Publications

Abstract

The authors look at many aspects of a nurse-managed primary care center within an academic institution, as administrators and practicing clinicians. This article presents the history of the development of the center, the profile of clients and services, the education and preparation for the role of nurse practitioner and scope of practice, reimbursement, legal issues such as collaborative practice and barriers to practice, and risk management. Problems faced by many nurse-managed centers are addressed, especially the need for flexibility, with personal accounts of how they have been dealt with at this center. An evaluation of the center and its practice model is offered.

Abstract

Some individuals remain uninfected with human immunodeficiency virus type- 1 (HIV-1) despite multiple high-risk sexual exposures. We studied a cohort of 25 subjects with histories of multiple high-risk sexual exposures to HIV-1 and found that their CD8+ lymphocytes had greater anti-HIV-1 activity than did CD8+ lymphocytes from nonexposed controls. Further studies indicated that their purified CD4+ lymphocytes were less susceptible to infection with multiple primary isolates of HIV-1 than were CD4+ lymphocytes from the nonexposed controls. This relative resistance to HIV-1 infection did not extend to T-cell line-adapted strains, was restricted by the envelope glycoprotein, was not explained by the cell surface density of CD4 molecules, but was associated with the aCtivity of the C-C chemokines RANTES, MIP-1α, and MIP-1β. This relative resistance of CD4+ lymphocytes may contribute to protection from HIV-1 in multiply exposed persons.

Abstract

A growing body of empirical evidence documenting the negative effects and the limited effectiveness of physical restraints continues to shape policy and professional standards. In addition to occurrences of serious harm from restraint devices, ethical concerns about care with dignity have supported reevaluation of restraints in all settings for all patients. Lessons from considerable research conducted in nursing homes and clinical experience with restraint reduction in long-term care facilities are applicable to acute care settings, where restraint-free care can and should be embraced.

Abstract

Decisions by nurses to avoid physical restraint use in older adults is a complex process that requires individualized, comprehensive assessment and creative problem-solving. Institutional and social policy increasingly support a standard of restraint elimination influencing care decisions with frail older adults. It has become clear that the decision to avoid or use physical restraint is influenced as well by nurses' attitude or beliefs about the efficacy of restraint. To further understand how decisions are made to avoid physical restraint, it is important to also explore the degree to which nurses possess knowledge, autonomy, and accountability in this decision-making process. Understanding how decisions are influenced will advance the development of restraint-free care interventions for older adults.

Abstract

Objective: To determine the prevalence of cervical intraepithelial neoplasia (CIN) in women who are infected with human immunodeficiency virus (HIV) and who have mild cytologic atypia. Methods: As part of an ongoing, prospective study of cervical disease in HIV-infected women, Papanicolaou smears were analyzed cross-sectionally for the diagnosis of mild cytologic atypia. Results: Mild cytologic atypia was diagnosed in 112 (25%) of the 453 HIV-infected women enrolled in this study, compared with 36 (9%) of the 401 HIV-uninfected women (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.2- 5.1; P < .001). Mild cytologic atypia was diagnosed more frequently in HIV- infected women with lower CD4+ T-lymphocyte counts (χ2 for trend, P = .015) and in those with a history of an abnormal Papanicolaou smear or treatment for cervical disease (OR 3.0, 95% CI 1.2-7.6; P = .008). Coexistent CIN was detected by colposcopically directed biopsy in 42 (38%) of the 112 HIV- infected women with mild cytologic atypia, compared with five (14%) of the 36 HIV-uninfected women (OR 3.7, 95% CI 1.3-11.9; P = .008). Severe inflammation with associated epithelial reparative atypia was diagnosed in 90 (20%) of the HIV-infected women and in 87 (22%) of the HIV-uninfected women. Coexistent CIN was detected in 12% of the HIV-infected women with severe inflammation and associated epithelial reparative atypia, compared with 2% of the HIV- uninfected women with this cytologic diagnosis (OR 5.9, 95% CI 1.2-23; P = .01). Conclusion: Mild cytologic atypia, a frequent diagnosis on Papanicolaou smears from HIV-infected women, is associated with CIN. We recommend that all HIV-infected women with mild cytologic atypia be referred for colposcopy.

Abstract

The purpose of this focus group intervention was to characterize the health beliefs, self-care practices, diabetes education needs, weight-loss issues, and facilitators and barriers to diabetes health care in black women with non-insulin-dependent diabetes. Major themes that emerged from the focus group were motivation to prevent complications, unrealistic weight goals set by providers, multiple barriers to diet and exercise, and a dual role of family as supporter and deterrent to diabetes management, especially related to diet. These findings suggest that culturally sensitive and appropriate patient educational programs must be provided for minority groups such as black women who have higher rates of diabetes-related complications.

Abstract

Objectives: To assess the effectiveness of an intervention for providing information and support to HIV-positive donors on changes in their sexual behavior, and to assess which donor characteristics are predictive of behavior change. Design: Subjects were randomly assigned to a structured intervention or community referral group. Follow-up assessments were conducted every 6 months. Setting: New York City, New York, USA. Participants: A cohort of 271 HIV-infected persons who donated blood to the New York Blood Center. intervention: Donors randomized to the structured intervention program met individually with a nurse for counseling and were offered a six-session support group. The program was designed to provide information, encourage safer sexual behavior and provide support. Main outcome measures: Sexual behavior, psychological distress and psychological help seeking, and immune function. Results: In both groups there was a large decrease over time in reports of unsafe sexual activity. However, more than 30% of participants in both groups reported unsafe sexual activity at the 1-year follow-up visit. Donors randomized to the structured intervention program did not report significantly more behavior change at the 1-year follow-up. Conclusions: Better programs to promote behavior change in seropositive individuals are needed.

Abstract

THE DIABETES RESEARCH and Training Center at the Albert Einstein College of Medicine, in collaboration with Yale University School of Nursing, initiated a project to develop and implement a concentration of study at the Master's level within the field of diabetes. The concentration has resulted in involvement of advanced practice nurses in management and care of individuals with diabetes. In the article, an epidemiological perspective in diabetes care is given, along with information on how the program developed and evolved over the past 5 years. Program graduates have become certified diabetes educators and completed a Master's thesis in the area of diabetes care, resulting in practice-oriented publications.