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Piamjariyakul U, Wang K, Smith M, Young S, Shafique S, Navia RO, Williams K. Family Caregiving of Patients With Heart Failure and Vascular Dementia in Rural Appalachia: A Mixed-Methods Study. West J Nurs Res 2024; 46:344-355. [PMID: 38551329 DOI: 10.1177/01939459241242536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Vascular dementia and heart failure (HF) are common co-existing conditions among adult populations. Each condition requires extensive home caregiving from family caregivers, especially those in rural Appalachia. This study aimed to assess caregivers' burden and their physical and mental health status, as well as explore their experiences and needs. METHODS This study used an exploratory mixed-methods design combining quantitative and qualitative research (N = 20 caregivers). We collected data using questionnaires, short-answered interviews, and focus group discussions. The multivariable generalized linear model (GLiM) was used to analyze quantitative data; content analysis was used for qualitative data. RESULTS The average age of family caregivers was 64.95 years. The generalized linear model showed that the caregiving burden was associated with caregivers' depression/anxiety (r = 0.68, P < .001) and their number of dementia caregiving years (r = 0.54, P < .05). Caregivers' poor physical health status was associated with better preparedness for HF and dementia home caregiving (r = 0.52, P < .05) and male caregivers (r = -0.46, P < .01). Caregivers' mental health status was associated with depression/anxiety (r = -0.80, P < .001). The qualitative data identified key caregiving themes: emotional impact and physical demands of caregiving, lack of help in rural areas, dealing with multiple disease progression, and relationship changes with their loved ones. CONCLUSION Caregiving burden was associated with caregivers' home care responsibilities and the need for support. Nurse-led home caregiving preparedness interventions tailored for family caregivers of patients with HF and dementia in rural areas are recommended.
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Affiliation(s)
| | - Kesheng Wang
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Marilyn Smith
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Stephanie Young
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Saima Shafique
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - R Osvaldo Navia
- Department of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Kristine Williams
- School of Nursing, The University of Kansas Medical Center, Kansas City, KS, USA
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Piamjariyakul U, McKenrick SR, Smothers A, Giolzetti A, Melnick H, Beaver M, Shafique S, Wang K, Carte KJ, Grimes B, Haut MW, Navia RO, Patrick JH, Wilhelmsen K. Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol. PLoS One 2024; 19:e0296438. [PMID: 38166130 PMCID: PMC10760886 DOI: 10.1371/journal.pone.0296438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months. PURPOSE The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation. METHODS AND MATERIALS This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations. RESULTS Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73). DISCUSSION The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Susan R. McKenrick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angel Smothers
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Angelo Giolzetti
- West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Helen Melnick
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Molly Beaver
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Saima Shafique
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, WV, United States of America
| | - Kerri J. Carte
- Family & Community Development, West Virginia University-Extension, Kanawha County, Charleston, WV, United States of America
| | - Brad Grimes
- Meredith Center for Career Services and Professional Development, West Virginia University College of Law, Morgantown, WV, United States of America
| | - Marc W. Haut
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Department of Behavioral Medicine/Psychiatry, Director, Memory Health Clinic, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
| | - R. Osvaldo Navia
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Division Chief of Geriatrics, Palliative Medicine & Hospice and Grace Kinney Mead Chair of Geriatrics, West Virginia University School of Medicine, Morgantown, WV, United States of America
| | - Julie Hicks Patrick
- Life-Span Developmental Psychology, West Virginia University, Morgantown, WV, United States of America
| | - Kirk Wilhelmsen
- West Virginia University School of Medicine, Morgantown, WV, United States of America
- Chief Cognitive Neurology, Rockefeller Neuroscience Institute, Morgantown, WV, United States of America
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Piamjariyakul U, Shafique S, Friend DL, Adams KA, Sanghuachang W, Petitte TM, Young S. The development and evaluation of a short-term international student research and educational program. Int J Nurs Sci 2024; 11:83-90. [PMID: 38352285 PMCID: PMC10859586 DOI: 10.1016/j.ijnss.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 12/03/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives This study aimed to describe the "how-to" details and processes for developing and evaluating a short-term international student research and education program. Methods This study included two parts: development and implementation, and evaluation of the program. A foreign doctoral nursing student requested to visit the West Virginia University School of Nursing for research training and academic teaching experience. The global nursing program coordinator and the lead mentor met and identified the program basis and team participants. Learning activities were related to this student's interest in older adults and in-home end-of-life care, included four contents: research; educational engagement; practice/clinical engagement; special activities & professional development training and courses. The program evaluation was conducted at the end of the six-month visit using a focus group and an anonymous short survey. Participants (n = 10) included the host university's faculty, graduate students, and one short-term international student. Results Content analysis of the participant's short survey answers and the focus group discussion resulted in three themes: 1) lessons learned from participating in the program (enhanced diversity in education and research, gaining new global healthcare knowledge, and self-reflection on and promoting cultural awareness); 2) program barriers and challenges (the visa application process, the English language barrier, the lack of public transportation in the town, and scheduling conflicts); and 3) strategies to overcome these barriers and challenges (adding cultural diversity information into curriculum; attending English proficiency with others in the class; using different communication techniques; continuous collaboration with the University's Office of Global Affairs for the Visa application process; providing interactive experiences). All participants rated their engagement in the program as very satisfactory (Mean = 4.67, SD = 0.50), and highly impacted their nursing skills in research, teaching, and clinical practice (Mean = 4.67, SD = 0.50). Conclusions All the participants have gained some experience in this program, which can be used for future teaching guidance. Further, international nursing students need assistance to adjust and thrive in the host university learning community. Faculty must be culturally sensitive, understand the visiting foreign nursing student' learning needs, and advocate for an environment suitable for enhancing the students' learning.
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Affiliation(s)
| | - Saima Shafique
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Dana L. Friend
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | | | | | | | - Stephanie Young
- School of Nursing, West Virginia University, Morgantown, WV, USA
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Wang K, Shafique S, Xiao D, Walter SM, Liu Y, Piamjariyakul U, Xie C. Repeated measures analysis of opioid use disorder treatment on clinical opiate withdrawal scale in a randomized clinical trial: sex differences. J Addict Dis 2024; 42:33-44. [PMID: 36655851 DOI: 10.1080/10550887.2022.2131957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Sex differences may exist in opioid use disorder (OUD) treatment. This study examined the treatment effects of buprenorphine/naloxone (BUP/NX) and methadone (MET) on the Clinical Opiate Withdrawal Scale (COWS) score in individuals with OUD and tested whether the associations differ by sex. METHOD We performed a secondary analysis of the data from the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol-0027. A total of 1269 participants (861 males and 408 females) being aged 18 or older with OUD were randomly assigned to receive BUP/NX (n = 740) or MET (n = 529). The paired t test was initially used to compare the COWS scores between pre-dose and post-dose for BUP/NX and MET treatments, separately. The linear mixed model was used to examine the changes in COWS score adjusted for baseline demographic, substance use, and mental health disorders. The interaction of sex and treatment was detected and stratified analysis by sex was conducted. RESULTS The paired t test showed that both BUP/NX and MET treatments significantly reduced the COWS scores (p values <0.0001). BUP/NX revealed higher COWS scores than MET (p = 0.0008) and females demonstrated significantly higher COWS scores than males (p = 0.0169). Stratified by sex, BUP/NX compared with MET revealed higher COWS scores only in males (p = 0.0043), whereas baseline amphetamines use disorder and major depressive disorder were significantly associated with COWS scores in females (p = 0.0158 and 0.0422, respectively). CONCLUSIONS Both BUP/NX and MET are effective in decreasing opioid withdrawal symptoms via COWS scores, however, treatment plans for OUD by clinical providers should consider sex differences.
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Affiliation(s)
- Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Saima Shafique
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Danqing Xiao
- Department of STEM, School of Arts and Sciences, Regis College, Weston, MA, USA
- Neuroimaging Center, McLean Hospital, Belmont, MA, USA
| | - Suzy Mascaro Walter
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Ubolrat Piamjariyakul
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Changchun Xie
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
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Wang K, Shafique S, Wang N, Walter SM, Xie X, Piamjariyakul U, Winstanley EL. Early-onset alcohol, tobacco, and illicit drug use with age at onset of hypertension: a survival analysis. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02596-9. [PMID: 38104055 DOI: 10.1007/s00127-023-02596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To examine the associations of age when first substance use and early-onset substance use before age 18 with age at onset (AAO) of hypertension. METHODS This study included 19,270 individuals with AAO of hypertension from the 2015-2019 National Survey on Drug Use and Health. Age when first use of 10 substance use variables included alcohol, daily cigarettes, cigars, smokeless tobacco, marijuana, cocaine, hallucinogens, lysergic acid diethylamide (LSD), inhalants, and methamphetamine use. The outcome was AAO of hypertension and variable cluster analysis was used to classify the exposures and outcome. Substance use status was classified into three categories: early-onset substance use (first used substance before age 18), late-onset substance use (first used substance after age 18), and never used. RESULTS The mean AAO of hypertension was 42.7 years. Age when first use of 10 substance use variables had significant correlations with AAO of hypertension (all p values < 0.001). Individuals with early-onset alcohol, cigars, smokeless tobacco, marijuana, hallucinogens, inhalants, cocaine, LSD, and methamphetamine use revealed significantly earlier onset of hypertension than those never used. Compared with never used substances, the Cox regression model showed that early-onset alcohol, smokeless tobacco, marijuana, inhalants, and methamphetamine use had an increased risk of AAO of hypertension [hazard ratio (HR) (95%CI) = 1.22 (1.13, 1.31), 1.36 (1.24, 1.49), 1.85 (1.75, 1.95), 1.41 (1.30, 1.52), and 1.27 (1.07,1.50), respectively]. CONCLUSION These findings suggest that intervention strategies or programs focusing on preventing early-onset substance use before age 18 may delay the onset of adult hypertension.
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Affiliation(s)
- Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Saima Shafique
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Suzy Mascaro Walter
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Xin Xie
- Department of Economics and Finance, College of Business and Technology, East Tennessee State University, Johnson City, TN, 37614, USA
| | - Ubolrat Piamjariyakul
- Office of Research and Scholarly Activities, School of Nursing, Health Sciences Center, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Erin L Winstanley
- Department of Behavioral Medicine and Psychiatry, School of Medicine, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26506, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, 26506, USA
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Xu C, Acevedo P, Lu Y, Su BB, Ozuna K, Padilla V, Karithara A, Mao C, Navia RO, Piamjariyakul U, Wang K. Racial differences in the effect of APOE-ε4 genotypes on trail making test B in Alzheimer's disease: A longitudinal study. Int J Geriatr Psychiatry 2023; 38:e6037. [PMID: 38100638 DOI: 10.1002/gps.6037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES The trail making test part B (TMT-B) evaluates executive functions, memory, and sensorimotor functions. No previous study was found to examine the longitudinal effect of APOE-ε4 genotypes on the TMT-B scores in Alzheimer's disease (AD) across racial groups. METHODS This study used the data from Alzheimer's Disease Neuroimaging Initiative (ADNI): 382 participants with AD, 503 with cognitive normal (CN), 1293 with mild cognitive impairment (MCI) at baseline and follow-up of four years. The multivariable linear mixed model was used to investigate the effect of APOE-ε4 genotypes on changes in TMT-B scores. RESULTS Compared with Whites, African Americans (AA) and Hispanics had higher TMT-B scores (poor cognitive function). Furthermore, Whites subjects with 1 or 2 APOE-ε4 alleles had significantly higher TMT-B scores compared with individuals without APOE-ε4 allele at baseline and four follow-up visits; however, no differences in TMT-B were found between APOE-ε4 alleles in the Hispanic and AA groups. No APOE-ε4 by visit interactions was found for 3 racial groups. Stratified by AD diagnosis, the APOE-ε4 allele was associated with TMT-B scores only in the MCI group, while there were significant interactions for visit by education, APOE-ε4 allele, and the Mini Mental State Examination (MMSE) score in the MCI group. In addition, TMT-B was significantly correlated with the MMSE, AD Assessment Scale-cognitive subscale 13 (ADAS13), tTau, pTau, Aβ42, and hippocampus. CONCLUSIONS APOE-ɛ4 allele is associated with TMT-B scores in Whites subjects, but not in the Hispanic and AA groups. APOE-ε4 showed interaction with visit in the MCI group.
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Affiliation(s)
- Chun Xu
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Priscila Acevedo
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Yongke Lu
- Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Brenda Bin Su
- Department of Pediatrics - Allergy and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Kaysie Ozuna
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Victoria Padilla
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Annu Karithara
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - ChunXiang Mao
- Department of Health and Biomedical Sciences, College of Health Professions, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - R Osvaldo Navia
- Department of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Ubolrat Piamjariyakul
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Kesheng Wang
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
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Young S, Smith M, Shafique S, Piamjariyakul U. You're Not Who You Used to Be: A Case Report of a Family Living with Heart Failure and Vascular Dementia. Home Healthc Now 2023; 41:140-148. [PMID: 37144929 DOI: 10.1097/nhh.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Heart failure and vascular dementia have similar underlying pathologies, so it is not uncommon for one condition to exist in the presence of the other. In-home management of each condition is challenging for patients and their family caregivers, but when both conditions are present, those challenges are amplified. The purpose of this case report is to describe one family's experience managing heart failure and vascular dementia at home. A mixed method of semistructured interviews and short surveys was used to examine the health status and well-being of the patient and family caregiver. Data were derived from individual interviews and standardized measures. Survey results revealed the patient had worsening dementia, poor heart failure-related quality of life, poor spiritual well-being, depression, and diminished self-care. The caregiver reported poor physical and mental health. Interview data revealed frustration dealing with worsening symptoms, inadequate information about disease progression, and fear of an unknown future. Additionally, the patient suggested strategies to deal with challenges. Families managing heart failure and vascular dementia need easy-to-understand education from healthcare providers, on-going assessments, and early referrals to support services including those provided by social workers and chaplains.
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Antill Keener T, Tallerico J, Harvath R, Cartwright-Stroupe L, Shafique S, Piamjariyakul U. Nurses' Perception of Caring for Patients With Substance Use Disorder. J Addict Nurs 2023; 34:111-120. [PMID: 37276200 DOI: 10.1097/jan.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT The objective of this research was to explore the perceptions of nurses regarding patients with substance use disorder (SUD), healthcare provided, and desired resources to care for this population properly. This study used a cross-sectional, descriptive design. Data were collected via an anonymous 12-item survey and three open-ended questions. Data were analyzed using descriptive statistics and conventional content analysis. Nurses with less than 1 year of experience reported more significant challenges when caring for patients with SUD. These challenges included difficulties in managing pain, implementing alternative pain management techniques, and knowing who to contact when problems occur. The study revealed many needs of nurses to provide compassionate care for patients with SUD. Findings indicate a need for education for nurses, especially novice nurses, who care for patients with SUD.
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Antill Keener T, Wang K, Hall K, Hulsey T, Piamjariyakul U. Mediating Role of Resilience on Nursing Faculty and Student QoL during COVID-19. West J Nurs Res 2022; 44:1006-1015. [PMID: 34137309 DOI: 10.1177/01939459211024646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
COVID-19 greatly impacted nursing education and required nursing faculty and students to quickly adapt to changes caused by disease mitigation. The purpose of this study was to examine the mediating effects of resilience between the influence of demographics and school-related risk factors and nursing faculty and student quality of life (QoL) during the COVID-19 pandemic. A secondary data analysis was conducted using structural equation modeling to examine the mediating role of resilience on latent variables. Resilience had a positive, direct effect on nursing faculty and student QoL. Having a designated home workspace and being well-prepared for online learning had positive, indirect effects on QoL, mediated through resilience. Assisting children with schoolwork had a negative impact on the psychological and environmental QoL domains. Remarkably, having a caregiver role positively influenced the psychological QoL domain. Supporting and promoting faculty and nursing students' health and well-being is imperative during and after the pandemic.
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Affiliation(s)
| | - Kesheng Wang
- West Virginia University School of Nursing, Morgantown, WV, USA
| | | | - Tara Hulsey
- West Virginia University School of Nursing, Morgantown, WV, USA
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Petitte TM, Li J, Fang W, Shafique S, Piamjariyakul U. Modifiable Risk Factors Associated With Heart Failure Readmissions: 1-Year Follow-up. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Piamjariyakul U, Smothers A, Young S, Morrissey E, Petitte T, Wen S, Zulfikar R, Sangani R, Shafique S, Smith CE, Bosak K. Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results. Res Nurs Health 2021; 44:854-863. [PMID: 34196013 PMCID: PMC8440457 DOI: 10.1002/nur.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.
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Affiliation(s)
| | | | | | - Elizabeth Morrissey
- West Virginia University, School of Nursing
- West Virginia University Hospital
| | | | - Sijin Wen
- West Virginia University, Department of Biostatistics School of Public Health
| | - Rafia Zulfikar
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Rahul Sangani
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Saima Shafique
- West Virginia University, Department of Epidemiology School of Public Health
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing
- University of Kansas Medical Center, School of Preventive Medicine
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing
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Piamjariyakul U, Keener TA, Smothers A, Young S, Shafique S, McDill S, Keech K, Petitte T, Pacheco C. Mentoring Undergraduate Nursing Students in Palliative Home Care Research. Teach Learn Nurs 2021; 16:423-428. [PMID: 34720774 PMCID: PMC8553230 DOI: 10.1016/j.teln.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | | | - Saima Shafique
- West Virginia University, Department of Epidemiology, School of Public Health
| | | | | | | | - Cinthia Pacheco
- West Virginia University, Office of Undergraduate Research, Honors College
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Nwabueze C, Elom H, Liu S, Walter SM, Sha Z, Acevedo P, Liu Y, Su BB, Xu C, Piamjariyakul U, Wang K. Gender differences in the associations of multiple psychiatric and chronic conditions with major depressive disorder among patients with opioid use disorder. J Addict Dis 2021; 40:168-178. [PMID: 34328394 DOI: 10.1080/10550887.2021.1957639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The study examined the associations of multiple psychiatric and chronic conditions with the self-reported history of major depressive disorder (MDD) among patients with opioid use disorder (OUD) and tested whether the associations differed by gender. METHODS We conducted a secondary data analysis of baseline data from a clinical trial including 1,646 participants with OUD, of which 465 had MDD. A variable cluster analysis was used to classify chronic medical and psychiatric conditions. Multivariable logistic regression analyses were used to estimate their associations with MDD in subjects with OUD. RESULTS Nine variables were divided into three clusters: cluster 1 included heart condition, hypertension, and liver problems; cluster 2 included gastrointestinal (GI) problems and head injury, and cluster 3 included anxiety disorder, bipolar disorder, and schizophrenia. The overall prevalence of MDD in participants with OUD was 28.3% (22.8% for males and 39.5% for females). Gender, anxiety disorder, schizophrenia, liver problems, heart condition, GI problems, and head injury were significantly associated with MDD. Gender-stratified analyses showed that bipolar disorder, liver problems and individuals with one chronic condition were associated with MDD only in males, whereas heart condition, hypertension, and GI problems were associated with MDD only in females. In addition, anxiety disorder, head injury, individuals with one or more than two psychiatric conditions, and individuals with more than two chronic conditions were associated with MDD regardless of gender. CONCLUSIONS Treatment plans in patients with OUD should not only address MDD but also co-morbid psychiatric and chronic medical conditions that occur with MDD.
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Affiliation(s)
- Christian Nwabueze
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Hilary Elom
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Sophia Liu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Suzy Mascaro Walter
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Zhanxin Sha
- School of Kinesiology and Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Priscila Acevedo
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ying Liu
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Brenda Bin Su
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Chun Xu
- Department of Health and Biomedical Sciences, College of Health Affairs, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Ubolrat Piamjariyakul
- School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
| | - Kesheng Wang
- Department of Family and Community Health, School of Nursing, Health Sciences Center, West Virginia University, Morgantown, WV, USA
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Piamjariyakul U, Shapiro AL, Wang K, Zulfikar R, Petitte T, Shafique S, Smith CE. Impact of Sleep Apnea, Daytime Sleepiness, Comorbidities, and Depression on Patients' Heart Failure Health Status. Clin Nurs Res 2021; 30:1222-1230. [PMID: 33978519 DOI: 10.1177/10547738211015545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a gap in current research on common factors that impact patients with advanced heart failure (HF). The purpose of this secondary data analysis was to explore associations of those factors with three empirically verified measures of HF-related clinical, physical, and mental health status. Baseline data of 198 advanced systolic HF (EF < 40%) patients were analyzed. Patients were 61.6% male, with a mean age of 62.3 (SD = 13.2) years. The multivariable general linear modeling results indicated that patients who had poorer scores on HF-related clinical status were those who had sleep apnea (β = -6.6, p < .05), daytime sleepiness (β = -9.4, p < .01), four or more comorbidities (β = -11.8, p < .001), and depression (β = -18.7, p < .001). Depression was associated with all three measures of HF-related health status. These findings alert nurses to assess for sleep apnea and to use known screening measures for daytime sleepiness, depression, and comorbidities.
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Shapiro AL, Olson J, Shafique S, Piamjariyakul U. CPAP-SAVER follow-up study to determine long-term adherence and associated factors. J Am Assoc Nurse Pract 2021; 34:261-269. [PMID: 33927159 DOI: 10.1097/jxx.0000000000000605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many factors contribute to continuous positive airway pressure (CPAP) nonadherence, affecting health care burden. The original CPAP-SAVER study enrolled 66 CPAP-naive participants and showed high 1-month adherence and significantly higher apnea beliefs and CPAP attitude for the intervention group. PURPOSE AND METHODS Thirty-three participants from the original CPAP-SAVER study were recruited for a 3-year follow-up to determine adherence, examine the intervention effect, and identify adherence-associated factors. RESULTS Adherence rates dropped to 54.5% at 3 years, with a significant decrease in CPAP use hours (t = -2.37, p = .024) and nights (t = -4.05, p < .001). Group differences in beliefs and attitude were not sustained; however, beliefs (r = 0.57) and attitude (r = 0.44) were significant factors associated with adherence. Life satisfaction was significantly higher at present compared with before wearing CPAP (t = 5.17, p < .001). IMPLICATIONS FOR PRACTICE The authors recommend intervention with a focus on apnea beliefs, CPAP attitude, and long-term support to promote CPAP adherence. Focus on CPAP attitude and beliefs and enhanced support early in the obstructive sleep apnea (OSA) treatment trajectory may promote long-term adherence and subsequently reduce the health care burden of OSA disease.
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Affiliation(s)
- April L Shapiro
- School of Nursing, West Virginia University, Keyser, West Virginia
| | - Joeli Olson
- Mountaineer Home Medical, Morgantown, West Virginia
| | - Saima Shafique
- School of Nursing, West Virginia University, Morgantown, West Virginia
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Piamjariyakul U, Smothers A, Young S, Petitte T, Wen S, Morrissey E, Shafique S, Zulfikar R, Sangani R, Smith CE. Palliative care for rare advanced lung diseases in underserved Appalachia: Study protocol for a randomized controlled trial. J Adv Nurs 2020. [PMID: 32297352 DOI: 10.1111/jan.14395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 01/07/2023]
Abstract
AIM To pilot test a home end-of-life and palliative care intervention for family caregivers and patients with rare advanced lung diseases and to estimate effect-size for the power analysis in a future clinical trial. DESIGN This study uses a parallel randomized control trial. Families are randomly assigned to the intervention group or the control group in a 1:1 fashion. METHODS The study population includes patients with rare advanced lung diseases and their family caregivers who are involved in patients' home care. The control group receives standard care through their hospital or outpatient clinics. The intervention group receives standard care plus 2-weekly home end-of-life and palliative care coaching by experienced community nurses. Primary outcome is breathlessness measured by shortness of breath scale. Secondary outcomes are: (a) caregivers' anxiety and depression measures; (b) the presence of patient's signed advance directives in the medical record or not; and (c) Helpfulness of intervention measured by self-report Helpfulness scale. The study was funded in October 2018 and received ethical Institutional Review Board approval in February 2019. DISCUSSION West Virginia has one of the highest incidence rates of lung disease deaths in the nation. However, there is inadequate home end-of-life and palliative care for this underserved population. This is an initial interventional study of nurse-led coaching home-based palliative care for rare advanced lung diseases in rural Appalachia. Developing research collaboration with clinicians is essential for enrolment. Enrolment was successful due to regular meetings with pulmonologists who screened patients per the study inclusion criteria in their specialty clinic and made direct referrals to the research assistants. Results of this study will be used in the future trial. IMPACT The findings will contribute to the evidence-based home nursing care, planning for family/patient preferences and supportive end-of-life palliative care for managing advanced lung diseases at home. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03813667; registered January 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03813667.
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Affiliation(s)
| | - Angel Smothers
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Stephanie Young
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Trisha Petitte
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, WV, USA
| | | | - Saima Shafique
- Department of Epidemiology School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Rafia Zulfikar
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Rahul Sangani
- Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Carol E Smith
- School of Nursing and School of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Piamjariyakul U, Petitte T, Smothers A, Wen S, Morrissey E, Young S, Sokos G, Moss AH, Smith CE. Study protocol of coaching end-of-life palliative care for advanced heart failure patients and their family caregivers in rural appalachia: a randomized controlled trial. BMC Palliat Care 2019; 18:119. [PMID: 31884945 PMCID: PMC6936135 DOI: 10.1186/s12904-019-0500-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Heart failure (HF) afflicts 6.5 million Americans with devastating consequences to patients and their family caregivers. Families are rarely prepared for worsening HF and are not informed about end-of-life and palliative care (EOLPC) conservative comfort options especially during the end stage. West Virginia (WV) has the highest rate of HF deaths in the U.S. where 14% of the population over 65 years have HF. Thus, there is a need to investigate a new family EOLPC intervention (FamPALcare), where nurses coach family-managed advanced HF care at home. METHODS This study uses a randomized controlled trial (RCT) design stratified by gender to determine any differences in the FamPALcare HF patients and their family caregiver outcomes versus standard care group outcomes (N = 72). Aim 1 is to test the FamPALcare nursing care intervention with patients and family members managing home supportive EOLPC for advanced HF. Aim 2 is to assess implementation of the FamPALcare intervention and research procedures for subsequent clinical trials. Intervention group will receive routine standard care, plus 5-weekly FamPALcare intervention delivered by community-based nurses. The intervention sessions involve coaching patients and family caregivers in advanced HF home care and supporting EOLPC discussions based on patients' preferences. Data are collected at baseline, 3, and 6 months. Recruitment is from sites affiliated with a large regional hospital in WV and community centers across the state. DISCUSSION The outcomes of this clinical trial will result in new knowledge on coaching techniques for EOLPC and approaches to palliative and end-of-life rural home care. The HF population in WV will benefit from a reduction in suffering from the most common advanced HF symptoms, selecting their preferred EOLPC care options, determining their advance directives, and increasing skills and resources for advanced HF home care. The study will provide a long-term collaboration with rural community leaders, and collection of data on the implementation and research procedures for a subsequent large multi-site clinical trial of the FamPALcare intervention. Multidisciplinary students have opportunity to engage in the research process. TRIAL REGISTRATION ClinicalTrials.gov NCT04153890, Registered on 4 November 2019.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA.
| | - Trisha Petitte
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Angel Smothers
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Sijin Wen
- Department of Biostatistics School of Public Health, West Virginia University, Morgantown, USA
| | - Elizabeth Morrissey
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - Stephanie Young
- West Virginia University, School of Nursing Health Sciences Center, Post Office Box 9600 - Office 6701, Morgantown, WV, 26506-9602, USA
| | - George Sokos
- Advanced Heart Failure, West Virginia University Heart and Vascular Institute, J.W. Ruby Memorial Hospital, Morgantown, USA
| | - Alvin H Moss
- Sections of Nephrology and Supportive Care, West Virginia University Center for Health Ethics and Law, Morgantown, USA
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing and School of Preventive Medicine, Morgantown, USA
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Wallace K, Shafique S, Piamjariyakul U. The Relationship Between Oral Health and Hemodialysis Treatment Among Adults with Chronic Kidney Disease: A Systematic Review. Nephrol Nurs J 2019; 46:375-394. [PMID: 31490048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adult patients on hemodialysis experience a high prevalence of poor oral health and periodontitis. The chronic inflammation associated with poor periodontal health can increase the risk of cardiovascular disease and mortality among patients on hemodialysis. A systematic review of research articles published from 2012-2018 was conducted to synthesize current literature on the subject. Forty-three articles were identified. Findings were summarized into two categories: clinical measurements and lifestyle/quality of life. We suggest the development, implementation, and evaluation of oral health nursing interventions and periodontal treatments among patients on hemodialysis.
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Affiliation(s)
- Kimberly Wallace
- Nephrology Nurse Practitioner, West Virginia University Medicine, and PhD candidate, West Virginia University School of Nursing, Morgantown, WV
| | - Saima Shafique
- PhD student in Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV
| | - Ubolrat Piamjariyakul
- Associate Dean for Research, West Virginia University School of Nursing, Morgantown, WV
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Piamjariyakul U, Thompson NC, Russell C, Smith CE. The effect of nurse-led group discussions by race on depressive symptoms in patients with heart failure. Heart Lung 2018; 47:211-215. [PMID: 29606370 DOI: 10.1016/j.hrtlng.2018.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND African Americans with heart failure (HF) have the highest rates of depression among all ethnicities in the USA. OBJECTIVES To compare the effects by race on depressive symptoms and topics discussed in the first clinic appointment after HF hospitalization. METHODS This study is a secondary analysis of data from a randomized clinical trial testing a patient group discussion of HF self-management with 93 Caucasians and 77 African Americans. RESULTS Reduction in depressive symptoms was significantly greater among African American patients within the intervention group (F = 3.99, p = .047) than controls. There were significant differences by race in four topics (dietitian referral, appointment date, help preparing discussion questions, and advice on worsening HF symptoms) concerning patient-physician discussions. CONCLUSION The intervention showed greater effect in reducing depressive symptoms among African Americans than Caucasians. Preparing patients for discussions at physician appointments on diet, depressive symptoms, and HF symptoms is recommended.
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Affiliation(s)
- Ubolrat Piamjariyakul
- West Virginia University School of Nursing, 1 Medical Center Dr., PO Box 9600, Morgantown, WV 26506-9600.
| | - Noreen C Thompson
- University of Kansas Hospital Department of Nursing, 4000 Cambridge St., Mail Stop 2018, Kansas City, KS 66160
| | - Christy Russell
- Center for Advanced Heart Failure and Transplantation, University of Kansas Hospital, 3901 Rainbow Blvd., Mail Stop 4023, Kansas City, KS 66160
| | - Carol E Smith
- University of Kansas School of Nursing, University of Kansas School of Preventive Medicine, 3901 Rainbow Blvd., Mail Stop 4043, Kansas City, KS 66160
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Abstract
BACKGROUND The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL). METHODS A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care. RESULTS Technology dependence influences health-related QOL. Patients and their family caregivers must balance the positive aspects of being in the home environment with the challenges of administering complex therapies at home. Patients and caregivers need additional support to reduce the physical, emotional, social, and financial burdens they experience. CONCLUSIONS More research is needed to address effective interventions to reduce patient and caregiver burdens and to improve outcomes for technology-dependent individuals. A greater level of preparedness for managing home technology and technology-related problems may improve quality of life.
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Affiliation(s)
- Marion F Winkler
- Rhode Island Hospital, 593 Eddy Street, NAB218, Providence, RI 02903, USA.
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Abstract
The study describes the design and implementation of an Internet-based, computed-assisted telephone survey about the care-planning process in 107 long-term care facilities in the Midwest. Two structured telephone surveys were developed to interview the care planning coordinators and their team members. Questionmark Perception Software Version 3 was used to develop the surveys in a wide range of formats. The responses were drawn into a database that was exported to a spreadsheet format and converted to a statistical format by the Information Technology team. Security of the database was protected. Training sessions were provided to project staff. The interviews were tape-recorded for the quality checks. The inter-rater reliabilities were above 95% to 100% agreement. Investigators should consider using Internet-based survey tools, especially for multisite studies that allow access to larger samples at less cost. Exploring multiple software systems for the best fit to the study requirements is essential.
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Reeder K, Smith CE, Piamjariyakul U, Wick J, Ellerbeck EF, Spertus JA. Outcomes of a Multidisciplinary Heart Failure Self-management Group Clinic Appointments Intervention. Heart Lung 2016. [DOI: 10.1016/j.hrtlng.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Smith CE, Piamjariyakul U, Werkowitch M, Yadrich DM, Thompson N, Hooper D, Nelson EL. A Clinical Trial of Translation of Evidence Based Interventions to Mobile Tablets and Illness Specific Internet Sites. Int J Sens Netw Data Commun 2016; 5:138. [PMID: 27182451 PMCID: PMC4864853 DOI: 10.4172/2090-4886.1000138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article describes a method to translate an evidence based health care intervention to the mobile environment. This translation assisted patient participants to: avoid life threatening infections; monitor emotions and fatigue; keep involved in healthy activities. The mobile technology also decreased costs by reducing for example travel to visit health care providers. Testing of this translation method and its use by comparison groups of patients adds to the knowledge base for assessing technology for its impact on health outcome measures. The challenges and workflow of designing materials for the mobile format are described. Transitioning clinical trial verified interventions, previously provided in person to patients, onto tablet and internet platforms is an important process that must be evaluated. In this study, our evidence based guide's intravenous (IV) homeCare interventions (IVhomeCare) were delivered via Apple iPad mini™ tablet audiovisual instruction / discussion sessions and on a website. Each iPad audiovisual session (n = 41), included three to five families, a mental health specialist, and healthcare professionals. Patients and their family caregivers readily learned to use the wireless mobile tablets, and the IVhomeCare interventions, as described here, were successfully translated onto these mobile technology platforms. Using Likert scale responses on a questionnaire (1 = not helpful and 5 = very helpful) participants indicated that they gained problem solving skills for home care through iPad group discussion (M = 4.60, SD = 0.60). The firewall protected videoconferencing in real time with multiple healthcare professionals effectively allowed health history taking and visual inspection of the patient's IV insertion site for signs of infection. Supportive interactions with peer families on videoconferencing were documented during discussions. Discussion topics included low moods, fatigue, infection worry, how to maintain independence, and need for support from others with their same lifelong IV experiences. The visual family interactions, discussions with professionals, and the iPad internet links were highly rated. Mobile distance care delivery can result in saved time and money for both healthcare professionals and families.
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Affiliation(s)
- Carol E Smith
- School of Nursing, University of Kansas Medical Center, USA
- School of Preventive Medicine and Public Health, University of Kansas Medical Center, USA
| | | | | | | | | | - Dedrick Hooper
- Center for Telemedicine and Telehealth, University of Kansas Medical Center, USA
| | - Eve-Lynn Nelson
- Center for Telemedicine and Telehealth, University of Kansas Medical Center, USA
- Institute for Community Engagement, University of Kansas Medical Center, USA
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Piamjariyakul U, Werkowitch M, Wick J, Russell C, Vacek JL, Smith CE. Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans. Heart Lung 2015; 44:466-73. [DOI: 10.1016/j.hrtlng.2015.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
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Smith CE, Spaulding R, Piamjariyakul U, Werkowitch M, Yadrich DM, Hooper D, Moore T, Gilroy R. mHealth Clinic Appointment PC Tablet: Implementation, Challenges and Solutions. ACTA ACUST UNITED AC 2015; 4:21-32. [PMID: 26604991 DOI: 10.7309/jmtm.4.2.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients requiring daily intravenous (IV) home parenteral nutrition (HPN) would benefit from in-home professional observation to improve self-care, to assess, detect and prevent serious complications. AIMS The study aims are to assess the viability and utility of conducting mobile healthcare (mHealth) videoconference assessments with patients managing lifelong daily 12-hour IV nutrition infusions in their homes. The challenges and solutions to implementing mobile personal computer (PC) tablet based clinic appointments are described. METHODS A wireless Apple iPad Mini™ mobile touch-screen tablet computer with 5 mega-pixel camera was loaned to patients. Each tablet had Polycom RealPresence software and a fourth generation (4G) mobile telecommunications data plan. These supported audio-visual mobile videoconferencing encrypted connections between health professionals in their offices and HPN patients and their family members in their homes. Patients' and professionals' evaluations of their mHealth clinic experiences are collected. RESULTS Patients (mean age = 41.9, SD = 2.8 years) had been prescribed 12-hour home parenteral nutrition (HPN) infusions daily due short bowel disorders. Patients had been on HPN from 1 to 10 years (M=4, SD=3.6). Evaluation of clinic appointments revealed that 100% of the patients (n=45) and the professionals (n=6) indicated that they can clearly hear and easily see one another. The mHealth audio-visual interactions were highly rated by patients and family members. Professionals highly rated their ability to obtain a medical history and visual inspection of patients. Several challenges were identified and recommendations for resolutions are described. DISCUSSION All patients and professionals highly rated the iPad mHealth clinic appointments for convenience and ease of communicating between homes and offices. An important challenge for all mHealth visits is the clinical professional's ability to make clinically accurate judgments about what they observed and heard from the patients. Following our solutions for obtaining clear visuals with the iPad can improve ability to make clinical assessments.
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Affiliation(s)
- Carol E Smith
- Professor, School of Nursing and Preventive Medicine & Public Health Department, University of Kansas Medical Center
| | - Ryan Spaulding
- Research Associate Professor, Director, Center for Telemedicine and Telehealth, Interim Associate Vice Chancellor, Institute for Community Engagement, University of Kansas Medical Center
| | - Ubolrat Piamjariyakul
- Research Associate Professor, School of Nursing, University of Kansas Medical Center
| | | | | | - Dedrick Hooper
- Systems Coordinator, Center for Telemedicine and Telehealth, University of Kansas Medical Center
| | - Tyson Moore
- Research Assistant, School of Nursing, University of Kansas Medical Center
| | - Richard Gilroy
- Professor and Medical Director of Liver Transplantation, Department of Gastroenterology and Hepatology, University of Kansas Medical Center
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Williams PD, Piamjariyakul U, Shanberg R, Williams AR. Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments. J Pediatr Oncol Nurs 2015; 32:417-28. [PMID: 25616370 DOI: 10.1177/1043454214563754] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Symptom monitoring and alleviation are important during pediatric cancer treatments. AIMS To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents METHOD Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: <5 years, n = 33; 5 to 11 years, n = 44; 12 to 17 years, n = 25. Parents reported children's symptom occurrence/severity on the TRSC-C; and complementary care methods on the Symptom Alleviation: Self-Care Methods and their symptom alleviation methods. All tools had good psychometric properties. RESULTS 18 symptoms on the 30-item TRSC-C occurred in 42% to 95% of children. Mean severity of symptoms was between 1.0 ("a bit") and 2.0 ("quite a bit"); 5-month to 11-year-old children had higher (worse) TRSC-C total scores. Complementary care was used and reported. CONCLUSIONS Monitoring of multiple symptoms with the TRSC-C and parental symptom alleviation helped children. CLINICAL IMPLICATIONS Thai parents/patients need and accept assistance in monitoring/managing side effects of pediatric cancer therapy.
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Affiliation(s)
| | | | - Rachel Shanberg
- University of Chicago, Comer Children's Hospital, Chicago, IL, USA
| | - Arthur R Williams
- James A. Haley Veterans Affairs Medical Center, Tampa, FL, USA George Mason University, Washington, DC, USA
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Kim H, Spaulding R, Werkowitch M, Yadrich D, Piamjariyakul U, Gilroy R, Smith CE. Costs of multidisciplinary parenteral nutrition care provided at a distance via mobile tablets. JPEN J Parenter Enteral Nutr 2014; 38:50S-7S. [PMID: 25245253 DOI: 10.1177/0148607114550692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determining the costs of healthcare delivery is a key step for providing efficient nutrition-based care. This analysis tabulates the costs of delivering home parenteral nutrition (HPN) interventions and clinical assessments through encrypted mobile technologies to increase patients' access to healthcare providers, reduce their travel expenses, and allow early detection of infection and other complications. METHODS A traditional cost-accounting method was used to tabulate all expenses related to mobile distance HPN clinic appointments, including (1) personnel time of multidisciplinary healthcare professionals, (2) supply of HPN intervention materials, and (3) equipment, connection, and delivery expenses. RESULTS A total of 20 mobile distance clinic appointments were conducted for an average of 56 minutes each with 45 patients who required HPN infusion care. The initial setup costs included mobile tablet devices, 4G data plans, and personnel's time as well as intervention materials. The initial costs were on average $916.64 per patient, while the follow-up clinic appointments required $361.63 a month, with these costs continuing to decline as the equipment was used by multiple patients more frequently over time. Patients reported high levels of satisfaction with cost savings in travel expenses and rated the quality of care comparable to traditional in-person examinations. CONCLUSION This study provides important aspects of the initial cost tabulation for visual assessment for HPN appointments. These findings will be used to generate a decision algorithm for scheduling mobile distance clinic appointments intermittent with in-person visits to determine how to lower costs of nutrition assessments. To maximize the cost benefits, clinical trials must continue to collect clinical outcomes.
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Affiliation(s)
- Heejung Kim
- University of Kansas School of Nursing, Kansas City, Kansas
| | - Ryan Spaulding
- University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Donna Yadrich
- University of Kansas School of Nursing, Kansas City, Kansas
| | | | - Richard Gilroy
- University of Kansas School of Medicine, Kansas City, Kansas
| | - Carol E Smith
- University of Kansas School of Nursing and Preventive Medicine & Public Health, Kansas City, Kansas
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Smith CE, Piamjariyakul U, Wick JA, Spertus JA, Russell C, Dalton KM, Elyachar A, Vacek JL, Reeder KM, Nazir N, Ellerbeck EF. Multidisciplinary group clinic appointments: the Self-Management and Care of Heart Failure (SMAC-HF) trial. Circ Heart Fail 2014; 7:888-94. [PMID: 25236883 DOI: 10.1161/circheartfailure.113.001246] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This trial tested the effects of multidisciplinary group clinic appointments on the primary outcome of time to first heart failure (HF) rehospitalization or death. METHODS AND RESULTS HF patients (n=198) were randomly assigned to standard care or standard care plus multidisciplinary group clinics. The group intervention consisted of 4 weekly clinic appointments and 1 booster clinic at month 6, where multidisciplinary professionals engaged patients in HF self-management skills. Data were collected prospectively for 12 months beginning after completion of the first 4 group clinic appointments (2 months post randomization). The intervention was associated with greater adherence to recommended vasodilators (P=0.04). The primary outcome (first HF-related hospitalization or death) was experienced by 22 (24%) in the intervention group and 30 (28%) in standard care. The total HF-related hospitalizations, including repeat hospitalizations after the first time, were 28 in the intervention group and 45 among those receiving standard care. The effects of treatment on rehospitalization varied significantly over time. From 2 to 7 months post randomization, there was a significantly longer hospitalization-free time in the intervention group (Cox proportional hazard ratio=0.45 (95% confidence interval, 0.21-0.98; P=0.04). No significant difference between groups was found from month 8 to 12 (hazard ratio=1.7; 95% confidence interval, 0.7-4.1). CONCLUSIONS Multidisciplinary group clinic appointments were associated with greater adherence to selected HF medications and longer hospitalization-free survival during the time that the intervention was underway. Larger studies will be needed to confirm the benefits seen in this trial and identify methods to sustain these benefits. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00439842.
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Affiliation(s)
- Carol E Smith
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Ubolrat Piamjariyakul
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Jo A Wick
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - John A Spertus
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Christy Russell
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Kathleen M Dalton
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Andrea Elyachar
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - James L Vacek
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Katherine M Reeder
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Niaman Nazir
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
| | - Edward F Ellerbeck
- From the School of Nursing (C.E.S., U.P.), School of Medicine, Department of Preventive Medicine and Public Health (C.E.S., A.E., N.N., E.F.E.), Department of Biostatistics (J.A.W.), University of Kansas Medical Center, Kansas City, KS; School of Medicine, Department of Cardiovascular Medicine, University of Missouri Kansas City, Saint Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.); Department of Mid America Cardiology, University of Kansas Hospital (C.R., K.M.D., J.L.V.), and School of Medicine, Department of Cardiovascular Medicine (J.L.V.), Kansas City, KS; and Goldfarb School of Nursing, Barnes Jewish College, St Louis, MO (K.M.R.)
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Piamjariyakul U, Yadrich DM, Russell C, Myer J, Prinyarux C, Vacek JL, Ellerbeck EF, Smith CE. Patients' annual income adequacy, insurance premiums and out-of-pocket expenses related to heart failure care. Heart Lung 2014; 43:469-75. [PMID: 25012635 DOI: 10.1016/j.hrtlng.2014.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To (1) identify the amount patients spend for insurance premiums, co-payments, deductibles, and other out-of-pocket costs related to HF and chronic health care services and estimate their annual non-reimbursed and out-of-pocket costs; and (2) identify patients' concerns about nonreimbursed and out-of-pocket expenses. BACKGROUND HF is one of the most expensive illnesses for our society with multiple health services and financial burdens for families. METHODS Mixed methods with quantitative questionnaires and qualitative interviews. RESULTS Patients (N = 149) reported annual averages for non-reimbursed health services co-payments and out-of-pocket costs ranging from $3913 to $5829 depending on insurance coverage. Thirty one patients (21%) reported inadequate health coverage related to their non-reimbursed costs. CONCLUSIONS Non-reimbursed costs related to HF care are substantial and vary depending on their insurance, health services use, and out-of-pocket costs. Patient referral to social services to assist with expenses could provide some relief from the burden of high HF-related costs.
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Affiliation(s)
- Ubolrat Piamjariyakul
- University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA.
| | - Donna Macan Yadrich
- University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA
| | | | | | | | - James L Vacek
- University of Kansas Hospital, USA; School of Medicine, University of Kansas, University of Kansas Hospital, USA
| | - Edward F Ellerbeck
- Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, USA
| | - Carol E Smith
- University of Kansas School of Nursing, School of Nursing Building, 3901 Rainbow Boulevard, Mail Stop 4043, Kansas City, KS 66160-7502, USA; Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas, USA
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Piamjariyakul U, Myers S, Werkowitch M, Smith CE. End-of-life preferences and presence of advance directives among ethnic populations with severe chronic cardiovascular illnesses. Eur J Cardiovasc Nurs 2014; 13:185-9. [DOI: 10.1177/1474515113519523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Sarah Myers
- School of Nursing, University of Kansas, USA
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Smith CE, Kim H, Piamjariyakul U. Clinical observation and research data: a basis for health care policies. Heart Lung 2014; 43:1-2. [PMID: 24373336 DOI: 10.1016/j.hrtlng.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Carol E Smith
- Professor, School of Nursing, University of Kansas, USA; Professor, School of Preventive Medicine & Public Health, University of Kansas, USA; Director, KUMC Heartland Frontier CTSA Faculty Research Career Grants, USA
| | - Heejung Kim
- Assistant Professor, School of Nursing, University of Kansas, School of Nursing Building, MS 4043, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
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Piamjariyakul U, Smith CE, Russell C, Werkowitch M, Elyachar A. The feasibility of a telephone coaching program on heart failure home management for family caregivers. Heart Lung 2012; 42:32-9. [PMID: 23116654 DOI: 10.1016/j.hrtlng.2012.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To test the feasibility of delivery and evaluate the helpfulness of a coaching heart failure (HF) home management program for family caregivers. BACKGROUND The few available studies on providing instruction for family caregivers are limited in content for managing HF home care and guidance for program implementation. METHOD This pilot study employed a mixed methods design. The measures of caregiver burden, confidence, and preparedness were compared at baseline and 3 months post-intervention. Descriptive statistics were used to summarize program costs and demographic data. Content analysis research methods were used to evaluate program feasibility and helpfulness. RESULTS Caregiver (n = 10) burden scores were significantly reduced and raw scores of confidence and preparedness for HF home management improved 3 months after the intervention. Content analyses of nurse and caregiver post-intervention data found caregivers rated the program as helpful and described how they initiated HF management skills based on the program. CONCLUSIONS The program was feasible to implement. These results suggest the coaching program should be further tested with a larger sample size to evaluate its efficacy.
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Affiliation(s)
- Ubolrat Piamjariyakul
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Williams PD, Ridder EL, Setter RK, Liebergen A, Curry H, Piamjariyakul U, Williams AR. Pediatric chronic illness (cancer, cystic fibrosis) effects on well siblings: parents' voices. ACTA ACUST UNITED AC 2012; 32:94-113. [PMID: 21992093 DOI: 10.1080/01460860902740990] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study is a secondary analysis of data gathered during baseline data collection prior to a cognitive-psychosocial-respite intervention provided in a randomized controlled trial (RCT). Content analysis was used to identify themes in parents' responses to an open-ended item about their perceptions of the effects on siblings of having a brother or sister who has either cancer or cystic fibrosis (CF). Of 91 themes tallied in the cancer group (n = 29), 74.5% reflected negative manifestations of increased risk in siblings, 1.1% no risk; and 24.2%, positive outcomes. Of 53 themes tallied in the CF group (n = 15), the same three categories had 67.9 %, 0%, and 32.1%, respectively. Contemporary life in these families portrayed in parents' descriptions not only validate the rationale for the RCT done, but also suggest the need in ambulatory pediatrics for intervention research on these vulnerable populations.
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Affiliation(s)
- Phoebe Dauz Williams
- University of Kansas School of Nursing, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
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Gieseking A, Williams P, Piamjariyakul U, Kelly K, Dobos C, Connor R, Williams A, Sheehan K, Devorin B, Hoeppner C, Lucas M, Barakat L, Hobbie W, Deatrick J, Black K, Beaudoin W, McDonald C, Tulloh R, Montero L, Frias C, Canete A, Pablo M, Rebeca C, Miguel H, Patricia S, Victoria C, Avula S, Abernethy L, Pizer B, Pettorini B, Williams D, Mallucci C, Lafond D, DeLuca H, Steacy K, Cullen P, Moore I, Yeh-Nayre L, Le Floch N, Levy M, Donoghue D, Crawford J, Hoeppner C, Paiva P, Cappellano A, Dias C, Silva N, Clark E, Hemenway M, Madden J, Foreman N, Dorneman L, Rossiter J, Arvanitis T, Natarajan K, Wilson M, Davies N, Gill S, Grazier R, Crouch J, Auer D, Clark C, Grundy R, Hargrave D, Howe F, Jaspan T, Leach M, MacPherson L, Payne G, Saunders D, Peet A, Madden JR, Bess H, Chordas C, LaFond D, Packer R, Hilden J, Smith A, Chi S, Marcus K, Foreman NK, Liu AK, Bess H, Stillwell D, Olavarria G, Thomas D, Smith A. NURSING. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Piamjariyakul U, Smith CE, Werkowitch M, Elyachar A. Part 2: enhancing heart failure home management: integrated evidence for a new family caregiver educational plan. Appl Nurs Res 2011; 25:246-50. [PMID: 22079747 DOI: 10.1016/j.apnr.2011.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 07/05/2011] [Accepted: 07/13/2011] [Indexed: 10/15/2022]
Abstract
This article describes how the qualitative data integrated from patients, health care professionals, and family caregivers have been developed into a new heart failure (HF) educational plan for family caregivers to manage the complexities of HF self-management at home. In addition, the educational plan describes potential strategies and teaching materials based on these integrated data.
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Affiliation(s)
- Ubolrat Piamjariyakul
- University of Kansas Medical Center, School of Nursing, Mail Stop 4043, Kansas City, KS 66160, USA.
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Piamjariyakul U, Smith CE, Thompson N. Abstract P194: Depression Screening in Heart Failure: Preliminary Clinical Trial Results. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose:
To explore factors contributing to depression identified by patients and mental health nurse specialists.
Background:
Heart failure incidence approaches 10 per 1,000 Americans after age 65 years. Nearly half of all patients with heart failure experience depression, an independent risk factor for increased cardiovascular morbidity and mortality.
Methods:
Patients with heart failure (
n
= 175; mean age = 63.1 years,
SD
= 13; range age 25-over 89 years) were screened for depression, using the PHQ-9 and CESD. Mental health clinical nurse specialist referrals were made based on a combination of questionnaire scores (i.e., moderate to severe depression) and patient narratives, including expressed feelings of depression, loneliness, sadness, or suicidal thoughts. Content analysis research methods were used to categorize patient and mental health nurse specialist consultation narratives and identify factors contributing to depression.
Results:
Using the PHQ-9 and CESD screening questionnaires, 75 (43%) patients reported having felt depressed during the previous month, resulting in 47 (27%) patient referrals to the mental health clinical nurse specialist. Patients most often reported depressive symptoms due to complex illness care, loss of independence or function, self-care demands, financial concerns, and life stressors. The advanced practice mental health nurse consultations revealed patients most often experienced fatigue and insomnia, grief and situational depression, anger, and regret reactions. Patients were more likely to disclose mental health illnesses, domestic and family issues, and illicit substance use to the mental health clinical nurse specialist than to investigators administering the PHQ-9 and CESD.
Implications:
Exploring patient and expert mental health nurse narratives identified unique contributing factors of depression in heart failure, which warrant further study. The mental health clinical nurse specialist determined whether patients experienced grief responses or depression, an important distinguishing factor in screening for depression, with implications for research and clinical practice.
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Piamjariyakul U, Smith CE, Werkowitch M, Elyachar A. Part I: heart failure home management: patients, multidisciplinary health care professionals and family caregivers' perspectives. Appl Nurs Res 2011; 25:239-45. [PMID: 21741211 DOI: 10.1016/j.apnr.2011.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 04/26/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
Abstract
Using qualitative research study methods, this study identified the key factors that patients, health care professionals, and family caregivers perceived as most helpful in effectively managing heart failure (HF) at home. These key factors were the following: (a) family caregiver involvement, (b) continuous learning about HF, (c) acceptance of and coping with HF diagnosis, (d) learning from other patients with HF, (e) guidance for daily problem solving, (f) lifestyle changes, and (g) financial resources.
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Bowden K, Fitzgerald SA, Piamjariyakul U, Werkowitch M, Thompson NC, Keighley J, Smith CE. Comparing patient and nurse specialist reports of causative factors of depression related to heart failure. Perspect Psychiatr Care 2011; 47:98-104. [PMID: 21426355 PMCID: PMC3633565 DOI: 10.1111/j.1744-6163.2010.00279.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to compare participants' and a psychiatric nurse specialist's reports on factors precipitating depression and to validate a depression screening instrument. DESIGN AND METHODS Participants were screened for and asked to self-report causative factors of their depression. Participants with moderately severe and severe depressive symptoms received a psychiatric nurse specialist assessment. FINDINGS Participants self-reported several causative factors of depression. The psychiatric nurse specialist discovered these plus additional factors. The screening instrument was found to be reliable and valid for the measurement of depressive symptoms. PRACTICE IMPLICATIONS Participant self-report identifies many causative factors of depression. The psychiatric nurse specialist identifies additional factors, allowing individualized diagnoses and treatments.
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Piamjariyakul U, Williams PD, Prapakorn S, Kim M, Park L, Rojjanasrirat W, Williams AR. Cancer therapy-related symptoms and self-care in Thailand. Eur J Oncol Nurs 2010; 14:387-94. [DOI: 10.1016/j.ejon.2010.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 01/13/2010] [Accepted: 01/17/2010] [Indexed: 11/30/2022]
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Smith CE, Piamjariyakul U, Yadrich DM, Ross VM, Gajewski B, Williams AR. Complex home care: part III--economic impact on family caregiver quality of life and patients' clinical outcomes. Nurs Econ 2010; 28:393-9, 414. [PMID: 21291060 PMCID: PMC3075108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Family caregivers perform a significant role in the care of patients with chronic illnesses and prescribed life-long complex home care treatments. Both quantitative and qualitative data from this study suggest the mental health burdens and financial costs of home parenteral nutrition (HPN) caregiving are extensive. In this study, the variability in HPN out-of-pocket expenses and the uncertainty of incurring such extensive costs created additional financial worries within already stressed families. Based on these data, interventions to improve caregivers' sleepiness, depression, and physical health could be hypothesized to improve both patients' and caregivers' quality of life and reduce the frequency of patients' catheter-related infections. These specific nursing interventions also could improve caregiver health and subsequently reduce the costs of caregivers' health care.
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Affiliation(s)
- Carol E Smith
- School of Nursing and Preventive Medicine Department, University of Kansas, Kansas City, KS, USA
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Piamjariyakul U, Yadrich DM, Ross VM, Smith CE, Clements F, Williams AR. Complex home care: Part 2- family annual income, insurance premium, and out-of-pocket expenses. Nurs Econ 2010; 28:323-329. [PMID: 21158253 PMCID: PMC3088424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Annual costs paid by families for intravenous infusion of home parenteral nutrition (HPN) health insurance premiums, deductibles, co-payments for health services, and the wide range of out-of-pocket home health care expenses are significant. The costs of managing complex chronic care at home cannot be completely understood until all out-of-pocket costs have been defined, described, and tabulated. Non-reimbursed and out-of-pocket costs paid by families over years for complex chronic care negatively impact the financial stability of families. National health care reform must take into account the long-term financial burdens of families caring for those with complex home care. Any changes that may increase the out-of-pocket costs or health insurance costs to these families can also have a negative long-term impact on society when greater numbers of patients declare bankruptcy or qualify for medical disability.
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Affiliation(s)
- Ubolrat Piamjariyakul
- University of Kansas School of Nursing, School of Nursing Building, Kansas City, KS, USA
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Piamjariyakul U, Ross VM, Yadrich DM, Williams AR, Howard L, Smith CE. Complex home care: Part I--Utilization and costs to families for health care services each year. Nurs Econ 2010; 28:255-263. [PMID: 21625407 PMCID: PMC3101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
As many as 120 persons per million people in the United States are dependent on the lifelong, complex, technology-based care of home parenteral nutrition (HPN) infusions. However, data for costs paid by families for HPN-related health care services and for non-reimbursed expenditures are rarely tabulated and most often underestimated. The goals of this study were to describe health care services used by families to manage HPN, report the frequency of each service used annually, and estimate the average annual non-reimbursed costs to families for these health services. The numerous and varied types of services reported and the time required to coordinate and access HPN services illustrates the challenges faced by patients and their family caregivers. The lack of a coordinated and efficient system for delivering complex chronic care results in poorer outcomes for HPN patients and their families on-reimbursed costs and the extensive amount of time required to coordinate multi-professional services negatively impacts the clinical outcomes and quality of life of complex chronic home care.
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Russell C, Bowden K, Piamjariyakul U, Reeder K, Smith C, Thompson N. Depression in heart failure- the value of nurse assessment: Preliminary findings. Heart Lung 2010. [DOI: 10.1016/j.hrtlng.2010.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dauz Williams P, Piamjariyakul U, Graff JC, Stanton A, Guthrie AC, Hafeman C, Williams AR. Developmental disabilities: effects on well siblings. ACTA ACUST UNITED AC 2010; 33:39-55. [PMID: 20121579 DOI: 10.3109/01460860903486515] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Forty studies performed between 1970 and 1995 indicated that 60% of parents with children with developmental disabilities reported manifestations of increased risk or negative effects on the well siblings. METHOD A secondary data analysis was performed using qualitative data gathered during the baseline of a randomized controlled clinical trial of an intervention for siblings/families of children with long-term conditions, including developmental disabilities. Content analysis was used to identify themes from responses of 151 parents to an open-ended question on their perceptions of the effects on well siblings of living at home with a brother/sister with developmental disabilities. RESULTS Of 363 themes identified, 61.1% reflected negative manifestations of increased risk in well siblings; 1.7% indicated no risk; and 37.2% reflected positive outcomes, suggesting the continued need for potential interventions. CONCLUSION Contemporary family life in these families, as portrayed by parents' descriptions, reflects need in child health care for more intervention research on this vulnerable population.
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Gajewski BJ, Lee R, Bott M, Piamjariyakul U, Taunton RL. On estimating the distribution of data envelopment analysis efficiency scores: an application to nursing homes’ care planning process. J Appl Stat 2009. [DOI: 10.1080/02664760802552986] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Branstetter JE, Domian EW, Williams PD, Graff JC, Piamjariyakul U. Communication Themes in Families of Children with Chronic Conditions. ACTA ACUST UNITED AC 2009; 31:171-84. [DOI: 10.1080/01460860802475184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The Omnibus Budget Reconciliation Act of 1987 required nursing facilities to complete a standardized comprehensive assessment known as the Resident Assessment Instrument (RAI) and to formulate a plan of care from the RAI to guide nursing care. The purpose of this retrospective case study was to examine the issues around the translation of nursing facility resident care plans to documents that guide daily care. Data were obtained by auditing 96 resident care plans in 10 nursing facilities in two states. Despite the importance of the resident plan of care, the audit revealed the provider approaches to resident problems varied appreciably in nursing facilities. The results of this study support the need for further research to assist in the development and implementation of strategies in nursing facilities that focus on standardized practices. Consistent systems can be promoted that translate the resident care plan into daily practice.
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Bott MJ, Gajewski B, Lee R, Piamjariyakul U, Taunton RL. Care planning efficiency for nursing facilities. Nurs Econ 2007; 25:85-94, 55. [PMID: 17500493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The project reported here is the first in a series of cost analyses regarding the care planning process among 107 facilities. Process-based costing strategies and data envelopment analyses identified nursing facilities with efficient and less-efficient care planning processes. Having more people and more time devoted to the care planning process did not assure quality or efficiency. Efficiency varied across the nursing facilities and was not related to number of beds, profit status, or location; however, Medicare-certified facilities were less likely to be efficient.
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Affiliation(s)
- Marjorie J Bott
- University of Kansas School of Nursing, Kansas City, KS, USA
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Holston EC, Schweitzer R, Meeker ME, Hendrix CC, Gaspar PM, Kossman S, Piamjariyakul U. Preparing junior investigators to develop gerontological research. Nurs Outlook 2006; 54:287-93. [PMID: 17027606 DOI: 10.1016/j.outlook.2006.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Ezra C Holston
- The University of California, School of Nursing, Los Angeles, CA 90095-1705, USA.
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Williams PD, Piamjariyakul U, Ducey K, Badura J, Boltz KD, Olberding K, Wingate A, Williams AR. Cancer Treatment, Symptom Monitoring, and Self-care in Adults. Cancer Nurs 2006; 29:347-55. [PMID: 17006107 DOI: 10.1097/00002820-200609000-00001] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A descriptive study was conducted on self-reported symptoms and self-care by 37 adults receiving chemotherapy primarily for leukemia, lymphomas, or breast cancer or radiation therapy for head and neck or lung cancers. The Therapy-Related Symptom Checklist and demographic and interview forms on self-care for identified symptoms were used. Severe symptoms on the Therapy-Related Symptom Checklist subscales fatigue, eating, nausea, pain, numbness in fingers/toes, hair loss, and constipation were reported by patients on chemotherapy. Those on radiation therapy reported severe symptoms on the eating, fatigue, skin changes, oropharynx, and constipation subscales.Self-care strategies were in the following categories, using complementary medicine as framework: diet/nutrition/lifestyle change (eg, use of nutritional supplements; modifications of food and of eating habits; naps, sleep, and rest); mind/body control (eg, relaxation methods, prayer, music, attending granddaughter's sports events); biologic treatments (vitamins); herbal treatments (green mint tea); and ethnomedicine (lime juice and garlic). The first category was predominantly used by patients in both treatment types. Medications were prescribed also to help control symptoms (eg, pain and nausea). Symptom monitoring and self-care for symptoms identified may be facilitated by the Therapy-Related Symptom Checklist; based on reported symptom severity, care providers may prioritize interventions. A larger study needs to be done on (a) the use of the Therapy-Related Symptom Checklist as a clinical tool to assess symptoms that oncology patients experience during therapy; (b) whether care providers, based on patient-reported symptom severity, can prioritize interventions--and how this influences the efficiency of care; (c) the self-care strategies used by patients on chemotherapy or radiation therapy or both; and (d) how useful these strategies are in alleviating symptoms.
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Affiliation(s)
- Phoebe Dauz Williams
- School of Nursing, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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