Encountering Ostomies in Acute Care: Peristomal Skin Changes.

ABSTRACT: Up to 80% of individuals with an ostomy experience a peristomal skin complication, which can result in significant healthcare issues. All clinicians working with patients with stomas need to be aware of the signs and symptoms of peristomal skin complications and basic strategies to address the most common cause of skin complications: leakage of stool or other effluent onto the skin. Use of an evidence-based, standardized instrument to guide peristomal assessment and selection of appropriate interventions can improve patient outcomes and increase meaningful collaboration between all members of the healthcare team. This case study addresses dilemmas of care during a non-ostomy-related hospitalization.

Antibiotic Knowledge, Beliefs, and Behaviors: Testing Competing Hypotheses Using an Urban Community Sample.

Antibiotic use and misuse continue to be a worldwide concern with the increasing rate of antimicrobial resistance, lack of new antibiotics in the pipeline, and rising health care costs. Despite studies that attempt to distinguish between factors associated with antibiotic use and misuse (e.g., knowledge and beliefs and provider-patient communication), few studies have tested comparative hypotheses related to antibiotic use behavior. This study 1) compares two theoretical models (health belief and patient-centered communication) to learn which best represents the pathways associated with antibiotic use; and 2) describes urban consumers' knowledge, beliefs, and behaviors regarding antibiotic use. Interviewers completed 505 intercept surveys across six clinic- and community-based sites in Southeast Michigan. Structural equation modeling was utilized to compare two competing theoretical models predicting antibiotic behavior. Findings support the assertion that a patient-provider communication model fits the data better than the null model. Descriptive statistical analysis explicated participant knowledge was mixed. While many participants knew correct general facts about antibiotics, 35% of the sample put forth that they believed that antibiotics cure colds and flu and over half (57%) endorsed the belief that antibiotics are good for treating infections caused by viruses. The implications for theory and practice are discussed including the need for clinicians to target communication strategies for the populations that they serve.

C-reactive Protein Levels in Plasma and Chronic Venous Ulcer Exudate of Persons Who Inject Drugs: A Pilot Study.

BACKGROUND: Persons who inject drugs (PWID) in the groin, legs, and/or feet are at high risk for chronic venous ulcers (CVUs). The plasma C-reactive protein (CRP) level is a marker of systemic inflammation. OBJECTIVE: This pilot study examined CRP levels in plasma and CVU exudate of PWID. The aims were to (1) compare levels of CRP in plasma and exudate; (2) examine if the CRP level in exudate changed over 4 weeks with wound treatment; and (3) examine the relationship of the exudate CRP level with CVU area, CVU age, number of CVUs, and number of comorbidities. MATERIALS AND METHODS: Persons who inject drugs seeking wound care were enrolled in this Institutional Review Board approved prospective, longitudinal, descriptive study. A blood sample was collected on the first visit (week 1); the plasma was then separated. Wound exudate was collected on swabs during the first visit (week 1) and 4 weeks later (week 4). All samples were stored at -80° C. Samples were eluted from swabs using mass spectrometry grade water then aliquoted for CRP analysis. RESULTS: The participants of the study included 14 PWID (mean age, 62.14 ± 4.52 years; mean number of comorbidities, 5.71 ± 1.90; and mean number of ulcers 2.07 ± 1.07 that were present for a mean of 7.96 ± 11.91 years without healing). C-reactive protein level in plasma was a mean of 6.47 ± 8.56 mg/L, with lower levels found in wound exudate but highly correlated (rho = .925). Exudate CRP levels decreased from week 1 to week 4, and the 2 were highly correlated (rho = .895). Exudate CRP level week 1 was not significantly related to wound area, wound age, number of ulcers, or number of comorbidities. CONCLUSIONS: Plasma and exudate CRP levels were highly correlated. Exudate CRP levels decreased across time. Future large-scale wound healing studies should examine CRP levels over a longer duration and as they correlate to wound healing.

A Descriptive Study Using an Intercept Survey: Knowledge, Attitudes, Beliefs, and Behaviors About Systemic Antibiotic Use in Adults Who Reported a Wound Within the Previous Year.

PURPOSE: This project examined knowledge, attitudes, beliefs, and behaviors about systemic antibiotic use for persons who reported a wound within the previous year. DESIGN: Secondary data analyses of 505 adults from a cross-sectional, prospective, intercept survey where every fifth adult was randomly approached to participate. SUBJECTS AND SETTING: Twenty-six participants (5.15% of the parent sample) stated having a wound within the previous year. METHODS: Participants were "interviewed" using the Facilitators and Barriers to Consumer Use of Antibiotics questionnaire that included demographics, health, information sources, antibiotic knowledge, attitudes, beliefs, and behavior questions. Hierarchical agglomerative cluster analysis was used to find clusters of items on the attitude, beliefs, and behavior questions. RESULTS: Sample demographics included 15 women and 11 African Americans, and 17 had some college education. Knowledge about antibiotics had a mean correct score of 10 out of 15 (67%) questions. Higher antibiotic knowledge was significantly related to higher education (rs = 0.69, P < .001). There were 2 attitude and beliefs clusters: most participants (>85%) recognized the need for medical supervision of antibiotic use (cluster 1), and beliefs about the need for antibiotics to prevent illness or treat wounds varied in 27% to 62% of participants (cluster 2). There were 4 behavior clusters: almost all participants 96% (cluster 1) filled and took the antibiotic if prescribed; greater than 71% (cluster 2) disagreed with unapproved methods of obtaining antibiotics; greater than 87% (cluster 3) used prescribed antibiotics correctly; and 36% of participants heard about antibiotic resistance through television or radio or Internet (40%) (cluster 4). CONCLUSIONS: Knowledge about antibiotics was low, while attitudes were positive. These findings support the need for research and evidence-based information on the role of antibiotics in wound care.

Nonviral Injection-Related Injuries in Persons Who Inject Drugs: Skin and Soft Tissue Infection, Vascular Damage, and Wounds.

GENERAL PURPOSE: To explore skin and soft-tissue infections and vascular damage in persons who inject drugs and relate these changes to wound development and care. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Review the issues surrounding wound infections in persons who inject drugs.2. Describe the risk factors and manifestations of wound infections in persons who inject drugs.3. Summarize the treatment options for wound infections in persons who inject drugs. ABSTRACT: The number of persons who inject drugs (PWIDs) is increasing. The literature has placed a substantial focus on the association between injection drug use and the transmission of blood-borne viral infections such as HIV and hepatitis C, but there is less extant research on other injuries such as skin and soft tissue infections (SSTIs), vascular damage, and associated wounds. Both SSTIs and vascular injury can result in marked morbidity and mortality and wounds that are slow to heal, likely to reoccur, and lifelong. The aims of this article are to (1) explore SSTIs and vascular damage in PWIDs and (2) relate these changes to wound development and care. Providers must address the health and psychosocial problems of PWIDs; take physical, psychosocial, and substance use histories; and develop multifocal plans of care. Finally, care must be provided in a nonjudgmental manner.

Forgiveness and Spiritual Distress: Implications for Nursing.

Spirituality, spiritual distress, and forgiveness are constructs relevant to nursing diagnoses and care planning. Forgiveness has significant implications, as it contributes to the spirituality of the individual and has been linked to positive and negative health outcomes. In clinical practice, forgiveness facilitation, grief work facilitation, and spiritual growth facilitation are evidence-based nursing interventions to address Spiritual Distress. Need exists to enhance spiritual distress and forgiveness within nursing curricula, patient assessment, and research designs.

An Integrative Review of Depression in Patients Receiving Hemodialysis for End-stage Renal Disease and the Relevance to Patients With Wounds.

End-stage renal disease (ESRD) often is treated with hemodialysis, which carries significant psychological impact along with risks for wound development. Depression is a constant concern. PURPOSE: An integrative review was conducted to examine studies regarding depression in adults receiving hemodialysis for ESRD. METHODS: PubMed and the Cumulative Index for Nursing and Allied Health Literature were searched for English-language publications from 2012 to 2017 regarding ESRD using the search terms epidemiology, hemodialysis, and depression and hemodialysis, depression, nocturnal, and wounds, respectively. RESULTS: Eight (8) of 152 articles found met the inclusion criteria and were categorized thematically. Depression was noted to affect 9.3% to 83% of persons receiving hemodialysis for ESRD. The occurrence of depression does not change across the course of ESRD. Although no publications on patients that included all search terms were found, ESRD and hemodialysis were noted to be independent risk factors for ulcer development, poor healing, and amputation. Wounds can be another source for risk of depression. CONCLUSION: Although the literature does not include studies that contain all components, ESRD, depression, and wounds are linked. Depression is a common occurrence in patients with ESRD and dialysis. Examining the effect of wounds on depression for these patients is critical. As such, additional research is warranted to explore the interconnections of ESRD, depression, and wounds to improve clinician awareness and patient outcomes.

Comparison of biomechanical properties in ascending aortic aneurysms of patients with congenital bicuspid aortic valve and Marfan syndrome.

BACKGROUND: In patients with ascending aortic aneurysms (AscAA), biomechanical differences are seen among patients with congenital bicuspid aortic valves (BAV), Marfan syndrome (MFS), and tricuspid aortic valves (TAV). We examined the hemodynamic profiles and ultrastructures of aneurysmal specimens, focusing on vascular remodelling to better understand AscAA pathogenesis. METHODS: A total of 795 patients with BAV (43.97 ±â€¯0.51 years; 93.2% male), 69 with MFS (34.43 ±â€¯1.44 years; 86.2% male), and 90 with TAV (67.27 ±â€¯0.58 years; 60% male) were enrolled, primarily upon admission with AscAA. The biomechanical properties of the aortic root were assessed and intraoperative specimens were analyzed by light-microscopy and two-photon autofluorescence microscopy. RESULTS: Patients with BAV had significantly greater distension of the aortic root, irrespective of age or aneurysmal widening (R2 = 0.543, p < 0.05). This was associated with significantly increase in the size of the tunica media. Patients with MFS displayed significant stiffness in the sinuses that worsened with age (R2 = 0.752, p < 0.001), similar to patients with TAV (R2 = 0.626, p < 0.05). Patients with MFS showed significant root elasticity with aneurysmal growth (R2 = 0.596, p < 0.05) and increased medial degeneration. Patients with TAV maintained biomechanical properties, apart from aneurysmal dimensions and high levels of inflammation. CONCLUSIONS: Among patients with AscAA, those with BAV maintain tissue elasticity in the aortic root, regardless of age. Patients with MFS demonstrate increased sinus stiffness with medial degeneration, both during aging and with aneurysmal growth. Patients with TAV and AscAA present with increased inflammation.

Assessment of Prelicensure Undergraduate Baccalaureate Nursing Students: Ostomy Knowledge, Skill Experiences, and Confidence in Care.

Care of the patient with an ostomy is included in the curriculum of prelicensure nursing programs, but no studies examining student nurses' knowledge about stoma care have been published. The purpose of this project was to examine the ostomy knowledge, experiences, and confidence of nursing students in order to assess and improve the curriculum. At the end of the fall 2016 semester, students enrolled in 3 separate nursing courses in an undergraduate program were asked to participate in a project to examine students' ostomy knowledge, their experiences, and their confidence in providing care. This project was undertaken to explore the college's ostomy curriculum. Participation was voluntary, and no student who was willing to participate was excluded. Students completed a 50-question knowledge test, answered questions about the frequency of performing ostomy-related skills, and rated their confidence in providing ostomy care. Responses were examined with descriptive and inferential statistics. Of 189 possible participants, 138 completed the questionnaires and included mostly women (113, 81.9%); participant mean age was 27.26 ± 6.22 years. The mean number of correct knowledge responses was 35.66 (71.32%); 66 participants (47.8%) reported no experience caring for a patient with an ostomy. The most common skills performed in clinical rotations were emptying (49) and changing (24) the pouch. A scale of 1 to 5 was used to evaluate 6 confidence items, with students having a mean confidence score of 19.54 ± 5.20. They had the most confidence in their ability to empty a pouch and to size and fit the pouching and the least confidence in teaching and community resources. Confidence was related to the number of skills performed in the lab (r = .32; P <.001), the number of skills performed in clinical practice (r = .38; P <.001), and ostomy knowledge scores (r = .23; P <.007). Total correct knowledge scores did not differ significantly by year in the educational program. Based on the results of this survey, it was concluded that students had a beginning knowledge about ostomy care and very limited clinical experience, yet confidence in providing ostomy care was high. Curriculum adjustments were implemented, including strategies for increasing ostomy knowledge, opportunities to provide care, and confidence; these need further investigation in prelicensure undergraduate nursing programs. The effect of curriculum adjustments remains to be evaluated.

Difficult to Doable: Interprofessional Collaborative Practice in Distance Education.

BACKGROUND: This study investigated the effect of interprofessional educational (IPE) in a distance education setting on students' self-efficacy around the Interprofessional Collaborative Practice (IPEC) constructs. METHOD: Senior RN-to-Bachelor of Science nursing students, students from health sciences, and dietetic intern students participated in the IPE learning experience. A pre- postsurvey design measured the change in student self-efficacy in relation to the IPEC constructs of values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork. RESULTS: In total, 92 students participated and 46 completed the pre-postsurvey. There were statistically significant changes in student self-efficacy across all constructs. Qualitative comments revealed themes of collaboration strengthening care, the value of exposure to different perspectives, and desire for commonly shared goals among the team. CONCLUSION: Research on IPE in distance education lags behind IPE in traditional settings. This study revealed that IPE is attainable in distance education, with significant changes in student's self-efficacy. Self-efficacy is a key indicator of future behavior. [J Nurs Educ. 2018;57(4):225-228.].

Hepatitis C Virus: Patients' Risk Factors and Knowledge in an Urban Clinic Providing Wound Care.

INTRODUCTION: Affecting about 3.2 million people in the United States, hepatitis C virus (HCV) is the primary cause of chronic liver disease and a global health challenge. Hepatitis C virus can affect the functioning of the liver, the health of the person, and thus wound healing. OBJECTIVE: This quality project explores risk factors of HCV; self-reported screening, occurrence, and treatment; and knowledge of HCV in patients seeking wound care in an urban clinic. MATERIALS AND METHODS: Demographic risk factors, HCV history, and responses to a 22-item true-false-don't know HCV Knowledge Test were obtained from 58 patients. Risk factors included age (mean, 61.07 years), male sex (n = 41), non-Hispanic black race/ethnicity (n = 51), and history of injection drugs (n = 38). RESULTS: Thirty-nine (67.2%) stated they had been screened for HCV; 31 were told they were infected. Only 14 went to a clinic for HCV care and 11 reported they were treated. The mean number of correct answers on the HCV Knowledge Test was 14.4 (standard deviation, 5.7). CONCLUSIONS: This urban clinic had patients with multiple HCV risk factors; they often lacked HCV screening and/or referral for treatment. Their HCV knowledge was generally low. As a major public health problem that could impact wound healing, wound care practitioners should ask patients about their HCV status, encourage HCV screening and care, and provide HCV information.

A Quality Improvement Project: What First-year Nursing Students Include in Their Nursing Care Plans for Patients With Acute or Chronic Wounds.

Nursing education research is lacking with regard to nursing care plans for patients who have a wound and use of the nursing diagnosis impaired skin integrity. The purpose of this quality improvement project was to inform teaching about nursing care planning for patients with wounds by examining what rst-year nursing students attending a fundamentals of nursing course in a Bachelor of Science in Nursing program included in a nursing process assignment when caring for an assigned patient who had an acute or chronic wound. Because they were in their clinical rotation, students had access to the patients' medical records to facilitate composing the care plan; they also could ask the patient for information. Assessment data were entered on a predetermined form based on Gordon's Functional Patterns. Using this information, students had to provide 3 possible diagnoses and select 1 upon which they developed the care plan intended to include patient description, wound description, dressing, and nursing diagnoses and impressions. The forms then were ana- lyzed for assessment completeness. Thirty-eighty (38) care plans completed by students were collected on patients that included 23 men and 28 African-Americans; mean age of the patients was 60.11 ± 14.17 (range 20-87) years. Wounds included 25 surgical incisions, 4 pressure ulcers/injuries, 7 "other" wounds, and 2 not identi ed. None of the students' assessments provided a detailed wound description. The most common wound descriptors were location (n =19) and drainage (n = 15). For 8 patients, students stated the wound was covered by a dressing. Thirty (30) nursing diagnoses were listed. The most common nursing diagnoses were impaired physical mobility or activity intolerance, impaired com- fort, impaired skin integrity, imbalanced nutrition, and risk for infection. These nursing students had beginning skills in patient and wound assessment and writing nursing care plans about patients with impaired skin integrity. Students need to increase their depth of wound assessment and need more experience planning care for patients with wounds.

Long-Term (up to 21 Years) Follow Up after Biological and Mechanical Aortic Valve Replacement in Younger Patients.

BACKGROUND: Despite the limited durability of biological aortic valves, increasing numbers of younger patients are choosing to receive them, due mainly to the lack of a need for permanent anticoagulation. Few data exist, however, regarding the outcomes of valve replacement in patients aged <55 years, and additional data are required in this patient population. METHODS: Between 1993 and 2014, at the authors' institution, a total of 448 patients (237 males, 101 females; mean age 45.8 ± 8.0 years) underwent aortic valve replacement (AVR) with either a mechanical prosthesis (M1 group, n = 318) or a biological prosthesis (B1 group, n = 130). The mean follow up was 8.5 ± 5.8 years (range: 4 days to 20.8 years) in the M1 group, and 4.9 ± 4.6 years (range: 2 days to 21 years) in the B1 group. The entire collective (EC) (n = 448 patients) was compared and analyzed with a selective collective (SC) (n = 109 patients) after exclusion of patients with concomitant procedures or comorbidities (M2 group, n = 74; B2 group, n = 35). RESULTS: Early mortality was greater after biological AVR in the EC (6.1% versus 1.9%), but in the SC no early deaths were observed after both primary and redo procedures. The reoperation rate was greater after biological AVR in both collectives. The late mortality, survival and endocarditis rates were comparable in both collectives. Bleeding occurred more often in the EC after mechanical AVR. CONCLUSIONS: Biological AVR in patients aged <55 years provides satisfactory outcomes, whereas reoperations were performed less commonly in patients with mechanical valve substitutes. In selective patients, AVR can be performed with zero mortality.

Sleep Quality: A Pilot Study Comparing Patients With and Without Injection-Related Venous Ulcers.

PURPOSE: The purposes of this study were to (a) compare sleep quality of persons with and without injection-related venous ulcers (VU) and (b) examine associations between global sleep quality with age, sex, comorbidities, pain, nutrition, physical health rating, fatigue, emotional problems, health-related quality of life, attitude toward physical activity, and number of ulcers. DESIGN: This study used a cross-sectional design. SUBJECTS AND SETTING: The participants included 31 patients with VU and 30 without VU (men [n = 35] and women; mean age = 54 years) who were attending an indigent clinic for wound care or general health. METHODS: Participants were recruited from an urban clinic when they came for primary care or wound care. Questionnaires were administered at that time and included the Pittsburgh Sleep Quality Index (PSQI), Mini Nutrition Assessment, Patient Reported Outcomes Measurement Information System (PROMIS) questions about general physical health, fatigue, emotional problems, and quality of life, Brief Pain Inventory worst pain rating, Positive Attitude and Motivation for Physical Activity Scale, wound assessment, and demographic factors. RESULTS: The 2 groups did not differ on the PSQI in terms of time going to bed, minutes to fall asleep, time awakening, hours slept, and time in bed. Those with VU compared to without VU took more medications to help sleep (P≤ .03). There were no significant differences in PSQI correlations across groups. All study variables except age, gender, and quality of life were significantly related to Global sleep disturbance score. A higher number of comorbid conditions, worse pain, poorer nutrition, poor physical health rating, greater fatigue, more emotional problems, and poor attitude toward physical activity were related to greater sleep disturbances for all participants. Both groups had mean Global PSQI scores greater than 5 (with VU = 7.83 and without VU = 8.2), indicating sleep problems. CONCLUSIONS: Study findings suggest that sleep disturbances may be a concern in persons with VU and are related to many variables. Assessing sleep along with other aspects of wound care may provide a more comprehensive assessment of factors affecting a person with a VU.

A Cross-sectional, Descriptive, Quality Improvement Project to Assess Undergraduate Nursing Students' Clinical Exposure to Patients With Wounds in an Introductory Nursing Course.

Because nurses frequently participate in decisions related to wound care, learning about wounds and their care during undergraduate education is critical. A cross-sectional, descriptive, quality improvement project was conducted in an introductory baccalaureate nursing course to identify: 1) the types of patients with wounds assigned to beginning students, 2) patient wound care procedures and dressings, and 3) student level of participation in wound care. Data were collected from the weekly notes recorded about students' (N = 49) patient care experiences in 3 acute care hospitals for 9 clinical days during 1 semester. Data were recorded on a paper-and-pencil form by instructors at the end of the clinical day and included type of wound, wound irrigation, dressing, technique of care, and student's participation. Descriptive statistics were used to examine the frequency and distribution of the wound characteristics and care assessed. Of the 284 patients assigned to students, 75 (26.4%) had a wound. The most common wound was a surgical incision (49, 65%) and was closed (36, 73.5%). Twenty-six (26) patients had a pressure ulcer, most commonly Stage II. The most common dressing was dry gauze (29). Damp gauze was used on 18 wounds. Wound irrigation was recorded for 24 wound protocols and performed with a bulb syringe or by pouring the solution from a container. Generally, nonsterile wound care was performed. Twenty-five (25) students performed wound care with the instructor, 16 watched the care performed by another clinician, and 10 participated with another nurse in the wound care. For 22 patients, the wound care was neither observed nor performed because either it was not time for the dressing to be changed or it was only to be changed by a medical team. From these data, it was concluded beginning nursing students had some, but limited, clinical experience with patients with wounds. Students' wound care experiences need further examination, especially across multiple educational courses.

Falls, Balance Confidence, and Lower-Body Strength in Patients Seeking Outpatient Venous Ulcer Wound Care.

PURPOSE & ABSTRACT: To provide information about a quality improvement project examining falls in persons seeking outpatient wound care. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Describe the scope of the problem and the related quality improvement project. 2. Delineate the results of the project and their implications for treatment of patients with venous ulcers. OBJECTIVE: The authors aim to examine fall occurrence and fall injuries in persons seeking outpatient wound care and to compare falls, balance confidence, and lower-body strength in persons with injection-related venous ulcers (IRVUs) versus persons with venous ulcers (VUs) related to other risk factors besides injection drugs (VUs-other). DESIGN: This quality improvement project used a cross-sectional, comparative design. Participants responded to demographic questions, the Activities-specific Balance Confidence (ABC) Scale, fear of falling, fall numbers, and injuries and performed the 30-second chair-rise test. SETTING: Outpatient wound service. PATIENTS: Patients (N = 106; mean age, 59.94 years) included men (66%) and women. RESULTS: Sixty patients reported falling; 47 were recurrent fallers. Twenty patients stated they were injured, but did not go to an emergency department. A higher number of total falls was significantly related to more comorbidities. Total falls were significantly related to fear of falling and ABC Scale scores. Those with VUs-other had significantly more comorbidities and higher body mass index values than those with IRVUs. Those with IRVUs were comparable to those VUs-other on number of falls and fear of falling, respectively. Those with IRVUs (7.30) performed significantly more chair rises than those with VUs-other (4.72). Persons with IRVUs had significantly higher ABC Scale scores (63.24%) than those with VUs-other (49.38%). CONCLUSIONS: Falls are a common occurrence in persons seeking outpatient wound care. Despite greater strength sufficient to perform more chair rises among those with IRVUs, fall rates were comparable to those of weaker individuals with other types of VUs. With the high occurrence of falls during the project, long-term risk for fall injury would be high. Further research is needed to clarify interactions between VU risk and patient factors such as strength, age, agility, and impaired cognition.

The Perceived Control Over Pain Construct and Functional Status.

INTRODUCTION: Belief in one's ability to control pain is a significant predictor of health outcomes and is related to improved functional status. The purpose of this study was to introduce a novel formulation of the construct, Perceived Control Over Pain and to test its effects on functional status. METHODS: Participants (N = 301) were primarily African American (92%); and were adults with low income attending a primary care clinic and reporting pain within the past 2 weeks. A cross-sectional design was used with confirmatory factor analysis and structural equation modeling. The Perceived Control Over Pain construct consisted of four measures-two specific measures of control over pain and two general measures of control over life events. Perceived Control Over Pain has not been defined in this way previously. RESULTS: Mean worst pain scores for the past week were 8.4, where "0" (no pain) to "10" (pain as bad as you can imagine). The model demonstrated good construct validity for the components of pain, Perceived Control Over Pain and functional status. Mediation by Perceived Control Over Pain was partial but strong, accounting for a reduction of 29% in the effect of pain on functional status. DISCUSSION: In minority populations with low income, factors such as perceived control over pain and its effect on the outcome of patient function need to be considered. Improving Perceived Control Over Pain has the potential for improving patients' feelings of life control and purpose or meaning in life, and psychological and physical functioning for adults living with pain.

A cross-sectional pilot study to examine food sufficiency and assess nutrition among low-income patients with injection-related venous ulcers.

Adequate nutrition has long been considered a critical component for wound healing, but literature regarding the relationship between nutrition and venous ulcer (VU) healing is limited. A person's nutrition is affected by the availability of food as well as his/her overall health. Food sufficiency and nutrition are important concerns in the care of persons of low income with injection-related VUs, which tend to be large and slow to heal. A cross-sectional pilot study was conducted to explore the relationship between food sufficiency/security and nutrition with regard to demographic, wound, quality-of-life, physical activity, falls, and fall risk variables. Nutrition was examined using 2 well-developed instruments that measure food sufficiency/security and assess nutrition--the United States Department of Agriculture's Adult Food Sufficiency Questionnaire (FSQ) and the Nestle Mini Nutritional Assessment (MNA). All participants (N = 31, 54% men, mean age 56.1 ± 3.6 years, all African American) were recruited from an outpatient clinic. All had injection-related VUs from a history of injecting illicit substances. In terms of food sufficiency/security, most participants (26, 84%) reported having enough food in the house, but 10 (32%) worried about running out of food. From 16% to 22.6% of participants expressed concern with food sufficiency/security in terms of cutting meal size, eating less, hunger, and weight loss. Food sufficiency/security was high for 19 (61.3%), but 12 (39%) had marginal or lower food sufficiency/security. MNA scores showed 16 participants (52%) were at risk of malnutrition or malnourished. Low food sufficiency/security was significantly (P <0.05) associated with less motivation for activity (r = -0.40) and less walking (r = -0.36). Better nutrition assessment scores were significantly associated (P <0.01) with fewer comorbidities (r = -0.57) and falls (r = -0.46) and with higher quality of life (r = 0.50), motivation for physical activity (r = 0.59), and balance confidence (r = 0.60). Both food security and nutrition assessment are important to assess in low-income persons with injection-related VUs. A number of significant relationships of the FSQ and MNA to other variables was found but needs further investigation with a larger sample.