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Biomedical subjects

Kay Savik

Publications and source records attributed to Kay Savik.

At least 19 recordsLinked to original sources
PubMed2006

Community-based recruitment and enrollment for a clinical trial on the sensitive issue of fecal incontinence: the Fiber study.

The recruitment of community-living participants for clinical trials of sensitive topics, when the population is largely hidden and reluctant to self-identify, and the study protocols and procedures intensive, creates significant challenges to researchers. The Fiber Study is an ongoing randomized controlled clinical trial conducted to compare the effectiveness of three dietary fibers with different levels of fermentability for symptom management in community-living adults with fecal incontinence. The researchers developed a staged approach to recruitment using three primary recruitment methods and a three-phase approach to the enrollment process. We have been successful in reaching, recruiting, and enrolling participants in a clinical trial, as well as in effectively managing study resources and staff time.

Adult↗
PubMed2006

Correlates of neurocognitive function of patients after off-pump coronary artery bypass surgery.

BACKGROUND: Decreases in neurocognitive function have been reported in patients who have undergone off-pump coronary artery bypass surgery; however, few investigators have examined the correlates of the decreases. OBJECTIVES: To explore and determine the correlates of neurocognitive function at the time of discharge from the hospital in patients undergoing off-pump coronary artery bypass surgery. METHODS: Patients undergoing off-pump coronary artery bypass surgery at Abbott Northwestern Hospital, Minneapolis, Minn, were administered tests of neuro-cognition (cognition and motor function), anxiety, depression, and quality of life preoperatively (within 72 hours of surgery) and postoperatively (at least 72 hours after surgery but before discharge from the hospital). RESULTS: A total of 54 patients (79.6% men), mean age 64.5 years, completed tests both preoperatively and postoperatively. When baseline function was controlled for, increased age and new-onset atrial fibrillation (F(3,40)=42.97; P<.001) were associated with decreases in postoperative cognitive function; increased age and anxiety (F(3,35)=15.83; P<.001) were associated with decreases in postoperative motor function. CONCLUSION: Older patients, anxious patients, and patients with new-onset atrial fibrillation are at risk for neurocognitive changes after off-pump coronary artery bypass surgery. Further studies with larger sample sizes should be done to examine interventions to reduce preoperative anxiety in these patients. Interventions to prevent postoperative atrial fibrillation should be explored to determine whether the interventions prevent a decline in neurocognitive function.

Cognition Disorders↗
PubMed2005

Significance of benign endometrial cells in papanicolaou tests from women aged >or=40 years.

BACKGROUND: The 2001 Bethesda System recommends reporting benign endometrial cells (BECs) in women aged >or=40 years and considers these women at risk for endometrial pathology. The current study examines the relative risk of hyperplasia or malignancy conferred by the presence versus the absence of BECs in Papanicolaou (Pap) tests of women aged >or=40 years. METHODS: Women aged >or=40 years represented 29,177 (46.2%) of 63,202 Pap tests obtained over 1 year from a largely suburban screened population. Of these, 866 Pap tests (3%) showed BECs. Over the same 1 year period, 789 women aged >or=40 years had endometrial histologic evaluations between 14 days and 6 months following a Pap test. The Pap tests of 159 women had BECs, and 33 had atypical (n=32) or malignant (n=1) endometrial cells. The 597 remaining women, who had Pap tests without endometrial cells but who had endometrial sampling for other reasons, served as controls. RESULTS: There were nine endometrial hyperplasias (5.7%) and no adenocarcinomas in the BECs group, whereas 34 hyperplasias (5.7%) and 6 adenocarcinomas (1%) were diagnosed in the controls. These differences were not statistically significant, even after restricting the analysis to women aged >or=50 years or to women known to be postmenopausal. CONCLUSIONS: The current study found that women aged >or=40 years with BECs in their Pap tests did not have more endometrial hyperplasias or malignancies when compared with women who had endometrial sampling for reasons other than the presence of endometrial cells in a Pap test.

Adenocarcinoma↗
PubMed2005

c-kit expression in adenoid cystic carcinoma does not have an impact on local or distant tumor recurrence.

BACKGROUND: Adenoid cystic carcinoma (ACC) is a neoplasm with unpredictable behavior with frequent late relapses that lacks good prognostic indicators. c-kit tyrosine kinase oncogene has recently been found to be expressed in ACC. The aim of this study is to correlate the expression of c-kit in ACC with clinical follow-up. METHODS: Paraffin sections of 45 cases of ACC diagnosed during a 15-year period were immunostained for c-kit. RESULTS: Seventy-eight percent of tumors stained positive for c-kit. Mean follow-up time was 6 years. No degree/pattern of c-kit expression correlated to local or distant tumor recurrence. However, there was a significant association between surgical margin involvement by tumor and cell membrane expression of c-kit. Staining quality was not affected by storage time. CONCLUSIONS: Our results suggest that expression of c-kit may not serve as a useful marker for predicting outcome in ACC, although they need to be confirmed in a larger patient population with longer clinical follow-up.

Adult↗
PubMed2005

Proteomic identification of human neutrophil alpha-defensins in chronic lung allograft rejection.

Chronic allograft rejection remains a leading cause of morbidity and mortality in lung transplant recipients. Currently, diagnosis is based on lung biopsies or the presence of bronchiolitis obliterans syndrome (BOS). To identify a biomarker of rejection we performed a proteome survey of archived bronchoalveolar lavage fluid (BALF) acquired from lung transplant recipients between 1993 and 1996 using mass spectrometry (MS). A total of 126 BALF samples from 57 individuals were tested. Initial MS assessment revealed numerous differences in a majority of individuals who experienced BOS, but three unusually intense peaks at m/z = 3373, 3444, and 3488. These were identified as human neutrophil peptides 1-3 (HNP). Quantification by enzyme-linked immunoabsorbent assay showed an elevated HNP level (>0.3 ng/microg protein) in 89% of patients who developed BOS2-3 within 15 months, reaching as high as 6% of the total BALF protein. In control patients, 35% demonstrated a slightly elevated HNP level that declined in all who had subsequent BALF available for testing. HNP levels did not correlate with episodes of acute rejection, cytomegalovirus or fungal infection. In conclusion, elevated HNP levels are associated with the onset of BOS and can predate the clinical onset of disease up to 15 months.

Bronchiolitis Obliterans↗
PubMed2005

Preparing a large data set for analysis: using the minimum data set to study perineal dermatitis.

AIM: The aim of this paper is to present a practical example of preparing a large set of Minimum Data Set records for analysis, operationalizing Minimum Data Set items that defined risk factors for perineal dermatitis, our outcome variable. BACKGROUND: Research with nursing home elders remains a vital need as 'baby boomers' age. Conducting research in nursing homes is a daunting task. The Minimum Data Set is a standardized instrument used to assess many aspects of a nursing home resident's functional capability. United States Federal Regulations require a Minimum Data Set assessment of all nursing home residents. These large data would be a useful resource for research studies, but need to be extensively refined for use in most statistical analyses. Although fairly comprehensive, the Minimum Data Set does not provide direct measures of all clinical outcomes and variables of interest. METHOD: Perineal dermatitis is not directly measured in the Minimum Data Set. Additional information from prescribers' (physician and nurse) orders was used to identify cases of perineal dermatitis. The following steps were followed to produce Minimum Data Set records appropriate for analysis: (1) identification of a subset of Minimum Data Set records specific to the research, (2) identification of perineal dermatitis cases from the prescribers' orders, (3) merging of the perineal dermatitis cases with the Minimum Data Set data set, (4) identification of Minimum Data Set items used to operationalize the variables in our model of perineal dermatitis, (5) determination of the appropriate way to aggregate individual Minimum Data Set items into composite measures of the variables, (6) refinement of these composites using item analysis and (7) assessment of the distribution of the composite variables and need for transformations to use in statistical analysis. RESULTS: Cases of perineal dermatitis were successfully identified and composites were created that operationalized a model of perineal dermatitis. CONCLUSION: Following these steps resulted in a data set where data analysis could be pursued with confidence. Incorporating other sources of data, such as prescribers' orders, extends the usefulness of the Minimum Data Set for research use.

Aged↗
PubMed2005

Improving resident outcomes with GAPN organization level interventions.

This research tested the effectiveness of the second tier of interventions in a two-tiered nursing intervention model designed to improve quality of care for residents in long-term care facilities (LTCFs). The first tier of the model called for gerontological advanced practice nurses (GAPNs) to provide direct care and to teach staff to implement care protocols for residents with incontinence, pressure ulcers, depression, and aggression. Results of the first-tier study indicated significant improvement in resident outcomes in incontinence, pressure ulcers, and aggression. In the second tier, GAPNs added a set of organization-level (OL) interventions including membership on the LTCF quality assurance committee and collaborating with staff on problem-solving teams. Analysis following the addition of OL interventions revealed significant improvement in both depression scores and in the trajectory of depression in residents of the LTCF where OL interventions were used.

Aged↗
PubMed2005

Adolescents with type 1 diabetes: family functioning and metabolic control.

Families play central roles in the care of their adolescents with chronic illnesses. This study examined the relationship between family functioning and metabolic control in adolescents with Type 1 diabetes. The McMaster Family Assessment Device (FAD) measured family functioning; the Youth Self-Report Form (YSR) measured adolescent behavior. Older adolescents reported increased family dysfunction. Adolescents who reported family dysfunction on affective responsiveness had HbA(1c) levels greater than 9. Older adolescents, males, and adolescents who reported a greater number of behavior problems were significantly more likely to have HbA(1c) levels greater than 9. Considered together, older age and greater attention problems were most significantly associated with higher HbA(1c) levels. These findings suggest the importance of the relationship between the adolescent's perception of family functioning and metabolic control in the adolescents with Type 1 diabetes.

Adolescent↗
PubMed2005

Interobserver variability in thyroid fine-needle aspiration interpretation of lesions showing predominantly colloid and follicular groups.

We studied interobserver variability (IV) in the assessment of thyroid fine-needle aspiration (FNA). We limited our cases to those showing predominantly colloid and follicular cell groups. Twenty cases of thyroid FNA diagnosed by 1 experienced cytopathologist were reviewed by 4 other cytopathologists who made their own diagnoses while unaware of the original diagnoses. Two cytopathologists then assessed the cytologic features of the 20 cases. IV was calculated for noncollapsed and collapsed diagnoses. Diagnoses and observer agreement were compared with cytologic features. There was little correlation among observers regarding the diagnosis of follicular "lesion" vs "neoplasm." IV was somewhat poor before data were collapsed to treatment recommendations (kappa = 0.35) but was relatively good when data were collapsed (kappa = 0.65). Cellularity, cyst change, and amount of colloid correlated with treatment recommendations; no specific features correlated with poor performance. Thyroid FNA shows good interobserver agreement in the diagnoses of lesions showing predominantly colloid or follicular cells (when collapsed). We speculate that IV is poor in some cases owing to difficulty assessing thin colloid, some lack of agreement regarding criteria for adequacy, and a possible "gray zone" that might exist with lesions showing colloid and abundant follicular cells.

Biopsy, Fine-Needle↗
PubMed2005

Managing fecal incontinence: self-care practices of older adults.

Little is known about the ways in which community-dwelling elderly individuals manage fecal incontinence (FI) in their daily lives. In this study, community-dwelling elderly individuals were surveyed at clinics of a health maintenance organization (HMO) to describe the self-care practices used to manage FI and to examine factors that influenced the number of self-care practices used and the reporting of FI to a health care practitioner. Responses of 242 elderly individuals who reported that they had FI several times per year were analyzed. The self-care practices used most commonly were changing diet, wearing a sanitary pad/brief, and reducing activity or exercise. Elderly women and those with a greater severity of FI and more chronic health problems engaged in more self-care practices. Factors associated with reporting FI to a clinician were considering FI to be a problem, uncertainty about the cause of FI, and changing diet to avoid FI. There is a need to promote effective management strategies for FI to older individuals living in the community.

Activities of Daily Living↗
PubMed2005

Use of complementary and alternative therapies: a national survey of critical care nurses.

BACKGROUND: Demand for complementary and alternative therapies is increasing and is affecting all healthcare settings, including critical care. METHODS: A random sample of members of the American Association of Critical-Care Nurses was surveyed to determine the members' attitudes, knowledge, perspectives, and use of complementary and alternative therapies. RESULTS: Most of the 726 respondents were using one or more complementary and alternative therapies in practice. The most common therapies used were diet, exercise, relaxation techniques, and prayer. A majority of the nurses had some knowledge of more than half of the 28 therapies listed on the survey, and a majority desired additional training for 25 therapies. Respondents generally required more evidence judged as essential to use or recommend conventional therapy than to use or recommend complementary and alternative therapies. Nurses viewed complementary and alternative therapies positively overall, were open to use of the therapies, and perceived them as legitimate and beneficial to patients. Nurses judged the therapies helpful for treatment of a variety of symptoms. A majority of nurses desired an increase in the availability of the therapies for patients, patients' families, and nursing staff. Nurses' professional use of the therapies was related to having more knowledge of them, perceiving benefits of them, total number of therapies they recommended to patients, personal use, and affiliation with a mainstream religion. CONCLUSIONS: Educational programs that provide information about use of complementary and alternative therapies and the underlying evidence base most likely will increase the appropriate use of the therapies to achieve desired outcomes.

Adult↗
PubMed2004

Interpretive yields of screening Pap tests and diagnostic Pap tests.

Recently, our laboratory has introduced the Medicare classification "diagnostic Papanicolaou (Pap) test" (DPT) for both conventional and liquid-based Pap tests. Because little is known regarding the diagnostic yield of DPT, we review our experience with these tests in a community with a low incidence of squamous intraepithelial lesions and contrast this with our experience with screening Pap tests (SPTs). A search of our laboratory's computerized data system identified all Pap tests classified as SPT and DPT from December 3, 2002 to December 2, 2003. The interpretations were tabulated and statistical comparisons were made. Between December 3, 2002 and December 2, 2003 63,626 Pap tests were interpreted (57,922 SPTs and 5704 DPTs). DPTs were far more likely to yield abnormal results (atypical squamous cells or worse, P<0.001) and were especially more likely to yield malignant results. These differences have numerous possible implications regarding screening, rescreening, and the design of studies that investigate the screening value of the Pap test.

False Negative Reactions↗
PubMed2004

Severity of fecal incontinence in community-living elderly in a health maintenance organization.

An anonymous survey containing questions about the severity of fecal incontinence (FI)--frequency, amount, and type--and its correlates was distributed to community-living elderly at four managed-care clinics. Completed surveys were received from 1,352 respondents whose mean (+/-standard deviation) age was 75 +/- 6 years and 60% of whom were female. Approximately 19% reported having FI one or more times within the past year. Incontinence that soiled underwear or was of loose or liquid consistency was most common. More frequent FI and a greater amount of FI were significantly associated with loose or liquid stool consistency, defecation urgency, bowel surgery, and chronic health conditions. Therapies aimed at normalizing stool consistency or reducing urgency may be beneficial in lessening FI severity.

Aged↗
PubMed2004

Trauma and coping in Somali and Oromo refugee youth.

PURPOSE: To describe war-related trauma history, immigration factors, problems, and coping of Somali and Oromo refugee youth. METHODS: Analysis of a subset of participants (N = 338) aged 18-25 years from a population-based survey of Somali and Oromo refugees conducted in 2000-2002. Data included trauma history, life situation, and scales for physical (Cronbach alpha =.69), psychological (alpha =.56), and social problems (alpha =.69). Data were analyzed using Chi-square and Mann-Whitney U tests. RESULTS: Average emigration age was 14.8 years, with 4.2 years in transit and 2.0 years in the United States; 60% reported plans to return home to live. Two-thirds (66%) had less than a high school education, 49% had English language problems, 49% were employed (38% female vs. 57% male); 70% were single, with Somali females more likely than Oromo to be partnered and mothers (39% vs. 19%). There were significant ethnicity/gender differences for all problem scales. More females reported feeling alone (24% vs. 61%, p <.001). Youth with symptoms of posttraumatic stress syndrome reported more traumatic events (mean number of events: 28 vs.16). Trauma history was strongly associated with physical, psychological, and social problems. Most frequent strategies to combat sadness were praying (55.3%), sleeping (39.9%), reading (32.3%), and talking to friends (27.8%). CONCLUSIONS: Many young Somali and Oromo immigrants to the United States experience life problems associated with war trauma and torture, but many others are coping well. The findings suggest a need to develop age-appropriate strategies to promote the health of refugee youth to facilitate their successful adaptation to adult life in the United States.

Adaptation, Psychological↗
PubMed2004

Somali and Oromo refugees: correlates of torture and trauma history.

OBJECTIVES: This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS: A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS: Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS: This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Adult↗
PubMed2003

Perceived and measured hearing ability in construction laborers and farmers.

BACKGROUND: Construction and farming are characterized by small independently operated enterprises; few are included in hearing loss prevention programs. This study describes perceived and measured hearing ability among construction laborers and farmers in order to further the Healthy People 2010 goal to reduce noise-induced hearing loss (NIHL). METHODS: Construction laborers (n = 147) and farmers (n = 150) had screening audiograms at their workplace and a farm show, respectively. The relationship of the audiograms with a one-item measure of perceived hearing ability was explored using non-parametric statistics. RESULTS: At the 4,000 Hz frequency, indicative of NIHL, a high percentage of both groups exhibited hearing loss greater than 25 dB: laborers 53%, farmers 67%. Perceived hearing ability was significantly worse (P < 0.05) for workers with a measured hearing loss. The sensitivities of perceived hearing loss compared to audiometry ranged from 0.30 to 0.72 suggesting that perceived hearing loss was not a good indicator of actual hearing loss in this sample. CONCLUSIONS: The poor relationship between perceived and actual hearing loss in this study suggests that best practice requires inclusion of audiometric screening as part of a complete hearing loss prevention program. Future development of an improved instrument to measure perceived hearing ability may be useful in assessing this dimension of hearing.

Adult↗
PubMed2003

Personal use of complementary and alternative therapies by critical care nurses.

Critical care settings are stressful to nurses, and exposure over time may contribute to stress-related symptoms and illnesses. Nurses' personal use of complementary and alternative therapies (CAT) may lessen the effects of stress and contribute to their overall well-being and health maintenance. A national survey of critical care nurses who are members of the American Association of Critical-Care Nurses revealed that a majority (96.4%) of critical care nurse respondents were using one or more CAT for personal use or had consulted a provider for CAT therapy. The most common therapies used were exercise, diet, massage, and prayer (or spiritual direction). Nurses' personal use of CAT was related to having knowledge of more types of CAT, use of more CAT in practice, a perception of benefits of greater numbers of CAT, more openness to use, more types of CAT recommended to patients, and a perception of more barriers to use in their institutional setting. Data support our model that links nurses' personal use to use in practice. Educational programs to promote nurses' knowledge and personal use of CAT could lead to an increase in appropriate use of CAT in professional practice and potential benefits to critical care patients and their families.

Adult↗