Methodological considerations on estimating medication adherence from self-report, electronic monitoring and electronic healthcare databases using the TEOS framework.

AIMS: Measuring adherence to medication is complex due to the diversity of contexts in which medications are prescribed, dispensed and used. The Timelines-Events-Objectives-Sources (TEOS) framework outlined a process to operationalize adherence. We aimed to develop practical recommendations for quantification of medication adherence using self-report (SR), electronic monitoring (EM) and electronic healthcare databases (EHD) consistent with the TEOS framework for adherence operationalization. METHODS: An adherence methodology working group of the International Society for Medication Adherence (ESPACOMP) analysed implications of the process of medication adherence for all data sources and discussed considerations specific to SR, EM and EHD regarding the information available on the prescribing, dispensing, recommended and actual use timelines, the four events relevant for distinguishing the adherence phases, the study objectives commonly addressed with each type of data, and the potential sources of measurement error and quality criteria applicable. RESULTS: Four key implications for medication adherence measurement are common to all data sources: adherence is a comparison between two series of events (recommended and actual use); it refers to one or more specific medication(s); it applies to regular repeated events coinciding with known recommended dosing; and it requires separate measurement of the three adherence phases for a complete picture of patients' adherence. We propose recommendations deriving from these statements, and aspects to be considered in study design when measuring adherence with SR, EM and EHD using the TEOS framework. CONCLUSION: The quality of medication adherence estimates is the result of several design choices that may optimize the data available.

Wake-up Call: Night Shifts Adversely Affect Nurse Health and Retention, Patient and Public Safety, and Costs.

The purpose of this mini review is to (1) summarize the findings on the impact of night shift on nurses' health and wellness, patient and public safety, and implications on organizational costs and (2) provide strategies to promote night shift nurses' health and improve organizational costs. The night shift, compared with day shift, results in poorer physical and mental health through its adverse effects on sleep, circadian rhythms, and dietary and beverage consumption, along with impaired cognitive function that increases nurse errors. Nurse administrators and health care organizations have opportunities to improve nurse and patient safety on night shifts. Low-, moderate-, and higher-cost measures that promote night nurses' health and well-being can help mitigate these negative outcomes. The provided individual and organizational recommendations and innovations support night shift nurses' health, patient and public safety, and organizational success.

Covid-19 vaccine confidence and hesitancy in nursing students and faculty at a large academic medical center.

BACKGROUND: Little is known about nursing faculty and nursing student's confidence or potential hesitancy to receive the Covid-19 vaccine once it was available. METHODS: An anonymous electronic survey of nursing students and faculty was conducted at a large academic center in the eastern U.S. FINDINGS: Both students and faculty reported they were fairly or completely confident that the vaccine was safe (n = 235, 89.4%) and that it would effectively mitigate their risk (n = 230, 87.5%). There was a 52.6% decrease in vaccine hesitancy from 6 months prior (p <.01); 22% (n = 58) of those currently willing to receive the vaccine reported moderate to high concern about its side-effects and/or long-term efficacy. Access to vaccine research, vaccine education, and watching others be inoculated, had mitigated their concerns from the previous six months. DISCUSSION: While both nursing students and faculty reported having high confidence in the efficacy and safety of the Covid-19 vaccine, concerns remained.

TEOS: A framework for constructing operational definitions of medication adherence based on Timelines-Events-Objectives-Sources.

AIMS: Managing adherence to medications is a priority for health systems worldwide. Adherence research is accumulating, yet the quality of the evidence is reduced by various methodological limitations. In particular, the heterogeneity and low accuracy of adherence measures have been highlighted in many literature reviews. Recent consensus-based guidelines advise on best practices in defining adherence (ABC) and reporting of empirical studies (EMERGE). While these guidelines highlight the importance of operational definitions in adherence measurement, such definitions are rarely included in study reports. To support researchers in their measurement decisions, we developed a structured approach to formulate operational definitions of adherence. METHODS: A group of adherence and research methodology experts used theoretical, methodological and practical considerations to examine the process of applying adherence definitions to various research settings, questions and data sources. Consensus was reached through iterative review of discussion summaries and framework versions. RESULTS: We introduce TEOS, a four-component framework to guide the operationalization of adherence concepts: (1) describe treatment as four simultaneous interdependent timelines (recommended and actual use, conditional on prescribing and dispensing); (2) locate four key events along these timelines to delimit the three ABC phases (first and last recommended use, first and last actual use); (3) revisit study objectives and design to fine-tune research questions and assess measurement validity and reliability needs, and (4) select data sources (e.g., electronic monitoring, self-report, electronic healthcare databases) that best address measurement needs. CONCLUSION: Using the TEOS framework when designing research and reporting explicitly on these components can improve measurement quality.

Self-Management Behaviors, Glycemic Control, and Metabolic Syndrome in Type 2 Diabetes.

BACKGROUND: Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. OBJECTIVES: Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. METHODS: A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. RESULTS: Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. DISCUSSION: Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications.

A Couples-Oriented Intervention for Positive Airway Pressure Therapy Adherence: A Pilot Study of Obstructive Sleep Apnea Patients and Their Partners.

Background: Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants: Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods: Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results: Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality (d = -1.01), daytime sleepiness (d = -0.51), and daytime function (d = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality (d = -0.94; d = -0.40), daytime sleepiness (d = -0.42; d = -0.82), and daytime function (d = 0.41; d = 0.57), respectively. For partners, large effects for daytime sleepiness (d = -1.31) and daytime function (d = 1.54) and small to medium effect for sleep quality (d = -0.31) were found for the CES group. Worsening of sleep quality (d = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality (d = -0.77), daytime sleepiness (d = -0.77), and daytime function (d = 0.65). Conclusions: The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.

ESPACOMP Medication Adherence Reporting Guideline (EMERGE).

Research on assessing or managing medication adherence applies approaches from observational, interventional, and implementation science that spans many disciplines and demands coherent conceptualization, valid methods, appropriate analyses, and complete and accurate reporting. To ensure such reporting, the European Society for Patient Adherence, COMpliance, and Persistence (ESPACOMP) Medication Adherence Reporting Guideline (EMERGE) recommends standard reporting approaches based on an accepted taxonomy. This guideline is derived from a literature review, a reactive Delphi study with 26 medication adherence experts from many countries and disciplines, and feedback from ESPACOMP members. It is designed to supplement existing guidelines for health research reporting and is structured around 4 minimum reporting criteria and 17 items reflecting best reporting practice. By enhancing and harmonizing research reporting, EMERGE aims to advance research and, ultimately, patient outcomes.

Predictors of medication adherence: fact or artifact.

Numerous studies have examined socio-demographic, psychosocial, and other factors as potential contributors to poor adherence. Variability exists in the strength and consistency of findings. We speculated that the method of measuring adherence might be a factor in the variability in identification of predictor variables. We examined the identification of predictors of adherence by method of measurement in two randomized, controlled trials of adherence interventions. Both studies used the Aardex Medication Event Monitor and the Morisky Self-Report Scale. Twenty-one days of baseline data from 698 subjects were examined in relation to measures of depression, functional status, perceived therapeutic efficacy, number of co-morbidities, and socio-demographic indices. Analysis included Spearman rho, Pearson r, and multiple logistic regression. Differences in the identification of predictors between adherence measurement methods were identified. These data support the hypothesis that different measurement methods yield different predictors of adherence.

Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis.

Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups. Qualitative content analysis identified five themes: knowledge of sleep apnea, effects of sleep apnea, effects of CPAP, barriers and facilitators of CPAP, and ideas for a new user support program. Patients and partners emphasized the importance of partner involvement in the early CPAP treatment period. These data suggest consideration of a couple-oriented approach to improving CPAP adherence.

Integrating emerging areas of nursing science into PhD programs.

The Council for the Advancement of Nursing Science aims to "facilitate and recognize life-long nursing science career development" as an important part of its mission. In light of fast-paced advances in science and technology that are inspiring new questions and methods of investigation in the health sciences, the Council for the Advancement of Nursing Science convened the Idea Festival for Nursing Science Education and appointed the Idea Festival Advisory Committee to stimulate dialogue about linking PhD education with a renewed vision for preparation of the next generation of nursing scientists. Building on the 2010 American Association of Colleges of Nursing Position Statement "The Research-Focused Doctoral Program in Nursing: Pathways to Excellence," Idea Festival Advisory Committee members focused on emerging areas of science and technology that impact the ability of research-focused doctoral programs to prepare graduates for competitive and sustained programs of nursing research using scientific advances in emerging areas of science and technology. The purpose of this article is to describe the educational and scientific contexts for the Idea Festival, which will serve as the foundation for recommendations for incorporating emerging areas of science and technology into research-focused doctoral programs in nursing.

Emerging areas of science: Recommendations for Nursing Science Education from the Council for the Advancement of Nursing Science Idea Festival.

The Council for the Advancement of Nursing Science aims to "facilitate and recognize life-long nursing science career development" as an important part of its mission. In light of fast-paced advances in science and technology that are inspiring new questions and methods of investigation in the health sciences, the Council for the Advancement of Nursing Science convened the Idea Festival for Nursing Science Education and appointed the Idea Festival Advisory Committee (IFAC) to stimulate dialogue about linking PhD education with a renewed vision for preparation of the next generation of nursing scientists. Building on the 2005 National Research Council report Advancing The Nation's Health Needs and the 2010 American Association of Colleges of Nursing Position Statement on the Research-Focused Doctorate Pathways to Excellence, the IFAC specifically addressed the capacity of PhD programs to prepare nursing scientists to conduct cutting-edge research in the following key emerging and priority areas of health sciences research: omics and the microbiome; health behavior, behavior change, and biobehavioral science; patient-reported outcomes; big data, e-science, and informatics; quantitative sciences; translation science; and health economics. The purpose of this article is to (a) describe IFAC activities, (b) summarize 2014 discussions hosted as part of the Idea Festival, and (c) present IFAC recommendations for incorporating these emerging areas of science and technology into research-focused doctoral programs committed to preparing graduates for lifelong, competitive careers in nursing science. The recommendations address clearer articulation of program focus areas; inclusion of foundational knowledge in emerging areas of science in core courses on nursing science and research methods; faculty composition; prerequisite student knowledge and skills; and in-depth, interdisciplinary training in supporting area of science content and methods.

Emerging areas of nursing science and PhD education for the 21(st) century: response to commentaries.

We respond to commentaries from the American Academy of Nursing, the American Association of Colleges of Nursing, and the National Institute of Nursing Research on our thoughts about integrating emerging areas of science into nursing PhD programs. We identify areas of agreement and focus our response on cross-cutting issues arising from cautions about the unique focus of nursing science and how best to proceed with incorporation of emerging areas of science into nursing PhD programs.

Impact of Doctor of Nursing Practice education in shaping health care systems for the future.

The approval of the Doctor of Nursing Practice (DNP) by the American Association of Colleges of Nursing in 2004 and publication of The Essentials of Doctoral Education for Advanced Nursing Practice in 2006 promised significant benefit to nursing and to shaping health care systems. Currently, 229 DNP programs exist and more are planned. This article provides an overview of program types, graduates, and postgraduation placement, using Pennsylvania as an exemplar, to describe the potential impact of DNP education in health care systems. Nurse educators need to consider whether our current directions enable us to realize opportunities for shaping health care systems or whether we need to make course corrections. [

Shift work organization on nurse injuries: A scoping review.

BACKGROUND: Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety. OBJECTIVE: To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse. METHODS: A scoping review was conducted using search results from five bibliographic databases. RESULTS: Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes. CONCLUSIONS: Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

Nursing Students' Dissatisfaction With Course Organization and Student Engagement in Remote Learning 1 Year Post-COVID-19 Restrictions.

BACKGROUND: Undergraduate and doctoral nursing students enrolled in face-to-face (F2F) learning transitioned abruptly to remote learning in March 2020. Few studies have focused on these nursing students' satisfaction with remote learning a year after the unplanned transition. PURPOSE: Undergraduate and doctoral students' satisfaction with remote and F2F learning regarding course organization and student engagement were examined. METHODS: A cross-sectional descriptive study was conducted among 522 nursing students at a research intensive university in the eastern United States. Survey data were analyzed with an analysis of variance to compare students' remote and F2F learning satisfaction within the undergraduate and doctoral programs. RESULTS: Results indicated that nursing students who enrolled in F2F learning preferred F2F to remote learning (P < .001). Differences in satisfaction existed among programs (P = .035) and among undergraduate class levels (P < .001). CONCLUSION: It is essential to learn why nursing students were dissatisfied with remote learning to improve these types of learning experiences in the future.

Cognitive Behavioral Therapy (CBT) Telehealth Augmented With a CBT Smartphone Application to Address Type 2 Diabetes Self-Management: A Randomized Pilot Trial.

PURPOSE: The purpose of the study was to investigate the feasibility and acceptability of phone-delivered cognitive behavioral therapy (CBT) combined with an adjunctive smartphone application CBT MobileWork-DM© to improve self-management of type 2 diabetes mellitus (T2DM). METHODS: Participants were 12 patients with T2DM on antihyperglycemic medication and had an A1C level of 8 or greater. A randomized controlled pilot study assessed treatment as usual (TAU) T2DM care versus a phone-delivered CBT (6, 8, or 12 weekly sessions) augmented with a CBT skills practice smartphone application. The CBT telehealth intervention addressed T2DM self-management and diabetes distress. Electronic and self-report medication taking, diabetes-related distress, and A1C were assessed at baseline and post-intervention. RESULTS: After 16 weeks, a decrease in A1C and distress levels was observed in all 3 CBT phone groups and TAU group. The group with the most improvement was the 12-week CBT group, which had the greatest mean decrease in A1C (-2.33) and diabetes distress (-31.67). The TAU group exhibited a mean decrease of -2.15 and -21 for A1C and diabetes distress, respectively. The overall rate of completion for phone CBT sessions across the 3 CBT groups was 83%. CONCLUSION: This study demonstrates that telehealth CBT augmented with a smartphone application is feasible and acceptable. Patients demonstrated improvements in both T2DM management and distress.

National Institutes of Health State-of-the-Science Conference statement: preventing alzheimer disease and cognitive decline.

The National Institute on Aging and the Office of Medical Applications of Research of the National Institutes of Health convened a State-of-the-Science Conference on 26-28 April 2010 to assess the available scientific evidence on prevention of cognitive decline and Alzheimer disease. This article provides the panel's assessment of the available evidence.

Improving physical activity and function in overweight and obese older adults with osteoarthritis of the knee: a feasibility study.

Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6-month self-efficacy-based, individually delivered, lower-extremity exercise and fitness walking intervention with 6-month follow-up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6-minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self-efficacy was assessed by a questionnaire. Results showed significant increases in self-reported performance of lower-extremity exercise and participation in fitness walking distance in the 6-minute walk, and SPPB scores from baseline to 6-month follow-up with a trend for improvement in self-efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function.