Publications

Abstract

The recruitment of community-dwelling older adults, particularly those with cognitive impairment and those residing in rural areas, has been consistently challenging for researchers, especially in the dental field. This study reports on recruitment experiences from an ongoing study investigating the association between oral health and cognitive status in later life. Multiple recruitment strategies, including educational presentations and traveling to participants' homes, were used to enroll rural elderly participants with various levels of cognitive function. In general, multipronged, proactive recruitment strategies were more effective than traditional, passive methods in reaching participants with varying degrees of cognitive impairment. The outcome of this study suggests that successful recruitment of such populations involves gaining the support of staff at relevant community organizations, informing community members (including older adults and their family members) of the project and the importance of oral health, and making data collection sites accessible for older adults.

Abstract

Purpose of the research: The purpose of this study was to describe the occurrence of significant mood disturbance and evaluate for differences in sleep quality among four mood groups (i.e., neither anxiety nor depression, only anxiety, only depression, anxiety and depression) prior to the initiation of radiation therapy (RT). Methods and sample: Patients (n=179) with breast, prostate, lung, and brain cancer were evaluated prior to the initiation of RT using the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale, and the Spielberger State Anxiety Inventory. Differences in sleep disturbance among the four mood groups were evaluated using analyses of variance. Key results: While 38% of the patients reported some type of mood disturbance, 57% of the patients reported sleep disturbance. Patients with clinically significant levels of anxiety and depression reported the highest levels of sleep disturbance. Conclusions: Overall, oncology patients with mood disturbances reported more sleep disturbance than those without mood disturbance. Findings suggest that oncology patients need to be assessed for mood and sleep disturbances.

Abstract

By 2015, half of those with HIV will be over age 50. This group has a high level of needs, lacks social supports, and will need to access community services such as those provided by religious congregations. We examined whether disclosure to a congregation would pose a barrier to accessing congregational services among adults 50 and older with HIV (n = 819). Fifty-three percent had disclosed, but those who did not disclose generally remained engaged with their congregations. Findings suggest that congregations can be a feasible source of support for older adults with HIV.

Abstract

Injection drug users (IDUs) face an increased risk of acquiring blood borne viral infections, including HIV and the hepatitis C virus (HCV). However, the discrepancy in funding for services to address these two diseases has implications. Although drug treatment programs have played an important role in fighting HIV/AIDS, the HCV-related services offered at these programs remain limited. Research from other countries suggests that drug users view HCV as less important than HIV, yet little is known about the extent to which our society's focus on HIV has been adopted within the drug treatment program culture. This qualitative study examines the perceptions of both staff (n = 165) and clients (n = 215) at these programs with regard to HIV and HCV and presents data on how staffs' attitudes toward HCV changed after participating in an HCV training. Clients described a services landscape at drug treatment programs that favors HIV services over those targeting HCV.

Abstract

Studies suggest that people living with HIV (PLWH) experience many unrelieved symptoms. The purpose of this study was to estimate the occurrence of pain in adult PLWH and to determine whether participants with pain differed from those without pain on selected demographic factors, clinical characteristics, symptoms of fatigue, sleep disturbance, anxiety, or depression. The authors conducted a descriptive, comparative, and correlational study of 317 PLWH seen at academic and community clinics in San Francisco. Participants completed a demographic questionnaire, the Memorial Symptom Assessment Scale, the Fatigue Severity Scale, the General Sleep Disturbance Scale, the Profile of Moods State Tension-Anxiety subscale, and the Center for Epidemiological Studies-Depression Scale. Clinical characteristics (i.e., disease and treatment information) were obtained by self-report. A single item on pain from the Memorial Symptom Assessment Scale was used to classify participants into those with and without pain. Pain was highly prevalent (55%) and was associated with immune status (CD4+ T-cell count), race, and sleep disturbance, but not with age, gender, or symptoms of fatigue, depression, or anxiety.

Abstract

Objectives: To describe rates of scheduled and unscheduled readmissions among midlife and older patients with diabetes and to examine associated socioeconomic and clinical factors. Study Design: Population-based data set study. Methods: Using the 2006 California State Inpatient Dataset, we identified 124,967 patients 50 years or older with diabetes who were discharged from acute care hospitals between April and September 2006 and examined readmissions in the 3 months following their index hospitalizations. Results: About 26.3% of patients were readmitted within the 3-month period following their index hospitalizations, 87.2% of which were unscheduled readmissions. Patients with unscheduled readmissions were more likely to have a higher comorbidity burden, be members of racial/ethnic minority groups with public insurance, and live in lower-income neighborhoods. Having a history of hospitalization in the 3 months preceding the index hospitalization was also a strong predictor of unscheduled readmissions. Almost one-fifth of unscheduled readmissions (constituting approximately 27,500 inpatient days and costing almost $72.7 million) were potentially preventable based on definitions of Prevention Quality Indicators by the Agency for Healthcare Research and Quality. Scheduled readmissions were less likely to occur among patients 80 years or older, the uninsured, and those with an unscheduled index hospitalization. Conclusions: The predictors of scheduled and unscheduled readmissions are different. Transition care to prevent unscheduled readmissions in acutely ill patients with diabetes may help reduce rates, improving care. Further studies are needed on potential disparities in scheduled readmissions.

Abstract

Vigilance has been central to nursing practice since Florence Nightingale. Often, the nurse's work of surveillance goes unnoticed and the public never recognizes the value of the nurse's work. The 1999 Institute of Medicine report on hospital deaths due to preventable errors has lifted the veil shrouding professional vigilance. But how to measure vigilance remained elusive, until the concept, failure to rescue (FTR), was proposed. FTR has taken a prominent role in health care since its adoption as a patient safety indicator by the Agency for Healthcare Research and Quality (AHRQ) and as a measure for nursing performance in acute care by the National Quality Forum (NQF). However, its applicability to school nursing has been unexplored. This article provides an initial review of the literature and an analysis of anecdotal stories and media accounts that illustrate professional vigilance in school nursing practice.

Abstract

Objective: To examine the relationship between typically collected second trimester maternal serum biomarkers and preterm birth among pregnancies without intrauterine-growth-retardation or other specific risk factors. Methods: Included were 102 861 singleton pregnancies without specific risks that resulted in the live birth of an infant of normal birth weight for gestational age without aneuploidy or a neural tube defect. Logistic binomial regression analyses were used to estimate the relative risk (RR) of giving birth preterm among pregnancies with an abnormal level of alpha-fetoprotein (AFP), human chorionic gonatotropin (hCG), and/or unconjugated estriol (uE3) compared to pregnancies with normal biomarker levels. Results: When compared to pregnancies with normal levels of AFP, hCG, and uE3, pregnancies with elevated levels of any biomarker [multiple of the median (MoM) ≥2.0] were at an increased risk for preterm birth regardless of preterm grouping (RRs 1.3-5.4). Risks for preterm birth tended to increase substantially when at least two biomarkers were elevated (RRs 2.2-18.7). Conclusion: The results suggest that second trimester maternal serum biomarkers may help identify pregnancies at increased risk for preterm birth when no other identified risks are present. Data indicates that biomarkers may be particularly predictive of early preterm birth.

Abstract

Objective To describe maternity nurses' perspectives on how they contribute to safety during labour and birth at two urban academic medical centres in the United States. Design Grounded theory: data were collected using semistructured, open-ended interviews and participant observations with registered nurses (RNs) in two inpatient maternity settings. Data were analysed simultaneously using constant comparison, and dimensional and situational analysis. Participants Purposive sample of 12 RNs working in the two maternity units. Findings Safety was broadly conceptualised by RNs as protecting the physical, psychological and emotional wellbeing of a woman and her family. During labour and birth, safety was maintained by RNs through "skilful anticipation" of situational potential. This required integration of medical and technical knowledge and skill with intimate knowledge of the woman and the operational context of care to achieve accurate situation awareness and appropriate future planning. Conditions and processes promoting skilful anticipation included being prepared, knowing, and envisioning the whole picture. Conclusions In the two settings, maternity RNs made active contributions to safe birth in the context of constrained resources through preparing the environment, anticipating potential problems and trapping errors before they reached the patient. The contributions of maternity nurses to team situation awareness and to creating safety need to be appreciated and administratively supported. Continued research with RNs may reveal previously unrecognised opportunities for safety improvements.

Abstract

This study investigated a potential independent association between hypovitaminosis D and suspected nonalcoholic fatty liver disease (NAFLD) in a nationally representative sample of the US adolescents. Data from 1630 subjects 12-19 years of age were examined using the National Health and Nutrition Examination Survey, 2001-2004. The vitamin D status of subjects was categorized into quartiles of serum 25-hydroxyvitamin D. Subjects with serum ALT>30 U/L were classified as having suspected NAFLD. Data regarding age, sex, race, BMI, and poverty level were also analyzed in bivariate and multivariate analyses using SAS and SUDAAN software. Suspected NAFLD was identified in 12.1% of adolescents in the lowest quartile compared to 6.9% of adolescents in the second quartile, 8.0% in the third quartile, and 13.17% in the highest quartile of serum 25(OH)D concentrations (P=.05). In analyses utilizing vitamin D as a continuous variable, no independent association was found between Vitamin D levels and rates of elevated ALT levels. In multivariate analyses, higher risks for suspected NAFLD were observed in males and overweight adolescents; however, vitamin D status was not found to be independently associated with suspected NAFLD after adjusting for obesity.

Abstract

The Sustainability Budgeting Model (SBM) is presented in the context of a department of nursing of a major hospital. If successfully incorporated in the department of nursing, the SBM can easily be moved into the larger hospital context. The SBM was designed recognizing the three necessary components underlying all budgeting models. The SBM incorporates the inherent variability of the resource inflows and outflows and in that sense is robust; it is recommended these resource flows be calibrated for the various time horizons using the standard Present Value model so as to provide comparability across projects. Most importantly, the SBM focuses on financial sustainability considering all the relevant costs - variable and fixed - and so speaks to longterm coordinated planning and continuation of desired patient services.

Abstract

Purpose: Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information.Design: A cross-sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (<73 years) versus older (≥73 years) patients in the ability to detect and interpret their heart failure symptoms.Methods: Shortness of breath was stimulated using a 6-minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person's shortness of breath by trained registered nurse research assistants (inter-rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In-depth interviews were used to assess symptom interpretation ability.Findings: Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT.Conclusions: These results support our theory of an age-related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection.Clinical Relevance: The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients-particularly older ones-in somatic awareness and symptom interpretation. It may be useful to explore patients' statements about how they feel: " Compared to what? How do you feel today compared to yesterday?"

Abstract

BACKGROUND: Data on the quality of life (QOL) of children with non-alcoholic fatty liver disease (NAFLD) are needed to estimate the true burden of illness in children with NAFLD.AIM: To characterize QOL and symptoms of children with NAFLD and to compare QOL in children with NAFLD with that in a sample of healthy children.METHODS: Quality of life and symptoms were assessed in children with biopsy-proven NAFLD enrolled in the NASH Clinical Research Network. PedsQL scores were compared with scores from healthy children. For children with NAFLD, between-group comparisons were made to test associations of demography, histological severity, symptoms and QOL.RESULTS: A total of 239 children (mean age 12.6 years) were studied. Children with NAFLD had worse total (72.8 vs. 83.8, P < 0.01), physical (77.2 vs. 87.5, P < 0.01) and psychosocial health (70.4 vs. 81.9, P < 0.01) scores compared with healthy children. QOL scores did not significantly differ by histological severity of NAFLD. Fatigue, trouble sleeping and sadness accounted for almost half of the variance in QOL scores. Impaired QOL was present in 39% of children with NAFLD.CONCLUSIONS: Children with NAFLD have a decrement in QOL. Symptoms were a major determinant of this impairment. Interventions are needed to restore and optimize QOL in children with NAFLD.

Abstract

Conducting qualitative interviews with seriously ill individuals about end-of-life issues is challenging for interviewers seeking to understand the problems, processes, and experiences individuals undergo when faced with death and dying. Although all qualitative interviewers face issues of building trust and obtaining answers to their research questions, these issues are exacerbated for interviewers of end-of-life issues due to the challenges of debilitated participants, sensitive subject matter, and heightened emotionalism. The purpose of this article is to offer field-tested techniques to tailor basic interviewing practices for discussions of end-of-life issues with seriously ill individuals. Use of tailored techniques facilitates the comfort of both interviewer and participant and enhances the probability of obtaining complete and accurate data, which in turn can improve the effectiveness of subsequent programs, policies, and clinical practice based on research findings.

Abstract

From 2005 to 2008, the Bienvenidos Project trained Puerto Rican patients of New York City and New Jersey Methadone Maintenance Treatment Programs to conduct peer-based community outreach to migrant Puerto Rican drug users to reduce migrants' HIV risk behaviors. Ethnographic research, including focus groups, individual interviews, and observations, was conducted with a subset of the patients trained as peers (n 49; 67 male; mean age 40.3 years) to evaluate the self-perceived effects of the intervention. Results of the ethnographic component of this study are summarized. The role of ethnographic methods in implementing and evaluating this kind of intervention is also discussed.

Abstract

Background: Fatigue is a significant problem associated with radiation therapy (RT). Objective: This study examined how evening and morning fatigue changed from the time of simulation to 4 months after the completion of RT and investigated whether specific demographic and disease characteristics and baseline severity of symptoms predicted the initial levels of fatigue and characteristics of the trajectories of fatigue. Methods: Seventy-three women with breast cancer completed questionnaires that assessed sleep disturbance, depression, anxiety, and pain prior to the initiation of RT and the Lee Fatigue Scale, over 6 months. Descriptive statistics and hierarchical linear modeling were used for data analysis. Results: Large amounts of interindividual variability were found in the trajectories of fatigue. Evening fatigue at baseline was negatively influenced by having children at home and depression. The trajectory of evening fatigue was worse for women who were employed. Morning fatigue at baseline was influenced by younger age, lower body mass index, and the degree of sleep disturbance and trait anxiety. Trajectories of morning fatigue were worse for patients with a higher disease stage and more medical comorbidities. Conclusion: Interindividual and diurnal variability in fatigue found in women with breast cancer is similar to that found in men with prostate cancer. However, the predictors of interindividual variability in fatigue between these 2 cohorts were different. Implications for Practice: Diurnal variability and different predictors for morning and evening fatigue suggest different underlying mechanisms. The various predictors of fatigue need to be considered in the design of future intervention studies.