bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive Assessment of Outcomes From Patients With Severe Early-onset Scoliosis Treated With a Vertebral Column Resection: Results From an SRS Global Outreach Site (FOCOS) in Ghana
Authors: Verma Kushagra , Slattery Casey , Duah Henry , Yankey Kawdwo P. , Mundis Gregory , Boachie-Adjel Oheneba
Published: May 2018

Background:

Early-onset scoliosis (EOS) remains a challenging pediatric spine condition to manage. Some severe deformities can be managed with a vertebral column resection (VCR), which is fraught with high complication rates and the outcomes have not been well reported. The purpose of this study is to provide an assessment of operative, radiographic, and clinical outcomes from children diagnosed with severe EOS treated with a VCR.

Methods:

We performed a retrospective review of prospectively collected data. Basic demographic data was collected along with the diagnosis, procedure performed, FOCOS risk score, blood loss (estimated blood loss), operative time, neuromonitoring events, intraoperative complications, and clinical follow-up. Coronal and sagittal radiographic parameters were measured by the first author.

Results:

We identified 14 patients with posttuberculosis deformity (n=7) or congenital deformity (n=7) that underwent VCR between 2013 and 2016 (5 female; age, 7.7±3 y; body mass index, 17.7±2.8). There was significant improvement in coronal radiographic parameters (primary curve: 55 to 21 degrees, secondary: 37 to 13 degrees, T1-12 length: 137 to 151 mm, T1-S1 length: 219 to 271 mm, P<0.05) and sagittal parameters (kyphosis: 85 to 41 degrees, compensatory lordosis 56 to 39 degrees, P<0.001). There was no change in chest width, sagittal vertical axis, or pelvic tilt. Mean proximal junctional kyphosis (PJK) angle was 12±9 degrees and distal junctional kyphosis angle was 9±17 degrees. Estimated blood loss was 860±520 mL and operative time was 200±66 minutes. Seven cases had neuromonitoring changes that improved with corrective maneuvers and blood pressure elevation. Three patients required reoperation for junctional breakdown with 1 having a third operation for an infection, while 2 additional patients had evidence of radiographic PJK.

Conclusions:

VCR in the setting of EOS has excellent radiographic outcomes but a high complication profile. Half of these cases had neuromonitoring changes intraoperatively that improved without lasting neurological deficit. Three patients had PJK and 1 had an infection requiring reoperation.

Level of Evidence:

Level IV—case series.
Rectal Culture and Sensitivity Analysis for Reducing Sepsis Risk After Fiducial Marker Placement
Authors: Mendenhall William M. , Sarto Gail , Bryant Curtis M. , Morris Christopher G. , Williams Christopher R. , Costa Joseph A. , Bandyk Mark , Hoppe Bradford S. , Henderson Randal H. , Nichols R. Charles , Mendenhall Nancy P.
Published: May 2018

Purpose:

Placement of fiducial markers for prostate radiotherapy (RT) is associated with a 2% to 3% risk of bacterial urinary tract infection (UTI) that may progress to sepsis necessitating hospitalization. These bacterial UTIs are primarily due to flouroquinolone (FQ) resistantEscherichia coli(E. coli). The incidence of this complication has increased in recent years. The purpose of this study is to determine whether rectal culture and sensitivity (C&S) to identify FQ resistantE. coliobtained before placement of fiducial markers for prostate RT reduces the likelihood of this complication.

Methods:

In total, 412 patients treated with RT at the University of Florida Proton Therapy Institute between 2015 and 2017 were included in the study. Rectal C&S were obtained at the time of initial consultation which preceded placement of fiducial markers for planning and realignment for prostate RT. Patients in whom resistantE. coliwere identified had their prophylactic antibiotic regimen modified accordingly. Whether bacterial UTI requiring hospitalization following fiducial placement occurred was prospectively recorded in the medical record on the first day of RT.

Results:

One of 412 patients (0.2%) developed bacterial sepsis requiring hospitalization after fiducial placement.

Conclusion:

Rectal C&S to identify FQ resistantE. colibefore placement of fiducial markers for prostate RT likely reduces the risk of bacterial UTI necessitating hospitalization.
Risk effects of near-roadway pollutants and asthma status on bronchitic symptoms in children
Authors: Urman Robert , Eckel Sandrah , Deng Huiyu , Berhane Kiros , Avol Ed , Lurmann Fred , McConnell Rob , Gilliland Frank
Published: May 2018

Background:

Bronchitic symptoms in children pose a significant clinical and public health burden. Exposures to criteria air pollutants affect bronchitic symptoms, especially in children with asthma. Less is known about near-roadway exposures.

Methods:

Bronchitic symptoms (bronchitis, chronic cough, or phlegm) in the past 12 months were assessed annually with 8 to 9 years of follow-up on 6757 children from the southern California Children’s Health Study. Residential exposure to freeway and non-freeway near-roadway air pollution was estimated using a line-source dispersion model. Mixed-effects logistic regression models were used to relate near-roadway air pollutant exposures to bronchitic symptoms among children with and without asthma.

Results:

Among children with asthma, a 2 SD increase in non-freeway exposures (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.17, 1.78) and freeway exposures (OR: 1.31; 95% CI: 1.06, 1.60) were significantly associated with increased risk of bronchitic symptoms. Among children without asthma, only non-freeway exposures had a significant association (OR: 1.14; 95% CI: 1.00, 1.29). Associations were strongest among children living in communities with lower regional particulate matter.

Conclusions:

Near-roadway air pollution was associated with bronchitic symptoms, especially among children with asthma and those living in communities with lower regional particulate matter. Better characterization of traffic pollutants from non-freeway roads is needed since many children live in close proximity to this source.
Vaspin Prevents Tumor Necrosis Factor-α–Induced Apoptosis in Cardiomyocytes by Promoting Autophagy
Authors: Ke Xuan , Hao Yanqin , Li Bingong , Zou Jin , Li Xuelian , Wei Chunying , Liu Fuyou , Zhang Zhiyong
Published: May 2018

Visceral adipose tissue–derived serine protease inhibitor (Vaspin) is an adipocytokine that has been shown to exert anti-inflammatory effects and inhibits apoptosis under diabetic conditions. This study was designed to investigate the impact of vaspin on autophagy in tumor necrosis factor (TNF)-α–induced injury in cardiomyocytes and its cardioprotective effects in the pathogenesis of diabetic cardiomyopathy (DCM). H9C2 cells were treated with TNF-α with or without vaspin in vitro. Tumor necrosis factor-α treatment inhibited autophagy and promoted apoptosis in H9C2 cells after stimulating for 24 hours. Pretreatment with vaspin significantly mitigated apoptosis induced by TNF-α partly because of augment effects of vaspin on autophagy as demonstrated by a higher ratio of LC3-II/LC3-I, higher expression of Beclin-1, and increased autophagosomes formation. Furthermore, the AKT agonist IGF-1 significantly reversed the effect of vaspin on autophagy. In vivo DCM model was also developed by treating rats with streptozotocin followed by intraperitoneal injection with vaspin. In DCM rats, upregulation of vaspin reversed cardiac dysfunction, as identified by increased left ventricular ejection fractions and fractional shortening levels, a higher Em/Am ratio, and lower levels of TNF-α, lactate dehydrogenase, creatine kinase, and creatine kinase-myocardial isoenzyme. In conclusion, vaspin attenuated the TNF-α–induced apoptosis by promoting autophagy probably through inhibiting the PI3K/AKT/mTOR pathway and further ameliorated the cardiac dysfunction in DCM rats.
Cardiovascular Nursing Science Priorities
Authors: Piano Mariann R. , Artinian Nancy T. , DeVon Holli A. , Pressler Susan T. , Hickey Kathleen T. , Chyun Deborah A.
Published: May 2018

Background:

The American Heart Association's (AHA) Council on Cardiovascular and Stroke Nursing (CVSN) plays a critical role in advancing the mission of the AHA in the discovery of new scientific knowledge. The aim was to identify priority research topics that would promote and improve cardiovascular (CV) health, provide direction for the education of future nurse scientists, and serve as a resource and catalyst for federal and organizational funding priorities.

Methods:

A Qualtrics survey, which included 3 questions about priorities for CVSN nurse researchers, was sent to the CVSN Leadership Committee and all CVSN Fellows of the AHA (n = 208). Responses to the questions were reviewed for word repetitions, patterns, and concepts and were then organized into thematic areas. The thematic areas were reviewed within small groups at the November (2016) in-person CVSN leadership meeting.

Results:

Seventy-three surveys were completed. Five thematic areas were identified and included (1) developing and testing interventions, (2) assessment and monitoring, (3) precision CV nursing care, (4) translational and implementation science, and (5) big data. Topic areas noted were stroke, research methods, prevention of stroke and CV disease, self-management, and care and health disparities.

Conclusion:

Five thematic areas and 24 topic areas were identified as priorities for CV nursing research. These findings can provide a guide for CV nurse scientists and for federal and foundational funders to use in developing funding initiatives. We believe additional research and discovery in these thematic areas will help reduce the rising global burden of CV disease.
Nursing Challenges in Interactions With Patients Receiving Mechanical Circulatory and Respiratory Support
Authors: Wrigley Cara , Straker Karla , Nusem Erez , Fraser John F. , Gregory Shaun D.
Published: May 2018

Background:

Mechanical circulatory and respiratory support (MCRS) systems provide short- to long-term life support for patients with severe cardiac or respiratory failure. Whereas the challenges of patients with these lifesaving systems are well understood, the challenges faced by nurses of patients receiving MCRS remain relatively unidentified.

Objectives:

In this study, we investigated the challenges and experiences of MCRS nurses, with the aim of informing the design of future interventions.

Design:

A qualitative approach was taken to develop an in-depth understanding of the emotional issues nurses experience in their daily interactions with patients.

Participants and Setting:

Nine MCRS nurses ranging in clinical experience were recruited from Australian hospitals.

Methods:

Participants were divided into 3 focus groups, with design prompts being used in the focus groups to facilitate discussion. Data from these focus groups were analyzed through a thematic analysis protocol.

Results:

The nurses’ accounts were clustered around 2 themes, including (1) patient connection and (2) compassion vitality and fatigue. Each theme elicits a conflicting compromise that MCRS nurses face daily.

Conclusion:

The challenges of nurses who support patients with MCRS are complex, multifaceted, emotionally stimulating, and exhausting. We therefore contributes a set of design criteria to support such nurses, setting a direction for future research.
Patient and Professional Factors That Impact the Perceived Likelihood and Confidence of Healthcare Professionals to Discuss Implantable Cardioverter Defibrillator Deactivation in Advanced Heart Failure
Authors: Hill Loreena , McIlfatrick Sonja , Taylor Brian J. , Jaarsma Tiny , Moser Debra , Slater Paul , McAloon Toni , Dixon Lana , Donnelly Patrick , Stromberg Anna , Fitzsimons Donna
Published: May 2018

Background:

Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently.

Aim:

The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation.

Methods and Results:

Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making.

Conclusions:

Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.
Reflections on 50 Years of Neuroscience Nursing: Neuro-Oncology, Moving Forward by Looking Back
Authors: Reed Marilyn E. , Anthony Patricia P. , Rosenfeld Priscilla B. , Ligon Brandi L. , Doris Estelle M. , Fox Sherry W.
Published: May 2018

During the past 50 years, there have been more than 100 articles published in the Journal of Neuroscience Nursing covering the topic of neuro-oncology. This article will explore the historical implications and milestones from these articles. The analysis highlights the scope and depth of the many articles as they relate to the advancements in neuro-oncology.
Sexual Function in Young Individuals With Multiple Sclerosis: Does Disability Matter?
Authors: Calabrò Rocco Salvatore , Russo Margherita , Dattola Vincenzo , De Luca Rosaria , Leo Antonino , Grisolaghi Jacopo , Bramanti Placido , Quattrini Fabrizio
Published: May 2018

Introduction: Studies on the prevalence of sexual dysfunction (SD) in multiple sclerosis (MS) have shown that 40% to 80% of women and 50% to 90% of men have had sexual complaints. Sexual function is often disregarded during consultation with healthcare professionals, and SD is frequently underdiagnosed. The aim of this study was to investigate the prevalence of SD and its relationship to sociodemographic and disease-related factors, with regard to disability state, in a hospital cohort of MS patients, by using a semistructured interview. Methods: Of 130 screened outpatients, 87 met the inclusion criteria and completed the study. The mean age of the participants was 39.3 ± 8.3 years, with a disease duration of 8.3 ± 5.4 years and a mean Expanded Disability Status Scale (EDSS) score of 2.04 ± 0.19. Sexual function was evaluated by means of a semistructured interview, investigating a patient’s 3 main life areas: sociodemographic information, illness perception, and sexuality. Results: Approximately 70% of the patients complained at least 1 SD (decreased libido, erectile dysfunction, premature or retarded ejaculation, painful penetration), and 22% of them reported the disorder as frequent. The disease duration was associated with lower satisfaction in sexual function, and lack of sexual interest was the most common problem having a negative correlation with EDSS. Conclusions: Healthcare professionals involved in MS, should assess patients for SD. Further studies should be fostered to better quantify SD etiology, the degree of sexual impairment, and its impact on patients’ quality of life to “overcome” this problem.
Reliability and Validity of National End of Rotation Examinations: An Update
Authors: Gietzen Lindsay , Roman Christopher , Hegmann Theresa
Published: May 2018

Purpose

This study sought to evaluate the reliability of the PAEA End of Rotation™ exam scores used as a combined scale. The study also investigated how closely the individual exam scores and the combined scale correlate with Physician Assistant National Certifying Exam (PANCE) performance to validate their use as tools for assessing physician assistant (PA) students during their clinical training.

Methods

Deidentified PAEA End of Rotation examination and PANCE scores were used to calculate Pearson correlations, Cronbach's alpha, and value of Cronbach's alpha if individual exams were removed from the analysis. A linear regression model was generated to predict certification exam scores.

Results

End of Rotation examinations are a reliable predictor of certification examination performance independent of PA program or test version, with Cronbach's alpha at 0.847.

Conclusions

The mean of all 7 examinations may be used, but the mean of just 4 examinations (Emergency Medicine, Family Medicine, General Surgery, and Internal Medicine) is also a valid predictor of certification examination performance.
Perceived Discrimination, Harassment, and Abuse in Physician Assistant Education: A Pilot Study
Authors: DiBaise Michelle , Tshuma Lisa , Ryujin Darin , LeLacheur Susan
Published: May 2018

Purpose

A 2014 meta-analysis found that by graduation, 16.6% of medical students had reported abuse, harassment, or discrimination and that this hostile environment caused an increase in depression and anxiety. The purpose of this research study was to increase the understanding of discrimination and psychological/physical abuse in physician assistant (PA) education programs and the potential impact on student attrition.

Methods

Information was collected using an online, anonymous survey that asked about witnessed or experienced discrimination and psychological or physical abuse during the didactic and clinical years of training in PA programs in the United States.

Results

The survey received 1159 respondents, which represents 6.1% of total PA student enrollment. Up to 30% of respondents had witnessed or experienced discrimination, and up to 2.3% had experienced psychological abuse while in PA school. The majority of witnessed or experienced discrimination during PA education was not reported (<2%). Reports were not made because students feared retribution or they simply did not know who to report to, particularly if the incident involved faculty.

Conclusion

Reducing the prevalence of discrimination in PA education requires recognition of this issue and targeted efforts to ensure that the infrastructure of every program is inclusive and values diversity of all kinds. The authors advocate that PA programs discuss their current institutional reporting structure; develop a universal curriculum on workplace violence, discrimination, and harassment; and develop value statements that explicitly identify diversity and equity as a core value as an important first step to improving the overall “climate” and culture of the program.
Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes
Authors: Gamble Alexander Shand Davis , Mountjoy Margo Lynn , Bigg Jessica Lynne , Spriet Lawrence Leon
Published: May 2018

Objective:

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

Design:

Longitudinal prospective surveillance study.

Setting:

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

Participants:

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

Interventions:

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

Main Outcome Measures:

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

Results:

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

Conclusions:

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.
Postprofessional Physical Therapist Education: A Report From Two Regions of the World
Authors: Westervelt Karen C. , Chenette Jennifer , Merkel Liana , Sibold Jeremy , Crane Linda , Hing Wayne
Published: May 2018

Introduction.

Leaders in the physical therapy profession have identified a global need for high-quality postprofessional physical therapist (PT) education. However, the educational needs and realities for busy practicing PTs have yet to be identified. Therefore, the purpose of this research was to provide information to assist institutions around the world in designing appropriate postprofessional education programs for PTs.

Methods.

The study sample consisted of 10 years of alumni from a Doctor of Physical Therapy (DPT) program in the United States of America (USA) and 7 years of alumni from an equivalent DPT program in Australia (AUS). Data were collected via survey and were analyzed using descriptive statistics and phenomenological analysis.

Results.

Approximately 10% of participants from each country had completed a formal postprofessional education program. More recent graduates in both groups reported the greatest interest in postprofessional education. Both groups showed high interest in returning to their alma maters, utilizing a hybrid learning format, and participating in international collaborations. Orthopedics and musculoskeletal were the specialty areas of greatest interest in the USA and AUS, respectively. Barriers to pursuing postprofessional education identified by both groups were cost and lack of access/locations. Focus group participants identified access to a mentor and increased recognition as important aspects of postprofessional education.

Discussion and Conclusion.

Universal interest in, and barriers to, postprofessional physical therapy education exists worldwide. Offering hybrid education including international collaboration and mentoring targeted at recent graduates may be effective in meeting the needs of busy PTs. Institutions looking to establish successful postprofessional education programs should take cost, access, time, and area of study into consideration.
Excess Cost of Cervical Cancer Screening Beyond Recommended Screening Ages or After Hysterectomy in a Single Institution
Authors: Teoh Deanna , Hultman Gretchen , DeKam McKenzie , Isaksson Vogel Rachel , Downs Levi S. , Geller Melissa A. , Le Chap , Melton Genevieve , Kulasingam Shalini
Published: May 2018

Objective

The aim of the study was to estimate the excess cost of guideline nonadherent cervical cancer screening in women beyond the recommended screening ages or posthysterectomy in a single healthcare system.

Materials and Methods

All Pap tests performed between September 1, 2012, and August 31, 2014, in women younger than 21 years, older than 65 years, or after hysterectomy, were coded as guideline adherent or nonadherent per the 2012 America Society of Colposcopy and Clinical Pathology guidelines. We assumed management of abnormal results per the 2013 America Society of Colposcopy and Clinical Pathology management guidelines. Costs were obtained from a literature review and Center for Medicare and Medicaid Services data and applied to nonadherent screening and subsequent diagnostic tests.

Results

During this period, 1,398 guideline nonadherent Pap tests were performed (257 in women <21 years, 536 in women >65 years, and 605 after hysterectomy), with 88 abnormal results: 35 (13.5%) in women younger than 21 years, 14 (2.6%) in women older than 65 years, and 39 (6.5%) in women after hysterectomy. The excess cost for initial screening, diagnostic tests, and follow-up was US $35,337 for 2 years in women younger than 21 years, US $54,378 for 5 years in women older than 65 years, and US $77,340 for 5 years in women after hysterectomy, resulting in a total excess cost of US $166,100 for 5 years. Of the 1,398 women who underwent guideline nonadherent screening, there were only 2 (0.1%) diagnoses of high-grade dysplasia (VaIN3).

Conclusions

Guideline nonadherent cervical cancer screening in women beyond the recommended screening ages and posthysterectomy resulted in costs exceeding US $160,000 for screening, diagnostic tests, and follow-up with minimal improvement in detection of high-grade dysplasia.
Modern management of osteoradionecrosis
Authors: Raggio Blake S. , Winters Ryan
Published: May 2018

Purpose of review

Despite recent advances in radiotherapy, osteoradionecrosis (ORN) remains a common and difficult complication of radiation therapy in head and neck cancer patients. Available treatment options are complementary to its complex pathophysiology and the currently available theories of ORN development. The efficacy of hyperbaric oxygen therapy has recently been questioned, and therapies targeting the fibroatrophic process have become a focus of ORN treatment. The objective of this review is to evaluate the literature regarding ORN of the mandible, with a focus on available treatment options.

Recent findings

The recently proposed fibroatrophic theory has challenged the traditional hypovascular-hypoxic-hypocellular theory as the mechanism of ORN. Medical management targeting this fibroatrophic process offers promising results, but has yet to be confirmed with robust clinical trials. The routine use of hyperbaric oxygen therapy is not substantiated in the literature, but may be justified for select patients. Systemic steroids may also have a role, though data are limited.

The fibroatrophic process has gained acceptance as a main mechanism of ORN. No gold standard treatment or consensus guidelines exist, though a combination of therapeutic strategies should be considered, taking into account the severity of disease and individual patient characteristics.
Evaluation of Helicobacter pylori Infection and Clarithromycin Resistance in Strains From Symptomatic Colombian Children
Authors: Rosero Yuliet L. , Arévalo‐Jaimes Betsy V. , Delgado María Pilar , Vera‐Chamorro José F. , García Daniella , Ramírez Andrea , Rodriguez‐Urrego Paula A. , Álvarez Johanna , Jaramillo Carlos A.
Published: May 2018

The aim of the study was to determine the current prevalence of Helicobacter pylori in symptomatic Colombian children and evaluate the presence of mutations associated with clarithromycin resistance. Biopsies from 133 children were analyzed. The gastric fragment was used for urease test and reused for polymerase chain reaction sequencing of the 23SrDNA gene. Mutations were detected by bioinformatic analysis. Polymerase chain reaction sequencing established that H pylori infection was present in 47% of patients. Bioinformatics analysis of the 62 positive sequences for 23SrDNA revealed that 92% exhibited a genotype susceptible to clarithromycin, whereas the remaining strains (8%) showed mutations associated with clarithromycin resistance. The low rate of resistance to clarithromycin (8%) suggests that conventional treatment methods are an appropriate choice for children. Recycling a biopsy that is normally discarded reduces the risks associated with the procedure. The 23SrDNA gene amplification could be used for a dual purpose: detection of H pylori and determination of susceptibility to clarithromycin.
What Influences Home Care Nurses to Accept or Reject Precepting Opportunities? A Pilot Study
Authors: Egan Judith , Toughill Eileen Helbig , Painter Ann , Truex Rita
Published: May 2018

Nurse managers and nursing faculty report, anecdotally, on their difficulty identifying nurses willing to precept new staff or students. To understand more about this topic, we queried home care nurses at a small agency on their perceived incentives and barriers to precepting, their preceptor status, generation of birth, and birth order. The purpose of this pilot study was to identify home care nurses' perceived incentives and barriers to becoming a preceptor. We also sought to examine possible relationships between preceptor status, generation of birth, and ordinal position of birth.
Exposing Baccalaureate Nursing Students to Transitional Care
Authors: O'Connor Melissa , Arcamone Angelina , Amorim Frances , Hoban Mary Beth , Boyd Regina M. , Fowler Lauren , Marcelli Theresa , Smith Jacalyn , Nassar Kathleen , Fitzpatrick M. Louise
Published: May 2018

Management and facilitation of care transitions from hospital to alternative settings requires skill and attention to avoid adverse events. Several interprofessional organizations and nurse leaders have called for the expansion and redesign of undergraduate nursing curricula to include care transitions. Yet there is little evidence describing how undergraduate baccalaureate nursing students are educated on this critical topic or how successful they are in improving student knowledge about care transitions. To address this gap, an in-classroom and clinical experience was implemented to prepare students to manage and facilitate care transitions from the hospital to alternative settings—including the home. Perceptions of undergraduate nursing students and home healthcare nurse preceptors were assessed via an electronic survey that was emailed to participants. Forty-eight responses to the survey were received. Students agreed this experience contributed to their understanding of caring for adults and older adults who are experiencing a care transition and they had a good understanding of care transitions to apply to their future nursing courses. Home healthcare nurse preceptors agreed they were able to demonstrate transitional care and that students were engaged. Future work should include expanding transitional care immersion to other care settings as well as the inclusion of additional healthcare disciplines in care transition education.
Home Health Nurse Collaboration in the Medical Neighborhood of Children with Medical Complexity
Authors: Nageswaran Savithri , Golden Shannon L.
Published: May 2018

The objectives of this study were to describe how home healthcare nurses collaborate with other clinicians caring for children with medical complexity, and identify barriers to collaboration within the medical neighborhood. Using qualitative data obtained from 20 semistructured interviews (15 English, 5 Spanish) with primary caregivers of children with medical complexity and 18 home healthcare nurses, researchers inquired about experiences with home healthcare nursing services for these children. During an iterative analysis process, recurrent themes were identified by their prevalence and salience in the data. Home healthcare nurses collaborate with many providers within the medical neighborhood of children with medical complexity and perform many different collaborative tasks. This collaboration is valued by caregivers and nurses, but is inconsistent. Home healthcare nurses' communication with other clinicians is important to the delivery of good-quality care to children with medical complexity at home, but is not always present. Home healthcare nurses reported inability to share clinical information with other clinicians, not receiving child-specific information, and lack of support for clinical problem-solving as concerns. Barriers for optimal collaboration included lack of preparedness of parents, availability of physicians for clinical support, reimbursement for collaborative tasks, variability in home healthcare nurses' tasks, and problems at nursing agency level. Home healthcare nurses' collaboration with other clinicians is important, but problems exist in the current system of care. Optimizing collaboration between home healthcare nurses and other clinicians will likely have a positive impact on these children and their families.
A Home Care Practice Scenario Using Clinical Dashboards
Authors: Lee Seonah , Huebner Trish
Published: May 2018

Portable electronic medical records used by home care nurses do not provide well-organized displays of previous documentation regarding patient care. The retrieved information is in a disorderly format; therefore, clinicians have to manually organize necessary information from multiple screens. This article describes the development of clinical dashboards to present key information necessary for individual patient care; a scenario using the clinical dashboards; and home care nurses' perceptions of the clinical dashboards. Four health problems (congestive heart failure, anticoagulation, ulcer wounds, and diabetes) and health problem-specific key data were selected based on home care practice and presented in the respective clinical dashboards. A questionnaire developed by the researchers consisted of 28 closed-ended and 2 open-ended questions to assess home care nurses' perceptions of the clinical dashboards in the scenario. Fourteen of 19 nurses recruited from three home care organizations positively perceived the clinical dashboards presented in the scenario and provided suggestions for improvement. A few features of the dashboards were perceived neutrally or negatively, which indicated the need for further development of the clinical dashboards to fit the needs of home care nurses.
The 2015-2020 Dietary Guidelines
Authors: Rouen Patricia A. , Wallace Brenna R.
Published: May 2018

This article reviews the 2015-2020 Dietary Guidelines for Americans released in 2016. Key recommendations are summarized and significant changes in the guidelines are highlighted. Implications for nursing practice to promote nutrition health are identified and resources to support implementation are included.
Fall Reduction Interventions for Hospice Patients
Authors: Kowalski Sonya
Published: May 2018

Despite efforts to decrease inpatient falls at a Midwestern Veterans Administration Medical Center, patients on the hospice unit continued to have higher rates of falls than patients on other units. The purpose of this article is to review the literature to determine if evidence-based, population-specific, fall prevention measures could be implemented to reduce the risk of falls for hospice patients. As a result of this literature review, an end-of-life care plan was developed and will be utilized to increase the frequency of assessment and rounding, and to encourage family involvement during this critical time frame.
Occupational Exposures of Home Healthcare Workers
Authors: Agbonifo Noma , Hittle Beverly , Suarez Rassull , Davis Kermit
Published: May 2018

Population demographics in the United States are rapidly changing with increased dependence on home healthcare (HHC) by an aging population, patients suffering from chronic diseases, and inability to perform activities of daily living. Despite the occupational injury rates for HHC workers (HHCW) being higher than the national average, an understanding of the occupational safety and health experiences and exposures of HHCW is limited. The purpose of this study was to understand the health and safety risk factors for HHCW. One-on-one interviews were conducted with HHCW to elicit frequency of daily occupational exposures to hazards and risk factors during visits to patients' homes. Approximately 67% of the study population was over 40 years old and mostly obese, potentially increasing risk for injury. HHCW routinely perform physical tasks with increased risk for occupational musculoskeletal injuries. Exposures to drug residue from dispensing oral medications and anticancer medications and exposure to potentially infectious agents and cleaning chemicals used for infection prevention were reported. The majority of HHCW were also exposed to secondhand smoke and occasionally experienced violence. Developing and implementing intervention strategies that address engineering controls, establish employee safety-related policies, provide training and retraining, promote a healthy lifestyle among HHCW, and providing suitable personal protective equipment may help to decrease occupational injury rates.
Complicated Dementia
Authors: Jones Andrea L. , Pastor Diane K.
Published: May 2018

Older adults who exhibit extreme behaviors present a complex diagnostic and management picture for home healthcare clinicians and family caregivers. This case study describes the situation of Mrs. M, whose aggressive, combative behavior was so difficult for her children to comprehend and manage, she was secluded in a locked basement of her home. This article details assessment techniques, symptom presentation and possible diagnostic implications, as well as resources for caregivers.
Home Telehealth Interventions for Older Adults With Diabetes
Authors: Walker Cassondra L. , Kopp Mary , Binford Roxanne M. , Bowers Cynthia J.
Published: May 2018

The purpose of this literature review was to explore home telemedicine interventions for the treatment of older adults with diabetes. Eight databases were searched for articles published between 2011 and 2016, in the English language, and in peer-reviewed journals, resulting in 1,274 relevant articles. Following review against inclusion and exclusion criteria, six articles were retained. Studies included participants with a mean age from 68 to 76.8 years and from three different countries, with either Type 1 or Type 2 Diabetes Mellitus. The articles reviewed suggest that case management, education, closed-loop feedback and communication, home telemonitoring devices or units, and motivational interviewing or coaching can effectively decrease admissions, costs per person per year, mortality, and cognitive decline in older adults with diabetes. The scarcity of high-quality studies is consistent with findings from previous systematic reviews, and highlights the need for additional investigation before applying the results in practice.
Healthcare Benefits for Veterans
Authors: Erickson-Hurt Carma , McGuirk Dianne , Long Carol O.
Published: May 2018

As the world prepares for an increasingly aging population with chronic debilitating diseases, the demand for home healthcare services is increasing. As such, home healthcare clinicians face increased pressure to find resources and continuing support for patients. One area that may be underutilized is accessing Veteran benefits. Home healthcare clinicians care for Veterans every day, and knowing what benefits are available and how to access those benefits can help some Veterans who may be struggling with healthcare needs. Home healthcare clinicians may find understanding Veteran's health benefits intimidating and may falsely assume that a Veteran is aware of his or her benefits. Staying current on home healthcare benefits can be challenging and this article is intended to provide an overview of current and relevant information regarding Veteran health benefits.
Development of a Tool to Identify Problems Related to Medication Adherence in Home Healthcare Patients
Authors: Mahan Kathryn R. , Clark Jeffrey A. , Anderson Kurt D. , Koller Nolan J. , Gates Brian J.
Published: May 2018

In the home healthcare setting, clinicians are required to evaluate patient's medication therapy, including adherence. To facilitate this conversation, a pilot question list to help uncover potential medication nonadherence was created after completing a review of the literature and ascertaining the common themes as to why patients were nonadherent to their medication therapies. Pharmacy personnel who provide onsite consultations in a home healthcare setting used the question list to identify medication-related problems that could contribute to nonadherence and to document potential solutions. Through pharmacist–patient interactions, which occurred after admission to the home healthcare agency, pharmacy personnel found on average 2.3 issues per patient, which could affect medication adherence. Side effects were the most common problem identified. After this tool was tested with 65 patient interviews, the questions were analyzed and condensed into a shorter list more specific to the identification of medication-related problems for use by home care clinicians.
Prevalence of and Factors Related to Prescription Opioids, Benzodiazepines, and Hypnotics Among Medicare Home Health Recipients
Authors: Cotton Brandi P. , Lohman Matthew C. , Brooks Jessica M. , Whiteman Karen L. , Bao Yuhua , Greenberg Rebecca L. , Bruce Martha L.
Published: May 2018

High rates of controlled prescription drugs are associated with cognitive impairment, falls, and misuse and dependence. Little is known about the prevalence of these medications among older adults receiving home healthcare. The purpose of this study was to determine the frequency of, and the factors related to, opioid analgesics, benzodiazepines (BNZ), and nonbenzodiazepine (NBNZH) hypnotics among a large sample of older adults entering home healthcare services. The data came from administrative records of 133 Certified Home healthcare Agencies located across 32 states. Patients (age ≥ 65) receiving Medicare home healthcare services and who received a start-of-care Medicare OASIS assessment between January 1, 2013, and December 31, 2014, were included in the study (n = 87,780). Rates of controlled medication use were compared across patient-level sociodemographic, clinical, functional, and environmental variables. The prevalence of controlled medication was high, with 58% prescribed at least one class of controlled drug, 44% were prescribed an opioid, 19% were prescribed a BNZ, and almost 7% were prescribed a NBZDH. Factors independently associated with higher levels of controlled medication usage include younger-old age, white race, postsurgical status, injuries, referral from inpatient settings, and rural location. Home healthcare clinicians are well positioned to review and reconcile medication, oversee referrals and follow-up care, and provide ongoing assessment of risk regarding the use of opioids, BNZ, and hypnotics among home healthcare patients.
The Home Healthcare Universal Best Practice Protocol
Authors: Panozzo Gina L. , Rossetti Jeanette , Hess Katherine
Published: May 2018

To address rehospitalization rates and emergency department rates that were above the state and national averages, a quality improvement project was implemented at a midsized home healthcare agency. In order to address these escalating rates, the Home Health Universal Best Practice Protocol was developed and implemented by a home healthcare consultant. The protocol is evidence-based, time-specific, comprehensive, and includes interventions that are linked to reducing avoidable hospital visits. Interventions include risk assessment for rehospitalization, initiation of telehealth, utilization of teach-back method, and timely documentation. The Home Health Universal Best Practice Protocol was effective in not only exceeding objectives regarding decreasing rehospitalization and emergency department rates within a 6-month period but also in improving home healthcare agency referral rates.
Five Strategies for Encouraging Seafood Consumption
Authors: Quam Julia , Casavale Kellie
Published: May 2018

There is confusion among many Americans, particularly women who are pregnant or breastfeeding and parents and caregivers of young children, regarding seafood consumption. The 2015-2020 Dietary Guidelines for Americans encourages us to eat a greater variety of protein foods. One way to do this is to choose seafood twice a week in place of meats, poultry, or eggs. Seafood, which includes fish and shellfish, is recommended for the total package of nutrients it provides. However, the average American is eating much less seafood than recommended. Whether that's due to taste preferences, lack of confidence with buying or preparing seafood, or concern about potential contaminants like methyl mercury, healthcare professionals have an important role. You can help to clear up confusion and encourage patients and clients—particularly women who are pregnant or breastfeeding and parents and caregivers of young children—to include seafood as part of an overall healthy eating pattern.
Caregiving and Caregivers
Authors: Marrelli Tina
Published: May 2018

As a home care and hospice consultant, I have written a newspaper column about caregiving in Sarasota County, Florida, a county with a median population age of 55 years (City-Data.com, n.d.) for many years. The following story is one of many I hear about every year. Sarah, an 86-year-old woman, has moved in with her adult daughter and son-in-law. My involvement began with a phone call from this very distraught couple who were trying to do the right thing and bring a family member into their home when it became obvious she was no longer safe on her own. This move did not occur with much forethought or planning; however, it soon became clear that Sarah was very demanding and difficult, and would not follow the doctor's recommendations nor theirs. The son and daughter-in-law work full time and have two children, ages 14 and 18, living at home. They related that, although Sarah had always been “prickly,” her negative behaviors seemed magnified when she moved into their home. The last straw was when Sarah fired the aide they had hired to assist with her personal care. They knew they needed to regroup and develop a long-term plan that would be best for Sarah and her care needs.
Developing a Strong Direct Care Workforce
Authors: Stear Lynda A.
Published: May 2018

The aging population of the United States has led to a need for more direct care workers to provide personal care to older adults and disabled people in their homes. The U.S. Bureau of Labor Statistics predicts employment of paraprofessionals in home care will grow 49% between 2012 and 2022 as the baby boomer generation ages and requires more assistance in activities of daily living. The typical direct care worker is a female aged 25 to 54 years old, a demographic that is projected to remain flat in the coming years. Direct care workers typically are poorly paid for work that is labor-intensive and often work in less than optimal working conditions. It is important that agencies hiring direct care workers understand the challenges these workers face and institute sound hiring practices and provide proper training and ongoing supervision. It is possible to have a quality direct care team. Proper training, role modeling, and supervision will improve employee satisfaction, decrease turnover, and improve care outcomes for patients.