How Do Youth with Cystic Fibrosis Perceive Their Readiness to Transition to Adult Healthcare Compared to Their Caregivers' Views?

PURPOSE: To describe how perceived stages of change for self-care management skills varies by age in youth with cystic fibrosis in preparation for transition to adult healthcare, to compare caregiver perception of youth readiness for self-care, and age/frequency of transition discussion with provider. DESIGN AND METHODS: The Transition Readiness Assessment Questionnaire and a modified version (TRAQ-C) for caregivers were used for data collection. Descriptive statistics, simple linear regression, and t-tests were employed. RESULTS: Regression equations suggest that age predicts youth perception of self-care management skill in all five domains on the TRAQ (p ≤ .009). A paired t-test compared the overall TRAQ and TRAQ-C mean scores between dyads. Youth rated themselves significantly higher in perception of self-care skill management (m = 3.187, sd = 0.769) than caregivers (m = 2.490, sd = 0.788; t = 7.408, df = 51, p < .001). Sixteen was the average age of transition discussion for both youth and caregiver. Reported frequency of discussion varied considerably. CONCLUSIONS: Although increasing age predicts perception of self-care management, many youth age 18-22 were still only contemplating or starting to learn skills. Skill level perceptions between youth and caregiver differed, but scores from all self-care management domains followed a similar trend. Discussions with providers began later than guidelines recommend and were often not recognized as such by youth. PRACTICE IMPLICATIONS: Results underscore the importance of beginning transition discussion and skill evaluation in youth with cystic fibrosis at an early age, incorporating caregivers' perception in the process.

Differential temperature-dependent multimeric assemblies of replication and repair polymerases on DNA increase processivity.

Differentiation of binding accurate DNA replication polymerases over error prone DNA lesion bypass polymerases is essential for the proper maintenance of the genome. The hyperthermophilic archaeal organism Sulfolobus solfataricus (Sso) contains both a B-family replication (Dpo1) and a Y-family repair (Dpo4) polymerase and serves as a model system for understanding molecular mechanisms and assemblies for DNA replication and repair protein complexes. Protein cross-linking, isothermal titration calorimetry, and analytical ultracentrifugation have confirmed a previously unrecognized dimeric Dpo4 complex bound to DNA. Binding discrimination between these polymerases on model DNA templates is complicated by the fact that multiple oligomeric species are influenced by concentration and temperature. Temperature-dependent fluorescence anisotropy equilibrium binding experiments were used to separate discrete binding events for the formation of trimeric Dpo1 and dimeric Dpo4 complexes on DNA. The associated equilibria are found to be temperature-dependent, generally leading to improved binding at higher temperatures for both polymerases. At high temperatures, DNA binding of Dpo1 monomer is favored over binding of Dpo4 monomer, but binding of Dpo1 trimer is even more strongly favored over binding of Dpo4 dimer, thus providing thermodynamic selection. Greater processivities of nucleotide incorporation for trimeric Dpo1 and dimeric Dpo4 are also observed at higher temperatures, providing biochemical validation for the influence of tightly bound oligomeric polymerases. These results separate, quantify, and confirm individual and sequential processes leading to the formation of oligomeric Dpo1 and Dpo4 assemblies on DNA and provide for a concentration- and temperature-dependent discrimination of binding undamaged DNA templates at physiological temperatures.

Detection of high-molecular-weight amyloid serum protein complexes using biological on-line tracer sedimentation.

The systemic amyloidoses are a rare but deadly class of protein folding disorders with significant unmet diagnostic and therapeutic needs. The current model for symptomatic amyloid progression includes a causative role for soluble toxic aggregates as well as for the fibrillar tissue deposits. Although much research is focused on elucidating the potential mechanism of aggregate toxicity, evidence to support their existence in vivo has been limited. We report the use of a technique we have termed biological on-line tracer sedimentation (BOLTS) to detect abnormal high-molecular-weight complexes (HMWCs) in serum samples from individuals with systemic amyloidosis due to aggregation and deposition of wild-type transthyretin (senile systemic amyloidosis, SSA) or monoclonal immunoglobulin light chain (AL amyloidosis). In this proof-of-concept study, HMWCs were observed in 31 of 77 amyloid samples (40.3%). HMWCs were not detected in any of the 17 nonamyloid control samples subjected to BOLTS analyses. These findings support the existence of potentially toxic amyloid aggregates and suggest that BOLTS may be a useful analytic and diagnostic platform in the study of the amyloidoses or other diseases where abnormal molecular complexes are formed in serum.

A quantitative approach to evaluating caring in nursing simulation.

AIM: This study was designed to test a quantitative method of measuring caring in the simulated environment. BACKGROUND: Since competency in caring is central to nursing practice, ways of including caring concepts in designing scenarios and in evaluation of performance need to be developed. Coates' Caring Efficacy scales were adapted for simulation and named the Caring Efficacy Scale-Simulation Student Version (CES-SSV) and Caring Efficacy Scale-Simulation Faculty Version (CES-SFV). METHOD: A correlational study was designed to compare student self-ratings with faculty ratings on caring efficacy during an adult acute simulation experience with traditional and accelerated baccalaureate students in a nursing program grounded in caring theory. RESULTS: Student self-ratings were significantly correlated with objective ratings (r = 0.345, 0.356). CONCLUSIONS: Both the CES-SSV and the CES-SFV were found to have excellent internal consistency and significantly correlated interrater reliability. They were useful in measuring caring in the simulated learning environment.

Preventive health practices and behavioral risk factors in women surviving traumatic brain injury.

Traumatic brain injury (TBI) affects millions globally and is considered a universal public health concern. Our study addresses a considerable knowledge gap about the health of female survivors of TBI. Using a retrospective cohort study design, we examined behavioral risk factors, access to health screenings, and primary care services among women with a history of moderate to severe TBI. We compared findings with a general female population. Female survivors (n = 75) appeared to have comparable use of primary care services with the general population. Significantly more women reported poor mental health postinjury; reported alcohol consumption was also greater.

Sustaining health in faith community nursing practice: emerging processes that support the development of a middle-range theory.

This article reveals processes that support theoretical development for holistic nursing in the context of a faith community. The emerging processes enhance the articulation of the holistically focused practice, add clarity to faith community nursing activities and outcomes, and contribute to theoretical clarification and development. Theoretical clarity is essential to guide faith community nursing practice, research, and education because there is tremendous potential for the specialty practice to contribute to the health of a community across the continuum of caring and because to date there has been no unifying model for this practice proposed. A lack of a theoretical basis can result in disparate and disconnected approaches to studying, testing, and promoting the practice.

A methodological review of faith-based health promotion literature: advancing the science to expand delivery of diabetes education to Black Americans.

Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies' methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.

Self-debriefing in healthcare simulation: An integrative literature review.

OBJECTIVES: Debriefing is an essential component of simulation-based education. In-person, facilitator-led debriefing may not always be practical for newer forms of simulation, such as individual virtual simulations. Self-debriefing addresses the issue of practicality, but evidence of implementation and design are unknown. The aims of this review were to explore the use and design of self-debriefing in healthcare simulation and to identify to what extent self-debriefing found in the literature align with the INACSL Standards of Best Practice for debriefing. DESIGN: Integrative review. DATA SOURCES: Peer-reviewed studies indexed within CINAHL, MEDLINE, PsycINFO, ERIC, Education Full Text (H.W. Wilson), Education Source, and Academic Search Premier databases. REVIEW METHODS: A comprehensive database search was conducted using PRISMA guidelines. The INACSL Standard of Best Practice: Simulation Debriefing was used as a framework for analysis. Ten articles were appraised and analyzed for this review. RESULTS: Alignment to best practice standards and presence of required criteria varied in self-debriefing designs. Self-debriefs used with graduate-level learners and self-debriefs with higher alignment to standards showed equivalent performance gains when compared to instructor-led debriefs. None of the studies measured reflection capacity despite it being a recommendation. CONCLUSION: Findings indicate that well-designed self-debriefing provides equivalent outcomes to instructor-led debriefing. Best practice recommendations, such as promoting reflection, are underexplored in self-debriefing research.

Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury.

BACKGROUND: The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning. METHODS: This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis. RESULTS: Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning. CONCLUSION: This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.

State of research for Faith Community Nursing 2009.

The aim of this paper is to report the current state of research for Faith community Nursing (FCN), reviewing the related research literature dating back to 1993. Over 20 years old, the practice of FCN is a maturing specialty practice that links religious communities and health through professional nursing, but no review of research literature is published. The review of the literature was done utilizing the Cumulated Index to Nursing and Allied Health Literature (CINAHL) and PubMed. The keyword terms selected for search were: faith community nursing, parish nursing, and/or church nursing for the years 1993-2008. The review identifies four major content areas in the FCN research literature: (1) development and implementation of FCN practices; (2) roles and activities of faith community nurses; (3) FCN evaluation and documentation; and (4) congregation perceptions of FCN. Overall, findings indicate the FCN literature documents successful approaches for developing faith community programs, provides descriptive analyses of this specialty practice and perceptions associated with the practice, yet inadequately addresses the relationship of FCN to patient outcomes. To advance the effectiveness for this growing specialty, emphasis must be placed on measuring FCN components and related outcomes with analyses yielding evaluative data on the efficacy of this practice in terms of educational, psychosocial, spiritual, and physiological care.

The practice doctorate: innovation or disruption?

Advanced practice nurses, particularly nurse practitioners, have been described as a disruptive innovation. The American Association of Colleges of Nursing (AACN) has proposed that by 2015 all advanced practice nurses be prepared with a Doctor of Nursing Practice (DNP). This article uses critical reflection on published literature to examine the potential difficulties that mandating such a change may present to potential students, practicing advanced practice nurses, colleges of nursing, and doctoral education in general. After considering the pressures in the nursing profession to prepare nurse faculty and reviewing the success of current models of education for advanced practice, we explore in depth the unintended consequences of the AACN recommendation. Implications for academic nursing, curriculum, advanced practice nurses, doctoral education, titling and licensure, economic issues, and the lack of evaluation research are addressed. We recommend abandoning the 2015 deadline for implementation of advanced practice nurse preparation with the DNP.

Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed With Diabetes.

PURPOSE: The purpose of this study was to identify factors affecting early and intermediate hospital-to home transition outcomes of older adults with preexisting diabetes mellitus. METHODS: A mixed-methods design was used. A sample of 96 hospitalized older adults with a prior diagnosis of diabetes were recruited within 4 hours of discharge. Data reflective of general health status, diabetes status, perceived discharge readiness (Readiness for Hospital Discharge Scale), hospitalization, and anticipated postdischarge support were gathered upon enrollment. Transition outcome data including unplanned care encounter occurrences, perceived transition quality (Care Transition Measure-15), and postdischarge difficulty (scale and free responses to the Post-Discharge Coping Difficulty Scale [PDCDS]) were obtained by telephone interview 7 and 30 days after discharge. Three unique, dichotomous variables were created from recurrent subthemes that emerged during content analysis of free-response data and were used in statistical testing. Binary logistic regression was performed to identify predictive factors for an unplanned care encounter within 30 days of discharge. RESULTS: Multimorbidity was prevalent in participants. Difficulties managing medications, blood glucose, and chronic illnesses other than diabetes were common problems. Higher PDCDS scores 7 and 30 days following discharge and difficulty managing a nondiabetes chronic health problem were predictive of an unplanned care encounter within 30 days of discharge. CONCLUSIONS: Multimorbidity complicates home recovery of older adults with diabetes. Diabetes adds complexity to hospital-to-home care transitions. Transition difficulties predict higher risk for an unplanned care encounter. More intensive follow-up of older adults with diabetes during the first month following discharge is recommended.

Long-term survival following traumatic brain injury.

PURPOSE: The study used a retrospective cohort design to establish long-term mortality rates and predictors of mortality for persons after moderate to severe traumatic brain injury (TBI). METHOD: Consecutive records of persons with moderate to severe TBI who were discharged from a large rehabilitation hospital in Pittsburgh, Pennsylvania in the years 1974-1984, 1988 and 1989 were reviewed. RESULTS: Six hundred and forty-two eligible individuals were identified and mortality was ascertained up to 24 years post injury. One hundred and twenty-eight of these individuals were found to be deceased. Poisson regression analyses revealed at least a 2-fold increased risk for mortality compared to the general population. Pre-injury characteristics and levels of disability at discharge from in-patient rehabilitation were among the strongest predictors of mortality. CONCLUSIONS: These data constitute evidence for premature death in the post-acute TBI population following a moderate to severe head injury and are discussed in relation to other research in the area.

Decisions and caregiving: end of life among blacks from the perspective of informal caregivers and decision makers.

This focus group study describes end-of-life caregiving and decision making among blacks from the perspective of the informal caregivers and decision makers. The Behavioral Model of Health Services Use framed the study. Five focus groups with a total of 53 informal caregivers/decision makers were conducted. A qualitative phenomenological approach was used for the data analysis. Findings are presented under the themes of end of life caregiving and decision making roles, dynamics and process, and beliefs and values. The common thread of care giving and decision-making within relationship and six subthemes were identified. Findings also suggest the need for support and inclusion of designated informal caregivers and decision-makers in the advance care planning process early in the disease trajectory.

Postmenopausal hormone replacement and cardiovascular disease: incorporating research into practice.

The long-standing practice of prescribing hormones to postmenopausal women was based in part on the observation that following menopause, women's incidence of cardiovascular diseases such as atherosclerosis, myocardial infarction, and cerebral vascular accident increased. Recent large-scale research has shown an increase in cardiovascular events for postmenopausal women receiving estrogen replacement in oral form. This article examines research on positive effects of hormone replacement therapy, discusses what is known about the development of cardiovascular disease in women, and evaluates recent research that has shown increased cardiovascular risk in women receiving hormone replacement. It concludes with recommendations for preventing cardiovascular disease in women. This is essential information for nurses, who need to be informed of ways to maintain their own health while serving as sources of health information for the public at large.

Lead Faculty Workload Model: recognizing equity and leadership in faculty.

Teaching more efficiently while maintaining quality and consistency of course offerings is imperative in nursing education. At odds with this goal for nursing faculty are increased workloads impacted by trends to provide more distance learning, the faculty shortage, and pressure to produce more nurses at all educational levels. The Lead Faculty Workload Model updates current methods of evaluating workload and formalizes the role of lead faculty members and supporting faculty members with current expectations and responsibilities for mentoring and monitoring junior faculty. As a new standard, this new model provides a more equitable way to address chronic and more recent faculty workload issues.

Duplicated laboratory tests: evaluation of a computerized alert intervention abstract.

Redundant testing contributes to reductions in healthcare system efficiency. The purpose of this study was to: (1) determine if the use of a computerized alert would reduce the number and cost of duplicated Acute Hepatitis Profile (AHP) laboratory tests and (2) assess what patient, test, and system factors were associated with duplication. This study used a quasi-experimental pre- and post-test design to determine the proportion of duplication of the AHP test before and after implementation of a computerized alert intervention. The AHP test was duplicated if the test was requested again within 15 days of the initial test being performed and the result present in the medical record. The intervention consisted of a computerized alert (pop-up window) that indicated to the clinician that the test had recently been ordered. A total of 674 AHP tests were performed in the pre-intervention period and 692 in the postintervention group. In the pre-intervention period, 53 (7.9%) were duplicated and in postintervention, 18 (2.6%) were duplicated (p<.001). The implementation of the alert was shown to significantly reduce associated costs of duplicated AHP tests (p≤.001). Implementation of computerized alerts may be useful in reducing duplicate laboratory tests and improving healthcare system efficiency.

Use of the novel technique of analytical ultracentrifugation with fluorescence detection system identifies a 77S monosomal translation complex.

A fundamental problem in proteomics is the identification of protein complexes and their components. We have used analytical ultracentrifugation with a fluorescence detection system (AU-FDS) to precisely and rapidly identify translation complexes in the yeast Saccharomyces cerevisiae. Following a one-step affinity purification of either poly(A)-binding protein (PAB1) or the large ribosomal subunit protein RPL25A in conjunction with GFP-tagged yeast proteins/RNAs, we have detected a 77S translation complex that contains the 80S ribosome, mRNA, and components of the closed-loop structure, eIF4E, eIF4G, and PAB1. This 77S structure, not readily observed previously, is consistent with the monosomal translation complex. The 77S complex abundance decreased with translational defects and following the stress of glucose deprivation that causes translational stoppage. By quantitating the abundance of the 77S complex in response to different stress conditions that block translation initiation, we observed that the stress of glucose deprivation affected translation initiation primarily by operating through a pathway involving the mRNA cap binding protein eIF4E whereas amino acid deprivation, as previously known, acted through the 43S complex. High salt conditions (1M KCl) and robust heat shock acted at other steps. The presumed sites of translational blockage caused by these stresses coincided with the types of stress granules, if any, which are subsequently formed.

Online health information seeking by people with physical disabilities due to neurological conditions.

OBJECTIVE: This study investigates how neurologically disabled people's intention to continue seeking and actual use of online health information are related to various factors. DESIGN: A cross-sectional survey was conducted to collect data from people who have neurological disabilities. MEASUREMENTS: An online questionnaire was used to measure demographic, physical, cognitive, and behavioral factors based on subjects' self-reported data. RESULTS: Regression analyses on 330 data show that a person's intention to continue online health information seeking (OHIS) increases as perceived usefulness (PU) and ease of use (PEOU) and disability level increase. The OHIS intention is also predicted by a negative interaction between PU and disability, a positive interaction between PEOU and disability, and a negative interaction between PU and PEOU. It is also find that a person's use of online health information is positively related to PU and negatively related to perceived risk and the interaction between PU and risk. LIMITATIONS: The sample was not randomly selected and the cross-sectional survey cannot suggest causal relationships between variables. CONCLUSION: Neurologically disabled people's online health information seeking and use can be predicted by their cognitive perceptions. A heightened disability level increases an individual's online health information seeking, but is not related to the use of such information. Moreover, seeking more online health information does not make an individual use more such information, suggesting that these two behaviors should be carefully differentiated.