Publications

Abstract

The present review assesses the public's perceptions about cognitive health and Alzheimer's disease among adults in the United States. We searched the published literature and Internet, and contacted experts in the field to locate surveys assessing the public's perceptions about cognition. We found 10 eligible surveys and abstracted data concerning the public's knowledge, beliefs, concerns, and sources of information. Most of the surveys were conducted in the 2000s and focused on Alzheimer's disease rather then cognitive health. Based on the findings from the surveys, most adults were found to be aware of Alzheimer's disease but lacked specific information about the disease and its treatments. Most respondents did not perceive themselves as being very knowledgeable about Alzheimer's disease. Although we could classify the findings into several overarching domains, such as knowledge, we found considerable variability among surveys in the questions asked. Additional work is needed to understand the public's perceptions about cognitive health. Moreover, we also lack studies that help us understand perceptions about cognition across diverse demographic and cultural groups. Only by addressing these gaps can we develop targeted and effective strategies to enhance knowledge and beliefs about cognitive impairment and health.

Abstract

Background: In most multicenter studies that examine the relationship between nurse staffing and patient safety, nurse-staffing levels are measured per hospital. This can obscure relationships between staffing and outcomes at the unit level and lead to invalid inferences. Objective: In the present study, we examined the association between nurse-staffing levels in nursing units that treat postoperative cardiac surgery patients and the in-hospital mortality of these patients. Design-setting-participants: We illustrated our approach by using administrative databases (Year 2003) representing all Belgian cardiac centers (n = 28), which included data from 58 intensive care and 75 general nursing units and 9054 patients. Methods: We used multilevel logistic regression models and controlled for differences in patient characteristics, nursing care intensity, and cardiac procedural volume. Results: Increased nurse staffing in postoperative general nursing units was significantly associated with decreased mortality. Nurse staffing in postoperative intensive care units was not significantly associated with in-hospital mortality possibly due to lack of variation in ICU staffing across hospitals. Conclusion: This study, together with the international body of evidence, suggests that nurse staffing is one of several variables influencing patient safety. These findings further suggest the need to study the impact of nurse-staffing levels on in-hospital mortality using nursing-unit-level specific data.

Abstract

Purpose: Most individuals with Alzheimer's are cared for in their homes by unpaid family members. Research on caregiving focuses disproportionally on costs of care, service utilization, and negative psychosocial outcomes. Few narrative accounts of Alzheimer's exist; those that do suffer similar pejorative framings and narrow foci. No studies that we are aware of examine the health beliefs of diagnosed individuals and support persons, or their attitudes about brain health. This research reports perceptions of "aging well" held by those most intimately acquainted with Alzheimer's. Design and Methods: Diagnosed individuals and their support persons (N = 85) were enrolled into 14 focus groups. Grounded theory methods were used to collect, code, and analyze textual interview data into overarching themes. Results: Respondents found physical and mental health, social activity, independence, and happiness integral to aging well. An acceptance of various limitations was also deemed crucial. Support persons placed more emphasis on lifestyle factors and memory loss as potential obstacles. Diagnosed respondents defined memory loss in less medicalized terms, whereas support persons labeled it Alzheimer's and negatively characterized those affected. Both groups warned against discussing "prevention" of dementia: Diagnosed individuals noted the implication of "aging poorly" and support persons cautioned against blaming diagnosed individuals. Implications: These findings can be used to encourage positive health beliefs and behaviors tailored to the needs of diagnosed seniors and their families, to help practitioners and researchers identify and become sensitive to differences between and among older adults, and to further advance the utility of narrative accounts for informing health interventions and education efforts.

Abstract

Conducting research on nurse staffing and outcomes is very challenging, and the application of staffing-outcomes research in practice is both fraught with controversy and vitally important for the safety of our patients and the future of the profession. As I stand back and think about being involved in staffing-outcomes research for nearly a decade and sharing many of my thoughts about this rapidly growing literature in reviews and commentaries in print, certain metaphors for trends in this field come to mind. I won't claim originality for the insights that follow or attempt to thoroughly trace the genealogy of the stories and metaphors here, but offer them to provide what I hope is a fresh perspective to material that I and many of my colleagues have visited and revisited on numerous occasions.

Abstract

Tinea capitis is a fungal infection involving the hair shaft of the scalp. It is commonly referred to as ringworm and occurs primarily in children. Treatment with a systemic anti-fingal rather than topical treatment is required. Currently, two medications, griseofulvin (Grifulvin) and terbinafine (Lamisil Granules), are FDA-approved to treat tinea capitis. Treatment with griseofulvin is usually 6 to 8 weeks, while treatment with terbinafine requires 6 weeks. There are other medications currently not FDA-approved to treat tinea capitis that have similar cure rates and shorter durations of treatment for tinea capitis, and as a result, are being used off-label. The research-based literature related to the treatment of tinea capitis with various pharmacologic agents is reviewed.

Abstract

Tinea capitis is a fungal infection involving the hair shaft of the scalp. It is commonly referred to as ringworm and occurs primarily in children. Treatment with a systemic anti-fungal rather than topical treatment is required. Currently, two medications, griseofulvin (Grifulvin) and terbinafine (Lamisil Granules), are FDA-approved to treat tinea capitis. Treatment with griseofulvin is usually 6 to 8 weeks, while treatment with terbinafine requires 6 weeks. There are other medications currently not FDA-approved to treat tinea capitis that have similar cure rates and shorter durations of treatment for tinea capitis, and as a result, are being used off-label. This article reviews the research-based literature related to the treatment of tinea capitis with various pharmacologic agents.

Abstract

Predictors of and trajectories for evening and morning fatigue were evaluated in family caregivers of oncology patients using hierarchical linear modeling. Evening fatigue trajectory fit a quadratic model. Predictors included baseline sleep disturbances in family caregivers and baseline evening fatigue in patients. Morning fatigue trajectory fit a linear model. Predictors were baseline trait anxiety, levels of perceived family support, and baseline morning fatigue in patients. Findings suggest considerable inter-individual variability in the trajectories of evening and morning fatigue. Evaluating family caregivers for sleep disturbance, anxiety, and poor family support, as well as high levels of patient fatigue, could identify those family caregivers at highest risk for sustained fatigue trajectories.

Abstract

Rationale Over the last decade, in order to close the safety and health care quality chasm, there has been a growing imperative to translate evidence-based research into practice. Aims and Objectives This study examines the major facilitators and barriers of implementing in a large US insurance organization - Aetna Corporation - an evidence-based model of care, the Transitional Care Model, which has been rigorously tested over the past twenty years by a multidisciplinary team at the University of Pennsylvania. Methods Semi-structured interviews of 19 project leaders, case managers, and transitional care nurses were conducted during two phases of translation - start-up and roll out. Qualitative analysis was used to identify more than a dozen key barriers to and facilitators of translation in these two critical phases. Results Six facilitators and seven barriers that are consistent with the literature were identified during and categorized as either start-up or roll-out. Conclusion The combined results have important practical implications for other, subsequent translational efforts and for assisting providers, policy makers, payers, and other change agents in integrating evidence-based practice with "real world" management.

Abstract

Background: Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical settings is needed. Objective: The objective of this study was to examine the reach, implementation, and efficacy of a 6-month lifestyle program implemented in primary care by nurse practitioners (NPs) for adults at risk of type 2 diabetes. Methods: The NP sites (n = 4) were randomized to an enhanced standard care program (one NP and one nutrition session) or a lifestyle program (enhanced standard care and six NP sessions). These NPs recruited adults at risk of diabetes from their practice (n = 58), with an acceptance rate of 70%. Results: The program reached a diverse, obese, and moderately tow income sample. The NPs were able to successfully implement the protocols. The average length of the program was 9.3 months. Attendance was high (98%), and attrition was low (12%). The NPs were able to adopt the educational, behavioral, and psychosocial strategies of the intervention easily. Motivational interviewing was more difficult for NPs. Mixedmodel repeated-measures analysis indicated significant trends or improvement in both groups for nutrition and exercise behavior. Participants of the lifestyle program demonstrated trends for better high-density lipoprotein (HDL) and exercise behavior compared with the enhanced standard care participants. Twenty-five percent of lifestyle participants met treatment goals of 5% weight loss compared with 11 % of standard care participants. Discussion: A lifestyle program can be implemented in primary care by NPs, reach the targeted population, and be modestly successful. Further research is indicated.

Abstract

OBJECTIVE: To examine screening performance of California's triple-marker screening program, using data from a statewide registry for chromosomal defects. METHODS: This study included 752,686 women who received a screening risk and had an expected date of delivery between July 2005 and the end of June 2007. Follow-up diagnostic services for screen-positive women were performed at state-approved centers. Data on diagnostic outcomes from these visits were entered into the California Chromosomal Defect Registry (CCDR). Other CCDR sources include mandatory reporting by all cytogenetic laboratories and hospitals and outcome data forms submitted by prenatal care providers. RESULTS: The observed detection rate for Down syndrome (N = 1,217) was 77.4%. It varied significantly by gestational dating method and maternal age. The rates for women aged younger than 35 years and 35 years and older were 62.4% and 94.0%, respectively. The detection rates were 81.3% for ultrasound-dated pregnancies and 67.5% for last menstrual period-dated pregnancies. For Turner syndrome, trisomy 18, triploidy, and trisomy 13, the detection rates were 79.4%, 82.5%, 98.1%, and 36.0%, respectively. The positive rate for Down syndrome was 5.4%. Of women with a Down syndrome fetus who were screen positive, only 49.5% opted for amniocentesis. Of women who obtained results from amniocentesis indicating a Down syndrome fetus, 61.4% had an elective termination, 26.2% had a live birth, 4.5% had a death or miscarriage, and 7.9% had an unknown outcome. CONCLUSION: The observed performance of this large triple-marker screening program exceeds generally predicted detection rates for Down syndrome. This study methodology will be used to measure the performance of subsequent screening enhancements.

Abstract

Purpose The purpose of this secondary analysis was to describe and compare physiological, psychosocial, and self-management characteristics of urban black and rural white women with type 2 diabetes (T2D) in the northeast United States. Methods A descriptive, cross-sectional secondary analysis was conducted with baseline data from 2 independent study samples: rural white women and urban black women. Results Results revealed the sample were on average educated, working, low-income, mid-life women with poor glycemic and blood pressure control, despite having a usual source of primary care. When compared, black women were younger, had lower income levels, worked more, and were often single and/or divorced. They had worse glycemic control, significantly higher levels of diabetes-related emotional distress, and less support than white women. Conclusion Despite differences in geography and study findings, both groups had suboptimal physiological and psychosocial levels that impede self-management. These findings serve to aid in the understanding of health disparities, emphasizing the importance of developing and evaluating effective interventions of diabetes care for women with T2D.

Abstract

BACKGROUND: Traditional Chinese medicine (TCM) diagnosis is a complex multifaceted process that often yields multiple differential diagnoses and subdiagnoses. OBJECTIVES: The aims of this study were to (1) understand cognitive strategies and diagnostic reasoning processes of TCM practitioners engaged in tongue diagnosis and (2) investigate TCM practitioners' diagnostic accuracy. Clinical decision making and problem solving frameworks served as a basis for this study. METHODS: Nine TCM practitioners verbalized their thinking processes via think-aloud protocols and were audiotaped while engaged in the cognitive task of tongue diagnosis. Protocol analysis was used to identify TCM diagnostic reasoning patterns. Diagnostic accuracy was assessed by participant self-report and via independent TCM expert judges. RESULTS: Protocol analysis revealed that TCM practitioners use systematic processes to arrive at diagnoses and that there were differences between novices and experts in both pre- and post-adjustments after viewing case histories. Novices tended to use more descriptors and come to the diagnoses earlier. Experts tended to use higher-level intellectual processes when coming to their diagnoses and tended to use these terms earlier in the process. Correlations between practitioner self-assessment and judges' ratings of diagnostic accuracy were noted and corollary case history information improved diagnostic accuracies. CONCLUSION: TCM practitioners use systematic reasoning patterns to determine diagnoses associated with evaluation of tongues. These processes are congruent with those observed in Western medicine whereby clinician reasoning involves a combination of analytical reasoning of domain knowledge and the use of exemplar patterns. An explicit understanding of TCM reasoning processes can inform clinical practice and education and will facilitate the development of supporting technologies and identification of best practices.

Abstract

▶ Nursing turnover is costly for health care organizations. ▶ Newly licensed registered nurses work behavior is a complex process, influenced by their attitudes toward their work, personal characteristics, job opportunities, and workplace attributes. ▶ Several characteristics are significant in predicting satisfaction (ethnicity, gender) and organizational commitment (patient load, mandatory overtime, shift, and unit type) and intent to stay (income, age) over and above work attitudes. ▶ Among the most important implications are how the findings can inform management and policy. ▶ Findings from this study provide information that may be useful for those organizations that want to decrease their turnover rates.

Abstract

To understand factors that promote retention of Newly Licensed Registered Nurses (NLRNs) and those that contribute to turnover, a survey of a national sample of NLRNs was conducted. This article describes the content analysis of 612 NLRN comments about their work life. Using Krippendorff's1 technique, 5 themes were discovered. Colliding expectations describes conflicts between nurses' personal view of nursing and their lived experience. The need for speed describes the pressure related to a variety of temporal issues. You want too much expresses the pressure and stress NLRNs feel personally and professionally. How dare you describes unacceptable communication patterns between providers. Change is on the horizon suggests optimism for the future as NLRNs speak of transforming the systems where care is provided. This content analysis reveals that the working environment where NLRNs begin their career is in need of reform. Suggestions are offered from the nurses themselves.

Abstract

This study examined contemporary frontline workforce issues related to residential care for elders in rural China. Residential facilities in rural China are in transition from exclusively providing shelter to childless elders to providing long-term care for frail elders. These facilities are also under pressure to improve the quality of services that they provide. The study is based on in-depth interviews with administrators and field observations of facilities. The study focused on the following issues related to the workforce: recruitment and retention, training, work environment, workforce organization, regulations, compensation, and career ladders. The implications of resident characteristics for demands on the work force were examined. The study found that lack of skilled personnel is one of the major reasons that the overwhelming majority of facilities deny admission to frail and demented elders. Improving workers' skill is critical if these facilities are to meet the increasing demand for institutional long-term care needs.

Abstract

Since 1980, at least 9 studies have assessed the potential associations between zinc supplementation and cognitive development in human infants and children. This article provides a brief review of the literature on the roles of zinc and its proposed associations with cognition. At present, the body of evidence is insufficient to warrant recommending routine zinc supplementation to enhance cognitive performance among children. In the United States and internationally, there are few available data on zinc status or deficiency rates in children and further study is necessary to assess the efficacy of zinc supplementation, alone or in combination with other nutrients, for improving cognitive outcomes.

Abstract

Heart failure, a common syndrome in developed countries worldwide, is associated with poor quality of life, frequent rehospitalizations, and early death. Self-care is essential to improving outcomes in this patient population. The purpose of this article is to describe a situation-specific theory of heart failure self-care in which self-care is defined as a naturalistic decision-making process involving the choice of behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Self-care maintenance is further defined to encompass routine symptom monitoring and treatment adherence. Self-care management is characterized as a process initiated by symptom recognition and evaluation, which stimulates the use of self-care treatments and treatment evaluation. Confidence in self-care is thought to moderate and/or mediate the effect of self-care on various outcomes. Four propositions were derived from the self-care of heart failure conceptual model: (1) symptom recognition is the key to successful self-care management; (2) self-care is better in patients with more knowledge, skill, experience, and compatible values; (3) confidence moderates the relationship between self-care and outcomes; and (4) confidence mediates the relationship between self-care and outcomes. These propositions were tested and supported using data obtained in previous research. Support of these propositions provides early evidence for this situation-specific theory of heart failure self-care.

Abstract

Background: Heart failure (HF) self-care is extremely challenging and few people master it. Self-care was defined as an active, cognitive process in which persons engage for the purpose of maintaining their health (maintenance) and managing symptoms (management). Aim: To examine the contribution of attitudes, self-efficacy, and cognition to HF self-care management. Methods: In this mixed methods study, 41 individuals (63.4% male, 68.3% Caucasian, mean age 49.17 (10.51) years, 58.5% NYHA III, median ejection fraction 30%) were interviewed and completed instruments on HF self-care, cognition, and physical functioning. Content analysis of narrative data revealed themes of self-care management practices, attitudes and self-efficacy towards self-care. Non-parametric tests assessed differences based on the types identified in the content analysis. Results: A self-care typology was constructed from the data: experts, novices and inconsistent. There were statistically significant differences (p = 0.001) in self-care practices among types and variance in attitudes, self-efficacy, and cognition. Experts had experience and skill in self-care, which novices lacked, and positive attitudes and self-efficacy that aligned with their behaviors. Most patients (71%) were classified as inconsistent, a self-care type associated with impaired cognition, poor physical functioning, negative attitudes, and poor self-efficacy. Conclusions: This typology provides insight into how expertise in self-care develops and the reasons why it is not always sustained.

Abstract

Survival among perinatally infected children and youth with HIV has been greatly extended since the advent of highly active antiretroviral therapies. Yet, adherence to HIV medication regimens is suboptimal and decreases as children reach adolescence. This paper reports on a qualitative study examining psychosocial factors associated with adherence among perinatally infected youth ages 10-16 years. The study was based on in-depth interviews with a sample of 30 caregivers participating in a comprehensive health care program in New York City serving families with HIV. A subsample comprising 14 caregivers of children ages 10 and above is the focus of this paper. The analysis identified a number of themes associated with the psychosocial context of managing adherence among older children. Maintaining adherence was an ongoing challenge and strategies evolved as children matured. Regimen fatigue and resistance to taking the medications were major challenges to maintaining adherence among the oldest children. In other cases, caregivers developed a kind of partnership with their child for administering the medications. Disclosure to the child of his or her HIV status was used as a strategy to promote adherence but seemed to be effective only under certain circumstances. Social support appeared to have an indirect influence on adherence, primarily by providing caregivers with temporary help when needed. Health care professionals were an important source of disclosure and adherence support for parents. The study illustrates the interplay of maturational issues with other contextual psychosocial factors as influences on adherence among older children and adolescents.