Associations of Neighborhood Environments and Socioeconomic Status With Subclinical Atherosclerosis: An Integrative Review.

BACKGROUND: A limited understanding exists on the associations of neighborhood environment with subclinical atherosclerosis and its progression. PURPOSE: The purpose of this integrative review was to explore associations of neighborhood environments and socioeconomic status (SES) with subclinical atherosclerosis and its long-term progression. RESULTS: Three themes were identified: environmental exposure affects the natural history of atherosclerosis, neighborhood characteristics are associated with subclinical atherosclerosis, and individual SES is associated with development and progression of subclinical atherosclerosis more so than neighborhood SES. Some variations in results were noted based on the vascular site examined. CLINICAL IMPLICATIONS: Disadvantaged neighborhoods and low SES are associated with greater subclinical atherosclerosis. Inconsistencies in a few studies seemed to be related to lack of coronary artery progression among the relatively young adults. This suggests further examination is needed of the contextual associations of neighborhood and SES with markers of generalized atherosclerosis, such as carotid intima-media thickness.

Moral Distress and Intention to Leave During COVID: A Cross-sectional Study on the Current Nursing Workforce to Guide Nurse Leaders for the Future.

OBJECTIVE: The aim of this study was to investigate how the experience of caring for COVID-19 patients, nurses' moral distress, and the current practice environment impact nurses' intention to leave. BACKGROUND: Caring for COVID-19 patients has been associated with an increase in nurses' moral distress and an increase in nurses' turnover. To date, research has focused on nurses' moral distress, the practice environment, and intentions to leave during the pandemic's peak. The current workplace climate, including those who stayed in their positions, has not been adequately assessed. METHODS: This cross-sectional correlational study was conducted in a Magnet® hospital. RESULTS: Moral distress related to team/system (B = 0.64, t = 3.86, P < 0.001), nurses' participation in hospital affairs (B = -2.21, t = -3.52, P < 0.001), and staffing (B = -1.91, t = -5.48, P < 0.001) are strongest predictors for nurses' intention to leave postpandemic. CONCLUSIONS: Nurses in practice still report experiencing COVID-related moral distress; however; issues related to resources and staffing have the most substantial impact on intention to leave among the current nursing workforce.

A Feasibility Study to Assess Sleep and Subsequent Breast Milk Volume Among Mothers With Hospitalized Preterm Infants.

BACKGROUND: Sleep is essential for optimal health, and disturbed postpartum sleep is associated with compromised infant attachment. The postpartum experience of mothers with preterm infants is unlike the biological norm, as they are separated from their infants and often express breast milk. PURPOSE: The purpose of this study was to examine the feasibility of conducting a clinical research study among women with hospitalized preterm infants. We also explored for associations between maternal sleep patterns and sleep-related psychological states and subsequent breast milk volume. METHODS: Participants were recruited from Magee-Womens Hospital, located in Pittsburgh, Pennsylvania New mothers completed daily sleep and pumping logs and scales to measure stress, trauma, depression, fatigue, and sleep quality. RESULTS: A total of 78 women were screened, 18 women consented, and a total of 8 participants completed the study. Screening from the postpartum unit increased recruitment. The participants experience worsening sleep quality over time, moderate stress, and fatigue. Stress, postnatal depression, and fatigue are negatively associated with milk volume. IMPLICATIONS FOR PRACTICE AND RESEARCH: Postpartum recruitment with frequent follow-ups improved recruitment and retention. We present a preliminary association between maternal stress, fatigue, and depression, and subsequent breast milk volume. Sleep-related psychological states may negatively influence milk volume.

Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products.

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires-one focusing on pharmacists and the other focusing on pharmacy students-were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.

A pharmacist-led medication review service with a deprescribing focus guided by implementation science.

Background: Little research addressed deprescribing-focused medication optimization interventions while utilizing implementation science. This study aimed to develop a pharmacist-led medication review service with a deprescribing focus in a care facility serving patients of low income receiving medications for free in Lebanon followed by an assessment of the recommendations' acceptance by prescribing physicians. As a secondary aim, the study evaluates the impact of this intervention on satisfaction compared to satisfaction associated with receiving routine care. Methods: The Consolidated Framework for Implementation Research (CFIR) was used to address implementation barriers and facilitators by mapping its constructs to the intervention implementation determinants at the study site. After filling medications and receiving routine pharmacy service at the facility, patients 65 years or older and taking 5 or more medications, were assigned into two groups. Both groups of patients received the intervention. Patient satisfaction was assessed right after receiving the intervention (intervention group) or just before the intervention (control group). The intervention consisted of an assessment of patient medication profiles before addressing recommendations with attending physicians at the facility. Patient satisfaction with the service was assessed using a validated translated version of the Medication Management Patient Satisfaction Survey (MMPSS). Descriptive statistics provided data on drug-related problems, the nature and the number of recommendations as well as physicians' responses to recommendations. Independent sample t-tests were used to assess the intervention's impact on patient satisfaction. Results: Of 157 patients meeting the inclusion criteria, 143 patients were enrolled: 72 in the control group and 71 in the experimental group. Of 143 patients, 83% presented drug-related problems (DRPs). Further, 66% of the screened DRPs met the STOPP/START criteria (77%, and 23% respectively). The intervention pharmacist provided 221 recommendations to physicians, of which 52% were to discontinue one or more medications. Patients in the intervention group showed significantly higher satisfaction compared to the ones in the control group (p < 0.001, effect size = 1.75). Of those recommendations, 30% were accepted by the physicians. Conclusion: Patients showed significantly higher satisfaction with the intervention they received compared to routine care. Future work should assess how specific CFIR constructs contribute to the outcomes of deprescribing-focused interventions.

Translation and validation of the medication management patient satisfaction survey: The Lebanese Arabic version.

Background: No Arabic translation exists for the medication management patient satisfaction survey (MMPSS), a 10-item psychometrically valid patient satisfaction survey tool developed to assess patient satisfaction for comprehensive medication management. The objective of this study is to translate the medication management patient satisfaction survey into Lebanese Arabic while culturally adapting and assessing the psychometric properties of the translated survey in the outpatient setting. Methods: Guidelines for translation, adaptation, and validation of instruments for cross-cultural healthcare research were followed. The process included forward translation, expert panel review, back-translation, pretesting, and cognitive interviewing. Participants were approached after picking up their medications from the pharmacy at a primary care facility. The medication management patient satisfaction survey was administered verbally by two trained data collectors. Instrument psychometric analyses included testing both for reliability using Cronbach's alpha (α) and McDonald's omega (ω) and for construct validity using exploratory factor analysis (EFA). Pearson correlations between items were calculated. Results: During the translation process, the term "clinical pharmacist" was changed to "pharmacist today" for improved understanding. Four items were adapted through minor linguistic modifications. Data were collected from 143 patients. The mean age of participants was 72 years. Participants were mostly females (69%) and had an average of four comorbidities and eight daily medications. Findings from Cronbach's α and McDonald's ω indicated that the internal consistency among items from one to nine was very strong (α = 0.90; ω = 0.90). Exploratory factor analysis indicated that all items are strongly influenced by one factor, except for item six, "My clinical pharmacist is working as a team member with my other healthcare providers" which was the least influenced (loading = 0.44) with the highest uniqueness (0.81). The latent factor captured over 50% of the variance originally observed between variables. Items four and five "My clinical pharmacist helped me find easier ways to take my medicines" and "My clinical pharmacist helped me understand the best ways to take my medicines", had the strongest correlation (0.77), while the weakest correlation was seen between item six "My clinical pharmacist is working as a team member with my other healthcare providers" and other items. Conclusion: The Lebanese Arabic version of the medication management patient satisfaction survey was produced as a brief tool to serve as a valid and reliable instrument for measuring patient satisfaction with comprehensive medication management services.

Mechanistic Research for the Student or Educator (Part I of II).

Many discoveries in the biological sciences have emerged from observational studies, but student researchers also need to learn how to design experiments that distinguish correlation from causation. For example, identifying the physiological mechanism of action of drugs with therapeutic potential requires the establishment of causal links. Only by specifically interfering with the purported mechanisms of action of a drug can the researcher determine how the drug causes its physiological effects. Typically, pharmacological or genetic approaches are employed to modify the expression and/or activity of the biological drug target or downstream pathways, to test if the salutary properties of the drug are thereby abolished. However, experimental techniques have caveats that tend to be underappreciated, particularly for newer methods. Furthermore, statistical effects are no guarantor of their biological importance or translatability across models and species. In this two-part series, the caveats and strengths of mechanistic preclinical research are briefly described, using the intuitive example of pharmaceutical drug testing in experimental models of human diseases. Part I focuses on technical practicalities and common pitfalls of cellular and animal models designed for drug testing, and Part II describes in simple terms how to leverage a full-factorial ANOVA, to test for causality in the link between drug-induced activation (or inhibition) of a biological target and therapeutic outcomes. Upon completion of this series, students will have forehand knowledge of technical and theoretical caveats in mechanistic research, and comprehend that "a model is just a model." These insights can help the new student appreciate the strengths and limitations of scientific research.

Mechanistic Research for the Student or Educator (Part II of II).

This two-part series describes how to test hypotheses on molecular mechanisms that underlie biological phenomena, using preclinical drug testing as a simplified example. While pursuing drug testing in preclinical research, students will need to understand the limitations of descriptive as well as mechanistic studies. The former does not identify any causal links between two or more variables; it identifies the presence or absence of correlations. Parts I and II of this educational series encourage the student to 1) ensure the sensitivity and specificity of their measurements, 2) establish or optimize an appropriate disease model, 3) find pharmaceutical drug doses/concentrations that interfere with experimental disease processes, 4) leverage the literature and exploratory datasets to craft a mechanism-oriented hypothesis on drug binding and downstream effects, 5) and design a full-factorial experiment to test the hypothesis after sketching potential outcomes and imagining their interpretations. These creative goals facilitate the choice of the appropriate positive and negative controls to avoid false data interpretations. Here, Part II describes in detail how to test for a causal link between drug-induced activation of biological targets and therapeutic outcomes. Upon completion of this two-part series, the new student will have some of the tools in hand to design mechanistic studies, interpret the outcomes of their research, and avoid technical and theoretical pitfalls, which can otherwise decelerate scientific progress and squander human and financial resources.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review.

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

Suicide and altitude: A systematic review of global literature.

OBJECTIVE: The purpose of this systematic review was to synthesize the existing global literature examining the relationship between altitude and suicide. METHOD: Using the electronic databases PubMed, CINAHL, EMBASE, and PsychInfo published articles in English that addressed the relationship between altitude and suicide as a primary or secondary aim, and included human subjects, where identified. Studies were assessed for quality based on methodological approach and data relevance on a three-point scale (strong, moderate, or weak). RESULTS: Of the 19 studies related to the purpose and aims, 17 reported evidence of a positive correlation between altitude and increased suicide. Vast design differences were employed within the literature, individual-level suicide data was identified as the preferred level of analysis. DISCUSSION: The relationship between altitude and suicide is an evolving science with a small but growing body of literature suggesting altitude is associated with an increased risk of suicide. This review identifies the need for additional studies examining both individual-level suicide data and improving geographic precision. Public health nurses have a responsibility to carefully examine the quality of studies and the strength of the evidence when addressing variables associated with suicide.

A Pediatric-Specific View on Improved Nurse-Sensitive Indicators Related to Increased BSN or Higher Rates Over Time.

BACKGROUND: Nurses obtaining higher levels of education has been recommended nationally for more than a decade to support improved patient outcomes. LOCAL PROBLEM: Organizational strategies were implemented to achieve a highly educated workforce at the project site over 14 years. However, there was no evaluation of relationship with increasing education levels and pediatric patient outcomes. METHODS: A quality improvement project explored the relationship of Bachelor of Science in Nursing (BSN) or higher prepared nurses with 9 different nurse-sensitive indicators (NSIs). Educational preparation and NSI data were retrieved retrospectively from hospital databases from up to 14 years. RESULTS: Moderate to moderately strong correlations were noted between the proportion of BSN or higher prepared nurses and 2 NSIs (central line-associated bloodstream infections, r = -0.55 and surgical site infections, r = -0.71). Four of the 9 indicators were approaching moderate correlation. CONCLUSIONS: Increasing the proportion of highly educated nurses at the project site correlated with improvements in select NSI outcomes.

Impact of a Digital Intervention on Perceived Stress, Resiliency, Social Support, and Intention to Leave Among Newly Licensed Graduate Nurses: A Randomized Controlled Trial.

BACKGROUND: The nursing shortage has been deemed a public health crisis as the turnover rate of newly licensed graduate nurses (NLGNs) continues to grow. One of five NLGNs are leaving the profession due to work dissatisfaction and feelings of inadequacy, risking patient safety. METHOD: A prospective, randomized controlled trial evaluated the impact of a 6-week digital intervention (text messaging) on NLGNs' self-reported stress, resiliency, sense of support, and intention to leave their jobs, organization, and profession. Messages to the experimental group (n = 10) conveyed emotional, esteem, and networking support, and messages to the control group (n = 11) were medical facts. RESULTS: The digital intervention in the form of medical facts increased the control group's sense of social support. Stress, resilience, and intention to leave their jobs, organizations, or profession did not change for either the control or experimental group. CONCLUSION: A digital intervention, such as text messaging, potentially can increase NLGNs' sense of support during their first year of hire. [J Contin Educ Nurs. 2021;52(8):367-374.].

Issues and recommendations for exploratory factor analysis and principal component analysis.

This commentary provides a brief mathematical review of exploratory factor analysis, the common factor model, and principal components analysis. Details and recommendations related to the goals, measurement scales, estimation technique, factor retention, item retention, and rotation of factors. For researchers interested in attempting to identify latent factors, exploratory factor analysis, the common factor model, is the appropriate analysis. For surveys with Likert-type scales weighted least squares with robust standard errors is recommended along with oblique rotation. Alternative techniques for analyzing the data, e.g., item response theory and machine learning, are briefly discussed. Finally, a basic check list for researchers and reviewers is provided.

Health inequities in unscheduled healthcare for children with intellectual disabilities in Ireland: a study protocol.

Background: Health inequities for children with intellectual disabilities  are prevalent within different health systems, and children with intellectual disabilites  have shorter life expectancies than the general population, higher mortality rates before the age of 17 and have a greater risk of potentially preventable hospitalisations. A health systems approach to research in this area provides a useful means through which research can inform policy and practice to ensure people with intellectual disabilities receive equitable healthcare; however, there is a paucity of evidence regarding how to address differences that have been described in the literature to date. The overall aim of this research is to establish the extent of health inequities for children with intellectual disabilities  in Ireland compared to children without intellectual disabilities with respect to their utilisation of primary care and rates of hospitalisation, and to gain a better understanding of what influences utilisation of primary care and emergency department services in this population. Methods and analysis: The design of this research adopts a multi-methods approach: statistical analysis of health data to determine the extent of health inequities in relation to healthcare utilisation; discrete choice experiments to explore General Practitioners' decision making and parental preferences for optimal care; and concept mapping to develop consensus between stakeholders on how to address current healthcare inequities. Discussion: By applying a systems lens to the issue of health inequities for children with intellectual disabilities, the research hopes to gain a thorough understanding of the varying components that can contribute to the maintenance of such healthcare inequities. A key output from the research will be a set of feasible solutions and interventions that can address health inequities for this population.

An integrative review of nurse practitioner practice and its relationship to the core competencies.

BACKGROUND: Competency based education (CBE) has been suggested for nurse practitioner (NP) education reform. For this to occur, competencies should reflect the knowledge, skills, and attitudes that NPs need for independent practice. PURPOSE: This integrative review examined the general practice activities of NPs across all population foci to determine the extent to which these activities are reflected in current NP competencies. METHOD: Using the Whittemore and Knafl (2005) integrative review method, 17 studies that focused on NP practice between 2008 and 2018 were retrieved from three electronic databases. These studies were evaluated, analyzed and synthesized for themes. Afterwards the themes were compared with seven sets of current NP core competencies. RESULTS: The themes for NP practice activities were direct and indirect patient care activities with a majority of NP time spent performing direct patient care activities. However, only 14% of the NP core competencies reflected these direct care activities. CONCLUSION: In order to successfully implement CBE, a need exists for the NP core competencies to reflect current NP practice.

Determining nurse practitioner core competencies using a Delphi approach.

BACKGROUND: Competency-based education (CBE) has been recommended for nurse practitioner (NP) education. To implement CBE, existing NP core competencies need to be reduced in number and refined. PURPOSE: This study refined and reduced redundancy in the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) NP core competencies through the consensus of experts in NP practice. This study used the current NP Core Competencies (NONPF, 2017), the Essentials of Doctoral Education for Advanced Nursing Practice (AACN, 2006), and the Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a) because these documents are the competencies-accredited NP programs commonly used in curriculum development. The primary aim of this study was to refine and reduce redundancy of these competencies; a secondary aim was to ensure that the final competencies were clear and measurable. METHODS: A Delphi approach was used to reach consensus among an expert panel who reviewed the core competencies via an online questionnaire. Descriptive statistics were used to calculate median and interquartile ranges; content analysis was conducted with qualitative data. RESULTS: Consensus was reached after 3 rounds and resulted in 49 final core competencies. IMPLICATIONS FOR PRACTICE: This study provides the NP community with a manageable list of relevant, clear, and measurable competencies that faculty members can use to implement CBE in their programs.

Cracking the Code for Quality: The Interrelationships of Culture, Nurse Demographics, Advocacy, and Patient Outcomes.

OBJECTIVE: The aim of this study was to describe the complex relationships among patient safety culture, nurse demographics, advocacy, and patient outcomes. BACKGROUND: Why has healthcare lagged behind other industries in improving quality? Little nursing research exists that explores the multifactorial relationships that impact quality. METHODS: A convenience sample of 1045 nurses from 40 medical/surgical units was analyzed using a correlational cross-sectional design with secondary data analysis. Data sources included survey results for patient safety culture, nurse perceptions of patient advocacy, and patient experience and fall and pressure ulcer rates. RESULTS: Significant findings included a positive correlation between patient safety culture and advocacy and a negative correlation between safety culture, advocacy, and years of experience as a nurse. No significant correlations were found between safety culture and patient outcomes or advocacy and patient outcomes. CONCLUSIONS: Newer nurses were more positive about safety culture and advocacy, whereas experienced nurses were overall less positive.

New paradigms for considering statistical significance: A way forward for health services research journals, their authors, and their readership.

This commentary discusses the new American Statistical Association forty-three article issue in The American Statistician. I cover some history of p-values, misunderstandings, along with NHST and the Neyman-Pearson model. Special focus is placed on Student [W. Gosset] and Fisher's work. Finally, a list of recommendations is provided.

Retrospective video analysis of the early speech sound development of infants and toddlers later diagnosed with lateralisation errors.

Purpose: Although lateralisation errors (LEs) are a common speech sound disorder, no studies have examined their early development. The purpose of this exploratory small-scale investigation was to compare the early (birth-24 months) speech sound development between children later diagnosed with LEs and typically developing children.Method: This was a between-group case-controlled design with six monolingual English-speaking participants. Participants were White, non-Hispanic girls with at least one college-educated parent. As children, three had been diagnosed with lateralisation speech sound errors and three demonstrated typical speech sound development. Participants' parents provided home video-recordings of the participants as infants/toddlers between birth and age 2. These videos were then analysed for the amount, type and diversity of sounds, and canonical babbling onset.Result: There was no statistically significant between-group difference in the volubility (i.e. combined frequency of non-resonant and resonant utterances) or in the age at which [s] or [z] emerged. However, infants/toddlers who were later diagnosed with LEs showed reduced frequency/minute in production of resonant utterances and consonants (including [s, z]), used fewer different consonants/minute, and used fewer syllable shapes/minute compared to typically developing infants/toddlers. At 7-12 months, none of the infants/toddlers later diagnosed with LEs, but all participants in the comparison group had reached the canonical babbling stage.Conclusion: Children who have LEs may have had a less robust speech sound system as infants/toddlers than their typically developing peers. However, these findings must be considered with caution due to the significant limitations of this investigation.