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Biomedical subjects

A Jalowiec

Publications and source records attributed to A Jalowiec.

At least 19 recordsLinked to original sources

Spouse quality of life before and 1 year after heart transplantation.

These results indicate that overall perceived quality of life in spouses of heart transplant patients did not change significantly from the pretransplant period to 1 year posttransplantation. Conversely, specific factors influencing quality of life such as health, socioeconomic satisfaction, family satisfaction, coping styles, and the impact of the transplant experience on the spouses' life did change after transplantation. One year after heart transplantation, spouses reported less satisfaction with their health and socioeconomic status but more satisfaction with their family than they experienced before the transplant. In addition, spouses used less fatalistic, emotive, optimistic, and self-reliant coping styles after transplant than before. Lastly, spouses perceived the transplant experience more positively after the transplant than they did before the transplant. An ideal analysis would encompass data collected at more frequent periods pretransplantation and posttransplantation. The significant negative change found in the spouses' perceived health 1 year after transplant when compared with the spouses' perceived health before the transplant was based on a single-item question. A more comprehensive measure is needed to assess the health changes in the spouse that take place over time. This investigation highlights the importance of studying the impact that a catastrophic illness has on family members and the patient. As health care systems cut costs and streamline production, the needs of spouses and family members are more likely to be ignored. As a result, at some point in the future they could enter the health care arena as patients themselves. Early interventions are thus necessary to support family members of patients during the illness and throughout the recovery trajectory.

Adaptation, Psychological↗

Predictors of quality of life in patients at one year after heart transplantation.

BACKGROUND: A multivariate approach to the study of relationships between quality of life and demographic, physical, and psychosocial variables after heart transplantation has not been examined in a large, multi-site sample. The purpose of this study was to describe quality of life, examine relationships between quality of life and demographic, physical, and psychosocial variables, and identify predictors of quality of life in patients who were 1 year post heart transplantation. METHODS: Data were collected from a nonrandom sample of adult patients (n = 232) who were 1 year post heart transplantation at a Midwestern or Southern medical center. Nine self-administered instruments and chart review were used to gather data from patients. All tools had adequate psychometric support. Descriptive statistics, Pearson correlations, and step-wise multiple regression were used to analyze data. Level of significance was set at 0.05. RESULTS: Patients were most satisfied with the areas of quality of life regarding social interaction and least satisfied with their psychological state. Patients experienced an average amount of stress, were coping fairly well, reported overall good quality of life, and were very satisfied with the outcome of their transplant surgery. Nine out of 16 variables were significant predictors of quality of life and explained 66% of the variance in quality of life: less stress, more helpfulness of information from health care providers, better health perception, better compliance with the transplant regimen, more effective coping, less functional disability, less symptom distress, older age, and fewer complications. CONCLUSIONS: Predictors of quality of life at 1 year after heart transplantation were primarily psychological. Additional variance in quality of life was explained by physical, somatic sensation, demographic, and health status variables. Knowledge of these factors provides (1) information to identify patients who are at risk for poor quality of life at 1 year after heart transplantation and (2) direction for the development of interventions to improve quality of life.

Adult↗

Preoperative psychosocial predictors of hospital length of stay after heart transplantation.

The effect of psychosocial factors on hospital length of stay (LOS) after heart transplantation has not been reported. This study examines relationships between preoperative psychosocial variables and LOS and identifies preoperative psychosocial predictors of LOS after transplant. A nonrandom sample of 307 patients at two medical centers completed a self-administered booklet of psychosocial measures. A chart review was also conducted. Psychosocial problems included anxiety, stress, and inadequate coping; questionable understanding of heart failure and treatment; substance abuse; and noncompliance. Self-care disability, a history of noncompliance, and more emotional disability predicted 8% of LOS. This supports the inclusion of psychosocial issues and functional disability in post-heart transplant clinical pathways.

Adult↗

Quality of life 6 months after heart transplantation compared with indicators of illness severity before transplantation.

BACKGROUND: Quality of life is an important healthcare outcome to study. Quality of life after heart transplantation has not been compared with indicators of severity of illness before heart transplantation. OBJECTIVE: To compare differences in quality of life 6 months after heart transplantation with two preoperative indicators of severity of illness: New York Heart Association classification and United Network for Organ Sharing status. METHODS: Data were collected from a nonrandom sample of 219 adult patients who had received a heart transplant 6 months earlier. Patients were divided into groups on the basis of their New York Heart Association classification and United Network for Organ Sharing status immediately before transplantation. Instruments used were the Heart Transplant Symptom Checklist, Heart Transplant Stressor Scale, Rating Question Form, Quality of Life Index, Sickness Impact Profile, and Jalowiec Coping Scale. Data were analyzed with descriptive statistics, chi-square tests, and independent t tests. RESULTS: Quality of life 6 months after receiving a heart transplant varied with severity of illness before transplantation. These differences in quality of life were in the following domains: physical and occupational function, psychological state, and social interaction. Six months after receiving a heart transplant, patients who were more severely ill before transplantation were less satisfied with their lives, perceived that they were not doing as well, experienced more family-related stress, and used more negative coping strategies than did patients who were less severely ill preoperatively. CONCLUSIONS: These findings indicate the need for further study of quality of life in the transplant recipients who are the most critically ill in intensive care settings before surgery, to develop interventions to improve recipients' quality of life, and to evaluate effectiveness of those interventions longitudinally.

Adaptation, Physiological↗

Patient compliance at one year and two years after heart transplantation.

BACKGROUND: The purpose of this report is to determine the extent of difficulty following and self-reported compliance with prescribed activities at 1 year after heart transplantation, identify postoperative predictors of compliance at 1 year after transplantation, and compare difficulty following and compliance with the therapeutic regimen at 1 year versus 2 years after transplantation. METHODS: Data were collected from a nonrandom sample of 120 adult patients 1 year after heart transplantation and 76 of 120 patients 2 years after transplantation. Patients were 83% male, mean age 54 years, 86% were married, 28% were employed, and 91% were in NYHA class I at 1 year after transplantation. Data were collected from the Assessment of Problems with the Heart Transplant Regimen, Quality of Life Index, Heart Transplant Symptom Checklist, Sickness Impact Profile, Heart Transplant Stressor Scale, Jalowiec Coping Scale, Social Support Index, Heart Transplant Intervention Scale, Rating Question Form, and chart review. Data were analyzed via frequencies, multiple regression, paired t-tests, and the Wilcoxon matched-pairs signed-ranks test. RESULTS: At both 1 year and 2 years after transplantation, patients had almost no difficulty following the heart transplantation regimen and complied almost all of the time with taking medications, attending clinic, and completing scheduled tests. Patients complied less with following a diet, exercising, and taking their vital signs. Predictors of compliance at 1 year after heart transplantation differed by prescribed activity, explaining from 13% to 52% of variance (p < or = 0.0001). CONCLUSIONS: These findings indicate the need to continue the study of heart transplant recipient compliance longitudinally for individual prescribed activities and provide evidence and direction for the development of interventions to enhance patient compliance.

Adaptation, Psychological↗

Symptom distress three months after heart transplantation.

BACKGROUND: Although symptoms of heart failure abate after heart transplantation, other symptoms caused by the surgery, immunosuppressant drugs, and complications can be new sources of symptom distress for patients after operation. METHODS: This two-site National Institutes of Health study compared symptom distress in 173 adult heart transplant recipients from before operation to 3 months after operation. The Heart Transplant Symptom Scale was used to measure 92 symptoms related to heart disease and heart failure, transplantation, medication side effects, and complications commonly found in this population. Analysis was via paired t tests with Bonferroni correction. Most patients (93%) were receiving a triple immunosuppressant regimen of cyclosporine, azathioprine, and prednisone. RESULTS: Total symptom distress decreased significantly (p = 0.013) from before operation to 3 months after heart transplantation. The 23 symptoms that decreased the most (p = 0.000) after operation accounted for a cumulative total reduction of 583% less symptom distress. These symptoms were primarily cardiopulmonary, neuromuscular, and emotional. The 10 symptoms that worsened the most (p = 0.000) after operation accounted for a cumulative total increase of 284% more symptom distress. These symptoms were primarily dermatologic, neurologic, and gastrointestinal and were all side effects of prednisone and cyclosporine. CONCLUSIONS: The net change in symptom distress resulted in 299% less symptom distress in this cohort at 3 months after heart transplantation. This significant improvement in symptom outcomes scientifically documents the effectiveness of heart transplantation in reducing symptoms of heart failure, along with accompanying emotional symptoms. These research findings therefore reinforce and support the positive symptom outcomes often reported anecdotally in clinical practice.

Adult↗

Impact of the heart transplant waiting process on spouses.

BACKGROUND: Practitioners working with candidates for heart transplants and their families know that the heart transplant waiting process is psychologically stressful and demanding. Spouses of heart transplant candidates struggle with multiple demands. Although many have studied the impact of heart transplantation on patients, only a few investigators have studied the impact of the heart transplant waiting period on spouses. METHODS: Using survey research methods, we studied the impact of the heart transplant wait on the lives of 85 spouses of heart transplant candidates from three sites using the following: Spouse Transplant Stressor Scale, Jalowiec Coping Scale, Family Inventory of Resources for Management, Quality of Life Index, a six-item rating scale, and a demographic form. RESULTS: One-third of the sample (30.6%) believed that the heart transplant waiting experience had a negative impact on their life, two-thirds (65.9%) believed it had a positive impact, and 3.5% believed that the heart transplant experience had no impact on their life. The longer the patient partner waited for a heart transplant, the more negative the impact was on the spouse's life (r = -0.23, p = 0.04). Spouses experiencing a negative impact from the heart transplant experience reported higher stressor scores (F = 3.74, p = 0.03), used more negative coping strategies (F = 3.69, p = 0.03), and had a lower quality of life (F = 3.28, p = 0.04). CONCLUSIONS: Spouses who reported a more negative impact from the heart transplant waiting experience were under more stress, used negative coping strategies, reported a lower quality of life, and had patient partners who waited longer for a heart.

Adult↗

Improvement in quality of life in patients with heart failure who undergo transplantation.

BACKGROUND: Very few studies have examined quality of life longitudinally in heart failure patients from before or after heart transplantation. The purpose of this study was to compare quality of life of patients with heart failure at the time of listing for a heart transplant with that 1 year after the operation. Major dimensions of quality of life measured in this study were health, physical and emotional functioning, and psychosocial functioning. METHODS: A convenience sample of 148 patients (80% male and mean age 52 years) was recruited from a midwestern and southern medical center. Data were collected from chart review and six patient-completed instruments: the Heart Transplant Symptom Checklist, Sickness Impact Profile, Heart Transplant Stressor Scale, Jalowiec Coping Scale, Quality of Life Index, and Rating Question Form. Informed consent was obtained, and patients who agreed to participate in the study completed the booklet of self-administered instruments. Statistical analyses included frequencies, measures of central tendency, paired t-tests, and Wilcoxon signed-ranks tests. RESULTS: Total symptom distress decreased significantly overall from before to after heart transplantation (before = 0.19 versus after = 0.15, p < 0.0001). Patients rated themselves as having significantly poorer health while listed as a heart transplant candidate than at 1 year after surgery (before = 4.5 versus after = 7.5, p < 0.0001). Although the overall level of functional disability was fairly low before and 1 year after transplantation, patients still reported significant improvement after surgery (before = 0.21 versus 1 year after = 0.13, p < 0.0001). No significant differences were found in total stress, which was low to moderate (before = .026 versus 1 year after = 0.26, p = not significant), coping use (before = 0.48 versus 1 year after = 0.48, p = not significant), or coping effectiveness (before = 0.40) versus 1 year after = 0.42, p = not significant), from before to 1 year after heart transplantation. However, changes in types of symptoms, functional disability, stressors, and coping were noted over time. Overall satisfaction with life, which was fairly high at both time periods, increased significantly from the time of listing for a transplant to 1 year after surgery (before = 0.72 versus 1 year after = 0.82, p <0.0001), and overall quality of life improved significantly from before to after heart transplantation (before = 5.5 versus after = 7.8, p < 0.0001). CONCLUSIONS: End-stage heart failure patients had improved quality of life from before to 1 year after heart transplant due to less total symptom distress, better health perception, better overall functional status, more overall satisfaction with life, and improved overall quality of life. However, post-transplant patients still experienced some symptom distress, functional disability, and stress, but were coping well.

Adult↗

Stressors in patients awaiting a heart transplant.

The authors identify 39 common preoperative stressors found in 175 heart transplant candidates from two medical centers. Relevance of the 10 worst and 10 least stressors during the preop wait is discussed. The 10 worst stressors were finding out about the need for a transplant, having end-stage heart disease, family worrying, illness symptoms, waiting for a donor, uncertainty about the future, no energy for leisure activities, constantly feeling worn out, less control over life, and dependency on others. The impact of transplant waiting time on the perceived stressfulness of illness factors is also examined. One factor was more stressful for those waiting longer than the median time of 1 month; 16 factors were more stressful for those waiting less than 1 month. The novelty or familiarity of the factor seemed to influence the stressfulness ratings of many variables during the period of waiting for the transplant.

Adaptation, Psychological↗

Coping and blood pressure.

The relationship between psychological coping strategies and BP was analysed in a group of 158 southern Italian men and women aged 20-59, randomly selected from an epidemiological study on coronary heart disease risk factors. Coping strategies were evaluated by use of a self-administered questionnaire (Jalowiec Coping Scale) listing 40 frequently used strategies. Factor analysis revealed the reported use of 5 different coping strategies. Males, on average, reported seeking less external support than females. In both sexes, increased years of education were associated with increased use of solution-oriented coping strategies and decreased use of resignation and sympathy seeking. After adjustment for age, alcohol use, body mass index, education and smoking, increased use of resignation was associated with lowered BP in both sexes. Emotional coping was inversely related to BP in males, but not in females. The search for external support was associated with a higher BP only in males. These data provide some evidence to suggest that psychological coping modalities are related to blood pressure.

Adaptation, Psychological↗

Issues in using multiple measures of quality of life.

Assessment of quality of life requires a multifaceted approach in order to evaluate the impact of an illness, treatment, or intervention on quality of life. The use of several measures offers notable advantages over unidimensional and global assessment techniques. Disadvantages of multiple measures also exist, but these problems can be circumvented with adequate knowledge and careful planning.

Humans↗

Nurse practitioner and physician care compared for nonurgent emergency room patients.

This experimental field study compared knowledge, satisfaction and compliance in 62 nonurgent emergency room (ER) patients based on whether they were cared for by a nurse practitioner (experimental group) or a physician (control). Data were collected via structured interviews in the ER, two weeks later by phone and three months later by phone, mail and chart review. No significant differences were found between groups in overall short- and long-term compliance scores, appointment-keeping scores for the three-month study period, number of health recommendations recalled, resolution of health problem or satisfaction ratings of ER care. It was also found that: referrals were the recommendation least complied with; 60 percent of appointments were kept; frequent reasons for noncompliance were inconvenience and lack of perceived need; experimental subjects showed greater comprehension of diagnostic recommendations and therapeutic applications, while controls had better knowledge of medications; 77 percent of experimentals were completely satisfied with NP care, as compared to only 48 percent of the controls with MD care; and reasons for satisfaction centered on the quality of care, while reasons for dissatisfaction focused on unresolved problems and slow care.

Consumer Behavior↗

Predictors of compliance with diet 6 months after heart transplantation.

OBJECTIVE: To examine and predict patient compliance with diet 6 months after heart transplantation. DESIGN: Prospective, correlational design, with nonrandom sample. SETTING: Midwestern and southern medical centers. PATIENTS: Ninety-four adult patients who had undergone heart transplantation 6 months previously (mean age 55 years; primarily married men). VARIABLES: Sixteen independent variables measured by nine instruments (with acceptable preliminary reliability and validity data) and chart review were used to predict compliance with diet 6 months after heart transplantation. STATISTICS: Descriptive statistics, correlations, and multiple regression were used to analyze the data. RESULTS: More than 85% of patients were compliant with their diet most or all of the time, and more than 70% of patients experienced little or no difficulty complying with their diet. Difficulty with dietary compliance, gastrointestinal symptoms, and health perception predicted dietary compliance (accounting for 38% of variance). CONCLUSIONS: This study will contribute to enhanced patient care and may decrease morbidity and deaths after transplantation.

Adult↗

Spouse stressors while awaiting heart transplantation.

OBJECTIVES: The objectives of this study were to identify common stressors experienced by spouses of heart transplantation (HT) candidates; to identify differences in stressors among spouses of HT candidates based on selected demographic variables; and to report preliminary psychometric data on the newly developed Spouse Transplant Stressor Scale. DESIGN: Comparative, cross-sectional survey. SAMPLE: Spouses of 85 HT candidates awaiting HT at midwestern and southeastern medical centers and a midwestern Department of Veterans Affairs hospital. MEASURES: Spouse Transplant Stressor Scale (Collins), an investigator-developed rating form and demographic data sheet. RESULTS: Spouses of HT candidates reported high levels of stress during the wait for a donor heart. Factors related directly to the transplantation experience were rated as the most stressful. Fear that the patient (partner) would die before a heart became available was the worst stressor for the spouses. Working spouses perceived more stressors related to responsibility, socioeconomics, and self. Stressors associated with the transplantation process itself were equally stressful for spouses who work and spouses who do not work.

Adult↗

Stress and coping in hypertensive and emergency room patients.

Stressful life events (SLEs) and coping behavior were compared in 25 emergency room patients with nonserious acute illness and 25 newly diagnosed hypertensive patients. Stress was evaluated with a modified Rahe's SLE questionnaire and coping with a rate scale developed by the primary investigator. Results showed that: ER patients reported significantly more (p < .05) SLEs for one year preceding illness onset, although more hypertensives subjectively rated their stress level as high; ER patients experienced significantly more SLEs in personal and social, home and family, and financial categories; hypertensives experienced significantly more health-related SLEs; age was seen as influencing SLEs; hypertensive patients used significantly more problem-oriented coping methods than did ER patients; hypertensives relied more on religion and physical activity in coping than did the ER group; ER patients more often day-dreamed or used their past experience as a guide for coping with stress; each group rated use of drugs as least important in coping; and educational level proved to be a salient variable affecting coping.

Acute Disease↗

Symptom distress in cardiac transplant candidates.

OBJECTIVE: To examine symptom frequency and distress in heart transplant candidates. DESIGN: Prospective, two-site study with a correlational design. SETTING: Large Midwestern and large Southern medical center. SAMPLE: Convenience sample of 175 adult patients (mean age 52 years, 85% men) awaiting heart transplantation. Fifty percent of the patients had ischemic cardiomyopathy and 47% had dilated cardiomyopathy. INSTRUMENTS: The Heart Transplant Symptom Checklist (Grady, Jalowiec, & Grusk, 1988), a 92-item self-administered instrument that measures how much patients are bothered by symptoms on a four-point rating scale, was developed by the research team for the study. Cronbach alpha reliability for the total scale was 0.95. RESULTS: The most frequent and distressing symptoms for patients awaiting heart transplantation were tiredness, difficulty breathing when walking or doing something, difficulty sleeping, and weakness in the whole body. Patients who had more symptom distress were unable to work. Higher symptom distress correlated significantly with higher stress, less life satisfaction, lower quality of life, and more functional disability. SUMMARY: Heart transplant candidates experience symptoms that may affect their ability to work and are associated with more functional disability and lower quality of life. IMPLICATIONS: Identification of the most frequent and distressing symptoms helps nurses and other health care providers to better assess and intervene with patients who are heart transplant candidates.

Activities of Daily Living↗

Multidimensional assessment of quality of life in clinical studies.

Four types of issues in conducting a multidimensional assessment of quality of life in clinical studies are presented: practical issues, measurement issues, data quality issues, and data analysis issues. The various issues are described, and ways of dealing with the issues are discussed. Examples are used from the literature and also from the author's multivariate, longitudinal study on quality of life in cardiac transplant patients. Consideration of these issues and knowing options for dealing with them before the study is conducted is imperative. With a carefully thought out approach to better planning of the study, the clinician/investigator can conduct a scientifically sound study with credible results that will provide meaningful direction for improving the quality of life of clinical populations in the future.

Clinical Trials as Topic↗

Profile of the well-controlled, well-adjusted hypertensive patient.

The study purpose was to identify discriminant predictors of blood pressure control and adjustment to chronic illness in 450 hypertensive patients. Hypertension control was determined by physician judgment, and adjustment was assessed by Derogatis' (1977) Psychosocial Adjustment to Illness Scale. Potential predictors of the outcome variables were measured by structured interview, formal instruments, and chart review. Well-controlled hypertensive patients had better health adjustment scores, reported more illness-related job problems and less illness-related sexual problems, were more satisfied with health care, knew what to do about medication side effects, were on medications longer, and had lower blood pressure readings on chart review. Well-adjusted hypertensive patients had fewer hypertension-related problems; had their blood pressure under control; were less likely to eat, smoke, or use drugs to handle tension; had no recent weight gain; knew what to do about medication side effects and that there is no cure for hypertension; were less pessimistic and less likely to worry; rated their stress level lower and their quality of life higher; felt that their health was under their own control; tried to problem solve when coping with stress; were on hypertensive medications a shorter time and on fewer medications overall; did not like to be alone when feeling stressed; and ate fewer high sodium foods.

Adaptation, Psychological↗