Biomedical subjects

Karyn Holm

Publications and source records attributed to Karyn Holm.

11 recordsLinked to original sources

PubMed2005

Quality of life in women following coronary artery bypass graft surgery.

The purpose of this study was to determine the effect of coronary artery bypass graft (CABG) surgery on the quality of life of women. Wilson and Cleary's conceptual model of health-related quality of life, which examines five major outcomes (biological variables, symptom status, functional status, general health perceptions, perceived quality of life), was used. Participants included 61 women who provided information by self-report questionnaires before and three months after surgery. The major findings of the study are that women had significantly improved quality of life (p = .004) due to increased satisfaction with health and functioning (p < .001) at three months following CABG surgery. They experienced less angina (p < .001) and shortness of breath (p = .014), although fatigue was unrelieved for the majority of women. Psychological well being improved after surgery for most women (p < .001), with lower anxiety levels (p < .001), greater levels of well being (p = .021), feelings of health (p < .001) and vitality (p = .023). Women reported less use of emotive coping (p = .043), indicating less emotional distress. Nevertheless, 25% of the sample continued to experience severe psychological distress three months after surgery, indicating the need for continued follow-up.

Adult↗

PubMed2004

Relationship between soft tissue body composition and bone mass in perimenopausal women.

OBJECTIVES: Perimenopause, the transition into menopause, marks the beginning of accelerated bone loss, contributing to the development of osteoporosis, a major public health problem. This perimenopausal transition has also been associated with a decrease in body lean mass, an increase in fat mass, and an increase in body weight. How these changes in fat mass and lean mass may influence bone mineral density (BMD) is currently unknown. The purpose of this study is to determine the independent effect and relative contribution of lean mass and fat mass to BMD in perimenopausal women. MATERIAL AND METHODS: The sample consisted of 43 sedentary perimenopausal women (age: mean = 49.6; S.D. = 3.2) with an intact uterus and ovaries, participating in a study of exercise and perimenopausal symptoms. Total body BMD, regional BMD, and soft tissue body composition were measured by dual-energy X-ray absorptiometry. Other measures including age, height, weight, and serum FSH and E2 were also obtained. RESULTS: Findings revealed that 14% of these perimenopausal women had low bone mass (osteopenia) in the lumbar spine and/or the femoral neck. Overall body fat mass and lean mass had positive relationships with BMD of lumber spine and the femur. However, using multiple regression analyses, only lean mass and ethnicity remained significant predictors for BMD of the femoral neck (r2 = 45%) with lean mass explaining more variance than ethnicity. Lean mass was the sole predictor of total proximal femur BMD explaining 38% of the variance. Fat mass was not a significant predictor of BMD at any skeleton site. CONCLUSIONS: These findings suggest that body lean mass, not fat mass, is a significant contributor to femoral BMD in perimenopausal women.

Absorptiometry, Photon↗

PubMed2003

Physical activity alone and in combination with hormone replacement therapy on vasomotor symptoms in postmenopausal women.

The purposes of this study were (a) to examine the influence of physical activity alone, and in combination with, hormone replacement therapy (HRT) on vasomotor symptoms and (b) to identify factors that are predictive of vasomotor symptoms at menopause. A total of 239 postmenopausal women completed a modified Women's Health Assessment scale, a Usual Physical Activity questionnaire, and a Health History and Demographic questionnaire. It was found the inactive women without HRT experienced more vasomotor symptoms than women with HRT, regardless of their levels of physical activity. Physical activity, however, may be synergistic to HRT, as a trend was noted that within the same HRT-non-HRT groups, active women tended to report fewer vasomotor symptoms than inactive women, although the difference did not reach statistical significance. In addition, sociodemographic and health-related variables had limited predictive power for vasomotor symptoms.

Aged↗

PubMed2003

Clinical reasoning in experienced nurses.

As an essential component of nursing practice, clinical reasoning is used to assimilate information, analyze data, and make decisions regarding patient care. Little is known about the reasoning strategies of experienced nurses who are not yet experts. This qualitative descriptive study explored the cognitive strategies used by experienced nurses as they considered assessment findings of assigned patients. To date, few studies of nurses' clinical reasoning have been conducted in a practice setting during actual patient care. A small group research design was employed using the think-aloud (TA) method with protocol analysis. A total of 15 experienced nurses were asked to "think aloud" about patient assessment findings. Data were audiotaped, transcribed, and analyzed using the three steps of protocol analysis. The results suggest that experienced nurses used a conceptual language to reason about assessment findings and used heuristics to reason more quickly and efficiently.

Adult↗

PubMed2003

Self-management decision influences in heart failure: a preliminary investigation.

Self-management decision making places significant cognitive demands on individuals with heart failure (HF). Before theoretically valid decision supports can be developed, a better understanding of underlying decision characteristics is needed. The purpose of this preliminary study was to describe sources of self-management decision influences for individuals (N = 38) with varying levels of HF (New York Heart Association (NYHA) classifications). Therapeutic value was the most influential source of self-management decision making for these patients, followed by personal beliefs and values, information sources, symptom influence, and task difficulty across all NYHA classes. Symptom influence was least influential for persons in Class II, whereas task difficulty was least influential for those in Classes III and IV. Moderate and significant associations were noted between information sources and personal beliefs and values and between information sources and symptom influence. As the disease progressed, a trend toward fewer decision influences, especially in the task difficulty scale, was noted.

Decision Making↗

PubMed2003

Frequency and outcomes of transient myocardial ischemia in critically ill adults admitted for noncardiac conditions.

BACKGROUND: Critically ill adults admitted for noncardiac conditions are at risk for acute myocardial ischemia. OBJECTIVES: To detect myocardial ischemia and injury in patients admitted for noncardiac conditions and to examine the relationship of myocardial ischemia, injury, and acuity to cardiac events. METHODS: Transient myocardial ischemia, acuity, elevations in serum troponin I, and in-hospital cardiac events were examined in 76 consecutive patients. Transient myocardial ischemia, determined by using continuous electrocardiography, was defined as a 1-mm (0.1-mV) change in ST level from baseline to event in 1 or more leads lasting 1 or more minutes. Acuity was determined by scores on Acute Physiology and Chronic Health Evaluation II. RESULTS: A total of 37 ischemic events were detected in 8 patients (10.5%); 32 (86%) were ST-segment depressions, and 35 (96%) were silent. Twelve patients (15.8%) had elevated levels of troponin I. Transient myocardial ischemia, elevated troponin I levels, and advanced age were significant predictors of cardiac complications (R2 = 0.387, F = 15.2, P < .001). Acuity correlated only modestly with increased length of stay in the intensive care unit (r = 0.26, P = .02) and elevated troponin I levels (r = 0.25, P = .03). Patients with transient myocardial ischemia had significantly higher rates of elevations in troponin I (P < .001) and cardiac events (P < .001) than did patients without. CONCLUSIONS: Transient myocardial ischemia and advanced age are predictors of cardiac events and may indicate patients at risk for cardiac events.

APACHE↗

PubMed1984

Assessment of the pain experience in relation to selected nurse characteristics.

This study was designed to investigate the impact of select nurse characteristics (years in practice, age, relative job satisfaction, educational preparation, clinical practice area, cultural background and shift assignment) on assessments of patient pain and psychological distress. Fifty registered nurses were randomly selected from two surgical units, two medical units, and a combined intensive care unit/coronary care unit. Upon agreement to participate, an appointment was scheduled to administer the Standard Measure of Interferences of Suffering, the Job Descriptive Index, and a sociodemographic questionnaire. The results indicated that nurses inferred significantly less pain than psychological distress (t (98) = -12.68, P less than 0.01). The relationships between nurses' assessments of pain and psychological distress and years in practice, age, and relative job satisfaction were weak and non-significant. The associations between educational preparation, clinical practice area, and shift assignment were also non-significant. Further analysis of the Standard Measure of Inferences of Suffering, in regard to the patient characteristics of age, sex, and illness/injury, demonstrated that only the category of illness/injury significantly influenced nurses' inferences of suffering (F(4, 245) = 8.486, P less than 0.01). In evaluating the differences for all categories of sex, age (4-12, 30-45, and 64 years and older), and illness/injury (cardiovascular, cancer, infection, trauma, and psychiatric), the ratings for psychological distress were again significantly higher than those for pain.

Adult↗

PubMedDate not supplied

The coronary artery bypass experience: gender differences.

OBJECTIVE: The primary purpose of this study was to examine differences between women and men on physical, social and psychological domains of health quality of life before, 1 month after, and 3 months after coronary artery bypass surgery. DESIGN: A prospective, longitudinal design was used. SETTING: The study was conducted at a Midwestern, 500-bed community hospital with an ongoing cardiothoracic surgical program. PARTICIPANTS: Forty pairs of women and men matched on age within 5 years and body surface area within 0.1m 2. INSTRUMENTS: The physical, social and psychological domains of health quality of life were assessed using the following instruments: Ferrans and Powers Quality of Life Index, Specific Activity Scale, Symptom Scale, Profile of Mood States, Overall Health Rating Index, and Personal Resource Questionnaire. RESULTS: Both women and men improved on physical and psychological measures following coronary artery bypass surgery. Compared with men, women reported more shortness of breath and depression and lower ratings of activity, vigor, and overall health. Measures of social support yielded little information. CONCLUSIONS: Despite matching for age and body surface area, women did not have as favorable an outcome after surgery as men. Continued research needs to further examine the interaction of physical outcomes and depression in women after coronary artery bypass surgery.

Chi-Square Distribution↗

PubMedDate not supplied

A longitudinal study of bone density in midlife women.

A longitudinal study of 386 healthy Black and White women aged 35-60 years was conducted to determine the effects of physical activity and other related factors on lumbar bone mineral density over 24 months. Bone mineral density of the lumbar spine, L2-L4, was measured using dual energy x-ray (Hologic 1000). Physical activity levels in three dimensions (leisure, household, and occupational) from both a lifelong and current perspective were obtained by questionnaire. Body mass index was calculated from measured weight in kilograms divided by measured height in meters squared. Calcium, caffeine, and alcohol intake was estimated using a food frequency questionnaire. Age, race, and smoking were determined by self-report. Radioimmunoassays of follicle stimulating hormone (FSH) and estradiol were used to validate self-reports of menopausal status. Multiple regression analysis revealed that race, age, weight, FSH, calcium, and years of tobacco intake formed the best model at baseline (r(2) = 0.32) and at 24 months (r(2) = 0.303). Physical activity was not a significant predictor for bone mineral density at either time point. There were cross-sectional changes of bone mineral density with race, age, and menopausal status. Black women had significantly higher bone mineral density than White women. However, an age-related decline in bone mineral density was exhibited in both Black and White women. Perimenopausal women had significantly lower bone mineral density as compared with premenopausal women. Furthermore 37 (9.6%) women at baseline and 34 (11%) at 24 months were designated at risk for fracture.

Absorptiometry, Photon↗

PubMedDate not supplied

Self-rated competency and education/programming needs for Care of the Older Adult with Cardiovascular Disease: a survey of the members of the Council of Cardiovascular Nursing.

An online survey, Care of the Older Adult with Cardiovascular Disease (COA-CVD), was used to describe self-rated competency in the care of the aging adult with cardiovascular disease and subsequently determine the future education and programming needs of the Council of Cardiovascular Nursing. Respondents indicated that developing relationships, patient teaching, and assessment were areas where they felt most competent. The areas of highest priority for future programming included assessment of the older adult, diagnosis of health status, deriving a plan of care, implementing a treatment plan, patient teaching, and ensuring quality care. Most stated that content relative to the care of the older adult should be available at the annual meeting, Scientific Sessions of the American Heart Association, followed by self-study modules (65%), local and regional conferences (64%), and stand-alone national conferences (53%). The conclusions are that the Council of Cardiovascular Nursing and its membership need to address the importance of care of aging adults with cardiovascular disease and stroke in future programming. Although the Scientific Sessions of the American Heart Association is an appropriate venue, efforts can be directed toward developing self-study modules and local and regional conferences. As always, there is a need to work collaboratively with the other councils of the American Heart Association and other nursing organizations who view the care of the older adult as a high priority.

Cardiovascular Diseases↗

PubMedDate not supplied

Analysis of measures of functional and cognitive ability for aging adults with cardiac and vascular disease.

Baseline and follow-up assessments of functional and cognitive status are essential for aging patients who survive acute cardiac and vascular disease, as they are faced with new medications and implementing changes in lifestyle. Because declining functional and/or cognitive status will interfere with treatment regimens and taking prescribed medications, it is imperative that healthcare providers develop an understanding of approaches to functional and cognitive assessment that can be used with aging patients, selecting those most appropriate for the venue in which they practice and for their particular patient population.

Activities of Daily Living↗