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AnteayerNursing Research

Prescribed Walking for Glycemic Control and Symptom Management in Patients Without Diabetes Undergoing Chemotherapy

imageBackground Hyperglycemia may potentiate symptom experiences. Exercise is a nonpharmacological intervention that can potentially improve glycemic control and mitigate symptom experiences in patients undergoing chemotherapy for cancer. Objectives The primary objective was to assess the feasibility of patients engaging in a walking exercise study for 6 months. We also evaluated the effects of a prescribed walking program on glycemic control and for changes over time in the severity of pain, fatigue, depression, and sleep disturbance in patients undergoing chemotherapy for breast, lung, gynecologic, or gastrointestinal cancer. Methods A randomized pilot intervention study was conducted to evaluate differences within and between a prescribed walking program intervention group and a control group. All patients were followed for 6 months, had glycosylated hemoglobin A1c measured at enrollment and 6 months, and completed symptom questionnaires at enrollment, 3 months, and 6 months. Data were analyzed using descriptive statistics and analysis of covariance. Results Most of the patients who enrolled completed the 6-month study. The few who withdrew expressed feeling overwhelmed. The sample was predominately non-Hispanic White female patients with breast cancer with a normal-to-slightly-overweight body mass index. The intervention group had a slight decrease in glycosylated hemoglobin A1c at 6 months. In addition, at 6 months, compared to the control group, the intervention group had significantly less sleep disturbance and depression. No other within- or between-group differences were found. Discussion It is feasible for patients undergoing chemotherapy to participate in a prescribed walking program. Exercise, such as walking, may decrease hyperglycemia and symptom severity. Additional research with larger samples is warranted.

Truth and Science

Por: Pickler · Rita H.
No abstract available

Ethical Considerations of Social Media to Recruit Caregivers of Children With Cancer

imageBackground Social media platforms are useful for recruiting hard-to-reach populations, such as caregivers of children with cancer, for research. However, there are unique ethical considerations in using social media. Objectives The aim of the study was to describe the methods used to recruit hard-to-reach caregivers (parents of children with cancer) for research and related ethical considerations. Methods We used The Belmont Report tenets (respect for persons, beneficence, and justice) as a guiding framework to identify issues relevant to social media recruitment of hard-to-reach populations and to describe how we addressed these issues in our study. Results We engaged leaders of two online communities that offer peer support for caregivers of children with cancer to help with recruitment to our study on financial effect of pediatric cancer. We identified issues in using social media for recruiting hard-to-reach populations in alignment with The Belmont Report, including risk for subject selection bias, privacy rights, protecting identity of participants, data security issues, and access to research. We addressed issues by deliberate study design decisions and engagement with online community advocates. Discussion Using social media to recruit hard-to-reach populations may be a successful way to engage them in research. Although researchers may remain compliant with the institutional review board of their facilities and are faithful to the tenets of The Belmont Report, unanticipated ethical issues may arise directly or indirectly as a result of using social media. This article identifies these issues and provides suggestions for dealing with them.

Adherence to a Hypoglycemia Protocol in Hospitalized Patients: A Retrospective Analysis

imageBackground Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality. Objectives This was a retrospective pre–post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed. Methods Data from hospitalizations of patients who experienced hypoglycemia (

Influence of Oxidative Stress-Related Genes on Susceptibility to Fibromyalgia

imageBackground Fibromyalgia (FM) is a complex syndrome to diagnose and treat because of its unknown etiology. However, previous studies reported that patients with FM experience oxidative stress. Objectives In this study, we investigated single-nucleotide polymorphisms (SNPs) in genes encoding enzymes involved in oxidative stress (superoxide dismutase 1 [SOD1], catalase, and NADPH oxidase [CYBA]) in patients with FM and in healthy subjects, as well as the possible relation with demographic and clinical manifestations of FM. Methods A total of 141 patients with FM and 73 healthy subjects participated in this case–control study. For DNA extraction, buccal swabs were collected from patients with FM, and a peripheral blood sample was extracted from controls. We analyzed SNPs in genes related to oxidative stress (rs10432782 in SOD1, rs1001179 in catalase, and rs4673 in CYBA) using TaqMan probes. In patients with FM, severity of FM, fatigue, and pain were assessed by Fibromyalgia Impact Questionnaire, Multidimensional Fatigue Inventory, and Visual Analogue Scale (VAS), respectively. Physical (PCS-12) and mental (MCS-12) health statuses were evaluated by the 12-Item Short-Form Health Survey. Results The selected SNPs did not show significant differences between patients with FM and controls. The rs10432782 (SOD1) was associated with Fibromyalgia Impact Questionnaire scores in patients with FM, whereas the rs4673 (CYBA) was associated with the Multidimensional Fatigue Inventory score, MCS-12 score, and duration of the disease. Discussion We have identified significant correlations between SOD1 and CYBA variants with clinical manifestations of FM. These results provide new insights into the pathogenesis of FM that could be useful for guiding future studies along the way to find the cause(s) of this syndrome.

A Protocol to Examine Surgical Team Communication in a Large Military Medical Center

imageBackground Preventable clinician communication errors are the most frequent root cause of surgical adverse events. Effective communication among surgical team members is an important overall indicator of clinical nursing excellence and is crucial to promote patient safety and reduce healthcare risk. Objective The purpose of this publication is to describe our research protocol, which will comprehensively investigate surgical team communication and surgical team structure. There are two overall study objectives: (a) to characterize the network factors that influence perioperative clinician communication and (b) to identify how team structure shapes communication effectiveness. Specifically, we will study the association among clinician relationships, surgical team familiarity, surgical team size, and communication effectiveness. Methods We will use an exploratory, prospective, cross-sectional, network-centric approach using social network analysis to determine how interdependent clinician relationships influence surgical communication patterns. Targeting an 80% response rate, we will use total population sampling to recruit all clinicians (nurses, surgeons, anesthetists, surgical technologists, students, residents) who directly provide surgical care in the operating room at a large military medical center. We will administer an electronic survey to surgical teams at the end of the surgical day to elicit clinician communication assessments and relational preferences. From the survey questions, we will develop six relational networks (interaction, close working relationship, socialization, advice seeking, advice giving, speaking up/voice) and three models that represent communication effectiveness for each participant and team. We will use various statistical methods to characterize the network factors that shape operating room clinician communication and identify how team structure shapes communication effectiveness. Results This study will start enrolling participants in 2020. Discussion We are among the first to comprehensively investigate operating room communication using social network analysis. The results of this study will provide valuable insight into nurse collaboration and communication in interprofessional teams, enable a thoughtful analysis of surgical staffing and perioperative team building, and inform future-targeted interventions to improve operating room communication weaknesses.

A Mixed Methods Study of Symptom Experience in Patients With End-Stage Renal Disease

imageBackground Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients’ experiences is lacking. Objectives The aim of this study was to explore factors that are associated with patients’ symptom experiences. Methods The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display. Results Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously. Discussion This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients’ symptom experiences.

Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study

imageBackground Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. Objectives The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals’ phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. Methods This cross-sectional survey study included 678 women (aged 14–42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals’ phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. Results We reproduced three dysmenorrhea symptom-based phenotypes: the “mild localized pain” phenotype (characterized by mild abdominal cramps), the “severe localized pain” phenotype (characterized by severe abdominal cramps), and the “multiple severe symptoms” phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals’ phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. Discussion Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.

Voicing Jordanian Adolescents’ Suicide

imageBackground Studies focusing on adolescent suicide in Arab countries are particularly scarce, with the few available undertaken from within an epidemiological paradigm. Objective This study aimed to understand Jordanian adolescents’ perceptions, beliefs, and attitudes toward suicide. Methods A qualitative design using 12 dual-moderator focus group discussions was conducted in public schools. Participants were selected from the three main regions of the country (rural southern, urban central, and suburban northern). Participants included Jordanian adolescent boys and girls, aged 14–17 years, who reported experiencing mild to moderate depressive symptoms. A relational content analysis approach was used for coding data, and a content analysis was used to identify salient thematic categories. Data were analyzed using NVivo software. Results Four themes emerged, including perceived risk factors, perceived protective factors, active and passive suicidal ideations, and e-games and Internet influences. Main risk factors were depression; anxiety; stigma, shame, and isolation; family issues; life pressures; and guilt. Conversely, religiosity, perceived positive family functioning, and availability of long-term goals seemed to confer resilience to adolescents’ suicidal ideation and behavior. Passive suicidality (having death wishes without any plans to complete suicide) was noticed most among participants who feared jeopardizing the family’s reputation if they committed suicide. Several boys with active suicidal ideations used the Blue Whale Challenge e-game to learn how to complete suicide and relinquish their problems. Discussion Suicide is a multifactorial problem requiring multimodal strategies. Evidence from this research suggests that those most passionate about the outcome of interest are encouraged to redouble efforts to reduce modifiable risk factors, enrich protective factors, target the underlying psychiatric illness that informs suicidal ideations and behavior, and research the effect of social media and Internet activity more deeply. Parents are advised to monitor the online activities of their children and familiarize themselves with the digital applications they use.

Family Functioning Mediates the Relationship Between Activities of Daily Living and Poststroke Depression

imageBackground Poststroke depression is common and includes depressive and somatic symptoms. However, few studies have confirmed the influence of family functioning on poststroke depression or explored the association among daily activities, family functioning, and poststroke depression. Objectives We examined the independent risk factors of daily activities and family functioning for poststroke depression and identified the mediating effect of family functioning on the association between daily activities and poststroke depression. Methods This cross-sectional study design used convenience sampling to recruit 422 stroke survivors from the neurology department of a hospital in Harbin, China, from February to July 2018. We assessed participants’ demographic and clinical variables, including depression, daily activities, and family functioning. Pearson’s correlations and multiple linear regression analyses were conducted, and a path analysis with bootstrapping was utilized to define direct/indirect effects. Results Daily activities and family functioning had a significant and direct negative effect on participants’ depression. The indirect effect of 1,000 bootstrap samples after bias correction with a 95% confidence interval was below zero, indicating that family function had a significant mediating effect on the association between depression and daily activities. Discussion This study revealed the importance of family functioning in the association between depression and daily activities in stroke survivors. To the best of our knowledge, this study was the first to explore the mediating role of family functioning in poststroke depression, emphasizing the importance of family for the mental health of stroke patients. To reduce the incidence of poststroke depression, interventions that enhance daily activities and family functioning may include nurses, family therapists, rehabilitation physicians, and community workers.

Suicide Risk Management Protocol for a Randomized Controlled Trial of Cardiac Patients Reporting Hopelessness

imageBackground Investigators conducting studies that include potentially suicidal individuals are obligated to develop a suicide risk management (SRM) protocol. There is little available in the literature to guide researchers in SRM protocol development. Objectives The aim of the study was to describe an SRM protocol developed for a randomized controlled trial (RCT) currently enrolling cardiac patients who report moderate to severe levels of hopelessness. Methods The SRM protocol identifies suicidal ideation and measures ideation severity through use of the Columbia-Suicide Severity Rating Scale risk factor questions. Based on responses, study participants are deemed safe or at low, moderate, or high risk for suicide. The SRM protocol guides research staff through a plan of action based on risk level. The protocol further guides staff through a plan over the course of this prospective study—from hospital enrollment to home-based visits. Results Research staff are well trained to identify suicidal ideation risk factors, initiate specific questioning about suicidal intent, determine level of risk, identify protective factors and a safe environment, and make referrals if needed. Of the 51 patients hospitalized with cardiac disease who reported moderate to severe hopelessness, 43 scored at a safe suicide risk level and 8 scored at low risk. Thirty-five of the 51 patients enrolled in the RCT. Of the 35 participants who received home visits to date, there have been three instances of low and one instance of moderate suicide risk. The SRM protocol has been consistently and accurately used by research personnel in both hospital and home settings. One modification has been made to the protocol since study activation, namely, the addition of an assessment of counseling history and encouragement of continued counseling. Booster training sessions of research staff will continue throughout the course of the RCT. Discussion Use of the SRM protocol identifies study participants who are safe or at risk for suicide in both hospital and home settings, and research staff can refer participants accordingly. Conclusion The SRM protocol developed for this RCT can serve as a model in the development of SRM protocols for future research in acute care, community, or home-based settings.

Scoring Interpersonal Violence Measures: Methodological Considerations

imageBackground Interpersonal violence, such as intimate partner violence, sexual assault, and adverse childhood experiences, is a significant global health concern. A major challenge to nurses and others working in the field of interpersonal violence deals with the complexity involved in measuring interpersonal violence. Numerous validated instruments exist; however, there is no standard approach for scoring these instruments. There is also a tendency to examine different forms of violence separately, not accounting for the known co-occurrence of violence. This has led to confusion as the interpretation of results often differs depending on the specific method used. Objectives The purpose of this article is to summarize the major methods for scoring interpersonal violence measures and implications of each approach with a specific focus on co-occurrence. Methods The article begins with a summary of the primary goals of measuring interpersonal violence, major methods for scoring interpersonal violence measures, along with scoring challenges. We then provide a case exemplar examining the relationship between interpersonal violence and posttraumatic stress disorder symptoms to illustrate how scoring methods can affect study results and interpretation of findings. Results Our article shows that each scoring method provides a different picture of the distribution of interpersonal violence experiences and varies regarding the ease of interpretation. Scoring methods also affect interpretation of associations between interpersonal violence and other factors, such as having statistical power to detect significant associations. Accounting for the co-occurrence is critical for making accurate inferences by identifying potential confounding interactions between different types of violence. Discussion The application of different scoring methods leading to varying interpretations highlights the need for researchers to be purposeful when selecting a method and even applying multiple methods when possible. Recommendations are provided to assist researchers and providers when making decisions about the use of scoring methods in different contexts.

Self-Efficacy, Pain Intensity, Rheumatic Disease Duration, and Hand Functional Disability on Activities of Daily Living

imageBackground Knowledge regarding the possible influence of self-efficacy, pain intensity and disease duration on hand functional disability could promote new intervention strategies for activities of daily living (ADLs) in patients with rheumatic disease (RD). These approaches could prevent the health problems and socioeconomic costs associated with these diseases. Objective The aims of this study were to evaluate if there are differences between the levels of perceived self-efficacy, pain intensity and disease duration among people with RD and non-RD diseases, and to analyze if hand functional disability in ADLs is related to self-efficacy, pain intensity and disease duration in a sample of patients with RD. Methods A multicenter, observational, cross-sectional study was conducted on a total sample of 335 participants over 50 years old (176 patients with RD and 159 individuals with non-RD). The Duruöz Hand Index, the General Perceived Self-Efficacy Scale, the Rheumatic Diseases Self-Efficacy Scale (RDS-ES), the Visual Analog Scale (VAS), and the mean time of evolution in years of the disease (disease duration) were used to analyze the possible relationships surrounding hand functional disability in ADLs. Results The comparison analysis showed significant differences between the RD/non-RD sample for the General Perceived Self-Efficacy Scale, RDS-ES, and VAS scores (p

The Year That Wasn’t

Por: Pickler · Rita H.
No abstract available

Identifying Individuals With Intellectual Disability Within a Population Study

imageBackground Much remains unknown about the longitudinal health and well-being of individuals with intellectual disability (ID); thus, new methods to identify those with ID within nationally representative population studies are critical for harnessing these data sets to generate new knowledge. Objective Our objective was to describe the development of a new method for identifying individuals with ID within large, population-level studies not targeted on ID. Methods We used a secondary analysis of the de-identified, restricted-use National Longitudinal Study of Adolescent to Adult Health (Add Health) database representing 20,745 adolescents to develop a method for identifying individuals who meet the criteria of ID. The three criteria of ID (intellectual functioning, adaptive functioning, and disability originating during the developmental period) were derived from the definitions of ID used by the American Psychiatric Association and the American Association on Intellectual and Developmental Disabilities. The ID Indicator was developed from the variables indicative of intellectual and adaptive functioning limitations included in the Add Health database from Waves I to III. Results This method identified 441 adolescents who met criteria of ID and had sampling weights. At Wave I, the mean age of this subsample of adolescents with ID was 16.1 years. About half of the adolescents were male and from minority racial groups. Their parents were predominately female, were married, had less than a high school education, and had a median age of 41.62 years. The adolescents’ mean maximum abridged Peabody Picture Vocabulary Test standardized score was 69.6, and all demonstrated at least one adaptive functioning limitation. Discussion This study demonstrates the development of a data-driven method to identify individuals with ID using commonly available data elements in nationally representative population data sets. By utilizing this method, researchers can leverage existing rich data sets holding potential for answering research questions, guiding policy, and informing interventions to improve the health of the ID population.

Integration of Person-Centered Narratives Into the Electronic Health Record: Study Protocol

imageBackground Incorporating a patient’s personal narrative into the electronic health record is an opportunity to more fully integrate the patient’s values and beliefs into care, thus creating opportunities to deliver high-quality/high-value, person-centered care. Objectives The aim of the study was to present a study protocol of a narrative intervention to (a) compare the effects of the narrative intervention to usual care on primary outcome of person’s (patient) perceptions of quality of communication, (b) compare the effects of the narrative intervention on secondary outcomes of biopsychosocial well-being, and (c) examine the feasibility and acceptability of the narrative intervention from the perspective of both persons: the patient and the acute care bedside nurse. Methods A randomized control trial is being conducted with a targeted enrollment of 80 patient participants and 80 nurse participants. The patient participants include individuals who are admitted to the acute care hospital for either heart failure or end-stage renal disease. An acute care beside nurse who has cared for the patient participant is also enrolled. Through a 1:1 random allocation scheme, stratified by illness, we will enroll 40 in the narrative intervention group and 40 in the usual care group. Patient participants will be assessed for patient-reported outcomes of patient’s perception of quality of communication and biopsychosocial well-being. Results The study began in October 2019; 53 potential patient participants have been approached, 21 have enrolled, and 20 have completed the data collection process. Discussion The testing and integration of a person-centered narrative into the electronic health record is a novel approach to provide opportunities for improvement in communication between patients and nurses. The results from this study will provide important preliminary knowledge to inform future randomized clinical trials of narrative interventions leading to advances in how to best provide high-value, high-quality, person-centered care for persons living with serious illness.

Prediction of Cognitive Ability With Social Determinants in Children of Low Birth Weight

imageBackground Despite strong prevention efforts and advances in neonatal care in recent decades, low birth weight remains a serious public health problem in the United States, and survivors remain at increased risk for lifelong problems including cognitive deficits. Current regional and local strategies for referral often rely on variable thresholds for birth weight and gestational age that may be poor analogues to cognitive risk. Improving early referral criteria offers many benefits, including improved cognitive outcomes for children and improved cost-effectiveness and resource utilization in resource-limited communities. Objectives We hypothesized that social determinants measurable at birth or at birth hospital discharge, when combined with birth weight and gestational age, would offer an improvement over birth weight and gestational age alone in predicting cognitive test scores in school-aged children with low birth weight. Methods We conducted a secondary analysis using a birth cohort of children from the Fragile Families and Child Wellbeing Study. We created a panel of maternal, familial, and community-level social determinant indicators from the data and examined associations with cognitive measures assessed at age of 9 years. Results The final social determinant model was statistically significant and explained 35% of the total variance in composite test scores. The “standard care” model (birth weight and gestational age) only explained 9% of the variance. Discussion Assessment of social determinants may offer improvement over traditional referral criteria to identify children most at risk of cognitive deficits after low birth weight.

Fatigue and Sleep Quality Predict Eating Behavior Among People With Type 2 Diabetes

imageBackground People with Type 2 diabetes frequently report increased fatigue and sleep disturbance. These symptoms might put them at a higher risk for unhealthy eating behavior—detrimental to diabetes control. Objectives The aim of the study was to examine the effect of fatigue and sleep on eating behavior in people with Type 2 diabetes by using a daily diary approach. Methods Data from 56 patients were collected during a baseline interview and an 8-day ambulatory assessment period in the free-living setting. Each day, participants completed one diary upon awakening to assess their sleep duration and sleep quality during the previous night and morning fatigue. They also completed one diary before going to bed to assess their eating behavior during the day (e.g., uncontrolled eating, cognitive restraint, emotional eating, and snacking). Data from 7 days were analyzed using generalized estimating equations. Results During the 7 days, controlling for age, gender, and body mass index, between-person fatigue was a significant predictor of uncontrolled eating, emotional eating, and snacking. Similarly, controlling for the covariates, between-person sleep quality was a significant predictor of uncontrolled eating and emotional eating. No associations were found between sleep duration and eating behavior. Discussions At the between-person level, reporting higher fatigue or poorer sleep quality was associated with higher levels of unhealthy eating behavior. Patients with Type 2 diabetes with high fatigue or poor sleep quality may require additional attention to support their healthy eating.
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