Identifying and treating sepsis in older people: a quality improvement project in hospitals and nursing homes in Texas.

Sepsis, if not identified and treated early, can be fatal, particularly in older people. A lack of knowledge and understanding of sepsis among nursing staff can result in a missed or delayed diagnosis, leading to delayed treatment and potentially to patient death. A quality improvement project was conducted in nine hospitals and 200 nursing homes in the Lower and Upper Rio Grande Valley regions of Texas, in the US, to improve the identification and treatment of sepsis by nursing staff. Interventions included educational webinars for hospital staff and train-the-trainer sessions for nurse leaders in nursing homes. All participating hospitals had implemented a sepsis screening tool and sepsis care bundles by the end of the project, and an overall decline in sepsis mortality rates was seen in these hospitals. Among participating nurse leaders in nursing homes, a dramatic improvement in sepsis knowledge was seen. The outcomes of the project support the use of comprehensive nursing staff education on sepsis identification and treatment. Sepsis education needs to be ongoing to maintain optimal levels of knowledge among nursing staff.

Nutritional imbalance endorsed by televised food advertisements.

The ubiquity of television in American culture makes it a potential contributor to the obesogenic (obesity-causing) environment. Televised food advertisements, which encourage viewers to eat the foods promoted for sale, constitute a de facto set of dietary endorsements. The purpose of this study was to compare the nutritional content of food choices endorsed on television to nutritional guidelines. Using a cross-sectional design, food advertisements were observed during 84 hours of primetime and 12 hours of Saturday-morning televised broadcast during the fall of 2004. One-sample t tests were used to compare the food group servings of observed food items to the recommended daily servings and to compare the nutrient content of observed food items to the Daily Values. Results suggest that a diet consisting of observed food items would provide 2,560% of the recommended daily servings for sugars, 2,080% of the recommended daily servings for fat, 40% of the recommended daily servings for vegetables, 32% of the recommended daily servings for dairy, and 27% of the recommended daily servings for fruits. The same diet would substantially oversupply protein, total fat, saturated fat, cholesterol, and sodium, while substantially undersupplying carbohydrates, fiber, vitamins A, E, and D, pantothenic acid, iron, phosphorous, calcium, magnesium, copper, and potassium. Overall, the food choices endorsed on television fail to meet nutrition guidelines and encourage nutritional imbalance.

Kennedy Space Center Cardiovascular Disease Risk Reduction Program evaluation.

This program evaluation examined the Kennedy Space Center (KSC) Cardiovascular Disease (CVD) Risk Reduction Program which aims to identify CVD risk factors and reduce these risk factors through health education phone counseling. High risk participants (those having two or more elevated lipid values) are identified from monthly voluntary CVD screenings and counseled. Phone counseling consists of reviewing lab values with the participant, discussing dietary fat intake frequency using an intake questionnaire, and promoting the increase in exercise frequency. The participants are followed-up at two-months and five-months for relevant metrics including blood pressure, weight, body mass index (BMI), total cholesterol, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, triglycerides, dietary fat intake, and exercise frequency. Data for three years of the KSC CVD Program included 366 participants, average age of 49 years, 75% male, and 25% female. For those with complete two and five month follow-up data, significant baseline to two-month follow-up comparisons included decreases in systolic blood pressure (p = 0.03); diastolic blood pressure (p = 0.002); total cholesterol, LDL cholesterol and dietary fat intake (all three at p < 0.0001) as well as a significant increase in exercise frequency (p = 0.04). Significant baseline to five-month follow-up comparisons included decreases in triglycerides (p = 0.05); and total cholesterol, LDL cholesterol and dietary intake (all three at p < 0.0001). These program evaluation results indicate that providing brief phone health education counseling and information at the worksite to high risk CVD participants may impact CVD risk factors.

Use of body-mind-spirit dimensions for the development of a wellness behavior and characteristic inventory for college students.

The purpose of this study was to use a body-mind-spirit model to measure wellness behaviors and characteristics and develop the Body-Mind-Spirit Wellness Behavior and Characteristic Inventory (BMS-WBCI) for college students. The first study of this two-part project included item generation and factor analysis using 1,000 college students with average loadings of .64, .51, and .58 for the Spirit, Mind, and Body factors, respectively. Using a minimum 4.0 Eigenvalue criterion, the factors accounted for 30% of item variance. The second study phase included validity testing using TestWell (college version), a meal screener, and construct physical activity question with 141 students. The BMS-WBCI dimensions had high, positive correlations with all appropriate TestWell subscales. The Body dimension significantly correlated with the By-Meal Screener and physical activity question. Factor split-half reliabilities ranged from .73 to .84 and alpha coefficients ranged from .75 to .92. Implications and utilization of the BMSWBCI for college students are discussed.

Biofeedback-assisted relaxation training for essential hypertension: who is most likely to benefit?

The main purpose of this study was to develop a way to predict which persons with essential hypertension would benefit most from biofeedback-assisted relaxation (BFAR) training. Second, the authors evaluated the effect of BFAR on blood pressure (BP) reduction, which was measured in the clinic and outside the clinic using an ambulatory BP monitor. Fifty-four adults with stage 1 or 2 hypertension (78% taking BP medications) received 8 weeks of relaxation training coupled with thermal, electromyographic, and respiratory sinus arrhythmia biofeedback. Blood pressure was measured in the clinic and over 24 hours using an ambulatory BP monitor pretraining and posttraining. Systolic BP dropped from 135.0 +/- 9.8 mmHg pretraining to 132.2 +/- 10.5 mmHg posttraining (F = 6.139, P = .017). Diastolic BP dropped from 80.4 +/- 8.1 mmHg pretraining to 78.5 +/- 10.0 mmHg posttraining (F = 4.441, P = .041). Data from 37 participants with baseline BP of 130/85 mmHg or greater were used to develop a prediction model. Regression showed that those who were able to lower their SBP 5 mm Hg or more were (1) not taking antihypertensive medication, (2) had lowest starting finger temperature, (3) had the smallest standard deviation in daytime mean arterial pressure, and (4) the lowest score on the Multidimensional Health Locus of Control-internal scale. Since these types of persons are most likely to benefit from BFAR, they should be offered BFAR prior to starting hypertensive medications.

Obesity-related cardiovascular risk factors: intervention recommendations to decrease adolescent obesity.

The incidence of adolescent obesity is increasing dramatically in the United States with associated risks of hypertension, adverse lipid profiles, and Type II diabetes. Unless reversed, this trend predicts an epidemic of adult cardiovascular disease. Interventions at home, at school, and in the community are required to empower teens to increase physical activity and to modify eating habits. This article describes assessment for obesity-related health problems as well as scientific guidelines and research-based intervention strategies to decrease obesity in adolescents.

Factors of fruit and vegetable intake by race, gender, and age among young adolescents.

OBJECTIVE: To explore demographic differences in individual, social, and environmental factors potentially related to fruit and vegetable intake. DESIGN: Self-report questionnaires administered to a convenience sample of middle school students during regular classes. PARTICIPANTS: Black and white adolescents, 11 to 15 years of age (N = 736). VARIABLES MEASURED: Measures included self-efficacy, family dinner frequency, normative beliefs, outcome expectations, modeling, availability, preferences, snack choice, and demographics. ANALYSIS: Chi-square, general linear models, and Poisson and linear regressions as appropriate. RESULTS: Black participants reported greater social influences than did white participants, whereas white adolescents reported greater family environmental influences on fruit and vegetable intake. The oldest adolescents reported lower self-efficacy, peer modeling, family dinner frequency, and fruit and vegetable preferences compared with younger adolescents. White participants and females reported a higher preference for vegetables than did black participants and males. Regression models for self-efficacy and snack choice explained 41% and 34% of the variance, respectively. Preferences for vegetables and parental modeling were the strongest correlates of self-efficacy. Self-efficacy was the strongest correlate of snack choice. CONCLUSIONS AND IMPLICATIONS: Decreases in several factors with age highlight the importance of intervention for this age group. Future research is needed for a better understanding of the formation and modification of self-efficacy and snack choice.

Comparison of blood pressure measurement consistency using tonometric and automated oscillometric instruments.

To effectively evaluate treatments for hypertension, researchers and clinicians must be able to measure blood pressure (BP) in a valid and reliable way. The purpose of this study is to compare measurements made in the clinic using beat-to-beat radial BP tonometry, measurements made during 24 hours using an ambulatory BP monitor, and measurements made in the clinic using an automated oscillometric BP monitor. Fifty-seven adults with primary hypertension participated in this study, which used a repeated measures descriptive design. Clinic and ABPM daytime averages were compatible for both SBP and DBP. In contrast, clinic SBP was 7.56 mmHg higher than the beat-to-beat SBP; clinic DBP was 9.83 mmHg higher than the beat-to-beat DBP. These data suggest that automated clinic measurements may be used in place of daytime ambulatory BP measurements. We also estimate sample sizes for future studies based on characteristics of clinic BP.