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Biomedical subjects

W L Holzemer

Publications and source records attributed to W L Holzemer.

At least 19 recordsLinked to original sources
PubMed2002

Self-care management for neuropathy in HIV disease.

Peripheral neuropathy is the most common neurological complication in HIV and is often associated with antiretroviral therapy. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of peripheral neuropathy in HIV disease, the self-care strategies, and sources of information for self-care utilized by the sample. A convenience sample of 422 respondents was recruited from an Internet web-based site developed by the University of California, San Francisco International HIV/AIDS Research Network and from five geographic data collection sites (Boston, New York City, San Francisco and Paterson in the USA, and Oslo, Norway). Results of the study indicated that respondents with peripheral neuropathy identified 77 self-care behaviours including complementary therapies, use of medications, exercise and rest and/or elevation of extremities. Sources of information included health care providers, informal networks and media sources.

Adult↗
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↗
PubMed2000

Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS.

The purpose of this descriptive, correlational study was to examine the relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. The convenience sample of 707 non-hospitalized persons receiving health care for HIV/AIDS was recruited from seven U.S. sites. All measures were self-report. Perception of engagement with health care provider was measured by the newly developed Engagement with Health Care Provider scale. Adherence to therapeutic regimen included adherence to medications, provider advice, and appointments. Health status was measured by the Medical Outcomes Study Short Form 36 (MOS SF-36), Living with HIV scale, CD4 count, and length of time known to be HIV-positive. There were no significant relationships between engagement with health care provider and age, gender, ethnicity, and type of health care provider. Subscales of the MOS SF-36 and Living with HIV explained a significant, but modest amount of the variance in engagement. Clients who were more engaged with their health care provider reported greater adherence to medication regimen and provider advice. Clients who missed at least one appointment in the last month or who reported current or past injection drug use were significantly less engaged.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Linking nursing care interventions with client outcomes: a community-based application of an outcomes model.

This article describes a conceptual model that provides an organizing framework for assessing client outcomes in community-based settings. The "Outcomes Model for Community-Based Settings" (OMCBS) examines the relationships among structure, process, and outcomes juxtaposed to the dimensions of client, provider, and setting including sample measures for each variable. OMCBS incorporates the Omaha System including its comprehensive list of client health problems, nursing interventions, and an outcome rating scale assessing client knowledge, behavior, and health status to standardize nursing care and client outcomes. The OMCBS provides a strategy to evaluate the effectiveness of nursing interventions for clients in a variety of milieus.

Community Health Nursing↗
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

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

A comparison of three strategies for risk-adjustment of outcomes for AIDS patients hospitalized for Pneumocystis carinii pneumonia.

BACKGROUND: The need for risk-adjustment of patient outcomes has been driven by the competitive health care market and the subsequent increase in comparative outcome reporting among health care institutions, among managed care plans, and among individual providers for some procedures (e.g. coronary artery bypass graft surgery). However, if the outcomes reported do not take into account patient characteristics that can be considered dimensions of risk for poor clinical outcomes or increased utilization of services, there is the possibility that inaccurate conclusions will be drawn about the quality of care provided. OBJECTIVE: The specific purpose of this study was to examine the ability of four measures, APACHE III - acute physiology scale, Quality Audit Marker - ambulation score, Quality Audit Marker - self-care ability score, and Nursing Severity Index, to predict mortality and hospital length of stay in a convenience sample of 140 males with Pneumocystis carinii pneumonia. METHODS: The study utilized a descriptive, longitudinal design. RESULTS: APACHE III - acute physiology scale (P = 0.006, odds ratio = 1.40), and Quality Audit Marker - ambulation (P = 0.037, odds ratio = 0.50), were significant predictors of hospital mortality and the APACHE III - acute physiology scale was also a predictor of mortality within 3 (P = 0.004, odds ratio = 1.13) and 6 months (P = 0.009, odds ratio = 1.10) following hospitalization. Only Quality Audit Marker - ambulation (P = 0.0001) was a significant predictor of length of stay. CONCLUSIONS: The findings of this study confirm the findings of other investigators that measures of acute clinical stability and functional status have utility as risk-adjustment approaches for the outcomes of mortality and length of stay. Further research is needed that compares the utility of generic vs. disease-specific measures for prediction of outcomes in HIV/AIDS.

AIDS-Related Opportunistic Infections↗
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↗
PubMed1998

Pain behaviors: postsurgical responses of children and adolescents.

There is scant data identifying the range and variety of pain behaviors associated with ongoing, short-term acute pain of older children and adolescents. The purposes of this study were to identify and record pain behaviors manifested by children and adolescents during the first 3 days after surgery and examine the relationship between behaviors and self-report of pain intensity. Data were collected from 37 multi-ethnic children and adolescents using the Word Graphic Rating Scale for self-report of pain intensity and the Pediatric Pain Behavior List to record pain behaviors. The five most frequently observed behaviors were calm, maintaining one position, flexing limbs, eyes shut, and knees drawn up. All children reported pain on the first 2 days postsurgery. Many children who were lying in one position with a calm expression, at the same time, reported moderate to severe pain.

Adolescent↗
PubMed1998

Validation of the quality of life scale: living with HIV.

A grounded theory of Salvaging Quality of Life provided the conceptual framework for the development of the Living with HIV scale which was validated in this study. The HIV + convenience sample (n = 187) was 66% male, with a mean age of 40.6 years, 69% African-American, and with an average CD4 count of 229 mm3. A principal components factor analysis with varimax rotation was conducted on the final 32-item scale and nine factors with Eigenvalues > 1 explained 60% of the variance. A second order factor analysis of these nine factors resulted in a two factor solution (HIV Struggles and HIV Reverence) which explained 49.4% of the variance. Cronbach alpha reliability coefficient for the total scale was 0.84. Differences between gender, ethnicity, education and presence of an AIDS diagnosis, and quality of life, were explored. Females had higher total scores which suggested they had a more positive quality of life than males. The Living with HIV scale can be used as a method of obtaining input from patients for care planning and for evaluating the effectiveness of nursing care intervention using quality of life as an outcome of care.

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

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

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↗
PubMed1996

Physical and social correlates of perceived psychological support among hospitalized AIDS patients.

Persons living with HIV disease are faced with a broad array of physical and psychosocial problems across the trajectory of their illness. Almost all will be hospitalized for nursing care during the course of their disease. The purpose of this study was to explore the physical health and social correlates of perceived psychological support among hospitalized AIDS patients. The sample consisted of 168 AIDS patients hospitalized with Pneumocystis carinii pneumonia (PCP). Each patient rated his or her psychological support and physical condition on a scale of 1-10. Self-care ability was measured by the Quality Audit Marker. Physiological and social variables were obtained from an audit of the patient record. Stepwise regression analysis by sets indicated that only 12% of the variance was explained by the antecedent variables of physical health (self-care ability, white blood count, perception of physical condition, and first PCP admission)) and social (living alone and insurance status) correlates. Self-care ability and living alone were found to be significant predictors of self-rating of perceived psychological support in this sample. Further research is needed in the area of perceived psychological support among hospitalized AIDS patients as a basis for providing quality nursing care.

Acquired Immunodeficiency Syndrome↗