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Biomedical subjects

K H Kjerulff

Publications and source records attributed to K H Kjerulff.

17 recordsLinked to original sources
PubMed2000

Effectiveness of hysterectomy.

OBJECTIVE: To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief. METHODS: In a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1,299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed. RESULTS: Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy. CONCLUSION: Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

Adult↗
PubMed2000

Patient satisfaction with results of hysterectomy.

OBJECTIVE: The objectives of this study were to measure patient satisfaction with the results of hysterectomy and to determine factors associated with dissatisfaction. STUDY DESIGN: A total of 1299 women who underwent hysterectomy at 28 hospitals in Maryland were interviewed before and at 3, 6, 12, 18, and 24 months after the operation. RESULTS: At 12 and 24 months after the hysterectomy 95.8% and 96.0%, respectively, reported that the hysterectomy had completely or mostly resolved the problems or symptoms they had before surgery; 93.3% and 93.7%, respectively, reported that the results were better than or about what they expected; 85.3% and 81. 6%, respectively, reported that their health was better than before the hysterectomy; and 87.9% and 93.1%, respectively, reported being totally recovered. The factor most strongly and consistently associated with patient reports of negative outcomes was readmission because of a postdischarge complication. CONCLUSION: Postdischarge complication necessitating readmission plays an important role in patient dissatisfaction with the results of hysterectomy.

Adult↗
PubMed1999

Hysterectomy and sexual functioning.

CONTEXT: Women considering hysterectomy often are concerned about its potential effects on their sexual functioning but the effects of hysterectomy on sexual functioning remain unclear. OBJECTIVE: To examine changes in sexual functioning after hysterectomy. DESIGN AND SETTING: A 2-year prospective study (Maryland Women's Health Study) of hysterectomy, which included measures of sexual functioning prior to hysterectomy and at 6, 12, 18, and 24 months after hysterectomy, performed during 1992 and 1993. PATIENTS: Of 1299 women interviewed prior to hysterectomy, 1101 (84.8%) completed the study and provided information about their sexual functioning. Most were between the ages of 35 and 49 years, white, married or living with a partner, and high school graduates. MAIN OUTCOME MEASURES: Frequency of sexual relations, dyspareunia, orgasm, vaginal dryness, and sexual desire. RESULTS: The percentage of women who engaged in sexual relations increased significantly from 70.5% before hysterectomy to 77.6% and 76.7% at 12 and 24 months after hysterectomy. The rate of frequent dyspareunia dropped significantly from 18.6% before hysterectomy to 4.3 % and 3.6% at 12 and 24 months after hysterectomy. The rates of not experiencing orgasms dropped significantly from 7.6% before hysterectomy to 5.2% and 4.9% at 12 and 24 months after hysterectomy. Low libido rates also decreased significantly from 10.4% before hysterectomy to 6.3% and 6.2% at 12 and 24 months after hysterectomy. The distribution of women not reporting vaginal dryness in the past month improved significantly from 37.3% before hysterectomy to 46.8% and 46.7% at 12 and 24 months after hysterectomy. Prehysterectomy depression was associated with experiencing dyspareunia, vaginal dryness, low libido, and not experiencing orgasms after hysterectomy. CONCLUSIONS: Sexual functioning improved overall after hysterectomy. The frequency of sexual activity increased and problems with sexual functioning decreased.

Adult↗
PubMed1997

Hormone replacement and menopausal symptoms following hysterectomy.

Hormone replacement therapy (HRT) is recommended for most women who experience surgical menopause following hysterectomy/oophorectomy for noncancerous conditions; it is also commonly prescribed for postmenopausal women. Beginning in 1992, 1,299 women undergoing hysterectomy in 28 hospitals throughout Maryland were interviewed prior to hysterectomy and were subsequently followed over a 2-year period. Interviews included questions about HRT use and symptoms associated with menopause. The majority of the women (66 percent) were white, 55 percent had a high school education or better, 49 percent were obese (body mass index > or =27.3), and 11 percent were postmenopausal. Over 40 percent of premenopausal women underwent bilateral oophorectomy. At 3 months posthysterectomy, 89 percent of these women were on HRT; this figure dropped to 85 percent at 24 months. Among postmenopausal women, 50 percent were on HRT both at 3 months and at 24 months posthysterectomy. Among premenopausal women who had unilateral oophorectomy, 21 percent were on HRT at 3 months, increasing to 35 percent at 24 months. Among premenopausal women who had no ovaries removed, 5 percent were on HRT at 3 months, increasing to 13 percent at 24 months. There were few within-group differences between HRT users and nonusers, except that among postmenopausal women, HRT users were younger and more likely to be white and had higher income and educational levels. Women who were postmenopausal or who underwent bilateral oophorectomy were less likely to have hot flashes if they were on HRT, but women with 0-1 ovary removed who were on HRT were more likely to have hot flashes than those not on HRT. Black women were significantly more likely to experience hot flashes than were white women, independent of HRT status and weight. Obese women were on HRT at approximately the same rates as nonobese women but were significantly more likely to have hot flashes, even when analyses controlled for HRT and race.

Adult↗
PubMed1996

Pathologic findings from the Maryland Women's Health Study: practice patterns in the diagnosis of adenomyosis.

Criteria for the diagnosis of adenomyosis vary widely in practice. The reported frequency of adenomyosis in hysterectomy specimens varies from 5-70% in published series. In this study, 1252 pathology reports on hysterectomy specimens from women enrolled in the Maryland Women's Health Study were reviewed. The frequency of adenomyosis was calculated based on two subgroups: 1114 reports from 15 hospitals, and 705 reports signed by 25 pathologists. The frequency of diagnosis of adenomyosis ranged from 12% to 58% among the 15 hospitals, and 10% to 88% among the 25 pathologists. This wide variation could not be explained by differences in patient age or number of pregnancies, factors known to correlate with the frequency of adenomyosis. These data suggest that adenomyosis may be overdiagnosed. Stringent and widely accepted criteria for the diagnosis of adenomyosis are needed, as epidemiologic studies of this common condition would be facilitated by the use of standard criteria in practice.

Adult↗
PubMed1996

Chronic gynecological conditions reported by US women: findings from the National Health Interview Survey, 1984 to 1992.

OBJECTIVES: This study sought to describe prevalence rates of chronic gynecological conditions and correlates of these conditions in a representative sample of US women. METHODS: National Health Interview Survey data from 1984 through 1992 for women aged 18 to 50 were used. RESULTS: The estimated annual prevalence rate for the reported presence of one or more gynecological conditions was 97.1 per 1,000 women. Menstrual disorders were most common, with an annual prevalence rate of 53.0 per 1,000 women. Adnexal conditions and fibroids were the next most common conditions, with rates per 1,000 women of 16.6 and 9.2, respectively. Prolapse, endometriosis, and fibroids were the conditions most likely to lead to hysterectomy within the year prior to the interview. More than three quarters (77.1%) of women with gynecological conditions had talked with a doctor in the previous year concerning their condition, and 28.8% reported spending 1 or more days in bed in the previous year because of their condition. CONCLUSIONS: Nearly a tenth of American women aged 18 to 50 report having one or more chronic gynecological conditions annually, the most common being disorders of menstruation.

Adolescent↗
PubMed1996

Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis.

OBJECTIVE: To investigate racial differences in the presence of leiomyomas, condition severity, associated symptoms and age at diagnosis between black and white hysterectomy patients. STUDY DESIGN: This study included 409 black women and 836 white women aged 18 or older who underwent hysterectomy for noncancerous conditions at 28 hospitals in Maryland. Patients were interviewed shortly before surgery, and hospital records were abstracted after discharge. RESULTS: Overall, 89% of the black women and 59% of the white women were found to have leiomyomas. Among those with a confirmed presurgical diagnosis of leiomyomas, the average age at diagnosis was 37.5 years for black women and 41.6 for white women, and the average age at hysterectomy was 41.7 for black women and 44.6 for white women. The average uterine weight for black women with leiomyomas was 420.8 g and for white women was 319.1 g. Black women were more likely to have seven or more leiomyomas (57%) in comparison to white women (36%). Black women with leiomyomas were more likely to be anemic (56%) than white women (38%) and more likely to report having very severe or severe pelvic pain (59%) than white women (41%). CONCLUSION: Black women having hysterectomy had larger and more numerous leiomyomas, and the leiomyomas were more symptomatic than in white women despite a younger age at diagnosis and hysterectomy.

Adult↗
PubMed1995

A comparison of alternative ways of measuring fatigue among patients having hysterectomy.

In a study of the outcomes of hysterectomy, 1,205 patients rated their fatigue levels via three single-item measures and the Profile of Mood States (POMS) Fatigue Scale. The single-item fatigue measures asked patients to indicate how often they were tired during the day, how often feeling tired had prevented them from doing what they wanted to do, and how big a problem feeling tired was for them. All four measures of fatigue were found to be correlated with pain, activity limitation, and psychological dysfunction, although the POMS Fatigue Scale was more strongly related to psychological dysfunction than the other fatigue measures. All four measures indicated substantial relief from fatigue 6 months after hysterectomy among the participants in this study. Patients who remained or became fatigued by 6 months posthysterectomy had more physician contacts than those not fatigued, and were less satisfied with the results of the surgery. Fatigue was found to be a useful outcome measure of medical treatment. Each of the fatigue measures examined provided unique and useful information, with no one fatigue measure proving to be substantially superior to the others.

Fatigue↗
PubMed1993

Hysterectomy and race.

OBJECTIVE: To investigate black-white differences in factors related to hysterectomy. METHODS: Discharge summary data were analyzed for 53,159 hysterectomies that occurred in Maryland from 1986-1991. RESULTS: The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. Logistic regression was used to measure the effect of race on complications, length of stay, and mortality after adjustment for a variety of factors including age, comorbidities, diagnosis, route (abdominal, vaginal, or subtotal), hospital characteristics, and source of payment. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care (odds ratio 1.4, 95% confidence interval [CI] 1.3-1.5), a length of stay of more than 10 days (odds ratio 2.7, 95% CI 2.5-3.1), and in-hospital mortality (odds ratio 3.1, 95% CI 2.0-4.8). CONCLUSIONS: In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate.

Adolescent↗
PubMed1992

Technology anxiety as a potential mediating factor in response to medical technology.

Technology anxiety, defined as a fear of working with medical equipment, was measured via the use of the Technology Response Questionnaire. Nurses (N = 414) working on nine types of nursing units at two hospitals participated in the study. Nurses working on psychiatric units were found to be most anxious about working with medical equipment, while nurses working on surgical and adult intensive care units were least anxious. A comparison of the nurses who were highest and lowest on technology anxiety indicated that those who were most anxious about technology were less positive toward computers, felt more stressed by their work, were lower on job satisfaction, less positive toward the physicians they worked with, lower on personality scales of autonomy and adaptability, were less likely to do care planning regularly or to use nursing diagnoses, and tended to be older than less anxious nurses.

Analysis of Variance↗
PubMed1984

Medical information system training: an analysis of the reactions of hospital employees.

Six months after the implementation of a medical information system (MIS) employees were questioned concerning their evaluation of the training they received. Wide variability is observed in the range of employee responses to questions addressing their: satisfaction with the training experience, desire for any additional training, ease of learning to use the system, and level of felt competence in currently using the system. The results of stepwise regression analyses of the response patterns indicate that personality traits, attitudes toward automation, and work history variables are key factors in explaining why employees have different reactions to training.

Computers↗
PubMed1983

Implementation of a medical information system: evaluation of adaptation.

A study was conducted to explain variability in hospital employee responses to the implementation of a medical information system. Results showed that 28 to 35 percent of the variance in adaptation was explained by the predictor variables, and that the significant variables were attitudes toward computers in general, role ambiguity, personality attributes, the person's work shift and previous history of job mobility.

Adaptation, Psychological↗
PubMedDate not supplied

The impact of computer systems in a medical environment.

The acceptance and proliferation of computer technology in health care has not been as rapid as many expected. Research in this area suggests that several factors are related to computer acceptance including social network processes, attitudes toward computers, and personality characteristics. Potential implications for the field of magnetic resonance imaging are discussed.

Attitude to Computers↗