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T Nieman

Publications and source records attributed to T Nieman.

2 recordsLinked to original sources

Positive impact of an intervention by arthritis patient educators on knowledge and satisfaction of patients in a rheumatology practice.

OBJECTIVE: The goal of the study was to determine whether an intervention by a trained arthritis patient educator could have a positive impact on the health status, knowledge, and satisfaction with services of arthritis patients attending an ambulatory rheumatology care clinic by providing education and support. METHODS: One hundred eight arthritis patients were randomly assigned to have an intervention by an arthritis patient educator as well as standard rheumatologic care (n = 47) or were assigned to the control group receiving only standard rheumatologic care (n = 61). Both groups completed the Arthritis Impact Measurement Scales 2 and the Arthritis Self-Efficacy Scale at baseline arrival to the clinic. After the appointment with the rheumatologist, each patient of the study group met with an arthritis patient educator. This session included educational and social support. A week later this group of patients received a followup telephone call from an arthritis patient educator to determine whether the patient had unanswered questions or needed additional support. Eight weeks later, both groups completed the baseline questionnaire again, a basic arthritis knowledge test, and a satisfaction survey. RESULTS: Eight weeks after the interventions, basic knowledge scores, on a scale of 1 to 8, were significantly different for the study group and the control group (6.48 +/- 0.31 versus 5.35 +/- 0.35, respectively, P = 0.02). A greater percentage of patients who received the intervention by an arthritis patient educator was able to identify two of the educational resources available to them compared with patients in the control group (92.6 +/- 0.05% versus 64.50 +/- 0.08%, P = 0.015, 77.7 +/- 0.08% versus 54.8 +/- 0.09%, P = 0.041). A greater percentage of persons in the active intervention group was also able to identify one self-help aid compared with the control group (88.8 +/- 0.06% versus 67.74 +/- 0.08%, P = 0.028). Overall satisfaction with care was rated "good" or "excellent" more often by the study group when compared with the control group (88.5 +/- 0.24% versus 61.3 +/- 0.32%, P = 0.01). Of the study group, 69% found the session helpful, and 58% desired further interactions; 16% of the control group also requested future appointments with the arthritis patient educators. CONCLUSION: Arthritis patient educators can provide a meaningful and useful addition to traditional rheumatology care, positively affecting patient knowledge and satisfaction with clinic services.

Ambulatory Care↗

Intravenous heparin dosing: patterns and variations in internists' practices.

OBJECTIVE: To characterize internists' dosing practices when administering and adjusting intravenous heparin regimens. DESIGN: A survey administered by physician-investigators. SETTING: Two community teaching hospitals and one Veterans Affairs Medical Center. SUBJECTS: Sixty-one attending physicians in internal medicine. MEASUREMENTS: Physicians' choices of therapeutic activated partial thromboplastin time (APTT) range, initial heparin bolus, initial infusion dose, and dose/infusion adjustments when APTT levels are < 1.2 x control (< 35 seconds), 1.2-1.5 x control (35-45 seconds), 1.5-2.3 x control (46-70 seconds), 2.3-3.0 x control (71-90 seconds), and > 3.0 x control (> 90 seconds). RESULTS: Physicians' dosing decisions and therapeutic ranges during heparin treatment varied widely. Responses to nontherapeutic APTT levels had especially high coefficients of variation (0.67-0.81). Two groups of physicians, together comprising a majority of all respondents, use mutually exclusive therapeutic ranges (mean 44-56 seconds and 60-83 seconds). These two groups differ significantly in several types of dosing decisions. CONCLUSION: In the absence of generalizable standard guidelines for intravenous heparin therapy, internists' dosing practices vary widely. Because such practices may impede timely, effective anticoagulation, experimental studies comparing standardized dosing protocols are needed.

Adult↗