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Biomedical subjects

Sally H Rankin

Publications and source records attributed to Sally H Rankin.

18 recordsLinked to original sources
PubMed2006

Trajectory of prehospital delay in patients with acute myocardial infarction in the Japanese health care system.

OBJECTIVE: The purpose of this study was to understand the trajectory of prehospital delay in patients with acute myocardial infarction (AMI) in the Japanese health care system, which offers patients a choice between seeking treatment in a neighborhood clinic/small hospital (clinic group) or a large hospital with comprehensive cardiac services, including a cardiac catheterization laboratory (hospital group). METHODS: In this cross sectional study, 155 consecutive patients admitted with AMI to one of 5 urban hospitals in Japan were interviewed within 7 days after admission. RESULTS: The median total prehospital delay time in the clinic group (n=84) was significantly longer than the hospital group (n=71) (6 h and 48 min vs 2 h and 9 min, p<.001). Patients with severe chest pain were significantly less likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients with mild or moderate symptoms (OR 0.85, 95% CI: 0.75, 0.97). Patients who did not interpret their symptoms as cardiac in origin were significantly more likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients who interpreted their symptoms as cardiac in origin (OR 3.32, 95% CI: 1.56, 7.10). After controlling for demographic and medical history, patients in the clinic group were 3.69 times (95% CI: 1.28, 10.66) less likely to receive any reperfusion therapy compared to patients in the hospital group. CONCLUSIONS: Findings support the need for public education in Japan that focuses on the appropriate response to AMI symptoms. Moreover, regional AMI networks need to be instituted to provide for early transfer for PCI from clinic/small hospitals to tertiary centers.

Aged↗
PubMed2005

Comparing interventions in older unpartnered adults after myocardial infarction.

BACKGROUND: Older adults after myocardial infarction (MI) are a vulnerable group who may benefit from interventions to improve health outcomes. The use of a peer advisor or an advanced practice nurse (APN) to provide a self-efficacy intervention is a promising method of improving health outcomes after MI. AIMS: The purpose of this paper was to compare the effect of two self-efficacy interventions, a peer advisor and an APN, to a group who received standard care after MI. METHODS: The study was a three-group randomized clinical trial with a peer advisor intervention group, an APN intervention group, and a standard care group. Outcome data were collected in the hospital after MI and by telephone at 12 weeks after hospital discharge, after the interventions were completed. RESULTS: At 12 weeks after MI, there were no significant differences between the 3 groups in health outcomes. There were similar changes in self-efficacy for performing recovery behaviors, the actual performance of recovery behavior, physical and mental health across both intervention groups and the standard care group. CONCLUSIONS: Although the data did not validate the benefits of these self-efficacy interventions, future efforts at identifying changes in health outcomes may need to use more discrete measurements that are more sensitive to changes in the older unpartnered adult after an MI.

Activities of Daily Living↗
PubMed2005

Acculturation and stress in Chinese-American parents of infants cared for in the intensive care unit.

PURPOSE: To describe the stressful experiences of Chinese-American parents who have an infant in the intensive care unit (ICU), and to assess the influence of acculturation, parents' characteristics, and social supports on parental stress. DESIGN: A cross-sectional, descriptive, correlational study. SAMPLE/SETTING: A convenience sample of 30 Chinese-American families (30 mothers, 25 fathers) who had an infant hospitalized in 3 ICU sites in the San Francisco area. METHODOLOGY: Measures included: (1) Infant's health data from the medical records and parents' demographic data, and (2) Parental Stressor Scale: Infant Hospitalization, Suinn-Lew Asian Self-Identity Acculturation Scale, and Family Support Scale. MAIN OUTCOME MEASURE: The dependent variable was mothers' and fathers' stress levels. Independent variables included personal/family characteristics, acculturation, uncertainty regarding infants' illness, and social supports. PRINCIPAL RESULTS: The ICU stressors were ranked by both mothers and fathers in the following order: infant's appearance, parental role alteration, staff communication and behaviors, and ICU environment. The combined effects of uncertainty about their infant's illness and its future impact, a strong belief in Asian family values, and lack of support from healthcare providers accounted for 26% and 55% of the variance in parental stress for mothers and fathers, respectively. CONCLUSIONS: Findings from this study suggest implications for the education of both families and the ICU staffs.

Acculturation↗
PubMed2005

Donkey work: women, religion, and HIV/AIDS in Malawi.

Addressed in this article are the familial, cultural and religious influences on Malawi women that contribute to HIV/AIDS. Thirty-nine adult Malawi women representing voluntary assistance groups, religious groups, and university women participated in 3 focus groups in Malawi. Interview data were taped, transcribed, and analyzed using qualitative descriptive analysis. Findings revealed that multiple burdens in the lives of Malawi women resulting from poverty and responsibility for family members are made more onerous by religious institutions, sexual practices, and cultural beliefs. In conclusion, women's "donkey work" may result in at-risk sexual behavior as a means of survival, thus increasing the incidence of HIV/AIDS. Alleviating the burdens involves efforts from religious groups and restructuring of belief systems.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Malawi women and HIV: socio-cultural factors and barriers to prevention.

Heterosexually transmitted HIV/AIDS continues to devastate the health and economy of sub-Saharan African countries. In Malawi, 15.4% of 15-49 year olds are infected with HIV and 18-26% of pregnant women are living with HIV. Research has shown that sociocultural factors, especially gender roles and relationships, play a significant role in the transmission of HIV in Africa but little is known about Malawi women's perspective on HIV/AIDS. What do Malawi women say about the impact of HIV/AIDS on their lives, their role in prevention, and the barriers they face in trying to stem the spread of the disease? To answer these questions, three focus groups with Malawi women were conducted and analyzed for themes. The purpose of this paper is to describe one emergent theme captured in the statement, "We are just vessels for our husbands." This theme is explicated through discussions of women's and men's images, women's roles, gender/power relationships, disempowerment, role models and empowerment. Evident in this theme are interrelated messages for those involved in HIV/AIDS prevention. Health education alone is insufficient to stem the tide of HIV in Malawi. A multidisciplinary, systematic approach that includes women's education and economic empowerment as well as modifying legal and social structures that contribute to the spread of HIV/AIDS in Malawi is suggested as necessary additions to HIV and AIDS intervention programs. Only through forging partnerships between health, education, women's development groups, and political and social leaders will we be able to reduce the impact of HIV/AIDS in Malawi.

Adolescent↗
PubMed2004

Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction.

Reducing the time from symptom onset to reperfusion therapy is an important approach to minimizing myocardial damage and to preventing death from acute myocardial infarction (AMI). Previous studies suggest that certain ethnic or national groups, such as the Japanese, are more likely to delay in accessing care than other groups. The aims of this paper were the following; (1) to examine whether culture (defined as independent and interdependent construal of self) is associated with delay in accessing medical care in Japanese patients experiencing symptoms of AMI; (2) to determine if the relationship between independent and interdependent construal of self and prehospital delay time is mediated by cognitive responses and/or emotional responses; and (3) to determine if independent and interdependent construal of self independently predicts choice of treatment site (clinic vs. hospital). A cross-sectional study was conducted at hospitals in urban areas in Japan. One hundred and forty-five consecutive patients who were admitted with AMI within 72 h of the onset of symptoms were interviewed using the modified response to symptoms questionnaire and the independent and interdependent construal of self scale. The interdependent construal of self scores were significantly associated with prehospital delay time, controlling for demographics, medical history, and symptoms (p<.001). However, the relationship between independent and interdependent self and prehospital delay times was not mediated by cognitive or emotional responses. In multiple logistic regression analysis, patients with high independent construal of self were more likely to seek care at a hospital rather than a clinic compared to those with lower independent construal of self. In conclusion, cultural variation within this Japanese group was observed and was associated with prehospital delay time.

Adult↗
PubMed2004

Internet-based patient education and support interventions: a review of evaluation studies and directions for future research.

The Internet provides patients, families, and health providers with unparalleled opportunities to learn, inform, and communicate with one another. This paper is a review of studies that have evaluated the impact of professionally facilitated Internet-based programs for diverse clinical populations on health outcomes, utilization, and user satisfaction. The findings suggest that some outcomes in certain groups can be moderately improved and that user satisfaction has been generally positive. Given the increasing need to provide timely and effective patient-centered care, a stronger evidence base for eHealth applications must be established before broader deployment of such programs will take place.

Chronic Disease↗
PubMed2003

Predictors of quality of life in women 1 year after myocardial infarction.

In an analysis of 30 African American and Caucasian women, the authors describe changes in the various quality-of-life domains (health, family, socioeconomic, psychosocial, and spiritual) and predictors of quality of life for a group of women more than 1 year post-acute myocardial infarction (MI). Data reported represent three recovery points post-MI (before hospital discharge, 6-weeks post-MI, and 12-months post-MI). Matched pair t tests indicated significant changes in all five domains of quality of life/cardiac, and through a multiple regression analysis 45% of the variance in quality of life could be explained by mood states and social support. The finding that social support and mood states were the only predictors of quality of life for this cohort of women at 1-year post-MI suggests that health care professionals should mobilize and reinforce social support networks and make mental health referrals for the most vulnerable women. Further study should be conducted on the unique needs of African American women, since insufficient numbers were available at 1 year to determine their unique patterns of recovery.

Affect↗
PubMed2002

Using the resiliency model to deliver culturally sensitive care to Chinese families.

In 1998, 4% of U.S. children were Asian/Pacific Islander; of these, 23% were Chinese. The incidence of infants with congenital heart defects (CHD) in Chinese children approximates that of Caucasian children in the United States. Parents of children with CHD are faced with caring for the children at home after surgery. Parents' roles and responsibilities expand significantly as their children return home with complex care needs. In pediatric nursing, we not only take care of the individual child but also the family as a whole. The family is the primary institution in society that preserves and transmits culture. Understanding Chinese culture and its association with health care practice helps nurses to establish culturally sensitive nursing interventions; develop appropriate discharge plans; decrease family stress; reduce future medical hospitalization costs; increase positive coping, adaptation, and family function; and improve health outcomes of the child and the family. The Resiliency Model was used to examine its applicability in caring for Chinese families in this paper.

Adaptation, Psychological↗
PubMedDate not supplied

Recovery trajectory of unpartnered elders after myocardial infarction: an analysis of daily diaries.

The study reported here analyzed daily diary entries of unpartnered elders after myocardial infarction (MI) to gain perspective into their recovery. A total of 33 diaries were included as part of the qualitative analysis of the larger study referred to above. Diary content was evaluated through qualitative descriptive analysis. Six categories--activities of daily living, exercise practices, social support, symptom reporting, healthcare activities, and health-related expenses--were identified from the diaries. Results suggest that recovering, unpartnered MI elders have a need to return to a familiar lifestyle. Moreover, a few differences and similarities based on gender were found. In the rehabilitation setting, nurses should recognize the need for elders to return to normal activities, the importance of social support, the acknowledgement of gender differences, and the potential cost burden for these patients. Diaries were a valuable tool with which to uncover information about the recovery trajectory of unpartnered elders after MI.

Activities of Daily Living↗
PubMedDate not supplied

Implementation of efficacy enhancement nursing interventions with cardiac elders.

Intervention strategies based on social cognitive theory and encompassing the bio-psycho-behavioral domains are proposed to enhance self-efficacy in men and women 65 years and older recovering from myocardial infarction and coronary artery bypass grafting. This paper describes a study in which the theory-based development of efficacy enhancement (EE) nursing interventions and their implementation and utilization with interventions from the Nursing Interventions Classification (NIC) were used with cardiac elders in the treatment group of the community-based randomized clinical, trial, "Improving Health Outcomes in Unpartnered Cardiac Elders." Advanced practice nurses (APNs) provided the nursing intervention to 110 participants (mean age = 76.2, SD = 6.0) for the first 12 weeks after discharge to home. After an initial introductory meeting in the acute-care setting, participant contacts by the APNs were made at a home visit and telephone calls at 2, 6, and 10 weeks. Results describe the number of participants receiving interventions at all contacts over 12 weeks, at specified contact points, and the intensity (nurse time) of the interventions. Verbal encouragement and mastery were EE interventions used with the greatest number of participants. Exercise promotion, energy management and active listening were NIC interventions used with the most participants. Variations in the use of interventions over 12 weeks and their intensities, suggest patterns of recovery in the elders. During rehabilitation EE interventions can be successfully implemented with men and women 65 years and older and individualized to the recovery trajectory. Nurses can integrate specific EE interventions with more general interventions from the bio-psycho-behavioral domains to enhance the recovery process for cardiac elders.

Adaptation, Psychological↗
PubMedDate not supplied

Is Internet-based support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible? Results of a pilot study.

BACKGROUND: As of 2003, approximately 67% of US adults have Internet access. The purpose of this study was to determine the feasibility and preliminary efficacy of an Internet-based dyspnea self-management program (iDSMP) for people with chronic obstructive pulmonary disease. A related aim was to compare the differential effects of the iDSMP on 2 different groups: (1) to test a "booster" effect and (2) to evaluate the program as a primary intervention. METHODS: Two groups (n = 16) were evaluated at baseline and at 3 months after completing the iDSMP, which included education, exercise, self-monitoring, and support. Dyspnea, self-efficacy, perception of available support, and exercise behavior were measured. Paired, independent t tests and Mann-Whitney U tests were used. RESULTS: Most subjects (87%) reported that the program increased their access to information and resources for managing dyspnea. Dyspnea with activities of daily living and self-efficacy for managing the symptom showed significant improvements (both P < .01), whereas more modest changes were noted in perceived support and exercise behavior in the overall sample. There were no differences between the 2 groups on these outcomes. CONCLUSIONS: The findings suggest that additional investigations of Internet-based interventions to promote self-management in patients with chronic obstructive pulmonary disease are warranted.

Access to Information↗
PubMedDate not supplied

Women recovering from acute myocardial infarction: psychosocial and physical functioning outcomes for 12 months after acute myocardial infarction.

OBJECTIVE: The purpose of this study was to describe the recovery trajectories for women after acute myocardial infarction (AMI). DESIGN: The study was designed as a prospective, comparative, longitudinal, convenience sample. SETTING: The study was set in 5 West Coast major medical centers and 1 northeastern major medical center. PATIENTS: The subjects were 76 women (81% white, 19% African American; mean age, 67.8 years) with AMI. OUTCOME MEASURES: Outcome measures were the Duke Activity Status Index (DASI), a measure of cardiac and physical functional capacity; the Profile of Mood States (POMS), a measure of mood disturbance; the Mastery instrument, a sense of mastery in one's life; and the Support Requirements Interview, a measurement of needs for social support and assistance during recovery. RESULTS: Repeated measures analysis of variance results revealed that white women recovered more quickly than did African American women, with DASI scores approximately 50% better. POMS and Mastery results improved over time for both groups, with limited differences between African American and white women. At 6 weeks after AMI, age, social support, and mastery contributed significantly and predicted 42% of the variance in functional status (DASI) and 44% of the variance in mood disturbance as measured with the POMS. CONCLUSION: African American women and white women have similar recovery trajectories in terms of psychosocial recovery from AMI but different physical recovery trajectories.

Activities of Daily Living↗
PubMedDate not supplied

FAMISHED for support: recovering elders after cardiac events.

BACKGROUND: Heart disease causes disproportionately heavy burdens on unpartnered elders (widowed, divorced, never married) who have limited social resources to contend with recovery demands and complications resulting from acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery. Research suggests that the availability of social support improves recovery after AMI and CABG, yet functional support expressly designed to modify health and stimulate recovery remains unspecified. Advanced practice nurses (APNs) in the clinical nurse specialist (CNS) role who provide social support to recovering elders may be able to improve health outcomes for this vulnerable group. AIMS: The investigators' aims are to (1) quantify the duration and frequency of nurse contact with unpartnered elders recovering from cardiac events and (2) describe the functional support provided by the CNS to the unpartnered recovering elder. METHODS: Forty narrative accounts comprising 670 entries by interventional CNS APNs were examined using thematic analytic techniques. RESULTS: Over a 14-week period, CNS APNs contacted recovering elders 16 times, with a total of 4.5 hours spent per elder, or 13 minutes per phone call and 80 minutes per home visit. Analysis of 670 entries demonstrated functional and emotional support that was captured in the acronym, FAMISHED. CONCLUSIONS: Functional and emotional support from the CNS may enhance self-efficacy for recovery from cardiac events for unpartnered elders.

Aged↗
PubMedDate not supplied

Supporting cardiac recovery through eHealth technology.

The Internet continues to evolve as a popular and increasingly vital channel for health information and communication among patients, families, and health providers. This article provides an overview of published studies that have described or tested Internet-based resources and interventions designed to support recovery and enhance health outcomes for the cardiac population. Three categories of applications are discussed: (1) peer support communities; (2) information support through automated, tailored patient education; and (3) professionally facilitated education and support programs. The article also address key issues such as barriers to innovation adoption, patient literacy, and the digital divide that must be overcome for successful integration of such interventions into clinical practice. How Internet-based interventions will fit with existing conventional programs and clinical practice structures is not yet clear. However, evidence that supports use of this new communication channel is likely to emerge as more programs are developed and rigorously evaluated.

Cardiac Rehabilitation↗