Linda E. Moody

Hospice patient and caregiver congruence in reporting patients' symptom intensity.

As healthcare increasingly moves out of hospitals, the care of patients with cancer is provided in the community with the help of family caregivers. In many cases, nurses depend on family caregivers to provide assessment data about patients. This makes the accuracy and dependability of the data given by caregivers particularly important. However, it is not clear whether caregivers can accurately and dependably report such subjective data as symptom intensity. The purpose of this project was to evaluate the ability of the primary caregiver to report the symptom intensity of hospice patients with cancer. The sample consisted of 264 newly admitted adult patients with advanced cancer in hospice home care and their primary caregivers. These subjects were part of a large National Institutes of Health (NIH)-funded randomized clinical trial focused on symptom management and quality of life. The patients were alert and oriented. Among the questionnaires completed by both patients and caregivers on admission were numeric rating scales for pain and dyspnea and the Constipation Assessment Scale. All of these scales were designed to describe the patient’s symptom intensity. The patient sample was predominantly white (83%) and male (57%), with a mean age of 71.6 years. The caregiver sample was predominantly white (85%) and female (78%), with a mean age of 62 years. The results indicated that caregivers significantly overestimated symptom intensity for all three symptoms (P = .000). Furthermore, the limited variance accounted for by the two sets of scores for each of the symptoms (R2 = .16−.26) indicated much more error in the scores than agreement between patient and caregiver. It appears that family caregivers cannot reliably report patient symptom intensity. Healthcare providers need to train family caregivers in conducting systematic assessments instead of assuming that they understand patient symptoms.

Dyspnea assessment and management in hospice patients with pulmonary disorders.

Accurate assessments and appropriate management of dyspnea are essential to provide improved quality of life for hospice patients. This study describes methods of assessing dyspnea and interventions used to manage dyspnea in 72 hospice patients with end-stage lung disease or lung cancer. The mean age of the sample was 72.46 years old and the majority was white (80 percent) and male (62 percent). Paired t-tests were used to compare mean scores on admission and near death for dyspnea severity, Karnofsky functional status, pain, and Mini-Mental Status scores. Results showed significant decline in functional and cognitive status, but no significant changes in dyspnea severity and pain. Dyspnea was often assessed subjectively with observational methods only. Use of inhalants, oxygen, positioning, steroids, and oral opioids were the most frequent therapies for dyspnea. Relaxation, guided imagery, and other complementary therapies were rarely used (five percent or less). Measurement of dyspnea needs to be done frequently by using standardized instruments to assess severity and degree of symptom distress as well as the effects of treatment. Clinical trials are needed to determine which dyspnea interventions are most effective in terminally ill patients. Guidelines such as those developed for pain management are needed for effectively managing dyspnea.

Psychophysiologic predictors of weaning from mechanical ventilation in chronic bronchitis and emphysema.

Tis study identified psychophysiologic variables related to successful weaning in 27 ventilator-dependent patients with chronic bronchitis and emphysema (CBE) from two long-term care pulmonary-specialty hospitals in South Central Florida Subjects were studied from admission until weaning occurred (successful weaning without mechanical ventilation) or until they were transferred without being weaned or died (unsuccessful weaning). The study subjects, 15 males and 12 females, ranged in age from 56 to 89. Baseline data on the variables (age, mastery, hope, social support, dyspnea, and rapid shallow breathing index [RSBI]) were not statistically significant by gender. he logistic regression model identified mastery and RSBI to be the best predictors of successful weaning (model X2 = 16.33, df = 2, and p value = .0003; prediction rate 82%).

Assessing abuse among the elderly living in public housing

Abuse and victimization among the elderly have received increased attention in the last few years from practitioners, researchers, and policymakers but remain growing problems, especially for elders who live in public housing. This study assessed the psychometric properties of an existing instrument, the Hwalek-Sengstock Elder Abuse Screening Test (HSEAST), which has been tested in only two studies. The instrument was administered to 100 African American, Hispanic, and White elders living in public housing. Study results were compared to findings from a previous study of elderly groups. A principal components factor analysis of the 15-item instrument supported the 3-factor structure for a total of 10 items (factor loadings = 0.4 or >), explaining 38% of the variance. A discriminant function analysis showed that 6 items were as effective as the 9-item model in classifying cases (71.4%) as abused.

Carpal Tunnel Syndrome; Current Theory, Treatment, and the Use of B6

Purpose To present the current state of the science of pathophysiology, assessment and treatment of carpal tunnel syndrome, including the use of pyridoxine (B6). Data Sources Selected research articles, texts, websites, per‐sonal communications with experts, and the authors’ own clinical experience. Conclusions Much is yet to be learned about carpal tunnel syndrome. While the basic treatment of NSAIDs and nighttime splints seems universally accepted, much controversy remains. The use of vitamin B6 as a treatment is one such controversy requiring further investigation. Implications for Practice Current treatment for carpal tunnel syndrome should include NSAIDs, nighttime splinting, ergonomic workstation review, and vitamin B6 200mg per day.

Data Mining Strategies for Shaping Nursing and Health Policy Agendas

Data mining of electronic databases is becoming more popular as a method for researchers to study issues in the health policy arena. The advantages of using electronic databases, such as the decreased investments in time and costs associated with subject recruitment and data collection, contribute to its appeal. Despite these features, the use of electronic databases to address health policy issues in nursing has been limited. This article discusses potential uses of secondary analysis for nursing research and outlines the steps involved in the process of data mining. Examples of health services research using samples generated from electronic databases support the discussion. The growing popularity of secondary analyses has given rise to concerns regarding the protection of patient rights and confidentiality. The authors discuss steps taken by federal agencies and institutional review boards to ensure that data are protected while preserving the research potential of this method of analysis.

Factors Influencing Post‐Menopausal African‐American Women's Participation in a Clinical Trial

The Office on Women’s Health Research was established within the Office of the Director, National Institutes of Health (NIH) in 1990 with a mandate to strengthen and enhance prevention, diagnosis, and treatment of illness in women and to enhance research related to diseases and conditions that affect women. The NIH Office for Women’s Health Research summary of public testimony targeted the following areas as high priority for research: cancer prevention (especially breast cancer) cardiovascular disease, osteoporosis, autoimmune diseases, sexually transmitted diseases, work site safety, domestic violence, postnatal care, AIDS, and consequences of women’s hormonal cycles for pharmacotherapy (Barry, Gooding, Harris, Hazzard, 8c Winograd, 1993). The diversity of women’s health needs was stressed, considering special populations, African-American, Hispanic, and poor women (Grisso & Watkins, 1992). In keeping with the priorities of the NIH Office for Women’s Health Research, the authors implemented an observational study to identify risk factors in AfricanAmerican post-menopausal women and to further identify women who would be eligible for a clinical trial examining the effects of alendronate on bone density. (The geminal biphosphonates are specific inhibitors of bone resorption, potentially useful in osteoporosis.) This report describes efforts undertaken to recruit subjects from the community of African-American women for an observational study and a subsequent clinical trial. The observational study was designed to identify health risk factors in this group about which very little is known, and to screen subjects for eligibility for the clinical trial. According to the National Institute on Aging (NIA), half of all people older than 75 suffer from osteoporosis, a major cause of fractures in the spine, hip, wrist, and other bones. Twenty-five percent of women older than 60 have osteoporosis (Barry et al., 1993). The prevalence of osteoporosis in African-American women is not known, but is expected to be a great deal lower than in whites. Clinicians report that African-American women who do experience a fracture of the femur have a much longer recovery time and a higher rate of mortality than whites (Bocanegra, personal communication, January 13, 1994). Women’s health has been the missing chapter in America’s focus on medical research. Heart disease, cancer, and osteoporosis are the three main causes of morbidity and mortality in older women. While a major focus has been launched in these areas during the last 3 years, few efforts have been directed specifically at older African-American women (Cotton, 1992). In the past 5 years, the NIH has launched major campaigns and guidelines to encourage the recruitment of minorities and women in clinical trials. Critical to the success of any clinical trial is the recruitment of adequate sample sizes of eligible subjects and the prevention of subject attrition once the trial begins (Bennett, 1993). The purpose of this substudy was to determine which factors most influence post-menopausal African-American women’s participation in a multisite clinical trial. Research questions for the substudy were: Which recruitment methods work best with African-American women? 0 Which methods prevent attrition and adherence to the study protocol? 0 What special strategies need to be considered in recruiting and implementing a clinical trial for this population of women?

A focus group for caregivers of hospice patients with severe dyspnea

The use of focus groups has grown in all aspects of our society, including the areas of politics and business. More recently, clinical research investigators have begun using focus groups to acquire important information from potential study subjects, such as patients and caregivers. Researchers use focus groups to help them design and test data collection measures, assess responses to proposed interventions, and obtain guidance on recruitment and retention methods for clinical trials. This report explains the basic requirements and methods for conducting focus groups. The authors conducted a focus group study based on six former caregivers of hospice patients with severe dyspnea. The paper describes the results of this study and illustrates how caregivers assisted in evaluating potential interventions for dyspnea, which will be tested in a future clinical trial. Subsequently, the researchers used the focus group data to adapt the guided-imagery intervention to the lifestyle and culture of the study subjects and their caregivers.

Advance Directives Preferences of Functionally and Cognitively Impaired Nursing Home Residents in the United States

This study analyzed advance directives preferences of nursing home residents by level and type of impairment (cognitive and functional). There is a great need to improve care of nursing home residents by honoring their advance directives and reducing the number of adverse events. This secondary data analysis included a random sample of 3,747 subjects from the national Medical Expenditure Panel Survey-Nursing Home Component (MEPS-NHC) Round 1 database. Cognitive and/or functionally impaired residents were more likely to have urinary tract infections, pneumonia, and tuberculosis. Logistic regression models identified several factors (noted in parentheses) that were significantly associated with four advance directives preferences: (a) living will (age, educational level, marital status, and the interaction of functional and cognitive impairment), (b) do not resuscitate (DNR) (age, educational level, marital status, and the interaction of functional and cognitive impairment), (c) no hospitalization (age, educational level, and the interaction of functional and cognitive impairment), and (d) no medications and treatments (educational level).

The Soviet health care system: Glasnost, Perestroika, and health problems of the 1990s.

Worsening economic conditions and political turmoil in the Soviet Union have led to significant health care problems in the 90s. The Soviet people are calling for reforms of education and the health care system that extend beyond the unsuccessful program of glasnost and perestroika. The purposes of this article are to (a) describe the health care system in the Soviet Union, (b) highlight health issues and concerns of the Soviet people, (c) describe the education of physicians and nurses, and (d) compare and contrast common and unique factors about Soviet health care with health care in the West. The data base for the article was collected from observational site visits, on-site focused interviews with key informants in Kiev and Moscow, and extensive computerized and manual literature searches. Data were also gathered from questionnaires distributed to a convenience sample of 17 nurses in Moscow. Study results include demographic information and the state of nursing education and research, including availability and access to resources to conduct nursing research in Moscow.