with Rare Kidney Disease.

Chronic kidney disease (CKD) affects more than 35 million people in the United States, many of whom are undiagnosed. Included in this number are individuals with many types of rare kidney diseases, affecting 20,000 to 200,000 individuals nationwide. There is a major need to educate these individuals on the disease and its progression, especially since many individuals are not aware they have the disease. Descriptive correlational research was conducted in a nationwide sample of adult individuals living with rare glomerular kidney disease. Patient activation and quality of life were the concepts studied across the five CKD stages. New findings included statistically significant differences between participants' self-reported mental health quality of life and CKD Stage 1, with CKD Stages 4 and 5 in the rare kidney disease population. Nurses are essential for educating and supporting patients with rare kidney disease to preserve kidney function and slow disease progression.

Reducing Fresh Tracheostomy Decannulations Following Implementation of a Fresh Tracheostomy Guideline.

Pediatric patients undergoing tracheostomy placement are often medically fragile with multiple comorbidities. The complexity of these patients partnered with the risks of a newly placed tracheostomy necessitates a clear understanding of patient management and clinical competence. At our institution, a quality improvement initiative was formed with a focus on increasing the safety of these patients by developing a postoperative care guideline.

We stop for no storm: coping with an environmental disaster and public health research.

Coping with natural disasters is part of the public nurses' role, and the public health nursing (PHN) researcher is doubly challenged with continuing to conduct community-based research in the midst of the disaster. The PHN may provide service along with attempting to continue the research. The challenges faced by public/community health nurse researchers as a result of hurricane Ike are discussed to provide lessons for other public/community health researchers who may be affected by natural disasters in the future. It is important to consider challenges for recruitment and retention of research subjects after a disaster, impact of natural disasters on ongoing research, and opportunities for research to be found in coping with natural disasters. A community-based study that was in progress at the time of hurricane Ike will be used as an example for coping with a natural disaster. We will present "lessons learned" in the hope of helping researchers consider what can go wrong with research studies in the midst of natural disasters and how to proactively plan for keeping research reliable and valid when natural disasters occur. We will also discuss the opportunities for collaborations between researchers and the community following any disaster.

Pediatric airway maintenance and clearance in the acute care setting: how to stay out of trouble.

Traditional airway maintenance and clearance therapy and principles of application are similar for neonates, children, and adults. Yet there are distinct differences in physiology and pathology between children and adults that limit the routine application of adult-derived airway-clearance techniques in children. This paper focuses on airway-clearance techniques and airway maintenance in the pediatric patient with acute respiratory disease, specifically, those used in the hospital environment, prevailing lung characteristics that may arise during exacerbations, and the differences in physiologic processes unique to infants and children. One of the staples of respiratory care has been chest physiotherapy and postural drainage. Many new airway clearance and maintenance techniques have evolved, but few have demonstrated true efficacy in the pediatric patient population. Much of this is probably due to the limited ability to assess outcome and/or choose a proper disease-specific or age-specific modality. Airway-clearance techniques consume a substantial amount of time and equipment. Available disease-specific evidence of airway-clearance techniques and airway maintenance will be discussed whenever possible. Unfortunately, more questions than answers remain.

Regulatory, institutional, and market-based approaches towards achieving comprehensive chemical policy reform.

The purpose of this article is to inform nurses and other health care professionals about the nexus between the environment and health and present approaches in which they can be involved so as to support comprehensive reform of chemicals management in the United States. It discusses the health impact of hazardous chemicals and the environmental regulatory failures within the U.S. to protect the public. It also reports on international chemical management initiatives and key elements of chemical policy reform that can guide the U.S. regulatory, market-based, and institutional-based approaches to a comprehensive, chemical policy reform. The role of nursing in advocating for these reforms will be presented.

Association and correlation of self-reported home environmental factors and health symptoms.

The authors used community-based participatory research to survey 238 residents in public housing. They developed 9 exposure and 2 health symptom indexes through exploratory factor analyses. The univariate analysis showed that most environmental risk factors were associated with the symptom indexes. The authors found a statistically significant intercorrelation between 29 of 36 risk factor pairs. Because of this, most of the univariate associations lost statistical significance in multivariate models. The authors found a normal distribution of risk factors across household; however, risk factors per apartment were associated with symptoms. Environmental risk factors accounted for 2% to 26% of the variation in symptoms. The analysis suggests that correlation between factors could affect surveys in which researchers assess a small number of housing risk factors or assess larger numbers of factors without testing intercorrelation. The analysis is consistent with the possibility that building quality or housekeeping might drive the development of risk factors.