Sandra Engberg

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

Medication Non-Adherence Among Older Adults: A Review of Strategies and Interventions for Improvement

Medication non-adherence among older adults is a prevalent and costly problem; approximately one half have problems following their prescribed medication regimen, and more than 10% of hospital admissions are the result of medication non-adherence. In this literature review, medication non-adherence is defined and described among adults age 50 and older. Factors associated with medication non-adherence are presented, interventions to improve medication non-adherence are discussed, and methods for assessing medication non-adherence are reviewed. In addition, nursing assessment and intervention to improve medication non-adherence are described.

Effectiveness of behavioral therapy to treat incontinence in homebound older adults.

OBJECTIVES: To examine the (1) short‐term effectiveness of behavioral therapies in homebound older adults and (2) characteristics of responders and nonresponders to the therapies.

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

OBJECTIVES: To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants. METHODS: A multicenter randomized controlled trial in 3 NICUs in Switzerland compared the effectiveness of oral sucrose, facilitated tucking (FT), and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation. Data were collected during the first 14 days of their NICU stay. Three phases (baseline, heel stick, recovery) of 5 heel stick procedures were videotaped for each infant. Four independent experienced nurses blinded to the heel stick phase rated 1055 video sequences presented in random order by using the Bernese Pain Scale for Neonates, a validated pain tool. RESULTS: Seventy-one infants were included in the study. Interrater reliability was high for the total Bernese Pain Scale for Neonates score (Cronbach’s α: 0.90–0.95). FT alone was significantly less effective in relieving repeated procedural pain (P < .002) than sucrose (0.2 mL/kg). FT in combination with sucrose seemed to have added value in the recovery phase with lower pain scores (P = .003) compared with both the single-treatment groups. There were no significant differences in pain responses across gestational ages. CONCLUSIONS: Sucrose with and without FT had pain-relieving effects even in preterm infants of <32 weeks of gestation having repeated pain exposures. These interventions remained effective during repeated heel sticks across time. FT was not as effective and cannot be recommended as a nonpharmacologic pain relief intervention for repeated pain exposure.

Effect size estimation: Methods and examples

BACKGROUND While the p-value will tell the reader a studys results are statistically significant, it does not provide any information about the practical or clinical importance of the findings. Furthermore, p-values are influenced by sample size. They are more likely to be significant when sample size is large and less likely if the sample is small. Effect size estimates, on the other hand, are not sensitive to sample size and provide information about the direction and strength of the relationship between variables (e.g., a treatment and an outcome). In addition to providing valuable clinical information about study findings, effect size estimates can provide a common metric to compare results across studies. Despite their usefulness, effect size estimates are often not reported as part of the research results. Consequently, effect sizes often have to be calculated based on summary and test statistics reported in research articles. RESULTS This article provides the formulas utilized to directly calculate common effective size estimates using summary statistics reported in research studies, as well as methods to more indirectly estimate these effect sizes when basis summary statistics are not reported. In addition we present formulas to compute the corresponding confidence interval for each effect size.

An Ecological Perspective on Medication Adherence

Adherence to a prescribed medication regimen is influenced not only by characteristics of the individual patient, but also by factors within the patient’s environment, or so-called system level factors. Until now, however, health care system factors have received relatively little attention in explaining medication nonadherence. Ecological models might serve as a framework to help explain the influence of health care system factors on patient behavior (e.g., adherence). In an ecological model, different levels of factors influence patients’ behavior, i.e. factors at the patient-level, micro- (provider and social support), meso- (health care organization), and macro (health policy) -levels. In order to understand medication adherence and implement interventions to improve medication adherence, factors at these different levels should be taking into consideration. This paper describes an ecological model compromised of the most important factors at the patient-, micro-, meso- and macro-levels.

Variability in pain response to a non-pharmacological intervention across repeated routine pain exposure in preterm infants: a feasibility study.

Aim: To explore the variability in pain response in preterm infants across time who received sucrose during routine heel stick.

Prevalence and Recognition of Depressive Symptoms Among Homebound Older Adults with Urinary Incontinence

Within a group of homebound elders with urinary incontinence, the objectives of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized by health care providers, (3) describe the type and intensity of antidepressant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A descrip tive correlational design was used. The 15-item Geriatric Depression Scale (GDS-15) was administered to 345 homebound adults age 60 years and over referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large metropolitan county in Pennsylvania. Data were collected during in-home assess ments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Service Center Physical and Instrumental Activities of Daily Living scales, Mini- Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toileting Assessment, and bladder diaries. One half of the participants (n = 173; 50.1%) had significant depressive symptomatology, with 35.7% having scores suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class of antidepressants was tricyclic anti depressants, being taken by 9.0% (n = 31) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antide pressants continued to exhibit significant depressive symptomatology. Greater dependence in physical activities of daily living, the need for assistance during ambulation, higher MMSE scores, and higher levels of comorbidity were associated (P < .05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older adults with urinary incontinence, but clinical recognition and treatment are limited. (J Geriatr Psychiatry Neurol 2001; 14:130-139).

Characteristics of Urinary Incontinence in Homebound Older Adults

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults.

Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization.

PURPOSE To examine barriers, complications, adherence, and health-related quality of life in people using clean intermittent catheterization (CIC). DESIGN This pilot study used a cross-sectional, survey design. SETTINGS AND SUBJECTS Forty-four community-dwelling men and women who had been using CIC for 2 or more months participated in the study. METHODS Participants were mailed the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and a sociodemographic survey instrument to complete and mail back to the study office. Upon receipt of the completed forms, the participant was called to complete the investigator-developed instrument to collect the data related to every-day barriers, complications, and physician recommendations regarding the use of CIC. RESULTS The mean age of the sample was 56.6 ± 16.0 years (mean ± SD); 59% were women, and 93% were whites. The mean SF-36 physical component score was 33.60 ± 12.4, while the mean mental component score was 50.26 ± 13.9. Twenty participants (45.5%) reported that they did not void at all on their own. The median duration of using CIC was 60 months. Twenty-five participants (56%) reused catheters a median of 20 times. The most common complication was urinary tract infection (n = 34; 77.2%). The most common difficulties associated with self-catheterization were lack of access to a bathroom (n = 15; 34%); for women it was positioning to insert the catheter (n = 11; 25%) and dexterity (n = 9; 21%) reported by people with multiple sclerosis (MS). Although most participants reported catheterizing on their own schedule (n = 18, 40.9%) or in response to bladder fullness (n = 24; 54.5%), 84.6% reported a catheterization schedule co ge their bladder. CONCLUSION While the physical component SF-36 score in this sample was lower, the mental health component score was similar to the population norm for the age group. The most common complication of CIC was urinary tract infection and the most frequent catheterization difficulties were lack of access to a bathroom (34%) and positioning to insert the catheter (25%).