.25, 5.62]) counts were overall prognostic predictors for patients with advanced NSCLC and remained in the multivariate survival model. CONCLUSIONS This study detected two known clinical parameters, cancer stage and nutritional status (i.e., BMI and neutrophil and platelet counts), as having independent prognostic significance for shorter survival in NSCLC. Research on survival in patients with NSCLC should include those identified laboratory biomarkers and clinical parameters for screening patients at risk for shorter survival time following hospitalization. Investigation of whether treatments tailored to address neutrophil and platelet counts and BMI can improve survival outcomes also is warranted. IMPLICATIONS FOR NURSING Attention to common biomarkers recorded in patient charts (e.g., neutrophil and platelet counts) as well as BMI could allow nurses to identify patients at risk for low survival. Interventions should be identified and initiated. Longitudinal studies in clinical settings that follow the survival of patients with NSCLC are essential.

Effectiveness of community-based integrated care in frail COPD patients: a randomised controlled trial.

Background:Chronic obstructive pulmonary disease (COPD) generates a high burden on health care, and hospital admissions represent a substantial proportion of the overall costs of the disease. Integrated care (IC) has shown efficacy to reduce hospitalisations in COPD patients at a pilot level. Deployment strategies for IC services require assessment of effectiveness at the health care system level.Aims:The aim of this study was to explore the effectiveness of a community-based IC service in preventing hospitalisations and emergency department (ED) visits in stable frail COPD patients.Methods:From April to December 2005, 155 frail community-dwelling COPD patients were randomly allocated either to IC (n=76, age 73 (8) years, forced expiratory volume during the first second, FEV1 41(19) % predicted) or usual care (n=84, age 75(9) years, FEV1 44 (20) % predicted) and followed up for 12 months. The IC intervention consisted of the following: (a) patient’s empowerment for self-management; (b) an individualised care plan; (c) access to a call centre; and (d) coordination between the levels of care. Thereafter, hospital admissions, ED visits and mortality were monitored for 6 years.Results:IC enhanced self-management (P=0.02), reduced anxiety–depression (P=0.001) and improved health-related quality of life (P=0.02). IC reduced both ED visits (P=0.02) and mortality (P=0.03) but not hospital admission. No differences between the two groups were seen after 6 years.Conclusion:The intervention improved clinical outcomes including survival and decreased the ED visits, but it did not reduce hospital admissions. The study facilitated the identification of two key requirements for adoption of IC services in the community: appropriate risk stratification of patients, and preparation of the community-based work force.

Characteristics Influencing Weight Reduction Among Veterans in the MOVE!® Program

Obesity is a common health problem for veterans. This study explored background and program characteristics associated with a 5% weight reduction for veterans enrolled in MOVE!®, a weight management program. For data analysis, 404 veteran records were examined using logistic regression. Background characteristics included socio-demographic variables, comorbidity, body mass index, rurality, and Veterans Administration (VA) priority group. Program characteristics included the program type (group attendee or self-managed) as well as the number and type of provider contacts. Thirteen percent of participants achieved a 5% weight reduction. Age in years (odds ratio [OR] = 1.04) and the number of group visits (OR = 1.05) were significant predictors for achieving a 5% weight reduction. Given the importance of weight reduction, health professionals should consider these significant predictors when planning weight-reduction programs for veterans.

The development and psychometric analysis of the short‐form pulmonary functional status scale (PFSS‐11©)

This article describes the development and psychometric evaluation of the short-form Pulmonary Functional Status Scale (PFSS-11©) derived from the previously validated 35-item PFSS, using data from 179 subjects (120 Chronic Obstructive Pulmonary Disease [COPD]/59 normative, non-COPD). Items were extracted based on item-response distribution and commonality >.60. Factor analysis yielded a three-factor solution, accounting for 65.6% of total variance. Construct validity was supported by PFSS-11© scores for COPD versus norms (p < .001). The PFSS-11© was robustly associated with the PFSS-35 (r = .93), accounting for 88% of variance in the longer version. Internal consistency was satisfactory and significant response to treatment was shown by score changes pre/post-rehabilitation. The PFSS-11© has solid psychometric properties useful in research and clinical practice, similar to the PFSS-35.

Feasibility Study: Home Telemonitoring for Patients With Lung Cancer in a Mountainous Rural Area

PURPOSE/OBJECTIVES To explore the feasibility of rural home telemonitoring for patients with lung cancer. DESIGN Exploratory, descriptive, observational. SETTING Patient homes within a 75-mile radius of the study hospital in West Virginia. SAMPLE 10 patients hospitalized with lung cancer as a primary or secondary-related diagnosis. METHODS Data included referral and demographics, chart reviews, and clinical data collected using a HomMed telemonitor. Five patients received usual care after discharge; five had telemonitors set up at home for 14 days with daily phone calls for nurse coaching; mid- and end-study data were collected by phone and in homes through two months. MAIN RESEARCH VARIABLES Enrollment and retention characteristics, physiologic (e.g., temperature, pulse, blood pressure, weight, O2 saturation) and 10 symptom datapoints, patient and family telemonitor satisfaction. FINDINGS Of 45 referred patients, only 10 consented; 1 of 5 usual care and 3 of 5 monitored patients completed the entire study. Telemonitored data transmission was feasible in rural areas with high satisfaction; symptom data and physiologic data were inconsistent but characteristic of lung cancer. CONCLUSIONS Challenges included environment, culture, technology, and overall enrollment and retention. Physiologic and symptom changes were important data for nurse coaching on risks, symptom management, and clinician contact. IMPLICATIONS FOR NURSING Enrollment and retention in cancer research warrants additional study. Daily monitoring is feasible and important in risk assessment, but length of time to monitor signs and symptoms, which changed rapidly, is unclear. Symptom changes were useful as proxy indicators for physiologic changes, so risk outcomes may be assessable by phone for patient self-management coaching by nurses.

Delivering telemedicine interventions in chronic respiratory disease.

Educational Aims To explain the basic principles of telemedicine applicable to chronic respiratory diseases To review telemedicine interventions for patients with chronic respiratory diseases To outline the advantages and limitations (including cost and barriers to implementation) of telemedicine for patients with chronic respiratory diseases To propose recommendations for clinical management of patients receiving telemedicine for chronic respiratory diseases