Effectiveness of continuous glucose monitoring in children, adolescents, and young adults with poorly controlled type 1 diabetes.

OBJECTIVE: The purpose of this study was to determine the effect of continuous glucose monitoring (CGM) on glycemic control in children, adolescents, and young adults ages 7-21 years with poorly controlled diabetes HbA1c 9.0% or more (74 mmol/mol IFCC). MATERIALS AND METHODS: The primary outcome was improvement in HbA1c. The secondary outcome included self-reported hypoglycemia. This 12-week study used a prospective, one-group, pre- and posttest pre-experimental design with a convenience sample. The study used the Medtronic Guardian CGM with Enlite Sensor. RESULTS AND CONCLUSIONS: Thirty-three subjects enrolled in the study. The mean age of the participants was 15.57 years, range was 11-20 years, 47.6% were male, and 52.4% were female. Twenty-one (63.6%) completed the final study visit. There was a clinically and statistically significant reduction of 1.46 (SD = 1.6711) (p = .001) in HbA1c at 12 weeks. Fifteen of the 21 participants (71.4%) had an HbA1c reduction of greater than 0.5%. The CGM monitor was worn a mean of 4.262 days a week. None of the subjects reported significant hypoglycemia while wearing the monitor. CGM was effective in improving glycemic control in this population with poorly controlled diabetes.

Perceptions of Asthma Quality of Life in Children and Parent Dyads in Two Rural Counties in West Virginia.

This study examines perceived quality of life (QOL) in a convenience sample of children (aged 7-11) with asthma and their parents from two schools in rural West Virginia. Forty-nine child-parent dyads representing 25 males and 24 females completed the study. The PedsQL™ 3.0 Asthma Module was utilized to separately measure child and parent perceptions of various dimensions of pediatric, asthma-specific, health-related QOL. Dimensions of the tool were scored separately and included symptoms, treatment, worry, and communication. The mean module dimension scores for children ranged from 63.27 to 80.47 and for parents, the range was from 61.26 to 79.79, with higher scores indicating higher QOL. Parents of male children perceived their son's QOL to be higher than that of female children in the symptoms and treatment dimensions. Strong relationships occurred between the child's worry and the other three dimensions as well as between the symptoms and the treatment dimensions. For the dyads, the only significant relationship was between the child and the adult treatment dimensions. With the well-documented burden of asthma in school-aged populations, information regarding the QOL of child and parent dyads will enhance school nurses' ability to improve health and educational outcomes in schools.

Use of Bloodborne Pathogens Exposure Control Plans in Private Dental Practices: Results and Clinical Implications of a National Survey.

Dental healthcare workers (DHWs) are at risk for occupational exposure to bloodborne pathogens (BBPs). The Occupational Safety and Health Administration Bloodborne Pathogens Standard requires employers to have a written exposure control plan (ECP) detailing methods and means to reduce and manage occupational BBP exposures. Because little information is available on whether ECPs are created and used, the National Institute for Occupational Safety and Health and the Organization for Safety, Asepsis and Prevention conducted an online survey to determine if dental practices had an ECP, whether present ECPs had the necessary components, and if impediments existed to prevent having an ECP in place. Respondents were primarily from nonfranchised practices (69%) and dentists who owned the practice (63%). Seventy-two percent of survey participants had an ECP, and 20% were unaware of any federal requirements for an ECP prior to the survey. Engineering controls were used by many practices, although the type varied. Fifteen percent of practices did not offer the hepatitis B vaccine for employees. The survey revealed many dental practices were unaware of or were lacking required elements of the ECP. Findings from this survey indicate DHWs would benefit from increased education regarding methods to prevent occupational exposures to BBPs.

An Integrative Review of Correlates and Predictors of Depression in Patients with Rheumatoid Arthritis.

Depression creates an additional burden for adults with rheumatoid arthritis (RA), negatively affecting disease outcomes and quality of life. An integrative literature review of twenty-three quantitative studies was conducted on correlates and factors predictive of depression in adults with RA. Methodological assessment tools were used to independently evaluate the data quality by two reviewers. Prevalence rates ranged from 6.6 to 66.25%. Correlates included pain, functional status, disease duration, and RA treatment. Predictors, including sociodemographics, pain, coping ability, support, functional status, and clinical factors, varied depending upon the sample, standardized measure, and geographic location. Understanding correlates/predictors could guide the development of comprehensive care.

Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention.

BACKGROUND: The Cleaning and Disinfecting in Healthcare Working Group of the National Institute for Occupational Safety and Health, National Occupational Research Agenda, is a collaboration of infection prevention and occupational health researchers and practitioners with the objective of providing a more integrated approach to effective environmental surface cleaning and disinfection (C&D) while protecting the respiratory health of health care personnel. METHODS: The Working Group, comprised of >40 members from 4 countries, reviewed current knowledge and identified knowledge gaps and future needs for research and practice. RESULTS: An integrated framework was developed to guide more comprehensive efforts to minimize harmful C&D exposures without reducing the effectiveness of infection prevention. Gaps in basic knowledge and practice that are barriers to an integrated approach were grouped in 2 broad areas related to the need for improved understanding of the (1) effectiveness of environmental surface C&D to reduce the incidence of infectious diseases and colonization in health care workers and patients and (2) adverse health impacts of C&D on health care workers and patients. Specific needs identified within each area relate to basic knowledge, improved selection and use of products and practices, effective hazard communication and training, and safer alternatives. CONCLUSION: A more integrated approach can support multidisciplinary teams with the capacity to maximize effective and safe C&D in health care.

An integrative review of promoting trust in the patient-primary care provider relationship.

AIM: An integrative review of empirical studies on factors promoting trust in the patient-primary care provider relationship. BACKGROUND: Trust is essential to the patient-provider relationship. Patients with high trust in their healthcare providers have been found to have improved outcomes, including improved chronic disease management, increased use of preventative services and satisfaction with care. Breaches of trust in the healthcare system threaten trust. Exploring factors that promote trust in the patient-provider relationship is warranted. DESIGN: Integrative literature review. DATA SOURCES: Electronic databases searched included CINAHL, MEDLINE and PsycARTICLES, using combinations of the key term 'trust' with: concept, practitioner, provider, physician, developing, creating, engendering, promoting and establishing. The results were limited to original publications in English, published between 1998-2013. REVIEW METHODS: A review of the literature was conducted by two independent reviewers based on the criteria established by Cooper; Whittemore and Knafl; and Polit and Beck. Methodological assessment tools were used to organize, evaluate the quality of and synthesize the data. RESULTS: A new conceptual definition of promoting trust is proposed that includes three core qualities: interpersonal and technical competence, moral comportment and vigilance. Gaps in the literature still exist related to rural, young adult, older adult and well patient populations. CONCLUSION: The core qualities could serve as target areas for the development of interventions aimed at modifying provider behaviours so that trust can be established, maintained or improved. Future prospective longitudinal research studies are needed that enhance understanding of trust with multiple primary care provider types.

Review of interventions to reduce stress among mothers of infants in the NICU.

Nearly half a million preterm infants are born each year in the United States. Preterm delivery has significant psychosocial implications for mothers, particularly when their baby spends time in the neonatal intensive care unit (NICU). The decrease in length of gestation causes mothers to have to parent prematurely, without the less time for emotional preparation than mothers of full-term infants. Parents of NICU infants experience stress related to feelings of helplessness, exclusion and alienation, and lack sufficient knowledge regarding parenting and interacting with their infants in the NICU. There are a number of interventions that nurses can do that help reduce the stress of mothers of infants in the NICU.

Experiences of non-navigated women undergoing breast diagnostic evaluation.

During the diagnostic period, women need appropriate, timely information regarding tests and procedures. Nurse navigator programs were developed to combat the negative effects on survival that are caused by delays in the diagnosis of breast cancer and lack of support from the healthcare team. Nurse navigators decreased barriers to care, increased patient satisfaction, and lowered anxiety in women undergoing diagnostic evaluation. However, although patient navigation programs have become a presence in oncology centers, those programs and the accompanying support are not offered at every facility that provides components of diagnostic evaluation. Therefore, the purpose of the current study was to explore the experiences of women who underwent a breast diagnostic evaluation without any accompanying navigation services.

SRD5A1 genotype frequency differences in women with mild versus severe premenstrual symptoms.

The aims of this small pilot study were to explore the association between premenstrual symptom severity and two genes from the gamma-aminobutyric acid (GABA) pathway: steroid-5-alpha-reductase, alpha polypeptide 1 (SRD5A1) and gamma-aminobutyric acid receptor subunit alpha-4 (GABRA4). Saliva samples were obtained from a convenience sample of 19 Caucasian females ages 18-25 years, ten cases and nine controls. Deoxyribonucleic acid (DNA) was isolated, and genotyping performed on ten single nucleotide polymorphisms (SNPs). Ten percent of cases and 44% of controls had the cytosine/cytosine (C/C) genotype for the SRD5A1 SNP, rs501999 indicating that this genotype may protect women against severe premenstrual symptoms. Replication of this study using an adequately powered sample size is warranted.

The maternal experience of having diabetes in pregnancy.

PURPOSE: To describe the maternal experience of having type 2 or gestational diabetes in pregnancy using focus groups and individual telephone interviews. DATA SOURCES: Eight women who had type 2 or gestational diabetes in at least one pregnancy and participated in the qualitative study addressing the open-ended guiding questions on their experience. CONCLUSIONS: This phenomenological study gave voice to the women's experience with and concerns about having diabetes in pregnancy. Three primary themes emerged and were identified: (a) feeling concern for the infant related to diabetes, (b) feeling concern for self related to diabetes, and (c) sensing a loss of personal control over their health. Subthemes for each of the primary themes were also identified. IMPLICATIONS FOR PRACTICE: The experiences shared by these women may serve to inform the development of interventions aimed at meeting the needs of women with diabetes in pregnancy. By learning from the themes of the phenomenological study, advance practice nurses may anticipate the needs of the women diagnosed with diabetes in pregnancy to augment their care, education, and promotion of diabetes self-management in pregnancy.

Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review.

AIM: This paper is a report of a review conducted to define the manifestations that characterize psychological distress during the diagnostic phase for suspected breast cancer, define the extent of psychological distress associated with the threat of potential cancer, and identify factors influencing psychological distress levels. BACKGROUND: Raising the possibility that a malignancy might be present is threatening. The resulting distress is believed to influence treatment outcomes in those diagnosed with cancer and result in behavioural changes in those with benign disease. DATA SOURCES: Research papers published between January 1983 and May 2009 were identified in CINAHL, MEDLINE and PsycINFO. The search was performed using the following terms: breast cancer diagnosis, mammography, breast biopsy, breast diagnostic, anxiety, distress and uncertainty. REVIEW METHODS: A systematic review was conducted of 30 studies meeting the inclusion criteria of a quantitative design with at least one standardized measure of distress and specifically addressing distress during the evaluation period. RESULTS: It is well-documented that distress, manifested as anxiety, exists. In a small cohort of women, distress levels are heightened to worrying levels that may have long-term implications. There was strong evidence for relationships among medical history, education and trait anxiety with distress. There was no substantiation of the association between younger age and increased psychological distress that has been consistently reported with other cancers. CONCLUSION: It is necessary to understand the impact of factors on distress so that heightened levels can be predicted and targeted by interventions initiated at the first mention of the possibility of the presence of malignancy.

Chronic obstructive pulmonary disease, anxiety, and depression: state of the science.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects millions worldwide. Despite advances in the treatments of other chronic diseases, little progress in decreasing COPD morbidity and mortality has been made. The death rate associated with COPD has doubled in 30 years. The presence of psychiatric comorbidities, such as anxiety and depression, has been linked to increased mortality, decreased functional status, and decreased quality of life. OBJECTIVE: This review was undertaken to determine the state of the science of COPD, anxiety, and depression, and to identify nursing implications derived from these findings. CONCLUSION: Although the prevalence of anxiety and depression among patients with COPD is significantly higher than the general population, there are serious barriers to the recognition and treatment of these comorbid conditions. Routine assessment and screening for anxiety and depression in all patients diagnosed with COPD should be considered.

Effectiveness of a nutrition intervention with rural low-income women.

OBJECTIVES: To evaluate Cookin' Up Health, a computer-based interactive nutrition intervention. METHODS: After randomization to intervention and control groups, 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey. RESULTS: Compared to the control group, the intervention group had significantly improved scores on knowledge of dietary fats, food label reading, and readiness to eat 5 fruits and vegetables a day and foods lower in fat. CONCLUSIONS: This brief interactive nutrition intervention shows potential as a strategy to begin the process of change, but follow-up may be needed for actual behavior change to occur.

Cookin' Up Health: developing a nutrition intervention for a rural Appalachian population.

Cookin' Up Health is a culturally targeted and individualized tailored nutrition intervention using a computer-based interactive format. Using a cooking show theme, the program demonstrates step-by-step meal preparation emphasizing healthy selection and portion control. Focus groups were conducted with women in two rural counties in West Virginia to guide the development of the intervention. Women felt more susceptible to heart disease because the changing role of women creates more stress and less time; weight loss was a greater motivator for dietary change than was preventing heart disease; social support is a barrier and facilitator for dietary change; cultural heritage and the way women were raised were major barriers to making health changes as adults; convenience and the cost of eating healthier were major factors when trying to make changes in diet; and women did not feel confident in their ability to maintain dietary changes.

Detection of depression in primary care.

OBJECTIVE: The first purpose of this study was to examine the variables related to the diagnosis of a depressive disorder and associated with referral to a mental health clinician. The second purpose was to examine the level of agreement of the primary care provider's diagnosis of depression with that of the mental health clinician. METHODS: The design was a retrospective, case-control study (n = 162). Data were analyzed with descriptive statistics and logistic regression. RESULTS: Referred patients tended to be Caucasian, middle-aged or older men who had a history of depression, were experiencing depressive symptoms and/or an acute or chronic stressor, had a diagnosis of cardiovascular disease or cerebrovascular accident, and were taking a greater number of medications. Mental health clinicians agreed with the primary care clinicians' diagnoses of depression 76% of the time. CONCLUSIONS: Primary care clinicians accurately diagnosed depression for the majority of patients and appropriately referred them for psychiatric care.

Development of the Breastfeeding Personal Efficacy Beliefs Inventory: a measure of women's confidence about breastfeeding.

The newly developed Breastfeeding Personal Efficacy Beliefs Inventory (BPEBI) was tested as a measure of breastfeeding confidence to support breastfeeding promotion research. Participants were 479 volunteers who returned the BPEBI after it was mailed to 700 randomly selected female students enrolled at a land grant university in a predominately White Appalachian state. Internal consistency reliability was .89. Five factors emerged during factor analysis (eigenvalue = 7.3 to 1.2, variance explained = 53%) consistent with the conceptual basis of the inventory. Further reliability and validity assessments were recommended with ethnically and academically heterogeneous women with different breastfeeding experience.

Metabolic effects of the addition of resistive to aerobic exercise in older men.

The metabolic changes associated with the addition of 4 months of resistive exercise to an existing aerobic exercise program (AEX+RT, n = 7) were compared to a maintenance aerobic exercise program (AEX, n = 8) in overweight, older men. The subjects in this study had recently completed a 6-month aerobic exercise program (treadmill walking, 45 min/d, 2 d/wk). The AEX+RT group added 6 exercises on upper- and lower-body pneumatic-resistance machines (2 sets, 15 repetitions each, 2 d/wk) to an aerobic exercise program at > or = 70% heart rate reserve for 30-40 min, 2 d/wk on treadmill, while the AEX group continued the same maintenance treadmill AEX program. There were no baseline differences in body weight, VO2max, or glucose metabolism between groups. The AEX+RT group increased upper- and lower-extremity strength by 28 +/- 4% and 46 +/- 6%, respectively (p < .05), despite a 9% decrease in VO2max (p < .05). VO2max did not change in the AEX group. There was no change in the fasting glucose or insulin levels, or the 3-h glucose responses to an oral glucose load in either group. The insulin responses decreased by 25 +/- 4% in the AEX+RT group (p < .01) but did not change in the AEX group. In conclusion, the addition of resistive exercise training to an existing aerobic exercise program may improve insulin sensitivity in overweight, older men, and thus prevent the development of type 2 diabetes.