Designing cancer nursing courses for community hospitals.
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Adult↗
Biomedical subjects
R B Hyman
Publications and source records attributed to R B Hyman.
Predictors of hospital length of stay and nursing home placement in an elderly medical population.
OBJECTIVE: To identify predictors of adverse outcomes (nursing home placement and hospital length of stay) in a cohort of older hospitalized patients. DESIGN: Prospective cohort study. SETTING: A suburban medical center in the New York City metropolitan area. PARTICIPANTS: Patients aged 65 years and older admitted from the emergency department to medical services who could be seen within 24 hours. Patients with terminal illness, planned stays < 2 days, and admission to other than medicine were excluded. MEASUREMENTS: Sociodemographic data, mobility, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mental status, length of stay (LOS), discharge diagnosis, and disposition (nursing home vs. other). RESULTS: Of 681 patients screened, 322 were eligible and assessed at admission,206 were reassessed at discharge. Using multiple regression, greater dependency in IADL, more household help, and impaired mental status at admission predicted hospital LOS significantly (P = 0.0001). Compared with those discharged home, the nursing home (NH) group had lower scores on mean mobility and mean ADLs and IADLs and was more likely to exhibit a decline in at least one ADL. Stepwise discriminant analysis was performed using admission, discharge, and combined variables. In our final model of the predictors of discharge disposition, the use of admission functional variables, age, and sex correctly classified 100% of the NH group and 91% of the other group, with IADL, ADL, and mobility defining the function that discriminated the groups. CONCLUSIONS: Our data indicate the value of cognitive and physical function at admission as predictors of adverse outcomes and support early assessment of the elderly for discharge planning for long-term care.
Journal Article↗
The effects of relaxation training on clinical symptoms: a meta-analysis.
Forty-eight experimental studies of nonmechanically assisted relaxation techniques used to control a variety of clinical symptoms were synthesized using meta-analysis. Effect sizes for three types of comparisons, experimental-control, experimental-placebo, and pre-post, ranged from .43 to .66, demonstrating that treatment of any type included in the analysis moved the client from the 50th to the 67th percentile of an untreated group at minimum and from the 50th to the 75th percentile at maximum. All treatments included in the analysis except Benson's relaxation technique demonstrated evidence of effectiveness, particularly for nonsurgical samples with chronic problems such as hypertension, headache, and insomnia.
Adult↗
Survival rates and coping styles of maintenance hemodialysis patients.
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Activities of Daily Living↗
Clean vs. sterile tracheotomy care and level of pulmonary infection.
As reported in the literature and observed in clinical practice, a variety of tracheotomy care procedures (tracheotomy suctioning and cleaning techniques) are currently used. The purpose of this research was to determine if clean tracheotomy care was more effective than sterile as measured by levels of postoperative pulmonary infection. Ten hospitals with large Head and Neck/ENT services were selected as data collection sites. At these centers a minimum of 15 tracheostomy patient charts were reviewed pre- and postoperatively for clinical and laboratory data related to infection. Patient level of infection was defined using the Weighted Level of Pulmonary Infection Tool, which was constructed for this study. Three categories of aseptic type emerged (clean, sterile, and mixed) because existing tracheotomy care procedures did not fall into one of the two hypothesized types. Data were analyzed using a maximum likelihood approach to mixed model analysis of variance or covariance. The findings indicated significant differences among the three procedures with laboratory, but not clinical, data. Laboratory data supported practicing clean procedures as those associated with the least postoperative infection.
Analysis of Variance↗
Preventing HIV transmission: behavior and attitudes of medical house staff in a high-prevalence area.
Our objective was to evaluate human immunodeficiency virus (HIV) risk-factor assessment and counseling behavior in 86 medical house staff and to ascertain the effect of question format (closed versus open) on reported physician behaviors. We designed a cross-sectional survey using a self-report questionnaire; we received 78 returns of 86 questionnaires (91% response) from one-year and three-year medical housestaff at two general medical clinics in a university-affiliated Bronx municipal hospital. House staff reported assessing sexual behavior (51%) and intravenous drug use (81%) in new patients significantly less often than they assessed smoking (95%) or alcohol use (94%). Counseling to reduce the risk of HIV transmission among all patients occurred even less frequently (41%, all P < .05). Question format (closed versus open) significantly affected response rate; respondents to closed-format questions reported far more behaviors performed. Intravenous drug users (IVDUs) received more frequent advice than general clinic patients about reducing HIV transmission (85% versus 41%), but house staff may ignore sexual risks in IVDUs. Resident confidence that IVDUs would change sexual or drug risk behavior was equally low, 1.5 on a 4-point scale. They reported greater discomfort discussing sexuality than drug use (2.4 versus 1.7; 4-point scale, P = .003). Discomfort discussing sexuality inversely associated with sexual history-taking in multi-variate analysis. Greater involvement with HIV positive patients and fewer perceived barriers to counseling were also associated with more assessment or counseling about risks for HIV transmission. These results suggest that enhancing house staff assessment and counseling efforts to reduce risks for HIV transmission requires interventions that foster involvement with HIV positive patients, emphasize the importance of sexual transmission in IVDUs, facilitate competence in discussing sexual behavior, and address provider belief that IVDUs will not change risk behaviors. Results also demonstrate a significant effect of question format on reported physician behavior.
Attitude of Health Personnel↗