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Biomedical subjects

S B Henry

Publications and source records attributed to S B Henry.

At least 19 recordsLinked to original sources
PubMed2000

Hematological complications and quality of life in hospitalized AIDS patients.

The relationships among the biological and physiological indicators of cytopenias in AIDS and measures of quality of life are not well characterized. The purpose of this secondary analysis was to determine the relationships among anemia, neutropenia and thrombocytopenia and characteristics of the individual, physiological markers, symptoms, functional status, general health perceptions, and well-being in people with AIDS. The five dimensions of the Wilson and Cleary model of health-related quality of life provided the conceptual model for this study. In addition to descriptive statistics, logistic regression was used to analyze clusters of variables. The sample of 146 hospitalized patients with AIDS had an 85% prevalence of anemia, a 53% prevalence neutropenia and a 33% prevalence of thrombocytopenia. The mean age was 38 years old, 19% were female, 35% were white, 27% had a history of injection drug use and the mean T-helper cell count was 74 mm3. The five dimensions of the Wilson and Cleary model offered significant predictability for anemia only. Patients with higher symptom scores were more likely to have treatable anemia, defined as a hematocrit of < 30%. Treatable anemia was also associated with lower self-care scores and lower T-helper cells. Fifty-four percent of the cohort were candidates for colony stimulating factors, while only 17% of those eligible received them. These data suggest suboptimal treatment of anemia and neutropenia in this cohort of AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Dimensions of health-related quality of life in persons living with HIV disease.

The purpose of this secondary analysis was to test empirically the influence of biological and physiological variables, symptom status, functional status, general health perceptions, characteristics of the individual and characteristics of the environment on overall quality of life in persons living with HIV disease. Path analysis, using multiple linear regression, was used to examine the fit between a health-related quality of life (HRQOL) theoretical model and data from a sample of 142 persons with an AIDS diagnosis. Thirty-two per cent of the variance in overall quality of life was explained by the HRQOL model with symptom status having the greatest influence (beta = -0.237, R2(Y x 2) = 5%). This analysis suggests that symptom status, functional status and general health perceptions are key dimensions of HRQOL. With a focus on prevention, health promotion, symptom management, and the alleviation of acute and chronic illness effects, HRQOL may be appropriate for capturing the outcomes of nursing interventions.

Adult↗
PubMed1999

Representing nursing judgements in the electronic health record.

The naming of nursing phenomena and representing the phenomena in a standardized manner suitable for encoding in computer-based systems is a challenge for the nursing profession at the national and the international level. Considerable progress has been made in the development of classification systems for nursing practice. The focus of this article is on language systems developed to represent nursing judgements in computer-based systems, in particular the electronic health record. A review of two current systems and their proposed revisions (North American Nursing Diagnosis Association, NANDA, Taxonomies I and II, and the International Classification for Nursing Practice, ICNP, Alpha and Beta versions), according to the features suggested by the Computer-based Patient Record Institute (CPRI) for classification systems appropriate for implementation in computer-based systems, suggests that the evolving versions extend the current versions in terms of sufficient granularity (depth and level of detail) and atomic and compositional character. However, it is not clear from the literature available to date whether the characteristics that are most closely related to definition of a formal terminology (i.e. clear and non-redundant representation of concepts, syntax and grammar for logical constructions of compositional terms, synonyms and language independence) will be part of the evolving vocabularies. Formal terminology models and related tools have the potential to complement, extend, and refine existing nursing classification systems.

Humans↗
PubMed1999

Validation of the Sign and Symptom Check-List for Persons with HIV Disease (SSC-HIV).

Symptom management for persons living with HIV disease is recognized as an extremely important component of care management. This article reports the validation of a new sign and symptom assessment tool designed to assess the intensity of HIV-related symptoms using two samples (study 1: n=247; study 2: n=686) of people living with HIV disease. Study 1 data were collected between 1994 and 1996 before the initiation of highly active antiretroviral therapy (HAART). Study 2 data were collected between 1997 and 1998 after the wide adoption of HAART therapy. The initial version of the Sign and Symptom Check-List for Persons with HIV Disease (SSC-HIV) included 41 signs and symptoms. This scale was submitted to a principal components factor analysis with a varimax rotation. The final solution reports six factors explaining 68.9% of the variance. The six symptom clusters (factors), the number of items in the factor, and the Cronbach alpha reliability estimates were: malaise/weakness/fatigue (six items, alpha=0.90); confusion/distress (four items, alpha=0.90); fever/chills (four items, alpha=0.85); gastrointestinal discomfort (four items, alpha=0. 81); shortness of breath (three items, alpha=0.79); and nausea/vomiting (three items, alpha=0.77). These six factors have strong reliability estimates and a stable factor structure that supports the construct validity of the 26-item instrument. Additional evidence supports the concurrent validity of the scale as well as its sensitivity to change over time. The final version of the SSC-HIV is a 26-item scale available for use by clinicians and researchers to measure the patient's self-report of HIV-related signs and symptoms.

Adult↗
PubMed1999

Predictors of self-reported adherence in persons living with HIV disease.

This study examined the relationships between the five dimensions of the Wilson and Cleary model of health-related quality of life and three self-reported adherence measures in persons living with HIV using a descriptive survey design. Data collection occurred in seven cities across the United States, including university-based AIDS clinics, private practices, public and for-profit hospitals, residential and day-care facilities, community-based organizations, and home care. The three dependent adherence measures studied were "medication nonadherence," "follows provider advice," and "missed appointments." The sample included 420 persons living with HIV disease with a mean age of 39 years of which 20% were women and 51% were white; subjects had a mean CD4 count of 321 mm3. HIV-positive clients with higher symptom scores, particularly depression, were more likely to be nonadherent to medication, not to follow provider advice, and to miss appointments. Participants who reported having a meaningful life, feeling comfortable and well cared for, using their time wisely, and taking time for important things were both more adherent to their medications and more likely to follow provider's advice. No evidence was found demonstrating any relationship between adherence and age, gender, ethnicity, or history of injection drug use. These findings support the need to treat symptoms, particularly depression, and to understand clients' perceptions of their environment as strategies to enhance adherence. A limitation of this study was that adherence was measured only by self-report; however, the study did expand the concept of adherence in HIV care beyond medication adherence to include following instructions and keeping appointments.

Adult↗
PubMed1997

Using structured text and templates to capture health status outcomes in the electronic health record.

BACKGROUND: Because of the difficulty of implementing clinical outcomes-focused quality improvement (QI) projects, most organizations' efforts and comparative quality report cards have centered on structure and process indicators or on outcomes captured in administrative data systems. Ultimately, however, health care is intended to improve health. Health status is now frequently included in the set of quality of care information requested by purchasers of health care, accrediting and governmental agencies, and consumer groups. Subsequently, users of electronic health record (EHR) systems are demanding that the EHR support the collection and comparative analysis of health status information over time and by clinical population and provider. APPROACH: As opposed to the current practice in most organizations of collecting health status data via an annual mail survey, the approach discussed in this article utilizes standardized coding and classification (SCC) systems and standardized surveys to capture health status information in the EHR during the routine course of care delivery through the use of templates built on structured text. This method is illustrated with examples from the WAVE EHR. The EHR-based structured text and template approach facilitates the incorporation of health status measurement into the documentation of the patient-provider encounter, builds on recognized SCC systems and standardized surveys, and enables information retrieval for a variety of analyses, including those focused on QI. CONCLUSIONS: Health status outcomes are an essential component of an information set focused on health care quality. To routinely capture and analyze health status variables, SCC systems and standardized health status surveys are necessary.

Forms and Records Control↗
PubMed1997

Achievement of appropriate self-care. Does care delivery system make a difference?

OBJECTIVES: The purpose of this article is to review the evidence linking variations in care delivery system with achievement of appropriate self-care. METHODS: This synthetic review of the research literature used the Outcomes Model for Health Care Research. The concept of self-care was reviewed from several theoretical perspectives, as was the quality of instruments used to measure aspects of self-care. Finally, studies examining the linkage between care delivery system and self-care were critically analyzed. RESULTS: Reliable and valid instruments exist to measure self-care agency and self-care performance, and these data elements are collected routinely in many care settings. Only a few studies, however, have examined the relation between achievement of self-care and variations in delivery systems. CONCLUSIONS: Achievement of appropriate self-care may be an outcome measure better suited to nonacute care settings or across the continuum of care. Additionally, work is needed in applying risk-adjustment strategies to the measurement of achievement of appropriate self-care.

Activities of Daily Living↗
PubMed1997

Comparison of nursing interventions classification and current procedural terminology codes for categorizing nursing activities.

PURPOSE: To compare the frequency with which nursing activity terms could be categorized using Nursing Interventions Classification (NIC) and Current Procedural Terminology (CPT) codes. DESIGN: Descriptive. The sample was 201 patients with AIDS hospitalized 1989-1992 for pneumocystis carinii pneumonia in three US medical centers. METHODS: Nursing activity terms (n = 21,366) were collected from patient interviews, nurse interviews, intershift reports, and patient records, then were categorized using NIC and CPT codes. RESULTS: Nursing activity terms were categorized into 80 NIC interventions across 22 classes and into 15 CPT codes. All terms in the data set were classifiable using the NIC system and the majority (60%) of the terms were classified into 14 NIC intervention categories; 6% of the terms were classifiable by CPT codes. The most frequently used CPT code was "pulse oximetry." Significantly (p < .0001) greater numbers of nursing activity terms could be categorized in the NIC system compared to the CPT system. CONCLUSIONS: Findings provide evidence that NIC is superior to CPT for categorizing nursing activities in this study's population. The findings support the importance of discipline-specific classifications for categorization of health care interventions. Nursing-specific intervention classification systems such as NIC, the Omaha System, and the Home Health Care Classification are essential to defining the contribution of nursing to both quality and cost outcomes.

Adult↗
PubMed1997

Evaluating standardized coding and classification systems for clinical practice: a critical review of the nursing literature in the United States.

Developers of healthcare information systems are challenged by the difficulty of meeting the simultaneous goals of 1) capturing and electronically representing the broad array of data related to healthcare with sufficient expressibility to provide adequate documentation of the patient encounter, and 2) utilizing standardized coding and classification systems to facilitate linkages among computer-based systems. The evaluation studies to date have primarily focused on matching actual clinical data with terms in the recognized classification systems. These studies have provided evidence that the classification systems are relatively domain complete for categorizing patient problems and nursing interventions. Although several of the published criteria for evaluation relate to structure, it is noteworthy that this has not yet been a major focus of study in nursing. There are several areas of critical need that must be addressed. First, additional work is needed to develop and refine a standardized set of atomic-level terms relevant to nursing, including those for assessments, problems, and activities. Second, knowledge representations must be developed to support the building of complex concepts from atomic-level data.

Classification↗
PubMed1997

An evaluation of the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting.

The purpose of this study is to evaluate the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting. The data set comprised 5,844 problem terms and 20,055 interventions terms. All terms could be categorized using the Nursing Components and Major Categories for Nursing Diagnoses and Interventions. A total of 1,767 (30.2%) patients problem terms could be placed into Major Nursing Diagnosis categories, but not subcategories even though there were subcategories related to the major category. All intervention terms whether they were classified at the Intervention Category or Subcategory could be coded according to Type of Nursing Action. These findings demonstrate that the Home Health Care Classification, at the level of Nursing Components and Major Categories, was domain complete for the data set. The fact that not all terms could be classified according to the existing subcategories suggests some areas for future development, but is also a reflection of the level of detail expressed in the data set itself. The results suggest that the Home Care Classification will be adequate and appropriate for categorizing problems and interventions across setting for the next phases of the research project.

AIDS-Related Opportunistic Infections↗
PubMed1997

Developing a generic health status measure for use in a computer-based outcomes infrastructure.

This descriptive, correlational study was designed to determine the sensitivity of a generic health status instrument to patient population and to time. The study sample included adult patients undergoing total joint replacement (TJR), adult patients in acute congestive heart failure (CHF), and pediatric patients receiving chemotherapy (PediOnc). A 2 x 3 (population x time) ANOVA for TJR and CHF demonstrated a significant main effect of time (F = 8.0, p = .0006) and a significant interaction effect between time and population (F = 14.4, p < .0001) for functional status. In the PediOnc subsample (HSOD child version), the highest scores for all HSOD factors with the exception of functional status were at Time 3. There was also a significant main effect of time on health care involvement, on the caregiver factor, and the family factor. These results support the sensitivity of the HSOD to patient population and to time.

Adult↗
PubMed1997

Health status measurement in computer-based patient record systems.

As requests for information about quality of health care have increased, purchasers of computer-based patient record (CPR) systems are demanding information regarding the manner in which these systems can assist in measuring health care quality. The type of information requested by purchasers of health care, accrediting agencies, and consumer groups is shifting toward more complex measures of health status. Both provider and patient perceptions of health status are relevant in measuring the impact of health care interventions. Standardized coding and classification systems and standardized health status measurement instruments each offer utility in capturing and representing health status in CPR systems.

Humans↗
PubMed1997

Nurses use of health status data to plan for patient care: implications for the development of a computer-based outcomes infrastructure.

The purpose of this study was to examine the relationships between the patient's health status at hospital admission and the initial care planned by the nurse. Functional status, engagement in care, and psychosocial well-being were measured by the Health Status Outcome Dimensions(HSOD) instrument. The HSOD is the foundation for developing a computer-based infrastructure for the analysis of health related outcomes. The consecutive, convenience sample of 308 subjects was drawn from five acute clinical populations: pulmonary; cerebrovascular, cardiac; gastrointestinal; and infection. Logistic and multiple regression analyses were used to test the relationships between control (patient and setting) variables, health status, and the dependent variables of type of problem identified, number of problems identified, and the time required to implement interventions ordered for the patient. In seven of ten models, control variables of facility, age, and/or severity of illness contributed to a model at p < .01. In six of ten models, at least one health status measure significantly explained variation beyond the control variables, at p < .01. Study results support using data gathered during the course of care, to evaluate the process of that care. Further work is needed to understand the effects of setting and provider variables on the use of health status data in care planning. Computer-based outcomes infrastructures are essential to support the collection and analysis of health status over time.

Aged↗
PubMed1997

Documenting 'what nurses do'--moving beyond coding and classification.

A variety of strategies for knowledge representation have been applied to the texts from a number of medical domains. Many of the techniques rely on the well-defined ways in which medical terms are used within a given domain, a phenomenon referred to as 'sublanguage.' Because much of nursing documentation involves the use of 'everyday' language, the viable application of sublanguage-based approaches to knowledge representation of nursing documentation is not a forgone conclusion. We propose an approach utilizing semantic markup of nursing notes as a strategy for determining whether the documentation of 'what nurses do' is a sublanguage Results of an initial feasibility study utilizing the approach are presented.

Abstracting and Indexing↗
PubMed1996

The role of ambulatory care information systems in supporting the provision of holistic care for persons infected with the human immunodeficiency virus.

Given an appropriate conceptual model, such as the Wilson and Cleary model for linking clinical variables with health-related quality of life, ambulatory care information systems have the potential to facilitate holistic care for persons infected with the human immunodeficiency virus. Four examples of the manner in which an ambulatory care system can support the provision of holistic care are the contextualization of care through inclusion of the patient's voice, improved coordination of care and knowledge-harvesting through systems integration, timely application of agency-specific information and domain information and knowledge to an individual patient, and blurring of the boundaries of ambulatory care.

Ambulatory Care Information Systems↗
PubMed1996

Standardized nursing classification systems: necessary, but not sufficient, for representing what nurses do.

The American Nurses Association Steering Committee on Databases to Support Nursing Practice has recognized three standardized nursing intervention classification systems. Because each of these classifications systems focuses on encoding informational abstractions of nursing actions, rather than providing a controlled vocabulary and compositional grammar from which informational concepts and abstractions can be constructed, the systems are necessary, but not sufficient, for representing what nurses do. In particular, computer based patient record systems focused on process understanding and process improvement will require atomic-level representations of nursing actions suitable for transformation into a variety of information abstractions, including, but not limited to, the abstractions contained in the three existing classification systems.

Nursing↗