Publications

Abstract

The American Association of Colleges of Nursing identifies palliative and hospice care as one of 4 core spheres of nursing in its new Essentials outcomes. However, research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. When a large urban hospital opened a specialty unit for comfort-focused EOL care, nurses felt unprepared to communicate effectively with patients and families. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed. It included environmental cues, engaging pocket cards, and an education module on communication techniques. Data were collected on nurses' confidence and competence in EOL communication, and qualitative feedback on the usefulness of the interventions was obtained. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Nurses reported pocket cards and posters were helpful clinical reminders. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.

Abstract

Background: Shift work and scheduling are major contributors to occupational stress for nurses, leading to job dissatisfaction and risk of turnover. Nurse scheduling processes are complex, as they are dynamically linked to nurse staffing and patient demand. Objective: This study sought to describe barriers and facilitators influencing job and scheduling satisfaction among staff nurses and nurse managers. Methods: We used a qualitative descriptive design. The sampling frame included staff nurses and nurse managers employed at an urban academic medical center. Participants (N = 16) completed individual semi-structured Zoom interviews from August 2023 to February 2024, which were audio recorded and transcribed. Data were analyzed using content analysis. Results: The overarching theme identified was “Scheduling is everything,” reflecting the importance of scheduling for nurses’ satisfaction in and outside of work. Both staff nurses and managers identified tensions between scheduling for patient care needs (e.g., adequate staffing) and scheduling to optimize staff needs (e.g., health, sleep). They also identified staffing shortfalls as a contributor to these scheduling tensions. Staff nurses reported that scheduling challenges compromised their health and well-being, caused work-family conflict, and influenced turnover intentions. Facilitators of scheduling satisfaction included scheduling flexibility, autonomy, and equity. Participants also provided pragmatic ideas for improving scheduling processes. Conclusions: Our study explored perspectives on job and scheduling satisfaction through the lens of both staff and managers. Scheduling challenges contribute to nurses’ job dissatisfaction and turnover intentions. By increasing scheduling flexibility, equity, and integrating nurse-led innovations into the scheduling process, healthcare organizations can potentially increase nurse retention.

Abstract

Background: In the United States, nearly 1 million older adults reside in assisted living facilities, which aim to provide support for safe, autonomous living. However, low-income residents, especially those in Medicaid-supported facilities, experience unmet medical and social complex care needs and limited serious illness communication due to limited resources. Objective: The objective of this study was to explore the complex care needs and serious illness communication challenges experienced by low-income older adults in Medicaid-supported assisted living. Methods: A qualitative secondary framework analysis was conducted on data from a parent qualitative study involving 17 residents aged 60 and older with serious illnesses at a Medicaid-supported facility in New York City. Residents completed the Edmonton Symptom Assessment Scale and participated in semistructured interviews. This study was guided by the National Consensus Project for Quality Palliative Care, focusing on the residents’ experiences, complex care needs, and communication within palliative care domains. Results: Residents were predominantly Black and Hispanic, with nearly one-third having a history of homelessness or shelter use, and they experienced a high symptom burden. Four key themes emerged: (1) compromised quality of life; (2) high symptom burden and limited access to care, with residents reporting pain, fatigue, and emotional distress; (3) communication gaps while navigating health care, resulting in frustration and feelings of being unheard; and (4) fragmented care coordination, which exacerbated feelings of isolation and mistrust in the health care system. Conclusion: The findings reveal that Medicaid-supported assisted living residents encounter substantial challenges related to complex care needs and serious illness communication. There is an urgent need for community-based interventions to enhance care access, improve symptom management, and facilitate effective communication, ultimately supporting the residents’ quality of life and health outcomes. Enhanced training for staff and policy changes are key to addressing these systemic barriers to care.

Abstract

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals’ perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Abstract

AIM: To describe the self-reported mental health of nurses from 35 countries who worked during the COVID-19 pandemic. BACKGROUND: There is little occupationally specific data about nurses' mental health worldwide. Studies have documented the impact on nurses' mental health of the COVID-19 pandemic, but few have baseline referents. METHODS: A descriptive, cross-sectional design structured the study. Data reflect a convenience sample of 9,387 participants who completed the opt-in survey between July 31, 2022, and October 31, 2023. Descriptive statistics were run to analyze the following variables associated with mental health: Self-reports of mental health symptoms, burnout, personal losses during the pandemic, access to mental health services, and self-care practices used to cope with pandemic-related stressors. Reporting of this study was steered by the STROBE guideline for quantitative studies. RESULTS: Anxiety or depression occurred at rates ranging from 23%-61%, with country-specific trends in reporting observed. Approximately 18% of the sample reported experiencing some symptoms of burnout. The majority of nurses' employers did not provide mental health support in the workplace. Most reported more frequently engaging with self-care practices compared with before the pandemic. Notably, 20% of nurses suffered the loss of a family member, 35% lost a friend, and 34% a coworker due to COVID-19. Nearly half (48%) reported experiencing public aggression due to their identity as a nurse. CONCLUSIONS: The data obtained establish a basis for understanding the specific mental health needs of the nursing workforce globally, highlighting key areas for service development. IMPLICATIONS FOR NURSING POLICY: Healthcare organizations and governmental bodies need to develop targeted mental health support programs that are readily accessible to nurses to foster a resilient nursing workforce.

Abstract

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other’s persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Abstract

Background: Chronic kidney disease (CKD) impacts more than 800 million people. It causes significant suffering and disproportionately impacts marginalized populations in the United States. Kidney palliative care has the potential to alleviate this distress, but has not been tested. This pilot study evaluates the feasibility of a randomized clinical trial (RCT) testing the efficacy of integrated kidney palliative and CKD care in an urban safety-net hospital. Methods: This is a single-site pilot RCT designed to enroll 85 participants, with a goal of at least 60 completing the study. The inclusion criteria are adults 18 or older, who are either Spanish or English speakers, have an estimated Glomerular Filtration Rate (eGFR) of ≤30 mL/min/1.73 m2, and are receiving care at our safety net hospital. Participants will be randomized in permuted blocks of two or four to either the intervention group, who will receive monthly ambulatory care visits for six months with a palliative care provider trained in kidney palliative care, or to usual nephrology care. Primary outcomes are feasibility of recruitment, retention, fidelity to the study visit protocol, and the ability to collect outcome data. These outcomes include symptom burden, quality of life, and engagement in advance care planning. Discussion: This pilot RCT will provide essential data on the feasibility of testing integrated palliative care in CKD care in an underserved setting. These outcomes will inform a larger, fully powered trial that tests the efficacy of our kidney palliative care approach. Clinical trial registration: NCT04998110.

Abstract

Psychedelic-assisted therapy (PAT) involves supported experiences with psychedelic medicines in carefully curated environments. Early evidence suggests possible utility of PAT for addressing psychosocial-spiritual-existential concerns, yet gaps remain in understanding findings related to PAT's role in palliative care. This rapid review aims to synthesize current literature on applications of PAT in the context of palliative care. Through a systematic process, we identified 34 articles published between January 2021 and July 2024. Protocols varied yet included common components of participant screening, preparation, dosing, and integration. Psilocybin was the most commonly studied compound. Results support safety and initial efficacy of PAT for psycho-spiritual-existential outcomes among carefully screened and highly homogonous samples of patients with serious illness (predominantly cancer). Current efforts and challenges around integrating PAT into systems of palliative care were highlighted. Additional work is needed to (1) explore PAT's safety and efficacy within more diverse samples and contexts, (2) train palliative care providers on PAT, (3) determine systems of care delivery best suited for translation of PAT into practice, and (4) begin developing policy solutions to support safe and equitable access to PAT. Because many patients lack access to basic psychosocial-spiritual-existential care, careful consideration is needed around integration of PAT. The psychedelic substances which are the topic of this article are not currently FDA approved for use in the United States.

Abstract

Hypermutated proviruses, which arise in a single Human Immunodeficiency Virus (HIV) replication cycle when host antiviral APOBEC3 proteins introduce extensive guanine to adenine mutations throughout the viral genome, persist in all people living with HIV receiving antiretroviral therapy (ART). However, hypermutated sequences are routinely excluded from phylogenetic trees because their extensive mutations complicate phylogenetic inference, and as a result, we know relatively little about their within-host evolutionary origins and dynamics. Using >1400 longitudinal single-genome-amplified HIV env-gp120 sequences isolated from six women over a median of 18 years of follow-up—including plasma HIV RNA sequences collected over a median of 9 years between seroconversion and ART initiation, and >500 proviruses isolated over a median of 9 years on ART—we evaluated three approaches for masking hypermutation in nucleotide alignments. Our goals were to (i) reconstruct phylogenies that can be used for molecular dating and (ii) phylogenetically infer the integration dates of hypermutated proviruses persisting during ART. Two of the approaches (stripping all positions containing putative APOBEC3 mutations from the alignment or replacing individual putative APOBEC3 mutations in hypermutated sequences with the ambiguous base R) consistently normalized tree topologies, eliminated erroneous clustering of hypermutated proviruses, and brought env-intact and hypermutated proviruses into comparable ranges with respect to multiple tree-based metrics. Importantly, these corrected trees produced integration date estimates for env-intact proviruses that were highly concordant with those from benchmark trees that excluded hypermutated sequences, supporting the use of these corrected trees for molecular dating. Subsequent molecular dating of hypermutated proviruses revealed that these sequences spanned a wide within-host age range, with the oldest ones dating to shortly after infection. This indicates that hypermutated proviruses, like other provirus types, begin to be seeded into the proviral pool immediately following infection and can persist for decades. In two of the six participants, hypermutated proviruses differed from env-intact ones in terms of their age distributions, suggesting that different provirus types decay at heterogeneous rates in some hosts. These simple approaches to reconstruct hypermutated provirus’ evolutionary histories reveal insights into their in vivo origins and longevity toward a more comprehensive understanding of HIV persistence during ART.

Abstract

Background: Condom use has long been recommended as an effective method for preventing HIV/AIDS. However, a large proportion of older adults in China reported not using condoms, leading to an alarming increase in HIV prevalence among this population. Negative attitudes, especially condom-related stigma, have been identified as the main barrier. However, no condom-related stigma scale has been developed or validated for older adults in the Chinese cultural context. This study aimed to adapt and validate a condom-related stigma scale for older adults (CRSS-OA) in China, based on a scale previously developed for men who have sex with men (CRSS). Methods: Based on qualitative interviews, we adapted and revised the CRSS to better address the ageism and unique stigma faced by older adults in the Chinese cultural context. The reliability and validity of the adapted CRSS-OA were examined using a random sample of 498 older adults in Hunan Province, south-central China. Reliability was assessed by calculating Cronbach’s alpha. Construct validity was assessed through exploratory and confirmatory factor analyses. Concurrent validity was assessed by examining the correlation between each factor of the CRSS-OA and two criterion scales (the HIV/AIDS Stigma Scale and the Aging Sexual Attitudes Scale). Predictive validity was evaluated by analyzing the association between condom-related stigma and engagement in condomless sexual behavior. Results: The adapted scale included 16 items, loading on three factors, and collectively explaining 70.646% of the variance. These factors were named “labeling condom use,” “shaming condom purchase,” and “violating traditional sex beliefs,” demonstrating strong internal consistency with Cronbach’s alpha coefficients of 0.942, 0.850, and 0.852, respectively. Concurrent validity was established by evaluating the correlation between each factor of the CRSS-OA and two criterion scales, with Pearson correlation coefficients ranging from 0.227 to 0.508 (p < 0.05). Predictive validity was assessed by measuring the scale’s ability to correctly predict condomless sexual behavior, with an average predictability of 0.77. Conclusions: The adapted CRSS-OA has proven to be a valid and cultural-adaptive tool for assessing condom-related stigma among older adults in China. Further studies are needed to explore the external validity of this scale in the future.

Abstract

Background: Adverse events in nursing homes, which are unintended incidents causing unnecessary harm to older residents. Previous studies in Chinese populations often focused on adverse events in hospitals, rather than residents in nursing homes. Additionally, they tended to focus on single incident rather than multiple types of adverse events. This study aims to assess the occurrence and contributing factors of multiple adverse events perceived by staff in Chinese nursing homes. Methods: A cross-sectional survey was conducted among 691 frontline staff from 11 nursing homes in Southern China (August 2021–January 2022). Data were collected using a General Information Questionnaire, the Adverse Event Reporting Awareness Scale, and the Adverse Event Reporting Habit Scale. Logistic regression models were employed to analyze the contributing factors of adverse events. Results: A total of 13 types of adverse events were screened out in nursing homes, and 477 (69.0%) participants reported that the adverse events “had happened” in the past year. The most common events were falls, unplanned extubation, and pressure sores. Clinical staff were 2.06 times more likely than frontline workers to report adverse events (95% CI = 1.13–3.76). Increased awareness (OR = 1.24, 95% CI = 1.15–1.34) and habitual reporting of adverse events (OR = 1.04, 95% CI = 1.01–1.08) were positively associated with higher reporting rates. Conclusion: A significant proportion of staff reported adverse events, with clinical staff and those with better reporting habits noting higher occurrences. To enhance resident safety, nursing homes must prioritize preventing high-risk adverse events. Targeting frontline workers with lower reporting awareness and habits is crucial for effective interventions.

Abstract

Objective: To determine if microbiome differences exist in head and neck squamous cell carcinoma (HNSCC) based on high-risk pathologic features, smoking, and outcomes using The Cancer Microbiome Atlas (TCMA). Study Design: Database study. Setting: Database review. Methods: TCMA is a publicly available database containing curated, decontaminated microbial profiles for tumors from 1772 patients. The data were limited to microbiome profiles, survival, and clinicopathologic features for HNSCC patients. Phyloseq objects were created, low-read samples were removed, and differential abundance analysis (DAA) using Analysis of Compositions of Microbiomes with Bias Correction 2 (ANCOM-BC2) was performed. Statistical analysis was done in R (v4.3.1). Results: One hundred fifty-six patients with HNSCC were included from TCMA with a mean age of 59 (std 13, min 19, and max 90), 72% male (n = 113), and 91% white (n = 140). Primary sites encompassed oral cavity (n = 106, 68%), oropharynx (n = 26, 17%), and larynx/hypopharynx (n = 24, 15%). For all HNSCC in TCMA, rates of lymphovascular invasion were 17% (n = 26), perineural invasion, 34% (n = 53), and microscopic or gross extranodal extension (ENE), 19% (n = 30). DAA revealed significant changes in bacterial genera based on high-risk pathologic features, smoking status, vital status, and disease-specific survival (DSS). Genera observed with ANCOM-BC2 include Scardovia, Alloscardovia, Lactobacillus, and Corynebacterium genera for vital status and DSS. Conclusion: Changes in the relative abundance of select intratumoral bacterial genera are associated with adverse pathologic features, DSS, and vital status in HNSCC. Shifts in the microbiome need further investigation to determine if they can provide any mechanistic insight or predictive role.

Abstract

We report results of a workforce initiative to increase functional screenings for older adults with lived experiences of homelessness. Thirty-four healthcare practitioners screened 253 patients ages 50 years + using a battery of screening tools aligned with the 4 Ms. Using secondary analyses, we describe practitioners’ participation in the workforce initiative, patients’ functional scores, and a qualitative analysis of “what matters” to patients. Many practitioners did not complete all screenings. Among patient respondents, 6% reported moderate to severe ADL impairment; 24% scored positive cognitive impairment; 32% reported being unable to walk 250 feet; 46% reported moderate to severe pain. Resilience strategies developed during homelessness “matter.” Few participants reported impaired ADL performance, which may reflect levels of independence needed to survive homelessness or to maintain services while homelessness. Findings suggest a need for additional workforce training to increase functional screenings for older adults in this population.

Abstract

Background: Oral hygiene care is instrumental to maintaining optimal oral health. As dementia progresses, individuals face challenges performing adequate oral hygiene care and become dependent on their caregivers. The role of family caregivers in assisting with oral hygiene care becomes increasingly critical. This study explored the association between caregiving circumstances, care recipient characteristics, and assistance in oral hygiene care among dementia caregivers in Chinese American communities. Methods: Data came from a pilot study on Chinese dementia caregivers in New York City collected between November 2021 and June 2022. Purposive sampling was used to recruit family caregivers to participate in a survey (online or via telephone). Current caregivers (n = 76) were included. Caregiver assistance with oral hygiene care was measured by assistance with toothbrushing (yes or no) and assistance with flossing (yes or no). Descriptive analyses, group comparisons, and logistic regressions were conducted. Results: Female caregivers tended to assist with toothbrushing. Caregivers with an average of 2.4 years in providing care tended to assist with flossing. Care recipients with tooth pain were 5.12 times more likely to receive assistance with toothbrushing. Care recipients with more natural teeth were 1.07 times more likely to receive assistance with toothbrushing. Care recipients with severe dementia were 94 % less likely to receive assistance with flossing. Conclusions: The findings underscore the importance of understanding the factors that influence caregivers’ assistance with oral hygiene care. This study is a crucial first step toward developing effective, caregiver-led interventions to improve the oral hygiene of individuals with dementia.

Abstract

South Asians are among the fastest-growing immigrant population group in the United States (U.S.) with a unique disease risk profile. Due in part to immigration and acculturation factors, South Asians engage differently with behavioural risk factors (e.g. smoking, alcohol intake, physical activity, sedentary behaviour, and diet) for hypertension, which may be modified for the primary prevention of cardiovascular disease. Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, we conducted a cross-sectional analysis to evaluate the association between behavioural risk factors for cardiovascular disease and diet. We created a behavioural risk factor score based on smoking status, alcohol consumption, physical activity, and TV watching. We also calculated a Dietary Approaches to Stop Hypertension (DASH) dietary score based on inclusion of relevant dietary components. We used both scores to examine the association between engaging with risk factors for hypertension and the DASH diet among a cohort of South Asian adults. We found that participants with 3–4 behavioural risk factors had a DASH diet score that was 3 units lower than those with no behavioural risk factors (aβ: –3.25; 95% CI: –4.28, –2.21) and were 86% less likely to have a DASH diet score in the highest category compared to the lowest DASH diet score category (aOR: 0.14; 95% CI: 0.05, 0.37) in the fully adjusted models. These findings highlight the relationship between behavioural risk factors for hypertension among South Asians in the U.S.

Abstract

Aim: To evaluate the association between oral hygiene behaviour and cognitive decline in adults. The outcomes include changes in global cognitive function, visual attention, task switching and the risk of dementia. Design: We conducted a systematic review following the preferred reporting items for systematic reviews and meta-analyses guidelines. Data Sources: A systematic search of 11 databases and grey literature sources was conducted from inception to January 2024. We included interventional trials or cohort studies that investigated the effect of oral hygiene behaviours (e.g., toothbrushing, mouth washing, flossing, using toothpicks and cleaning dentures) on cognitive decline in adults. Methods: Data extraction and risk of bias assessment were performed by two independent reviewers with expertise in conducting systematic reviews. Meta-analyses were conducted using random-effects models, and heterogeneity was assessed with the I2 statistic and χ2 test. Results: A total of eight studies (six intervention studies and two cohort studies) met inclusion criteria, including 261,772 participants. Follow-up periods ranged from 30 days to 48 months for interventions and 9 to 18 years for cohorts. Toothbrushing was associated with a significantly slower decline in global cognitive overtime. Toothbrushing in older adults with moderate/severe dementia could achieve significant changes in cognitive decline. There was no significant difference between the effectiveness of toothbrushing performed by professionals and caregivers. Other oral hygiene behaviours, including dental flossing, using mouthwash, using toothpicks and cleaning dentures, were not associated with the risk of dementia. Conclusions: Toothbrushing is linked to a decreased risk of dementia and improved global cognitive function. Promoting toothbrushing at least twice daily may significantly reduce the risk of cognitive decline and dementia. Impact: These findings highlight the urgent need for programmes that encourage daily toothbrushing, particularly in nursing home settings and among older adults with moderate-to-severe dementia.

Abstract

Background: Motoric cognitive risk (MCR) syndrome is a predementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Although past research has suggested that personality traits could play a significant role in the onset and progression of MCR among older adults, the exact relationships between specific personality profiles and MCR remain unclear. This study aimed to examine the relationship between personality profiles and MCR among community-dwelling older adults. Methods: A cross-sectional study was conducted from March 2021 to January 2022. Personality traits, including openness, extraversion, agreeableness, conscientiousness and neuroticism, were measured using the 40-item brief version of the Chinese Big Five Inventory. The Latent profile analysis was used to identify personality profiles among these older adults who shared similar patterns of personality traits. The Lanza, Tan, and Bray’s approach was employed to investigate the personality profile-specific differences in MCR prevalence. Furthermore, a stepwise multinomial logistic regression revealed unique population characteristics for different personality profiles. Results: A total of 538 eligible participants were included in this study. The mean age was 73.25 years (SD = 9.0) and 62.50% were females. This study identified four distinct personality profiles: the resilient, ordinary, reserved, and anti-resilient profiles. The resilient profile exhibited the lowest prevalence of MCR (mean = 6%, SE = 0.024), whereas the anti-resilient profile had the highest (mean = 20.3%, SE = 0.043). The prevalence of MCR differed among personality profiles (overall χ2 = 14.599, p = 0.002). Personality profile membership was characterized by different population characteristics. Notably, the anti-resilient profile was association with symptoms of depression (OR = 28.443, 95%CI = 11.095–72.912), while the reserved profile was linked with advanced age (OR = 1.031, 95%CI = 1.003–1.061). Overall, a low education level and poor sleep quality were the robust attribution factors. Conclusions: This study revealed that personality profiles may assist in identifying older adults at greater risk of MCR. Increased awareness and management of personality profiles may contribute to the prevention of MCR.

Abstract

Background: Experiential learning activities on care for people with disabilities (PWD) would help nursing students develop the knowledge, skills, and attitudes (KSAs) needed to provide quality care for PWD. Purpose: The purpose of this study was to evaluate the perceived changes in nursing students' KSAs related to the care for PWD following participation in health assessment and prevention (HAP) experiential learning activities. Methods: This was a quasi-experimental, pre- and posttest educational intervention study. Nursing students (n = 160) attended multiple experiential learning activities as a required part of their HAP coursework and completed a pre and posttest survey to assess changes in their KSAs. Results: Participation in experiential learning activities on care for PWD was associated with significant increases in perceived knowledge, skills and positive attitudes toward PWD. Conclusions: Experiential learning activities aligned with core competencies for health care providers caring for PWDs have the potential to change nursing care and address health inequities for this population.

Abstract

Introduction: Timely diagnosis is critical for persons with Alzheimer’s disease and related dementias (ADRD) to ensure they receive adequate services; however, timely diagnosis may be prevented by a person’s English language skills. The purpose of this integrative review was to understand how limited English proficiency (LEP) impacts older Latino’s ability to access a timely ADRD diagnosis. Methods: Whittemore and Knafl’s methodological approach guided the review. Searches in five databases yielded 12 articles for inclusion. Results: Lack of culturally congruent health care systems, health care providers, and knowledge of ADRD resulted in delays in obtaining a timely ADRD diagnosis among older Latinos with LEP. Discussion: Latinos with LEP and risk for ADRD benefit from language assistance and support in navigating the health care system. Nurses must be advocates, even when a language barrier is present, and recognize that interpreters are not a single source solution.

Abstract

Background: Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men. Objectives: This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI. Methods: Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups. Results: The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (−0.52 [95% CI: −0.77 to −0.28]) but not the heart disease education arm (−0.19 [95% CI: −0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036). Conclusions: MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.

Abstract

Background: Clinical use of continuous glucose monitoring (CGM) is increasing storage of CGM-related documents in electronic health records (EHR); however, the standardization of CGM storage is lacking. We aimed to evaluate the sensitivity and specificity of CGM Ambulatory Glucose Profile (AGP) classification criteria. Methods: We randomly chose 2244 (18.1%) documents from NYU Langone Health. Our document classification algorithm: (1) separated multiple-page documents into a single-page image; (2) rotated all pages into an upright orientation; (3) determined types of devices using optical character recognition; and (4) tested for the presence of particular keywords in the text. Two experts in using CGM for research and clinical practice conducted an independent manual review of 62 (2.8%) reports. We calculated sensitivity (correct classification of CGM AGP report) and specificity (correct classification of non-CGM report) by comparing the classification algorithm against manual review. Results: Among 2244 documents, 1040 (46.5%) were classified as CGM AGP reports (43.3% FreeStyle Libre and 56.7% Dexcom), 1170 (52.1%) non-CGM reports (eg, progress notes, CGM request forms, or physician letters), and 34 (1.5%) uncertain documents. The agreement for the evaluation of the documents between the two experts was 100% for sensitivity and 98.4% for specificity. When comparing the classification result between the algorithm and manual review, the sensitivity and specificity were 95.0% and 91.7%. Conclusion: Nearly half of CGM-related documents were AGP reports, which are useful for clinical practice and diabetes research; however, the remaining half are other clinical documents. Future work needs to standardize the storage of CGM-related documents in the EHR.

Abstract

The rising prevalence of Alzheimer's disease and Alzheimer's disease-related dementias has led to renewed public discourse and policy changes in response to the care needs of persons living with dementia and their care partners. Comprehensive dementia care models are central to many recent policy initiatives, most notably the Centers for Medicare & Medicaid Services Guiding an Improved Dementia Experience model. Gerontological nursing research is uniquely positioned to design and lead research investigating the effectiveness of these initiatives, as well as the dissemination and scaling of existing comprehensive dementia care models. The current Annual State of the Science Review provides an overview of the current state of comprehensive dementia care models in the United States and relevant policies. Challenges and opportunities for nursing education, research, and implementation across the translational research continuum are also outlined. [Research in Gerontological Nursing, 18(1), 7-16.].

Abstract

Introduction: South Asian adults are at high risk for atherosclerotic cardiovascular disease, for which coronary artery calcification is an early predictor. Adherence to the Dietary Approaches to Stop Hypertension diet is a modifiable risk factor that may mitigate the progression of coronary artery calcification and atherosclerotic cardiovascular disease. Methods: Using data from the Mediators of Atherosclerosis in South Asians Living in America cohort, the authors calculated a Dietary Approaches to Stop Hypertension dietary score (categorized as low, moderate, and high) to examine the associations of Dietary Approaches to Stop Hypertension diet adherence with coronary artery calcification after a 5-year follow up. Results: The authors found that participants in the high Dietary Approaches to Stop Hypertension category were 41% less likely to have coronary artery calcification score >100 (age-adjusted incidence rate ratio=0.59; 95% CI=0.36, 0.95) than those in the low category; this association was attenuated in multivariable models. Differences were observed by sex. Men in the high Dietary Approaches to Stop Hypertension category were 51% less likely to have coronary artery calcification score >100 (adjusted incidence rate ratio=0.49; 95% CI=0.26, 0.95) and experienced 0.46-fold coronary artery calcification change (fold change=0.46; 95% CI=0.18, 0.90) in multivariable models. Conclusions: The findings indicate a relationship between Dietary Approaches to Stop Hypertension diet and early predictors of atherosclerotic cardiovascular disease risk among South Asians living in the U.S., particularly men.

Abstract

Background In clinical settings, counseling patients on physical activity starts by assessing patients' current physical activity levels. Self-report measures of PA are generally easy to administer; however, they may be too long to be convenient and are known to correlate poorly with objective measures of physical activity. Objective To assess the concurrent validity of a self-report three-question physical activity vital sign with objective Fitbit step counts and the distance walked during a 6-min walk test. Methods This pilot study tested a best practice advisory embedded in the Epic electronic health record, which was designed to prompt providers in a preventive cardiology clinic to counsel patients reporting low levels of physical activity. Patients were invited to participate in the remote patient monitoring phase to assess the change in their physical activity by wearing a Fitbit for 12 weeks and completing a 6-min walk test at baseline and 12 weeks. This analysis used the cross-sectional data collected in this phase. Pearson correlations were conducted between self-reported physical activity, Fitbit step counts, and the distance walked during the 6-min walk - a measure associated with current physical activity levels. Kappa coefficients were calculated to assess agreement between the self-reported physical activity and step counts. Results Participants who enrolled in the Fitbit monitoring were approximately 50% female, with the majority identified as White non-Hispanic adults. Their most common cardiovascular risk factor was hypertension. The self-reported physical activity vital signs were significantly associated with step counts at baseline and 12 weeks but were not associated with the distance during the 6-min walk test. However, the distance walked was significantly associated with step counts at baseline and 12 weeks. The Kappa results demonstrate a poor level of agreement between two categories (meeting or not meeting current physical activity guidelines) of self-report physical activity vitals and the objective Fitbit step counts. Discussion There were moderate correlations between the self-reported physical activity vital signs and the Fitbit step counts, but there was lack of agreement when they were categorized. Further validation of this physical activity vital sign is warranted.