Biomedical subjects

Barbara Riegel

Publications and source records attributed to Barbara Riegel.

At least 55 records · Page 3Linked to original sources

PubMed2004

Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors.

Dehydration has serious consequences for older adults, including increased risk of illness or death. This retrospective review of medical records describes the prevalence, assessment, and risk factors for chronic dehydration in 185 older adults who visited an emergency department in June 2000. Results showed chronic dehydration was present in 89 (48%) patients. Physicians documented assessment for signs of dehydration in 23 (26%) of the dehydrated older adults, but no independent assessments for dehydration were recorded by nurses. These findings indicate many older adults may suffer from unrecognized dehydration, and nurses should be alert to the possibility that dehydration may be present in community-dwelling older adults as well as those who live in residential facilities.

Aged↗

PubMed2003

The Public Access Defibrillation (PAD) trial: study design and rationale.

The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, will form part of a comprehensive, integrated community approach to the treatment of OOH-CA. The study is being conducted at 24 field centers in the United States and Canada. Approximately 1000 community units (e.g. apartment or office buildings, gated communities, sports facilities, senior centers, shopping malls, etc.) were randomized to treatment by trained laypersons who will provide either cardiopulmonary resuscitation (CPR) alone or CPR plus use of an AED, while awaiting arrival of the community's emergency medical services responders. The primary endpoint is the number of OOH-CA victims who survive to hospital discharge. Secondary endpoints include neurological status, health-related quality of life (HRQL), cost, and cost-effectiveness. Data collection will last approximately 15 months and is expected to be completed in September 2003.

Canada↗

PubMed2003

Critical care nursing practice regarding patient anxiety assessment and management.

Anxiety is common in critically ill patients and can adversely affect recovery if not properly assessed and treated. The objectives of this study were to: (1) identify the clinical indicators that critical care nurses consider to be the defining attributes of anxiety in critically ill patients; and (2) delineate the interventions that critical care nurses use to alleviate anxiety in their patients. A total of 2500 nurses who worked in adult critical care areas were randomly selected from the membership of the American Association of Critical Care Nurses. Nurses selected were mailed a survey designed to determine what they considered to be the important attributes of anxiety in their patients and what interventions they commonly used to manage anxiety. The 593 nurses (31.6% response rate) who responded identified 70 individual anxiety indicators and 61 anxiety management strategies that were categorized into four and three major categories, respectively. The four major anxiety assessment categories were: (1) physical/physiological; (2) behavioral; (3) psychological/cognitive; and (4) social. The three major anxiety management strategies were: (1) care techniques; (2) improving knowledge and communication; and (3) support. Critical care nurses reported numerous and distinctive anxiety indicators and management strategies. Further research is needed to examine exactly how appropriate and effective these assessment indicators and management strategies are.

Adult↗

PubMed2003

Changes over 6-months in health-related quality of life in a matched sample of Hispanics and non-Hispanics with heart failure.

Hispanics are a growing ethnic minority in the United States and one at significant risk for heart failure. Health-related quality of life (HRQL) is poor in individuals with heart failure, especially during and immediately following hospitalization. No prior research into the HRQL of Hispanics with heart failure was located. A sample of 80 individuals with heart failure, evenly divided by primary language and matched on functional status using the New York Heart Association classification system and age, was studied for 6 months following hospital discharge. Data on HRQL were collected using Spanish and English versions of the Minnesota Living with Heart Failure Questionnaire. Scores improved over time in both groups but significantly more so in the Hispanics when compared to the non-Hispanics. Group differences in HRQL could not be explained by demographics, clinical characteristics, treatment received, perceived support, or instrument response characteristics. Further exploration of this naturally occurring phenomenon may provide insight into how HRQL can be improved in the general heart failure population.

Activities of Daily Living↗

PubMed2003

Gender differences in quality of life are minimal in patients with heart failure.

BACKGROUND: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. METHODS: Data from a sample of 640 men and women (50% each) matched on New York Heart Association functional classification and age were used for this secondary analysis. Scores on the Minnesota Living with Heart Failure Questionnaire were compared at baseline and 3 months after enrollment using multivariate techniques with ejection fraction controlled. Treatment group (intervention versus control) was controlled statistically at 3 months because the original data were drawn from experimental and quasi-experimental studies in which an improvement in quality of life had been a goal of the intervention. The sexes differed on marital status, so this variable was controlled in analyses as well. RESULTS: In all analyses, quality of life was minimally worse in women compared with men (1-3 points at most). None of the differences reached statistical significance except for emotional quality of life at baseline (P =.03). By 3 months, both men and women reported significantly improved and comparable quality of life and there were no significant differences between them. CONCLUSION: Quality of life is similar in men and women with heart failure when functional status, age, ejection fraction, and marital status differences are controlled.

Age Factors↗

PubMed2003

Perceived effects of testosterone replacement therapy in perimenopausal and postmenopausal women: an internet pilot study.

Women experience somatic, mood, energy, and libido changes during menopause. Testosterone replacement therapy is being prescribed in conjunction with estrogen replacement therapy (ERT) for these symptoms. Little is known about women's perceptions of the benefits and risks of testosterone, so an Internet survey was conducted to elicit women's perceptions of the effects on mood, energy, sexuality, and somatic symptoms. A sample of 61 women primarily from the United States and Canada participated in the survey; one woman from Germany and one from Sweden also took part in the survey. Participants reported significantly improved sexuality and improved mood and vigor, with a decline in fatigue. Of the 7 somatic complaints assessed, improvements were noted in 5 (sleep disturbances, hot flashes, night sweats, vaginal dryness, and appetite). A prospective clinical trial is needed to confirm these results.

Adult↗

PubMed2003

Critical care nurses' beliefs about and reported management of anxiety.

BACKGROUND: Anxiety is associated with increased morbidity and mortality. Critical care nurses are uniquely positioned to reduce anxiety in their patients. Critical care nurses' beliefs about and frequency of use of strategies to reduce anxiety have not been studied. OBJECTIVES: To explore critical care nurses' beliefs about the importance of anxiety management and to describe nurses' reported use of strategies to manage anxiety in their patients. METHODS: A random sample (N = 2500) of members of the American Association of Critical-Care Nurses was asked to complete the Critical Care Nurse Anxiety Identification and Management Survey. RESULTS: Respondents (n = 783) were primarily female (92%), white (88.5%) staff nurses (74.1%) who thought that anxiety is potentially harmful (mean, 4.1; SD, 0.8; range, 1 = no harm to 5 = life-threatening harm), that anxiety management is important (mean, 4.8; SD, 0.6; range, 1 = not important to 5 = very important), and that effective anxiety management is beneficial (mean, 4.6; SD, 0.6; range, 1 = no benefit to 5 = profound benefit). A majority commonly used pharmacological management; most also used information and communication interventions. Fewer subjects used the presence of patients' family members to alleviate patients' anxiety; few reported using stress-reduction techniques. CONCLUSION: Most respondents thought that treating anxiety is important and beneficial. Commonly used strategies included pharmacological relief of anxiety and pain and information and communication interventions. Although these strategies are useful, they may not effectively reduce anxiety in all patients.

Anxiety↗

PubMed2002

Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure.

BACKGROUND: Case management is believed to promote continuity of care and decrease hospitalization rates, although few controlled trials have tested this approach. OBJECTIVE: To assess the effectiveness of a standardized telephonic case-management intervention in decreasing resource use in patients with chronic heart failure. METHODS: A randomized controlled clinical trial was used to assess the effect of telephonic case management on resource use. Patients were identified at hospitalization and assigned to receive 6 months of intervention (n = 130) or usual care (n = 228) based on the group to which their physician was randomized. Hospitalization rates, readmission rates, hospital days, days to first rehospitalization, multiple readmissions, emergency department visits, inpatient costs, outpatient resource use, and patient satisfaction were measured at 3 and 6 months. RESULTS: The heart failure hospitalization rate was 45.7% lower in the intervention group at 3 months (P =.03) and 47.8% lower at 6 months (P =.01). Heart failure hospital days (P =.03) and multiple readmissions (P =.03) were significantly lower in the intervention group at 6 months. Inpatient heart failure costs were 45.5% lower at 6 months (P =.04). A cost saving was realized even after intervention costs were deducted. There was no evidence of cost shifting to the outpatient setting. Patient satisfaction with care was higher in the intervention group. CONCLUSIONS: The reduction in hospitalizations, costs, and other resource use achieved using standardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches.

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PubMed2002

Facilitators and barriers to heart failure self-care.

Self-care of heart failure (HF) is difficult to master, but the reasons why remain unclear. The purpose of this study was to explore how HF influences patients' lives, assess how they perform self-care, and determine how their life situation facilitates or impedes HF self-care. Qualitative data were obtained from 26 individuals with chronic HF. Data were gathered using structured interviews and analyzed using content analysis. Physical limitations, debilitating symptoms, difficulties coping with treatment, lack of knowledge, distressed emotions, multiple comorbidities, and personal struggles were common. Self-care involved the recognition of symptoms, but atypical symptoms such as faintness were rarely attributed to HF. Patients discussed their successes and failures in following dietary, exercise, and medication recommendations. Some adaptation strategies were practical and some involved internal resources. Many patients accepted support from others, but some withdrew. With the number of barriers these patients face, it is not surprising that self-care of HF is typically poor and that readmission rates continue to be high. Recommendations are provided for a stepped approach to patient education and counseling that uses these findings in practice.

Adaptation, Psychological↗

PubMed2002

Can we talk? Developing a social support nursing intervention for couples.

Social support is an important influence on success during lifestyle modification attempts. According to the theory of expressed emotion, support that is perceived by the recipient as critical or overprotective is unhelpful and perhaps harmful. This article describes an intervention for couples and preliminary assessment of its feasibility and acceptability by the nurses who trialed it. Four staff nurses and 2 advanced practice nurses administered the intervention to 15 couples and reported on the benefits and limitations of the intervention. One individual in each couple had a chronic or an acute cardiac illness. The nurses perceived the intervention as valuable; even a single session stimulated discussion between the couple about important issues. Complexity, logistic barriers, and time constraints limited the technique. The authors conclude that this intervention may be most useful to clinical nurse specialists who have additional education, training in communication, and teaching and consulting skills.

Communication↗

PubMed2002

The contribution of chronic illness to acceptance of death in hospitalized patients.

This pilot study explored acceptance of death in the chronically ill. It was hypothesized that chronic illness would be a positive predictor of premature acceptance of death. Acceptance of death, if premature, may lead to untimely acquiescence to death, making people less likely to seek medical care and practice preventive health behaviors. A correlational design was used to explore the relationship between chronic illness and acceptance of death, controlling for age. Data were collected on death acceptance using the revised version of the Life Attitude Profile. Number of chronic illnesses was obtained from self-report and a review of the medical record in a sample of 76 hospitalized individuals. The number of chronic illnesses was significantly and positively associated with death acceptance, but age was not. The model explained only 5.2% of the variance in death acceptance, however. Chronic illness is clearly only one of many factors stimulating individuals to ponder death earlier than expected. Nurses need to be alert to the possibility that individuals with multiple chronic illnesses may be prematurely acquiescing to death. If acquiescence causes failure to participate in care, it could potentially exacerbate chronic conditions unnecessarily.

Attitude to Death↗

PubMed2002

Critical care nurses' assessment of patients' anxiety: reliance on physiological and behavioral parameters.

BACKGROUND: Anxiety activates the sympathetic nervous system and hypothalamic-pituitary-adrenal axis and may increase morbidity and mortality in vulnerable critical care patients. Despite the adverse effects of anxiety, little is known about critical care nurses 'practices for assessing anxiety. OBJECTIVE: To determine the importance that critical care nurses place on evaluating anxiety and to describe clinical indicators used to assess anxiety. METHODS: Twenty-five hundred members of the American Association of Critical-Care Nurses received the Critical Care Nurse Anxiety Identification and Management Survey and were asked to rate the importance of anxiety assessment, to rate the importance of 61 anxiety indicators, and to select and rank the 5 most important anxiety indicators. RESULTS: Seven hundred eighty-three completed surveys (31.6%) were returned by female (92.0%), white (88.6%) staff nurses (74.2%) who practiced critical care nursing 32.5 hours (SD, 12.3 hours) weekly. Nearly three quarters (71.3%) of respondents thought that anxiety assessment is very important. Only 2 indicators, agitation and patients' verbalization of anxiety, were rated as very important to anxiety assessment. Thirty-nine indicators rated as important primarily included measurable physiological changes and observable behaviors. The top 5 anxiety indicators were agitation, increased blood pressure, increased heart rate, patients' verbalization of anxiety, and restlessness. CONCLUSION: Important indicators of anxiety included observable behaviors and measurable physiological changes. Reliance on these criteria may produce an inaccurate and incomplete anxiety evaluation in vulnerable patients and lead to poorer outcomes. A comprehensive, systematic anxiety assessment tool for valid and reproducible evaluation of patients' anxiety is needed.

Adult↗

PubMed2002

Teaching staff a brief cognitive-behavioral intervention.

Lifestyle behaviors contribute significantly to the onset and course of numerous diseases and affect well-being in general. Patient education is the principal strategy nurses use to modify individuals' knowledge, attitudes, and beliefs about their health behaviors. However, current approaches are failing to induce the behavior changes necessary to reduce the incidence and prevalence of lifestyle-related disorders. In this pilot project, a brief cognitive-behavioral program was developed. The project yielded important insights into ways to improve current and develop new and more effective patient education strategies.

Cognitive Behavioral Therapy↗

PubMed2002

Cognitive impairment in heart failure: issues of measurement and etiology.

BACKGROUND: Clinicians need easy methods of screening for cognitive impairment in patients with heart failure. If correlates of cognitive impairment could be identified, more patients with early cognitive impairment could be treated before the problem interfered with adherence to treatment. OBJECTIVES: To describe cognitive impairment in patients with heart failure, to explore the usefulness of 4 measures of cognitive impairment, and to assess correlates of cognitive impairment. METHODS: A descriptive, correlational design was used. Four screening measures of cognition were assessed in 42 patients with heart failure: Commands subtest and Complex Ideational Material subtest of the Boston Diagnostic Aphasia Examination, Mini-Mental State Examination, and Draw-a-Clock Test. Cognitive impairment was defined as performance less than the standardized (T-score) cutoff point on at least 1 of the 4 measures. Possible correlates of cognitive impairment included age, education, hypotension, fluid overload (serum osmolality < 269 mOsm/kg), and dehydration (serum osmolality > or = 295 mOsm/kg). RESULTS: Cognitive impairment was detected in 12 (28.6%) of 42 participants. The 4 screening tests varied in effectiveness, but the Draw-a-Clock Test indicated impairment in 50% of the 12 impaired patients. A summed standardized score for the 4 measures was not significantly associated with age, education, hypotension, fluid overload, or dehydration in this sample. CONCLUSIONS: Cognitive impairment is relatively common in patients with heart failure. The Draw-a-Clock Test was most useful in detecting cognitive impairment, although it cannot be used to detect problems with verbal learning or delayed recall and should not be used as the sole screening method for patients with heart failure. Correlates of cognitive impairment require further study.

Adult↗

PubMedDate not supplied

Predictors of successful heart failure self-care maintenance in the first three months after hospitalization.

OBJECTIVE: The objective of this study was to replicate a prior study of predictors of self-care in heart failure (HF). DESIGN: A non-experimental, correlational replication study retested a model of 7 variables: social support, symptom severity, comorbidity, education, age, gender, and income; the last variable, income, was tested in the prior study but was excluded in this study because of missing data. The model was tested at baseline and 3 months after hospitalization. SETTING: Participants were enrolled from 2 hospitals in southern California. PATIENTS: A convenience sample of 66 patients with chronic HF were studied. The sample was elderly, primarily female, and educated at the high school level or above. Approximately half of the patients had systolic HF, and most were functionally compromised. Outcome measure Self-care maintenance, a component of self-care, was measured with the maintenance subscale of the Self-Care of Heart Failure Index. RESULTS: At baseline, the model was significant (F = 2.61, df = 7.58, P = .02) and explained 14.8% of the variance in HF self-care. Significant predictors of self-care were higher age and male gender. Three months later, when baseline self-care maintenance scores were controlled in the analysis, the model explained 45.3% of the variance in HF self-care. Most of the variance was explained by the baseline self-care score, but male gender and low comorbidity added an additional 6% of the variance (F = 6.9, df = 9.56, P < .0001). CONCLUSIONS: Elderly men and those with fewer comorbid illnesses were most successful at HF self-care.

Adult↗

PubMedDate not supplied

Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease.

The New York Heart Association (NYHA) functional classification system was developed to help physicians in clinical practice evaluate the effect of cardiac symptoms on a patient's daily activities. Over time, the role of the NYHA classification system has expanded, and it is now frequently used in clinical research. This review of the literature was undertaken to explore whether the NYHA classes have sufficient validity and reliability to serve as a functional outcome measure in research studies. After exploring its strengths and limitations, we conclude that the NYHA classes are a valid measure of functional status, a concept that is distinct from functional capacity and functional performance. The reproducibility of the NYHA functional classification system has not been established in the literature. Researchers are urged to report the methods for determining NYHA class, the training of raters, and the intra-rater or inter-rater reliability in studies that have multiple raters or measurements. Until the reliability of the NYHA functional classification system is determined, it is prudent to refrain from using the NYHA classes as the sole outcome measure of change in function in research studies of cardiac patients.

Clinical Trials as Topic↗

PubMedDate not supplied

Is individual peer support a promising intervention for persons with heart failure?

Peer support has been used effectively in a variety of patient populations, but its effectiveness in improving outcomes in persons with chronic heart failure has not been explored. We trained 9 persons with heart failure to mentor other heart failure patients and tested the effectiveness of this approach in a randomized controlled clinical trial. A low proportion (37%) of the eligible population of hospitalized patients agreed to participate. At the end of the 3-month trial, there was significantly higher heart failure self-care in the intervention group (P < .05). The only difference in social support was a significant decline in perceived support reciprocity in the intervention group (F = 5.94, P = .004). No significant group differences in heart failure readmissions, length of stay, or cost were evident at 90-days, although the heart failure readmission rate was 96% higher in the intervention group when compared to that in the control group. The reasons for low overall enrollment and high readmission rates in the intervention group require further study. Including additional self-care education by a professional, rather than leaving all the education to the mentor, could strengthen the peer support intervention trialed in this study. Small group meetings may be less intrusive and more desirable for this patient population.

Adult↗

PubMedDate not supplied

Psychometric testing of the heart failure somatic awareness scale.

BACKGROUND: Self-management of heart failure relies on patients to assess their symptoms, but their ability to do so is often difficult to determine. The 12-item self-report Heart Failure Somatic Awareness Scale (HFSAS) was developed to measure awareness of and distress secondary to heart failure symptoms. The purpose of this study was to test the psychometric properties of the HFSAS. METHODS AND RESULTS: Feasibility and discriminant validity of the HFSAS were tested in 49 patients admitted for an exacerbation of heart failure. The HFSAS was acceptable to patients and discriminated between heart failure symptoms and anxiety (r = 0.25, P = .08). When reliability and validity were tested in 201 patients with acute heart failure, theta reliability was adequate (0.71). The HFSAS was low to moderately correlated with general bodily awareness (r = 0.48). No difference was found based on gender, but younger patients had higher mean and median HFSAS scores (more distress). The HFSAS was a significant predictor of symptom duration prior to seeking care for heart failure; higher scores were associated with longer delay before seeking care. CONCLUSION: The HFSAS is reliable with content, discriminant, and construct validity. Evaluation of its usefulness in teaching patients to monitor daily symptoms is needed.

Aged↗