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1.
Ann Allergy Asthma Immunol ; 132(3): 274-312, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38108679

RESUMO

BACKGROUND: Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).


Assuntos
Asma , Dermatite Atópica , Eczema , Hipersensibilidade , Inibidores de Janus Quinases , Criança , Humanos , Estados Unidos , Dermatite Atópica/tratamento farmacológico , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Corticosteroides , Imunossupressores
2.
J Allergy Clin Immunol ; 151(1): 147-158, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36191689

RESUMO

BACKGROUND: Atopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli such as allergens, irritants, and microbes. The role of environmental allergens (aeroallergens) in triggering AD remains unclear. OBJECTIVE: We systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. METHODS: As part of the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters AD Guideline update, we searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT), and/or no AIT (placebo or standard care) for guideline panel-defined patient-important outcomes: AD severity, itch, AD-related quality of life (QoL), flares, and adverse events. Raters independently screened, extracted data, and assessed risk of bias in duplicate. We synthesized intervention effects using frequentist and Bayesian random-effects models. The GRADE approach determined the quality of evidence. RESULTS: Twenty-three randomized controlled trials including 1957 adult and pediatric patients sensitized primarily to house dust mite showed that add-on SCIT and SLIT have similar relative and absolute effects and likely result in important improvements in AD severity, defined as a 50% reduction in SCORing Atopic Dermatitis (risk ratio [95% confidence interval] 1.53 [1.31-1.78]; 26% vs 40%, absolute difference 14%) and QoL, defined as an improvement in Dermatology Life Quality Index by 4 points or more (risk ratio [95% confidence interval] 1.44 [1.03-2.01]; 39% vs 56%, absolute difference 17%; both outcomes moderate certainty). Both routes of AIT increased adverse events (risk ratio [95% confidence interval] 1.61 [1.44-1.79]; 66% with SCIT vs 41% with placebo; 13% with SLIT vs 8% with placebo; high certainty). AIT's effect on sleep disturbance and eczema flares was very uncertain. Subgroup and sensitivity analyses were consistent with the main findings. CONCLUSIONS: SCIT and SLIT to aeroallergens, particularly house dust mite, can similarly and importantly improve AD severity and QoL. SCIT increases adverse effects more than SLIT. These findings support a multidisciplinary and shared decision-making approach to optimally managing AD.


Assuntos
Asma , Dermatite Atópica , Eczema , Hipersensibilidade , Imunoterapia Sublingual , Adulto , Animais , Humanos , Criança , Dermatite Atópica/tratamento farmacológico , Qualidade de Vida , Teorema de Bayes , Dessensibilização Imunológica/efeitos adversos , Pyroglyphidae , Hipersensibilidade/etiologia , Asma/tratamento farmacológico , Alérgenos/uso terapêutico , Imunoterapia Sublingual/efeitos adversos , Dermatophagoides pteronyssinus
3.
J Allergy Clin Immunol ; 152(6): 1493-1519, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37678572

RESUMO

BACKGROUND: Atopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. OBJECTIVE: We sought to systematically synthesize the benefits and harms of AD prescription topical treatments. METHODS: For the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups-group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). RESULTS: The 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes-among the best for 2; high-dose tacrolimus (0.1%) improved 5-among the best for 2; low-dose tacrolimus (0.03%) improved 5-among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6-among the best for 3; group 4 TCS and delgocitinib improved 4-among the best for 2; ruxolitinib improved 4-among the best for 1; group 1 TCS improved 3-among the best for 2. These interventions did not increase harm. Crisaborole and difamilast were intermediately effective, but with uncertain harm. Topical antibiotics alone or in combination may be among the least effective. To maintain AD control, group 5 TCS were among the most effective, followed by tacrolimus and pimecrolimus. CONCLUSIONS: For individuals with AD, pimecrolimus, tacrolimus, and moderate-potency TCS are among the most effective in improving and maintaining multiple AD outcomes. Topical antibiotics may be among the least effective.


Assuntos
Asma , Dermatite Atópica , Fármacos Dermatológicos , Eczema , Humanos , Dermatite Atópica/tratamento farmacológico , Tacrolimo/uso terapêutico , Metanálise em Rede , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fármacos Dermatológicos/uso terapêutico , Asma/tratamento farmacológico , Antibacterianos/uso terapêutico
4.
J Allergy Clin Immunol ; 152(6): 1470-1492, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37678577

RESUMO

BACKGROUND: Atopic dermatitis (AD) is an inflammatory skin condition with multiple systemic treatments and uncertainty regarding their comparative impact on AD outcomes. OBJECTIVE: We sought to systematically synthesize the benefits and harms of AD systemic treatments. METHODS: For the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, Web of Science, and GREAT databases from inception to November 29, 2022, for randomized trials addressing systemic treatments and phototherapy for AD. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. This review is registered in the Open Science Framework (https://osf.io/e5sna). RESULTS: The 149 included trials (28,686 patients with moderate-to-severe AD) evaluated 75 interventions. With high-certainty evidence, high-dose upadacitinib was among the most effective for 5 of 6 patient-important outcomes; high-dose abrocitinib and low-dose upadacitinib were among the most effective for 2 outcomes. These Janus kinase inhibitors were among the most harmful in increasing adverse events. With high-certainty evidence, dupilumab, lebrikizumab, and tralokinumab were of intermediate effectiveness and among the safest, modestly increasing conjunctivitis. Low-dose baricitinib was among the least effective. Efficacy and safety of azathioprine, oral corticosteroids, cyclosporine, methotrexate, mycophenolate, phototherapy, and many novel agents are less certain. CONCLUSIONS: Among individuals with moderate-to-severe AD, high-certainty evidence demonstrates that high-dose upadacitinib is among the most effective in addressing multiple patient-important outcomes, but also is among the most harmful. High-dose abrocitinib and low-dose upadacitinib are effective, but also among the most harmful. Dupilumab, lebrikizumab, and tralokinumab are of intermediate effectiveness and have favorable safety.


Assuntos
Asma , Dermatite Atópica , Eczema , Humanos , Dermatite Atópica/tratamento farmacológico , Metanálise em Rede , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Geriatr Nurs ; 56: 184-190, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38359738

RESUMO

A cross-sectional study was conducted to determine preventive-health-activity engagement in community-dwelling older adults participating in student-led health screenings in east Alabama. From 2017-2019, health professions students conducted health screenings at 23 community and independent living sites to assess medical and social needs of adults. Clients' responses to questions regarding vaccinations (flu/pneumonia/shingles), cancer screenings (colon/sex-specific), and other (dental/vision) screenings were aggregated to create a preventive health behavior (prevmed) score. Chi-square, t-tests, and regression analyses were conducted. Data from 464 adults ages 50-99 (72.9±10.1) years old were analyzed. The sample was 71.3% female, 63.1% Black/African American (BA), and 33.4% rural. Linear regression indicated BA race (p=0.001), currently unmarried (p=0.030), no primary care provider (p<0.001) or insurance (p=0.010), age <65 years (p=0.042) and assessment at a residential site (p=0.037) predicted lower prevmed scores. Social factors predict preventive health activity engagement in community-dwelling adults in east Alabama, indicating several opportunities to improve health outcomes.


Assuntos
Negro ou Afro-Americano , Comportamentos Relacionados com a Saúde , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Transversais , Serviços Preventivos de Saúde , Sudeste dos Estados Unidos , Estados Unidos , Pessoa de Meia-Idade
6.
Nurs Educ Perspect ; 44(4): 261-262, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36731093

RESUMO

ABSTRACT: Innovative teaching strategies incorporated into curricula can prepare students for interprofessional practice and have a positive impact on patient outcomes and team dynamics in health care. Our team of faculty from nursing, social work, and pharmacy developed and implemented an activity using simulation in the large classroom to improve students' perceptions of working in interprofessional teams. Effectiveness was assessed using the Interprofessional Collaborative Competencies Attainment Survey with a pretest-posttest design. Our experience indicated that this teaching approach can be an effective strategy for maximizing resources and providing meaningful interprofessional student experiences.


Assuntos
Educação Interprofissional , Relações Interprofissionais , Humanos , Currículo , Atenção à Saúde , Inquéritos e Questionários
7.
Ann Allergy Asthma Immunol ; 128(6): 660-668.e9, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35367346

RESUMO

BACKGROUND: Bleach bathing is frequently recommended to treat atopic dermatitis (AD), but its efficacy and safety are uncertain. OBJECTIVE: To systematically synthesize randomized controlled trials (RCTs) addressing bleach baths for AD. METHODS: We searched MEDLINE, EMBASE, CENTRAL, and GREAT from inception to December 29, 2021, for RCTs assigning patients with AD to bleach vs no bleach baths. Paired reviewers independently and in duplicate screened records, extracted data, and assessed risk of bias (Cochrane version 2) and GRADE quality of evidence. We obtained unpublished data, harmonized individual patient data and did Frequentist and Bayesian random-effects meta-analyses. RESULTS: There were 10 RCTs that enrolled 307 participants (median of mean age 7.2 years, Eczema Area Severity Index baseline mean of means 27.57 [median SD, 10.74]) for a median of 6 weeks (range, 4-10). We confirmed that other trials registered globally were terminated. Bleach baths probably improve AD severity (22% vs 32% improved Eczema Area Severity Index by 50% [ratio of means 0.78, 95% credible interval 0.59-0.99]; moderate certainty) and may slightly reduce skin Staphylococcal aureus colonization (risk ratio, 0.89 [95% confidence interval, 0.73-1.09]; low certainty). Adverse events, mostly dry skin and irritation, along with itch, patient-reported disease severity, sleep quality, quality of life, and risk of AD flares were not clearly different between groups and of low to very low certainty. CONCLUSION: In patients with moderate-to-severe AD, bleach baths probably improve clinician-reported severity by a relative 22%. One in 10 will likely improve severity by 50%. Changes in other patient-important outcomes are uncertain. These findings support optimal eczema care and the need for additional large clinical trials. TRIAL REGISTRATION: PROSPERO Identifier: CRD42021238486.


Assuntos
Anti-Infecciosos , Dermatite Atópica , Eczema , Anti-Infecciosos/uso terapêutico , Banhos , Criança , Dermatite Atópica/tratamento farmacológico , Eczema/tratamento farmacológico , Humanos , Prurido/tratamento farmacológico , Staphylococcus aureus
8.
Nurs Educ Perspect ; 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36731075

RESUMO

ABSTRACT: Incorporation of interprofessional activities within health profession programs is critical to prepare students for practice. Faculty at our institution saw a need to incorporate interprofessional education in the nursing, pharmacy, social work, and dietetics program curricula. We collaborated with a medical school in the area to develop a mobile, community-based interprofessional clinic to deliver care and education and address the needs of older adults while also providing unique, meaningful learning opportunities for students. We describe several lessons learned from our experience of developing and implementing this interprofessional clinic.

10.
J Holist Nurs ; 41(4): 335-346, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37016765

RESUMO

The purpose of this evidence-based project (EBP) was to determine if an evidence-based sleep health and wellness intervention improved sleep in veterans self-reporting a history of insomnia. Insomnia can negatively affect an individual's physical and psychological well-being, as well as increase health-care costs and decrease the overall quality of life. The intervention utilized a combination of insomnia treatments, delivered to two American Legion veteran participant groups: an Alabama American Legion Retreat and individuals at an American Legion Post site. The holistic-focused modalities used in this intervention included Cognitive Behavioral Therapy for Insomnia (CBT-I) techniques, sleep hygiene principles, and Complementary and Alternative Medicine (CAM) methods. The measurement tool, the Insomnia Severity Index (ISI), indicated statistically significant changes in the severity of participants' self-reported insomnia. Based upon the research evidence and results of the pre- and post-test ISI, a more permanent, ongoing sleep health and wellness intervention is feasible and would have numerous beneficial effects for the veteran's management of insomnia symptoms. Future efforts include implementing sleep hygiene, CAM interventions, and holistic nursing-supported education interventions at other sites and venues within the Alabama American Legion, as well as maintaining long-term community partnerships with veteran groups such as the Alabama American Legion.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono , Veteranos , Humanos , Distúrbios do Início e da Manutenção do Sono/terapia , Veteranos/psicologia , Qualidade de Vida , Terapia Cognitivo-Comportamental/métodos , Sono , Resultado do Tratamento
11.
JAMA Dermatol ; 159(3): 320-330, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696136

RESUMO

Importance: Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of evidence addressing patient values and preferences have not previously been available. Objective: To inform American Academy of Allergy, Asthma & Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters AD guideline development, patient and caregiver values and preferences in the management of AD were systematically synthesized. Evidence Review: Paired reviewers independently screened MEDLINE, Embase, PsycINFO, and CINAHL databases from inception until March 20, 2022, for studies of patients with AD or their caregivers, eliciting values and preferences about treatment, rated risk of bias, and extracted data. Thematic and inductive content analysis to qualitatively synthesize the findings was used. Patients, caregivers, and clinical experts provided triangulation. The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) informed rating of the quality of evidence. Findings: A total of 7780 studies were identified, of which 62 proved eligible (n = 19 442; median age across studies [range], 15 years [3-44]; 59% female participants). High certainty evidence showed that patients and caregivers preferred to start with nonmedical treatments and to step up therapy with increasing AD severity. Moderate certainty evidence showed that adverse effects from treatment were a substantial concern. Low certainty evidence showed that patients and caregivers preferred odorless treatments that are not visible and have a minimal effect on daily life. Patients valued treatments capable of relieving itching and burning skin and preferred to apply topical corticosteroids sparingly. Patients valued a strong patient-clinician relationship. Some studies presented varied perspectives and 18 were at high risk for industry sponsorship bias. Conclusions and Relevance: In the first systematic review to address patient values and preferences in management of AD to our knowledge, 6 key themes that may inform optimal clinical care, practice guidelines, and future research have been identified.


Assuntos
Asma , Dermatite Atópica , Eczema , Humanos , Feminino , Adolescente , Masculino , Dermatite Atópica/terapia , Cuidadores , Prurido , Eczema/tratamento farmacológico
12.
Nurse Educ Today ; 119: 105578, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36206632

RESUMO

BACKGROUND: Interprofessional education is imperative for training future healthcare professionals. While barriers exist within and across institutions to implement and sustain effective interprofessional education experiences for students, virtual clinics utilizing electronic health records may provide comparable benefits to in-person clinics. OBJECTIVE: To determine whether differences in pre- and post-test self-assessments of interprofessional collaborative competencies are different between in-person and virtual clinics. DESIGN: Pretest-posttest design utilizing the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) before and immediately after participating in clinics, virtual or in-person. SETTING: A large, public university in the southeastern United States. PARTICIPANTS: Senior nursing students, third-year pharmacy students, senior nutrition/dietetics students, and undergraduate and graduate social work students. METHODS: This study was conducted evaluating five cohorts of students engaged in interprofessional education clinics. Two cohorts completed in-person community clinics in 2019. In March 2020, the interprofessional education program adopted virtual clinics (three cohorts) utilizing pre-selected electronic health record cases. Student responses from the 20-item ICCAS, which was completed before and immediately after clinics, were aggregated into interprofessional competency subscale scores (communication, collaboration, roles and responsibilities, collaborative patient/family-centered approach, conflict management/resolution, and team functioning) and a total ICCAS score. Two-way ANOVA assessed Pre-Post and Mode (in-person vs. virtual) on total ICCAS score. t-tests compared Pre-Post ICCAS scores for each Mode. RESULTS: Effects of Pre-Post (p < 0.001), but not Mode (p = 0.523), were observed on Total ICCAS scores. All ICCAS subscale scores were significantly higher in Post compared to Pre regardless of Mode. CONCLUSIONS: Virtual interprofessional education clinics confer similar benefits to interprofessional collaborative competencies in healthcare professions students compared to in-person community clinics. Thus, modality offers flexibility for interprofessional education and provided several benefits over the in-person clinic approach.


Assuntos
Relações Interprofissionais , Estudantes de Farmácia , Humanos , Autoavaliação (Psicologia) , Comunicação , Inquéritos e Questionários
13.
Appl Nurs Res ; 22(4): e1-7, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19875032

RESUMO

This study sought to determine the effect of an advanced-practice-nurse (APN)-led telephone intervention on hospital readmissions, quality of life, and self-care behaviors (SCBs) of patients with heart failure (HF). Twenty participants were randomly assigned to either an experimental group that received the APN-led telephone intervention (ALTI) or a control group that received usual care in this pretest-posttest experimental study. The results of this study support the idea that an ALTI positively impacts outcomes of patient with HF, particularly by improving SCBs and decreasing hospital readmissions. An ALTI warrants consideration to improve outcomes of patients with HF.


Assuntos
Insuficiência Cardíaca/terapia , Profissionais de Enfermagem , Relações Enfermeiro-Paciente , Avaliação de Resultados em Cuidados de Saúde , Telefone , Feminino , Humanos , Masculino , Readmissão do Paciente
14.
Nurse Educ ; 32(5): 207-11, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17828021

RESUMO

As society becomes increasingly culturally diverse, preparing nursing students to become culturally competent practitioners has become more critical. The authors share one school's experience with the development and implementation of a cross-cultural, international, service-learning experience. Discussion will include the development of an elective nursing course with cross-cultural content and the implementation of an international service-learning trip to Quito, Ecuador.


Assuntos
Competência Clínica/normas , Diversidade Cultural , Bacharelado em Enfermagem/organização & administração , Intercâmbio Educacional Internacional , Enfermagem Transcultural/educação , Alabama , Atitude do Pessoal de Saúde , Currículo , Equador , Docentes de Enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Educacionais , Pesquisa em Educação em Enfermagem , Técnicas de Planejamento , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudantes de Enfermagem/psicologia , Inquéritos e Questionários , Enfermagem Transcultural/organização & administração
15.
Heart Lung ; 34(4): 231-9, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16027642

RESUMO

PURPOSE: The purposes of this study were to (1) describe the characteristics of the population with congestive heart failure (CHF) who were admitted to a large, southeastern, acute-care hospital and (2) determine which patients are at risk for readmissions within 6 months. METHODS: A descriptive correlational design, using variables maintained in a computerized data bank on patients with CHF (N = 557, 39% were black) who were admitted between October 2000 and March 2002, was used to describe the adult population with CHF and identify variables associated with a likelihood of readmission. RESULTS: In the 6 months after the index admission, 224 (40%) of the patients were readmitted to the hospital for CHF. Variables significantly associated with readmission included lack of cardiology consult during admission, living status, point of entry of index admission, receiving Medicare, and having pulmonary hypertension. Four models, composed of subsets of variable from the data bank were developed and tested with logistic regression. The model composed of discharge variables was the only model that predicted readmission at a significant level. CONCLUSIONS: There is a need to develop comprehensive data banks to describe patterns of care and their outcomes. Such data should inform plans to manage this vulnerable population.


Assuntos
Insuficiência Cardíaca/terapia , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco
16.
Nurs Educ Perspect ; 26(5): 287-90, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16295308

RESUMO

This article describes the incorporation of a service-learning project in a maternal-infant health course in a baccalaureate nursing program. Partnership goals between university faculty and project Early Head Start were to develop and implement a clinical education experience that not only enhanced services to teenage mothers, but also taught students key elements in the delivery of community services to this vulnerable population. This article examines the impact of the service-learning experience on students' understanding of diversity, perceptions of social responsibility in community service, and health care issues. Implications for faculty investment of time and resources are also explored.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Bacharelado em Enfermagem/organização & administração , Enfermagem Materno-Infantil/educação , Estudantes de Enfermagem/psicologia , Adolescente , Alabama , Enfermagem em Saúde Comunitária/educação , Enfermagem em Saúde Comunitária/organização & administração , Intervenção Educacional Precoce/organização & administração , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Enfermagem Materno-Infantil/organização & administração , Papel do Profissional de Enfermagem/psicologia , Pesquisa em Educação em Enfermagem , Objetivos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Gravidez na Adolescência , Avaliação de Programas e Projetos de Saúde , Seguridade Social , Inquéritos e Questionários
18.
J Gerontol A Biol Sci Med Sci ; 67(1): 93-9, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22042723

RESUMO

BACKGROUND: Little is known regarding the relationship between overall diet quality and physical performance among older adults. We examined the association between overall diet quality, as measured by the US Department of Agriculture's Healthy Eating Index-2005 (HEI-2005), and physical performance, as measured by gait speed (n = 2,132) and knee extensor power (n = 1,392), among adults aged 60 years or older. METHODS: Using data from the 1999-2002 National Health and Nutrition Examination Survey, multiple linear regression models controlling for age, gender, race/ethnicity, education, smoking status, comorbidities, medication use, cognitive function, body mass index, and physical activity were used in the analyses. RESULTS: After adjusting for age, gender, race/ethnicity, education, and smoking status, total HEI-2005 scores were positively associated with both gait speed (p for trend = .02) and knee extensor power (p for trend = .05). Older adults with higher HEI-2005 scores had a faster gait speed (p = .03 for both Quartile 3 and Quartile 4 vs quartile 1) compared with those with HEI-2005 scores in the lowest quartile. Those with HEI-2005 scores in Quartile 4 had a greater knee extensor power compared with those with HEI-2005 scores in the lowest quartile (p = .04). The associations between HEI-2005 scores and physical performance remained after further adjustment for comorbidities, medication use, cognitive function, and body mass index. However, the associations were no longer statistically significant after further adjustment for physical activity. CONCLUSION: Adherence to overall dietary recommendations is associated with better physical performance among older adults.


Assuntos
Inquéritos sobre Dietas/estatística & dados numéricos , Ingestão de Alimentos , Marcha/fisiologia , Joelho/fisiologia , Idoso , Índice de Massa Corporal , Cognição/fisiologia , Estudos Transversais , Dieta/normas , Dieta/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Inquéritos Nutricionais , Caminhada/fisiologia
19.
Nurse Educ ; 35(5): 192-6, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20729674

RESUMO

Peer mentoring is a relationship in which a more experienced person assists a less experienced person to achieve desired outcomes. Mentoring relationships provide benefits for both the mentor and the mentee. The authors describe a peer-mentoring strategy implemented in a skills laboratory to improve skills knowledge, decrease anxiety associated with skills demonstrations, and provide positive socialization and its outcomes.


Assuntos
Bacharelado em Enfermagem/métodos , Mentores , Grupo Associado , Avaliação Educacional , Humanos , Desenvolvimento de Programas , Socialização , Estados Unidos
20.
J Am Diet Assoc ; 110(5): 768-72, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20430139

RESUMO

Decreased food and beverage consumption among older adults can lead to inadequate intakes of energy and numerous micronutrients. Although older adults are prone to having inadequate diets, little research attention has been directed at their dietary behaviors, such as snacking. The purpose of this study was to examine the association between snacking frequency and older adults' daily intakes of vitamins, carotenoids, and minerals. Cross-sectional data for 2,056 older adults (65 years and older) from the 2003-2006 National Health and Nutrition Examination Survey were used for this study. Dietary data were collected through two 24-hour dietary recall interviews. Participants' snacking occasions and daily nutrient intakes were averaged during the two 24-hour recalls. Using linear regression models to adjust for multiple covariates, mean vitamin, carotenoid, and mineral intakes by snacking category were estimated. As snacking frequency increased, daily intakes of vitamins A, C, and E and beta carotene increased. Older adults' daily intakes of magnesium, copper, and potassium also increased as snacking frequency increased. As older adults' snacking frequency increased, their daily intake of selenium decreased, and their snacking frequency was not associated with their daily intakes of the B-complex vitamins, vitamin K, lycopene, phosphorus, iron, and zinc. Providing healthy snacks on a regular basis has practical implications for institutions, centers, or organizations that serve older adults; however, nutritional benefits obtained from snack food and beverages warrant their inclusion in older adults' diet.


Assuntos
Envelhecimento/fisiologia , Carotenoides/administração & dosagem , Comportamento Alimentar , Minerais/administração & dosagem , Vitaminas/administração & dosagem , Idoso , Estudos Transversais , Dieta , Ingestão de Energia/fisiologia , Feminino , Avaliação Geriátrica , Humanos , Modelos Lineares , Masculino , Rememoração Mental , Avaliação Nutricional , Inquéritos Nutricionais , Fenômenos Fisiológicos da Nutrição , Necessidades Nutricionais
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