摘要:

BackgroundAlthough numerous health-related quality-of-life instruments are available to measure patients’ quality of life, few studies have compared these measures directly to determine how they function in the same group of patients.ObjectiveThe purpose of this study was to empirically compare psychometric properties of the Chronic Heart Failure Questionnaire (CHQ), the Minnesota Living with Heart Failure Questionnaire (LHFQ), and the General Health Survey Short-form-12 (SF-12).SampleA convenience sample of 211 patients with heart failure completed baseline questionnaires; 165 patients completed the entire 26-week study.MethodsPatients completed telephone interviews at baseline and at 4, 8, and 26 weeks after baseline. To compare mode of administration, a subset of patients (n= 173) completed face-to-face and telephone interviews.ResultsPatients reported low-to-moderate health-related quality-of-life overall. Reliability of the three instruments was satisfactory. Responsiveness to changing condition, as evaluated by analysis of variance, receiver operating curve characteristics, and the minimal clinically important difference method, indicated that the CHQ and LHFQ were more responsive to changing conditions than the SF-12. No major differences were noted between the scores of the face-to-face interviews and the baseline telephone interviews. The LHFQ and SF-12 were easier and took less time to administer than the CHQ.ConclusionsWhile all three instruments were reliable and valid, the CHQ and LHFQ were more sensitive than the SF-12 in detecting clinically important changes over time.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundDespite the widespread availability of hospice services for more than two decades in the United States, currently many terminally ill cancer patients who may benefit from hospice care do not receive it.PurposeTo identify determinants of the use of hospice home care services for terminally ill cancer patients during their final days of life.MethodsSecondary analysis of data from 127 terminally ill cancer patients who participated in a prospective and exploratory study aimed at identifying determinants of congruence between the preferred and actual place of death. Multivariate logistic regression analysis was conducted to identify determinants of hospice home care use.ResultsSixty-four (50.4%) out of the 127 participants had used hospice home care services before death. Important determinants of hospice home care use included: (a) longer length of survival (odds ratio [OR] 1.02; 95% confidence interval [CI]: 1.01–1.03); (b) perceived greater family ability to achieve preferred place of death (OR: 1.85; 95% CI: 1.30–2.62); (c) home as the realistic preferred place of death (OR: 5.58; 95% CI: 1.95–16.03); (d) being female (OR: 5.37; 95% CI: 1.81–15.95); (e) lower levels of functional dependency (OR: 0.94; 95% CI: 0.89–0.99); and (f) use of emergency care during the final days of life (OR: 4.03; 95% CI: 1.26–12.94).ConclusionsThe results of this study identified several groups of terminally ill cancer patients who were at a disadvantage to use hospice home care, including those without sufficient family resources but who required intensive nursing care. Providing nursing care that enables family care-taking at home may facilitate hospice home care use for patients.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe translation and grounded theory techniques typically cited as the method for producing qualitative metasyntheses do not lend themselves well to qualitative survey findings as they do not contain the integrating concepts or controlling metaphors upon which these techniques depend.ObjectivesThe purpose of this article is to describe a process for creating metasummaries of qualitative survey findings.MethodsThis article is based on completed work in an ongoing methodological study aimed at developing a usable and transparent protocol for combining the findings in reports of health-related qualitative studies. The sample for this work included 45 published and unpublished reports of qualitative studies of HIV-positive women with findings on motherhood, 39 of which contained findings in the form of surveys of data. Almost 800 findings were extracted. These extracted findings were reduced to 93 abstracted findings, and manifest frequency and intensity effect sizes were calculated.ResultsFive findings had effect sizes ranging from 25–60%, with both published and unpublished reports contributing about equally to the strength of these findings. Seventy-three findings had effect sizes of <9%, 47 of them with effect sizes of only 2%. In most of these cases, only one work contained the finding and these works had generally fewer space restrictions. Four reports with few space restrictions contained 63% of the findings across all 45 reports.ConclusionsQualitative metasummaries are useful end products of research integration studies involving reports of findings in the form of qualitative surveys, and may serve as a foundation for qualitative metasyntheses.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundHomeless adolescents are vulnerable to poor health outcomes owing to the dangerous and stressful environments in which they live. Despite their vulnerability, many of them are motivated to engage in self-care behaviors.ObjectiveThe specific aim of this study was to explore self-care attitudes and behaviors of homeless adolescents.MethodIndividual interviews were conducted with 15 homeless adolescents. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of grounded theory.ResultsFindings revealed a basic social process of taking care of oneself in a high-risk environment. This basic social process was supported by three categories: Becoming Aware of Oneself, Staying Alive With Limited Resources, and Handling One’s Own Health, each including two processes.DiscussionFindings support Orem’s conceptualizations of self-care and self-care agency and suggest the need for programs to support further healthy growth and development among homeless adolescents.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundCardiac output is an extremely important measurement in the care of critically ill patients, but the accuracy of measurement is unknown when patients are in positions other than flat and supine.ObjectiveThe purpose of this study was to compare the effects of varying degrees of backrest elevation on continuous cardiac output measurements in critically ill patients at head-of-bed angle of 0°, 30°, and 45°, and at time points of 0 minutes, 5 minutes, and 10 minutes after each position change.MethodA within participants design using a convenience sample (N= 26). Data were collected in a 24-bed adult Medical/Surgical/Trauma Intensive Care Unit. A continuous cardiac output catheter was used for all continuous cardiac measurements and continuous cardiac output values were indexed to continuous cardiac index values.ResultsFour repeated measures analyses of variance (ANOVA) were run, one for each dependent variable (continuous cardiac index, stroke volume, heart rate, and mean arterial pressure). There were two within participant factors with three levels each (time and head-of-bed angle). The results indicated no overall significant differences in continuous cardiac index values at the various head-of-bed angle and time points (p= .715). In addition, no significant differences were found for stroke volume (p= .614), heart rate (p= .289) or mean arterial pressure (p= .246).ConclusionNo differences in the continuous cardiac index values across the nine different measurement conditions were found. An examination of the determinants of cardiac output (stroke volume and heart rate) indicated that the lack of change in continuous cardiac index was not a result of a compensatory change in either stroke volume or heart rate. These data indicate that in daily clinical practice with critical medical surgical patients it may be unnecessary to reposition patients solely for the purpose of obtaining continuous cardiac index measurements. The measurements appear to be reproducible at head-of-bed angle up to 45°.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIt is important to determine the factors that predict whether nurses accept and use a new intravenous (IV) safety device because there are approximately 800,000 needlesticks per year with the risk of contracting a life-threatening bloodborne disease such as HIV or hepatitis C.ObjectivesTo determine the predictors of nurses’ acceptance of the Protectiv®Plus IV (Trademark JJM) catheter safety needle device at a teaching hospital in Texas.MethodA one-time cross-sectional survey of nurses (N= 742) was conducted using a 34-item questionnaire. A framework was developed identifying organizational and individual predictors of acceptance. The three principal dimensions of acceptance were (a) satisfaction with the device, (b) extent to which the device is always used, and (c) nurse recommendations over other safety devices. Measurements included developing summary subscales for the variables of safety climate and acceptance. Descriptive statistics and multiple linear and logistic regression models were computed.ResultsThe findings showed widespread acceptance of the device. Nurses who had adequate training and a positive institutional safety climate were more accepting (p≤.001). Also, nurses who worked at the hospital a shorter period were more likely to be accepting of the device (p≤ .001). Nurses who felt that the safety climate was positive and who had used the device for at least 6 months were more likely to use the device (p≤ .001).DiscussionTo achieve maximum success in implementing IV safety programs, high quality training and an atmosphere of caring about nurse safety are required.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include “grey literature” in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it.ObjectiveTo examine evidence regarding whether grey literature should be included in meta-analyses and strategies to manage grey literature in quantitative synthesis.MethodsThis article reviews evidence on whether the results of studies published in peer-reviewed journals are representative of results from broader samplings of research on a topic as a rationale for inclusion of grey literature. Strategies to enhance access to grey literature are addressed.ResultsThe most consistent and robust difference between published and grey literature is that published research is more likely to contain results that are statistically significant. Effect size estimates of published research are about one-third larger than those of unpublished studies. Unfunded and small sample studies are less likely to be published. Yet, importantly, methodological rigor does not differ between published and grey literature.ConclusionsMeta-analyses that exclude grey literature likely (a) over-represent studies with statistically significant findings, (b) inflate effect size estimates, and (c) provide less precise effect size estimates than meta-analyses including grey literature. Meta-analyses should include grey literature to fully reflect the existing evidential base and should assess the impact of methodological variations through moderator analysis.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundMeasuring health status is challenging in Mexican Americans and other diverse groups, because most health measurement instruments were developed and tested in English. Thus, it is difficult to determine whether measured health disparities are the result of actual differences or due to measurement error resulting from translation or conceptual differences.ObjectivesThe purpose of this study was to test the metric equivalence of the United States (US) Spanish Short-Form-36 Health Survey (SF-36) in a group of elderly Mexican Americans. In addition, the SF-36 scores of elderly Mexican American women in our sample were compared with normed scores for the SF-36 scales in the general population of elderly US women.MethodHealth status was measured by the US Spanish SF-36 in telephone surveys conducted entirely in Spanish. The sample (N= 65) was elderly (mean age 75.3) and primarily female (78%). Most had less than 7 years of education and an annual income below $10,000.ResultsMissing data were negligible, and did not indicate difficulty with particular items. The item response values were well distributed and item response means were generally similar within a scale. Most item correlations were higher with the item’s hypothesized scale than with other scales, though some items in the Mental Health, Vitality, and Social Functioning scales were highly correlated with other scales. Internal consistency reliability (Cronbach alpha) was .80 or above on all scales except Social Functioning (.69). SF-36 scale scores were lower in elderly Mexican American women than in elderly women in the general US population.DiscussionThe US Spanish SF-36 was a generally satisfactory measure of health status in a sample of elderly Mexican Americans with little formal education. The performance of some items in the Mental Health, Vitality, and Social Functioning scales warrants further research.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThis study used a qualitative approach in which participants were asked to write about their experiences in recruiting older women into either one of two exercise intervention studies that are part of the Baltimore Hip Studies. The sample included 8 researcher nurses all women, White, and 42–53 years of age.BackgroundOlder adults, particularly older women, are less likely to participate in research studies when compared to their younger counterparts. The purpose of this study was to explore the techniques successfully used by research nurses in the Baltimore Hip Studies to recruit older women after hip fracture into exercise intervention studies.MethodData analysis was performed using basic content analysis (Crabtree & Miller, 1992; Miles & Huberman, 1984) “in vivo” coding (Dowd, 1991), or “grounded” coding (Glaser & Strauss, 1967), which involves using the informants’ own words to capture a particular idea.ResultsA total of 16 codes were identified and reduced to nine themes. Seven themes focused on techniques that facilitated recruitment: (a) caring for individuals; (b) emphasizing benefits; (c) eliciting support from others; (d) being an expert; (e) using role models; (f) using good timing; and (g) giving good first impressions. The remaining two themes identified barriers to recruitment: (a) time commitment and (b) lack of support.DiscussionBased on these themes, specific recruitment techniques are recommended. Ongoing research, however, is needed to establish the most effective recruitment procedures with older women.

ISSN:0029-6562    

出版商:OVID    

年代:2003

数据来源: OVID