Publications

Abstract

OBJECTIVE - To assess the prevalence and clinical predictors of silent myocardial ischemia in asymptomatic patients with type 2 diabetes and to test the effectiveness of current American Diabetes Association screening guidelines. RESEARCH DESIGN AND METHODS - In the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study, 1,123 patients with type 2 diabetes, aged 50-75 years, with no known or suspected coronary artery disease, were randomly assigned to either stress testing and 5-year clinical follow-up or to follow-up only. The prevalence of ischemia in 522 patients randomized to stress testing was assessed by adenosine technetium-99m sestamibi single-photon emission-computed tomography myocardial perfusion imaging. RESULTS - A total of 113 patients (22%) had silent ischemia, including 83 with regional myocardial perfusion abnormalities and 30 with normal perfusion but other abnormalities (i.e., adenosine-induced ST-segment depression, ventricular dilation, or rest ventricular dysfunction). Moderate or large perfusion defects were present in 33 patients. The strongest predictors for abnormal tests were abnormal Valsalva (odds ratio [OR] 5.6), male sex (2.5), and diabetes duration (5.2). Other traditional cardiac risk factors or inflammatory and prothrombotic markers were not predictive. Ischemic adenosine-induced ST-segment depression with normal perfusion (n = 21) was associated with women (OR 3.4). Selecting only patients who met American Diabetes Association guidelines would have failed to identify 41% of patients with silent ischemia. CONCLUSIONS - Silent myocardial ischemia occurs in greater than one in five asymptomatic patients with type 2 diabetes. Traditional and emerging cardiac risk factors were not associated with abnormal stress tests, although cardiac autonomic dysfunction was a strong predictor of ischemia.

Abstract

We demonstrate a model for categorical data that parallels the MIMIC model for continuous data. The model is equivalent to a latent class model with observed covariates; further, it includes simple handling of missing data. The model is used on data from a large-scale study of HIV that had both biological measures of infection and self-report (missing on some cases). The model allows the determination of sensitivity and specificity of each measure, and an assessment of how well true HIV status can be predicted from characteristics of the individuals in the study.

Abstract

This article addresses significant challenges in the delivery of critical care services in hospitals including the need for partnerships between service and education, the need to strengthen interdisciplinary teams, and educational challenges in preparing critical care nurses at both the specialist and generalist levels. Each of these challenges has a direct impact on the quality-of-care outcomes for critical care patients.

Abstract

The purpose of this article is to discuss the development of the psychiatric-mental health nurse practitioner (PMHNP) competencies. The historical context and controversy regarding the role of advanced practice psychiatric mental health nursing as well as the consensus process of a national panel charged with the development of these competencies are described. Also, implications for education, practice, research, and policy are examined. The PMHNP competencies is a seminal document that will provide direction for the future of advanced practice psychiatric-mental health nursing.

Abstract

Millions of Americans use dietary supplements without full knowledge of their effects. Given the serious safety issues surrounding dietary supplements and the potential for nurses to play pivotal roles as patient educators and policy advocates, this article describes laws and regulations pertaining to dietary supplements, relevant research, the role of organized interests in policy making for dietary supplements, and how other countries regulate dietary supplements. We offer recommendations for policy change and identify implications of this issue for nursing practice.

Abstract

Purpose: To identify dimensions of the role enactment process of acute care nurses. Design: Dimensional analysis, rooted in grounded theory methodology, was used to analyze the role enactment process. Methods: Twenty-eight articles related to acute care staff nurse roles were selected for analysis. Articles were from eight countries and were published between 1995 and 2002. Significant phrases or themes from each document were categorized to identify themes. Findings: Initial analysis of the articles indicated 37 separate dimensions in the role enactment process of acute care nurses. The final, integrative analysis reduced the initial 37 to 7 core dimensions: care delivery, autonomy, culture management, information management, leadership, psychologic management, and relationship management. The analysis showed a role that is rooted in management processes. Conclusions: The multidimensional nature of the role of acute care nurses was indicated in the dimensional analysis. The findings have implications for the administration and education of nurses, as well as for human resource development of nurses in many parts of the world.

Abstract

This paper uses qualitative methods to examine both staff and clients' perceptions about the delivery of hepatitis C prevention education services at their respective residential drug treatment programs. Through in-depth discussion with participants, as well as program observation, we elicited clients' and staff attitudes about the role that drug treatment programs can play in providing prevention education services for hepatitis C, their evaluation of existing hepatitis C prevention education services, and recommendations for enhancing future services. Although participants identified limitations to services, most perceive that treatment programs can play an important role in hepatitis C prevention education service delivery. Participants view clients' misconceptions about hepatitis C, increased disease stigma, and diminished service utilization as potential consequences of limited hepatitis C prevention education services. Recommendations for improving services include more detailed and frequent opportunities for hepatitis C education, formalizing services, offering education in multiple formats, and providing additional staff training.

Abstract

Parkinson's disease (PD) is a common neurodegenerative disorder in humans with wide variability in the age of disease onset. Although the disease has been thought previously to occur sporadically in most patients, there is increasing evidence of a genetic contribution to the disorder. Recently, a polymorphic variant within intron 6 of the Nurr1 gene was reported to be associated with sporadic and familial PD. In an effort to identify susceptibility genes for PD, we have collected 783 PD patients from 372 families and 397 healthy controls from 217 families. PD patients and healthy controls were genotyped for the intron 6 insertion polymorphism by BseRI restriction endonuclease digestion. No significant difference in either homozygosity or heterozygosity for the 7048G7049 (IVS6 1361 +16insG) polymorphism was detected in the PD patient cohort as compared with the panel of healthy controls. Moreover, direct sequencing of exon 1 of the Nurr1 gene in PD patients failed to detect either of the two recently reported Nurr1 mutations identified in a small subset of a PD patient cohort. Taken together, these data suggest that genetic alteration at the Nurr1 locus is not a significant risk factor for the development of Parkinson's disease in our large sample of familial PD patients.

Abstract

The purpose of this article is to critically evaluate the evidence related to family-based interventions designed to treat childhood obesity. A MEDLINE, PSYCLIT, and CINAHL search identified articles published between January 1980 and January 2004 relating to family-based interventions. Thirteen studies were included, and all of the interventions used nutrition education, exercise, and behavioral interventions, including behavioral modification, behavioral therapy, or problem solving. Behavioral modification interventions targeted children and parents together or separately and were reported to be successful in improving weight-loss outcomes in both parents and children. Behavioral therapy interventions targeting children and parents together or the parents of children separately improved weight outcomes. Problem-solving interventions that targeted parents of children showed improved weight outcomes for their children. However, when problem solving was used with both parents and children together or children alone, weight outcomes did not improve. A majority of the studies have some methodological weaknesses.

Abstract

Clinical HIV risk assessments have not typically integrated questions about sex partners' HIV status with questions about condom use and type of sex. Since 2001, we have asked all men who have sex with men (MSM) evaluated in an urban sexually transmitted disease (STD) clinic how often in the preceding 12 months they used condoms for anal sex with partners who were HIV-positive, HIV-negative, and of unknown HIV status. Overall, MSM displayed a pattern of assortative mixing by HIV status, particularly for unprotected anal intercourse (UAI). Nevertheless, 433 (27%) of 1580 MSM who denied knowing they were HIV-positive and 93 (43%) of 217 HIV-positive MSM reported having UAI with a partner of opposite or unknown HIV status. Among men who denied previously knowing they were HIV-positive, 24 (9.6%) of 251 MSM who reported having UAI with an HIV-positive partner or partner of unknown HIV status compared with 11 (1.7%) of 620 MSM who denied such exposure tested HIV-positive (odds ratio = 5.8, 95% confidence interval: 2.8-12.1). UAI with an HIV-positive partner or partner with unknown HIV status was 69% sensitive and 73% specific in identifying men with previously undiagnosed HIV infection; UAI regardless of partner HIV status was 80% sensitive but only 45% specific. The positive predictive value was highest for risk assessments that included partner HIV status. Integrating questions about anal sex partner HIV status and condom use identifies MSM at greatest risk for HIV acquisition and transmission. These risk criteria might be effectively used to triage MSM into more intensive prevention interventions.

Abstract

PURPOSE: To propose an evidence-based model (EBM) to improve diagnostic accuracy in nursing. DATA SOURCES: Published literature, experience, and expertise of authors. DATA SYNTHESIS: Using an EBM directs clinicians on how to use the best available evidence from the literature to determine the best fit between cues and diagnoses, integrate this evidence with clinician expertise and patient preferences, and conduct a self-evaluation of the process. CONCLUSIONS: Use of an EBM to teach nurses how to ask relevant diagnostic questions and provide a framework for nurse educators to teach evidenced-based practice may lead to developing more competent diagnosticians and improving diagnostic accuracy in nursing.

Abstract

Drug treatment facilities are important sites for providing targeted prevention and health services to injection drug users (IDUs) who are infected with the hepatitis C virus (HCV). A nationwide survey was conducted to examine whether differences exist in the HCV-related services provided by drug treatment programs that have varying proportions of IDUs among their patients. The results indicate that, overall, drug treatment programs with a greater proportion of IDUs offer significantly more HCV services as compared to programs with a smaller proportion of IDUs. However, important components of hepatitis C-related care, such as universal basic education and counseling about HCV and extensive HCV-antibody testing, are not yet being provided by all programs with a large proportion of IDUs among their patient populations.

Abstract

BACKGROUND: Asthma is one of the most prevalent childhood chronic illnesses in the United States leading to nearly 190,000 pediatric hospitalizations yearly. In response to the increasing number of children with asthma being hospitalized, some institutions have developed and implemented clinical pathways and are now reporting their findings in the literature. The purpose of this paper was to conduct an integrative literature review of studies using an inpatient clinical pathway for the management of pediatric asthma. METHOD: Five research-based articles evaluating clinical pathways for the management of inpatient pediatric asthma were included in this review. The integrative review was conducted using the guidelines set forth by Ganong (1987). RESULTS: The results revealed that clinical pathways appear to be effective in reducing length of stay and hospital costs associated with inpatient pediatric asthma. The pathways were not as effective in reducing readmission rates or affecting clinical outcomes for patients such as increasing asthma education, the use of controller medications, spacers, and peak flow meters. PRACTICE IMPLICATIONS: Although the pathways are effective in reducing hospitalization costs associated with asthma, there was little reported improvement in clinical outcomes. Nurses should ensure that each pediatric asthma hospitalization provides an opportunity to promote education about asthma. This approach may lead to decreased asthma admissions and increased self and family management of pediatric asthma. Future research should focus on the clinical outcomes of patients using the inpatient pathways and also on the development of pathways to be used in outpatient settings that manage pediatric asthma.

Abstract

Researchers at Johns Hopkins University conducted a randomized clinical trial to test the effect of nurse case management and community health worker interventions on diabetes control among inner city African Americans. The results demonstrated that the greatest improvement occurred when nurse case managers and community health workers worked together. This study has implications for how nurse/home health aide collaboration can enhance diabetes management in home care.

Abstract

Data collected among African-American and Caucasian women and men in the southeastern USA indicate that participants' perceptions of nature, God's will and the human body influence reproductive health and decision-making. Attitudes about the health care system, pharmaceutical companies and government programmes for fertility regulation reinforce these views and may negatively affect willingness to use contraceptive methods consistently, and correctly.

Abstract

Objectives: To examine the association between intrauterine growth restriction and neurodevelopmental outcome among full-term small-for-gestational-age (SGAT) infants at 8 months and 4 years of age. Study Design: Growth parameters at birth and test scores on measures of neurodevelopmental function for 3922 children born SGAT were compared with those of 29,369 children born appropriately grown-for-gestational-age term from similar economic backgrounds. Additional within-SGAT/economic group comparisons were made for 1684 SGAT infants with symmetric undergrowth at birth and 2034 SGAT infants with asymmetric undergrowth at birth. Results: Regardless of socioeconomic background, infants born SGAT were found to be at significantly increased risk for neurodevelopmental difficulties at 8 months and at 4 years of age. Few within SGAT/socioeconomic group differences in neurodevelopmental outcome appeared to be associated with specific pattern of growth restriction at birth. Conclusions: The present findings provide further evidence of the individual and public health impact of SGAT birth.