Patient activation, knowledge, and health literacy association with self-management behaviors in persons with heart failure.

BACKGROUND: More evidence is needed about factors that influence self-management behaviors in persons with heart failure. OBJECTIVE: To test a correlational mediation model of the independent variables of health literacy, patient activation, and heart failure knowledge with heart failure self-management behaviors. METHODS: The study used a prospective, cross-sectional, correlational design. Correlation and multiple regression were used to analyze associations among variables. RESULTS: Of 151 participants, 57% were male, and mean age was 68 years. Heart failure self-management behaviors was positively correlated with patient activation level (p = .0008), but not with health literacy or heart failure knowledge. CONCLUSIONS: Persons with heart failure may better manage their condition if sufficiently activated, regardless of their level of health literacy or knowledge of heart failure disease and management processes.

Value of, Attitudes Toward, and Implementation of Evidence-Based Practices Based on Use of Self-Study Learning Modules.

BACKGROUND: It is unknown if completing educational modules on understanding, reviewing, and synthesizing research literature is associated with higher value of, attitudes toward, and implementation of evidence-based practices. METHOD: Nurses completed valid, reliable questionnaires on the value of, attitudes toward, and implementation of evidence-based practice 6 months after four educational modules were introduced. Multivariable modeling was used to learn associations of education modules and evidence-based practice themes. RESULTS: Of 1,033 participants, 54% completed at least one education module; 22% completed all modules. Value and attitude about evidence-based practice were moderately high, but implementation was low (mean = 15.15 ± 15.72; range = 0 to 72). After controlling for nurse characteristics and experiences associated with evidence-based practice value, attitudes, and implementation scores, education modules completion was associated with the implementation of evidence-based practice (p = .001), but not with value or attitude of evidence-based practices scores. CONCLUSION: Education on reviewing and synthesizing literature strengthened implementation of evidence-based practices. J Contin Educ Nurs. 2017;48(5):209-216.

Facilitators of and barriers to hip protector acceptance and adherence in long-term care facilities: a systematic review.

BACKGROUND: Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with hip protector use. PURPOSE: The objective of this systematic review is to synthesize available research evidence to identify factors that influence acceptance and adherence among older adults living in long-term care facilities. METHODS: A key word search was conducted for studies published in English between 2000 and 2013 that employed quantitative, qualitative, or mixed-methods research designs. Two independent reviewers evaluated each article for inclusion, with a third reviewer when needed to resolve discrepancies. RESULTS: Twenty-eight articles met our inclusion criteria, and facilitators and barriers were clustered into 4 socio-ecological levels: system (eg, facility commitment, staff shortages), caregiver (eg, belief in the efficacy of protectors, negative perceptions), resident (eg, clinical risk factors for falls and related fractures, acute illness), and product (eg, soft shell, discomfort). DISCUSSION: The outcomes provide decision makers, health professionals, and caregivers with a greater awareness of strategies to improve compliance with the use of hip protectors. Furthermore, researchers can use this information to design clinical trials that yield high acceptance and adherence.

Predictors of over-the-counter drug and herbal therapies use in elderly patients with heart failure.

BACKGROUND: Over-the-counter (OTC) drug and herbal therapies (HT) may worsen heart failure or interact with prescription medications. Frequency of and predictors for routine OTC drug and HT use are not well studied. METHODS AND RESULTS: We examined routine use of OTC drug and HT in patients at 8 medical centers. Medical conditions independently associated with use of OTC drugs, HT, or both were assessed using multivariable logistic regression models. Of 374 subjects, OTC drug and HT were routinely used by 349 and 43 patients, respectively. Mean age was 69.6 +/- 13.1 years, 63% were male, and 81% were Caucasian. Common OTC drugs were antiplatelets (baby-dose aspirin), vitamins, acetaminophen, antacids, laxatives, and calcium. The most common HT used was echinacea. History of hypercholesterolemia was associated with higher OTC drug use (OR 4.36; 95% CI 1.60-11.87; P = .004); renal failure predicted less use (OR 0.09; 95% CI 0.01-0.59; P = .013). History of hypertension was associated with less HT use (OR 0.47, 95% CI 0.24-0.92; P = .028). CONCLUSIONS: In HF patients, routine use of OTC drugs was common, but HT use was not. OTC drugs were used more often in patients with hypercholesterolemia and were used for a variety of reasons; thus, routine assessment and individualized education are advocated.

Acute ethanol exposure inhibits renal folate transport, but repeated exposure upregulates folate transport proteins in rats and human cells.

Deficiency of folate in heavy-drinking alcoholic populations can occur partly because of an increased urinary folate excretion. Ethanol directly reduces the reabsorption of folate in the renal proximal tubule (PT) by acting on either of 2 folate transport proteins, the reduced folate carrier (RFC) and the folate receptor (FR). This study was designed to determine the effects of ethanol on the transport of folate by PT cells and to examine the effects of ethanol on RFC and the FR protein expression. Normal human PT (HPT) cells were cultured on membrane inserts to study intracellular transport of 5-methyltetrahydrofolate from the apical or basolateral direction in the presence of ethanol [11-109 mmol/L (50-500 mg/dL)]. The long-term effect of ethanol on the renal folate transport protein content was determined by western blot in treated HPT cells and in vivo in rats pair-fed control diets or ethanol-containing liquid diets. A 1-h treatment of HPT cells with ethanol (> or = 65 mmol/L) reduced the apically directed transport of folate by 20-25% without affecting the basolateral transport. A 5-d exposure of HPT cells to ethanol dose-dependently increased the content of both the FR and RFC proteins, with a greater effect on the RFC. Similarly, a 14-d exposure of rats to ethanol increased the in vivo expression of both the RFC and FR. These studies demonstrate that ethanol decreases the reabsorptive transport of folate by renal PT cells, which would increase urinary folate excretion. In contrast, subchronic exposure of PT cells, both in vivo and in vitro, to folate-depleting concentrations of ethanol leads to an upregulation of the 2 folate transport proteins. The increase in folate transporters partly counteracts the inhibitory effects of ethanol on folate transport activity, which explains the lower magnitude of ethanol's effect on transport with subchronic exposure compared with that with acute exposure.

High dietary intake of phytosterol esters decreases carotenoids and increases plasma plant sterol levels with no additional cholesterol lowering.

The objective of this study was to measure the effects on serum lipids and plasma phytosterols of 6.6 g/day phytosterols from three foods (bread, breakfast cereal, and spread) consumed for 12 weeks compared with a diet that was not enriched with phytosterols. Thirty-five subjects undertook a nonrandomized, single-blind study consisting of a 2 week baseline period, 6 weeks on high-phytosterol intake, 6 weeks on high-phytosterol intake plus increased fruit and vegetable intake, and a final 2 week washout period. Serum total cholesterol decreased by 8.3% from 6.59 to 6.04 mmol/l, and LDL cholesterol decreased by 12.6% from 4.44 to 3.88 mmol/l. Plasma phytosterol levels increased by 45% (sitosterol) and 105% (campesterol). Cholesterol-adjusted plasma alpha- and beta-carotene levels decreased by 19-23%, lutein by 14%, and lycopene by 11%. Levels of alpha-carotene and lutein increased with extra fruit and vegetables. Only lycopene failed to increase during the washout phase. There were no significant changes in biochemical parameters. Serum LDL cholesterol lowering with 6.6 g/day ingested phytosterols was in the range seen with 1.6-3.2 g/day phytosterols. Lowering of plasma carotenoids was greater than that seen with lower phytosterol intake and was partially reversed by increased fruit and vegetable intake.

Enrolling eligible children and keeping them enrolled.

Coverage under Medicaid and the State Children's Health Insurance Program (SCHIP) provides low-income children with a vital link to needed health care, yet a significant proportion of children eligible for these programs remain uninsured. States have found that expanding eligibility and marketing new programs are not enough to increase enrollment of eligible uninsured children in public health programs. States also need to simplify enrollment and renewal procedures to make them more family-friendly. According to survey data, a key reason for underenrollment is that families find enrollment and renewal procedures too complex. This article details the efforts that states have made to increase enrollment in Medicaid and SCHIP, and it offers recommendations for strengthening these efforts. Although barriers to enrollment and renewal still exist, states are making progress in several ways, such as: Simplifying eligibility procedures. Using community-based application assistance. Eliminating procedural differences between Medicaid and separate SCHIP programs. The authors recommend that states continue to simplify program requirements and procedures, making it easier for children to enroll in Medicaid and SCHIP, retain coverage for as long as they qualify, and transfer between programs when necessary. In addition, outreach and community-based application assistance will continue to be essential activities, along with developing efforts to enroll children through other public programs, such as the food stamp program.

Creating a cultural shift. A gerontological enrichment program for acute care.

As the number of older adults in acute care rises, acute care specialty nurses must gain gerontological knowledge in their nursing practice with older patients. A blend of two bodies of knowledge and competencies is required to care effectively for older adults in the hospital. To this end, a gerontological enrichment program was developed to improve care to hospitalized older patients by augmenting acute care nurses competencies with gerontological skill, knowledge, and abilities. This article will explain the implementation details, the anticipated outcomes for nurses and older acutely ill patients, the evaluation process, and the strategies that are in place to maintain the gains.