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Biomedical subjects

B Pieper

Publications and source records attributed to B Pieper.

At least 19 recordsLinked to original sources
PubMed2001

Chronic venous insufficiency in persons with a history of injection drug use.

Persons with a history of injection drug use have many risk factors for the development of chronic venous insufficiency (CVI), yet this phenomenon has not been studied systematically in this population. Persons (N = 204) with a history of injection drug use who were in enrolled in a treatment center were examined for clinical manifestations of CVI. The CVI clinical classification was graded on a 7-point scale for each leg. Most participants (n = 179, 87.7%) exhibited clinical evidence of CVI. Significant predictors of CVI clinical manifestations were leg infections/cellulitis (rho =.53); years injection in the veins of the groin, legs, and feet (rho =.47); deep vein thrombosis (rho =.37); and total years injection heroin (rho =.27). There was a linear functional relationship between years of injection drug use and the CVI clinical classification, but only when the injections were in the veins of the groin, legs, or feet; otherwise, the specific mechanisms of this relationship were not evident. The findings indicate that CVI is a common occurrence in persons who have injected drugs.

Adult↗
PubMed2001

Health maintenance in a primary care clinic for urban, indigent adults.

OBJECTIVE: The objective was to examine the delivery of preventive health care services in an urban clinic for indigent adults and the impact of advanced practice nursing on these practices. DESIGN: The study design was a descriptive chart review. SETTING AND SUBJECTS: Data were collected in an urban outpatient clinic. Seven hundred sixty-five records were examined prospectively for health maintenance. Of these records, 523 were randomly selected and reviewed retrospectively for completion of health maintenance. The mean age of participants was 45.15 years (SD = 9.87); 92% were African American, and 48.9% were male. INSTRUMENTS: The Health Maintenance Form was used to record data about demographics, health history, care provider, and completion of 10 health maintenance items. METHODS: Records were reviewed prospectively prior to the patient's clinic visit. A form summarizing the patient's health maintenance status was placed at the front of the record. At least 4 weeks later, the record was reviewed a second time for completion of health maintenance items. This second review was the data collection phase. RESULTS: Completion of health maintenance items was found to be low. The most up-to-date areas were serum cholesterol (83.9%) and mammography (70.1%). The lowest levels were rectal examination (34.5%), pneumococcal vaccination (35%), and fecal occult blood test (37.1%). Patients followed up by a nurse practitioner had significantly more health maintenance areas up-to-date than did patients followed-up by the nurse practitioner-physician team, which in turn had significantly more areas up-to-date than did patients followed up by a physician alone. CONCLUSIONS: Health maintenance was accomplished at a low level, indicating that preventive health practices need to be re-evaluated. The nurse practitioner had the greatest impact on a patient's health maintenance being up-to-date.

Adult↗
PubMed2000

Psychosocial adjustment, coping, and quality of life in persons with venous ulcers and a history of intravenous drug use.

OBJECTIVE/PURPOSE: Psychosocial adjustment, coping, and quality of life for persons with a venous ulcer and a history of intravenous drug use were examined. DESIGN: A cross-sectional design was used. SETTING AND SUBJECTS: Data were collected in an urban outpatient clinic. All eligible persons were asked to participate. Thirty-two patients agreed to participate, providing an 89% response rate. The mean age of participants was 44.6 years (SD = 4.3); 91% were African American, and 72% were male. INSTRUMENTS: Subjects responded to questions about their health and substance abuse history and completed the Quality of Life With a Leg Ulcer Questionnaire, Psychosocial Adjustment to Illness Scale (PAIS), Ways of Coping Instrument, and Pain Questionnaire. Leg ulcer tracings were measured with the SigmaScan computer program. METHODS: Questionnaires were read to participants. Leg ulcers were traced at their borders onto plastic. RESULTS: Wound area correlated significantly with the domestic environment (r = .43) and the psychosocial distress (r = .38) scores of the PAIS. Wound area was negatively correlated to Quality of Life With a Leg Ulcer Questionnaire score (r = -.52). Pain interference was significantly related to the self-controlling coping score (r = .40), domestic environment score of the PAIS (r = .51), and Quality of Life With a Leg Ulcer Questionnaire score (r = -.65). Cox and Wermuth's multiple regression modeling approach was used to summarize the study's variables. CONCLUSIONS: A larger wound area was associated with greater illness-induced difficulties in the home environment, greater psychological distress, and poor quality of life. Pain Interference was associated with a greater effort to regulate one's feelings and actions, difficulties in the home, and poor quality of life.

Adaptation, Psychological↗
PubMed2000

HIV/AIDS: impact on healing.

Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) are leading chronic illnesses in many major cities worldwide. Frequently, people with HIV infection require surgery or develop chronic wounds. This paper summarizes the impact of HIV infection on body organs and systems and the effect of antiretroviral therapy as a basis for potential complications with wound care and healing. The authors also present research on wound healing in HIV-positive people undergoing operative procedures. Besides the physical effect of HIV infection on the person, clinicians must also realize psychosocial and economic effects of the disease when considering wound care. This paper also addresses care considerations for patients with HIV/AIDS in the inpatient, outpatient, and home care settings.

Anti-HIV Agents↗
PubMed2000

Prevalence and types of wounds among children receiving care in the home.

The purpose of this study was to determine the number of children with wounds receiving home care, determine the types of wounds among these children, and identify wound care products used in the treatment of children. This study was a multi-site, descriptive, cross-sectional, collaborative, study involving 13 home healthcare agencies and a university. Nurses (n = 281) were systematically selected to collect data for patients receiving home care visits during a 1-week period. The nurses recorded data on 77 children who ranged in age from less than 1 year to 18 years (mean = 3.1 years, SD = 4.72). The children included 47 males and 30 females, most of whom were African-American (n = 59). Among the 77 children, 16.9% had wounds. Children with wounds were significantly older and had more reasons for the home healthcare visit than children without wounds. The presence of a wound was not significantly related to the length of the visit, gender, or race. The most common wound was a surgical incision. The wound care treatments used most were tap water and gauze. In conclusion, wound care is frequently part of the care for a child in the home. Therefore, nurses need to be aware of wound assessment and wound care protocols that match a child's growth and development and family needs.

Adolescent↗
PubMed1999

Project RATEMA--one year's experience.

The RATEMA project is an international cooperation between the University of Ulm in Germany and the Urals Research Centre for Radiation Medicine in Chelyabinsk, Russia. For one year we conducted weekly conferences between the two sites, based on a satellite link with a 384 kbit/s connection. During the videoconferences the physicians on both sides--experts in radiation medicine--discussed the health status of Russian patients who had been chronically exposed to ionizing radiation in the South Urals region. The German partners presented patients with comparable haematological and oncological diseases. The project has shown the advantages and difficulties of working in an international and interdisciplinary environment. The experience gained has been very valuable for planning new projects with similar tasks. The results and the contents of the RATEMA database are the basis for education and research for physicians involved in the management of radiation victims.

Databases, Factual↗
PubMed1999

Wound prevalence, types, and treatments in home care.

OBJECTIVE: To ascertain the number of home care patients with wounds, determine the types of wounds being treated in the community, and identify wound care treatments used at home. DESIGN: Descriptive, multisite, collaborative project. SETTING: 13 home care agencies located throughout lower Michigan that had voluntarily formed a research consortium. The location of patients visited was 43% urban, 39% suburban, 16% rural, and 2% unaccounted. PATIENTS: Systematic sampling was used to select nurses in each agency to collect data. Nurses (n = 281) recorded information about adult patients visited during the 1 week of the study. Data were recorded about 2847 patients, M age = 72.5 years. They included 1793 women and 1040 men (gender was not recorded for 14 patients); most patients in the sample (72%) were white. MAIN PLANNED OUTCOMES: A significant number of home visits would include wound care and that wound care would be primarily done with tap water and gauze. RESULTS: Wounds were present in 36.3% of patients. Of the patients with wounds, 58.3% had 1 wound and 41.7% had multiple wounds. Wound types included surgical (62.4%), pressure ulcers (24.9%), and vascular leg ulcers (22.2%). Tap water and gauze were the most-used wound care treatments. Patients with wounds had significantly longer home care visits than patients without wounds. CONCLUSIONS: Patients with wounds are commonly found in home care. There is a low utilization of specialty dressings and commercial irrigation solutions across all wound types. Nurses who follow patients with wounds may need additional time to provide the care.

Adult↗
PubMed1998

Reasons for nonattendance for the treatment of venous ulcers in an inner-city clinic.

PURPOSE: This study examined the reasons that people attending an inner-city wound clinic gave for missing appointments and compared these reasons with those of people who did not have chronic wounds. METHODS: Thirty-six patients with venous ulcers and 115 people without leg ulcers responded to a survey that queried the reasons for missing clinic appointments. Consecutive sampling was used to obtain participants. The Clinic Attendance Questionnaire was developed for the study and consisted of a demographic section and the Reasons for Nonattendance Questionnaire, which has 45 Yes/No items. Items in the Reasons for Nonattendance Questionnaire were sorted by the investigators into 5 subscores (Personal, Clinic Problem, Illness, Mental Health, and Social). Questionnaires were read to participants. Data were not collected from patients who kept all appointments or from new patients. RESULTS: The primary reasons that patients seeking wound care gave for missing appointments were no ride, no money, out of town, forgot, and in too much pain. People with leg ulcers had significantly more Social, Illness, Personal, and Total reasons, but fewer Clinic Problem reasons, for missing appointments than did the people without leg ulcers. The two groups did not differ in their rating of health, importance of health, or age. Most of the people with leg ulcers had a history of illicit drug abuse. CONCLUSIONS: Nonattendance for clinic appointments may delay healing of venous ulcers and decrease the efficiency of the clinic. Reasons for missing wound clinic appointments are numerous and may vary with the patient's condition and background.

Adult↗
PubMed1998

Drinking water fluoridation: bone mineral density and hip fracture incidence.

The role of drinking water fluoride content for prevention of osteoporosis remains controversial. Therefore, we analyzed the influence of drinking water fluoridation on the incidence of osteoporotic hip fractures and bone mineral density (BMD) in two different communities in eastern Germany: in Chemnitz, drinking water was fluoridated (1 mg/L) over a period of 30 years; in Halle, the water was not fluoridated. BMD was measured in healthy hospital employees aged 20-60 years (Halle: 214 women, 98 men; Chemnitz: 201 women, 43 men, respectively) using dual-energy X-ray absorptiometry. Hip fractures in patients > or = 35 years admitted to the local hospitals in the years 1987-1989 were collected from the clinic registers. There was no difference in age, anthropometric, hormonal, or lifestyle variables between the two groups. Mean fluoride exposure in Chemnitz was 25.2 +/- 7.3 years. No correlation was found between fluoride exposure and age-adjusted BMD. We found no significant difference in spinal or femoral BMD between subjects living in Halle and Chemnitz [lumbar spine: 0.997 +/- 0.129 (g/cm2) vs. 1.045 + 0.171 (g/cm2), p = 0.08, for men; 1.055 +/- 0.112 (g/cm2) vs. 1.046 +/- 0.117 (g/cm2), p = 0.47, for women]. The fracture incidence showed an exponential increase with aging in men and women with an incidence about 3.5 times higher for women. In Chemnitz, we calculated an age-adjusted annual incidence of 142.2 per 100,000 for women and 72.5 per 100,000 for men, respectively. In Halle, the incidences were 178.5 per 100,000 for women and 89.2 per 100,000 for men. There was a lower hip fracture incidence after the age of 85 in women in Chemnitz (1391 per 100,000 in Chemnitz vs. 1957 per 100,000) in Halle, p = 0.006). Using the age-adjusted incidences, significantly fewer hip fractures occurred in Chemnitz in both men and women. In conclusion, our study suggests that optimal drinking water fluoridation (1 mg/L), which is advocated for prevention of dental caries, does not influence peak bone density but may reduce the incidence of osteoporotic hip fractures in the very old.

Adult↗
PubMed1998

Risk factors, prevention methods, and wound care for patients with pressure ulcers.

The purposes of this study about patients with pressure ulcers were to: (a) examine demographic characteristics, laboratory values, Braden Scale scores, and presence of pressure ulcer prevention methods and (b) examine pressure ulcers in terms of classification, stage, wound care, and documentation. The investigation was a prospective, descriptive study; the methods used were patient observations and data recordings from the medical record. Of the patients followed (n = 694), 71 had pressure ulcers. Patients with pressure ulcers were significantly older, with longer lengths of stay, more comorbid conditions, lower blood hemoglobin, lower serum albumin, higher white blood cell counts, and lower Braden Scale scores than patients without pressure ulcers. The presence of pressure ulcer prevention methods was greatly lacking. Nosocomial pressure ulcers tended to be a lower stage compared with pressure ulcers present on admission. Dressings used for wound care were generally gauze or a hydrocolloid. Nurses' charting about pressure ulcers was complete for only 35% of notations. The results of this study indicate that advanced practice nurses have a critical role in caring for patients with pressure ulcers and educating care providers.

Aged↗
PubMed1998

Developing collaborative multisite research in home care.

This article present the collaborative process for conducting research among a state home care foundation, its associated membership, and a university. Research collaboration allowed the merging of talents and resources from persons, home care agencies, and a university. The history and development of the project, sampling procedure, and data collection and analysis are discussed. The project increased the appreciation for research, allowed an opportunity for scholarly exchange, and accented the positive use of resources in all settings.

Communication↗
PubMed1998

Altered bleeding time associated with ibuprofen and zidovudine use.

The purpose of this article is to describe a patient who was HIV-positive, had a massive venous ulcer, and developed a prolonged bleeding time with marked blood loss from the ulcer. The patient underwent a workup to rule out possible causes for this prolonged bleeding time; all studies were negative. A review of his history identified that he was self-medicating with ibuprofen while taking zidovudine. A potentiated effect of these two medications on the bleeding time has been reported in the literature. This case illustrates the importance of revisiting a patient's history while working up an acute problem as well as clinically monitoring for blood loss if a person takes ibuprofen and zidovudine.

Adult↗
PubMed1998

Pain associated with venous ulcers in injecting drug users.

Pain is a concern among people with venous ulcers. Although the prevalence is unknown, venous ulcers occur in those who have a history of illicit injecting drug use. The purpose of this study was to (a) examine the relationship between venous ulcer characteristics and pain severity, (b) ascertain factors that cause pain, (c) determine methods to alleviate pain, and (d) explore beliefs about pain medications among people with a history of injection drug use. Thirty-two patients answered pain and demographic questionnaires and had their venous ulcers traced onto plastic to identify wound area. Greater current pain, worse pain in 24 hours, and higher levels of pain relief from medications were significantly related to larger wound areas. Ibuprofen, compression dressing Unna's boot, and heroin ranked highest in decreasing pain. The most painful activities were working, walking outside, standing, and stair climbing. Many patients (41%) did not like to bother others with their complaints of pain. Participants were generally satisfied with pain treatments and the response of care providers to their pain. People who have used injected drugs and have venous ulcers do have pain. Therefore, research must continue to evaluate this pain as well as the best ways to treat it.

Adult↗
PubMed1997

Presence of pressure ulcer prevention methods used among patients considered at risk versus those considered not at risk.

PURPOSE: This study examined pressure ulcer-prevention strategies available for patients considered at risk versus those considered not at risk. DESIGN: The study used a prospective, longitudinal design. SETTING AND SUBJECTS: Six hundred ninety-four patients from units of five acute care hospitals, a rehabilitation facility, and two nurses' home care caseloads participated in the investigation. INSTRUMENTS: Data-collection instruments included the Braden Scale for risk assessment, demographic information, and the Pressure Ulcer-Prevention Strategies tool, which assessed for the presence of 16 pressure ulcer-prevention strategies. METHODS: All patients admitted to a participating unit during a 2-month period were followed up until discharge. Depending on the site, patients were assessed for the presence of pressure ulcer-prevention strategies one to three times per week. RESULTS: Patients in the at-risk group versus those in the not-at-risk group were more likely (p < 0.01) to have the head of the bed in a low position, a pressure-reducing bed surface, pressure ulcer prevention charted, a positioning wedge, incontinence cleanser and ointment, heel protection, a prevention care plan, a trapeze, and a posted turning schedule. The at-risk group had significantly (p < 0.01) more prevention strategies present than did the not-at-risk group. However, the percentage of patients placed on a pressure ulcer-prevention program was low for both groups. CONCLUSIONS: Pressure ulcer prevention was evident for the at-risk group, but at a low rate. Institutions must continue to explore this critical area affecting patient outcomes.

Aged↗