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Biomedical subjects

Carmen J Portillo

Publications and source records attributed to Carmen J Portillo.

10 recordsLinked to original sources
PubMed2005

Utility of a standardized nursing terminology to evaluate dosage and tailoring of an HIV/AIDS adherence intervention.

PURPOSE: To illustrate the utility of a standardized nursing terminology to calculate the dosage of the Client Adherence Profiling-Intervention Tailoring (CAP-IT) and to determine the extent to which a tailored intervention was delivered to 117 persons with HIV/AIDS who participated in the experimental arm of a randomized controlled trial (RCT). METHODS: The intervention nurse assigned nursing diagnoses from the Home Health Care Classification (HHCC) based upon CAP scores. During the IT phase of CAP-IT, the nurse delivered and documented a tailored set of nursing interventions associated with the CAP and assigned nursing diagnoses. Hierarchical linear regression was used to evaluate the extent to which the number of interventions and intervention times were tailored to client needs. RESULTS: Linear regression models that included CAP scores and nursing diagnoses as predictor variables explained 53.2% of the variance in total number of interventions and 58.9% of the variance in intervention time. CONCLUSIONS: The use of the standardized nursing terminology enabled calculation of the intervention dose and documentation that a tailored intervention was delivered.

Adult↗
PubMed2004

The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes.

BACKGROUND: A primary focus of self-care interventions for chronic illness is the encouragement of an individual's behavior change necessitating knowledge sharing, education, and understanding of the condition. The use of the Internet to deliver Web-based interventions to patients is increasing rapidly. In a 7-year period (1996 to 2003), there was a 12-fold increase in MEDLINE citations for "Web-based therapies." The use and effectiveness of Web-based interventions to encourage an individual's change in behavior compared to non-Web-based interventions have not been substantially reviewed. OBJECTIVE: This meta-analysis was undertaken to provide further information on patient/client knowledge and behavioral change outcomes after Web-based interventions as compared to outcomes seen after implementation of non-Web-based interventions. METHODS: The MEDLINE, CINAHL, Cochrane Library, EMBASE, ERIC, and PSYCHInfo databases were searched for relevant citations between the years 1996 and 2003. Identified articles were retrieved, reviewed, and assessed according to established criteria for quality and inclusion/exclusion in the study. Twenty-two articles were deemed appropriate for the study and selected for analysis. Effect sizes were calculated to ascertain a standardized difference between the intervention (Web-based) and control (non-Web-based) groups by applying the appropriate meta-analytic technique. Homogeneity analysis, forest plot review, and sensitivity analyses were performed to ascertain the comparability of the studies. RESULTS: Aggregation of participant data revealed a total of 11,754 participants (5,841 women and 5,729 men). The average age of participants was 41.5 years. In those studies reporting attrition rates, the average drop out rate was 21% for both the intervention and control groups. For the five Web-based studies that reported usage statistics, time spent/session/person ranged from 4.5 to 45 minutes. Session logons/person/week ranged from 2.6 logons/person over 32 weeks to 1008 logons/person over 36 weeks. The intervention designs included one-time Web-participant health outcome studies compared to non-Web participant health outcomes, self-paced interventions, and longitudinal, repeated measure intervention studies. Longitudinal studies ranged from 3 weeks to 78 weeks in duration. The effect sizes for the studied outcomes ranged from -.01 to .75. Broad variability in the focus of the studied outcomes precluded the calculation of an overall effect size for the compared outcome variables in the Web-based compared to the non-Web-based interventions. Homogeneity statistic estimation also revealed widely differing study parameters (Q(w16) = 49.993, P < or = .001). There was no significant difference between study length and effect size. Sixteen of the 17 studied effect outcomes revealed improved knowledge and/or improved behavioral outcomes for participants using the Web-based interventions. Five studies provided group information to compare the validity of Web-based vs. non-Web-based instruments using one-time cross-sectional studies. These studies revealed effect sizes ranging from -.25 to +.29. Homogeneity statistic estimation again revealed widely differing study parameters (Q(w4) = 18.238, P < or = .001). CONCLUSIONS: The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18-month weight loss maintenance.

Adult↗
PubMed2004

Community partnerships: the cornerstone of community health research.

Community partnerships have been recognized as the cornerstone of community research. The recent Institute of Medicine report, Unequal Treatment, puts forth the idea of creating community partnerships as a strategy to address racial and ethnic disparities in health care. Community-based research is frequently reported in the literature as a study conducted in the community versus with the community. The objective of this review is to examine models of community partnerships, to consider their implications for community-based research, and to identify directions for future nursing research.

Community Health Nursing↗
PubMed2002

Randomized controlled trial of interventions to improve follow-up for latent tuberculosis infection after release from jail.

BACKGROUND: Adherence to treatment of persons with latent tuberculosis infection after release from jail has been poor. METHODS: A randomized controlled trial was conducted at the San Francisco City and County Jail, San Francisco, Calif. Subjects undergoing therapy for latent tuberculosis infection who spoke either English or Spanish were randomly allocated to receive education every 2 weeks while in jail; an incentive if they went to the San Francisco County Tuberculosis Clinic within 1 month of release; or usual care. The main outcome measures were completion of a visit to the tuberculosis clinic within 1 month of release and completion of therapy. RESULTS: Of 558 inmates enrolled, 325 were released before completion of therapy. Subjects in either intervention group were significantly more likely to complete a first visit than were control subjects (education group, 37%; incentive group, 37%; and controls, 24%) (adjusted odds ratio based on pooled results for the education and incentive groups, 1.85; 95% confidence interval, 1.04-3.28; P =.02). Those in the education group were twice as likely to complete therapy compared with controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.04-4.72; P =.04). Of those who went to the tuberculosis clinic after release, subjects in the education group were more likely to complete therapy (education group, 65% [24/37]; incentive group, 33% [14/42]; and control group, 48% [12/25]; P =.02). CONCLUSIONS: Education or the promise of an incentive improved initial follow-up. Education was superior to an incentive for the completion of therapy. Fairly modest strategies provided in jail can improve adherence. Further links between jail health services and community care should be explored.

Adult↗
PubMed2002

Self-care for fatigue in patients With HIV.

PURPOSE/OBJECTIVES: To identify when fatigue is reported as a problem by people who are HIV positive, what the perception of fatigue is, and which self-care behaviors are used and with what efficacy. DESIGN: Multisite descriptive study. SETTING: University-based AIDS clinics, community-based organizations, and homecare agencies located in cities across the United States, in Norway, and through a university Web site. SAMPLE: Convenience sample of 422 self-identified people who are HIV positive. MAIN RESEARCH VARIABLES: Symptom description, symptom relief, symptom help, and self-care strategies. FINDINGS: The sixth most reported symptom in this study, fatigue, was treated with a variety of self-designed strategies. In only three instances was consultation with a healthcare provider (i.e., physician) or an injection (medication not defined) mentioned. The most frequently used interventions were supplements, vitamins, and nutrition followed by sleep and rest; exercise; adjusting activities, approaches, and thoughts; distraction; and complementary and alternative therapies. In addition to self-designed strategies, the media and friends and family were sources of information. CONCLUSIONS: Fatigue was reported less frequently in this study than in other HIV-, AIDS-, or cancer-related studies. This may be an artifact of the study design. The use of informal networks for assistance, let alone the prevalence of unrelieved fatigue, indicates the need for more attention to this problem among people with AIDS. IMPLICATIONS FOR NURSING: Careful assessment of the pattern of fatigue and its onset, duration, intervention, and resolution is required if the varied types of fatigue are to be identified and treated successfully.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Physical and mental fullness as descriptors that influence sleep in women with HIV.

Through individual interviews, this qualitative study examined the subjective experience of sleep quality in the lives of 6 women with HIV infection. Three major themes emerged: living differently, sleep patterns, and strategies to normalize sleep. The women in this study revealed that they were living differently than before their infection and their experience of sleep had similarly changed. Four adaptive mechanisms were used to normalize sleep: automaticized behaviors, processing alternatives, yielding to a lack of control, and vigilant self-monitoring. This article includes discussion and implications for future research.

Adaptation, Psychological↗
PubMedDate not supplied

Self-care strategies and sources of information for HIV/AIDS symptom management.

BACKGROUND: Self-care is one of the challenges that people with HIV/AIDS face in the long-term symptom management of the disease. OBJECTIVE: To identify the category schemes of self-care strategies and sources of information for symptom management reported by HIV-positive individuals. METHODS: A secondary analysis was conducted in a large dataset of an HIV/AIDS symptom management study. Narrative data of symptom self-care management strategies and sources of information for symptom management were analyzed by a content analysis technique to identify category schemes. The 359 participants in the study reported 776 symptom self-care strategies and 526 sources of information for these strategies. RESULTS: The symptom self-care management strategies were summarized into eight categories: medications (23.45%), self-comforting (15.21%), complementary treatments (14.69%), daily thoughts and activities (12.89%), diet changing (10.95%), help seeking (9.28%), spiritual care (6.83%), and exercise (6.70%). There were four categories of information sources: self (34.41%), healthcare provider (27.95%), personal network (19.20%), and community (18.44%). The category schemes had moderate to high interrater reliability (Cohen's kappa:.49-1.00 for self-care strategy and .70-.87 for source of information). Most of the self-care strategies were perceived as helpful. Except for complementary treatments, self-care strategies were used differently among people with the six most frequently occurring symptoms (chi2 [5, n = 286] = 28.53-79.89). DISCUSSION: The eight categories of self-care strategies identified in this study showed that people with HIV/AIDS not only seek the help of medications, but also follow a wide array of other self-developed or self-taught nonpharmaceutical strategies to allay their symptoms.

Adolescent↗
PubMedDate not supplied

Testing a nurse-tailored HIV medication adherence intervention.

BACKGROUND: The relationship between patient adherence and treatment outcomes has been documented across chronic health conditions, but the evidence base for effective adherence interventions in human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) requires more rigorous research and reporting. OBJECTIVES: The aims of this study were to determine whether a tailored, nurse-delivered adherence intervention program--Client Adherence Profiling and Intervention Tailoring (CAP-IT)--improved adherence to HIV medications, compared with standard care, and to identify the relationship among adherence measures. METHODS: A randomized controlled trial (RCT) with repeated measures was used to test the efficacy of CAP-IT over a 6-month period. A convenience sample of 240 participants was recruited from a freestanding public HIV/AIDS clinic in Houston, TX, that provides medical, psychological, and pharmaceutical services for over 5,000 clients. Study instruments and measures included demographics; chart audit to capture CD4 count, viral load, and prescribed medications; health literacy; and five measures of adherence (AIDS Clinical Trial Group-Revised Reasons for Missing Medications, Morisky Self-Report of Medication Non-Adherence, Pill Count, Medication Event Monitoring System [MEMS] caps, and Pharmacy Refill). RESULTS: A logistic regression using generalized estimating equations method showed no significant differences over time on the five medication-adherence measures between the experimental and control groups. Little correlation was documented among the five different adherence measures, and there was minimal correlation with clinical markers. DISCUSSION: It is unclear why the tailored adherence intervention was not efficacious in improving medication adherence. The findings suggest that these measures of medication adherence did not perform as expected and that, perhaps, they are not adequate measures of adherence. Effective and efficient adherence interventions are needed to address the barriers to medication adherence in HIV/AIDS.

Adult↗
PubMedDate not supplied

Self-care management of anxiety and fear in HIV disease.

The purpose of this study is to describe the frequency and correlates of self-reported anxiety and fear and the self-care behaviors used to manage these symptoms. Data were collected in a convenience sample (N = 422) of HIV-positive subjects. Demographic and disease-related variables were compared for those who did and did not report anxiety and fear. Anxiety and fear were the most frequently reported symptoms (17.3%, n = 73). There were significant differences on gender, level of education, and the use of antiretroviral medications. Self-care behaviors (n = 212) for anxiety and fear were grouped into seven categories: using activities for distraction = 25%, talking to others = 21%, using alternative/complementary therapies = 18%, taking prescribed medications = 10%, using self-talk = 9%, using substances = 9%, and using avoidance behaviors = 7%. Anxiety and fear are commonly experienced by people with HIV/AIDS. Self-care strategies are imperative in the management of these clinical manifestations.

Adult↗