Karen Prestwood - Academia.edu (original) (raw)

Papers by Karen Prestwood

PubMed, Sep 1, 2003

Objectives Describe the development of a novel instrument to measure resident knowledge and self-... more Objectives Describe the development of a novel instrument to measure resident knowledge and self-efficacy in palliative care. Discuss the psychometric analysis used to assess this novel palliative care competency-based instrument. Original Research Background. We developed a needs assessment based on consensus palliative care (PC) competencies for internal medicine (IM) residents to identify baseline knowledge and self-efficacy as a first step in developing a competency-based PC curriculum (Shaefer, 2014). Research Objectives. To evaluate a novel competency-based instrument assessing residents' self-efficacy and knowledge in PC. Methods. We created a 2-part instrument with a knowledge test (KT; 14 questions) and self-efficacy inventory (SEI; 35 statements) addressing 13 core resident PC competencies across 5 domains: Pain/ Symptom Management (PSM); Communication (COMM); Psychosocial/Spiritual/Cultural Aspects of Care (PSC); Terminal Care/Bereavement (TCB); and PC Principles/Practice (PCPP). We distributed the instrument to all IM residents between June-July 2015. We performed a standard item analysis on the KT; for the SEI, we measured internal consistency (Cronbach's Alpha) and variable relationships among the domains (Pearson's bivariate correlations).

Obstetrical & Gynecological Survey, Jun 1, 1999

Previous studies have shown that treatment with estrogen or calcium decreases bone turnover in ol... more Previous studies have shown that treatment with estrogen or calcium decreases bone turnover in older women. The mechanisms by which estrogen and calcium exert their effects are probably different. We therefore examined the possibility of an additive or synergistic effect of combined treatment with calcium and low dose estrogen on bone turnover in older women, using biochemical markers. Thirty-one healthy women over 70 yr of age were randomized to 12 weeks of treatment with either micronized 17beta-estradiol [0.5 mg/day Estrace (E2)] or 1500 mg/day elemental calcium, given as carbonate plus vitamin D (800 IU/day; Ca+D). At the end of the initial 12-week treatment period, both groups received both Ca+D and E2 for an additional 12 weeks. Eleven older women were followed for 36 weeks without any treatment and served as a control group. Serum and urine were collected at baseline, at 12 and 24 weeks on treatment, and at 12 weeks after treatment was terminated for measurement of biochemical markers of bone turnover. Markers of bone formation were bone alkaline phosphatase, osteocalcin, and type I procollagen peptide; markers of bone resorption were urinary cross-linked C-telopeptides and N-telopeptides of type I collagen, serum cross-linked N-telopeptides of type I collagen, urinary free deoxypyridinoline cross-links, and serum bone sialoprotein. Repeated measures ANOVA was used to determine changes in bone turnover measures over time by group. All markers of bone resorption decreased with initial treatment and decreased further with combination therapy (P < 0.001). Markers of bone formation decreased with Ca+D treatment, but not with E2 alone; there was no additional effect of combination therapy on formation markers compared to Ca+D alone. Neither markers of formation nor resorption changed in the control group. These results suggest that there is an additive effect of low dose estrogen and calcium on bone resorption, but not on bone formation, in older women. Thus, the combination of low dose estrogen plus calcium is likely to be more effective in older women than either treatment alone.

Topics in Geriatric Rehabilitation, Jun 1, 1993

Clinics in Geriatric Medicine, Aug 1, 1998

Journal of women's health and gender-based medicine, Sep 1, 1999

A number of studies suggest that progestogens have beneficial effects on bone in postmenopausal w... more A number of studies suggest that progestogens have beneficial effects on bone in postmenopausal women, particularly in combination with estrogen, although these studies have used derivatives that may have estrogenic and androgenic properties in addition to effects mediated by progesterone receptors. Progesterone itself affects only progesterone and glucocorticoid receptors. However, until the development of micronized progesterone (MP), absorption of progesterone preparations was too low to be clinically useful. MP has similar protective effects on the uterus and fewer effects on the lipid profile than other preparations, but its effects on bone are unknown. We tested the hypothesis that MP would alter bone turnover, as measured by serum and urine biochemical markers, in postmenopausal women. Fourteen women aged 65 or over who were not on estrogen replacement received a 6-week course of daily MP (200 mg). Markers of bone turnover were measured in serum and urine collected at baseline, at 6 weeks on MP, and 6 weeks after termination of MP. We also measured total and high-density lipoprotein (HDL) cholesterol and progesterone levels during the study. Markers of bone résorption were urinary free deoxypyridinoline cross-linked N-telopeptides and C-telopeptides of type I collagen. Markers of bone formation were serum osteocalcin, bone alkaline phosphatase, and type I C-terminal and N-terminal procollagen peptides. Using repeated measures analysis of variance, markers of bone formation and résorption did not change with MP treatment in spite of an increase in progesterone levels in all women. We conclude that 6-week treatment with MP alone does not have an effect on bone turnover in postmenopausal women in spite of high physiological levels. These data suggest that effects on bone demonstrated using other progestogen preparations might be due to androgenic or estrogenic effects or that progesterone may not affect bone in estrogen-deficient women.

Journal of Gerontological Nursing, Jul 1, 2004

ABSTRACT The purpose of this study was to evaluate the effect of several interventions on improvi... more ABSTRACT The purpose of this study was to evaluate the effect of several interventions on improving medication adherence among White, Black, and Hispanic older women. A total of 109 women older than age 65 who were participating in a clinical osteoporosis trial were recruited for this 12-month study examining medication adherence. After baseline medication adherence was assessed, participants underwent standardized teaching. Participants were contacted monthly by telephone and were seen in a clinic setting every 3 months. All participants used a pillbox for 6 months, and the minority women used an electronic monitoring bottle for 6 months. Adherence was highest in White women. Black women showed significant improvement in adherence at 9 and 12 months, and Hispanic women demonstrated a significant increase in adherence at 12 months. The use of electronic monitors had a positive effect on adherence for the minority women.

Cambridge University Press eBooks, Aug 24, 2000

Obstetrical & Gynecological Survey, Apr 1, 1996

This study examined the effects of tamoxifen (TAM) on biochemical markers of bone turnover in hea... more This study examined the effects of tamoxifen (TAM) on biochemical markers of bone turnover in healthy women, 20-30 yr past menopause. Ten women (mean age, 75 yr; range, 70-85 yr) were given TAM (20 mg/day) for 10 weeks. Serum and urine were collected twice at baseline, at weeks 9 and 10 of TAM treatment, and at weeks 9 and 10 post-TAM. Markers of bone formation were serum osteocalcin, total alkaline phosphatase, bone-specific alkaline phosphatase, and type I procollagen peptide. Markers of bone resorption were fasting urinary calcium, hydroxyproline, pyridinoline, and deoxypyridinoline, all corrected for urinary creatinine. Total cholesterol, triglycerides, and high density lipoproteins were measured; low density lipoprotein levels were calculated. Pyridinoline and deoxypyridinoline decreased during therapy by 23% and 25% and returned to baseline posttherapy (F = 37.01; P = 0.001), with no significant changes in urinary calcium and hydroxyproline. Markers of bone formation declined 17-36%, with a variable return toward baseline (F = 85.56; P < 0.001). Ionized calcium decreased 5% (P < 0.001) and PTH increased 21% (P = 0.05) during TAM treatment. Total cholesterol decreased 15% (P < 0.001), and calculated low density lipoprotein cholesterol decreased 22% (P < 0.001); levels of triglycerides and high density lipoprotein did not change significantly. We conclude that short term TAM treatment inhibits bone turnover in women over 70 yr of age.

Clinical Cornerstone, 2000

Osteoporosis develops in older adults when the normal processes of bone formation and resorption ... more Osteoporosis develops in older adults when the normal processes of bone formation and resorption become uncoupled or unbalanced, resulting in bone loss. Fractures are the result of decreased bone mass and strength and, in the case of wrist and hip fractures, usually involve a fall. Osteoporosis prevention and treatment programs should then focus on strategies that minimize bone resorption and maximize bone formation as well as on strategies that reduce falls. Optimal treatment and prevention of osteoporosis require modification of risk factors, particularly smoking cessation, adequate physical activity, and attention to diet, in addition to pharmacologic intervention. A number of pharmacologic options are now available to health care providers. This article focuses on US Food and Drug Administration-approved medications for osteoporosis and emphasizes the importance of using these agents as part of a comprehensive program that includes nonpharmacologic measures, complete diagnostic evaluation, and adequate follow-up with bone mineral density measurement.

Journal of the National Medical Association, 2001

This preliminary study explored the roles of knowledge, attitudes, and significant others on deci... more This preliminary study explored the roles of knowledge, attitudes, and significant others on decisions of older African-American women to enroll in a clinical trial involving estrogen and osteoporosis. Sixteen older African-American women (average age 75 years) participated in three focus groups. Twelve of the women had enrolled in the clinical trial and four, although eligible, refused to enroll. Discussions revealed that knowledge of osteoporosis and estrogen and expectations of personal rewards and group benefits from medical research appear to differentiate the women who participated in the clinical trial from those who refused. The women who participated also perceived the research institution as accessible. In addition, assuring full disclosure of testing procedures and test results eased their apprehensions about participation. However, the women who refused to enroll saw no personal benefit and were unwilling to expose themselves, in part because of their age, to the risks o...

JAMA: The Journal of the American Medical Association, 1992

Bone and Mineral, Apr 1, 1992

Techniques in Orthopaedics, 2003

... 26. Therapeutic touch, healing touch, Reiki are probably the most commonly used energy healin... more ... 26. Therapeutic touch, healing touch, Reiki are probably the most commonly used energy healing modalities, and all these involve a practitioner who assesses the client's ... Dolores Kreiger andDora Kunz developed this intervention and nurses have used it for more than 25 years ...

Encyclopedia of Endocrine Diseases, 2004

Osteoporosis is a disease that is characterized by low bone mass and microarchitectural deteriora... more Osteoporosis is a disease that is characterized by low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture incidence.

Connecticut medicine, 2003

Hip fracture incidence accelerates approximately 10 years following the menopause in women and af... more Hip fracture incidence accelerates approximately 10 years following the menopause in women and after age 70 in men. Approximately one million Americans suffer fragility fractures each year at a cost of over 14 billion dollars. The disability, mortality and cost of hip and vertebral fractures are substantial in the rapidly growing aging population so that prevention of osteoporosis is a major public health concern. Bone mineral density (BMD) measurement is used to make the diagnosis of osteoporosis prior to incident fracture, and to predict fracture risk. Recommendations for treatment and prevention of osteoporosis based on bone mineral density score published by the World Health Organization and the National Osteoporosis Foundation are outlined.