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ABSTRACT: Intermittent pneumatic compression (IPC) therapy is an effective modality to reduce the volume of the lymphedematous limbs alone or in conjunction with other modalities of therapy such as decongestive therapy. However, there is no consensus on the frequency or treatment parameters for IPC devices. We undertook a systematic review of contemporary peer-reviewed literature (2004-2011) to evaluate the evidence for use of IPC in the treatment of lymphedema. In select patients, IPC use may provide an acceptable home-based treatment modality in addition to wearing compression garments.
Lymphology 03/2012; 45(1):13-25. · 1.02 Impact Factor
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ABSTRACT: Breast cancer survivors are at life-time risk of developing lymphedema (LE). Quantification of LE has been problematic as the criteria used to identify lymphedema use various methods to assess changes in the volume of the affected limb. In part because of difficulties and variability in measurement and diagnosis, the reported incidence of LE varies greatly among women treated with surgery and radiation for breast cancer. The goal of this research was to describe the trends for LE occurrence over three points in time (12, 30, and 60 months) among breast cancer survivors using four diagnostic criteria based on three measurement techniques. Participants were enrolled following diagnosis of breast cancer but before surgery. Baseline limb volume and symptom assessment data were obtained. Participants were followed every 3 months for 12 months, then every 6 months thereafter for a total of 60 months. Limb volume changes (LVC) in both limbs were measured using three techniques: objectively by (a) circumferences at 4 cm intervals and (b) perometry and subjectively by (c) symptom experience via interview. Four diagnostic criteria for LE most often reported in the literature were used: (i) 2 cm circumferential change; (ii) 200 mL perometry LVC; (iii) 10% perometry LVC; and (iv) signs and symptoms (SS) report of limb heaviness and swelling, either 'now' or 'in the past year' (diagnostic criteria i-iii define increases/differences in limb volume from baseline and/or between the affected and non-affected limb). Standard survival analysis methods were applied to identify when the criteria corresponding to LE were met. Trends in LE occurrence are reported for preliminary analysis of data from 236 participants collected at 6-, 12-, 18-, 24-, 30-, and 60-months post-op. At 60 months post-treatment, LE incidence using the four criteria ranged from 43% to 94%, with 2 cm associated with the highest frequency for lymphedema occurrence and SS the lowest. Sixty-month trends are compared to earlier trends at 12- and 30-months, per criterion. These preliminary findings provide additional evidence that breast cancer survivors are at risk for developing LE beyond the first year following treatment. Cases of lymphedema continue to emerge through 60-months post-breast cancer surgery. This 60-month analysis supports the previous 12- and 30-month analyses in finding the 2 cm criteria to be the most liberal definition of LE. The self-report of heaviness and swelling, along with 10% LVC, represent the most conservative definitions (41% and 45%, respectively). Furthermore, the variety of criteria used to identify LE, along with the absence of baseline (pre-treatment) measurements, likely contribute to the wide range of LE incidence rates reported in the literature.
Lymphology 09/2010; 43(3):118-27. · 1.02 Impact Factor
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ABSTRACT: We sought to define the incidence, risk factors, symptoms, and quality of life (QOL) outcomes associated with various degrees of postoperative limb volume change (LVC). A prospective cohort study was performed obtaining serial limb volume measurements using a perometer on 269 women undergoing surgery for breast cancer. Four groups were created based on maximum LVC: none < 5.0%, mild 5.0-9.9%, moderate 10.0-14.9%, and severe 15.0%. Symptoms and QOL were assessed. 81 (30.1%), 70 (26.0%), and 14 (5.2%) women developed mild, moderate, and severe LVC, respectively. Increases in body mass index (p < 0.001) and post-operative complications (p = 0.002) were associated with increasing LVC. Lower QOL scores were associated with a moderate LVC (OR = 3.72, 95% CI, 1.29-10.73, p = 0.015) and postoperative infections (OR = 5.04, 95% CI, 1.73-14.70, p = 0.003). LVC at 5.0% occurs in up to 61.3% of breast cancer survivors and is associated with a significant increase in symptoms and a change in reported quality of life.
Lymphology 12/2009; 42(4):161-75. · 1.02 Impact Factor
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ABSTRACT: Lymphedema is a problem for breast cancer survivors. The proliferation of limb measurement techniques makes it difficult to know how best to measure an at-risk limb. Using a sample of healthy volunteers and individuals with lymphedema, this study: 1) examined the relationship between more commonly used circumferential limb measurement methods and newer measurement methods of infrared laser perometry and bioelectrical impedance; 2) compared self-reported arm symptoms in healthy volunteers and breast cancer survivors with known lymphedema; and 3) explored the relationships among self-reported arm symptoms and circumferential tape measurement, infrared laser (perometry), and single and multi-frequency bioelectrical impedance. Lymphedema index ratios were calculated to allow comparison among measurement methods. Measurement methods correlated strongly with each other. Fourteen symptoms were reported by one or more participants in the lymphedema group while participants in the healthy volunteer group reported only eight symptoms over the same time frames. Using p < 0.001, all measurement methods correlated with self-reported arm swelling in the past year, while only circumferential and impedance measurements correlated with firmness. Future research needs to include serial arm measurements to explore arm volume variation in healthy and lymphedema volunteers and to further investigate possible lymphedema index ratios cut points as lymphedema diagnostic criteria.
Lymphology 03/2007; 40(1):35-46. · 1.02 Impact Factor
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Journal of Gerontological Nursing 07/2001; 27(6):28-37. · 0.78 Impact Factor
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ABSTRACT: Although kin and church are considered premier support sources for rural elders, few scholars have undertaken descriptive studies to explore the nature of rural Black elders' support networks and their preferences for in-home service providers. In the case study described in this article, methods of support network analysis and descriptive phenomenology were used to analyze data from five lengthy, open-ended interviews with a 94-year-old rural Black woman. The various groups and individuals of her network are labeled in her words, the network's supportive functions are described, and preferences for providers are noted. In addition, the varying structures of her home care experience with the support network members are described. Her attempts to voice and exercise her preferences for in-home service providers are explained in terms of two contrasting processes: preference uptake and preference suppression. Based on these findings, implications for appraising the appropriateness of rural elders' in-home services are discussed.
Qualitative Health Research 08/2000; 10(4):452-70. · 2.19 Impact Factor
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Journal of Gerontological Nursing 01/1997; 22(12):5-6. · 0.78 Impact Factor
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J M Armer
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ABSTRACT: The aim of this preliminary qualitative study was to examine factors influencing the adjustment of 34 elderly people relocating to an age-segregated planned housing unit in a rural community. Factors identified as affecting urban relocation were explored as a basis for developing a greater understanding of rural elders. Data from open-ended interviews were analyzed through sorting into categories by themes. Inclusion of factors reported to influence relocation among urban-dwelling elders in rural relocation research was validated through the template analytic technique. Content analysis resulted in support for the variables of predictability, controllability, social support and interaction, recency of loss, and prior life satisfaction as potential influences on post-relocation adjustment. Health professionals can ease adjustment through increased understanding of the factors that affect adjustment to relocation. Based on these preliminary findings, a more comprehensive study of relocation among the rural aged is warranted.
Image--the journal of nursing scholarship 02/1996; 28(1):35-9.
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ABSTRACT: Meta-analysis research reports are increasingly found in the public health literature. Meta-analysis is a quantitative method for summarizing existing studies. Although it is often advocated to synthesize research, nurses must be able to read these reports critically to determine applicability to practice.
Public Health Nursing 07/1994; 11(3):163-7. · 0.72 Impact Factor
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Nursing Outlook 44(6):267-71. · 1.52 Impact Factor
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ABSTRACT: The pressing dilemma in this era of health care reform is how to provide cost-effective, high quality health care for all Americans. At the present time, due to a number of complex factors, including attrition and economic disincentives, a shortage of primary care physicians exists in certain medically underserved areas of the country. At the same time, however, primary care nurse practitioners are increasing in number.
Nursing and health care perspectives 21(1):29-33.
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J M Armer
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ABSTRACT: A randomly-drawn statewide sample of 891 consumers revealed overall support for the advanced practice nurse role to be greater than 75 percent. Seeking health care consumers' reactions to proposed alternatives is a crucial step in planning and implementing a program of health care reform that will meet current and future health needs.
N & HC perspectives on community: official publication of the National League for Nursing 18(2):86-90.
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J M Armer
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ABSTRACT: As the trend in relocation to congregate housing continues, protecting the well-being of relocating elderly becomes a major concern. The relationships of perceived choice, predictability, perceived social support, cognitive appraisal, and coping strategies on relocation adjustment were examined through semistructured interviews with elders relocating to a congregate setting in New York state. Perceived choice in relocation, predictability, perceived social support from family and neighbors, and cognitive appraisal of the move as threat or challenge were found to correlate significantly with adjustment. The majority of subjects viewed the move to a congregate setting positively, predominantly as a challenge, and as different but not extremely difficult. This study provides increased research-based understanding of the factors influencing postrelocation adjustment and fuller understanding of the personal meaning of the relocation experience that may be used to aid the successful transition of an older person to a group residential setting.
Issues in Mental Health Nursing 14(2):157-72.
