Jennie T. Nickel

Quality of life in nurse case management of persons with AIDS receiving home care

Effects of case management on quality of life were tested with 57 home care patients with AIDS, randomly assigning individuals to either usual care or case-managed care over the duration of home services (ranging from 5 days to over 2 years). Participants were primarily male (93%), white (79%), and never married (82%). Quality of life was measured monthly using the quality of Well-Being Index (QWB). Case-managed patients showed advantages over the usual care group in descriptive analyses of quality of life and survival. Large standard deviations in the QWB scores resulting from high fatality among subjects impeded statistical analyses of effects.

Socioeconomic determinants of continuing functional disablement from chronic disease episodes

Functional disablement of persons with chronic disease is a complex outcome shaped by a variety of medical and socioeconomic factors, including those influencing the competing risk of death from the disease. The increasingly important task of explaining trends in the functional health status of various populations requires more detailed knowledge about the respective roles of these disability determinants. This paper reports the results of an analysis of the determinants of continuing functional incapacity after an episode of heart disease. A proportional hazards regression model is used to estimate the relative effects of socioeconomic and disease factors on the duration of work disablement and functional incapacitation of 976 surviving and nonsurviving patients hospitalized for presumptive myocardial infarction. The analysis shows that socioeconomic variables play a prominent role in disability outcomes, especially in work resumption. Evidence of aging effects on disability prevalence is also found.

Hospital and emergency department use by young low-income children.

BACKGROUND Limited data are available concerning determinants of health care service usage by low-income young children. OBJECTIVES To explore predictors of hospitalization and emergency department (ED) use by young children of low-income families by using the Aday and Andersen Access Framework. METHODS Low-income women (n = 474) with a child younger than 6 years completed a structured face-to-face interview at human service offices or Women, Infants, and Children (WIC) clinics in four central Ohio counties. Women were considered low-income if they or their child were Medicaid eligible or uninsured. Data were collected for both the mother and the index child on sociodemographic status, health services use, health status, and access to care. RESULTS Fifteen percent of the children had been hospitalized the previous year, and half had an ED visit. Hospitalization was significantly related to maternal hospitalization the previous year (OR = 2.5), child age younger than 1 year old (OR = 2.1) and more than two chronic conditions (OR = 2.2). Maternal ED usage in the last year (OR = 2.2), Medicaid fee for service plan (OR = 1.7), and rural residence (OR = 2.0) were predictive of ED use. CONCLUSIONS Predisposing characteristics (maternal hospital/ED use) were predictive of both hospitalization and ED use by the index child. Enabling characteristics (fee-for-service Medicaid plan, rurality) were only predictive of ED use, and need characteristics (childs health) were only predictive of hospitalization. Further research to explore linkages between maternal and child use of health care services as well as the effect of changes in health care access, managed care, and other innovations on hospitalization and ED use in young, low-income children is recommended.

The Burden of Disease in Those With Serious Mental and Physical Illnesses

BACKGROUND: Clients with severe mental illness are known to have higher morbidity than the general population, but little is known about their perception of disease burden. OBJECTIVE: This study examined the disease burden in a cohort of community-dwelling persons diagnosed with severe mental illness. STUDY DESIGN: This was a descriptive study that included: interviews, measures of blood pressure, height and weight, and chart audits from 109 volunteers. RESULTS: Mean scores on the Medical Outcomes Study Short Form–12 (MOS SF-12) were compared by gender and five chronic illnesses. The participants had lower scores on the physical (PCS) and mental (MCS) health components of the MOS SF-12 than the general population. Participants with depression, hypertension, arthritis, diabetes, and chronic lung disease scored lower than the general population on the PCS and MCS. CONCLUSION: This study suggests that clients with severe mental illness and physical health problems experience a greater disease burden than do their counterparts in the general population.

Methodologic Issues Associated With Secretion Weight as a Dependent Variable in Research Using Closed-system Suction Catheters

BACKGROUND Closed-system suction catheters (CSSC) were designed to eliminate the need to disconnect the patient from the ventilator during endotracheal suctioning (ETS). During data collection on an NIH-funded study, it was noted that moisture accumulated on the inside of the CSSC and sleeve when attached to the patient for 30 minutes. Because CSSC are not disconnected, they present unique methodologic problems related to measurement of secretions as a dependent variable in clinical research. OBJECTIVES To describe a valid, reliable, and practical method for weighing secretions obtained during ETS using a CSSC; and to determine the change in weight of a CSSC after its attachment for 30 minutes to a mechanically ventilated patient. METHODS After being weighed, a CSSC and sputum trap were attached to the endotracheal tube of a mechanically ventilated adult and remained attached for 43 minutes (30 minutes to allow positive end expiratory pressure and oxygenation levels to return to normal and 13 minutes to mimic the time frame for the ETS procedure used in another study). No ETS occurred. The CSSC and sputum trap were then removed and reweighed. RESULTS A convenience sample consisted of 50 adults who were critically ill and mechanically ventilated. Independent variables included tidal volume, pressure support, body temperature, and respiratory rate. The dependent variable was wet weight of the CSSC, determined by subtracting the preprotocol catheter weight from the postprotocol catheter weight. The mean wet weight for all catheters was 0.5142 +/- 0.1215 grams. In a subset of 37 patients, two wet weights (74 paired observations) were determined. The mean wet weight for these catheters was 0.54014 +/- 0.1404 grams. The paired wet weights were statistically different (t = 2.433; df = 36; p = 0.02). Pearson correlation coefficients and beta coefficients were computed. While tidal volume and pressure support were highly correlated (r = 0.678; p = 0.011), there were no other statistically significant associations. CONCLUSIONS The amount of secretions is a common dependent variable in ETS research. During the time that CSSC are attached to the patient and ventilator, moisture from either the ventilators humidification system or the patient accumulates in the CSSC. This wet weight is not actually part of the secretions retrieved during ETS and should not be considered in the actual weight of secretions. Further study on the determinants of wet weight is warranted.

A comparison of bolus versus continuous cardiac output in an experimental model of heart failure.

Objective The majority of studies examining cardiac output measurement have been done in physiologically stable models with low thermal background noise. Research comparing continuous cardiac output (CCO) with bolus thermodilution cardiac output (COTD) measures in human and animal models have reported high correlations, negligible bias, but large limits of agreement. The purpose of this project was to compare CCO with COTD measures in an experimental model of heart failure where the cardiac output values were low and the range was narrow. Design A one-group experimental design with preintervention control measures and repeated CCO and COTD measures across nine time points. Setting Cardiovascular research laboratory. Subjects Thirty dogs. Measures and Main Results Univariate and multivariate versions of repeated-measures analysis were used to assess the influences of temperature, weight, and stage of the experimental protocol on CCO, COTD, and the differences between them. The two measures CCO and COTD were assessed for agreement by using methods proposed by Bland and Altman. Two hundred and fifty pairs of measurements were obtained during sinus rhythm. The range for COTD measures was 0.5–4.67 L/min and for CCO measures 1.0–5.40 L/min. Of the 250 cardiac outputs estimated by the continuous method, 73.4% of the values were within ±15% of that estimated by the repetitive, single thermodilution method. The mean bias for the entire protocol was 0.01 (sd = 0.51) with a range of 4.33 L/min. Conclusion Agreement between the two measures may be the function of biological variability, responses to anesthesia, and technique. Bland and Altman evaluation demonstrated low bias and precision and similar levels of agreement when compared with previous studies in an experimental model where the cardiac output was low and the range was narrow.

Preventive Health Counseling Reported by Uninsured Women With Limited Access to Care

Low-income women in the childbearing years are at an increasing risk of becoming uninsured as welfare reforms are enacted and women enter minimum-wage jobs without insurance benefits. This study contrasts preventive counseling reported by low-income uninsured mothers and mothers insured through Medicaid. Low-income women attending Women, Infant, and Children (WIC) clinics and human services offices who had received health care during the previous 12 months (N = 406) were asked if they had received counseling from a health provider regarding any of seven types of preventive health behaviors. Uninsured women were less than half as likely to receive counseling on three or more preventive topics (OR = 0.42) as were mothers on Medicaid. Risk estimates were stable on bivariate analyses and logistic regression models. Findings indicate that opportunities for preventive health counseling need to be maximized for this group already experiencing compromised access to care.

Missed opportunities to immunize preschoolers

Local health departments (n = 122) and private physician offices (n = 90) responded to a mailed survey assessing practices of immunizing children presenting with any of 17 conditions identified in the literature as invalid contraindications to immunizations. More than 30% of both provider groups withheld immunizations in the presence of six conditions identified as invalid, specifically tuberculosis, current antimicrobial therapy, recent exposure to infectious disease, mild diarrheal illness in an otherwise well child, any convalescent phase of an illness, and current or recent mild illness. These findings document provider contributions to the problem of inadequate childhood immunizations and underscore the importance of improved provider education on immunization practices.

Case-control design : an appropriate strategy for nursing research

The case-control design is a well-established research method in epidemiology and has considerable potential for nursing research. It is particularly appropriate for studying health or service outcomes that occur relatively infrequently and offer advantages in time, sample size, and resource requirements. While the retrospective observational nature of the design presents challenges in selection of subjects, avoidance of biases, and control confounding, the processes for managing these pitfalls are increasingly being explored. The analysis is straightforward and presents estimates of risk that are clearly interpretable by the nurse researcher, the policy makers, and other research consumers.