Publications

Abstract

Background: The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor's degree, and inter-professional education. Purpose: The purpose of this paper is to report the progress toward achievement of these recommendations. Methods: We used a longitudinal, multi-state data from four cohorts of nurses newly licensed in 2004 to 2005, 2007 to 2008, 2010 to 2011, and 2014 to 2015 to examine and compare the trends. Finding: The percentage of males who became licensed increased, from 8.8% in 2004 to 2005 cohort to 13.6% in the 2014 to 2015 cohort. The percentage of white-non-Hispanic nurses who were licensed decreased from 78.9% in 2007 to 2008 to 73.8% in 2014 to 2015. These differences primarily reflect an increase in white-Hispanic nurses. More nurses are obtaining a bachelor's degree as their first professional degree, from 36.6% in 2004 to 2005 cohort to 48.5% in 2014 to 2015 cohort. About 40% of the 2014 to 2015 cohort reported that they learned to work in inter-professional teams. Collegial nurse-physician relations had an upward positive trajectory over time increasing almost 7%. Discussion: The diversity and education of new nurses have increased, but are short of meeting the IOM recommendations.

Abstract

Objective: This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States. Method: Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study (N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results: Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health. Discussion: Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

Abstract

We previously demonstrated an association between lipoprotein (a) [Lp(a)] levels and atherosclerosis in human immunodeficiency virus (HIV)-seropositive women. The effects of antiretroviral therapy (ART) on Lp(a) levels in relation to apo(a) size polymorphism remain unclear. ART effects on allele-specific apo(a) level (ASL), an Lp(a) level associated with individual apo(a) alleles within each allele-pair, were determined in 126 HIV-seropositive women. ART effects were tested by a mixed-effects model across pre-ART and post-ART first and third visits. Data from 120 HIV-seronegative women were used. The mean age was 38 years; most were African-American (∼70%). Pre-ART ASLs associated with the larger (4.6 mg/dl vs. 8.0 mg/dl, P = 0.024) or smaller (13 mg/dl vs. 19 mg/dl, P = 0.041) apo(a) sizes were lower in the HIV-seropositive versus HIV-seronegative group, as was the prevalence of a high Lp(a) level (P = 0.013). Post-ART ASL and prevalence of high Lp(a) or apo(a) sizes and frequency of small size apo(a) (≤22 kringles) did not differ between the two groups. ART increased Lp(a) level (from 18 to 24 mg/dl, P < 0.0001) and both ASLs (P < 0.001). In conclusion, regardless of genetic control, Lp(a) can be modulated by HIV and its treatment. ART initiation abrogates HIV-induced suppression of Lp(a) levels and ASLs, contributing to promote CVD risk in HIV-seropositive individuals.

Abstract

Background—Infants with critical congenital heart disease (CCHD) are more likely to be small for gestational age (GA). It is unclear how this affects mortality. The authors investigated the effect of birth weight Z score on 1-year mortality separately in preterm (GA <37 weeks), early-term (GA 37–38 weeks), and full-term (GA 39–42 weeks) infants with CCHD. Methods and Results—Live-born infants with CCHD and GA 22 to 42 weeks born in California 2007–2012 were included in the analysis. The primary predictor was Z score for birth weight and the primary outcome was 1-year mortality. Multivariable logistic regression was used. Results are presented as adjusted odds ratios and 95% confidence intervals (CIs). The authors identified 6903 infants with CCHD. For preterm and full-term infants, only a Z score for birth weight <−2 was associated with increased mortality compared with the reference group (Z score 0–0.5, adjusted odds ratio, 2.15 [95% CI, 1.1–4.21] and adjusted odds ratio, 3.93 [95% CI, 2.32–6.68], respectively). In contrast, in early-term infants, the adjusted odds ratios for Z scores <−2, −2 to −1, and −1 to −0.5 were 3.42 (95% CI, 1.93–6.04), 1.78 (95% CI, 1.12–2.83), and 2.03 (95% CI, 1.27–3.23), respectively, versus the reference group. Conclusions—GA seems to modify the effect of birth weight Z score on mortality in infants with CCHD. In preterm and full-term infants, only the most severe small-for-GA infants (Z score <−2) were at increased risk for mortality, while, in early-term infants, the risk extended to mild to moderate small-for-GA infants (Z score <−0.5). This information helps to identify high-risk infants and is useful for surgical planning.

Abstract

Background: Improving patient safety within health care organizations requires effective leadership at all levels. Purpose: The objective of this study was to investigate the effects of nurse managers’ transformational leadership behaviors on job satisfaction and patient safety outcomes. Methods: A random sample of acute care nurses in Ontario (N = 378) completed the crosssectional survey. Hypothesized model was tested using structural equation modeling. Finding: The model fit the data acceptably. Transformational leadership had a strong positive influence on workplace empowerment, which in turn increased nurses’ job satisfaction and decreased the frequency of adverse patient outcomes. Subsequently, job satisfaction was related to lower adverse events. Conclusion: The findings provide support for managers’ use of transformational leadership behaviors as a useful strategy in creating workplace conditions that promote better safety outcomes for patients and nurses.

Abstract

BACKGROUND: Efforts to decrease adverse effects of tobacco use are affected by emergence of new nicotine delivery products. Advertising, product promotion, and social media promote use of these products, yet a lack of evidence regarding safety leaves nurses unprepared to counsel patients. OBJECTIVES: To critically evaluate current research, reviews of literature, expert opinion, and stakeholder policy proposals on use and safety of electronic nicotine delivery systems (ENDS). DESIGN: A targeted examination of literature generated by key stakeholders and subject matter experts was conducted using key words, modified by risk factors, and limited to the past 8 years. RESULTS: Current knowledge gaps in research literature and practice implications of the literature are discussed. CONCLUSIONS: The safety of ENDS is questionable and unclear. There are clear health risks of nicotine exposure to developing brains. Potential health risks of ENDS secondhand emissions exposure exist. Using ENDS to facilitate total tobacco cessation is not proven.

Abstract

Background: Little is known about the end-of-life (EOL) care preference and its associated factors among community-dwelling adults in Mainland China. This study investigated the EOL care preference and its associated factors among community-dwelling Chinese adults in Shanghai, China.Methods: A cross-sectional survey was conducted in Shanghai, China, from April to June in 2013. A total of 1200 older adults aged 60 years and older and another 200 middle-aged and older adults aged 45 years and older who lost their only child were included in the current study. In the current study, the EOL care preference included three categories: preferred family care, preferred care provided by visiting healthcare professionals, and preferred care in a specialized EOL care institute. Childlessness was coded as lost the only child, had children but not coresiding, and had coresiding children. Mor and Hiris's model of choices of setting at the EOL was used to explore the EOL care preference and its associated factors, including sociodemographic characteristics, support networks, functional characteristics, and healthcare system. Multinomial logistic regressions were used to estimate the factors associated with their EOL care preference.Results: In terms of EOL care preference, adults who lost their only child preferred care provided by a specialized EOL care institute (58.43%), while adults who had children preferred family care at home (46.72% for adults who did not coreside with children and 49.04% for those who did). Results from multinomial logistic regressions showed that adults with higher income, having properties, and having children tended to opt for family care at home. Participants with friends' support preferred EOL care provided by visiting healthcare professionals or specialized EOL care institutions over family care at home.Conclusions: Income, wealth, having children, and having friends' support were significant factors that were associated with the EOL care preference among Chinese adults. Home-based EOL care, professional and individualized hospice, or palliative care provided by institutions need to be developed in China.

Abstract

Higher exposure to tenofovir (TFV) increases the risk for kidney function decline, but the impact of genetic factors on TFV exposure is largely unknown. We investigated whether single-nucleotide polymorphisms (SNPs, n=211) in 12 genes are potentially involved in TFV exposure. Participants (n=91) from the Women's Interagency HIV Study, underwent a 24 h intensive pharmacokinetic sampling of TFV after witnessed dose and TFV area under the time-concentration curves (AUCs) were calculated for each participant. SNPs were assayed using a combination of array genotyping and Sanger sequencing. Linear regression models were applied to logarithmically transformed AUC. Those SNPs that met an a priori threshold of P<0.001 were considered statistically associated with TFV AUC. ABCG2 SNP rs2231142 was associated with TFV AUC with rare allele carriers displaying 1.51-fold increase in TFV AUC (95% confidence interval: 1.26, 1.81; P=1.7 × 10 -5 ). We present evidence of a moderately strong effect of the rs2231142 SNP in ABCG2 on a 24 h TFV AUC.

Abstract

Background: We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has 2 main components: (1) a novel online curriculum addressing core SUD research topics, to reach a large number of students; (2) a mentored summer research experience for in-depth exposure. Methods: Modules were integrated into the curricula of the lead institution, and of 5 external schools. We assessed the number of Web modules completed and their effect on students’ interest in SUD research. We also assessed the impact of the mentorship experience on participants’ attitudes and early career trajectories, including current involvement in SUD research. Results: Since 2008, over 24,000 modules have been completed by approximately 9700 individuals. In addition to integration of the modules into curricula at the lead institution, all 5 health-professional partner schools integrated at least 1 module and approximately 5500 modules were completed by individuals outside the lead institution. We found an increase in interest in SUD research after completion of the modules for students in all 4 disciplines. From 2008 to 2015, 76 students completed summer mentorships; 8 students completed year-long mentorships; 13 published in SUD-related journals, 18 presented at national conferences, and 3 are actively engaged in SUD-related research. Mentorship participants reported a positive influence on their attitudes towards SUD-related clinical care, research, and interprofessional collaboration, leading in some cases to changes in career plans. Conclusions: A modular curriculum that stimulates clinical and research interest in SUD can be successfully integrated into medical, dental, nursing, and social work curricula. The SARET program of mentored research participation fostered early research successes and influenced career choice of some participants. Longer-term follow-up will enable us to assess more distal careers of the program.

Abstract

The purpose of the study was to describe participants’ experience of daily weighing and to explore factors influencing adherence to daily weighing among individuals who were successful in losing weight during a behavioral weight loss intervention. Participants completed a 12-month weight loss intervention study that included daily self-weighing using a Wi-Fi scale. Individuals were eligible to participate regardless of their frequency of self-weighing. The sample (N = 30) was predominantly female (83.3%) and White (83.3%) with a mean age of 52.9 ± 8.0 years and mean body mass index of 33.8 ± 4.7 kg/m2. Five main themes emerged: reasons for daily weighing (e.g., feel motivated, being in control), reasons for not weighing daily (e.g., interruption of routine), factors that facilitated weighing, recommendations for others about daily weighing, and suggestions for future weight loss programs. Our results identified several positive aspects to daily self-weighing, which can be used to promote adherence to this important weight loss strategy.

Abstract

Genetic factors that influence inflammation and energy production/expenditure in cells may affect patient outcomes following treatment with external beam radiation therapy (EBRT). Sestrins, stress-inducible genes with antioxidant properties, have recently been implicated in several behaviors including fatigue. This proof-of-concept study explored whether the sestrin family of genes (SESN1, SESN2, and SESN3) were differentially expressed from baseline to the midpoint of EBRT in a sample of 26 Puerto Rican men with nonmetastatic prostate cancer. We also examined whether changes in expression of these genes were associated with changes in fatigue scores during EBRT. Method: Participants completed the 13-item Functional Assessment of Cancer Therapy—Fatigue subscale, Spanish version. Whole blood samples were collected at baseline and at the midpoint of EBRT. Gene expression data were analyzed using the limma package in the R (version R 2.14.0.) statistical software. Linear models and empirical Bayes moderation, adjusted for radiation fraction (total number of days of prescribed radiation treatment), were used to examine potential associations between changes in gene expression and change in fatigue scores. Results: Expression of SESN3 (adjusted p <.01, log fold change −0.649) was significantly downregulated during EBRT, whereas the expressions of SESN1 and SESN2 remained unchanged. After adjustment for radiation fraction, change in SESN3 expression was associated with change in fatigue during EBRT (false discovery rate <.01). Conclusions: Downregulation of SESN3, a novel pharmacoactive stress response gene, was associated with fatigue intensification during EBRT. SESN3 may serve as an interventional target and a biomarker for the cellular and molecular events associated with EBRT-related fatigue.

Abstract

Introduction: Goals of care (GoC) conversations optimally begin early in the course of cancer care, yet most happen near the end of life. We sought to describe oncologist-reported facilitators of and barriers to GoC conversations with patients who have advanced cancer. Methods and Materials: We conducted individual, semistructured qualitative interviews with oncologists from 4 academic, community, municipal, and rural hospitals in New York and Connecticut. Interview topics included approach to GoC conversations, facilitators, barriers, and organizational influences. We analyzed data using interpretive description. We collected demographic and practice information and surveyed oncologists on their communication skills training. We calculated descriptive statistics for quantitative data. Results: Oncologists (n = 21) had a mean age of 46 years (range: 34-68), 67% were male, 71% were White, 24% were Asian, 10% were Hispanic, and 5% were Black. They reported an average of 20 years in practice (range: 8-42), and 62% had received training on having GoC conversations. Facilitators included patient’s poor functional status, patient’s high health literacy, family understanding and acceptance, oncologist’s practice experience, and a supportive practice environment. Barriers included certain patient demographic and clinical characteristics, patient religion and culture, patient’s denial, and lack of time. Conclusion: GoC conversations may be facilitated by enabling oncologists to conduct these conversations despite difficult circumstances and emotional reactions by activating patients and family via increased health literacy and by advancing palliative-informed practice environments.

Abstract

Honors programs in nursing can facilitate the professional development of high-achieving students, supporting their lifelong engagement in nursing practice, education, research, and health care policy issues. Strong mentoring relationships are commonly identified as essential to the success of nursing honors programs, but literature on mentoring relationships in an honors context is limited. The purpose of this study was to gain insight into faculty and student expectations for mentorship. Faculty and students shared similar expectations for both the mentor and mentee, highlighting key themes of engagement, facilitation, accountability, and collaboration as necessary for the success of an undergraduate nursing honors program.

Abstract

Although investigators in health sciences are increasingly interested in using mixed methods, greater adoption requires funding opportunities. Funding allocations can signal recognition of a particular methodology and proficiency of investigators in using such methods. We examined trends in prevalence of mixed methods research funded by federal agencies in the United States. We reviewed abstracts to describe the content and terminology related to mixed methods. The number of self-identified mixed methods awards (n = 535; 2009-2014) increased modestly from previous trends (n = 226; 1997-2008). Abstracts were highly variable in their depth of description and use of mixed methods terminology. We propose five elements to address when developing a scientific abstract for a mixed methods study to facilitate clear description of study design and methods.

Abstract

Frailty is defined as a disability in those of advanced age, often with comorbidities, poor nutritional status, cognitive decline, and reduced functional status. OBJECTIVES: The purpose of this article is to discuss the concept of frailty, assess the use of a comprehensive geriatric assessment (CGA), and understand the implications for treatment to maintain or enhance physical, functional, and cognitive health of older adult patients with cancer. METHODS: Literature about frailty in older adult patients diagnosed with cancer was reviewed to determine evidence-based assessment and treatment options. FINDINGS: About half of all older adult patients with cancer experience some degree of frailty. CGA is a useful way to evaluate frailty and the extent of limitations. Many frailty-specific tools have been developed. Evidence-based strategies are available to address limitations associated with frailty in older adult patients with cancer.

Abstract

Pain is frequent and underreported among HIV+ women. We determined occurrence and severity of pain, and types of pain treatments used among HIV+ and HIV− women. Cross-sectional analyses of pain as measured by the Brief Pain Inventory Short Form, and related pain therapies nested in the Women’s Interagency HIV Study (WIHS). Multiple variable linear regression models examined differences by HIV status in pain severity and pain interference in general activity, mood, ability to walk, work, relationships with others, sleep, and enjoyment of life. Among 1393 HIV+ and 587 HIV− participants with median age 47–48 years, there was no statistically significant difference in pain reported within the past week by HIV status (HIV+ 50% vs. 49% HIV−, p = 0.70). Ratings of pain severity and interference were similar between HIV+ and HIV− women, as was receipt of pain medication (58% HIV+ vs. 56% HIV−). Pain medications most frequently used were: NSAIDS (90% HIV+, 96% HIV−), opioids (65% HIV+, 67% HIV−), topical anesthetics (46% HIV+, 56% HIV−), muscle relaxants (23% HIV+, 14% HIV−), and anticonvulsants (23% HIV+, 14% HIV−). Nearly half of predominantly low income, minority women reported pain in the past week, and two-thirds reported opioid use for pain management. The occurrence, severity, and treatment of pain did not differ by HIV status, nor did report of pain interference with mood or function. Additional research is needed to better characterize pain etiology among HIV+ women in the era of potent antiretroviral therapy, and determine the extent to which pain severity and type of medication used for pain treatment impact HIV disease outcomes.

Abstract

The concepts at the heart of this book originated more than 35 years ago and stemmed from repeated observations of a single troublesome phenomenon: cyclical nurse shortages in hospitals. Inquiries to deal with nurse workforce problems occurred alongside growing research findings suggesting that clinical nurses and other professionals were at risk of mutating from enthusiastic workers engaged with their clients to becoming emotionally drained, cynical, and insecure-the phenomenon known as burnout. The journey of this research field-reflected in the progression of the chapters in this book-has led to a variety of studies attempting to address both phenomena by focusing on the organizational contexts of nursing practice. Each of the chapters in this book offers findings and insights that we have synthesized into four recommendations for future steps in practice and another four recommendations for future steps in research. Connecting all of these recommendations is an emphasis on continuous improvement and change processes embedded in the organizational context of nursing practice, the need to draw on relevant empirical research, and the imperative for research and practice in this field to guide and inspire each other.

Abstract

Interprofessional collaborative education and practice has become a cornerstone of optimal person-centered management in the current complex health care climate. This is especially important when working with older adults, many with multiple chronic conditions and challenging health care needs. This paper describes a feasibility study of the Geriatric Interdisciplinary Team Training 2.0 (GITT 2.0) program focused on providing interprofessional care to complex and frail older adults with multiple chronic conditions. A concurrent triangulation mixed-methods design facilitated program implementation and evaluation. Over three years (2013-2016), 65 graduate students from nursing, midwifery, social work, and pharmacy participated along with 25 preceptors. Participants were surveyed on their attitudes toward interprofessional collaboration pre and post-intervention and participated in focus groups. While attitudes toward interprofessional collaboration did not change quantitatively, focus groups revealed changes in language and enhanced perspectives of participants. Based on the evaluation data, the GITT 2.0 Toolkit was refined for use in interprofessional education and practice activities related to quality initiatives.