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Biomedical subjects

Barbara Riegel

Publications and source records attributed to Barbara Riegel.

At least 19 recordsLinked to original sources
PubMed2005

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.

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Adult↗
PubMed2005

Predictors of cardiopulmonary resuscitation and automated external defibrillator skill retention.

BACKGROUND: Few data exist regarding the retention of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills over time in relationship to characteristics of lay volunteer responders, training, or risk of exposure to victims. The purpose of this study was to describe the characteristics associated with adequate CPR and AED skill retention. METHODS AND RESULTS: Skill retention was tested 3 to 18 months (mean 6.9 +/- 3.5 months) after initial training. Instructors judged adequacy of performance of essential CPR or AED skills and provided an overall assessment (adequate/inadequate), which was used as the outcome. Data on 7261 laypersons trained in CPR (4358 also received AED training) in 24 sites across the United States and Canada were available from the Public Access Defibrillation (PAD) Trial. Characteristics of the volunteers, classes, and facilities were evaluated as predictors of performance adequacy. Adjusting for site, intervention assignment (CPR-only or CPR + AED), and time since initial training, volunteer characteristics associated with adequate CPR performance were age (OR 0.78 per 10-year increment), male sex (OR 1.44), minority (OR 0.62), married (OR 1.35), prior emergency experience (OR 1.66), prior CPR class (OR 1.68), prior advanced training (OR 1.59), and extracurricular CPR training (OR 1.91) (all P < .05). Characteristics associated with AED performance included age (OR 0.69), college education (OR 1.34), and native language other than English (OR 0.51) (all P < .05). CONCLUSIONS: Certain subgroups of lay volunteers may need targeted outreach programs in CPR and AED use, classes with longer training time, more practice, or more intense retraining to maintain their CPR and/or AED skills.

Adult↗
PubMed2005

Testing a published model of health-related quality of life in heart failure.

BACKGROUND: Health-related quality of life (HRQOL) in patients with heart failure is compromised and associated with increased mortality and rehospitalization. Inadequate conceptualization of variables related to HRQOL has hampered clinicians' efforts to enhance HRQOL. The purpose of this study was to test the Wilson and Cleary model (WCM) of HRQOL in patients with heart failure. METHODS AND RESULTS: Data from 293 patients with heart failure were analyzed to determine the best multivariate HRQOL model given variables derived from WCM. HRQOL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Health perception, symptom status, and age predicted the total MLHFQ (P < .0001) and the emotional scale (P < .0001), and health perception, symptom status, New York Heart Association predicted the physical scale (P < .0001). Health perception was a mediator of the effect of symptom status on HRQOL. Functional status was not a mediator of the effect of symptom status on health perception. CONCLUSION: The most influential variables associated with HRQOL were the subjective variables: health perception and symptom status. Objective variables proposed by WCM to drive the model were not significant predictors. Mediator effects hypothesized in the WCM were not fully demonstrated in this sample. Thus modification of the WCM is warranted.

Activities of Daily Living↗
PubMed2005

Negotiating compliance in heart failure: remaining issues and questions.

Living with heart failure (HF) means living with a chronic illness characterized by periods of acute decompensation alternating with periods of relative stability. Improved medical care for patients with cardiovascular diseases, coupled with the aging of the populations in the developed world, has resulted in a steadily increasing prevalence of HF. Rehospitalization rates are high for this patient population. In 20-64% of the cases, poor compliance by patients with the prescribed HF treatment is a contributing factor to hospitalization. This article uses a review of the literature on HF non-compliance, including the prevalence, barriers, consequences, and the long-term outcomes of non-compliance with HF therapy, to illustrate remaining issues and questions. Original studies published in English or German between 1966 and June 2004 identified by combining patient compliance, non-compliance, adherence, self-care, rehospitalization, patient education, and management programs, with heart failure in the search strategy are included. Creative approaches to achieving a true partnership between providers and patients are needed if clinical outcomes are to improve.

Heart Failure↗
PubMed2005

Modeling instructor preferences for CPR and AED competence estimation.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills competency can be tested using a checklist of component skills, individually graded "pass" or "fail." Scores are typically calculated as the percentage of skills passed, but may differ from an instructor's overall subjective assessment of simulated CPR or AED adequacy. OBJECTIVE: To identify and evaluate composite measures (methods for scoring checklists) that reflect instructors' subjective assessments of CPR or AED skills performance best. METHODS: Associations between instructor assessment and lay-volunteer skill performance were made using 6380 CPR and 3313 AED skill retention tests collected in the Public Access Defibrillation Trial. Checklists included CPR skills (e.g., calling 911, administering compressions) and AED skills (e.g., positioning electrodes, shocking within 90 s of AED arrival). The instructor's subjective overall assessment (adequate/inadequate) of CPR performance (perfusion) or AED competence (effective shock) was compared to composite measures. We evaluated the traditional composite measure (assigning equal weights to individual skills) and several nontraditional composite measures (assigning variable weights). Skills performed out of sequence were further weighted from 0% (no credit) to 100% (full credit). RESULTS: Composite measures providing full credit for skills performed out of sequence and down-weighting process skills (e.g., calling 911, clearing oneself from the AED) had the strongest association with the instructor's subjective assessment; the traditional CPR composite measure had the weakest association. CONCLUSION: Our findings suggest that instructors in public CPR and AED classes may tend to down-weight process skills and to excuse step sequencing errors when evaluating CPR and AED skills subjectively for overall proficiency. Testing methods that relate classroom performance to actual performance in the field and to clinical outcomes require further research.

Cardiopulmonary Resuscitation↗
PubMed2004

Psychometric testing of the self-care of heart failure index.

BACKGROUND: Self-care is believed to improve outcomes in heart failure (HF) patients. However, research testing this assumption is hampered by difficulties in measuring self-care. The purpose of this study was to evaluate the psychometric properties of a revised instrument measuring self-care in persons with HF, the Self-Care of Heart Failure Index (SCHFI). The SCHFI is a self-report measure comprised of 15 items rated on a 4-point response scale and divided into 3 subscales. METHODS AND RESULTS: Psychometric testing was done using data from 760 HF patients (age 70.36 +/- 12.3 years, 51% male) from 7 sites in the United States. Reliability of the SCHFI (alpha.76) was adequate. Reliability of the Self-Care Maintenance subscale was lower than desired (alpha.56) but the reliability of the other subscales was adequate: Self-Care Management (alpha.70) and Self-Care Self-Confidence (alpha.82). Construct validity was supported with satisfactory model fit on confirmatory factor analysis (NFI=.69, CFI.73). Construct validity was supported further with significant total and subscale (all P <.05) differences between patients experienced with HF and those newly diagnosed, consistent with the underlying theory. CONCLUSION: Low reliability of the Self-Care Maintenance subscale was expected because the items reflect behaviors known to vary in individuals. The reliability and validity of the SCHFI are sufficient to support its use in clinical research.

Aged↗
PubMed2004

State of the science for care of older adults with heart disease.

This article provided an overview of the current state of knowledge related to cardiovascular disease in elders. Some depth has been provided related to CHD and HF, two common diagnoses in older persons. The most striking finding is that although trials are increasingly including older cohorts of patients, research specifically testing known therapies in older patients is essential. In particular, research testing the safety, efficacy, and acceptability of therapies in the oldest old is greatly needed.

Aged↗
PubMed2004

A five-country comparison of anxiety early after acute myocardial infarction.

BACKGROUND: Anxiety is common after acute myocardial infarction (AMI) and has the potential to negatively affect physical and psychosocial recovery. There have been no cross-cultural comparisons of anxiety among AMI patients. AIMS: To evaluate whether anxiety after AMI differs across five diverse countries and to determine whether an interaction between country, and sociodemographic and clinical variables contributes to variations in reporting anxiety. METHODS AND RESULTS: A total of 912 individuals with confirmed AMI were enrolled in this prospective, comparative, cross-cultural study. Anxiety was assessed within 72 h of hospital admission using the Brief Symptom Inventory. The mean level of anxiety in the entire sample was 0.62+/-0.76, which is 44% higher than the normal mean level. Anxiety levels were not significantly different among the countries with the exception that patients in England reported lower levels of anxiety than those in the US (P=0.03). However, this difference disappeared after controlling for sociodemographic variables on which the countries differed. CONCLUSION: Patients from each country studied experienced high anxiety after AMI. Even though various cultures were represented in this study, culture itself did not account for variations in anxiety after AMI. It appears that anxiety after AMI is a universal phenomenon.

Acute Disease↗
PubMed2004

Unrecognized chronic dehydration in older adults: examining prevalence rate and risk factors.

Dehydration has serious consequences for older adults, including increased risk of illness or death. This retrospective review of medical records describes the prevalence, assessment, and risk factors for chronic dehydration in 185 older adults who visited an emergency department in June 2000. Results showed chronic dehydration was present in 89 (48%) patients. Physicians documented assessment for signs of dehydration in 23 (26%) of the dehydrated older adults, but no independent assessments for dehydration were recorded by nurses. These findings indicate many older adults may suffer from unrecognized dehydration, and nurses should be alert to the possibility that dehydration may be present in community-dwelling older adults as well as those who live in residential facilities.

Aged↗
PubMed2003

The Public Access Defibrillation (PAD) trial: study design and rationale.

The PAD Trial is a prospective, multicenter, randomized clinical study testing whether volunteer, non-medical responders can improve survival from out-of-hospital cardiac arrest (OOH-CA) by using automated external defibrillators (AEDs). These lay volunteers, who have no traditional responsibility to respond to a medical emergency as part of their primary job description, will form part of a comprehensive, integrated community approach to the treatment of OOH-CA. The study is being conducted at 24 field centers in the United States and Canada. Approximately 1000 community units (e.g. apartment or office buildings, gated communities, sports facilities, senior centers, shopping malls, etc.) were randomized to treatment by trained laypersons who will provide either cardiopulmonary resuscitation (CPR) alone or CPR plus use of an AED, while awaiting arrival of the community's emergency medical services responders. The primary endpoint is the number of OOH-CA victims who survive to hospital discharge. Secondary endpoints include neurological status, health-related quality of life (HRQL), cost, and cost-effectiveness. Data collection will last approximately 15 months and is expected to be completed in September 2003.

Canada↗
PubMed2003

Critical care nursing practice regarding patient anxiety assessment and management.

Anxiety is common in critically ill patients and can adversely affect recovery if not properly assessed and treated. The objectives of this study were to: (1) identify the clinical indicators that critical care nurses consider to be the defining attributes of anxiety in critically ill patients; and (2) delineate the interventions that critical care nurses use to alleviate anxiety in their patients. A total of 2500 nurses who worked in adult critical care areas were randomly selected from the membership of the American Association of Critical Care Nurses. Nurses selected were mailed a survey designed to determine what they considered to be the important attributes of anxiety in their patients and what interventions they commonly used to manage anxiety. The 593 nurses (31.6% response rate) who responded identified 70 individual anxiety indicators and 61 anxiety management strategies that were categorized into four and three major categories, respectively. The four major anxiety assessment categories were: (1) physical/physiological; (2) behavioral; (3) psychological/cognitive; and (4) social. The three major anxiety management strategies were: (1) care techniques; (2) improving knowledge and communication; and (3) support. Critical care nurses reported numerous and distinctive anxiety indicators and management strategies. Further research is needed to examine exactly how appropriate and effective these assessment indicators and management strategies are.

Adult↗
PubMed2003

Changes over 6-months in health-related quality of life in a matched sample of Hispanics and non-Hispanics with heart failure.

Hispanics are a growing ethnic minority in the United States and one at significant risk for heart failure. Health-related quality of life (HRQL) is poor in individuals with heart failure, especially during and immediately following hospitalization. No prior research into the HRQL of Hispanics with heart failure was located. A sample of 80 individuals with heart failure, evenly divided by primary language and matched on functional status using the New York Heart Association classification system and age, was studied for 6 months following hospital discharge. Data on HRQL were collected using Spanish and English versions of the Minnesota Living with Heart Failure Questionnaire. Scores improved over time in both groups but significantly more so in the Hispanics when compared to the non-Hispanics. Group differences in HRQL could not be explained by demographics, clinical characteristics, treatment received, perceived support, or instrument response characteristics. Further exploration of this naturally occurring phenomenon may provide insight into how HRQL can be improved in the general heart failure population.

Activities of Daily Living↗
PubMed2003

Gender differences in quality of life are minimal in patients with heart failure.

BACKGROUND: Prior investigators have suggested that quality of life differs in men and women with heart failure, especially in the physical functioning domain. The purpose of this study was to compare quality of life in men and women with heart failure to determine if differences exist after controlling for functional status, age, and ejection fraction. METHODS: Data from a sample of 640 men and women (50% each) matched on New York Heart Association functional classification and age were used for this secondary analysis. Scores on the Minnesota Living with Heart Failure Questionnaire were compared at baseline and 3 months after enrollment using multivariate techniques with ejection fraction controlled. Treatment group (intervention versus control) was controlled statistically at 3 months because the original data were drawn from experimental and quasi-experimental studies in which an improvement in quality of life had been a goal of the intervention. The sexes differed on marital status, so this variable was controlled in analyses as well. RESULTS: In all analyses, quality of life was minimally worse in women compared with men (1-3 points at most). None of the differences reached statistical significance except for emotional quality of life at baseline (P =.03). By 3 months, both men and women reported significantly improved and comparable quality of life and there were no significant differences between them. CONCLUSION: Quality of life is similar in men and women with heart failure when functional status, age, ejection fraction, and marital status differences are controlled.

Age Factors↗
PubMed2003

Perceived effects of testosterone replacement therapy in perimenopausal and postmenopausal women: an internet pilot study.

Women experience somatic, mood, energy, and libido changes during menopause. Testosterone replacement therapy is being prescribed in conjunction with estrogen replacement therapy (ERT) for these symptoms. Little is known about women's perceptions of the benefits and risks of testosterone, so an Internet survey was conducted to elicit women's perceptions of the effects on mood, energy, sexuality, and somatic symptoms. A sample of 61 women primarily from the United States and Canada participated in the survey; one woman from Germany and one from Sweden also took part in the survey. Participants reported significantly improved sexuality and improved mood and vigor, with a decline in fatigue. Of the 7 somatic complaints assessed, improvements were noted in 5 (sleep disturbances, hot flashes, night sweats, vaginal dryness, and appetite). A prospective clinical trial is needed to confirm these results.

Adult↗
PubMed2003

Critical care nurses' beliefs about and reported management of anxiety.

BACKGROUND: Anxiety is associated with increased morbidity and mortality. Critical care nurses are uniquely positioned to reduce anxiety in their patients. Critical care nurses' beliefs about and frequency of use of strategies to reduce anxiety have not been studied. OBJECTIVES: To explore critical care nurses' beliefs about the importance of anxiety management and to describe nurses' reported use of strategies to manage anxiety in their patients. METHODS: A random sample (N = 2500) of members of the American Association of Critical-Care Nurses was asked to complete the Critical Care Nurse Anxiety Identification and Management Survey. RESULTS: Respondents (n = 783) were primarily female (92%), white (88.5%) staff nurses (74.1%) who thought that anxiety is potentially harmful (mean, 4.1; SD, 0.8; range, 1 = no harm to 5 = life-threatening harm), that anxiety management is important (mean, 4.8; SD, 0.6; range, 1 = not important to 5 = very important), and that effective anxiety management is beneficial (mean, 4.6; SD, 0.6; range, 1 = no benefit to 5 = profound benefit). A majority commonly used pharmacological management; most also used information and communication interventions. Fewer subjects used the presence of patients' family members to alleviate patients' anxiety; few reported using stress-reduction techniques. CONCLUSION: Most respondents thought that treating anxiety is important and beneficial. Commonly used strategies included pharmacological relief of anxiety and pain and information and communication interventions. Although these strategies are useful, they may not effectively reduce anxiety in all patients.

Anxiety↗
PubMed2002

Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure.

BACKGROUND: Case management is believed to promote continuity of care and decrease hospitalization rates, although few controlled trials have tested this approach. OBJECTIVE: To assess the effectiveness of a standardized telephonic case-management intervention in decreasing resource use in patients with chronic heart failure. METHODS: A randomized controlled clinical trial was used to assess the effect of telephonic case management on resource use. Patients were identified at hospitalization and assigned to receive 6 months of intervention (n = 130) or usual care (n = 228) based on the group to which their physician was randomized. Hospitalization rates, readmission rates, hospital days, days to first rehospitalization, multiple readmissions, emergency department visits, inpatient costs, outpatient resource use, and patient satisfaction were measured at 3 and 6 months. RESULTS: The heart failure hospitalization rate was 45.7% lower in the intervention group at 3 months (P =.03) and 47.8% lower at 6 months (P =.01). Heart failure hospital days (P =.03) and multiple readmissions (P =.03) were significantly lower in the intervention group at 6 months. Inpatient heart failure costs were 45.5% lower at 6 months (P =.04). A cost saving was realized even after intervention costs were deducted. There was no evidence of cost shifting to the outpatient setting. Patient satisfaction with care was higher in the intervention group. CONCLUSIONS: The reduction in hospitalizations, costs, and other resource use achieved using standardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches.

Aged↗
PubMed2002

Facilitators and barriers to heart failure self-care.

Self-care of heart failure (HF) is difficult to master, but the reasons why remain unclear. The purpose of this study was to explore how HF influences patients' lives, assess how they perform self-care, and determine how their life situation facilitates or impedes HF self-care. Qualitative data were obtained from 26 individuals with chronic HF. Data were gathered using structured interviews and analyzed using content analysis. Physical limitations, debilitating symptoms, difficulties coping with treatment, lack of knowledge, distressed emotions, multiple comorbidities, and personal struggles were common. Self-care involved the recognition of symptoms, but atypical symptoms such as faintness were rarely attributed to HF. Patients discussed their successes and failures in following dietary, exercise, and medication recommendations. Some adaptation strategies were practical and some involved internal resources. Many patients accepted support from others, but some withdrew. With the number of barriers these patients face, it is not surprising that self-care of HF is typically poor and that readmission rates continue to be high. Recommendations are provided for a stepped approach to patient education and counseling that uses these findings in practice.

Adaptation, Psychological↗