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Biomedical subjects

K M Swanson

Publications and source records attributed to K M Swanson.

12 recordsLinked to original sources
PubMed2001

Step-down management of gastroesophageal reflux disease.

BACKGROUND & AIMS: As the economic burden of gastroesophageal reflux disease (GERD) is largely weighted to maintenance as opposed to initial therapy, switching from more potent to less expensive medication once symptoms are alleviated (step-down therapy) may prove to be most cost-effective. This study aimed to prospectively evaluate the feasibility of step-down therapy in a cohort of patients with symptoms of uncomplicated GERD. METHODS: Patients whose GERD symptoms were alleviated by proton pump inhibitors (PPIs) were recruited from outpatient general medicine clinics. After baseline demographic and quality of life information were obtained, PPIs were withdrawn from subjects in a stepwise fashion. Primary outcome was recurrence of symptoms during follow-up that required reinstitution of PPIs. Secondary outcomes included changes in quality of life and overall cost of management. Predictors of nonresponse to step-down were assessed. RESULTS: Seventy-one of 73 enrolled subjects completed the study. Forty-one of 71 (58%) were asymptomatic off PPI therapy after 1 year of follow-up. Twenty-four of 71 (34%) required histamine 2-receptor antagonists, 5/71 (7%) prokinetic agents, 1/71 (1%) both, and 11/71 (15%) remained asymptomatic without medication. Quality of life did not significantly change, whereas management costs decreased by 37%. Multivariable analysis revealed younger age and a dominant symptom of heartburn to predict PPI requirement. CONCLUSIONS: Step-down therapy is successful in the majority of patients and can decrease costs without adversely affecting quality of life.

Adult↗
PubMed2000

Predicting depressive symptoms after miscarriage: a path analysis based on the Lazarus paradigm.

Twenty percent of all pregnancies end in miscarriage. Findings are mixed about who is most at risk for a depressive response. The purpose of this study was to develop and test a theory-based path model that would enable prediction of the intensity of women's depressive symptoms at 4 months and at 1 year after miscarriage. The model is based on Lazarus's theory of emotions and adaptation. Model constructs examined included stage I contextual variables (gestational age, number of miscarriages, number of children, maternal age, perceived provider caring at the time of loss, and family income), stage II interceding variables (perceived social support, emotional strength, and subsequent pregnancy/birth), stage III primary appraisal of meaning (personal significance of miscarrying), stage IV secondary appraisal (active or passive coping), and stage V emotional response (depressive symptoms). Path analysis employing a series of stepwise, multiple regression equations was used to test the hypothesized model. The sample consisted of 174 women whose pregnancies ended prior to 20 weeks gestation (mean = 10.51, SD = 3.32). The model accounted for 63% of the variance in women's depressive symptoms at 4 months and 54% at 1 year. Findings support the utility of the Lazarus model and confirm that women most at risk for increased depressive symptoms after miscarriage are those who attribute high personal significance to miscarriage, lack social support, have lower emotional strength, use passive coping strategies, have lower incomes, and do not conceive or give birth by 1 year after loss.

Abortion, Spontaneous↗
PubMed2000

Industry perspectives on the use of microbial data for hazard analysis and critical control point validation and verification.

Microbial testing is an essential element in validation of critical limits identified within a hazard analysis critical control point (HACCP) plan. Without appropriate validation there is no assurance that the plan will control the hazards of concern. Once critical control points have been validated to effectively prevent, reduce, or eliminate hazards, application of routine testing for pathogens in finished product becomes an ineffective means to assure process control and therefore safety of the product. The occurrence of a pathogen in a product produced under an effective HACCP plan is so rare that sampling protocols are not capable of finding the needle in the haystack. Quantitative indicators can provide a much more effective tool for verifying that HACCP is properly implemented. Choice of appropriate indicators is product and process specific. In certain applications, finished product testing for even indicator organisms provides no meaningful data for verification of HACCP (e.g., canned products). Tests chosen should provide meaningful information that directs resources toward prevention and improvement of the system.

Colony Count, Microbial↗
PubMed1999

Research-based practice with women who have had miscarriages.

PURPOSE: To summarize a research-based description of what it is like to miscarry and to recommend an empirically tested theory of caring for women who have experienced miscarriage. DESIGN: The research program included three phases: interpretive theory generation, descriptive survey and instrument development, and experimental testing of a theory-based intervention. METHODS: Research methods included interpretive phenomenology, factor analysis, and ANCOVA. FINDINGS: A theory of caring and a model of what it is like to miscarry were generated, refined, and tested. A case study shows one woman's response to miscarrying and illustrates clinical application of the caring theory. CONCLUSIONS: The Miscarriage Model is a useful framework for anticipating the variety of responses women have to miscarrying. The caring theory is an effective and sensitive guide to clinical practice with women who miscarry.

Abortion, Spontaneous↗
PubMed1993

Nursing as informed caring for the well-being of others.

Assumptions about four main phenomena of concern to nursing (persons/clients, health/well-being, environments and nursing) are presented and an elaboration is made of the structure of a theory of caring. The issues that arise when nursing is viewed as "informed caring for the well-being of others is also examined."

Clinical Competence↗
PubMed1992

Pharmacy-coordinated, multidisciplinary adverse drug reaction program.

To date, the stated program objectives have been met. There is a heightened awareness of ADRs, and the program has had a positive impact on patient care. More work is needed in the prevention of ADRs as opposed to their tabulation. Future educational efforts will focus on how reporting suspected ADRs can positively impact patient care.

Adverse Drug Reaction Reporting Systems↗
PubMed1991

Pharmacist career ladder with clinical privilege categories.

The development of a career ladder program for staff pharmacists at a Department of Veterans Affairs (VA) medical center is recounted. Center policy required the establishment of clinical privileges for all pharmacists with direct patient contact and specified three VA privilege categories with increasing degrees of autonomy. The pharmacy department supported the need for all pharmacists to incorporate clinical activities into their daily practice but faced several problems, including inadequate instruction, insufficient incentives, fragmentation of clinical services, and subjectivity of measures of competence. In response, a pharmacy credentialing committee created a career ladder with three levels based on the established system of clinical privileges. Level A integrated basic clinical pharmacy knowledge with dispensing activities. Level B increased the number of clinical skills required and allowed the pharmacist to act as a therapeutic consultant. Level C incorporated the skills necessary for specialty practice. Instructors were designated for each clinical service area, readings and sample problems were assigned, and staff development presentations were improved. Objective tests of skills were designed. Combining the three levels on the career ladder with the three categories of clinical privileges formed a matrix of nine options for advancement. Pharmacists applying for advancement must master all requisite skills and submit relevant documentation. Each level carries a pay increase of 2%. A total of 53% of the staff pharmacists have participated in the program, which has had a favorable impact on staff retention. By combining nationally established categories of clinical privileges with an institution-specific career ladder, a pharmacy department helped ensure the consistency of services and promote the development of clinical practitioners.

Career Mobility↗
PubMed1990

Providing care in the NICU: sometimes an act of love.

The final phase of a research project is the communication of findings in a manner that is acceptable within the scholarly norms of a scientific community. While there exists in nursing a willingness to embrace many forms of inquiry, there remains a hesitancy to communicate study outcomes in alternative formats that are congruent with the innovative methods employed. This article serves a dual purpose. It presents a phenomenologic investigation of care provision in the NICU, and it serves as a forum for discussion of issues related to the conduct and communication of phenomenologic research.

Altruism↗
PubMed1989

Pharmaceutical continuing-education program based on a core curriculum.

The use of a core curriculum concept in the establishment of a comprehensive continuing-education program is described. A departmental staff development committee was selected to develop a core curriculum of topics for professional continuing education. Six core curriculum areas of interest and importance were identified: cardiology; infectious disease; total parenteral nutrition, acid-base balance, and fluid and electrolytes; pharmacy management; critical-care medicine; and pharmacokinetics. Coordinators were selected from the staff to identify topics and speakers in each core curriculum area. The drug information center was assigned responsibility for logistical aspects of the program such as scheduling, evaluations, objectives, information support, and providing continuing-education credit. A survey of staff perceptions revealed a very positive view of the program. The staff rated the program highly as meeting their needs for continuing-education credit, as an employee benefit, and in covering topics related to their practice. The core curriculum concept has been shown to be a successful and effective approach to the establishment of a comprehensive continuing-education program.

Curriculum↗
PubMedDate not supplied

Effects of caring, measurement, and time on miscarriage impact and women's well-being.

BACKGROUND: Responses to miscarriage range from relief to devastation, yet there have been no randomized controlled studies that demonstrate significant effects of counseling with women who miscarry. OBJECTIVE: To test the effects of caring-based counseling, measurement, and time on the integration of loss (miscarriage impact) and women's emotional well-being (moods and self-esteem) in the first year after miscarrying. METHOD: ANCOVA was used in this randomized, longitudinal Solomon four-group experimental investigation. Enrolled were 242; 185 completed. Outcomes included: self-esteem, overall emotional disturbance, anger, depression, anxiety, confusion, overall miscarriage impact, personal significance, devastating event, lost baby, and isolated. RESULTS: During the first year after loss (a) caring was effective in reducing overall emotional disturbance, anger, and depression; and (b) time passing led to increased self-esteem and decreased anxiety, depression, anger, confusion, and personal significance of loss. CONCLUSION: Caring, measurement, and time had some positive and significant effects on the integration of loss and enhancement of well-being in the first year subsequent to miscarrying.

Abortion, Spontaneous↗
PubMedDate not supplied

Empirical development of a middle range theory of caring.

A middle-range theory of caring was inductively derived and validated through phenomenological investigations in three separate perinatal contexts. Caring was described in Study I by 20 women who had recently miscarried, in Study II by 19 careproviders in the newborn intensive care unit, and in Study III by 8 young mothers who had been the recipients of a long-term public health nursing intervention. The empirical development and refinement of the theory is discussed. The five caring processes and an overall definition of caring are presented. Finally, study findings are compared and contrasted with Cobb's (1976) definition of social support, Watson's (1979, 1985) "carative" factors, and Benner's (1984) description of the helping role of the nurse.

Abortion, Spontaneous↗