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Janet L Larson

Publications and source records attributed to Janet L Larson.

9 recordsLinked to original sources
PubMed2005

Conceptual model of health-related quality of life.

PURPOSE: To revise the Wilson and Cleary model of health-related quality of life (HRQoL), with suggestions for applying each of the components, and to facilitate the use of HRQoL in nursing and health care. ORGANIZING CONSTRUCT: HRQoL, based on relevant literature over the past 20 years. METHODS: The original model was revised in three substantive ways: (a) indicating that biological function is influenced by characteristics of both individuals and environments; (b) deleting nonmedical factors; and (c) deleting the labels on the arrows that tend to restrict characterization of the relationships. FINDINGS: Theoretical background is provided for each of the major components of the model, and examples of instruments to measure them, were added. CONCLUSIONS: In quality-of-life research, the current challenge is to devise models to clarify the elements of health-related quality of life (HRQOL) and the causal relationships among them. This revision of Wilson and Cleary's model includes a taxonomy of the variables that often have been used to measure HRQoL. This revision should be useful in research and clinical practice.

Activities of Daily Living↗
PubMed2003

Potential nosocomial exposure to Mycobacterium tuberculosis from a bronchoscope.

OBJECTIVE: To investigate a possible nosocomial outbreak of tuberculosis (TB). DESIGN: Retrospective cohort study. SETTING: Community hospital. METHODS: We reviewed medical records, hospital infection control measures, and potential locations of nosocomial exposure. We examined the results of acid-fast bacilli (AFB) smears, cultures, and drug susceptibility testing, and performed a DNA fingerprint analysis. We observed laboratory specimen processing procedures and bronchoscope disinfection procedures. We also reviewed bronchoscopy records. RESULTS: In October 2000, three patients had bronchoscopy specimen cultures that were positive for Mycobacterium tuberculosis. Of the three, only one had clinical signs and symptoms consistent with TB and positive AFB sputum smears. The other two did not have signs and symptoms consistent with TB and had no known exposure to individuals with infectious TB. The three M. tuberculosis isolates had matching DNA fingerprints. No evidence of laboratory cross-contamination was identified. The three culture-positive specimens of M. tuberculosis were collected with the same bronchoscope within 9 days. This bronchoscope was inadequately cleaned and disinfected between patients, and the automated reprocessor used was not approved for use with the hospital bronchoscope. CONCLUSIONS: One of the bronchoscopes at this hospital was contaminated with M. tuberculosis during bronchoscopy of an AFB-smear-positive patient. Subsequent specimen contamination likely occurred because the bronchoscope had been inadequately cleaned and disinfected. Patients who subsequently underwent bronchoscopy were also potentially exposed to M. tuberculosis from this bronchoscope.

Aged↗
PubMed2002

Inspiratory muscle strength in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is associated with a functional weakness of the inspiratory muscles. Multiple factors contribute to the decline in functional strength including hyperinflation of the chest, deterioration in nutritional status, and the indirect effects of an exacerbation. The decreased inspiratory muscle strength contributes to sensations of dyspnea and places individuals at risk for respiratory muscle fatigue. The worsening dyspnea causes individuals to reduce their physical activities and ultimately become physically deconditioned. Maximal inspiratory pressure is commonly used to measure functional strength of the inspiratory muscles, and interventions to minimize the extent of decline include inspiratory muscle training, aerobic exercise training, nutritional supplementation, and methods to prevent exacerbations. In the critical care unit, multiple comorbid conditions contribute to further decline in inspiratory muscle strength, making it important to assess respiratory muscle function regularly.

Breathing Exercises↗
PubMedDate not supplied

Determining severe respiratory distress in older out-of-hospital patients.

OBJECTIVES: This preliminary investigation represents the first step in developing a clinical decision rule (CDR) to assist out-of-hospital providers in caring for older patients in respiratory distress. The specific aims of the study were: 1) to identify up to ten candidate clinical indicators of severe respiratory distress in older out-of-hospital patients and 2) to determine the feasibility of obtaining data on these indicators from out-of-hospital treatment records, and of obtaining a measure of severe respiratory distress from the emergency department (ED) medical record. METHODS: This mixed-methods study included a qualitative component to list possible clinical indicators of severe respiratory distress, and a Delphi survey N = six experts) to reduce the comprehensive list that resulted (aim 1). The feasibility of gathering clinical indicators and a measure of severe distress was evaluated using a retrospective chart review (N = 640) of out-of-hospital and ED medical records (aim 2). RESULTS: Nine clinical indicators were identified: level of consciousness/mentation, inability to speak in full sentences, position of the patient on arrival, decreased oxygen saturation, accessory muscle use, dyspnea, increased respiratory effort, altered respiratory rate, and retractions. There were sufficient data available on all indicators except dyspnea and retractions; a measure of severe distress was readily obtained from the ED medical record. CONCLUSION: Medical record data were available on seven out-of-hospital clinical indicators and an ED measure of severe distress. Further work needs to be done to refine the operational definitions of the indicators and to standardize the way they are documented in the out-of-hospital medical record.

Consensus↗
PubMedDate not supplied

Subjective fatigue, influencing variables, and consequences in chronic obstructive pulmonary disease.

BACKGROUND: Fatigue is a common symptom of chronic obstructive pulmonary disease (COPD), but little is known about the specific nature of COPD-related fatigue and its impact on daily life. OBJECTIVES: To (a) describe characteristics of fatigue in people with COPD and (b) test a theoretically and empirically supported model of the relationships among subjective fatigue, dyspnea, functional performance, anxious and depressed moods, and sleep quality in people with COPD. METHODS: A cross-sectional descriptive study was conducted with 130 people with moderate to severe COPD. Measures included the following: a Numerical Rating Scale (NRS) for frequency, intensity, and distress of fatigue and dyspnea; Fatigue Assessment Instrument (FAI); Chronic Respiratory Disease Questionnaire (CRQ); Profile of Mood States (POMS); Pittsburgh Sleep Quality Index (PSQI); Functional Performance Inventory (FPI); and spirometry. Path analysis was used to examine the relationships among variables. RESULTS: Participants reported moderate amounts of fatigue, which was described as situation-specific, had considerable consequences, and was responsive to rest and sleep. Dyspnea was slightly greater than fatigue, as measured by the NRSs (p <.001), and there was a strong relationship between fatigue and dyspnea (r =.74, p < .001). Dyspnea, depressed mood, and sleep quality accounted for 42% of the variance in subjective fatigue. Fatigue, dyspnea, airflow obstruction, and anxious mood accounted for 36% of the variance in functional performance. CONCLUSIONS: Fatigue is an important problem that affects performance of daily activities in people with COPD. The relationships or interactions that exist among fatigue and other symptoms are complex.

Activities of Daily Living↗